***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sixty patients with moderate and severe burns were r and omly assigned to receive topical silver sulfadiazine ( SSD ) alone ( n=30 ) or SSD combined with cerium nitrate ( SSD-CN ) ( n=30 ) . There were four deaths in the SSD group and one in the SSD-CN group ; more patients with higher risk severity survived in the SSD-CN group . Wound infection did not differ significantly between the groups . The rate of re-epithelialization of partial thickness burns was faster by 8 days in the SSD-CN group . The relatively dry shell-like eschar of the SSD-CN-treated burn allowed planned excisions with immediate autologous grafting and the tissue beneath was ready to accept grafting 11 days earlier than in the SSD group ( p=0.03 ) . This result ed in a significantly shorter hospital stay for those in the SSD-CN group than in the SSD group ( 23.3 vs. 30.7 days ; p=0.03 ) with consequent cost savings . A higher incidence of transient stinging pain was reported with application of SSD-CN , but this was effectively managed with analgesics where necessary . The results of this study confirm the greater efficacy of SSD-CN in the treatment of burns patients Burn injury is associated with a high incidence of death and disability ; yet , its management remains problematic and costly . We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40 % of body surface area and compared its results with those of silver sulphadiazine ( SSD ) . In this r and omised comparative clinical trial , carried out Burn Center of POF Hospital , Wah Cantt , Pakistan , from May 2007 to February 2008 , 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included . Each patient had one burn site treated with honey  and one treated with topical SSD , r and omly .  The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD ( 13·47 ± 4·06 versus 15·62 ± 4·40 days , respectively : P < 0·0001 ) . The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD . Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site , whereas 27 patients had positive culture in SSD-treated site . The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns The present paper reports the results of clinical and laboratory tests carried out on two homogeneous groups of ten burn patients subjected to local therapy , either with isotonic chloroxidating solution Amuchina * or with 1 % silver sulfadiazine cream at the Burns Centre of the Pisa University Dermatological Clinic . The local systemic behaviour of the patients examined was evaluated for the containment of septic complications at the burn site . In the group subjected to treatment with chloroxidating solution , sepsis appeared to have a lower incidence in the evolution of dermatitis in the phase of escharolysis , in the formation of granulation tissue , and in the attachment of cutaneous grafts . The systemic involvement ( temperature curve , etc . ) appeared to be more marked for some patients treated with silver sulfadiazine in response to septic aggression of the burn wounds . On the basis of data referring to the development of the wound granulation and the temperature curve , as well as the microbial presence and the subjective tolerance of the medication , the comparison was favourable , making all necessary allowances , to topical treatment with electrolytic chloroxidating solution ; other comparative data were at the limit of significance OBJECTIVE To evaluate the therapeutic effect of silver nitrate ointment on partial-thickness burn wounds , and observe its side-effects . METHODS Multi-center , r and omized , positive drug paralleled self-controlled trial was carried out . Eighty patients with superficial partial-thickness burns , and 40 with deep-partial thickness burns were r and omized into AgNO3 group and SD-Ag group according to drug topically applied to the wounds . The wound healing time , wound healing rate and bacterial culture of the wound , the effect and safety of the drug , as well as drug irritation to the wounds were studied in these two groups . RESULTS For the patients with superficial partial-thickness burn wounds , the wound healing time in silver nitrate group was ( 9.5 + /- 2.7 ) days , which was obviously shorter than that in SD-Ag group [ ( 10.8 + /- 3.4 ) days , P < 0.01 ] . The wound healing rate in silver nitrate group on 7 post-burn day ( PBD ) was ( 77.9 + /- 20.5)% , which was obviously higher than that in SD-Ag group [ ( 67.3 + /- 22.6 ) % , P < 0.01 ] . For those with deep-partial thickness burn wounds , the wound healing time in silver nitrate group was ( 21.5 + /- 4.8 ) days , which was evidently shorter than that in SD-Ag group [ ( 23.3 + /- 6.4 ) days , P < 0.01 ] . The wound healing rate in silver nitrate group on 20 PBD was ( 86.6 + /- 15.9)% , which was evidently higher than that in SD-Ag group [ ( 78.5 + /- 17.7)% , P < 0.01 ] . Silver nitrate ointment has the same antibacterial effect as 1 % SD-Ag cream , but it was less painful when applied to the open wounds . CONCLUSION Silver nitrate ointment is an effective and safe medicament for the clinical management of partial-thickness burn wounds Due to the limited re sources for the management of burns in most regions of Africa there is a significant role for many aspects of traditional African medicine . The active component of many traditional preparations is often of plant origin and more than 25 plants have been described as useful in relations to burns and wound healing . Carica papaya is currently used in The Gambia at the Royal Victoria Hospital , Banjul in the Paediatric Unit as the major component of burns dressings , where it is well tolerated by the children . Cheap and widely available , the pulp of the papaya fruit is mashed and applied daily to full thickness and infected burns . It appears to be effective in desloughing necrotic tissue , preventing burn wound infection , and providing a granulating wound suitable for the application of a split thickness skin graft . Possible mechanisms of action include the activity of proteolytic enzymes chymopapain and papain , as well as an antimicrobial activity , although further studies are required We prospect ively studied 52 consecutive patients who were treated by early tangential excision and grafting following thermal injury . The usefulness of two topical antimicrobial agents—0.5 % silver nitrate ( Ag ) and neomycin ( 1 gm/liter ) plus bacitracin ( 50,000 units/liter ) (NB)—was compared with the effectiveness of Ringer 's lactate ( RL ) for prevention of autogenous skin-graft loss due to infection . Graft loss of 10 percent or more occurred in 17 patients ( 33 percent)—due to infection in 16 . Skin-graft loss was a minor problem in patients with less than 20 percent total body surface area ( TBSA ) burn ( Ag : 0 of 6 , NB : 1 of 6 , RL : 1 of 5 ) . The use of either antimicrobial ( Ag or NB ) result ed in less graft loss ( 1 of 14 ) than RL ( 4 of 6 ; p < 0.05 ) in the 20 to 40 percent TBSA burn group . Large burns ( > 40 percent ) had a very high incidence of at least 10 percent graft loss ( 67 percent ) regardless of treatment . Infection in the area of graft loss was caused by antibiotic-resistant organisms or yeast in 50 percent of the Ringer 's lactate group and the entire neomycin plus bacitracin group . No graft infections were caused by resistant organisms or yeast in the silver nitrate group . This study demonstrates that topical antimicrobial agents reduce infection-related skin-graft loss in patients with medium-sized ( 20 to 40 percent TBSA ) burns and that neomycin plus bacitracin is associated with rapid emergence of drug-resistant organisms whereas silver nitrate is not 
    Output:
    
The evidence found in our review does not support differences in efficacy of topical agents to reduce sepsis and /or local infections in burn patients