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• Methylated spirit burns: An ongoing problem.

  Authors: J R H Jansbeken, A F P M Vloemans, F R H Tempelman, R S Breederveld

  Burns : journal of the International Society for Burn Injuries.

  OBJECTIVE: Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem. METHODS: WeOBJECTIVE: Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem. METHODS: We retrospectively collected data of all patients with burns caused by methylated spirit over twelve years from 1996 to 2008. Our main endpoints were: incidence, age, mechanism of injury, total body surface area (TBSA) burned, burn depth, need for surgery and length of hospital stay. RESULTS: Ninety-seven patients with methylated spirit burns were included. During the study period there was no decrease in the number of patients annually admitted to the burn unit with methylated spirit burns. 28% of the patients (n=27) were younger than eighteen years old, 15% (n=15) were ten years old or younger. The most common cause of burns was carelessness in activities involving barbecues, campfires and fondues. Mean TBSA burned was 16% (SD 12.4). 70% (n=68) had full thickness burns. 66% (n=64) needed grafting. Mean length of hospital stay was 23 days (SD 24.7). CONCLUSIONS: The use of methylated spirit is an ongoing problem, which continues to cause severe burns in adults and children. Therefore methylated spirit should be banned in households. We suggest sale only in specialised shops, clear labelling and mandatory warnings.

• Biodegradable staples, a needed revolution in burn future.

  Authors: Ali Akbar Mohammadi, Seyed Morteza Seyed Jafari

  Burns : journal of the International Society for Burn Injuries.

• Antimicrobial resistance patterns and their encoding genes among Acinetobacter baumannii strains isolated from burned patients.

  Authors: Parisa Asadollahi, Mahdi Akbari, Setareh Soroush, Morovat Taherikalani, Khairollah Asadollahi, Kourosh Sayehmiri, Abbas Maleki, Mohammad Hossein Maleki, Parviz Karimi, Mohammad Emaneini

  Burns : journal of the International Society for Burn Injuries.

  The purpose of this study was to determine the mechanisms and patterns of antimicrobial resistance among the isolates obtained from burned patients with wound infections at a teaching hospital inThe purpose of this study was to determine the mechanisms and patterns of antimicrobial resistance among the isolates obtained from burned patients with wound infections at a teaching hospital in Tehran, Iran. A total of 23 Acinetobacter baumannii isolates were collected from patients with burn wound infections between August 2009 and July 2010 from a hospital in Tehran. The susceptibility of these strains against 11 antimicrobial agents was determined by E-test according to the CLSI guidelines. All the resistant strains were then subjected to PCR assay for 28 distinct resistance genes. The most active antimicrobial agent was colistin with 100% sensitivity followed by gentamicin, amikacin and imipenem with 69.5%, 52.1% and 51.1% sensitivity, respectively. The most frequent resistance genes detected were bla(OXA-51-like) genes (n=23; 100%) that was intrinsic to A. baumannii isolates, gyrA (n=23; 100%), carO (n=23; 100%), tetA (n=22; 95.5%), tetB (n=15; 65.2%), intI (n=13; 56.5%) and PER (n=12; 52.1%), respectively. In order to make a proper choice of antibiotic for burn patients, it would be beneficial to physicians to identify drug resistance patterns in A. baumannii isolates.

• The use of a frailty scoring system for burns in the elderly.

  Authors: D Masud, S Norton, S Smailes, O Shelley, B Philp, P Dziewulski

  Burns : journal of the International Society for Burn Injuries.

