While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this paper is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment (OBPA). Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity (SPA) may be a viable addition to an assessment battery to address this essential need.

Scars are common and debilitating outcomes of burn injury, with no current consensus regarding the gold standard in scar management. Non-invasive interventions such as silicone gels are popular adjuvant treatments due to ease of application. Onion extract (OE) has been proposed as a potential scar treatment modality due to its anti-microbial and anti-inflammatory properties. A systematic search of the literature was conducted using PubMed, Scopus, and Cochrane for articles published between January 2000 and December 2021. Inclusion criteria were studies: (a) involved OE gel or OE treatment, and (b) those assessing scar prevention or treatment outcomes. Patient and physician reported scar outcomes after treatment and adverse effects were recorded. A total of 21 articles were included in the final review. Five studies found statistically significant improvements in overall scores and individual VSS components in the OE treatment group compared to the silicone groups. Several studies found combined treatment of OE with other topical treatment modalities such as triamcinolone or silicone gel produced significant improvements in scar symptoms. In this review, reported adverse effects were minimal, often consisting of self-resolving pruritus, irritation, and erythema. This review supports OE\'s potential utility in scar prevention and treatment. Most studies reported minimal adverse events with OE application and significant benefits in specific scar characteristics. Further research is needed to investigate scar outcomes after treatment with OE with larger sample sizes and a follow up period greater than a year.

There are approximately 180 000 deaths per year from thermal burn injury worldwide. Most burn injuries can be treated in local hospitals but 6.5% require specialist burn care. The initial ED assessment, resuscitation and critical care of the severely burned patient present significant challenges and require a multidisciplinary approach. The management of these patients in the resuscitation room impacts on the effectiveness of continuing care in the intensive care unit. The scope of the present practice review is the immediate management of the adult patient with severe burns, including inhalation injury and burn shock. The article uses an illustrative case to highlight recent developments including advanced airway management and the contemporary approach to assessment of fluid requirements and the type and volume of fluid resuscitation. There is discussion on new options for pain relief in the ED and the principles governing the early stages of burn intensive care. It does not discuss minor injuries, mass casualty events, chemical or radiation injuries, exfoliative or necrotising conditions or frost bite.

Silver nanoparticles (AgNPs), owing to their unusual characteristics, have been used in various pharmaceutical, cosmetic, and healthcare products. AgNPs, with their exceptional biological potential, exhibit antibacterial, antifungal, antiviral, anti-inflammatory, anticancer, and wound healing properties and have been extensively used in burn therapy. Several studies have established the use of silver nanoparticles in the treatment of burn injuries, resulting in reduced inflammation, quick tissue regeneration, and the remarkable creation of collagen fibers. Conventional physical and chemical techniques have synthesized AgNPs, but they appear to be highly costly and hazardous. Recently, there has been considerable interest in the synthesis of AgNPs using the green chemistry approach because of its tremendous benefits, including being non-toxic, low energy consumption, pollution-free, economical, environmentally friendly, and more sustainable. This review emphasizes the green synthesis of AgNPs using bacteria, fungi, plants, and other microorganisms and the current research related to the application of green synthesized AgNPs in burn therapy, including the biological aspects of AgNPs, their mode of action, and any possible detrimental effects.

Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar.
A 20-year-old male who sustained a flame burn over the scalp at 3 months of age developed a nonhealing ulcer over the burn scar 20 years later, which was treated with adequate surgical margins with adjuvant mold brachytherapy. Two months after completion of that treatment, he developed parotid nodal metastasis with positron emission tomography (PET)-positive bilateral cervical, supraclavicular, right suboccipital, and mesenteric lymph nodes that were treated with concurrent chemoradiation. One month later, the patient developed an ulcerative lesion involving the left parotid region with PET showing infiltration of the parotid gland, but with resolution of other previous sites of uptake. The patient was treated surgically with radical parotidectomy with elective neck dissection and reconstruction with locoregional flap. At 6-month follow-up, the patient developed extensive locoregional recurrence and distant metastasis and was started on oral metronomic therapy. The patient was alive with stable disease at 3-month follow-up after initiation of palliative chemotherapy.
Despite timely multimodality therapy, MU may present with a hostile clinical course with a short disease-free interval and early recurrence.

OBJECTIVE: to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care.
METHODS: this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions.
RESULTS: the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control.
CONCLUSIONS: the study identified essential technologies in burn care, emphasizing the need for further research on \"soft\" technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.

BACKGROUND: burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims.
METHODS: this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms \"Burns\", \"Self-Injurious Behavior\", \"Epidemiology\" and \"Brazil\" were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed.
RESULTS: From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]).
CONCLUSIONS: our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

