Iranian Journal of Burns and Wound Research
Iranian Journal of Burns and Wound Research (IJBWR) is an open-access, peer-reviewed journal that accepts different types of papers in all aspects of biomaterials, regenerative medicine, and critical care especially in the field of burns and wounds to facilitate and enhance the global exchange of knowledge. The Editorial Board consists of outstanding specialists in biomedical research, burns, and wounds who guarantee the accuracy and quality of the peer-review process for submitted manuscripts. We are eager to receive submissions from all over the world, particularly high-quality papers presenting advances in their research fields. The general fields of interest are surgical procedures, acute care, reconstruction, prevention, research and education, immunobiology, skin grafting, burn prevention and reconstruction, and trauma injury.
Correction to: [The emerging role of ChatGPT in cancer and burn research: Applications in wound healing and regenerative medicine]
Copyright (c) 2025 Hesameddin Larti, Niloofar Faraji, Nastaran Faraji, Tahereh Zeinali, Shahab Aali, Parinaz Mellatdoust, Kaveh Gharaei Nejad https://creativecommons.org/licenses/by-nc/4.0
Impact of biofilm-forming ability and multidrug resistance on clinical outcomes of burn wound infections caused by Pseudomonas aeruginosa
Burn wound infections caused by Pseudomonas aeruginosa represent a major clinical challenge due to the pathogen’s virulence, biofilm-forming capacity, and increasing multidrug resistance (MDR). These factors may adversely affect treatment efficacy and patient outcomes in burn units; however, their combined clinical impact remains insufficiently characterized in hospital-based settings. This study aimed to evaluate the association between biofilm-forming ability, MDR, and clinical outcomes in burn wound infections caused by P. aeruginosa. In this cross-sectional study, 30 non-duplicate P. aeruginosa isolates were obtained from hospitalized burn patients at a tertiary care burn center between March 2022 and March 2023. Bacterial identification was performed using standard microbiological methods. MDR was defined as resistance to at least one agent in three or more antimicrobial classes. Biofilm formation was assessed using the microtiter plate assay. Among the 30 patients, 76.7% were male, and the mean age was 45.8 ± 16.9 years. The mean total body surface area (TBSA) was 42.9% ± 20%. Fifteen isolates (50%) were classified as MDR. Biofilm assessment revealed that 40% of isolates were strong biofilm producers, 16.7% moderate, and 43.3% weak producers. No statistically significant associations were identified between biofilm strength, MDR status, TBSA, and clinical outcomes. P. aeruginosa burn wound infections were characterized by a high prevalence of biofilm formation and MDR. While no significant associations with mortality were demonstrated, trends toward poorer outcomes in patients infected with strong biofilm-producing and MDR isolates underscore the clinical relevance of these traits. Larger studies incorporating molecular analyses are warranted to clarify their prognostic significance.
Copyright (c) 2025 Meysam Hasannejad-Bibalan, Hadi Sedigh Ebrahim Saraei, Mohammadreza Mobayen, Heydar Ali Balou, Alireza Ostani, Niloofar Zamanian Fakoori https://creativecommons.org/licenses/by-nc/4.0
Engineering cellular metabolism for regenerative medicine: The role of bioenergetic materials
Copyright (c) 2025 Seyed Ali Hosseini, Sina Salem Ahim, Ali Aghajan https://creativecommons.org/licenses/by-nc/4.0
Predictive value of the Shock Index for in-hospital mortality and blood transfusion in trauma patients: A retrospective study
The Shock Index (SI), defined as heart rate divided by systolic blood pressure, is a simple bedside marker of hemodynamic instability in trauma. However, its predictive value for primary clinical outcomes remains debated. This retrospective cohort study evaluated the ability of SI measured at emergency department admission to predict in-hospital mortality and the need for blood transfusion among adult trauma patients triaged as Level I or II at a single trauma center between 2021 and 2022. A total of 185 patients were included (mean age 62.2 ± 22.3 years; 36.8% female). In-hospital mortality occurred in 78 patients (42.2%), and 44 (23.8%) required transfusion. Overall, SI demonstrated limited discriminative performance for mortality (Area Under the Curve (AUC) = 0.574; 95% Confidence Interval (CI): 0.49–0.66; p = 0.088) and transfusion (AUC = 0.573; 95% CI: 0.49–0.66; p = 0.135). Optimal cutoffs showed modest sensitivity but poor specificity. In exploratory subgroup analyses with small sample sizes, higher discrimination was observed in select groups, including patients with Glasgow Coma Scale (GCS) 13–15 (AUC = 0.768); however, these findings should be interpreted cautiously. Multivariable Cox regression identified higher Injury Severity Score, lower Glasgow Coma Scale, and need for mechanical ventilation as independent predictors of mortality, whereas SI was not independently associated with survival. In this single-center cohort, SI showed limited overall utility as a standalone predictor of mortality or transfusion, and its potential role may be restricted to specific clinical contexts requiring further validation.
Copyright (c) 2025 Siamak Rimaz, Seyyed Mahdi Zia Ziabari, Masoumeh Porkar, Reza Safaei, Amirali Soleymani Nejad, Nazanin Noori Roodsari https://creativecommons.org/licenses/by-nc/4.0
Predictors of Blood Product Utilization (RBC, FFP, and Platelet) in Severe Burn Patients: A Single-Center Retrospective Study
This single-center retrospective study aimed to identify predictors of any blood product transfusion—defined as the administration of one or more units of packed red blood cells (RBCs), fresh frozen plasma (FFP), or platelets—among adult patients with severe burns. In this cross-sectional study, 112 patients with burns that affected 20-50% of their total body surface area (TBSA) were analyzed. Demographic information, burn characteristics, and clinical outcomes were taken from medical records. Multivariate logistic regression was used to identify independent predictors. Transfusion indications during the study period followed institutional practice: RBC transfusion was generally considered for hemoglobin ≤7–8 g/dL or active bleeding; FFP was used for clinically significant coagulopathy or INR >1.5; and platelets were administered for counts <50×10⁹/L in surgical candidates. Blood product transfusion was administered to 46.4% of patients. The transfused group had significantly larger burns, higher rates of third-degree burns, more frequent inhalation injuries, and worse clinical outcomes, including higher rates of intensive care unit (ICU) admission (65.4% vs. 13.3%) and mortality (28.8% vs. 3.3%). Multivariate analysis revealed that third-degree burns (odds ratio (OR) = 5.98), the quantity of surgical procedures (OR = 1.80 per surgery), and the length of ICU stay (OR = 1.55 per day) serve as significant independent predictors of transfusion. Burn depth, surgical burden, and intensive care unit stay are key determinants of transfusion needs. These findings provide locally relevant evidence for transfusion management in severe burn patients, reflecting real-world practice patterns in our regional burn center. These findings support the development of risk-based protocols to optimize blood utilization and improve outcomes in severe burn patients.
