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Volume XXV

Number 1

March 2012

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Summaries

3 NOSOCOMIAL INFECTIONS AMONG BURN PATIENTS IN TEHERAN, IRAN: A DECADE LATER
(Alaghehbandan R., Azimi L., Rastegar Lari A. - Iran)
The aim of this study was to determine the epidemiology of nosocomial infections among burn patients in a tertiary burn care centre in Tehran, Iran. A cross-sectional study was carried out during a 6-month period from August 2010 to January 2011 at Motahari Burn and Reconstruction Center in Tehran. Of 155 patients, 677 samples of wound and blood were taken for culture during the course of hospitalization. The rate of positive culture during the 1st, 2nd, 3rd, and 4th week of hospitalization were 76.3%, 99.3%, 100%, and 100%, respectively. On the 2nd, 3rd, and 4th week of hospitalization, Pseudomonas aeruginosa was the most common pathogen followed by Acinetobacter, while the culture positive rate for Staphylococcus spp., Enterobacteriaceae, and Enterococcus spp. significantly decreased (P < 0.001). In this study, 70 patients out of 155 (45.2%) had at least one Acinetobacter positive culture. Our results showed that P. aeruginosa is still the leading cause of nosocomial infections. Additionally, Acinetobacter has appeared as an emerging nosocomial pathogen, and should be considered as a serious risk. We believe that changes in burn wounds' bacterial colonization over time require consistent assessment and monitoring of these changes in any burn center.
8 CURRENT SCENARIO IN CHEMICAL BURNS IN A DEVELOPING COUNTRY: CHENNAI, INDIA
(Ramakrishnan K.M., Mathivanan T., Jayaraman V., Babu M., Shankar J. - India)
Chemical burns are not uncommon in India. Both accidental and non-accidental chemical burns are encountered in our setting. In the paediatric age group, chemical burns are mainly accidental. Analysis of chemical burn admissions to the Burn Units of a medical college hospital, and to an exclusively tertiary care children's hospital in Chennai, India, from 2001 to 2010 is described. A total number of 75 adults and 38 children are included in the study. Detailed analysis of age, sex, percentage of burn total body surface area (TBSA %), causative agents, aetiology (accidental or non-accidental), treatment instituted, mortality, and outcome are reported.
13 PROFILE OF BURN SEPSIS CHALLENGES AND OUTCOME IN AN EXCLUSIVE CHILDREN'S HOSPITAL IN CHENNAI, INDIA
(Ramakrishnan K.M., Jayaraman V., Mathivanan T., Babu M., Ramachandran B., Sankar J. - India)
A group of 273 paediatric patients admitted to Kanchi Kamakoti Childs Trust Hospital Burn Unit, Chennai, India between the years 2004 to 2010 were analysed retrospectively. Of these, 89 were suffering from sepsis and septic shock and 15 died. Strict adherence to antibiotic administration and to the Paediatric Intensive Care Unit (PICU) and management protocol improved the outcome, especially in 2009 and 2010.
17 EFFECT OF MAJOR BURNS ON EARLY AND LATE ACTIVATING MARKERS OF PERIPHERAL BLOOD T LYMPHOCYTES
(Sayed S., Bakry R., El-Shazly M., El-Oteify M., Terzaki S., Fekry M. - Egypt)
It is known that lymphocytes immunophenotype is a reflection of the functional level of the immune system. The immunosuppressive effect of major burns is also known for many years. T lymphocytes of 50 major burn patients were analyzed in base line (BL) samples at 24 hours and at 1 week and 2 weeks after burn, using monoclonal antibodies of CD3, CD4, CD8, CD25 (IL2R) and HLA-DR by flow cytometry and 2-microglobulin (2-m) by ELISA. Recorded values were compared with those of 50 healthy donors. There was statistically significant reduction in absolute number of CD3 positive cells (CD3+) (p<0.000) and CD4/CD8 ratio (p=0.01) in the first 24 hours in comparison with controls. CD25 (IL-2R) shows insignificant upregulation on T lymphocytes after burn with significant upregulation of HLA-DR. The absolute number of CD3+ cells began to increase after 2 weeks (p=0.03) but remained less than controls (p=0.08). CD4/CD8 ratio was more or less same as healthy controls after 2 