The aim of this study is to provide a comprehensive review of the current therapeutic approaches to severe burn injuries. The study will cover the epidemiology of burn injuries, treatment options and adjunctive therapies. It will also emphasize the importance of a multidisciplinary approach in treatment options and discuss current challenges and future directions for research in the treatment of burns. This study aims to provide updated, evidence-based information and guidelines for medical professionals involved in the management of severe burn injuries, and to improve care and outcome for patients affected by these injuries. The WHO states that burn injuries are a major public health concern worldwide, with an estimated 180,000 deaths annually, with the majority of these deaths occurring in low- and middle-income countries.

This study is aimed at describing the patterns and trends of burns among children in the past 25 years in Albania, a transitional post-communist country in the Western Balkans. It included all burned children admitted to the Intensive Care Unit of the University Hospital Center “Mother Teresa” of Tirana in the past 5 years (i.e., 2018-2022). Overall, 275 children treated at the Service of Burns and Plastic Surgery were included in this analysis. Incidence of burns in children has importantly declined during the last 25 years. Of 275 children included in this study, 50.2% were boys and 49.8% were girls. The age range was from 2 months to 16 years. The number of children with burns declined progressively, but the lowest number was seen in 2020, which is explained by the Covid-19 pandemic. On the whole, the most affected age group is that of 1-3 year-olds. Regardless of age, hot liquids (51%) and pure hot water (39%) were the main causative agents of burns among children. There was an important decrease in the number of burns due to flame (from 18.5% to 7%) and chemical burns (from 5.9% to 1%). No electrical burns were found in the records. Most of the burned cases were burns of more than one site on the body, representing 35% of all the cases. Burns among children continue to constitute a significant burden of morbidity among Albanian children, which is a cause of concern. However, compared with 25 years ago, the total number of severely burned children has dropped in Albania.

This is an epidemiological review of electrical burns admitted to the Service of Burns and Plastic Surgery, UHC “Mother Theresa” of Tirana, Albania, covering a four-year period, from 2019 to 2022. Twenty-seven patients were identified as having sustained an electrical burn injury, all of them males and most of them, namely 85%, belonging to the “working force” age group 19-65 years old. Most of the accidents, 70% of them, occurred at work, and these were all high voltage electrical burns. A total 65% of the cases had at least one of the upper limbs involved and the mean surface area burned was estimated at around 20% TBSA, mortality rate 11.1%, and all the fatal cases were from occupational burns. Serum level of BUN, creatinine and liver enzymes were evaluated on admission and at least 7 days after, with no significant changes. WBC count was found to be elevated in almost all the patients, and remained elevated in the second week and even longer for patients with sepsis. Four of our patients needed amputations. Besides these, no other serious complications were registered.

TRACKING THE SHIFT IN PUBLIC DISCOURSE ON FOREST AND LAND FIRES IN INDONESIA THROUGH SOCIAL MEDIA: A SIX-YEAR LONGITUDINAL STUDY
(Kurniasih D., Wahyuningrat W. Setyoko P.I., Pedrason R.)

This study analyzes the distribution of content posted on Twitter in response to a specific event or crisis from 2014 to 2019. The aim of the study is to identify any shifts in the focus of the content and to explore the possible reasons for these changes. The findings suggest a shift from a disaster arena to a political arena over the six-year period. The initial years were dominated by content related to reporting on the situation, requesting help, and coordinating relief efforts, while the latter years saw an increase in content related to criticizing the government, appreciating government effort, and discussing social and political issues. The study provides insights into the changing nature of public responses to events and crises, and highlights the role of social media as a platform for political discussions.

Treatment of burned patients involves early excision of the burn. The approach to this excision has changed since bromelain-based enzymatic debridement was introduced. This treatment option reduces complications from the surgical procedure and improves scar quality. It is indicated for partial and full thickness burns. It is important to agree on the nursing care before, during and after enzymatic debridement treatment to ensure an optimal preparation and maintenance of the wound bed for later treatment to be most successful. A multi-centre Delphi study was conducted with enzymatic debridement nursing care on burned patient experts. A coordinating group developed a 29-item questionnaire based on clinical guidelines and experience. Two question rounds were asked, reaching consensus on answers > 70%. Nine panellists from nine leading burns centres in Spain participated. The aim was to develop a national consensus on enzymatic debridement treatment based on clinical practice and evidence from almost 1500 cases. The experts reached 29 agreements on different aspects of treatment and patient condition: general considerations about the treatment, burned patient admission, treatment prior to enzymatic debridement, applying debridement, removing enzymatic debridement and the post-enzymatic debridement phase. The expert consensus on nursing care of the burn patient and application of bromelain-based enzymatic debridement includes general recommendations for the patient before, during and after application and the planning of localised care after debridement. This consensus document supports knowledge on enzymatic debridement technique, increasing safety in clinical nursing practice and ensuring successful treatment for the patient.

