After the civil war, which caused the migration crisis in Syria, several Syrian refugees immigrated to Turkey. Burn trauma is quite common in refugees who migrated after the war. This study aims to examine the epidemiological and clinical characteristics of refugee patients in a burn center located on Turkey’s Syrian border (southeastern region). A total of 1200 patients in the present study were admitted between January 2016 and June 2023 in intensive care units and/or service units of the 25 Aralık State Hospital Burn Center. The data of these patients were obtained retrospectively from the database of the 25 Aralık State Hospital. Of the 1,200 patients, 696 were Turkish citizens, and 504 were refugees. The percentage of burns (total body surface area) was observed to be higher for the refugees (0.05). In addition, the mortality rates were higher for refugees (0.05). The refugee factor should also be considered in preventing burns and in developing policies for it.

Burn injuries are a critical public health issue globally, causing significant morbidity and mor- tality. This study investigates factors influencing mortality in burn patients. It also examines the effectiveness of total body surface area (TBSA) as a predictor of mortality, suggesting a new threshold to improve patient management and outcome predictions. A retrospective study was conducted at Lebanese Hospital Geitaoui - UMC from 2017 to 2023. The study included 474 patients with second-degree and third-degree burns. Statistical analyses were performed to identify factors significantly associated with mortality, and to assess the predictive power of TBSA. Of the 474 patients, 395 (83.3%) survived while 79 (16.7%) succumbed to their injuries. Patients with TBSA between 81% and 90% had a survival rate of 0%. The logistic regression analysis indicated that for each 1% increase in TBSA, the odds of mortality increased by 6% (0.001). Inhalation injuries were present in 70.9% of non-survivors (0.001). Patients requiring mechanical ventilation had markedly higher mortality (84.8% vs 15.2%) (0.001). Multi-site infections were notably more common among non-survivors (32.9%) substantially increasing mortality risk (p=0.001). The ROC curve analysis confirmed TBSA’s strong predictive value. The optimal cutoff point identified was 42.5% TBSA, above which the mortality risk increases significantly. The study highlights the significant impact of demographic factors, burn severity and medical interventions on the survival of burn patients. TBSA emerged as a robust predictor of mortality, underscoring the need for targeted interventions and specialized care for patients with extensive burns.

We aimed to evaluate the association between chronic malnutrition and nosocomial infections in pediatric patients with burns and controlled sociodemographic and clinical variables. We conducted a retrospec- tive observational cohort study in the Pediatric Burn Care Unit of the National Institute of Child Health in Peru. Patients were selected using stratified probability sampling with an annual proportional allocation. The exposure variable was chronic malnutrition according to the World Health Organization (WHO) definition, and the re- sponse variable was nosocomial infection. We used generalized linear Poisson models with robust standard errors. The relative risk (RR) and 95% confidence intervals (95% CI) of the crude model and of models adjusted for statistical criteria (aRR1) and epidemiological criteria (aRR2) were estimated. Of the 170 patients included in the study, 35% had chronic malnutrition, and the cumulative incidence of nosocomial infection was 22.3%. The frequency of nosocomial infections was 40% in the patients with chronic malnutrition and 12.7% in the normonourished patients. The model results were as follows: crude model (RR: 3.14, 95% CI: 1.75–5.61, 0,001), statistically adjusted model (aRR1: 2.88, 95% CI: 1.63–5.09, 0.001), and epidemiologically adjusted model (aRR2: 3.19, 95% CI: 1.71–5.93, 0.001). Chronic malnutrition increases the risk of nosocomial infec- tions in pediatric patients with burns independent of the demographic and clinical variables measured.

Thermal trauma ranks among the top external causes of death and carries substantial socio- economic impacts across all demographics. A prevalent complication following severe burn injuries is disseminated intravascular coagulation (DIC) syndrome. The onset of coagulopathy in severely burned patients is an early indicator of mortality risk, which persists throughout their clinical recovery. Early identification of DIC is crucial for determining the scope of surgical interventions. Concurrently, DIC presents a potential target for therapeutic intervention. Thus, forecasting the onset of DIC in burn victims, along with the capacity for its timely prevention and necessary treatment adjustments, is a critical objective. Current predictive models are complex and rely on specific markers not universally available in primary care settings for burn victims, nor do they consider the unique pathophysiological characteristics of severe burn injuries. Considering these factors, the purpose of this study is to develop a simple and effective approach to early prediction of DIC syndrome after severe burn injury in order to identify risk groups and initiate preventive measures.