weeks. Upregulation of CD25 was insignificantly increased and that of HLA-DR was markedly increased after 2 weeks (p=0.001). Significant negative correlations were detected between mean values of 2-m and both absolute numbers of CD3 and CD4 positive cells in BL and one week samples. In addition there was significant correlation between mean values of 2-m and values of CD25 expression in the BL samples. The obtained data is suggestive of persistent activation of T lymphocytes two weeks after major burns whereas early shedding of 2-m is related to activation of lymphocytes increasing their susceptibility to apoptosis, both indicative of altered immune response. Burn intensivists and surgeons should be keen to support the patients' immune system in the first hours following major burns. This support will ensure free-bacteremic blood with a consequent better prognosis.
22 SIGMOID DIVERTICULITIS PERFORATION IN BURNS: CASE REPORTS AND REVIEW OF THE LITERATURE
(Cirodde A., Jault P., Leclerc T., Donat N., Bargues L. - France)
Burned patients are prone to develop severe intestinal complications because of decreased splanchnic circulation. We report three cases of sigmoid perforation in burn patients appearing late during hospitalization. The common aetiological factor was a state of septic shock treated with infusion of vasopressors. Two patients also received corticosteroids as treatment for acute respiratory distress syndrome. These cases underline the necessity to maintain adequate organ perfusion and to prevent intestinal ischaemia in severe burns.
26 CARDIOVASCULAR DYSFUNCTION IN BURNS: REVIEW OF THE LITERATURE
(Abu-Sittah G.S., Sarhane K.A., Dibo S.A., Ibrahim A. - Lebanon)
Major burn injury produces substantial hemodynamic and cardiodynamic derangements, which contribute to the development of sepsis, multiple organ failure, and death. Cardiac stress is the hallmark of the acute phase response and its severity determines postburn outcomes, with poorer outcomes associated with cardiac dysfunction. With available evidence from the literature, the present is a comprehensive review of cardiac dysfunction in burns as well as the different monitoring modalities.
38 THE USE OF OSMED TISSUE EXPANDERS IN PAEDIATRIC BURNS RECONSTRUCTION
(Lohana P., Moiemen N.S., Wilson Y.T. - United Kingdom)
Background. Tissue expansion has been a major advance in reconstructive burn surgery. The conventional tissue expander requires serial filling with the possibility of painful procedures, which can be a major challenge and source of anxiety in children. The osmotic self-inflating tissue expander, on the other hand, is a device that does not require external filling, offering apparent benefits particularly in the paediatric population. We used Osmed tissue expanders for secondary burn reconstruction in children and teenagers who had sustained burns during childhood. Methods. Patients who were treated with Osmed expanders for secondary burns reconstruction were recorded. Patient demographics (i.e. burn injury data, indications for surgery), Osmed tissue expander data (i.e. operative data, complications, problems encountered during and after treatment, explantation time, final expander volume) and overall success were recorded. Results. Twelve Osmed self-inflating tissue expanders were used in patients for secondary burns reconstruction between October 2007 and January 2009. All our patients sustained their burns during childhood. There were three females and one male; the age range was 14-19 yr (mean age, 16 yr). Tissue expanders were removed on average at 6-7 weeks except in two patients. We noted four complications in our cohort. Overall the mean expansion was 65% of the proposed final volume. Discussion. We found the Osmed tissue expander simple to implant and well tolerated by our patients. However, none of the devices achieved full expansion and overexpansion was not possible. We believe conventional tissue expanders are still the gold standard, although osmotic expanders may have a role in burn reconstruction in younger children.
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