Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11).

The objective of this study is to assess the quality of life and how to return to work after burns in adults. We conducted a monocentric, observational, prospective and open study in an intensive care burn unit. Patients aged between 18 and 65 years old were enrolled. Quality of life was assessed with Burn Specific Health Scale-Brief (BSHS-B). A total 118 patients were included with one delayed death. There were 55 flame burns. Median age was 39 years, median total burn surface area (TBSA) was 5% and median length of stay was 11 days. After management in the intensive care burn unit, 84 patients were discharged home and 33 to a rehabilitation care department. We sent 117 queries and got 56 answers. Median BSHS-B score ratio was 142/160. The most impacted items were heat sensitivity, body image, treatment regimens and work. Simple abilities were also affected with up to 28% of patients having difficulties with everyday actions such as cleaning oneself. Regarding return to work, 32% of workers lost their full-time job and 18% were downgraded as disabled. The outcome was worse for those patients who had to go to rehabilitation. Our data suggest that even small burns may strongly impact quality of life and limit the ability to return to work. Our results are consistent with previous published studies, which found greater alteration of quality of life with larger TBSA. These results call for care in specialized centers even for limited burns, especially in the case of functional area involvement.
Le but de ce travail est d’évaluer la qualité de vie et le retour au travail après brûlure chez des adultes. Il s’agit d’une étude monocentrique, observationnelle, prospective et ouverte menée dans un CTB auprès de patients de 18 à 65 ans. La qualité de vie a été évaluée en utilisant l’échelle BSHS-B (Burn Specific Health Scale-Brief). Nous avons inclus 118 patients dont 55 brûlés par flamme, 1 d’entre eux est décédé secondairement. En médianes, l’âge était de 39 ans, la surface atteinte de 5 % et la durée de séjour de 11 jours. Après leur hospitalisation en USI, 84 patients sont rentrés chez eux et 33 ont été transférés en SMR. Nous avons reçu 56 réponses aux 117 questionnaires envoyés. Le BSHS-B médian était de 142/160. Les variables les plus impactées étaient la sensibilité à la chaleur, l’image corporelle, les contraintes liées au traitement et le travail. Vingt-huit pour cent des patients étaient gênés pour les actes de la vie courante comme l’hygiène corporelle. En ce qui concerne le travail, 32 % des patients avaient perdu leur emploi et 18 % étaient considérés comme des travailleurs handicapés. Les suites étaient pires chez les patients ayant eu besoin de rééducation. Cette étude suggère que même de petites brûlure peuvent retentir fortement sur la qualité de vie et limiter les capacités de travail, à l’instar d’études précédentes, qui s’intéressaient à des patients atteints sur de plus grandes surfaces. Ceci prouve la nécessité du traitement en CTB de patients même peu atteints, en particulier si une zone fonctionnelle est atteinte.

Burns are a major public health issue. Psychiatric issues require special attention. According to research, lowering stigma and anxiety and raising self-esteem are efficient ways to encourage the social reintegration of burn patients. The current study was aimed at investigating the association between burn patients\' anxiety, depression, low self-esteem levels and the total body surface area (TBSA) affected by burn injuries. This single-center, cross-sectional study was conducted from January to June 2022. A sample size of 200 burn patients was calculated. Any patient with a prior psychiatric diagnosis was disqualified from the trial except for nicotine dependency. The patients were evaluated for anxiety, depression and self-esteem using specific scales. The data were tabulated and statistically analyzed using SPSS 25.0. There was male predominance as 55% (n=110) of participants were males. The age range was 18-70 years, and the average age of participants was 36.4±8.6 years. About 68.50% of participants were married, 29.50% were unmarried and 2% were divorced/widowed. Men tended to experience anxiety symptoms more frequently. More than half (58.0%) suffered from burns involving 20-39% of total body surface area (TBSA). No significant relationship was found between TBSA and anxiety, depression or self-esteem. Psychiatric issues are highly prevalent in burn victims. More research is necessary to determine the extent and determinants of psychological issues in burn patients.
Les brûlures sont un problème de santé publique majeur et leurs conséquences psychiatriques ne doivent pas être négligées. La prise en compte de la baisse thymique, de l’anxiété et de la perte de confiance en soi promeuvent la réintégration sociale de ces patients. Cette étude a cherché une corrélation entre la surface brûlée et les conséquences psychologiques et/ou psychiatriques. Cette étude monocentrique cas- témoin a été conduite entre janvier et juin 2022, permettant de recruter l’effectif calculé de 200 brûlés, exempts de pathologie psychiatrique préalable (hors addiction au tabac). Anxiété, dépression et estime de soi ont été mesurées au moyen d’échelles spécifiques puis analysées avec SSPS 25.0. Cent dix (55%) des patients étaient de sexe masculin. L’âge moyen était de 36,4 +/- 8,6 ans (18-70). Environ 68,5% des patients étaient mariés, 29,5% célibataires et 2% séparés ou veufs. Les hommes tendaient à présenter plus souvent des symptômes anxieux. Plus de la moitié (58%) avaient une atteinte sur 20 à 39% de SCT, cependant il n’a pas été trouvé de corrélation entre la SCT et les variables étudiées. Les séquelles psychiatriques étant très fréquentes après une brûlure, il est nécessaire d’en déterminer la gravité et les facteurs déclenchants.

