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Volume XXV

Number 4

December 2012

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Summaries

171 EPIDEMIOLOGICAL DATA, OUTCOME, AND COSTS OF BURN PATIENTS IN KERMANSHAH
(Karami Matin B., Karami Matin R., Ahmadi Joybari T., Ghahvehei N., Haghi M., Ahmadi M., Rezaei S. - Iran)
Burn injuries in both developed and developing countries cause long-term disability, mortality, and socio-economic costs that are imposed on patients, families, and societies. This study was carried out to investigate the epidemiology, outcome, and cost of hospitalization of 388 burn patients admitted to the Imam Khomeini Hospital Burn Center in Kermanshah, Iran, between 21 March 2011 and 20 March 2012. The data about demographics, cause of burns, degree of burns, outcome of burns, burned body surface (BBS), length of stay (LOS), and cost of hospitalization were collected by reviewing medical records and analysed by SPSS 16. The patients' mean age was 27 years. The male/female ratio in burn patients was 1.14/1. The mean BBS was 36.06%. The mean LOS was 9.04 days. Flame (67.0%) and hot liquids (21.9%) were the major causes of burn. Burn injuries were more common in the upper limbs (81.4%), lower limbs (70.9%), and head and neck (65.2%). 11.6% of patients had all the regions involved. The fatality rate was 18.8%. The mean cost per patient was 20,463,227 Iran Rials (IRR). The cost per one percentage of burn and one day of hospitalization was 562,632 IRR and 2,263,631 IRR, respectively. The main factors relevant to death were identified including the extent of burn, gender, age, causes, and degree of burn. In addition, LOS proved to have a higher impact on costs than burn percentage.
178 EPIDEMIOLOGY AND OUTCOME OF BURNS AT THE SAUD AL BABTAIN BURNS, PLASTIC SURGERY AND RECONSTRUCTIVE CENTER, KUWAIT: OUR EXPERIENCE OVER FIVE YEARS (FROM 2006 TO 2010)
(Khashaba H.A., Al-Fadhli A.N., Al-Tarrah K.S., Wilson Y.T., Moiemen N. - Kuwait)
Aim. To determine the epidemiology and clinical presentation, and any contributing factors responsible for burns and outcome of care in Kuwait over the 5-yr period January 2006 to December 2010. Patients and methods. The study reviewed 1702 burn patients admitted over the study period to the Saud Al Babtain Burns, Plastic and Reconstructive Surgery Center, Kuwait. Patient characteristics, including age, sex, type of burn, nationality, total body surface area (TBSA) burn, hospital stay in days, and mortality were recorded. Results. Seventy-one per cent of the 1702 burn patients admitted were males; 540 were children. The majority of patients (64%) had less than 15% TBSA burns and only 14% had more than 50% TBSA burns. Flame burns were the most common cause of burn injuries (60%), followed by scalds (29%). Scalds were most common in children. The mortality rate was 5.75%. Flame burn was the leading cause of mortality. Lethal dose 50 (% TBSA at which a certain group has a 50% chance of survival) for adults (16-40 yr) and for the elderly (>65 yr) was 76.5% and 41.8% TBSA respectively. Conclusion. Burn injury is an important public health concern and is associated with high morbidity and mortality. Flame and scald burns are commonly a result of domestic and occupational accidents and they are preventable. Effective initial resuscitation, infection control, and adequate surgical treatment improve outcomes.
188 PREVENTION OF BURNS IN DEVELOPING COUNTRIES
(Van der Merwe A.E., Steenkamp W.C. - South Africa)
Burns represent an important health and economic problem in Africa and in the developing countries. Prevention programs in the developing countries are still at an infant phase. It is well known that prevention includes surveillance with data analysis and reporting. With information campaigns, an effort can be made to use regulatory action, to educate the population and modify the environment. The aim of this paper is to identify the risk factors in communities in order to implement communitybased burn prevention strategies, not only on the African continent but also in other developing countries. Effective prevention programs are highlighted. Evidence regarding adequate safety legislation with policing seems to show immediate effects with multiparty involvement and statistical decrease of injury and death. Three examples are discussed where political commitment is mobilised to ensure regulatory action. Other programs are cost-effective and have long-lasting effects, but they take time. Cochrane database system reviews highlighted the problems when people were encouraged to change their lifestyle. NGOs play a definite role in developing countries, and in Bangladesh and Pakistan efforts are being made to curb acid-throwing violence. Communities consist of many groups. There must be a societal responsibility to design products and environments so that people find it easy and convenient to behave in a safe manner, often referred to as "forgiving systems".
192 QUALITY OF LIFE IN BURN PATIENTS IN GREECE
(Stampolidis N., Castana O., Nikiteas N., Vlasis K., Koupidis S.A., Grammatikopoulos I.A., Mantzari E., Pallantzas A., Kourakos P., Papadopoulos O. - Greece)
The Burn Specific Health Scale - Brief (BSHS-B) is one of the most commonly used instruments for the evaluation of quality of life after burn injury. It can be self-administered, and it is useful in evaluating psychopathological symptoms in burn victims. The aim of this study was to translate and culturally adapt the BSHS-B into Greek, assessing its internal consistency and validity. The cultural adaptation included forward and backward translation, reconciliation, and a pilot study. The Greek version was administered to a sample of 40 adult burn victims admitted to our Burn Centre. Internal consistency was verified using Cronbach's alpha, and construct validity was evaluated through correlation with the Short Form of Health Survey Questionnaire (SF- 36) using Spearman analysis. The Cronbach alpha coefficient of the questionnaire's total score was 0.954, demonstrating that the internal consistency of the Greek version was very high. The test-retest coefficient using kappa correlation was 0.830 (p < 0.001). Significant correlations were identified between BSHS-B subscales and the SF-36 subscales - Physical and Social Functioning, and Emotional Role. Despite the limited size of the sample, the Greek version of the BSHS-B shows good reliability and construct validity and can be used in clinical practice for further evaluations of burn patients' quality of life.