  INTRODUCTION: Burn in the elderly has a high mortality. Scoring systems incorporating age, and/or co-morbidities have been developed to assist in predicting outcomes in this high risk group. LifeINTRODUCTION: Burn in the elderly has a high mortality. Scoring systems incorporating age, and/or co-morbidities have been developed to assist in predicting outcomes in this high risk group. Life expectancy has increased in the general population and within the elderly age group medical co morbidity, physiological response to injury and socioeconomic factors give rise to the concept of biological versus chronological age. For a given age, baseline pre morbid state can vary. It is more valid to consider biological rather than chronological age when calculating risk. The Canadian Study of Health and Aging (CSHA) clinical frailty scale, incorporating fitness, co-morbidities and level of dependence was used to analyse our elderly burn patients admitted to Burns ITU, their surgical management and one-year survival. METHOD: Data from patients with burns greater than 10% and aged over 65years managed on the Burns ITU between 2005 and 2009 were obtained. A frailty score (1-7) was assigned to each patient based on the records of their admission assessment. 42 patients met the study criteria for analysis. 18 (42.9%) patients, with mean age 74.9years (range 65-95years) survived (S) their ITU stay and of these, 83.3% survived at 1year. 24 (57.2%) patients, mean age 78.4years (range 66-95years) died (D) whilst on ITU. There was no significant difference between the two groups with regard to age, percentage burn (30% TBSA range 10-85%) (P>0.05 using T Test) or inhalational injury (p>0.05 using Z test). Using Mann-Whitney U test analysis, the frailty score between the two groups showed a significant difference at p=0.0001 (Mann-Whitney U test=78), median=3 (S) and median=5 (D). This suggests patients with better pre-morbid capacity, as evaluated by the frailty scoring system, were more likely to survive their burn insult and treatment. Significantly, more patients in the group that survived underwent surgical debridement (Mann-Whitney U test=111, p=0.02). CONCLUSION: Frailty scoring system appears to be a useful adjunct in predicting outcome in burns requiring admission to HDU/ITU in the senior population. The frailty score may predict which patients will benefit from surgery which also continues to be an important determinant of outcome in these patients.

• The properties of an "ideal" burn wound dressing - What do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists.

  Authors: Harald F Selig, David B Lumenta, Michael Giretzlehner, Marc G Jeschke, Dominic Upton, Lars P Kamolz

  Burns : journal of the International Society for Burn Injuries.

  OBJECTIVE: Using Internet polling to classify characteristics of a burn wound dressing considered as "ideal" by burn care specialists for small sized burns (<20% TBSA). METHODS: Open, voluntaryOBJECTIVE: Using Internet polling to classify characteristics of a burn wound dressing considered as "ideal" by burn care specialists for small sized burns (<20% TBSA). METHODS: Open, voluntary Internet-based cross-sectional survey with twenty non-compulsory questions and collection of information related to profession, staff grade, work location. RESULTS: In total one-hundred and twenty-one participants from 39 countries were included (response rate: 121/1000=12.1%) within the one month survey period (1-31st December 2011). The majority of respondents were surgeons (72.1%; 88/121), and most participants were from Europe 59.4% (72/121). According to the survey the following are the properties of an "ideal" burn wound dressing: non-adhesion ("essential": 55/120, 45.8%; "desirable": 50/120, 41.7%), absorbency ("essential": 41/120, 34.2%; "desirable": 64/120, 53.3%) and antimicrobial activity ("essential": 52/121, 43.0%; "desirable": 49/121, 40.5%). In addition, ease of removal, which would produce more pain-free dressing changes, was also considered to be an asset - ideally requiring dressing changes twice per week with a range of different dressing sizes available. As polled directly, most of the respondents thought that such a dressing was currently not available. CONCLUSION: This Internet-based survey provides a first insight into a 'wish list' of properties for burn wound dressings required by specialists in burn care from around the world. As with any kind of idealism, to date, no such burn wound dressing seems to be available in clinical practice according to the poll. Future scientific efforts need to focus on designing materials, which feature at least some of the properties revealed by this analysis.

• Cooling properties of everyday liquids.

  Authors: Robert M Warner, Yvonne Wilson, Darren L Chester

  Burns : journal of the International Society for Burn Injuries.

  OBJECTIVE: To examine the cooling properties of a variety of 'everyday' hot liquids within the context of scald injuries in the United Kingdom. METHODS: The temperature of common hot liquids,OBJECTIVE: To examine the cooling properties of a variety of 'everyday' hot liquids within the context of scald injuries in the United Kingdom. METHODS: The temperature of common hot liquids, including water, tea, coffee and various other liquids (i.e. takeaway coffees, "Indian tea", chicken curries, hot milk and oil) were recorded over a time period, using digital cooking thermometers. RESULTS: Minimal difference was detected between the cooling rates of hot water, coffee and tea. Indian tea cooled at a slower rate. The speed at which milk cooled was less than other liquids and the higher the fat content the slower it cooled. Takeaway beverages had a lower starting temperature and retained heat for substantially longer periods. The assessment of cooking oil revealed intense heat production and prolonged cooling. CONCLUSION: The authors propose that if a patient is exposed to a 'common' scalding agent that has been cooling for 10min or less then the temperature of that fluid is likely to be greater than 60°C and therefore capable of causing a burn within seconds of exposure. Furthermore, most liquids tested take between 15 and 30min to reach a "safe temperature" below 53°C.