Copyright (c) 2025 Mohammad Omays, Nastaran Najd, Mohammadreza Mobayen, Mohammad Tolouei, Parissa Bagheri Toolaroud, Mahsa Sadeghi, Masiha Mobayen, Pariya Amirinezhad https://creativecommons.org/licenses/by-nc/4.0
Infection control and antimicrobial stewardship in the ICU: Preventing ARDS among burn patients
Acute respiratory distress syndrome (ARDS) represents a severe and often fatal complication in patients with extensive burn injuries admitted to intensive care units (ICUs). The pathophysiological continuum linking burn-related immune dysregulation, infection, and sepsis is recognized as a major driver of pulmonary inflammation and alveolar damage. This narrative review synthesizes current evidence on infection control and antimicrobial stewardship (AMS) as integrated strategies to prevent infection-driven lung injury and reduce the burden of acute lung injury in burn ICUs. Burn patients are uniquely predisposed to healthcare-associated infections and multidrug-resistant (MDR) organisms due to disrupted skin barriers, invasive procedures, and prolonged antimicrobial exposure. Studies have reported that structured infection prevention programs including hand hygiene, wound care standardization, and device-care bundles significantly decrease sepsis incidence and improve clinical outcomes. Complementary AMS initiatives focusing on appropriate antibiotic selection, dosing optimization, and de-escalation have been associated with reduced antimicrobial pressure and improved microbial ecology. Integration of these approaches within a unified clinical governance framework has been shown to enhance infection prevention efficiency and limit ARDS-related complications. The effectiveness of such integration depends on multidisciplinary engagement involving intensivists, infectious disease specialists, pharmacists, and nursing staff. Technological advances, including microbiological surveillance, artificial intelligence driven prediction models, and microbiome-based monitoring, are increasingly being incorporated to strengthen early infection detection and optimize stewardship interventions in burn care.
Copyright (c) 2025 The Author(s) https://creativecommons.org/licenses/by-nc/4.0
Bone burn reconstruction using fish skin xenograft: A case series report
Fourth-degree burns with bone exposure present a major reconstructive challenge due to periosteal loss, infection risk, and limited vascularity. Traditional flap procedures are complex, invasive, and costly, with prolonged hospitalization and pain. Acellular fish skin (AFS) xenograft has emerged as a biologically active, omega-3–rich matrix that supports granulation and epithelialization in complex wounds. This case series reports outcomes of a two-stage reconstruction using AFS followed by split-thickness skin grafting (STSG) in four patients with bone-exposed burns (three tibial, one cranial). After surgical debridement and irrigation, AFS (Kerecis®, Ísafjörður, Iceland) was rehydrated in sterile saline and applied to the wound as a periosteal substitute. Seven days after the AFS application, a thin-meshed STSG (mesh ratio 1:1.5–1:3) was placed over the wound. This dressing strategy reduced the frequency of dressing changes and was associated with decreased patient-reported pain and lower resource use; however, these observations require confirmation in larger studies. All patients achieved complete epithelial coverage within 3–4 weeks, and after six months of follow-up, tissue repair was flexible, of high quality, and demonstrated favorable aesthetic outcomes. No infections, graft losses, or major complications were observed. The two-stage AFS + STSG technique appears to promote rapid epithelialization and durable wound coverage with minimal morbidity, representing a simple and less invasive alternative for bone-exposed burn reconstruction when flap surgery is not feasible.
Copyright (c) 2025 Mostafa Dahmardehei, Ali Dahmardehei, Zahra Dahmardehei, Seyedeh Somayeh Mousavi, Mahmoud Amini, Maryam Milanifard, Hamidreza Atashhoosh https://creativecommons.org/licenses/by-nc/4.0
Antibiotic resistance in bacterial infections of burn wounds: Challenges, mortality, and solutions
Burn wounds pose a significant clinical challenge due to their vulnerability to bacterial infections, compounded by the frequent emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens. Factors such as immune dysregulation from burn injury, loss of the skin barrier, prolonged hospitalization, and invasive procedures contribute to increased susceptibility to colonization and infection by resistant bacteria, notably Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus (MRSA). This review synthesizes current evidence on the microbiological landscape of burn wound infections, highlighting high rates of MDR/XDR isolates harboring diverse resistance mechanisms, including carbapenemases and extended-spectrum beta-lactamases. These resistant pathogens significantly impair healing by prolonging inflammation and biofilm formation and severely restrict effective antibiotic options, often necessitating last-resort therapies with associated toxicity. Risk factors predictive of MDR infections include extensive burns, invasive device use, prior antibiotic exposure, and longer intensive care unit (ICU) stays. Clinical management challenges extend from infection control and wound care to antimicrobial stewardship and the integration of emerging diagnostics. Future perspectives emphasize rapid molecular diagnostics, development of novel antimicrobials and topical agents, and multidisciplinary approaches involving surgeons, infectious disease specialists, and pharmacists to optimize outcomes. Prevention strategies targeting both hospital and community settings are critical for reducing burn incidence and infection rates. In conclusion, addressing antibiotic resistance in burn wounds requires comprehensive, evidence-based interventions and continued innovation to reduce morbidity and mortality and lower healthcare costs.
