Effect of vitamin D supplementation and isokinetic training on muscle strength,explosive strength,lean body mass and gait in severely burned children: A randomized controlled trial

Objective

To determine the effects of vitamin D (VD) supplementation and isokinetic training on muscle strength, explosive strength (counter movement jump) (ES), lean body mass (LBM) and gait parameters in severe pediatric burn.

Effect of 12-week isokinetic training on muscle strength in adult with healed thermal burn

Introduction

Severe burns result in marked and prolonged skeletal muscle catabolism and weakness, which persist despite ‘standard” rehabilitation programmes of occupational and physical therapy. Therefore, the objectives of this study were of twofold: to quantify the long-term effects of burns on leg muscle strength and to assess whether adults with thermal burn would benefit from the isokinetic training programme.

Materials and methods

Burned adult patients, with 35–55% total body surface area (TBSA) burned, were assessed at 6 months after burn in respect to leg muscle strength at 150° s⁻¹, using isokinetic dynamometry. Non-burned adults were assessed similarly, and served as controls. The burned adults participated in the resistance training programme 3 times weekly. The isokinetic exercise programme was begun with 60% of the average peak torque. Intensity of isokinetic exercise was increased from one set to five sets during the first through fifth sessions and remained at six sets for the remaining 6th to 24th sessions. Finally, a dose of 10 sets was applied for the 25th to the 36th sessions. Each set consisted of five repetitions of concentric contraction in angular velocities of 150° s⁻¹ for knee extensors, and flexors. All exercise sessions were preceded by a 5-min warm-up period on the treadmill.

Results

Subjects with burns more than 35% of TBSA produced significantly less torque, work, and power in the quadriceps and hamstring than control subjects (20.5%, 15.2%, p < 0.05). Three months after isokinetic programme, muscle strength further increased by 17.9% ± 10.1% compared to the baseline measurement for burned patients but continued to be below the concurrent age-matched, non-burned adult.

Conclusion

We found that adults with severe burns, relative to non-burned adults, had significantly lower peak torque as well as total work performance using the extensors and flexors muscles of the thigh. Participation in isokinetic training resulted in a greater improvement in extensor and flexor muscle strength in adults with held thermal burn compared to base line values.     

Effect of whole body vibration on leg muscle strength after healed burns: A randomized controlled trial

Objective

To investigate the effects of eight weeks whole body vibration training program on leg muscle strength (force-producing capacity) in adults after healed burns.

Design

Randomized controlled trial.

Setting

Faculty of Physical Therapy, Cairo University.

Subjects

Thirty-one burned patients participated in the study and were randomized into whole body vibration group and control group. Non-burned healthy adults were assessed similarly to burned subjects and served as matched healthy controls.

Methods

The whole body vibration group performed an eight weeks vibration program three times a week on a vibration platform; the control group received home based physical therapy program without vibration training.

Main measures

Assessment of knee extensors and ankle planter flexor strength by isokinetic dynamometer at 150°/s were performed at the beginning of the study and at the end of the training period for both groups.

Results

Subjects with burns more than 36% TBSA produced significantly less torque in the quadriceps and calf muscle than non-burned healthy subjects. Patients in whole body vibration group showed a significant improvement in knee extensor and ankle planter flexor strength as compared with those in the control group. Knee extensor strength and percent improvement was 233.40 ± 5.74 (64.93 ± 3.03 change score) and 38.54% for the vibration group and 190.07 ± 3.99 (21.66 ± 4.41 change score) and 12.86% for the control group, ankle plantar flexor strength and percent improvement was 156.27 ± 5.95 (54.53 ± 6.16 change score) and 53.70% for the vibration group and 116.13 ± 3.24 (14.66 ± 2.71 change score) and 14.52% for the control group.

Conclusions

Participation in whole body vibration program resulted in a greater improvement in quadriceps and calf muscle strength in adults with healed thermal burn compared to base line values; a WBV program is an effective for strength gain in rehabilitation of burned patients.     