• Early depth assessment of local burns by videomicroscopy: A novel proposed classification.

  Authors: Kyomi Mihara, Hajime Shindo, Hiroya Mihara, Minako Ohtani, Kotaro Nagasaki, Norito Katoh

  Burns : journal of the International Society for Burn Injuries. 38(3):371-7.

  Videomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings ofVideomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings of burn wounds. The aim of this study was to propose a novel classification to assess burn depth in its early phase easily and reliably by videomicroscopy. Forty-four patients with 56 intermediate-depth burn wounds were included. Burn depth was divided into each grade according to our proposed classification, which is composed of five categories based on dermal capillary integrity patterns. The intrarater and interrater reliabilities of the assessment by the second and third authors were evaluated by Cohen's unweighted κ-value. The results of the measurements according to the proposed classification showed an accuracy of 92.9%, sensitivity of 81.8%, and specificity of 100.0%. The intrarater reliability of the second and third authors showed substantial agreement (κ=0.719 and 0.729, respectively). The interrater reliability of the sum of each observer's variable also showed substantial agreement (κ=0.636). This pattern analysis system is easy to use even for inexperienced personnel, and is reliable with high accuracy and specificity. Intrarater and interrater statistics also support its reliability and reproducibility.

• Response to Letter to the Editor: 'Photography and the mobile phone camera: A good method for burn depth analysis with implications for remote assessment'.

  Authors: David Boccara, Marc Chaouat, Cindy Uzan, Anne Lacheré, Maurice Mimoun

  Burns : journal of the International Society for Burn Injuries. 38(3):459-60.

• Lymphatic regeneration in meshed skin grafts.

  Authors: C Hadamitzky, H O Rennekampff, R Pabst, C Radtke, P M Vogt

  Burns : journal of the International Society for Burn Injuries. 38(3):461-3.

• Effect of N-acetylcysteine treatment on oxidative stress and inflammation after severe burn.

  Authors: C Csontos, B Rezman, V Foldi, L Bogar, L Drenkovics, E Röth, G Weber, J Lantos

  Burns : journal of the International Society for Burn Injuries. 38(3):428-37.

  Oxidative stress and inflammation generate edema in burns. The aim of our study was to assess effect of N-acetylcysteine (NAC) on oxidative stress, inflammation, fluid requirement, multiple organOxidative stress and inflammation generate edema in burns. The aim of our study was to assess effect of N-acetylcysteine (NAC) on oxidative stress, inflammation, fluid requirement, multiple organ dysfunction (MOD) score and vasoactive drug requirement. In this study 15 patients were on standard therapy, whereas for other 15 patients NAC was supplemented. Blood samples were taken on admission and on the next five consecutive mornings. Levels of malondialdehyde, protein sulfhydril (PSH) groups, reduced gluthation (GSH), activity of myeloperoxidase, catalase and superoxide dismutase enzymes and induced free radical generating capacity were measured as well as concentrations of TNF-α, IL-6, IL-8, and IL-10. MOD score, use of vasopressor agents and fluid utilisation were recorded daily. NAC treatment increased GSH level on days 4-5 (p<0.05) and PSH level on days 2-6 (p<0.05) compared to controls. Plasma IL-6 was lower on days 4-5 (p<0.05), IL-8 on days 4-6 (p<0.05) and IL-10 on days 4-6 (p<0.05) in NAC group. NAC group received less catecholamines than controls (p<0.01) from day 4 without significant differences in MOD score. NAC treatment is associated with a diminished oxidative stress reflected in preserved antioxidant levels, lower inflammation mirrored in lower interleukin levels and less vasopressor requirement.

• The severity of kettle burns and the dangers of the dangling cord.

  Authors: W J M Holmes, B Keane, H Rode

  Burns : journal of the International Society for Burn Injuries. 38(3):453-8.

