Cartilage Curvature Reshaping: A Quantitative Assessment.

BACKGROUND: Horizontal mattress suturing is frequently performed during rhinoplasty and otoplasty procedures to control the curvature of the cartilages. Despite the popularity of this technique, there are no quantitative methods for determining the effects of mattress sutures in the cartilage reshaping. OBJECTIVES: The aim of this experimental study was to quantify the straightening effect of mattress suturing on the convexity of ear cartilage in a rabbit model. METHODS: Eleven young adult male New Zealand white rabbits were used in this study. A horizontal mattress suture with spacing 3 mm × 6 mm was placed in a rectangle demarcated on the left ear in the area with maximum convexity. Preoperative and postoperative photographs were taken before and immediately after surgery, respectively. The radius of curvature (ROC), the first-order derivative (FOD), and the second-order derivative (SOD) were calculated to quantify the net cartilage reshaping, the changes in each point, and the homogeneity of the newly shaped cartilage, respectively. RESULTS: The mean ROCs were 1.112 cm and 2.169 cm before and after surgery, respectively, and this increase was statistically significant. The mean FOD for each point slope index was statistically lower after surgery (0.269 before surgery vs 0.135 after surgery). The mean SOD also significantly decreased after surgery (0.007 before surgery vs 0.003 after surgery). The values of the SOD remained positive after surgery, indicating that changes in the curvature were homogeneous. CONCLUSIONS: A quantitative measurement method was introduced to directly quantify the controlling effect of a mattress suture. This method makes it possible to achieve the important task of comparing the effect of horizontal mattress suturing with that of other cartilage-reshaping techniques.

Epidemiology of Occupational Electrical Injuries.

Electrical injuries are an uncommon but very destructive type of burn, with serious complications and disabilities for the victims. This study was conducted due to the importance of understanding the epidemiology of electrical accidents in planning to prevent their occurrence. This is a retrospective cross-sectional study that was performed on patients with electrical burns referred to Shahid Motahari Educational and Medical Center from 2017 to 2018. Patients' information was entered in the researcher-made information registration form, including demographic and accident-related information. In this study, most of the accidents occurred in the workplace with high-voltage electricity. Contact with overhead cables and wires was the most common cause of injury. Excision and graft surgeries were the most common type of surgery. The variables of sex, age, length of hospital stay, and type of job had a significant relationship with the type of voltage (P < .05). The difference between the ratio of men to women and the length of hospitalization in the group of injured with high-voltage electricity was greater and most of these patients were construction workers. The variables of sex, nationality, length of hospital stay, and cause of the accident had a significant relationship with the type of job (P < .05). Construction workers are the main group at risk of electrical damage in Iran. Therefore, it is recommended to conduct more extensive studies in the field of recognizing and implementing practical methods of preventing electrical injuries, especially in high-risk work environments.

The best strategy for red blood cell transfusion in severe burn patients, restrictive or liberal: A randomized controlled trial.

INTRODUCTION: Although blood transfusion is common in burns, data are lacking in appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold. MATERIAL AND METHODS: Eighty patients with TBSA > 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed cells only when Hemoglobin declined to less than 8 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10 g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications. RESULT: The mean hemoglobin level before transfusion was 7.7 ± 0.4 g/dL in the restrictive group and 8.8 ± 0.7 g/dL in the liberal group. The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 ± 2.2 units vs. 5.9 ± 3.7 units) (p-value = 0.006). The total number of RBC transfused units varied significantly between the two groups (p-value = 0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8 ± 1.4 units vs. liberal: 4.4 ± 2.6 units) (p = 0.004). We did not find any significant difference in mortality rate or other outcome measures between groups. CONCLUSION: Applying the restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications. CLINICAL TRIAL REGISTRATION REFERENCE: IRCT20190209042660N1.

Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns: A Systematic Review.

Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: "burn wounds", "enzymatic debridement", "papain", "papain-urea", "pine apple", "Bromelain", "collagenases", "Nexobrid", "Debrase", "Debridase", "Actinidia deliciosa", "Sutilains", "Debrace", "piruvat acid". Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients' clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.

A Smartphone Application for Burn Self-care.