Treadmill versus overground gait training in patients with lower limb burn injury: A matched control study

IntroductionGait impairment is commonly seen in patients with a lower limb burn injury (LLBI). Therefore, the aim of this study was to investigate the effects of two different gait training modes on gait symmetry, functional mobility and kinesiophobia in patients with LLBI.MethodsThis matched control study was conducted between January 2017 and August 2018. Patients with LLBI (n = 28) were allocated to 2 different groups by matching according to burn localization, age, and gender. Group 1 (overground group: n = 14) received overground gait training in addition to standard burn rehabilitation, and Group 2 (treadmill group: n = 14) received treadmill gait training in addition to standard burn rehabilitation. The rehabilitation program and gait training were started when the patient was admitted to the hospital and ended on discharge. These physical therapy interventions were performed 5 days per week. The gait training intensity, including walking speed and duration, was determined according to patient tolerance. Gait parameters, functional mobility, kinesiophobia and pain values were evaluated with GAITRite, the timed up-and-go test (TUG), Tampa Kinesiophobia Scale and Visual Analogue Scale, respectively. These evaluations were made twice; on admission and immediately prior to discharge. Gait symmetry was calculated using the Symmetry Index.ResultsThe baseline characteristics of the groups and initial outcome values were similar. In the comparison of the differences between the overground and treadmill groups, the change in kinesiophobia and TUG values were significantly higher in the treadmill group (p = 0.01, p = 0.02, respectively). The intragroup comparisons showed significant differences in SI in respect of step length (p = 0.004), swing (p = 0.006), stance (p = 0.008) and velocity (p = 0.001), cadence (p = 0.001), TUG (p = 0.001), kinesiophobia (p = 0.001) and pain (p = 0.001) in the overground group. Statistically significant differences were determined in step length (p = 0.01), swing (p = 0.01), stance (p = 0.02) and velocity (p = 0.001), cadence (p = 0.001), TUG (p = 0.001), kinesiophobia (p = 0.001) and pain (p = 0.001) in the treadmill group, when pre and post-training values were compared.ConclusionsThe results of this study have shown that treadmill gait training was more effective in the improvement of functional mobility and reduction in kinesiophobia levels of patients with LLBI compared to overground gait training. Both overground and treadmill gait training also provide greater improvements in the velocity and cadence, and gait symmetry for step length, swing and stance in patients with LLBI.Clinical trial registration numberNCT03217526.     

Evaluation of spatio-temporal gait parameters and gait symmetry in diabetic polyneuropathic patients with burn injury: A pilot study

PurposeThe purpose of this study was to investigate the effects of burn injury on spatio-temporal gait parameters and gait symmetry in individuals with diabetic polyneuropathy (DPN)-related lower extremity burn injury.MethodsDemographic information and the physical examinations of the lower extremities of 14 patients with unilateral lower extremity burn injury due to DPN (DPN_B) and 14 uninjured patients with DPN (DPN₀) were recorded. The GAITRite computerized gait analysis system was used to evaluate the spatio-temporal parameters of gait. Symmetry Index (SI) was calculated to determine gait symmetry. The Mann Whitney U test was used to determine the demographical and clinical differences between the groups, the Wilcoxon’s test was used to compare both sides of all the participants for all gait parameters and linear regression analysis was used to find the variables that affect gait parameters.ResultsThe groups were similar in terms of their demographic information except for age. Compared with the DPN₀ group, DPN_B group had increased extent of area with sensory loss and severity of DPN, decreased ankle joint range of motions and intrinsic foot muscles strength and they displayed lower gait speed, step length, stride length and swing percentage but their double support and stance percentage were increased.ConclusionThis study results have shown that, spatio-temporal gait parameters of DPN_B patients are different. These differences in spatiotemporal parameters are found on both sides, probably owing to the symmetric and bilateral sensory loss is superior to unilateral burn injury due to symmetrical and bilateral sensory loss. Gait analysis should be considered in order to reveal the changes in gait parameters and to improve appropriate healing process of patients with DPN-related lower extremity burn injury.     

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: A randomized controlled trial

ObjectiveTo evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn.MethodOne hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter^®, Tewameter^®, Sebumeter^®, and Cutometer^®, respectively.ResultsThe scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension.ConclusionOur results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.     