Copyright (c) 2025 Majid Taati Moghadam, Arezoo Barani, Seyedeh Shadi Vaziri, Morteza Fallah Karkan, Zahra Taati Moghadam, Mohammadreza Mobayen, Masiha Mobayen https://creativecommons.org/licenses/by-nc/4.0
The impact of pruritus, pain, and burn severity on the mental health of burn survivors: A prospective study
To prospectively investigate the relationship between pruritus, pain, and total body surface area (TBSA) with the mental health of burn survivors during the first six months of recovery. In this prospective longitudinal study, 78 adult burn patients admitted to a specialized burn center were assessed at one, three, and six months post-injury. Mental health was assessed using the 28-item General Health Questionnaire (GHQ-28), while pruritus and pain intensity were evaluated using Numeric Rating Scales (NRS). Correlational and multiple linear regression analyses were performed to identify predictors of mental health. Significant improvements in mental health and reductions in pruritus intensity were observed over the six-month (p < 0.001). At all time points, poorer mental health (higher GHQ-28 scores) was positively associated with greater pruritus intensity, pain intensity, and TBSA; however, in multivariable analysis, only TBSA and pruritus intensity remained as independent predictors, while pain lost its significance. Specifically, Spearman correlations for pruritus were modest (month 1: ρ = 0.227, p < 0.001; month 3: ρ = 0.283, p < 0.001; month 6: ρ = 0.221, p < 0.001), whereas correlations for pain (ρ = 0.566–0.684, p < 0.001) and TBSA (ρ = 0.757–0.885, p < 0.001) were stronger. In multivariable analysis, TBSA and pruritus intensity were independent predictors of GHQ-28. Multiple regression analysis revealed that only TBSA and pruritus intensity were significant independent predictors of mental health scores across all follow-ups. These findings underscore the clinical importance of prioritizing aggressive and specialized management of pruritus, not only for physical comfort, but as an essential component of mental health care for this vulnerable population.
Copyright (c) 2025 Amir Pirouz, Zahra Mostafavi Dezli, Pariya Amirinezhad, Masiha Mobayen, Mojdeh Esmailzadeh, Mohammadreza Mobayen, Mohammad Tolouei https://creativecommons.org/licenses/by-nc/4.0
Effects of high voltage pulsed current (HVPC) on pain, inflammation, and mobility in patients with anterior knee pain: A randomized clinical trial
Anterior knee pain is a prevalent musculoskeletal condition that limits function and quality of life. High-voltage pulsed current (HVPC) has been proposed as an adjunct therapy for reducing pain and effusion and improving mobility; however, its clinical effectiveness remains unclear. This randomized clinical trial investigated the impact of HVPC on pain, knee effusion, and range of motion in patients with anterior knee pain. Ninety-six individuals were screened, and 86 were randomized to receive either HVPC plus a routine physiotherapy program (including infrared radiation, transcutaneous electrical nerve stimulation (TENS), and strengthening exercises; n = 43) or routine physiotherapy alone (n = 43). After attrition, 75 participants completed the study. Pain intensity was measured using a visual analogue scale (VAS). Knee effusion was assessed by measuring the circumference with a tape at the infra-, mid-, and supra-patellar levels. Range of motion was evaluated using goniometry. Assessments were conducted at baseline, after five treatment sessions, after ten sessions, and at one-month follow-up. Both groups demonstrated significant improvements over time in pain, effusion, and range of motion (all p<0.001). However, mixed two-factor analysis of variance revealed no significant group × time interaction for any outcome (pain p=0.61; infra-patellar effusion p=0.37; mid-patellar effusion p=0.50; supra-patellar effusion p=0.38; flexion p=0.09; extension p=0.08). These findings suggest that adding HVPC to routine physiotherapy does not provide additional clinical benefit. Routine physiotherapy, including TENS and exercise, remains an effective treatment option for managing anterior knee pain.
Copyright (c) 2025 Kamran Ezzati, Mehran Soleymanha, Seyyed Mahdi Zia Ziabari, Atefeh Najafi https://creativecommons.org/licenses/by-nc/4.0
The emerging role of ChatGPT in cancer and burn research: Applications in wound healing and regenerative medicine
Artificial intelligence (AI) is increasingly shaping biomedical sciences, offering opportunities to accelerate discovery and translation. Chat Generative Pre-trained Transformer (ChatGPT), as a large language model, demonstrates potential to enhance cancer research, tissue repair, and burn care by rapidly synthesizing evidence, generating hypotheses, and supporting decision-making. This review examines ChatGPT’s emerging role in oncology and regenerative medicine, emphasizing the biological parallels between tumor progression and wound healing, including immune modulation, angiogenesis, fibroblast activation, and extracellular matrix remodeling. In oncology, ChatGPT may facilitate the identification of biomarkers, drug discovery, and the development of personalized therapeutic strategies. In regenerative medicine, it can assist in designing biomaterials, optimizing scaffolds, and contextualizing multi-omics data to accelerate tissue engineering. In burn management, ChatGPT shows promise in wound assessment, infection monitoring, fluid resuscitation guidance, scar prediction, and clinical education. To illustrate these applications, we conducted a conceptual simulation of ChatGPT responses in burn care, highlighting its utility for rapid evidence retrieval and training support. Despite these opportunities, ChatGPT faces critical limitations: a lack of domain expertise, contextual misinterpretation, data bias, and reliance on validation by human experts. Ethical challenges, including transparency, data privacy, and clinical reliability, further underscore the need for a cautious approach to integrating these technologies. Overall, ChatGPT should be considered a complementary assistant rather than a replacement for scientific and clinical expertise. With responsible implementation, continuous refinement, and interdisciplinary collaboration, it holds the potential to transform cancer biology, wound healing, and regenerative medicine, ultimately contributing to more precise, efficient, and patient-centered healthcare.