Burn treatment and management is largely patient-dependent and self-care education helps reducing tangible and intangible costs as well as improving quality of care. Thus, this study aimed to develop a smartphone application for burn self-care. This research, conducted in 2018, consisted of two phases. Initially, the educational content required for the application was determined based on the literature review and clinicians' and patients' perspectives. The setting of the study was the largest burn and plastic surgery hospital in the country. Based on the results derived from the first phase of the study, the application prototype was designed in the Persian language to be used on smartphones. The usability of the application was evaluated by using a standard questionnaire and the data were analyzed by using descriptive statistics. The educational content of the application included eight different areas of self-care; namely, wound care, scar management, care and control of hypertrophic burn scars, nutrition, in-home pain management, mental health, follow-up, and rehabilitation. A specialist was consulted and related texts and images were selected to be included in the application. The application was used by burn patients for a week and users evaluated its usability at a good level. It seems that the application designed in the present study can help to increase patients' knowledge about burn conditions and improve their self-care skills. Further studies are needed to present the efficiency and effectiveness of the application in practice.

Teleburn: Designing A Telemedicine Application to Improve Burn Treatment.

BACKGROUND: Due to the increasing rate of the burn injuries and a limited number of specialized treatment centers, providing medical advice and medical care at the point of need is necessary. The aim of the present study was to design and implement a teleburn system to enhance the quality of care for the burn patients. METHODS: This study was completed in 2016. In order to design the system, information needs assessment was conducted by using a questionnaire. The participants of this phase were five specialists, five general practitioners, and 12 nurses. The setting of the study was the burn department of a public hospital and a burn center. The prototype of the system was designed based on the findings derived from the first phase, and the usability of the system was evaluated later. RESULTS: The teleburn system was a web-based system with different sections for GPs/nurses and specialists. In total, 28 burn consultations were made successfully by using the system. The findings of the usability testing showed that most of the participants evaluated the system at a good level. The mean score for the specialists, general practitioners and nurses was 8.4±0.46, 7.7±0.39, and 7.5±0.51, respectively. CONCLUSION: Although it was the first time in the country that the teleburn system was designed and introduced to the clinicians, they seemed to be satisfied with using the system. This system could help general practitioners and nurses to receive specialist's advice on a timely manner to improve the treatment of the burn patients. However, more research should be conducted to determine the effectiveness of using this technology in the real work environment.

Common and differential genetically pathways between ulcerative colitis and colon adenocarcinoma.

AIM: In the present study, genes of Ulcerative Colitis and Colon Adenocarcinoma (COAC) were extracted by string App in Cytoscape software version 3.5.1. Then protein- protein interaction (PPI) networks analyzed. BACKGROUND: One of the most common chronic digestive problems is ulcerative colitis (UC) especially in developing countries. Prevalence of the disease is reported about 7.6 to 245 cases per 100,000 per year. UC can lead to colon cancer that is the third malignancy related death in the world. So awareness of the future of the patient with UC and the possibility of colon cancer is a very helpful approach. METHODS: The analysis was based on centralities values. The goal is determining common gene pathways and differential gene pathways of the two diseases. RESULTS: Results showed there are 11 and 29 central genes related to COAC and UC respectively. At least five common key genes between the two diseases were introduced. The number of 26 terms related to the common key genes were determined and clustered in seven clusters. CONCLUSION: ALB, AKT1, TP53, SRC and MYC are the common genes that play crucial roles in the related biological processes of UC and COAC. Besides introducing the common genes the differentiate genes related to the two diseases were proposed.

Early Reconstruction of Distal Leg and Foot in Acute High-Voltage Electrical Burn: Does Location of Pedicle in the Zone of Injury Affect the Outcome of Distally Based Sural Flap?

BACKGROUND: Distally based fasciocutaneous sural flap is popular in the reconstruction of distal leg and foot burns. However, utilization of this technique in high-voltage electrical injury has been challenging. AIMS: The present study aimed to compare the outcome of early aggressive debridement and coverage of contact point of acute high-voltage electrical injury using distally based fasciocutaneous sural flap between high-risk and low-risk patients defined by the anatomic proximity of the flap pedicle to the zone of injury. METHODS: A total of 51 patients with contact point of high-voltage electrical burn (HVEB) in distal leg and foot undergoing distally based fasciocutaneous sural flap were included in this prospective clinical study. In 28 patients, the flap pedicle was not involved in the contact point of high-voltage electrical injury (low risk/control group), whereas in 21 patients, it was located inside the zone of injury (high-risk/case group). Patients were followed up for a median of 21 months (range, 12-44 months). RESULTS: Wound dimensions to be covered were relatively similar between the 2 groups. Complications of flap survival (primary outcome) and other minor early and late complications (secondary outcome) did not significantly differ between the 2 groups (P > 0.05). CONCLUSIONS: Provided that early and completed debridements of contact points of HVEB were achieved, distally based sural flap is feasible and there is reliable coverage in HVEB even in patients with flap pedicle located in vicinity of the zone of injury.