  Kettle scalds are a major cause of paediatric burn injury. Whilst preventative measures have been advocated for years, the incidence of this type of injury is increasing. Information is lackingKettle scalds are a major cause of paediatric burn injury. Whilst preventative measures have been advocated for years, the incidence of this type of injury is increasing. Information is lacking regarding severity and mechanism of injury. We prospectively analysed all paediatric scald injuries that warranted referral to a tertiary burn centre to quantify severity, outcome, look into how these burns occurred with a view to providing information for preventative strategies and audited the safety features of 19 top selling kettles. A total of 119 kettle burns were included in the study. Mean age at time of injury was 2 years 1 month (5 months to 12 years). Mean TBSA was 11.8% (2-30) and 62% sustained TBSA >10%. Mean length of stay was 10.4 (1-120) days and a surgical procedure was required in 62% of all kettle scalds. Grafting was undertaken in 52% of patients. Mean number of surgical procedures was 1.7 (median 1, range 1-9). Pulling the kettle cord was the main mechanism of injury (74% vs. 37%). "Cord-pullers" were also significantly younger (mean 20 months vs. 51 months, p<0.05) and underwent significantly more grafting in "cosmetically sensitive" areas (69% vs. 23%, p<0.05). 4 cases of inhalational injury occurred as a result of pulling the kettle cord. Mean kettle cord length was 66cm (range 45-80) with only 30% employing a coil tidy feature. In view of these findings we discuss current legislative policy on kettle cord length and report on the current safety of today's kettles. Areas for future prevention are discussed.

• Are parents in the UK equipped to provide adequate burns first aid?

  Authors: Hamish E Graham, Sarah E Bache, Preetha Muthayya, Julie Baker, David R Ralston

  Burns : journal of the International Society for Burn Injuries. 38(3):438-43.

  Simple first aid following a burn injury has been shown to improve outcome. With this in mind, a prospective study was conducted to evaluate the knowledge of burns first aid amongst parents in SouthSimple first aid following a burn injury has been shown to improve outcome. With this in mind, a prospective study was conducted to evaluate the knowledge of burns first aid amongst parents in South Yorkshire, United Kingdom. This information was used to identify which aspects of burn first aid need to be highlighted in an education campaign and who the target audience should be. A simple mnemonic is suggested to assist parental education on the topic. Parents attending outpatient clinics at Sheffield Children's Hospital were interviewed and asked about the first aid they would provide for a child with a large scald. Removal of hot clothes and jewellery; application of cold water for 10-20min; obtaining medical advice; and covering the burn with a plastic film or clean cloth were all considered to be ideal responses. Variations in responses in relation to the age and ethnicity of the parent were noted. One hundred and eighty eight parents were included in the questionnaire. Of these, 81% (n=152) were white British and 20% (n=36) were from other ethnic groups. Only 10% (n=18) of all respondent would give all the ideal first aid steps. Less than 40% (n=73) of parents questioned would remove hot clothes and jewellery. There was no significant difference in responses between ethnic groups when assessing knowledge of the need to remove hot soaked clothing. Although 73% (n=137) of parents would run the burn under cool water, only 35% (n=66) would cool the burn for an adequate length of time. White British parents were significantly more likely to run cool water over the burn, and to continue this for the recommended 10-20min. Whilst 88% (n=165) of parents would seek medical attention, this was significantly less in parents under 20 years old. Finally, 92% (n=173) of parents would protect the wound with appropriate dressings, but of note, 26% (n=9) of parents from minority ethnic groups would potentially impair burn healing by using inappropriate dressings and topical agents including butter, milk, cooking oil and toothpaste. The questionnaire findings highlighted the need for improved parental awareness of burns first aid. This was across all ethnic groups and ages questioned. In particular, knowledge of appropriate cooling times and the use of inappropriate dressings were highlighted as areas for concern. Ideal burns first aid measures were summarised with the mnemonic STOP-Strip clothes, turn on the tap for 10min, organise help, put on plastic film. This mnemonic is to be used in a pilot educational campaign in the Sheffield area, with possible expansion nationwide.

• A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds.

  Authors: Z Aziz, S F Abu, N J Chong

  Burns : journal of the International Society for Burn Injuries. 38(3):307-18.

  Silver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings andSilver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. The Cochrane Central Register of Controlled Trials and relevant databases were searched. Drug companies and experts in this field were also contacted. Randomised controlled trials (RCTs) of silver dressings or topical silver (used with dressings) compared with non-silver dressings were eligible for inclusion. We identified 14 RCTs involving 877 participants. One small trial of a silver-containing dressing showed significantly better healing time compared to the control [MD -3.6; 95% CI -4.94 to -2.26 for partial thickness burns and MD -3.9; 95% CI -4.54 to -3.26 for superficial burns]. Topical silver showed significantly worse healing time compared to the non-silver group [WMD 3.96; 95% CI 2.41-5.51] and showed no evidence of effectiveness in preventing wounds infection [WMD 2.48; 95% CI 0.39-15.73]. Our review suggests that silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds.