Copyright (c) 2025 Niloofar Faraji, Tahereh Zeinali, Shahab Aali, Parinaz Mellatdoust, Kaveh Gharaei Nejad https://creativecommons.org/licenses/by-nc/4.0
Risk factors, clinical characteristics, and outcomes of lower limb cellulitis in a tertiary hospital in Iran
Lower limb cellulitis is a frequent bacterial infection associated with substantial morbidity, yet epidemiological data from Iran remain limited. This retrospective cross-sectional study analyzed the medical records of 120 patients admitted to a tertiary hospital in Zanjan, Iran, with lower limb cellulitis between July and December 2023. The mean age was 53.3 years, and 65.0% of the participants were male. The average duration of hospitalization was 6.3 ± 5.4 days. Hypertension (28.3%) and diabetes mellitus (17.5%) were the most common comorbidities. Trauma was the leading precipitating factor, reported in 50.0% of cases, and was significantly more frequent among males (p=0.007). Abscess formation occurred in 29.2% of patients and was strongly associated with trauma (p=0.001) and previous cellulitis (p=0.046). Hypertension and diabetes were more common among female patients, although their older mean age may partially confound this. A history of deep vein thrombosis and recurrent cellulitis was associated with prolonged hospitalization. These findings highlight trauma as the predominant risk factor for cellulitis in this population, with comorbid diabetes further worsening clinical outcomes. The results underscore the need for preventive strategies, including patient education on wound care, strict control of chronic diseases, and targeted interventions for high-risk groups such as diabetic patients and manual laborers. Despite providing valuable regional insight, the study is limited by its retrospective single-center design, reliance on univariate analysis, small subgroup sizes, and potential data inconsistencies. Future prospective, multi-center studies are warranted to validate and expand these observations.
Copyright (c) 2025 Manizhe Jozpanahi, Ahmadreza Mobaien, Azar Biat, Elham Sadr, Afsaneh Karami https://creativecommons.org/licenses/by-nc/4.0
The relationship between perfectionism, self-compassion, and repetitive negative thinking with job burnout in medical students during internship
Medical students are highly susceptible to psychological pressures, including perfectionism and burnout. This study investigated the relationship between perfectionism, self-compassion, repetitive negative thinking, and job burnout among medical internship students. A total of 148 participants from Guilan province were selected using Morgan’s sampling table and completed standardized questionnaires, including the Perfectionism Scale, Self-Compassion Scale, Repetitive Negative Thinking Scale, and Burnout Scale. Data were analyzed using descriptive statistics and Partial Least Squares Structural Equation Modeling (PLS-SEM). The results showed that perfectionism positively predicted repetitive negative thinking (β = 0.412, t = 6.292, p < 0.001) and burnout (β = 0.328, t = 4.998, p < 0.001), and negatively predicted self-compassion (β = −0.741, t = 23.666, p < 0.001). Self-compassion, in turn, negatively predicted repetitive negative thinking (β = −0.646, t = 12.048, p < 0.001) and burnout (β = −0.460, t = 7.608, p < 0.001). Repetitive negative thinking positively predicted burnout (β = 0.675, t = 12.436, p < 0.001). The model explained 55.0% of the variance in self-compassion, 42.7% in repetitive negative thinking, and 45.9% in burnout; predictive Q² values for the three endogenous constructs were 0.487, 0.398, and 0.412, respectively. Overall goodness-of-fit (GOF) = 0.5141. The structural model demonstrated acceptable reliability, convergent and discriminant validity, and strong explanatory power, confirming the hypothesized relationships. These findings highlight the dual role of self-compassion and repetitive negative thinking as mediators in the perfectionism–burnout pathway. Perfectionism indirectly increases burnout by reducing self-compassion and enhancing repetitive negative thinking, underscoring the importance of addressing these mechanisms in preventive interventions. Programs designed to foster self-compassion, challenge maladaptive perfectionistic standards, and reduce ruminative and worry-related thought patterns may help protect medical students from burnout and promote their psychological well-being and academic success.
Copyright (c) 2025 Morteza Hazrati, Sabereh Sedighi Kozani, Seyed Hasan Miri https://creativecommons.org/licenses/by-nc/4.0
Innovative hybrid platforms for overcoming antimicrobial resistance in wound healing: The synergy of mesoporous nanostructures and antimicrobial peptides
Copyright (c) 2025 Mostafa Golshekan, Seyed Ali Hosseini, Ali Aghajan, Hadi Sedigh Ebrahim-Saraie https://creativecommons.org/licenses/by-nc/4.0
Variability in serum sodium concentration and its prognostic significance in severe burn injuries: A retrospective study
Dysnatremia is a common electrolyte disturbance in severe burn patients and may significantly impact prognosis. This study investigated the association between serum sodium variability and mortality in adults with extensive burn injuries. In this retrospective cross-sectional study, 300 adult burn patients with burns involving more than 20% of total body surface area (TBSA) and at least second-degree depth were included. Patients were admitted to Velayat Burn and Plastic Surgery Center (Rasht, Iran) between March 2018 and March 2020. Serum sodium was measured daily during hospitalization. Hypernatremia and hyponatremia were defined as serum sodium >145 mmol/L and <135 mmol/L, respectively. Sodium variability was quantified as the standard deviation (SD) of daily sodium measurements. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality. Of the 300 patients (mean age: 47.5 ± 13.5 years; mean TBSA: 39.8 ± 21.9%), 21.3% of the patients had hypernatremia, and 33 (11%) developed hyponatremia. Overall mortality was 36.7%. Non-survivors had significantly higher mean serum sodium levels (143.2 ± 8.9 vs. 138.6 ± 3.0 mmol/L; P < 0.0001) and greater sodium variability. Multivariate analysis identified age (Odds ratio (OR): 1.15; P = 0.004), TBSA (OR: 1.24; P = 0.002), mechanical ventilation duration (OR: 1.38; P < 0.001), inhalation injury (OR: 23.5; P = 0.003), and sodium variability (OR: 1.12; P = 0.004) as independent predictors of mortality. Dysnatremia—particularly hypernatremia—and greater serum sodium variability are strongly associated with increased mortality in patients with severe burns. These findings underscore the prognostic importance of sodium monitoring and suggest that minimizing sodium fluctuations may improve outcomes in critically ill burn patients. Further prospective studies are warranted to validate these associations and inform clinical management strategies.