The burn intensive care unit (ICU) of the Queen Astrid Military Hospital experienced an outbreak with an extensively drug-resistant Acinetobacter baumannii (XDR-Ab) strain, which began when all burn wound patients from all over Belgium were sent there as part of the national COVID-19 action plan. The purpose of this study is to report on the investigation and strategies that were implemented to contain the outbreak. Between October 2020 and May 2021, five of the 72 patients admitted to the ICU met the acute outbreak case definition (attack rate 7%). Their median age was 46 years and their median total body surface area burned was 39%. All patients developed at least one XDR-Ab infection, with in total three pulmonary, three bloodstream and five burn wound infections. One patient died. All XDR-Ab isolates were only susceptible to colistin. Whole genome sequencing of the isolates from the first two patients revealed an identical A. baumannii ST2 genotype, suggesting an outbreak. XDR-Ab-positive patients were cohorted with dedicated staff. The infection control team intensified its training on hand hygiene, excreta management and bio-cleaning procedures. Concurrently, 30 environmental samples were collected, which proved negative for XDRAb. Spatio-temporal associations were found for all XDR-Ab-positive patients, suggesting cross-transmission via staff’s hands. We describe an XDR-Ab outbreak in a burn ICU over a seven-month period, in a context of increased workload. This series underlines the importance of a correct staff-to-patient ratio, especially in outbreak situations.

The management of burn wounds is a major challenge throughout the globe. Superficial and partialthickness burns generally do not need any surgical intervention, however, severe cases of burn injury require dressings (antimicrobial) and surgery in the worst-case scenario. The present study was conducted to assess the efficacy of bacterial nanocellulose dressing versus hydrocolloid dressing. All patients presenting with partial-thickness second-degree burns from June 2021 to May 2022 were screened for this randomized control trial; 65 burn patients were included in each group of this trial. The control group of patients was treated with hydrocolloid dressing and the experimental group with bacterial nanocellulose dressing sheets. Every third day, the wound was assessed. Other data collected included age, sex, %TBSA burned, signs of infection, time for epithelialization, and length of hospital stay. Statistical analyses were performed to see the significance of differences between the treatment groups by adjusting for size and depth of burn, and the patient’s age. There were 130 patients (65 in each group). The median age for the whole group was 17.4 years, and 51.53% (n=67) were males. The average TBSA was 22.4%, with a minimum of 10% and a maximum of 31%. Eleven of the patients had their burns excised, and four were given skin grafts in the control group. In the case of the experimental group, four excisions were performed, and one skin graft. Wound-related pain scores were low (mean of 2.6) for the bacterial nanocellulose group and higher for the hydrocolloid group. Hydrocolloid dressing is more cost effective than bacterial nanocellulose dressing. However, the pain scores were high, and healing time was less in the bacterial nanocellulose group. Moreover, the hydrocolloid group is more prone to infection due to frequent dressing changes.

La maladie thrombo- embolique (MTBE) veineuse est une complication potentiellement grave souvent sous-diagnostiquée chez le brûlé, dont l’incidence varie selon les études. Cette étude rétrospective et des- criptive menée dans le service de réanimation des brûlés de Tunis sur une période de 22 mois (1er janvier 2021 au 30 octobre 2022) a inclus 24 patients ayant présenté une complication thrombo- embolique, sur un total de 785 admissions (incidence de 3%): une embolie pulmonaire dans 15 cas et une thrombose veineuse profonde dans 9 cas. L’âge moyen des patients était de 43,8 ans, avec un sex-ratio de 2H/1F. Les 2/3 des patients (n=17) avaient des antécédents pathologiques : HTA (n=3), diabète (n=2), néoplasie (n=2), neuro- psychiatriques (n=7). Trois patients étaient obèses. La SCB moyenne était de 29%. Les lésions intéressaient les membres inférieurs chez 19 patients (79%). Le délai moyen de survenue de la MTBE était de 27,8 jours. Une dyspnée aiguë était présente dans la 1/2 des cas et une tachycardie dans un 1/3 des cas. L’association hypoxie-hypocapnie était retrouvée chez 5 patients. Le diagnostic a été confirmé par : angioscanner thoracique (n=14), scintigraphie pulmonaire (n=1), écho- Doppler veineux des membres inférieurs (n=2) ou phléboscanner des membres inférieurs (n=7). Les facteurs corrélés au risque thrombo- embolique retrouvés dans notre étude étaient : la SCB (p=0,029; RR=4), une durée de cathétérisme veineux ≥7 jours (p=0,048; RR=3); le nombre total de cathéters >1 (p=0,01; RR=3). L’évolution a été favorable chez 13 patients, fatale chez 11 patients.