The incidence of extubation failure varies between 2 and 25% depending on the studied population. Few studies have been conducted in burn victims. To determine the incidence, causes, risk factors and outcome of burned patients after a failed extubation, a retrospective single-center case-control study was conducted over a period of 3 years (January 2018-December 2021). All burned patients aged over 16, ventilated for at least 24 hours and having had at least one extubation attempt were included. Extubation failure was defined as the need for re-intubation within 48 hours. Eighty-eight patients had planned extubation. These patients were divided into 2 groups comparable in terms of age and sex. Failure group: including patients with failed extubation (N= 34) and a success group (N= 64) including patients who succeeded. The incidence of extubation failure was 36.6%. Hypophosphatemia, anemia <8g/dl, duration of mechanical ventilation of 8,5 days and abundant secretions during extubation were identified as risk factors for extubation failure (p<0.05). The main cause of failure was retention of secretion (50%). Extubation failure was associated with prolonged length of stay (34 vs. 19 days, P= 0.005), increased infectious complications (P=0.007) and mortality rate (79.4%, 1.5%, P<0.001).

Diabetes causes peripheral neuropathy with loss of sensitivity of feet to pain, predisposing diabetic patients to a high risk of severe burns. Our retrospective study aimed to look at epidemiological, clinical, therapeutic and outcome characteristics of feet burns occurring in patients with diabetes, hospitalized in the burn trauma center of Tunis over 4 years (from 2019 to 2022). We included 34 patients, among which 9 had only feet burns. Their mean age was 60 years (range: 41-83 years), with male predominance (sex ratio = 1.83). A quarter of patients (n=9) were on oral antidiabetic drugs (OADs) and more than half (n= 18) were at the stage of degenerative complications. At admission, blood glucose level was higher than 10 mmol/l in 73% of patients. TBSA was 19%. Twenty-two patients had deep feet burns, among which 5 patients underwent aponerrotomy for deep, circular burns. Amputation was done in 15 patients: toes (n=9), one limb (n=3) and two limbs (n=3). Duration of ICU stay was 18.3 days and mortality was 20.58%.