BACKGROUND: The inflammatory response to burn injuries can lead to organ dysfunction that ultimately results in increased mortality and morbidity. This meta-analysis was conducted to determine the efficacy of inflammatory biomarkers, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), procalcitonin (PCT), and C-reactive protein (CRP) as predictive tools of mortality among burn patients.
METHODS: The biomarker levels of survivors and non-survivors were consolidated according to guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three main databases were searched electronically: PubMed, Web of Science, and Scopus, on December 8, 2022. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate and score the methodological quality of the included studies. The standard mean difference (SMD) with a 95% confidence interval (CI) was utilized.
RESULTS: Twenty-four studies were included in our systematic review and meta-analysis, (3636 total burn patients), of whom 2878 survived. We found that deceased burn patients had elevated levels of NLR (SMD = 0.60, 95% CI; 0.19-1.00, P < 0.001), CRP (SMD = 0.80, 95% CI; 0.02-1.58, P = 0.04), and PCT (SMD = 0.85, 95% CI; 0.45-1.24, P < 0.001), compared to survivors. However, we found no association between PLR and mortality among burn patients (SMD = 0.00, 95% CI; -0.14-0.15, P < 0.001). In addition, CRP was significantly higher in non-survivors (SMD = 0.80, 95% CI; 0.02-1.58, P =0.04). Similar results were also found about PCT (SMD = 0.85, 95% CI; 0.45-1.24, P < 0.001). When we analyzed the PCT data, collected in the first 24-48 hours, we found similar results; the PCT level was significantly higher in non-survivors in the immediate postinjury-period (SMD = 0.67, 95% CI; 0.31-1.02, P < 0.001). There was no publication bias among studies on the role of NLR in burn (Egger\'s test P = 0.91). The based cut-off values for NLR (13), CRP (71), and PCT (1.77) yielded sensitivities of 69.2%, 100%, and 93.33%, and specificities of 76%, 72.22%, and 72.22% respectively.
CONCLUSIONS: PCT is a marker of sepsis, therefore its elevated level is presumably associated with a higher incidence and severity of sepsis among non-survivors. In addition, NLR and CRP are promising biomarkers for predicting and guiding prevention against burn deaths in clinical settings.

Despite advances in medical technology, mortality due to burn injuries remains significant. Scoring systems are aimed at allowing physicians to effectively and accurately predict the mortality of a given patient. Patients at a higher risk of death from burns include older patients over the age of 65, high-severity burn, presence of co-morbidities, and presence of inhalation injury. Constructing a burn prediction model also needs its own methodological standards. Hence, choosing a prediction model for predicting burn mortality requires careful analysis of its methodology. Attention towards mortality risk factors should be taken when treating burn patients. Tools such as burn prediction models prove helpful in aiding physicians to accurately and effectively predict a patient\'s mortality, stratify patient severity, and allocate resources appropriately, especially in settings where resources are scarce, such as natural disasters. Additionally, prediction models are used to monitor patient care and for research purposes.
Malgré les progrès médicaux, la mortalité due aux brûlures reste significative. Les scores de gravité ont pour but de permettre aux médecins de prévoir objectivement la mortalité d’un patient, permettant d’évaluer le niveau des soins à prodiguer, en particulier quand les ressources sont limitées comme après une catastrophe. Les patients les plus à risque sont ceux de plus de 65 ans, comorbides, à surface atteinte élevée, ayant inhalé des fumées. L’élaboration d’un score prédictif nécessite une méthodologie spécifique, devant être précisément analysée lors de son choix et les paramètres de mortalité devront être spécifiquement pris en compte lors du traitement des patients. Les scores de gravité peuvent aussi permettre d’évaluer la qualité des soins et d’analyser les résultats de protocoles de recherche.

Burn wound conversion describes the process by which superficial-partial thickness burns convert into deeper burns within 3-7 days after burn. Autophagy, inflammation, ischemia, infection and reactive oxygen species are thought to have a role in pathogenesis of burn wound conversion. This study aims to assess risk factors for burn conversion and develop a scoring system to predict it. The study was conducted using nested case control method, in burn patients treated in Dr. Cipto Mangunkusumo Hospital and Jakarta Islamic Hospital Cempaka Putih. Subjects were recruited by consecutive sampling in February 2019-August 2020. The role of clinical characteristics, local and systemic examination as predictors of burn wound conversion were assessed. Risk factors were analysed using bivariate and multivariate analysis. There were 40 subjects in the case group and 20 subjects in the control group. Involvement of trunk, limbs, burn extent measured using ImageJ, ≥ 9.49%TBSA, wound surface temperature measured using Flir one® thermography ≤ -1.55°C, procalcitonin level ≥ 0.075 ng/mL, and blood lactate level ≥ 1.75 mmol/L had a significant relationship with burn wound conversion. Three scoring models were developed: model 1 to be applied in tertiary health facilities, and model 2 and 3 to be applied in primary and secondary health facilities with sensitivity and specificity of 92.5% and 85%, 95% and 70% and 92.5% and 85%, respectively. The scoring models can be used in daily practice, especially as a reference for conservative and operative management.
L’approfondissement représente l’évolution en quelques jours d’une brûlure supposée superficielle vers une atteinte profonde. L’inflammation, l’ischémie, l’infection, les radicaux oxygénés actifs et l’apoptose sont supposés y jouer un rôle. Cette étude a pour but d’évaluer les facteurs de risque d’approfondissement et de développer un score de risque. Elle consiste en une étude cas (40), témoins (20) réalisée auprès de patients des hôpitaux Dr Cipto Mangunkusumo et Cempaka Putih de Djakarta, entre février 2019 et août 2020. Les paramètres cliniques locaux comme généraux ainsi que les données de surface (objectivées par ImageJ) et de température des zones atteintes (mesurées par Flir One®) ont été étudiées. L’atteinte du tronc ou des membres, une atteinte ≥ 9,49%, une baisse de température locale ≤ -1.55°C, une PCT ≥ 0,075 ng/mL et des lactates sanguins ≥ 1,75 mmol/L sont significativement associés à l’approfondissement. Nous avons développé 3 scores. Le premier s’adresse aux centres spécialisés, les 2ème et 3ème au pré-hospitalier et aux hôpitaux généraux respectivement, avec des sensibilités/spécificités de 92,5/85% ; 95/70% et 92,5/85%. Ces scores peuvent être utilisés en pratique courante, en particulier pour choisir une approche conservatrice ou chirurgicale.