Prevalence of HIV infection among burn patients: is there a relationship with patients' outcomes?

The aim of the present study was to determine the prevalence of human immunodeficiency virus (HIV) infection among acute burn patients and its impacts on patient's outcomes in an Iranian burn care hospital. A cross-sectional study was conducted in a tertiary burn care hospital in Iran, retrospectively reviewing the data records of all patients admitted between February 2011 and February 2012. The HIV status of all the patients was assessed in relation to clinical outcomes and the patient's prognosis. A total of 969 patients were included in this study. Five patients (0·5%) were HIV positive, and all of them were male. Mean burn area was significantly larger in HIV-positive patients than the healthy group (P < 0·05). HIV-positive patients had a longer period of hospitalisation than HIV-negative patients (23·2 ± 16·3 versus 13·1 ± 14·6, P = 0·008). Nonetheless, the average number of procedures and the mortality rate did not significantly differ between the study groups (P > 0·05). Comparison of age, sex and burn extent between HIV-positive patients and HIV-negative cases also revealed similar results. Prevalence of HIV infection among our burn population was 0·5%; thus, HIV status may be related with more extensive injuries and longer hospital stays.

A Randomized Controlled Trial Comparing Endoscopic-Assisted Versus Open Neck Tissue Expander Placement in Reconstruction of Post-Burn Facial Scar Deformities.

BACKGROUND: Tissue expansion has evolved reconstruction surgery by providing a great source of additional tissue for large skin defects. Nevertheless, wide application of tissue expander reconstruction is challenging due to high complication rates and uncertainty about final outcomes. Recently, endoscopy has shown promise in reconstructive surgeries using tissue expander placement. AIMS: This study aimed to compare outcomes between open and endoscopic-assisted neck tissue expander placement in reconstruction of post-burn facial scar deformities. METHODS: Through a randomized clinical trial, 63 patients with facial burn scars were assigned to an open group or endoscopic group for placement of 81 tissue expanders. The complication rate, operative time, length of hospital stay, and time to full expansion were compared between the two groups. RESULTS: Thirty-one patients were assigned to the open group and 32 patients to the endoscopic group. The average operative time was significantly reduced in the endoscopic group compared with the open group (42.2 ± 3.6, 56.5 ± 4.5 min, p < 0.05). The complication rate was significantly lower in the endoscopic group than the open group (6 vs. 16, p < 0.05). Hospital stay was also significantly diminished from 26.3 ± 7.7 h in open group to 7.4 ± 4.5 h in endoscopic group (p < 0.0001). There was a significant reduction in time to full expansion in the endoscopic group as compared with the open group (93.5 ± 10.2 vs. 112.1 ± 14.2 days, p = 0.002). CONCLUSION: Endoscopic neck tissue expander placement significantly reduced operative time, the postoperative complication rate, length of hospital stay, and time to achieve full expansion and allowed early initiation of expansion and remote placement of the port in relation to the expander pocket. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of Erectile Dysfunction Following Burn Injury.

OBJECTIVE: To determine the prevalence of erectile dysfunction (ED) following burn injury. MATERIALS AND METHODS: A cross-sectional study was conducted in 2013, recruiting 125 male patients with thermal and electrical burn injury. Using the simplified and validated Persian translation of the abridged, 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire, the patients were evaluated for the presence and severity of the ED following burn injury. RESULTS: ED was detected in 66 patients (53%). There was a significant association between the total body surface area (TBSA) and severity of ED, in which by increase in the TBSA, the severity of ED increased. There was a significant negative correlation between IIEF-5 score and age (r = -0.247, P = .005) and TBSA (r = -0.481, P < .001). The logistic regression analysis revealed that TBSA was significantly associated with ED (P < .001). CONCLUSION: Our study estimated the prevalence of ED among burn survivors to be higher than the general population. We found that TBSA is a significant risk factor of ED.

systematized review of telemedicine applications in treating burn patients.