Copyright (c) 2025 Siamak Rimaz, Saba Abedi, Sheyda Rimaz , Mohammadreza Mobayen , Sajjad Danesh , Mohammad Tolouei, Ali Ashraf, Latif Panahi https://creativecommons.org/licenses/by-nc/4.0
Ocular injuries among hospitalized burn victims: A one year census at a national tertiary center
Ocular injuries are potentially sight-threatening complications of burns that are frequently overlooked in clinical practice. To describe the epidemiology, mechanisms, clinical spectrum, and outcomes of ocular burns in hospitalized patients. We performed a one-year retrospective census of all burn in-patients who received ophthalmology consultation at Motahari Hospital, Tehran (April 2021–March 2022). Demographics, burn characteristics, ocular findings, management, and outcomes were extracted from charts and analyzed using descriptive statistics and chi-square or Mann-Whitney U tests. Among 1,914 admissions, 74 (3.9%) received ophthalmologic consultation, and 69 (3.6%) were diagnosed with ocular injuries. Patients were predominantly male (78%) with a median age of 29 years (Interquartile Range (IQR) 6–47 years). Flame exposure was the commonest mechanism (49%), followed by chemical (19%) and scald (19%) burns. Eyelid involvement occurred in 99% of cases, conjunctiva 61%, cornea 39% and limbus 7%. Corneal injury was significantly associated with chemical burns (p = 0.01). Ninety-two percent received medical therapy alone; 14% underwent surgery (cutaneous graft 9%, ocular procedure 5%). The median length of stay was 9 days (IQR, 5–16). Permanent ocular sequelae developed in five patients (7%), and mortality was 20%. In this large tertiary cohort, ocular burns affected 1 in 25 admitted burn patients, chiefly young men injured at home. The eyelids shield deeper structures, yet chemical exposure remains a significant threat to the cornea and limbus. Early ophthalmic assessment and standardized lubrication protocols could reduce the need for reconstructive surgery. Public-health measures aimed at domestic fire safety and chemical handling are warranted. This study highlights the importance of implementing routine ocular screening protocols in burn units, particularly for patients with high-risk exposures.
Copyright (c) 2025 Seyyed Amirhossein Salehi , Kiana Anousha , Kamran Asadi, Seyed Hamid Salehi https://creativecommons.org/licenses/by-nc/4.0
Advancing burn wound healing with artificial intelligence (AI): Innovative solutions in medical technology
Assessment of burn injuries, determining wound depth and total body surface area (TBSA), is a critical but also subjective and inaccurate process. These diagnostic errors can lead to unfortunate patient outcomes and the useless distribution of healthcare resources. Artificial intelligence (AI) has emerged as a promising technology to improve precision in burn care. Our review analyzes the current applications, foundational technologies, and significant challenges of AI in advancing burn wound healing. This review is based on a regulated analysis of key scientific literature. It also covers the range of AI applications, from initial diagnosis and assessment to final treatment. It examines the primary computational models and datasets that enable these novelties, as well as the practical and ethical barriers to their clinical implementation. The review reveals that deep learning (DL) models have significant potential to improve the precision of burn wound diagnosis. It also shows that AI is particularly effective at segmenting wound boundaries, grading burn depth, and approximating %TBSA. This review highlights AI's increasing role in predicting healing paths and personalizing treatment plans. The analysis identifies various barriers to widespread implementation, including the lack of diverse datasets, the risk of algorithmic bias, and the "black box" nature of some models, which can inhibit clinical trust. AI holds considerable potential to enhance the precision and objectivity of burn care by serving as a powerful decision support tool for clinicians. Realizing the full potential of these innovative solutions requires a mutual effort to address the known research gaps.
Copyright (c) 2025 Masiha Mobayen, Alireza Feizkhah, Mohammadreza Mobayen, Pariya Amirinezhad https://creativecommons.org/licenses/by-nc/4.0
E-learning for anesthesiology in burn care: A narrative review of current applications and future opportunities
Burn care presents significant clinical challenges, requiring anesthesiologists to possess advanced knowledge and skills in managing complex physiological responses and performing critical interventions. Traditional education models in anesthesiology have relied heavily on in-person teaching and clinical apprenticeship, which often lack flexibility, consistency, and broad accessibility. The rapid expansion of digital learning modalities, accelerated by Coronavirus disease 2019 (COVID-19) pandemic, has positioned e-learning as a transformative tool in medical education. This narrative review explores the current landscape of e-learning in anesthesiology with a particular focus on burn patient management. We review the design and implementation of digital modules for airway control, pain management, fluid resuscitation, and perioperative care in burn settings. Additionally, this study highlights the technological innovations—such as virtual simulations and adaptive learning algorithms—that are enhancing the educational experience. Barriers to implementation, including infrastructure limitations, faculty readiness, and learner engagement, are discussed. Finally, we propose strategic directions for future integration of e-learning into anesthesiology curricula to better prepare clinicians for the unique demands of burn care. Our findings suggest that while e-learning holds considerable promise, targeted development and systematic evaluation are necessary to optimize its impact on clinical competence and patient outcomes in the field of anesthesiology.