虚拟现实技术结合等速肌力训练对前交叉韧带重建术后患者的临床疗效观察

目的:探究虚拟现实技术结合等速肌力训练在前交叉韧带(anterior cruciate ligament,ACL)重建术后患者康复中的应用价值和效果。方法:选取2021年12月至2023年1月就诊的ACL重建术后12周的患者40例,按照治疗方法不同分为对照组和观察组。对照组20例,男15例,女5例;年龄17~44(29.10±8.60)岁;采用常规康复训练结合等速肌力训练。观察组20例,男16例,女4例;年龄17~45(30.95±9.11)岁;采用虚拟现实技术结合等速肌力训练。比较两组患者术后12周(训练前)、术后16周(训练后)的Lysholm膝关节评分、膝关节伸峰力矩和屈峰力矩。结果:所有患者获得随访,时间1~6(3.30±1.42)个月。训练前两组Lysholm膝关节评分、膝关节伸峰力矩和屈峰力矩比较,差异无统计学意义(P＞0.05)。训练后两组Lysholm膝关节评分、膝关节伸峰力矩和屈峰力矩均较训练前改善(P＜0.05);组间比较,观察组Lysholm膝关节评分、膝关节伸峰力矩和屈峰力矩评分均较对照组高(P＜0.05)。结论:应用虚拟现实技术结合等速肌力训练能更好地促进ACL重建术后患者的膝关节功能恢复,增强肌力。     

Consequences of extensile lateral approach to the calcaneal fractures on balance and isokinetic strength of muscle groups crossing the ankle joint

BackgroundInherent characteristics of extensile lateral approach (ELA) for fixation of displaced intraarticular calcaneal fractures together with delayed or probably insufficient physical therapy programs may lead to weakness of the muscle groups crossing the ankle joint. Peroneal tendons might be involved more than others because of possible postoperative adhesions. The aim of this study was to evaluate the isokinetic strength of the muscle groups crossing the ankle joint and also to assess balance and functional ability in this group of patients.MethodsBased on a pilot study, 23 patients undergone open reduction and internal fixation (ORIF) via ELA and 22 healthy subjects as the control group participated in this observational cross-sectional study. Patients more than 20 years of age with at least 12 months passed their unilateral closed intraarticular calcaneal fracture fixation without any postoperative complications like infection or wound dehiscence were included. Patients with history of concomitant lower extremity injury, spine trauma or surgery, cases underwent removal of calcaneal plates, and cases with neuromuscular or vestibular dysfunction were excluded. The outcome was assessed by isokinetic parameters such as peak torque, peak torque normalized to body weight, mean power and total work modified star excursion balance test, triple hop for distance test, and evertor-to-invertor (E/I) strength ratio. Isokinetic tests were performed at 60 and 120°/s.ResultsGreater strength was observed in all muscles in the control group at 60°/s (p < 0.05). Evertors and invertors were weaker in the operated group at 120°/s in comparison to the dorsiflexors and plantarflexors. Modified star excursion (p: 0.003) and triple hop tests (p: 0.001) were lower in the operated group. E/I ratio was not statistically significant between the two groups at 60°/s (p: 0.44) and 120°/s (p: 0.62).ConclusionsStrength deficit in all muscle groups crossing the ankle joint, and not evertors in isolation, in addition to balance and functional impairments would be seen one year following ORIF of calcaneal fracture via ELA. A long-term rehabilitation program emphasizing different kinds of contraction at low and high speeds and balance training in these patients is highly recommended.     

The treatment challenges and limitation in high-voltage pediatric electrical burn at rural area: A case report

IntroductionAlthough rare, electrical injury in pediatrics is potentially life threatening and has significant and long-term impact in life. It is challenging to manage such cases in rural areas.Presentation of caseA fully conscious 13-year-old boy was admitted to the emergency room after being electrocuted by high-voltage power cable, with superficial partial thickness burn over right arm, trunk, and left leg (26 % of total body surface area). Tachycardia and non-specific ST depression was found on ECG examination and was diagnosed with high-voltage electrical injury. Treatments were based on ANZBA algorithm with several modifications, i.e., administering lower concentration of oxygen with nasal cannula instead of non-rebreathing mask as well as Ketorolac and Antrain® for analgesic instead of morphine.DiscussionDifferent choices of treatments were given due to limited resources. Despite possible cardiac and renal complication, further tests could not be done. Fortunately, after strict monitoring, no signs of abnormality were found. We used silver sulfadiazine, Sofratulle® and dry sterile gauze as a dressing of choice following immediate surgical debridement. The patient was observed daily through 7 days of hospitalization and followed-up for 1 year, achieving normal physiologic function of the affected area but unsatisfactory esthetic result.ConclusionLack of infrastructure, drugs, and trained personnel are some of the challenges that still exist in most rural areas. Thus, implementation of available standardized guidelines such as ANZBA, and giving similar training to personnel as well as providing feasible equipment followed by strict monitoring for the patient are needed to achieve maximum results.     

