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Volume XXVI |
Number 4 |
December 2013 |
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Summaries
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IRON BURNS: A PROBLEM IN ADULTS AS WELL AS CHILDREN
(Chipp E., Pape S. - United Kingdom)
Burns from domestic irons are potentially preventable injuries which can result in significant morbidity. Several studies have reported these injuries in children but there are no reports to date in adults. Epidemiology, management and outcome of these injuries is described, and possible preventative strategies are discussed. We present a retrospective case note review of 50 adult and paediatric patients with electric iron burns. Cases were identified from data collected for a national burns database. Information regarding demographics, burn characteristics, treatment and long term outcome was gathered from the medical records. 42 children and 8 adults sustained a burn from an iron during the 4-year study period. The majority of paediatric patients were under 4 years of age. Most burns were small (< 1% TBSA) but despite this 30 (60%) patients were admitted to hospital and 13 (26%) required at least one surgical procedure. In children, most burns occurred at home and were commonly due to pulling the flex or knocking the iron from its surface. In adults, 50% of injuries were associated with epilepsy. Burns from domestic irons are relatively common and cause significant morbidity despite their small size. A bimodal presentation is seen with injuries occurring either before the age of 4 years or during adulthood, when they are typically associated with an underlying medical condition. Education campaigns and design features such as a retractable cord may further reduce the incidence of this type of burn.
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| 175 |
NEONATAL BURN INJURIES: AN AGONY FOR THE NEWBORN AS WELL AS THE BURN CARE TEAM
(Saaiq M., Ahmad S., Zaib S. - Pakistan)
This retrospective analysis of neonatal burn injuries was carried out at the Department of Plastic Surgery and Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. A total of 11 neonates who were aged less than 29 days were managed during the 2 year study period. Out of these, 72.7% (8) were male and 27.3% (3) were female. The mean age was 11.18±9.67days. The commonest underlying cause of burn insult was accidental direct contact with room heaters in 4 (36.3%) neonates. The TBSA burnt ranged from 3%-55%, with a mean of 18.72±17.13%. All the neonates (100%) presented during winter season. Among the body areas affected, the most common was face/head and neck (10). The commonest operative procedure undertaken among the neonates included early wound excision followed by resurfacing with split thickness autografts (5). There were three in-hospital mortalities (27.2%) in our series.
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| 182 |
SELECTIVE DIGESTIVE DECONTAMINATION (SDD) AS A TOOL IN THE MANAGEMENT OF BACTERIAL TRANSLOCATION FOLLOWING MAJOR BURNS
(Aboelatta Y.A., Abd-elsalam A.M., Omar A.H., Abdelaal M.M., Farid A.M. - Egypt)
Bacterial translocation after major burns plays an important role in burn sepsis and can be reduced with SDD. 30 patients with burns of 25-50% TBSA were divided into 2 groups. Group I received SDD regimen in the form of amikacin, miconazole, and colistin sulphate. Group II served as a control group. SDD treatment resulted in significant control of infectious episodes and multi-organ dysfunction syndrome (MODS). It also resulted in a reduction of mortality, although this was not statistically significant. Despite the statistical insignificance of the improved mortality rate, SDD treatment seems to be a useful tool in treating this group of highly critical patients.
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| 189 |
COEXISTENCE OF EXTENDED SPECTRUM BETA-LACTAMASES, AMPC BETA-LACTAMASES AND METALLO-BETA-LACTAMASES IN ACINETOBACTER BAUMANNII FROM BURNS PATIENTS: A REPORT FROM A TERTIARY CARE CENTRE OF INDIA
(Gupta V., Garg R., Garg S., Chander J., Attri A.K. - India)
Multidrug-resistant Acinetobacter baumanii is a major pathogen encountered in pyogenic infections, especially from burns patients in hospital settings. Often there is also coexistence of multiple beta-lactamase enzymes responsible for beta-lactam resistance in a single isolate, which further complicates treatment options. We conducted a study on burn wound pus samples obtained from the burns unit of our hospital. Phenotypic tests were used to determine the Extended Spectrum Beta-Lactamase, AmpC Beta-Lactamase and Metallo-Beta-Lactamase producing status of the isolates. Almost half of the samples from the burn wounds yielded Acinetobacter baumanii as the predominant pathogen (54.05%). Coexistence of the three resistance mechanisms was seen in 25 of the 100 (25%) isolates of Acinetobacter baumanii. This study emphasizes the need for the detection of isolates that produce these enzymes to avoid therapeutic failures and nosocomial outbreaks.