• Substrate stiffness regulates the proliferation, migration, and differentiation of epidermal cells.

  Authors: Yu Wang, Guixue Wang, Xiangdong Luo, Juhui Qiu, Chaojun Tang

  Burns : journal of the International Society for Burn Injuries. 38(3):414-20.

  The aim of this study was to investigate the role of substrate stiffness on the proliferation, migration, and differentiation of epidermal cells. To investigate the effects of substrate stiffness onThe aim of this study was to investigate the role of substrate stiffness on the proliferation, migration, and differentiation of epidermal cells. To investigate the effects of substrate stiffness on wound healing, epidermal cells were chosen and inoculated on silicone substrate with different values of Young's modulus of elasticity. The cell growth curve, MTT method, and cell cycle detection were used to investigate proliferation, and the scratch test was used to investigate cell migration. Fluorescence flow cytometry was used to study epidermal cell differentiation. The proliferation and migration of epidermal cells favoured stiffer surfaces. A highly stiff surface stimulated epidermal cell proliferation and migration and increased re-epithelialisation, but inhibited differentiation. The candidate pathways mediating epidermal cell proliferation and migration are linked to cell anchoring to substrates by integrin-mediated focal adhesion.

• PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment.

  Authors: A Lavrentieva, S Papadopoulou, J Kioumis, E Kaimakamis, M Bitzani

  Burns : journal of the International Society for Burn Injuries. 38(3):356-63.

  To evaluate the diagnostic and prognostic performance of inflammatory markers for septic and non septic (localized) bacterial infections in patients with severe burn. Data of 145 patients wereTo evaluate the diagnostic and prognostic performance of inflammatory markers for septic and non septic (localized) bacterial infections in patients with severe burn. Data of 145 patients were prospectively included in this study. Serum procalcitonin and other inflammatory markers were measured within 24h after burn and daily thereafter. Maximum procalcitonin (p=0.004) was independent predictors of outcome in logistic regression analysis. PCT thresholds of 1.5ng/ml, 0.52ng/ml and 0.56ng/ml had adequate sensitivity and specificity to diagnose sepsis, respiratory tract and wound infections respectively. A threshold value of 7.8ng/ml in PCT concentration on day 3 was associated with the effectiveness of the sepsis treatment with an AUC of 0.86 (95% CI 0.69-1.03, p=0.002). C-reactive protein levels and WBCs showed no significant change over the first 3 days in the patients with successfully treated sepsis (p=0.93). The maximum procalcitonin level has prognostic value in burn patients. PCT can be used as a diagnostic tool in patients with infectious complications with or without bacteremia during ICU stay. Daily consecutive PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in burn ICU patients.

• Burns, inhalation injury and ventilator-associated pneumonia: Value of routine surveillance cultures.

  Authors: Nele Brusselaers, Dennis Logie, Dirk Vogelaers, Stan Monstrey, Stijn Blot

  Burns : journal of the International Society for Burn Injuries. 38(3):364-70.

  Burn patients with inhalation injury are at particular risk for ventilator-associated pneumonia (VAP). Routine endotracheal surveillance cultures may provide information about the causative pathogenBurn patients with inhalation injury are at particular risk for ventilator-associated pneumonia (VAP). Routine endotracheal surveillance cultures may provide information about the causative pathogen in subsequent VAP, improving antibiotic therapy. Our objective was to assess the incidence of VAP in burn patients with inhalation injury, and the benefit of routine surveillance cultures to predict multidrug resistant (MDR) pathogens. Historical cohort (n=53) including all burn patients with inhalation injury requiring mechanical ventilation, admitted to the Ghent burn unit (2002-2010). Median (interquartile range) age and total burned surface area were 44y (39-55y) and 35% (19-50%). Overall, 70 episodes of VAP occurred in 46 patients (86.8%). Median mechanical ventilation days (MVD) prior to VAP onset were 7d (4-9d). The incidence was 55 episodes/1000 MVD. In 23 episodes (32.9%) at least one MDR causative pathogen was involved, mostly Pseudomonas aeruginosa and Enterobacter spp. The sensitivity and specificity of surveillance cultures to predict MDR etiology in subsequent VAP was respectively 83.0% and 96.2%. The positive and negative predictive value was 87.0% and 95.0%, respectively. The incidence of VAP in burn patients with inhalation injury is high. In this cohort routine surveillance cultures had excellent operating characteristics to predict MDR pathogen involvement.