七氟醚与丙泊酚用于小儿烧伤手术麻醉维持的比较

目的比较七氟醚与丙泊酚用于小儿烧伤手术麻醉维持的效果。方法择期手术烧伤患儿60例,随机分为丙泊酚组(P组)和七氟醚组(S组),每组30例。气管插管后P组泵注丙泊酚3~8 mg.kg-1.h-1维持麻醉,S组吸入1%~4%七氟醚维持麻醉;需要时均间断静注芬太尼和阿曲库铵。术毕前5 min停用丙泊酚和七氟醚。记录术中血流动力学指标以及术毕患儿自主呼吸恢复时间、苏醒时间、拔管时间、苏醒时躁动情况。结果气管拔管后P组SpO2明显降低,且低于S组(P<0.05)。S组患儿自主呼吸恢复时间、拔管时间和苏醒时间均明显短于P组(P<0.01)。结论七氟醚用于小儿烧伤手术麻醉维持循环稳定,术毕自主呼吸恢复快、苏醒迅速,拔管及时,躁动发生率低,麻醉效果优于丙泊酚。     

Effect of subspecialty training on outcome after pediatric appendectomy

Background/Purpose

There have been few studies documenting the effect of subspecialty training on outcomes after appendectomy in children. Some studies have suggested a better outcome in patients managed by pediatric surgeons as compared with general surgeons.

Methods

We studied the effect of subspecialty training on clinical outcome and negative appendectomy rate after pediatric appendectomy. Children less than 19 years in Ontario who underwent appendectomy were identified. Outcomes were compared between pediatric and general surgeons. Subanalyses were conducted for the age groups 0 to 5, 6 to 12, and 13 to 18 years.

Results

Over 8 years, 24,019 children underwent appendectomy with a preoperative diagnosis of appendicitis. Of these, 21,027 had appendicitis. General surgeons performed 81.2% of the operations. Negative appendectomy rates were 8.3% and 13.4% (P < .0001) in the pediatric and general surgeon groups, respectively. Children operated on by pediatric surgeons were younger (10.5 ± 3.6 vs 12.8 ± 3.8; P < .05), more likely to be perforated (36.6% vs 32.0%; P < .0001), and had a longer postoperative stay (3.8 vs 3.0 days; P < .0001). There was no difference between groups with respect to wound infection or readmission rate when age and perforation status were accounted for.

Conclusions

Pediatric surgeons performed significantly fewer negative appendectomies than general surgeons. Although pediatric surgeons kept their patients longer in the hospital, their patients' wound infection and readmission rates were not different from that of the patients of general surgeons.     

Effect of combined exercise training on bone,body balance,and gait ability: a randomized controlled study in community-dwelling elderly women

The purpose of this study was to investigate whether a 48-week multicomponent exercise program could improve the risk factors for fall and hip fracture. Fifty elderly women 65–70 years of age participated. These participants were divided into an exercise group (25 subjects) that attended an exercise program and a control group (25 subjects) that did not. The exercise program included stretching for 9 min, strength training for 10 min followed by 23 min of weight-bearing exercise at an intensity above 65%–75% of the maximal heart rate, and 18 min of balance and posture correction training. The program was conducted three times per week for 48 weeks. The 10-m maximal walk time, maximal step length, and eyes-open-one-legged-stand time in the exercise group improved significantly (P < 0.05). Concerning deoxypyridinoline, the exercise group achieved a significant improvement (P < 0.05) after the 48 weeks. Bone mineral density (BMD) of the femoral neck and trochanter in the exercise group was significantly increased after the exercise program; also body sway was significantly improved (P < 0.05). In conclusion, a multi-component exercise program with weight-bearing exercise at a moderate intensity and gait training may be effective in offsetting a decline in BMD and improving aggravation of bone resorption in this population. In addition, this program has a positive effect on postural stability and gait ability.     

A comparison of two different fluid resuscitation management protocols for pediatric burn patients: A retrospective study

Objective

Pediatric burn patients are more susceptible to burn shock than adults, and an effective fluid management protocol is critical to successful resuscitation. Our research aim was to investigate the safety and efficacy of two protocols for pediatric burn patients for use within the first 24 h.