This prospective study was performed on 68 adult burn patients with inhalation injury admitted within 24 hours to the National Burn Hospital from November 2021 to November 2023. Patients were divided into groups of non-CO poisoning and CO poisoning (SpCO ≥10%). The results showed that when hospitalized, the rate of CO poisoning was 35.3%. Prehospital respiratory support was recorded in 58.8% of patients and there was no significant difference between the two groups (63.6% vs. 58.8%; p =.28). Admission SpO2 of all patients was normal (96.9 vs 97.5%; p =.24). Meanwhile, compared to the non-poisoned group, the proportion of severe inhalation injury was significantly higher (29.2% vs. 9.1%; p =.03), likewise concentration of arterial lactate (5.2 ± 2.7 vs. 3.9 ± 1.8 mmol/l; p = .014) and hypocapnia rate (58.3 vs. 27.3%; p =.012), while lower PaCO2 values (34.4 ± 7.1 vs. 39.9 ± 9.3 mmHg; p <.01) were seen in the CO poisoning group. The duration of mechanical ventilation, length of hospital stay and mortality were not significantly different between the two groups. Further studies are needed to determine the prognostic value of admission SpCO in burn patients with inhalation injury.

The objective of this study is the evaluation of the use of tranexamic acid (TXA) for the reduction of blood loss and the use of blood products. We conducted a prospective, multicenter, interventional, randomized, blinded study in 4 burn intensive care units. Patients over 18 years of age with at least 5% body surface area burns scheduled for surgery were included. The treated group received 1g TXA intravenously, then 1g TXA over 8h. The placebo group received saline. Blood loss was calculated using the Mercuriali formula. 121 patients were enrolled. The groups were similar in terms of sex, age, burn etiology, total burn surface area (TBSA), SAPS II and ASA scores, weight, height and estimated total blood volume. The median TBSA was 15% and the median graft size was 1499 cm². The graft was typically performed 13 days after injury. Median total blood loss was 0.7 mL/cm² of excised and grafted skin [0.5-1.1] in the TXA group compared to 0.7 mL/cm² [0.5-1.2] in the placebo group (p=0.361). The packed red blood cells (pRBC) volume was similar in the 2 groups (0 [0-550] vs 0 [0-569]; p=0.992). There was no difference between the two groups regarding death, myocardial infarction, stroke, venous thrombosis, graft failure, seizure or acute renal failure. TXA does not offer any additional benefits when used alongside topical epinephrine in limited burn graft surgery. Further studies may be of interest in order to determine the threshold be- yond which the use of additional TXA would be useful.

La survenue de bactériémie durant le séjour hospitalier aggrave le pronostic des malades. Particulièrement chez le patient brûlé, elle constitue l’une des complications infectieuses les plus sévères durant son séjour en réanimation avec des taux de mortalité élevés. Par conséquent, la détection rapide des agents pathogènes responsables est cruciale pour une administration précoce d’antibiothérapie efficace. Dans notre étude, nous avons analysé 85 hémocultures positives prélevées de 66 patients hospitalisés dans le service de réanimation des brûlés et présentant des critères de sepsis. Les résultats du test moléculaire FilmArray BCID2 ont été comparés à ceux des méthodes conventionnelles. Au total, les résultats du panel BCID2 étaient concordants avec ceux de la culture classique dans 71,8% des cas. Pour les cultures monomicrobiennes la concordance d’identification était de 83,9%, cependant pour les cultures polymicrobiennes la concordance était de 36,4%. Le test a démontré de bonnes performances dans la détection des agents pathogènes, avec une sensibilité globale de 84,5% et une spécificité de 98,3%, pour les cibles du panel ces taux passaient à 95,4% et 98,1% respectivement. Pour les gènes de résistance, le BCID2 a pu détecter le gène blaCTX-M chez 9 entérobactéries et les gènes de carbapénèmase : blaNDM, blaOXA- 48- like, blaVIM chez 20 BGN. Le gène mecA/C a été isolé chez 5 Staphylococcus epidermidis et pour les Enterococci résistants à la vancomycine le gène vanA/B a été détecté chez 3 Enterococcus fæcium. La sensibilité et la spécificité du test dans la détection des gènes de résistance étaient 84,1% et 92%. Le délai médian de rendu du résultat (DRR) du test moléculaire était de 1 h 10 mn (Q1 1,09 h; Q3 1,12 h). Le DRR médian pour la BCID2 était significativement (Mann- Whitney, p 0,0001) plus court que la culture classique 39,1 h (Q1 33 h; Q3 57,6 heures). La modification de l’antibiothérapie selon le résultat du test moléculaire a eu lieu chez 35,3% des patients. Celle-ci était faite dans un délai médian de 04 heures de la réception du résultat du test (Q1 2,4h ; Q3 21h). Chez 70% de ces malades une évolution favorable a été notée.