196 EVALUATION OF MATERNAL AND FOETAL OUTCOMES IN PREGNANT WOMEN HOSPITALIZED IN KERMANSHAH HOSPITALS, IRAN, OWING TO BURN INJURY, 2003-2008
(Rezavand N., Seyedzadeh A., Soleymani A. - Iran)
This study addresses maternal and foetal complications in pregnant women hospitalized for burn injuries in 2003- 2008. It was a retrospective descriptive cross-sectional study, carried out in pregnant women hospitalized in the burn ward of Imam- Khomeini Hospital, Iran, in 2003-2008 (burn injury rate, 1.88%, 39 cases; mean age, 23.51 4.78 yr). The pregnant woman death rate was 66.7%: 26 patients died because of burn complications and 13 patients (23.3%) survived. The causes and circumstances of the fatalities are reported. There was a statistically significant relationship between burn severity and foetal and maternal mortality rates (p < 0.02). Burn severity was not statistically related to premature delivery and mode of delivery. The factors affecting prognosis and the maternal and foetal death rates were the total burn area, continuous clinical surveillance of the mother and foetus, and employment of appropriate treatment protocols.
200 HAIR BLEACHING AND SKIN BURNING
(Forster K., Lingitz R., Prattes G., Schneider C., Sutter S., Schintler M., Trop M. - Austria)
Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.
203 ELECTROCAUTERY BURNS: EXPERIENCE WITH THREE CASES AND REVIEW OF LITERATURE
(Saaiq M., Zaib S., Ahmad S. - Pakistan)
This brief report highlights three cases of iatrogenic electrocautery burns with review of the relevant published literature. The aim is to prompt awareness among surgeons and theatre staff regarding this avoidable hazard associated with the equipment frequently used for the purpose of electrocautery. This may serve as a reminder to professionals to be cautious about the pitfalls that lead to such preventable injuries.
207 DEVELOPMENT OF A COST-EFFECTIVE METHOD FOR PLATELET-RICH PLASMA (PRP) PREPARATION FOR TOPICAL WOUND HEALING
(Akhundov K., Pietramaggiori G., Waselle L., Darwiche S., Guerid S., Scaletta C., Hirt-Burri N., Applegate L.A., Raffoul W.V. - Switzerland)
Platelet-rich plasma (PRP) is a volume of plasma fraction of autologous blood having platelet concentrations above baseline whole-blood values due to processing and concentration. PRP is used in various surgical fields to enhance soft-tissue and bone healing by delivering supra-physiological concentrations of autologous platelets at the site of tissue damage. These preparations may provide a good cellular source of various growth factors and cytokines, and modulate tissue response to injury. Common clinically available materials for blood preparations combined with a two-step centrifugation protocol at 280g each, to ensure cellular component integrity, provided platelet preparations which were concentrated 2-3 fold over total blood values. Costs were shown to be lower than those of other methods which require specific equipment and high-cost disposables, while safety and traceability can be increased. PRP can be used for the treatment of wounds of all types including burns and also of split-thickness skin graft donor sites, which are frequently used in burn management. The procedure can be standardized and is easy to adapt in clinical settings with minimal infrastructure, thus enabling large numbers of patients to benefit from a form of cellular therapy.
214 ASSAULT BY BURNING IN JORDAN
(Haddadin W. - Jordan)
Criminal attacks by burns on women in Jordan are highlighted in this retrospective study carried out of all proved cases of criminal burns in female patients treated at the burn unit of the Royal Rehabilitation Center in Jordan between January 2005 and June 2012. Thirteen patients were included in our study, out of a total of 550 patients admitted, all in the age range of 16-45 yr. Of these 13 women, six were burned by acid throwing, five by hot water, and two by direct flames from fuel thrown over them. Burn percentage ranged from 15 to 75% of the total body surface area, with involvement in most cases of the face and upper trunk. The mean hospital stay was 33 days and the mortality rate was 3/13, i.e. 23%. Violence against women exists in Jordanian society, yet burning assaults are rare. Of these, burning by throwing acid is the most common and most disfiguring act, with a higher mortality rate in domestic environments.
217 BURNS DURING EASTER FESTIVITIES IN GREECE
(Pallantzas A., Kourakos P., Stampolidis N., Papagianni E., Balagoura A., Stathopoulos A., Polizoi A., Emvalomata A., Evaggelopoulou M., Castana O. - Greece)
Easter is the most important holiday for the Greek Church. It is rich in traditions and rituals but during the Greek Easter festivities, especially at midnight Mass on Easter Saturday night, it is customary to throw fireworks around. These fireworks are not part of the true Easter tradition and they are potentially fatal. Unfortunately, in the past few years, the custom has become more and more popular in Greece. There are some local variations, mainly in the Aegean islands, where homemade rockets are used to have a "rocket war". The rockets consist of wooden sticks loaded with an explosive mixture containing gunpowder and launched from special platforms. Many severe injuries involving loss of sight and limbs as well as major burns are also caused by the use of illegal fireworks at Easter. Every year numerous burn victims are hospitalized. The most affected areas are the face, the upper extremities, and the chest, often in association with slight or severe wounds and injuries. This study presents our department's experience with incidents due to the use of fireworks during Easter festivities.
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