Background: Telemedicine has been used in different fields of medicine in the past 20 years. The main advantages of this technology include saving costs, improving quality of care, and increasing access to specialists. This study aimed to review telemedicine applications in treating burn patients. Methods: In this systematized review study, related papers were searched using various databases, including PubMed, Scopus, and Science Direct. The time frame was between January 2000 and March 2016; finally, 32 papers were included in the study. Results: The findings revealed that telemedicine was used in burn care in three different ways: Remote patient follow-up, teleconsultation, and patient assessment. Conclusion: It seems that telemedicine can be easily applied in treating burn patients even when there is a limited financial resource. The use of this technology can help reduce possible errors in categorizing burn patients and decrease patients' transportation and treatment costs.

Effects of early versus delayed excision and grafting on the return of the burned hand function.

BACKGROUND: Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome. MATERIALS AND METHODS: This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients' conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting. RESULTS: The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P < 0.0001 and P = 0.019). CONCLUSION: The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

Evaluation of Amniotic Membrane Effectiveness in Skin Graft Donor Site Dressing in Burn Patients.

Although the recipient site in burn wounds is dressed with universally accepted materials, the ideal management of split-thickness skin donor sites remains controversial. The aim of our study is to compare two methods of wound dressing in donor sites of split-thickness skin graft in patients undergoing burn wound reconstructive surgery. Forty-two consecutive patients with second- and third-degree burns with a total body surface area between 20 and 40 % were enrolled in this randomized clinical trial conducted in Motahari Burn Hospital in Tehran, Iran. In each patient, two anatomic areas with similar features were randomly selected as intervention and control donor sites. The intervention site was dressed with amniotic membrane, whereas the control site was treated with Vaseline-impregnated gauze. Wounds were examined daily by expert surgeons to measure the clinical outcomes including duration of healing, severity of pain, and infection rate. The mean ± SD age of patients was 31.17 ± 13.72 years; furthermore, burn percentage had a mean ± SD of 31.19 ± 10.56. The mean ± SD of patients' cooperation score was 1.6 ± 0.79 in the intervention group compared with 2.93 ± 0.71 in the control group, revealing a statistically significant difference (P < 0.05). Duration of wound healing was significantly shorter (P < 0.05) in the intervention group (17.61 ± 2.56 days) compared with the control group (21.16 ± 3.45 days). However, there was no significant difference in terms of wound infection rate between donor sites in the control and intervention groups (P > 0.05). Amniotic membrane as an alternative for dressing of skin graft donor sites provides significant benefits by increasing patients' comfort via diminishing the number of dressing changes and facilitating the process of wound healing.

Rib Diced Cartilage-Fascia Grafting in Dorsal Nasal Reconstruction: A Randomized Clinical Trial of Wrapping With Rectus Muscle Fascia vs Deep Temporal Fascia.

BACKGROUND: Rib cartilage is an abundant source for cartilage grafts when significant dorsal nasal augmentation or structural support is indicated. Diced cartilage wrapped in fascia was developed to counteract warping, visibility, and displacement of rib cartilage as a dorsal solid graft. The technique for wrapping diced cartilage has evolved during the past several years. OBJECTIVES: The authors compared 2 distinct fascial sleeves for wrapping rib diced cartilage in the treatment of patients who required major dorsal nasal augmentation. METHODS: Thirty-six patients who planned to undergo major dorsal nasal reconstruction with diced costal rib cartilage were assigned randomly to 1 of 2 groups: the intervention group, which received grafts wrapped with rectus muscle fascia from the rib cartilage harvesting site, or the control group, which received deep temporal fascia harvested separately. Outcomes were compared between the groups. RESULTS: Patients in the intervention group had significantly shorter operating times, significantly higher average satisfaction scores, and significantly shorter postoperative hospital stays than did patients in the control group. CONCLUSIONS: Harvesting rectus muscle fascia for wrapping diced rib cartilage is a feasible and reliable technique in dorsal nasal reconstruction surgery. It is associated with favorable outcomes and a high level of patient satisfaction. LEVEL OF EVIDENCE: 4.

Soft-tissue response rate to chin skeletal advancement in patients with lower facial burn scar.