Tissue expansion for correction of scars due to burn and other causes: A retrospective comparative study of various complications

Background

Tissue expansion is associated with a relatively high complication rate. The aim of this study was to quantify the complication risk of burn scar patients who underwent tissue expansion in comparison to patients with other indications such as skin tumors. Furthermore it was attempted to compare the complication rates in children and adults.

Methods

A retrospective analysis was performed on 148 expanders implanted in 73 patients during the years 1994–2011. Two patient cohorts (burn scar cohort n = 31 and other indication cohort n = 42) were identified and analyzed.

Results

27 male and 46 female patients with a median age of 21 years were included. No statistically significant difference for complication risk between the burn and other indication cohorts could be found (p = 0.1412). Statistical analyses revealed a higher complication rate (52%) in the lower limb compared to all other anatomic sites (29%) (p = 0.1746). In addition, statistical analyses revealed a significantly higher total complication rate in children younger than 10 years (p = 0.0043). Moreover a greater TBSA was accompanied by a higher complication rate (p = 0.0258).

Conclusion

This set of data suggests that the burn scar patient is at no greater risk to suffer complications from tissue expansion. Other factors like age, TBSA and anatomical site have far more influence on the expander complication rate than the initial indication for tissue expansion.     

Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study.

High-frequency mechanical strain seems to stimulate bone strength in animals. In this randomized controlled trial, hip BMD was measured in postmenopausal women after a 24-week whole body vibration (WBV) training program. Vibration training significantly increased BMD of the hip. These findings suggest that WBV training might be useful in the prevention of osteoporosis. INTRODUCTION: High-frequency mechanical strain has been shown to stimulate bone strength in different animal models. However, the effects of vibration exercise on the human skeleton have rarely been studied. Particularly in postmenopausal women-who are most at risk of developing osteoporosis-randomized controlled data on the safety and efficacy of vibration loading are lacking. The aim of this randomized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration (WBV) in postmenopausal women. MATERIALS AND METHODS: Seventy volunteers (age, 58-74 years) were randomly assigned to a whole body vibration training group (WBV, n = 25), a resistance training group (RES, n = 22), or a control group (CON, n = 23). The WBV group and the RES group trained three times weekly for 24 weeks. The WBV group performed static and dynamic knee-extensor exercises on a vibration platform (35-40 Hz, 2.28-5.09g), which mechanically loaded the bone and evoked reflexive muscle contractions. The RES group trained knee extensors by dynamic leg press and leg extension exercises, increasing from low (20 RM) to high (8 RM) resistance. The CON group did not participate in any training. Hip bone density was measured using DXA at baseline and after the 6-month intervention. Isometric and dynamic strength were measured by means of a motor-driven dynamometer. Data were analyzed by means of repeated measures ANOVA. RESULTS: No vibration-related side effects were observed. Vibration training improved isometric and dynamic muscle strength (+15% and + 16%, respectively; p < 0.01) and also significantly increased BMD of the hip (+0.93%, p < 0.05). No changes in hip BMD were observed in women participating in resistance training or age-matched controls (-0.60% and -0.62%, respectively; not significant). Serum markers of bone turnover did not change in any of the groups. CONCLUSION: These findings suggest that WBV training may be a feasible and effective way to modify well-recognized risk factors for falls and fractures in older women and support the need for further human studies.     

Effect of autologous fat transfer in acute burn wound management: A randomized controlled study

ObjectiveThe use of fat grafting is being widely used for different indications one of which is wound healing. In this study we compare the use of autologous fat grafting (AFG) as a novel indication in acute burn wounds healing and burn scarring to the conventional methods of burn wound management both clinically and histologically. Several small observational studies demonstrated the effect of the AFG in healing of chronic wounds, different vascular ulcers or effect on scars yet no randomized controlled trial is available to compare its role with conventional methods.MethodsThe study was a prospective, open-label single center, randomized control clinical trial included 100 patients with superficial and deep dermal burns from March 2019 to March 2020 randomized to AFG protocol consisted of a single injection of autologous fat grafting then dressed with nano fat (Group A) or conventional methods of serial dressings with 1% silver sulphadiazine or other topical agents (Group B). Inclusion criteria included newly admitted burn patients with affected total body surface area (TBSA) (10%?25%) while exclusion criteria included burns patients with affected TBSA of< 10% or> 25%, or loss of subcutaneous fat, fascia, muscles and bones, inhalational burn, and burns in genitalia, perineum and peri-anal areas and co-morbidity(ies) that might affect wound healing or eligibility for anaesthesia and surgery. Also, results were confirmed by histological analysis for samples from both groups by light microscopic examination, and the nano-fat was subjected to flow cytometric analysis of the cluster of differentiation (CD) markers of mesenchymal stem cells markers CD 90, CD44, CD45, CD 73, and CD 34. (ClinicalTrials.gov Identifier: NCT03791710)ResultsWe found a significant reduction in total hospital stay days (p = <0.001), less further skin grafting (p = 0.003), less contracture formation (p = <0.002) while scar texture improved (p = <0.001) in group A compared to group B. Flow cytometric analysis documented that the nano-fat was positive to CD 90, 73, 44, 45 and 34.ConclusionIn a comparison between AFG protocol to the conventional methods in the treatment of acute burn wounds, AFG protocol was associated with significant clinical improvement in the form of lower hospital stay time, lower incidence of scaring or contracture and lower skin grafting use which was confirmed by serial photographic and histological assessment.     