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| 193 |
EVALUATION OF ZATARIA MULTIFLORA BOISS AND CARUM COPTICUM ANTIBACTERIAL ACTIVITY ON IMP-TYPE METALLOBETA-LACTAMASE-PRODUCING PSEUDOMONAS AERUGINOSA
(Fallah F., Taherpour A., Borhan R.S., Hashemi A., Habibi M., Sajadi Nia R. - Iran)
Carbapenem resistance due to acquired metallo-beta-lactamases (MBLs) is considered to be more serious than other resistance mechanisms. The aim of this study was to evaluate the antibacterial activity of Zataria multiflora Boiss and Carum copticum plants on IMP-producing P.aeruginosa strains. This experimental study was carried out on hospitalized burn patients during 2011 and 2012. Antibiotics and extracts susceptibility tests were performed by disc diffusion and broth microdilution methods. MBL detection was performed by Combination Disk Diffusion Test (CDDT). The bla(VIM) and bla(IMP) genes were detected by PCR and sequencing methods. Using Combination Disk Diffusion test method, it was found that among 83 imipenem resistant P.aeruginosa strains, 48 (57.9%) were MBL producers. PCR and sequencing methods proved that these isolates were positive for blaIMP-1 genes, whereas none were positive for bla(VIM) genes. The mortality rate of hospitalized patients with MBL-producing Pseudomonas infection was 4/48 (8.3%). It was shown that Zataria multiflora and Carum copticum extracts had a high antibacterial effect on regular and IMP-producing P. aeruginosa strains in 6.25 mg/ml concentration. The incidence of MBL-producing P. aeruginosa in burn patients is very high. In our study, all MBL-producing isolates carry the blaIMP-1 gene. Therefore, detection of MBL-producing isolates is of great importance in identifying drug resistance patterns in P. aeruginosa, and in prevention and control of infections. In this study, it was shown that extracts of Z. multiflora and C. copticum have high antibacterial effects on ß-lactamase producing P. aeruginosa strains.
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| 199 |
ULCERE DE MARJOLIN : COMPLICATION REDOUTABLE DES SEQUELLES DE BRULURES
(Ouahbi S., Droussi H., Boukind S., Dlimi M., Elatiqi O.K., Elamrani M.D., Benchamkha Y., Ettalbi S. - Maroc)
L'ulcère de Marjolin désigne la transformation maligne d'une cicatrice de brûlure ou de toute autre plaie ou ulcération chronique. Le type histologique prédominant reste le carcinome épidermoïde, et il est caractérisé par son agressivité locale, des métastases plus fréquentes, un risque de récurrence et une mortalité plus importante que les carcinomes épidermoïdes classiques. Notre travail est une étude rétrospective portant sur 21 cas d'ulcère de Marjolin, colligés au service de chirurgie plastique du CHU Mohammed VI de Marrakech, avec pour but de relever les aspects épidémiologiques, thérapeutiques et évolutifs de cette pathologie. L'amélioration du pronostic nécessite non seulement un diagnostic et un traitement précoce, mais surtout une attitude préventive qui consiste en des greffes cutanées précoces et des soins réguliers de toute cicatrice de brûlure.
