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Comparative study of conventional and topical heparin treatment in second degree burn patients for burn analgesia and wound healing
Abstract
Objective:
To compare clinical outcome of topical conventional with topical heparin treatment in 2nd degree or partial thickness (PTB) burn patients.
Methods:
Patients, between the ages of 14 and 60 years with 2nd degree burns involving <20%. Total body surface area (TBSA) on front of chest, abdomen and upper limbs excluding hands and lower limbs were enrolled from September 2015 to August 2016. Patients were randomized to conventional or heparin treatment groups. Clinical outcome measured were healed wound size, pain scores and total consumption of analgesic medication required to relieve pain. Safety of the treatment and adverse events were also measured RESULTS: Out of 66 patient included in study mean (SD) age of participants was 27 (10) years, of which 59% were males. Mean (SD) TBSA burn was 14% (3) [23 (35%) had SPTB, and 43 (65%) had DPTB]. The burn injury was caused by flames in 68% and by hot liquids in 32% patients. There was no statistically significant difference in distribution of patients according to age, gender, TBSA burn, etiology or depth of burns in the two treatment groups. As compared to conventional treatment group, heparin treatment group had significantly better outcomes. Number of days needed for wound healing was significantly lower in the heparin group than the conventional group (SPTB 14±1 vs. 20±4 days; P-value <0.000 and for DPTB, 15±3 vs. 19±2 days; P-value <0.003). Mean pain score was also lower in the heparin group (for both SPTB and DPTB 3±1 vs. 7±1; P-value <0.000). Similarly, total consumption of analgesic medication was significantly less in the heparin group (53±27 vs. 119±15mg; P-value <0.000 for SPTB and 46±6 vs. 126±12mg; P-value <0.000 for DPTB). In both groups, no patient had wound infection, skin necrosis, leucopenia, thrombocytopenia, worsening renal function, or abnormal liver enzymes CONCLUSION: Treatment of second degree or partial thickness burns (PTB) with topical heparin is superior to conventional treatment in terms of wound healing as well as for pain control. The treatment with topical heparin is well-tolerated and is without higher adverse effects.
... Heparinase inhibition and adhesive molecule inhibition are two of the mechanisms involved in leukocyte recruitment into tissues [12]. Heparin has anti-allergenic, anti-histaminic, anti-serotonin, analgesic, and anti-proteolytic characters [13]. Heparin's analgesic action could be related to its ability to block pro-inflammatory chemicals that act on nerve endings [13,14]. ...
... Heparin has anti-allergenic, anti-histaminic, anti-serotonin, analgesic, and anti-proteolytic characters [13]. Heparin's analgesic action could be related to its ability to block pro-inflammatory chemicals that act on nerve endings [13,14]. ...
... Furthermore, epithelization by the proliferation of these surviving de-epithelized island cells is induced with heparin thus making superficial and deep burns heal in a shorter period of time [11,12]. Manzoor et al., [13] also found similar results. In current study observed that no (0%) patient was found with wound infection in group A and 1(4.8%) patient was found with wound infection in group B. The difference was not statistically significant (p>0.05) between the two groups. ...
Introduction: Burn is a complex disease process, a trauma to physique as well as psyche. Visible disfigurement caused by burns translates into an altered pattern of socialization which in turn can have serious psychological ramifications. Patients with burns require immediate specialized care in order to minimize morbidity and mortality. So, the important part of the management of burns is wound management. Objectives: To assess the efficacy of topical heparin and silver sulfadiazine cream in burn wound management. Methods: Prospective comparative interventional study was carried out at the Department of Burn & Reconstructive Surgery, Faculty of Paedicatric Surgery, Bangladesh Shishu Hospital and Institute. A total 42 patients were included in this study after fulfilment of all selection criteria during the study period. Patients were randomly selected into two groups. In group A (n=21) patients were treated with topical heparin and in group B (n=21) patients were treated with silver sulfadiazine cream. Results: The mean pain relief time was 1.76±0.54 days in group A and 5.52±0.98 days in group B. The difference was statistically significant (p<0.05). The mean wound healing time was 4.62±0.86 days in group A and 8.0±1.97 days in group B. The difference was statistically significant (p<0.05). The mean hospital stay was 5.57±0.75 days in group A and 8.10±1.97 days in group B. The difference was statistically significant (p<0.05). Conclusion: Topical use of heparin is safe and more effective than silver sulfadiazine cream in the management of second-degree burns in children.
... Multiple local drugs were used to enhance donor area healing such as platelet-rich plasma (PRP) [3] and heparin [4]. On the other hand, systemic application of insulin-as an anabolic hormone-has a positive effect on all phases of wounds healing. ...