Glutamine relieves the hypermetabolic response and reduces organ damage in severe burn patients: A multicenter,randomized controlled clinical trial

BackgroundSevere burns can cause a hypermetabolic response and organ damage. Glutamine is a conditionally essential amino acid with various pharmacological effects. In this study, whether glutamine could alleviate the hypermetabolic response and maintain organ function after burn injury was analyzed.MethodsA multicenter, randomized, single-blind, parallel controlled trial was conducted to evaluate the efficacy of glutamine in decreasing hypermetabolism after burn injury. Physiological and biochemical indexes, such as vital signs, metabolic hormones, metabolic rate, and organ damage, were recorded on the 7th and 14th days after treatment.ResultsIn total, 55 adult burn patients with a total burn surface area (TBSA) of 30–70% were included in this study and randomly divided into the burn control (B, 28 patients) and burn+glutamine (B+G, 27 patients) groups. Except for the glutamine administration, the groups did not differ in the other treatments and nutrition supplements. The levels of diamine oxidase (DAO), lactulose/mannitol (L/M), β₂-microglobulin, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBD) and cardiac troponin l (cTnl) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). The levels of resting energy expenditure (REE), serum catecholamines, glucagon, lactate and Homeostasis model assessment (HOMA) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). No significant difference was found in the length of hospitalization or the mortality rate between the two groups (p > 0.05).ConclusionsGlutamine moderately alleviates the hypermetabolic response and reduces organ damage after severe burns. Therefore, the early application of glutamine, which is effective and safe, should be used as an active intervention as early as possible.     

The best strategy for red blood cell transfusion in severe burn patients,restrictive or liberal: A randomized controlled trial

IntroductionAlthough blood transfusion is common in burns, data are lacking in appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold.Material and methodsEighty patients with TBSA > 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed cells only when Hemoglobin declined to less than 8 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10 g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications.ResultThe mean hemoglobin level before transfusion was 7.7 ± 0.4 g/dL in the restrictive group and 8.8 ± 0.7 g/dL in the liberal group. The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 ± 2.2 units vs. 5.9 ± 3.7 units) (p-value = 0.006). The total number of RBC transfused units varied significantly between the two groups (p-value = 0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8 ± 1.4 units vs. liberal: 4.4 ± 2.6 units) (p = 0.004). We did not find any significant difference in mortality rate or other outcome measures between groups.ConclusionApplying the restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications.Clinical Trial Registration ReferenceIRCT20190209042660N1.     

Achilles tendon gait dynamics after rupture: A three-armed randomized controlled trial comparing an individualized treatment algorithm vs. operative or non-operative treatment

BackgroundIndividual treatment selection has been proposed as the key to optimized treatment. The purpose was to investigate if treatment selection using the individualized treatment algorithm Copenhagen Achilles Rupture Treatment Algorithm (CARTA) differs between patients treated as usual regarding gait dynamics and tendon elongation.MethodsThe patients were randomized to one of three parallel groups: 1) intervention group: participants treated according to CARTA, 2) control group: participants treated non-operatively, 3) control group: participants treated operatively. The primary outcome was ankle peak power during push off during walking at 12 months.Results156 patients were assessed for eligibility. 21 were allocated to the intervention group, and 20 and 19 to the control groups. The results indicated no statistically significant differences between the intervention group and the control groups.ConclusionsIndividualized treatment selection based on CARTA did not demonstrate less affected gait dynamics or less tendon elongation than patients treated as usual.