Copyright (c) 2025 Fatemeh Mehdipour, Mohammadreza Mobayen, Siamak Rimaz, Shahnam Sedigh Maroufi, Jamileh Abolghasemi, Mehdi Nazari, Zahra Ghaderi, Parisa Moradi Majd https://creativecommons.org/licenses/by-nc/4.0
Biomechatronic in burn trauma: Pioneering solutions and uncharted challenges
Copyright (c) 2025 Alireza Feizkhah, Leila Keshavarzi, Sina Kamrani Moghadam, Saeid Yaghoubi koupaei https://creativecommons.org/licenses/by-nc/4.0
Smart dressings and wearable technology: A new era in wound management
Healing a skin wound is an impressive reflection of the body's intricate cellular processes. The repair process is driven by a dynamic interaction among cells, growth factors, and cytokines, working in harmony to close the wound and restore tissue integrity. However, the most significant challenges often arise from the limitations of existing treatment and management methods, which can hinder efficient repair and recovery. These obstacles have inspired advancements in wound care, emphasizing approaches that align more closely with the body's natural healing capabilities. The limitations of traditional wound management have driven the development of innovative wound dressings, which offer improved accuracy, sensitivity, long-term stability, and environmental resilience. These advanced dressings provide clinicians with real-time insights into wound status, enabling them to make prompt and precise treatment decisions that support tissue repair and regeneration. Despite promising advancements, the complexity of wound healing and the challenges of working in challenging environments necessitate further enhancements in sensor performance. This review underscores the potential of intelligent wearable sensors and material innovations in revolutionizing wound management, highlighting the need for personalized treatment approaches to optimize efficiency and minimize risks during the healing process. To support this analysis, a comprehensive review of papers published in the last fifteen years from databases such as Google Scholar, PubMed, and Elsevier has been conducted. The findings emphasize the importance of multidisciplinary research in advancing wound care, offering new avenues for effective patient management and public health monitoring. By integrating wearable sensors and wireless transmission technologies, these comprehensive wound dressings facilitate remote monitoring, early diagnosis, and timely on-demand drug delivery. The investigation of various physicochemical markers—such as temperature, pH, humidity, and inflammatory factors—enables the early detection of wound conditions.
Copyright (c) 2025 Sara Hassani, Mohadeseh Pakroo , Yasaman Ghafarzadeh, Mina Sadat Naderi, Seyed Mehdi Tabaie https://creativecommons.org/licenses/by-nc/4.0
The effect of fibrinolysin ointment in the treatment of burn scars: A narrative review article
Burn injuries are a significant global health concern, ranking among the most common causes of trauma and leading to severe physical, functional, and psychosocial consequences. Effective burn wound management aims not only to promote healing but also to minimize scarring, infection, and long-term complications. Fibrinolysin ointment, a topical enzymatic agent containing proteolytic enzymes such as fibrinolysin, deoxyribonuclease, and trypsin, has been investigated as a treatment option for improving burn wound outcomes. This narrative review explores the potential therapeutic benefits, mechanisms of action, clinical applications, and limitations of fibrinolysin ointment in the context of burn injuries. Fibrinolysin functions primarily through enzymatic debridement, dissolving necrotic tissue, facilitating wound cleansing, reducing bacterial colonization, and stimulating tissue regeneration. Its anti-inflammatory properties also help reduce edema and local pain, creating a favorable microenvironment for re-epithelialization and collagen remodeling. Several animal studies suggest its usefulness in promoting faster healing in second- and third-degree burns. However, the results are often less favorable when compared to more aggressive enzymatic agents or natural alternatives, such as kiwi extract or honey. While fibrinolysin has shown promise in reducing healing time and indirectly improving scar quality, there is a lack of robust human clinical trials assessing its long-term effects on scar formation, particularly through the use of standardized scar assessment scales. Although generally safe with minimal side effects, fibrinolysin ointment may cause localized irritation or hypersensitivity in some patients. This review concludes that while fibrinolysin may serve as a supportive treatment in burn care, especially in superficial wounds, further clinical research is warranted to validate its efficacy, optimize its usage, and establish its role in multidisciplinary burn scar management protocols.
Copyright (c) 2025 Jafar Kazemzadeh https://creativecommons.org/licenses/by-nc/4.0
Biomimetic Wound Dressings: Advancements, Applications, and Challenges in Modern Wound Care
Wound dressings are critical in managing various injuries, including pressure ulcers, venous ulcers, and diabetic foot ulcers. Various dressing materials are employed in wound care, such as traditional dressings, interactive materials, skin substitutes, bioactive dressings, and dermal grafts. These materials, both synthetic and biological, contribute to effective wound healing by supporting the regeneration of skin tissues. However, biomimetic wound dressings are emerging as a superior alternative to conventional dressings due to their ability to align more closely with the natural wound healing process. Among these, hydrogels are particularly promising for their capacity to replicate the biological properties of human skin, offering enhanced moisture retention, flexibility, and biocompatibility. Biomimetic wound dressings are available in various forms, including films, gauzes, injectable gels, and sprays, catering to different wound types and healing stages. In recent years, the development of novel wound dressings has become a focal point in biomedical engineering, with a strong emphasis on leveraging the benefits of biomaterials. These advanced dressings promote faster healing and offer various advantages, such as reduced infection risk and improved patient comfort. However, despite their potential, biomimetic dressings also present specific challenges, such as production costs and variability in performance across different wound types. This review explores the strengths and limitations of biomaterial-based wound dressings, highlighting their growing significance in modern wound care and future therapeutic applications.