BACKGROUND: This study aimed to evaluate the long-term outcomes and the soft-tissue response to osseous genioplasty in patients with chin retrusion caused by early life facial burn injury. METHODS: Twenty-two consecutive patients with retrusive chin as a result of severe childhood facial burn were included in this study. Cephalometric analysis and photographs were used to assess the patients for eligibility of a surgical correction. Horizontal hard-tissue advancement and soft-tissue responses were measured as the primary outcomes at the early and late postoperative follow-up visits. RESULTS: A total of 22 patients fulfilled the study requirements. Average preoperative distance between the pogonion, as the most anterior point of the anterior mandibular contour, and a perpendicular line connecting the nasion and the supramental point of the mandible was 0.82 ± 1.1 mm, which increased significantly to 7.8 ± 0.8 mm after genioplasty (p < 0.0001). Soft tissue was repositioned on average 6.1 ± 0.4 mm anteriorly on average, which is in comparison with the amount of chin skeleton advancement, and a response ratio of 0.8:1 was calculated at late follow-up. CONCLUSION: Burn-related retrusive chin can appropriately be treated with sliding osseous genioplasty and will require slight overcorrection compared with patients without a history of lower face burn. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Endoscopic-assisted neck tissue expansion in reconstruction of facial burn injuries.

BACKGROUND: Endoscopic-assisted tissue expansion has been recently used in plastic surgery. However, there is limited evidence regarding its efficacy in reconstruction of facial burn injuries. AIMS: Our study aimed to evaluate the utility of endoscopic-assisted neck tissue expansion in reconstruction of facial burn deformities. METHODS: Through a prospective study, 42 consecutive patients with facial burn injuries attending a major referral center of plastic and reconstructive surgery in Iran underwent reconstruction of facial defects with endoscopic-assisted neck tissue expansion. Intraoperative events, expansion process, and postoperative outcomes were measured for this group of patients. RESULTS: The mean ± SD injected volume for intraoperative expansion was 66 ± 3.7 mL (range, 35-80 mL). The mean ± SD operative time was 45.6 ± 3.5 minutes. Moreover, the mean ± SD distance between the main access incision and the expander pocket was 5.6 ± 1.2 cm. Time to achieve full expansion ranged between 12 and 16 weeks, and the expanded volume at the time of reconstruction ranged from 400 to 800 mL. All the patients had less than 24 hours of hospital stay after placement of tissue expanders. There were only 2 minor complications during the postoperative follow-up including 1 case of seroma and 1 case of severe pain, which were treated conservatively. CONCLUSIONS: Endoscopic-assisted neck tissue expansion is associated with lower complication rate, shorter duration of hospitalization, reduced operative time, earlier initiation of expansion, and faster expansion process. It could be a feasible alternative to open technique in reconstructing facial burns, allowing smaller incision at port site, far placement of tissue expander, and excellent visualization of operation site.

Electrical injury in construction workers: a special focus on injury with electrical power.

BACKGROUND: Electrical injury in construction workers due to contact with overhead power lines accounts for an important cause of admission at the emergency department. Due to lack of specific treatment options for this type of injury, prevention remains the mainstay of management. AIMS: Our study aimed to demonstrate the characteristics of electrical injury in construction workers among one of the largest Iranian population at a burn care hospital. METHODS: Through a retrospective review of hospital data base, patients with electrical injuries admitted to Motahari hospital in Tehran, Iran between March 2011 and June 2012 were included for analysis. Patients were divided into construction workers and other patients. Primary characteristics and final outcomes were then compared between the 2 study groups. RESULTS: Of 202 patients included in this study, 105 patients (52%) were construction workers and 97 patients (48%) constituted the remainder. There was significant difference between the 2 groups in terms of mean age, gender, and average burn size. In contrast, mean duration of hospitalization and mortality rate did not differ significantly between the 2 study groups (p>0.05). Contacts with over head power-lines accounted for the most common mechanism of injury. There was significant difference between the 2 groups in terms of place of injury and electrical current power. However, total cost of treatment did not differ significantly between the 2 groups (p>0.05). Frequency of severe complications was higher in construction workers and this group underwent more invasive procedures such as limb amputation and fasciotomy. CONCLUSION: The most common mechanism of electrical injuries in construction workers is due to contact with over head high voltage power-lines at workplace. This type of electrical injury is associated with higher use of fasciotomy, flap and limb amputation.

Assessment of substances abuse in burn patients by using drug abuse screening test.

There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20). We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05). The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.