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Human dermo-epidermal skin equivalents (DE) comprising in vitro expanded autologous keratinocytes and fibroblasts are a good option for massive burn treatment. However, the lengthy expansion time required to obtain sufficient surface to cover an extensive burn together with the challenging surgical procedure limits their clinical use. The integration of DE and biodegradable scaffolds has been proposed in an effort to enhance their mechanical properties. Here, it is shown that poly(hydroxybutyrate) electrospun scaffolds (PHB) present good biocompatibility both in vitro and in vivo and are superior to poly-ε-caprolactone electrospun scaffolds as a substrate for skin reconstruction. Implantation of PHB scaffolds in healthy rats polarized macrophages to an M2-type that promoted constructive in vivo remodelling. Moreover, implantation of DE-PHB composites in a NOD/SCID mouse xenograft model resulted in engraftment accompanied by an increase in angiogenesis that favoured the survival of the human graft. Thus, PHB scaffolds are an attractive substrate for further exploration in skin reconstruction procedures, probably due in part to their greater angiogenic and M2 macrophage polarization properties. Copyright © 2017 John Wiley & Sons, Ltd.

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Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.

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ResumenLa Unidad de Grandes Quemados del Hospital La Fe de Valencia (España) atiende al año aproximadamente 1.600 urgencias por quemaduras. El paciente gran quemado constituye un gran reto para los profesionales sanitarios por las implicaciones biopsicosociales que requiere su abordaje: atención médica para su supervivencia, atención psicológica por el importante riesgo de sufrir alteraciones, asistencia rehabilitadora y fisioterapéutica destinada a su activación funcional y atención social.Realizamos un estudio observacional caso-control transversal de carácter descriptivo, con pacientes hospitalizados en nuestra Unidad de Grandes Quemados con trastornos mentales previos. El objetivo general fue determinar y describir las características sociodemográficas, tipología del trauma sufrido, características y topografía de las quemaduras y la comorbilidad con trastornos mentales previos del paciente gran quemado.El 19,8% de estos pacientes presentó trastornos relacionados con el espectro ansioso, psicótico, del ánimo, tóxicos y alcohol, de la personalidad y alteraciones cognitivas previos a la lesión. Los que menor prevalencia parecen tener son los del espectro psicótico y los trastornos asociados al consumo de alcohol y tóxicos. No aparecieron diferencias significativas entre ninguna de las variables sociodemográficas y clínicas, salvo sexo, edad y grupo de convivencia.Los resultados de nuestro estudio reflejan que en este tipo de pacientes podrían estar directamente implicados diferentes trastornos psiquiátricos. Es importante considerar que la propia quemadura también puede generar trastornos psicológicos. Por ello las intervenciones psicológicas precoces y la determinación en este tipo de pacientes son imprescindibles elementos que permitan conseguir un buen ajuste adaptativo. Palabras clave AbstractBurns Unit of Hospital La Fe in Valencia (Spain), annually serves about 1.600 emergency burns. Patient in severe burn is a big challenge for health professionals because of the biopsychosocial approach required: health care for their survival, psychological care and risk of major alterations, physiotherapy and rehabilitative assistance to its functional activation and even social attention, because of the limitations that occur in these patients.We conducted a case-control observational transversal descriptive research, in severe burn hospitalized patients with prior mental disorders. The overall objective was to identify and describe the sociodemographic characteristics, type of trauma experienced, features and topography of the burn and comorbidity with mental disorders in severe burn patients.We found that 19.8 % of the patients had related severe mental disorders as anxious spectrum, psychotic spectrum, mood and toxic alcohol personality and cognitive changes prior to the injury. Those who appear to have lower prevalence are of the psychotic spectrum disorders associated with alcohol and toxic. No significant differences appeared between any of the sociodemographic and clinical variables, except for age, sex and ...

Caring for family members after the death of a patient is essential for a good palliative care. Grief is a natural process that follows the family member's death. Up to 4% of general population may experience severe grief symptoms (Enez, 2018). A letter of condolence provides a humanist approach to care (Bedell et al., 2001), it can contribute to offer tribute to the deceased, and to be a source of comfort to bereaved relatives (Wolfson & Menkin, 2003) but did not alleviate grief symptoms because of a condolence letter may be insufficient to provide benefits on relatives' bereaved (Kentish- Barnes, Chevret, et al., 2017). Although relatives could describes benefits of receiving a letter of condolence, the bereavement follow-up has to be adjusted to each individual situation (Kentish-Barnes, Cohen-Solal, et al., 2017).We conducted a preliminary study to describe the use of condolence letters in the burns unit. All relatives of patients who died in the unit were eligible to receive a letter of condolence. Exclusion criteria were patients admitted for less than 24 hr, disagreements with the health care team, or unacknowledged relationships between patient and relatives. A formal condolence letter was sent with recommended guidelines (Bedell et al., 2001;Wolfson & Menkin, 2003). A total of 13 burn patients were death at the unit from October 2020 to April 2022. The median age of patients was 75 years (range: 53-96); there were five men (41.7%). The mean duration of hospital stay was 18.25 days (SD: 17.5; range 2-55), and total burn surface area was 32% (SD: 26; range 3-80).Twelve condolence letters were sent to patient's relatives, one of this was excluded because of family problems. In relatives, there were seven men (58.3%), relationships to patients were described as child (N ¼ 7; 63.7%), brother/ sister (N ¼ 3; 27.3%), and granddaughter (N ¼ 1; 9%). Two relatives responded to the condolence letter through one phone call and one visit to the department.In this study, although little agreement was found about the appropriateness of condolence letter by bereaved families in the burns unit, it put forward that condolence letter was a support at end-of-life with integrated care for patients and their relatives, provide nonintrusive support to relatives, and validate emotional experience of the bereaved relatives. Moreover, adding value to interdisciplinary approaches, because of the intervention with the burned patient, is a laborious process that requires working with different disciplines.