Copyright (c) 2025 Ehsan Ghiasy Nick, Mohsen Shahrousvand, Seyed Armin Fazeli Masouleh, Alireza Feizkhah, Bahar Alizadeh https://creativecommons.org/licenses/by-nc/4.0
Comparative Effects of Olive Oil and Flaxseed Oil on Glycemic Control and Lipid Profile in Burn Patients: A Randomized Clinical Trial
Burn injuries often result in hyperglycemia and dyslipidemia, complicating recovery and increasing the risk of adverse outcomes. While olive oil and flaxseed oil have been associated with improved metabolic health, their comparative effects on burn-induced glycemic and lipid disturbances remain unclear. This study aimed to compare the effects of olive and flaxseed oil on glycemic control and lipid profiles in burn patients. In this double-blind, randomized clinical trial, 112 patients with burns covering 20-50% of total body surface area were randomly assigned to four groups: control, olive oil, flaxseed oil, and a mixture of both groups. Interventions were administered from day 2 to day 22 post-burn. Fasting blood sugar (FBS), cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels were measured at baseline and during follow-up. Data were analyzed using analysis of variance and Kruskal-Wallis tests. After two weeks, the OO group showed a significant reduction in FBS (-34.03±69.65, P<0.05), whereas the FO group demonstrated an increase in cholesterol levels (+26.14±79.08 mg/dl, P<0.05). Significant changes were observed in HDL, LDL, and triglyceride levels across the groups (P<0.05). Olive oil was more effective in reducing LDL and cholesterol, compared to flaxseed oil, while the mixture group exhibited the most significant improvement in HDL levels. None of the groups showed a substantial impact on overall glycemic control. Olive oil was more effective than flaxseed oil in improving lipid profiles, particularly in reducing LDL and cholesterol levels in burn patients. However, neither oil demonstrated a significant effect on post-burn glycemic control. Future studies should explore the long-term metabolic outcomes of these interventions in burn patients.
Copyright (c) 2025 Atefeh Ghanbari, Sanaz Masoumi, Ezzat Paryad, Ehsan Kazemnezhad Leyli, Marjan Mahdavi-Roshan, Mahsa Sadeghi, Sara Bagheri https://creativecommons.org/licenses/by-nc/4.0
The Survey of Adverse Transfusion Reactions in Burn Patients for Five Years from 2015 to 2020 at Imam Musa Kazim Hospital, Isfahan Province, Iran
While blood transfusions are critical therapeutic interventions for burn patients, they pose a risk of adverse transfusion reactions (ATRs). The present study aimed to evaluate the clinical manifestations and underlying causes of ATRs in burn patients over five years at Imam Musa Kazim Hospital in Isfahan, Iran.This cross-sectional study analyzed the medical records of patients hospitalized from 2015 to 2020. The study focused on transfusion details, including the reasons for transfusion and the types and frequencies of ATRs. Data analysis was performed using SPSS (version 21). A total of 2,086 packed red blood cells were transfused during the study period, with 100 (4.79%) cases resulting in ATRs. Of these, 73% were allergic reactions, followed by transfusion-related acute lung injury (TRALI) (9%), febrile non-hemolytic transfusion reaction (FNHTR) (7%), and hemolytic reactions (4%). Most transfusions (51%) occurred in patients with burns covering 30-60% of their total body surface area (TBSA). Surgery (57%) and anemia (43%) were the leading reasons for transfusion. Most ATRs were mild, with allergic reactions showing the highest severity. The incidence of ATRs in burn patients highlights the need for careful monitoring of transfusion practices. Increased awareness and training of medical staff regarding ATR prevention can reduce unnecessary transfusions and improve patient outcomes in burn care.
Copyright (c) 2025 Fahimeh Beigi, Sara Rahdar, Esfandiar Esfandiarbakhtiari, Fatemeh Jafari, Ashraf Amirshahkarami https://creativecommons.org/licenses/by-nc/4.0
Predictive Value of Base Deficit, Serum Albumin, and C-reactive Protein/Albumin Ratio for Mortality in Severe Burn Patients
Burn patients are at risk of serious complications, including sepsis, acute respiratory distress syndrome, and organ dysfunction, despite advancements in medical treatment. Early prediction and management of sepsis and acute inflammation and the identification of high-risk patients are crucial for the improvement of outcomes. This study aimed to evaluate the prognostic value of serum albumin, base deficit, and C-reactive protein (CRP)/albumin ratio (CAR) in severe burn patients.In a retrospective analysis of 195 patients with 20%-80% total body surface area (TBSA) burns admitted to the burn intensive care unit (ICU) at Velayat University Hospital from April 2018 to April 2021, serum albumin, base deficit, and CAR were measured upon admission.Significant differences were observed between survivors and non-survivors in terms of serum albumin levels (3.05±0.56 vs. 1.89±0.69 g/dL), base deficit (3.36±2.15 vs. 10.62±1.71 mmol/l), CRP (20.95±29.33 vs. 54.62±46.29 mg/L), CAR (7.73±11.52 vs. 36.80±35.59), and length of ICU stay (2.75±2.51 vs. 6.45±4.50) (P<0.001). Multivariate logistic regression indicated that unlike CRP, serum albumin levels (P=0.045), base deficit (P=0.001), and TBSA (P=0.046) were significantly associated with increased mortality.As evidenced by the obtained results, serum albumin, base deficit, and CAR are linked to adverse outcomes and may be valuable tools for risk stratification, identifying high-risk patients, and guiding early interventions in burn patients. Further research is needed to validate these findings and explore the underlying mechanisms.
Copyright (c) 2025 Siamak Rimaz, Ali Shabbak , Abbas Sedighinejad, Talat Kaviyani Jebeli, Parissa Bagheri Toolaroud, Ehsan Ghiasy Nick, Negin Rahimzadeh, Sanaz Masoumi https://creativecommons.org/licenses/by-nc/4.0
Prevalence and Epidemiological Profile of Gasoline-Related Burn Injuries in Tehran: A Retrospective Descriptive Study
Gasoline, a highly volatile, flammable liquid, is frequently misused as a fire accelerant, leading to severe burn injuries, particularly in young men. These injuries are often associated with high mortality, extensive total body surface area (TBSA) involvement, and inhalation injuries. This study aimed to investigate the prevalence of burn injuries resulting from the misuse of gasoline in Tehran and to explore the contributing factors associated with these incidents.This retrospective cross-sectional study was conducted in 2019 at Motahari Hospital in Tehran, Iran. All burns related to flammable and combustible liquids were examined. Demographic data and burn-related information were extracted. Data were analyzed using descriptive measures in SPSS software (version 28). Out of 1,984 burn cases, 84 (10.6%) were attributed to the misuse of flammable liquids, predominantly gasoline (77.4%). Most of the victims of flammable liquid burns were men (96.4%) with an average age of 31.6 years. The average TBSA burned was 25.5%, and the mean hospital stay was 10.8 days. Inhalation injuries occurred in 40.5% of cases, and the mortality rate was 11.9%. A significant proportion of injuries occurred at workplaces (56%), with construction workers, auto mechanics, and painters being the most affected. Seasonal trends showed increased incidents during spring and summer, particularly during national and religious festivals, such as Chaharshanbeh Suri. Gasoline-related burns present a significant public health burden, with high rates of morbidity and mortality. Targeted interventions, including public education on the dangers of gasoline misuse and enhanced safety regulations, are essential to mitigate the impact of these injuries.