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| 205 |
PRESSURE GARMENT THERAPY (PGT) OF BURN SCARS: EVIDENCE-BASED EFFICACY
(Atiyeh B.S., El Khatib A.M., Dibo S.A. - Lebanon)
Hypertrophic burn scars pose a challenge for burn survivors and providers. In many cases, they can severely limit a burn survivor's level of function, including work and recreational activities. A widespread modality of prevention and treatment of hypertrophic scarring is the utilization of pressure garment therapy (PGT). Despite the magnitude of the problem of hypertrophic scarring and the ubiquitous use of pressure garments as therapy, strong clinical evidence of the efficacy of PGT in the literature is lacking. Some of the challenges facing measurement of efficacy of PGT on hypertrophic scarring are lack of clear definitions for degree of hypertrophic scarring, inability to quantify pressure applied to scars, patient noncompliance to strict PGT time schedules, and inability to conduct randomized controlled trials comparing PGT to no therapy for ethical reasons since PGT is considered a standard of care. In this review, we attempt to summarize and analyze evidence-based literature on PGT and its efficacy in burn hypertrophic scars published in English language in the past 15 years.
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| 213 |
THE ROLE OF A DEDICATED STAFF PSYCHIATRIST IN MODERN BURN CENTERS
(Moore M., Fagan S., Nejad S., Bilodeau M., Goverman L., Ibrahim A.E., Beresneva O., Sarhane K.A., Goverman J. - USA)
Psychiatric disorders may be more common in burn-injured subjects than in the general population, and oftentimes contribute to the injury itself. Even in the absence of underlying psychiatric illnesses, burn patients may still benefit from a psychiatric evaluation during and after their hospitalization. In this regard, we included a dedicated psychiatry service in our multidisciplinary burn team. We review herein the course of burn patients that were offered psychiatric evaluation and highlight the benefits of such a program. We conducted an IRB-approved retrospective chart review of burn subjects admitted to our institution between June 15, 2009 and April 30, 2010 and identified 83 patients that were examined by our psychiatrist. Indications for consultation, history of psychiatric illness and substance abuse, as well as administered drugs, were recorded. Among the 83 evaluated patients, 48 (57.8%) had a preexisting psychiatric disorder and 36 (43.4%) suffered from substance abuse. The most common indications for consultation were pain (28.1%), alcohol dependence (25.8%), anxiety (24.7%), illicit drug abuse (16.8%), depression (15.7%), post-traumatic stress disorder (8.9%), and sleep disturbances (8.9%). Pharmacotherapy was initiated in 75 patients (90.3%). 31 (37.3%) had neither a psychiatric disorder nor a history of substance abuse, although 26 of them (83.9%) still received drugs for psychiatric conditions. The inclusion of a dedicated psychiatrist as part of our burn team has improved our comprehensive burn care. In the overwhelming majority of cases, even in the absence of preexisting psychiatric illnesses, consultation resulted in pharmacologic intervention and enhanced patient care.
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| 217 |
SUICIDAL BURNS IN SAMARKAND BURN CENTERS AND THEIR CONSEQUENCES
(Shakirov B.M., Ahmedov Y.M., Hakimov E.A., Tagaev K.R., Karabaev B.H. - Uzbekistan)
Suicide is a global public health problem, particularly in Asia where few countries with large populations have high suicide rates accounting for the majority of the world's suicides. During a 14-year period, 76 individuals, aged 17 to 66 years, committed suicide from 1995 to 2008 and were included in this report. Data was collected on each patient including, age, sex, place of injury, patient occupation, accommodation, psychiatric illness, suicidal motives, flammable substances used, place of burn, season of the year, and total body surface area (TBSA) burnt. Most suicidal cases (55 out of 76) had a history of depressive episodes and emotional unstable disorders, and 18 of them had a known history of psychiatric illness. In 5 cases alcohol intoxication was present at the moment of suicide, and 3 patients had chronic alcohol dependence together with basic psychiatric disease. It is also evident from this study that the causes of suicide in females are mainly socio-economical and psychological.
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