• Evaluation of long term health-related quality of life in extensive burns: A 12-year experience in a burn center.

  Authors: Bing Xie, Shi-Chu Xiao, Shi-Hui Zhu, Zhao-Fan Xia

  Burns : journal of the International Society for Burn Injuries. 38(3):348-55.

  We sought to evaluate the long term health-related quality of life (HRQOL) in patients survived severely extensive burn and identify their clinical predicting factors correlated with HRQOL. AWe sought to evaluate the long term health-related quality of life (HRQOL) in patients survived severely extensive burn and identify their clinical predicting factors correlated with HRQOL. A cross-sectional study was conducted in 20 patients survived more than 2years with extensive burn involving ≥70% total body surface area (TBSA) between 1997 and 2009 in a burn center in Shanghai. Short Form-36 Medical Outcomes Survey (SF-36), Brief Version of Burn Specific Health Scale (BSHS-B) and Michigan Hand Outcome Questionnaire (MHQ) were used for the present evaluation. SF-36 scores were compared with a healthy Chinese population, and linear correlation analysis was performed to screen the clinical relating factors predicting physical and mental component summary (PCS and MCS) scores from SF-36. HRQOL scores from SF-36 were significantly lower in the domains of physical functioning, role limitations due to physical problems, pain, social functioning and role limitations due to emotional problems compared with population norms. Multiple linear regression analysis demonstrated that only return to work (RTW) predicted improved PCS. While age at injury, facial burns, skin grafting and length of hospital stay were correlated with MCS. Work, body image and heat sensitivity obtained the lowest BSHS-B scores in all 9 domains. Improvements of HRQOL could still be seen in BSHS-B scores in domains of simple abilities, hand function, work and affect even after a quite long interval between burns and testing. Hand function of extensive burn patients obtained relatively poor MHQ scores, especially in those without RTW. Patients with extensive burns have a poorer quality of life compared with that of general population. Relatively poor physical and psychological problems still exist even after a long period. Meanwhile, a trend of gradual improvements was noted. This information will aid clinicians in decision-making of comprehensive systematic regimens for long term rehabilitation and psychosocial treatment.

• Chemical burns - An historical comparison and review of the literature.

  Authors: Joseph Hardwicke, Thomas Hunter, Robert Staruch, Naiem Moiemen

  Burns : journal of the International Society for Burn Injuries. 38(3):383-7.

  Chemical burns represent a small proportion of cutaneous burn with an incidence of up to 10.7%, but have been reported to account for up to 30% of all burn deaths. A review of the literature showsChemical burns represent a small proportion of cutaneous burn with an incidence of up to 10.7%, but have been reported to account for up to 30% of all burn deaths. A review of the literature shows incidences ranging from 2.4% to 10.7%, with a substantial predominance in males. Adult patients with a burn referred to our Regional Burns Centre, over an eight-year period, were identified. 185 chemical burns were recorded (7.9%). The mean age of patient was 40years (range 16-81years) and male to female ratio was 6.4:1. Over three-quarters of chemical injuries occurred in the domestic or industrial setting. Acids caused 26% of all chemical burns and alkalis caused 55%. A previous study from the same centre highlights a change in the demographics of chemical burn over the last 25years. The proportion of chemical burns has risen from 2.7% to 7.9%. Chemical burns occurring in an industrial setting, have dropped, whilst the number of domestic chemical burns has increased by over three times. This change reflects the improved industrial health and safety policy in recent years. The move from the industrial setting to the domestic has implications for future regulations.

• A high prevalence of mupirocin and macrolide resistance determinant among Staphylococcus aureus strains isolated from burnt patients.

  Authors: Shadi Shahsavan, Mohammad Emaneini, Behshad Noorazar Khoshgnab, Babak Khoramian, Parisa Asadollahi, Marzieh Aligholi, Fereshteh Jabalameli, Mohammad Amin Eslampour, Morovat Taherikalani

  Burns : journal of the International Society for Burn Injuries. 38(3):378-82.