Copyright (c) 2025 Mostafa Dahmardehei, Majid Khadem Rezaiyan, Farhang Safarnejad, Ali Ahmadabadi https://creativecommons.org/licenses/by-nc/4.0
Biophysical approach to studying protein interactions in skin wound healing
Cutaneous wounds are a significant health problem worldwide. That is why wound healing and biological factors, including proteins, are substantial. This complicated and dynamic process consists of five overlapping phases: Hemostasis, Inflammation, Granulation tissue formation, Re-epithelialization, and Remodeling. Cells and proteins shared in these phases can trigger myriad activities that eventually complement each other. This paper aims to provide an understanding of the key proteins' functions and signaling involved in the wound healing process, based on data available on bioinformatics websites. These proteins include the interleukin-1 family, tight junction proteins (occludin and claudin), platelet-derived growth factor (PDGF), and extracellular matrix components such as matrix metalloproteinases (MMPs), fibronectin, and laminins. In addition, by examining the significant role of inflammatory cytokines, proteases, and members of the large family of metalloproteinases, we can take novel measures to accelerate the healing of chronic wounds that are stuck in the inflammatory phase. Additionally, it is notable that mediator proteins are vital, as they exhibit co-expression and share molecular interactions with key proteins. Therefore, their absence or impaired functioning can disrupt the normal healing process of skin wounds.
Copyright (c) 2025 Samin Khosravi, Hosna Basiri kheradmand Tehrani, Mina Sadat Naderi, Seyed Mehdi Tabaie , Shima Hatamzadeh https://creativecommons.org/licenses/by-nc/4.0
Bacterial etiology and antibiotic susceptibility pattern of ventilator-associated pneumonia (VAP) in burn patients
This research aimed to identify the spectrum of microbial pathogens associated with VAP and the drug resistance patterns at an intensive care unit (ICU) burn center in Iran. We conducted this single-center, retrospective, cross-sectional descriptive study on all burn patients with VAP who were treated in the ICU at Velayat Burn Injuries Hospital in Rasht, northern Iran. In this study, 29 samples were obtained from burn patients, of which P. aeruginosa accounted for 48.3%, Klebsiella for 17.2%, E. coli for 10.3%, coagulase-negative Staphylococci for 6.9%, and unknown pathogens for 17.2% of the bacterial cultures. All the E. coli isolates and most of the Klebsiella isolates (80%) were obtained in the first two days of hospitalization. P. aeruginosa was mainly isolated during the first 2 days of hospitalization (71.4%). The mortality rate was 75.9%, while 24.1% of the patients were discharged. Antibiotic susceptibility patterns of Gram-negative bacteria revealed that Enterobacter and P. aeruginosa were predominantly susceptible to aminoglycosides, with Amikacin exhibiting the highest effective rates of 40% and 66.7%, respectively. A guideline-based approach using the local ICU antibiogram can decrease the likelihood of Multidrug-resistant (MDR) strain occurrence.
Copyright (c) 2025 Hadi Sedigh Ebrahim-Saraie , Daniel Rahimi Nejat , Aref Chakari-Khiavi, Nastaran Habibollahpour , Siamak Rimaz , Mohammadreza Mobayen , Mahsa Sadeghi , Alireza Jafarinezhad, Sheyda Rimaz https://creativecommons.org/licenses/by-nc/4.0
The Necessity of Investigating Ways to Reduce Skin Complications Caused by Ionizing Radiation during Radiation Therapy
Copyright (c) 2025 Roshanak Ale-Esmaiel, Parand Pourghane, Pouya Nematzad Khamsi https://creativecommons.org/licenses/by-nc/4.0
Telemedicine and remote monitoring in burn care: A review of current applications
Burn injury is one of the most destructive types of trauma, with considerable physical, psychological, and financial costs to individuals as well as to healthcare systems. Specialized care for burns remains scarce in most areas, particularly in remote or resource-limited regions. Telemedicine and remote monitoring have become valuable tools for bridging these care gaps. This review provides an overview of existing applications, benefits, and challenges of telemedicine and remote monitoring for burns, as well as future directions for their wider application. An in-depth review of contemporary literature was conducted to evaluate telemedicine-based methodologies in various areas of burn treatment, including teleconsultation, remote patient follow-up, wound assessment, and rehabilitation. The use of advanced tools, such as artificial intelligence and wearable sensors, in augmenting remote care was also investigated. Telemedicine facilitates prompt specialist consultations, reduces unnecessary transfers, and supports early recognition in underserved groups. Remote monitoring devices have enhanced wound management, optimized rehabilitation processes, and facilitated greater patient satisfaction. Technical limitations, data privacy, security, and unstandardized clinical guidelines constitute challenges that still need answers from research and policy. Telemedicine, combined with remote monitoring, holds promising capabilities for significantly improving the provision of care for burns by expanding access, enhancing patient outcomes, and optimizing healthcare resource management. Overcoming the challenges on offer will require interdisciplinary collaboration and advancements in technology to unlock all these benefits fully.
Copyright (c) 2025 Masiha Mobayen, Pariya Amirinezhad, Fatemeh Mahdipoor, Sina Kamrani Moghadam, Saeid Yaghoubi koupaei, Mahsa Sadeghi, Parissa Bagheri Toolaroud https://creativecommons.org/licenses/by-nc/4.0