Photic retinopathy (PR) is due to retinal phototoxicity, especially affecting the macula, resulting from exposure to sun, welding devices and lasers. It leads to oxidative damage to the retinal pigment epithelium (RPE) and the surrounding photoreceptors. Early recognition of this visual threatening condition, follow-up lesion evolution, and prevention of prolonged ocular exposure to lights is warranted. We herein report the three principal types of retinal burns due to solar retinopathy, laser pointer-induced maculopathy and arc welding maculopathy.

Burn injury remains a health problem, specifically in Indonesia. In major burns, xenograft has been proved to be useful as temporary wound coverage. However, some xenografts are not widely available due to cultural, financial and religious backgrounds, or have an unesthetic appearance, such as the scaly appearance of tilapia fish xenograft. Striped catfish (Pangasius hypophthalmus) is a scaleless fish that has abundant type 1 collagen. This study aimed to compare striped catfish skin to commonly used xenograft (Nile tilapia and porcine skin) as xenograft material for burn wound. In this experimental study, nine different skin samples of striped catfish, Nile tilapia and porcine were prepared and histologically examined using hematoxylin-eosin stained samples. Macroscopic and microscopic features of each sample were documented and analysed. The macroscopic skin appearances of striped catfish were hairless and scaleless with black-silver color and moderate thickness. As for microscopic features, the epidermal thickness of striped catfish skin (8.49±1.60 μm) was significantly different to both Nile tilapia (2.18±0.37 μm; p<0.001) and porcine skin (42.22±14.85 μm; p=0.002). The dermal thickness of striped catfish skin (288.46±119.04 μm) was similar to Nile tilapia (210.68±46.62 μm; p=0.783) but differs significantly to porcine skin (1708.44±505.12 μm; p<0.001). The integrity and collagen organization of striped catfish was also similar to tilapia based on semi-quantitative histology scoring system (p>0.05). Striped catfish had potential macroscopic appearance and comparable microscopic features to Nile tilapia; smoother macroscopic appearance, thicker epidermis, and similar dermis thickness. Therefore, we believe it can be potentially used as a xenograft material. Further studies are required to evaluate the effectiveness and feasibility of striped catfish xenograft in burn wound management.

L’immolation par le feu est une cause relativement fréquente de brûlure, notamment en Tunisie, surtout après la révolution, avec un coût élevé, à l’échelle individuelle comme sociétale. Ce travail rétrospectif rapporte les caractéristiques épidémiologiques, cliniques et évolutives des brûlés par immolation hospitalisés dans le service de réanimation des brûlés de Tunis. Nous avons colligé 755 patients sur une période de 11 ans. L’âge moyen était de 33,38 ans avec un sex-ratio de 4,5 H/1F (618 H/ 137F). La moitié des patients (51%) était célibataires, les 2/3 (74,3%) avaient un niveau socio- économique faible ou moyen, 35,8% étaient au chômage. Il s’agissait d’un niveau d’instruction secondaire dans 46% des cas et primaire dans 33,9%. Il s’agissait d’un transfert secondaire dans 53,6% des cas avec accord dans 57,8%. Les patients provenaient de toutes les régions de la Tunisie avec prédominance de ceux provenant du grand Tunis (37,8%). Le 1/3 de nos patients avait des antécédents psychiatriques. Des antécédents de tentative de suicide antérieure ont été notés chez 5,1% des cas. Des antécédents d’alcoolisme et/ou de toxicomanie ont été rapportés dans 17,7% des cas. L’acte d’immolation a été réalisé dans un lieu public dans 59,2% des cas. La surface cutanée brûlée était en moyenne de 41,48%. Les brûlures étaient profondes dans 66,2% des cas. L’atteinte de la face a été notée chez 90% des patients. L’ABSI était en moyenne de 7,35 et l’indice de Baux à 78 +/- 50. La durée moyenne de séjour était de 17,64 jours. Les 2/3 des patients (72,1%) ont nécessité une intubation et une ventilation mécanique. La mortalité était de 57,2%.