  Infections due to Staphylococcus aureus have become increasingly common among burn patients. The antibiotic resistance profile of S. aureus isolates and inducible resistance against clindamycin wereInfections due to Staphylococcus aureus have become increasingly common among burn patients. The antibiotic resistance profile of S. aureus isolates and inducible resistance against clindamycin were investigated in this study. The presence of mecA gene, mupA gene and macrolide resistance genes were detected using PCR and multiplex-PCR. The resistance rate to methicillin, erythromycin and mupirocin were 58.5%, 58% and 40%, respectively. The prevalence of constitutive and inducible resistance among macrolide resistant isolates was 75% and 25%, respectively. Ninety five percent of the isolates were positive for one or more erm genes. The most common genes were ermA (75%), ermC (72%) and ermB (69%), respectively. The ermA gene predominated in the strains with the inducible phenotype, while ermC was more common in the isolates with the constitutive phenotype. The msrA gene was only found in one MRSA isolate with the constitutive phenotype. A total of 27 isolates (25%) carried the mupA gene. All the mupirocin resistant isolates and almost all the erythromycin resistant isolates were also resistant against methicillin which may indicate an outbreak of MRSA isolates with high-level mupirocin and erythromycin resistance in the burn unit assessed.

• Enhanced secretion of TIMP-1 by human hypertrophic scar keratinocytes could contribute to fibrosis.

  Authors: Franck Simon, Daniele Bergeron, Sébastien Larochelle, Carlos A Lopez-Vallé, Hervé Genest, Alexis Armour, Véronique J Moulin

  Burns : journal of the International Society for Burn Injuries. 38(3):421-7.

  Hypertrophic scars are a pathological process characterized by an excessive deposition of extracellular matrix components. Using a tissue-engineered reconstructed human skin (RHS) method, weHypertrophic scars are a pathological process characterized by an excessive deposition of extracellular matrix components. Using a tissue-engineered reconstructed human skin (RHS) method, we previously reported that pathological keratinocytes induce formation of a fibrotic dermal matrix. We further investigated keratinocyte action using conditioned media. Results showed that conditioned media induce a similar action on dermal thickness similar to when an epidermis is present. Using a two-dimensional electrophoresis technique, we then compared conditioned media from normal or hypertrophic scar keratinocytes and determined that TIMP-1 was increased in conditioned media from hypertrophic scar keratinocytes. This differential profile was confirmed using ELISA, assaying TIMP-1 presence on media from monolayer cultured keratinocytes and from RHS. The dermal matrix of these RHS was recreated using mesenchymal cells from three different origins (skin, wound and hypertrophic scar). The effect of increased TIMP-1 levels on dermal fibrosis was also validated independently from the mesenchymal cell origin. Immunodetection of TIMP-1 showed that this protein was increased in the epidermis of hypertrophic scar biopsies. The findings of this study represent an important advance in understanding the role of keratinocytes as a direct potent modulator for matrix degradation and scar tissue remodeling, possibly through inactivation of MMPs.

• Time and regeneration in burns treatment: Heading into the first worldwide clinical trial with cadaveric mesenchymal stem cells.

  Authors: Eduardo Mansilla, Vanina Díaz Aquino, Gustavo Roque, José María Tau, Alberto Maceira

  Burns : journal of the International Society for Burn Injuries. 38(3):450-2.

• Response to Letter to the Editor: Comments on "Late-onset rhabdomyolysis in burn patients in the intensive care unit".

  Authors: Sarah E Bache, Ian Taggart, Charlotte Gilhooly

  Burns : journal of the International Society for Burn Injuries. 38(3):461.

• Response to Letter to the Editor: 'Lymphatic regeneration in meshed skin grafts'.

  Authors: T O Meier, M Guggenheim, B R Amann-Vesti

  Burns : journal of the International Society for Burn Injuries. 38(3):463.

• Simultaneous lightning injury in a group of people: Case report.

  Authors: Darius Kubilius, Rytis Rimdeika

  Burns : journal of the International Society for Burn Injuries. 38(3):e9-e12.

• Late-onset rabdomyolysis in burn patients in the intensive care unit.

  Authors: Silviu Constantin Badoiu, Carmen Caramitru

  Burns : journal of the International Society for Burn Injuries. 38(3):460-1.

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