... When VAS scale on day 1 and day 7 were observed in both groups of our study, the control group was observed with much higher VAS values as compared to Heparin group on day 7 (i.e.7.71±1.58 in control vs. 3.15±0.92 in heparin group) and the difference was statistically highly significant (p<0.05). Sobia Manzoor et al, [15] found mean pain score was also lower in the heparin group (3 ± 1 in heparin vs. 7 ± 1 in control group). ...
Background: Heparin is a multifaceted compound with uses not only as an anticoagulant, but also as an anti-inflammatory, anti-allergenic, anti-histaminic, anti-serotonin, anti-proteolytic and neoangiogenic agent. The aim of the study was to study the effect of topical heparin in the management of burns in terms of morbidity, mortality & safety. Subjects and Methods: A hospital based RCT with total duration of 16 months from June, 2018 to September, 2019 with 100 patients (age between 15-45 years, burns from 20-60%, with less than 48 hours duration), randomly enrolled into 2 groups, after initial resuscitative measures, 50 cases receiving Topical Heparin treatment, 50 controls receiving conventional treatment (1% silver sulphadiazine) with i.v. antibiotics, after explaining the study objectives and taking informed written consent. Data analysis was performed using Epi Info software. Results: Patients treated with topical heparin experienced statistically significant (p<0.05) improved pain relief, rapid healing, lesser complications and reduced duration of hospital stays. Conclusion: The current study demonstrates that topical heparin can improve clinical outcomes in the treatment of burn injury.
Background: Human life is subject to certain environmental, cultural and ethnic origin factors. Based upon the above facts loose and tight variety of clothing/apparel are commonly used. Fire and flames are an integral part of human life on the other hand and accidents do occur in natural course of history. In such accidents type of apparel one might be wearing play a great role in degree or severity of burns. Association and assessments need to be established in this regard. Methods: The study has been conducted on 250 cases of dry flame burns in AED of Mayo Hospital Lahore/Medicolegal Clinic of King Edward Medical University Lahore for a period of nine months in 2017-18. The population of 250 cases were selected through convenient non-probability purposive sampling technique. The study descriptive cross-sectional study design was applied to the above population selected for the study. Results: Our study revealed1.6% females were involved more than males in the burn incident during the period of study. A wide majority up to 70% used Shalwar and Kameez of loose wearable category as per culture of the country in comparison to the relatively tight clothing of Trousers and Pantaloons variety. A grossly significant role has been established with a p value of 0.024 that loose variety of apparel are responsible for causing greater degree of damage in burns as compared to that of tight variety of apparel worn at the time of incidence. Conclusion: The study concludes that wearing relatively short apparels or of tight i.e. Trousers and Pantaloons variety can be safe, protective and a healthy habit during cooking, working in fire burning vicinity like that of industry, hotels, restaurants and winter outdoor activities. The loose variety hereafter referred as Shalwarand Kameezvariety of cultural apparels can be dangerous and even life threatening when it involves higher percentages of burns. Keywords: Burns, Apparel, Clothing, Degree of Burns
Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years’ work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1,536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
Objetivo: Delinear, de maneira integrativa, as perspectivas de abordagem terapêutica de pacientes adultos vítimas de queimaduras. Métodos: Mediante utilização de fórmula de busca configurada a partir de descritores disponíveis nos Descritores em Ciências da Saúde, foram coletados12 artigos disponíveis no Portal Biblioteca Virtual de Saúde para análise criteriosa dos desfechos mais relevantes. Resultados: Dentre as abordagens analisadas, destaca-se a utilização de curativos biológicos e/ou formulados com colágeno hidrolisado a fim de catalisar processos de cicatrização e prevenir infecções de ferida. Cabe ressaltar, ainda, a utilização de tecido StrataGraft como alternativa ao autoenxerto e a regeneração epidérmica propulsionada pelo Sistema RECELL. No que concerne ao manejo farmacológico, inovações em tecnologia analgésica têm ganhado relevância no cenário emergencial. Conclusão: Perspectivas terapêuticas promissoras têm sido desenvolvidas com o fito de reduzir desfechos desfavoráveis durante a evolução clínica de pacientes vítimas de queimaduras.
In general, the systems intended for the treatment and recovery of wounds, seek to act as a coating for the damaged area, maintaining an adequate level of humidity, reducing pain, and preventing the invasion and proliferation of microorganisms. Although many of the systems that are currently on the market meet the purposes mentioned above, with the arrival of nanotechnology, it has sought to improve the performance of these coatings. The variety of nano-systems that have been proposed is very extensive, including the use of very different materials (natural or synthetic) ranging from polymers or lipids to systems derived from microorganisms. With the objective of improving the performance of the systems, seeking to combat several of the problems that arise in a wound, especially when it is chronic, these materials have been combined, giving rise to nanocomposites or scaffolds. In recent years, the interest in the development of systems for the treatment of wounds is notable, which is reflected in the increase in publications related to the subject. Therefore, this document presents generalities of systems involving nanocarriers, mentioning some examples of representative systems of each case.
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