La survenue d’une complication digestive chez le brûlé grave est fréquente et est associée à un pro- nostic péjoratif. Ces complications sont dominées par l’hémorragie gastro-duodénale. Nous rapportons une étude descriptive rétrospective réalisée dans le service de réanimation des brûlés du centre de traumatologie et des grands brûlés (CTGB) de Tunis, sur une période de 6 ans, ayant pour but d’évaluer l’incidence des complications digestives chez le brûlé et leur impact pronostique. Un total de 54 patients a été inclus. L’âge moyen de nos pa- tients était de 40 +/- 22,5 ans, avec un sex-ratio H/F de 1,25/1. Dans notre série, 2 patients avaient des antécédents d’ulcère gastroduodénal et un seul était sous corticoïdes au long court. La surface cutanée brûlée était de 36,8 +/- 16,1%, avec un ABSI moyen de 6,4 +/- 2,8. Un traitement anti-ulcéreux prophylactique a été prescrit chez les 2 patients aux antécédents d’ulcère. L’analgésie systémique lors du changement des pansements était prescrite dans 88,9% des cas. L’incidence de complications digestives était de 2,4%. Le délai médian de survenue de ces complications était de 11,5 jours. La symptomatologie révélatrice était : mélæna (n=12) ; hématémèse (n=11) et distension abdominale (n=11). L’hémorragie digestive était la plus fréquente (59,3%) suivie par le syndrome compartimental abdominal (16,7%) et l’ulcère gastroduodénal isolé (11,1%). Le traitement était médical dans 87% des cas et la chirurgie a été nécessaire dans 13% des cas. La mortalité de ces patients était de 66,7%.

Ketamine is used as an anesthetic agent for pediatric burns patients due to its favorable pharmacological properties. However, concerns persist regarding its repeated administration in children due to potential neuropsychic adverse effects with varying reported prevalence in the literature. This study aimed to evaluate the similarity between midazolam and propofol in their ability to mitigate ketamine- associated neuropsychiatric effects. The non-randomized crossover clinical trial involved pediatric burn patients aged 4 months to 17 years who underwent dressing changes under general anesthesia. Each patient received the Midazolam-Ketamine and Propofol-Ketamine protocols, with a 48 to 72-hour interval. The study was carried out in the plastic, reconstructive, aesthetic and burn surgery unit. A total of 92 dressing changes were analyzed in 22 pediatric patients with a median age of 3 years. Of these patients, 45.5% had severe burns. The median doses of midazolam and propofol were 0.04 mg/kg and 1.47 mg/kg, re- spectively. Ketamine was administered at a median dose of 2.00 mg/kg for both protocols. Neuropsychic manifestations occurred in five cases with the Midazolam-Ketamine protocol, and two in the Propofol- Ketamine protocol without significant difference. Nystagmus was significantly more common in the Propofol-Ketamine protocol, while tachycardia, hypertensive spikes, and desaturation were more frequent in the Midazolam-Ketamine protocol. The Midazolam-Ketamine protocol was associated with a longer recovery time. In conclusion, both protocols could be considered similar in terms of preventing the pre- sumed neuropsychic effects induced by ketamine. In light of this study, the Propofol-Ketamine protocol emerges as the preferred choice in our current practice due to its better hemodynamic and respiratory sta- bility, as well as a faster wake-up time.

Les brûlures profondes de la face antérieure de jambe entraînent fréquemment une exposition osseuse de la crête tibiale antérieure, parfois très étendue. Plusieurs stratégies thérapeutiques sont utilisées pour assurer la couverture de ces pertes de substances : corticotomie, derme artificiel, lambeaux locaux ou libres. Chacune présente des limites d’utilisation. Une technique simple, fiable et reproductible serait l’idéale. Nous avons mis au point une technique de translation des muscles de la loge antérieure de jambe qui pourrait répondre à ces attentes. Nous présentons une série de 8 de ces lambeaux réalisés au bénéfice de 6 patients brûlés hospitalisés dans le CTB du CHU de Bordeaux, afin d’en évaluer l’utilisation et la faisabilité. Un travail anatomique préalable a été conduit pour analyser la vascularisation. La technique chirurgicale consiste à réaliser une corticotomie première puis à libérer les insertions médiales des muscles de la loge antérieure contre le tibia et les adhérences latérales contre le fascia pour translater l’ensemble des muscles et couvrir le tibia. Une couverture complète, immédiate et durable avec une cicatrisation acquise en 21 jours a été observée les 8 fois. Aucune altération ou gène fonctionnelle n’a été relevée, avec une dorsiflexion conservée. La translation de la loge antérieure de la jambe permet une couverture des expositions tibiales étendues jusqu’à son tiers distal. Cette technique semble être une bonne alternative aux autres stratégies usuelles.