BACKGROUND: Burns cause serious physical and psychological harm to patients, placing a heavy burden on the global healthcare system. Our previous study detailed the epidemiological characteristics of burn injuries in Chinese inpatients from 2009 to 2018. Interestingly, the anatomic locations of burn injuries vary by gender, age, provinces, and outcomes among different causes. Therefore, this current study aims to analyze the characteristics of burn injuries in inpatients with various burn sites by collecting data in China from 2009 to 2018. This analysis will inform future healthcare system decisions and provide effective strategies.
METHODS: Burns inpatients from 196 hospitals across 31 provinces in China were included in the study, covering the period from 2009 to 2018. The data collected encompassed information on gender, age, etiology, regions, clinical outcomes, and anatomical locations of the injuries. Data analysis was conducted using Microsoft Excel 2007.
RESULTS: From 2009 to 2018, a total of 333,995 burns inpatients were recorded. The most vulnerable parts to burns were multiple burn sites (230,090, 68.89%). Women were more susceptible to lower limb burns (15,608, 14%), while men were more prone to eye injuries (8,387, 3.37%) and hand burns (6,119, 2.75%). The age group of 0-10 years was the most vulnerable to burns across all body areas, including internal organs. In China, individuals aged 20-50 years were at a higher risk of head and neck burns compared to other age groups. The Han population showed increased vulnerability to eye injuries (2.12 times higher than minorities), respiratory tract issues (2.09 times higher than minorities), and trunk burns (1.83 times higher than minorities), while being less susceptible to internal organ injuries (0.23 times fewer than minorities) and lower limb burns (0.78 times fewer than minorities). The southwest region had the highest proportion of burns inpatients with burns affecting single body parts, whereas the eastern area had the highest rates of respiratory tract burns (0.85%) and multiple burn sites (80.64%). Scalding was identified as the most common cause of burns, while flame burns (769, 55.81%) and chemical burns (438, 47.35%) were the main causes of respiratory tract and internal organ injuries, respectively.
CONCLUSIONS: This study provides an initial description of characteristics of burns inpatients with various anatomic locations of burns in China over the past decade. Our findings will contribute to the most up-to-date clinical evidence database for healthcare planning and prevention initiatives in both China and other countries.

Extracellular vesicles (EVs) derived from dental pulp stem cells (DPSC) have been shown an excellent efficacy in a variety of disease models. However, current production methods fail to meet the needs of clinical treatment. In this study, we present an innovative approach to substantially enhance the production of \'Artificial Cell-Derived Vesicles (ACDVs)\' by extracting and purifying the contents released by the DPSC lysate, namely intracellular vesicles. Comparative analysis was performed between ACDVs and those obtained through ultracentrifugation. The ACDVs extracted from the cell lysate meet the general standard of EVs and have similar protein secretion profile. The new ACDVs also significantly promoted wound healing, increased or decreased collagen regeneration, and reduced the production of inflammatory factors as the EVs. More importantly, the extraction efficiency is improved by 16 times compared with the EVs extracted using ultracentrifuge method. With its impressive attributes, this new subtype of ACDVs emerge as a prospective candidate for the future clinical applications in regenerative medicine.

Burns are an underestimated serious injury negatively impacting survivors physically, psychologically and economically, and thus are a considerable public health burden. Despite significant advancements in burn treatment, many burns still do not heal or develop serious complications/sequelae. The nucleotide-binding oligomerization domain-like receptors (NLRs) family pyrin domain-containing 3 (NLRP3) inflammasome is a critical regulator of wound healing, including burn wound healing. A better understanding of the pathophysiological mechanism underlying the healing of burn wounds may help find optimal therapeutic targets to promote the healing of burn wounds, reduce complications/sequelae following burn, and maximize the restoration of structure and function of burn skin. This review aimed to summarize current understanding of the roles and regulatory mechanisms of the NLRP3 inflammasome in burn wound healing, as well as the preclinical studies of the involvement of NLRP3 inhibitors in burn treatment, highlighting the potential application of NLRP3-targeted therapy in burn wounds.

BACKGROUND: Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients\' platelet counts.
METHODS: In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0).
RESULTS: Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients\' outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057).
CONCLUSIONS: This study suggests that skin graft positively increases the patient\'s platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).

Hypertrophic scarring is a significant complication post burn injury, especially for delayed healing after 3 weeks. Burn injuries healing prior to 3 weeks also have the potential to develop hypertrophic scarring, even when prescribed prophylactic conservative scar interventions. A retrospective chart audit reviewed 326 burn patients treated at a paediatric tertiary hospital from 2014 to 2019 who sustained a partial thickness burn, healed >14 days and did not receive skin grafting. A scar was deemed hypertrophic if >1 mm in height. Early hypertrophic scar prevalence was defined as 3-6 months post burn, while persistent hypertrophic scarring was defined as 12-18 months post burn. Median days to wound closure was 18. The prevalence of early and persistent hypertrophic scarring was 56.1% and 16.3%, respectively. Seventeen (5.2%) children underwent medical interventions for scar modulation. Early signs of hypertrophic scarring were seen in just over half the patients presenting to burn therapy and despite scar intervention, persistent hypertrophic scarring was seen in 16.3%. At both time points, just over half of the children presenting healed between 14 and 21 days. Therefore, children healing prior to 21 days have potential to develop hypertrophic scarring.