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Volume XXVII

Number 3

September 2014

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115 Epidemiology of outpatient burns in Iran: an update
(Karimi H., Motevalian S.A., Momeni M. - Iran)
Burn injury remains a serious and devastating issue faced by developing countries. It is also true, however, that the developed world still tackles many of the challenges caused by burns. In order to reduce this problem through preventive programs, the characteristics of this type of injury must be studied and well documented in each setting. Our study aims to show the epidemiology, demographic distribution and clinical outcomes of burns patients referred to Motahari Burn Hospital, the burn care center that receives the most referrals in Iran. This cross-sectional study, from March 2009 to March 2010, included 6,910 patients with burn injuries who were managed as outpatients. The patient demographics along with the characteristics of the burn injuries and their outcomes were recorded for each case and then evaluated. A total of 6,910 burn patients with a mean ± SD age of 30.20 ± 19.11 years presented to our Emergency Department and were treated as outpatients. Of these, 2,900 were female (41.97%) and 4,010 were male (58.03%). Most of the patients were in the 25-35 year age group, with a prevalence of 1,148 (28.6% of total) males and 716 females (24.7% of total), followed by those aged ≤15-years-old. Most patients had been burned accidentally. An increase in the instance of self-immolation was identified with an increase in the TBSA burned. Mean follow-up was 30+/-5 months. The results revealed that burns were most likely to occur during housekeeping. Other high risk groups identified were males, those aged from 25 to 35 years-old, and those with lower socio-economic status.
121 Stevens-Johnson Syndrome triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old child
(Yapici A.K., Fidanci M.K., Kilic S., Balamtekin N., Mutluay Arslan M., Yavuz S.T., Kalman S. - Turkey)
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are diseases within the spectrum of severe cutaneous adverse reactions affecting skin and mucous membranes. Antiepileptic drugs (AEDs) are used in combination, leading to potential pharmacokinetic or pharmacodynamic interactions, causing more adverse effects than might occur when the AED is taken as monotherapy. Here, we report a rare case of SJS triggered by a combination of clobazam, lamotrigine and valproic acid in a 7-year-old boy. Because of inadequate seizure control, lorazepam was replaced with clobazam. Four weeks after the addition of clobazam, the patient developed SJS with a generalized rash, fever, with liver and kidney involvement, and eosinophilia one week after the initiation of treatment. All antiepileptic drugs were discontinued, and intravenous methylprednisolone, prophylactic systemic antibiotics, intravenous fluid supplement, antipyretic, special wound care, and supportive medical care for SJS were administered. He was discharged in a stable condition on the 18th day. Our case suggests that a drug-drug interaction between valproate, lamotrigine and clobazam contributed to the development of SJS. When the clobazam was added to valproic acid and lamotrigine co-medication, the lamotrigine dose should have been decreased.
126 Burn injury in epileptic patients: an experience in a tertiary institute
(Akhtar M.S., Ahmad I., Khan A.H., Fahud Khurram M., Haq A. - India)
The objective of this study was to evaluate the incidence, types and severity of burn injuries, including sites involved, morbidities, operative procedures, and their outcomes, to prevent or reduce the frequency and morbidity of such injuries in epileptic patients. This retrospective study was conducted at our centre between February 2008 and January 2012. The study included 54 patients who sustained burn injuries due to epileptic seizures, accounting for 1.3% of all burn admissions. All patients, irrespective of the severity of their injuries, were admitted to our centre, assessed, treated and educated regarding specific preventive measures. All study data were evaluated from patient medical records. Causes of burn injury were as follows: scald burns (30), contact with hot surfaces (12), electrical burns in the bathroom (6), and flame burns (6). Second degree burns were the most common (18 out of 54 patients) and third degree burns were the least common. Upper limb and trunk were the most common sites involved (36 out of 54 patients). Thirty patients required surgical intervention whereas the remainder was conservatively managed. Most of the injuries occurred in the age group between 30-37 years. Injuries occurred predominantly in females [42 females, 12 males; F:M=3.5:1]. The study revealed that patients with epilepsy should be categorized as a high risk group considering the sudden and unpredictable attack of epileptic seizures leading to loss of consciousness and accidental burn injuries. Early surgical intervention and targeting of all epileptic patients for education and instituting the specific preventive measures gives good outcomes.
130 Electric fly swatter: potentially harmful not only for insects?
(Ioannidis S., Spyropoulou G.A., Pavlidis L., Dionyssiou D., Demiri E. - Greece)
The electric fly-swatter is a household device used widely in Greece to kill mosquitoes. It consists of a racket-shaped electrical screen which is free of toxic and other chemicals. When the screen touches the insects, the contact generates an electric flash of light and the insects are incinerated. We present the case of a 15% flame burn caused by the flash of light produced by an electric fly-swatter. According to our review of the literature, this is the second case of burn injury caused by an electric fly swatter.
132 L'engelure causée par le butane commercial au cours d'un accident industriel
(Assi-Dje Bi Dje V., Abhe C.M., Sie-Essoh J.B., Kouamé K., Vilasco B. - République de Côte d'Ivoire)
Les engelures sont encore exceptionnelles en Afrique sub-saharienne, mais l'essor des industries pétrochimiques en rapport avec la promotion d'une large utilisation du gaz domestique (butane commercial) expose au risque de survenue de ce type de brûlures abusivement dites gelures. Nous rapportons un cas de brûlures au froid par gaz de pétrole liquéfié (GPL) en milieu professionnel dont le diagnostic de gravité et la prise en charge tardifs ont défavorisé l'évolution locale. Le respect des mesures de sécurité au sein des usines reste néanmoins le principal moyen de prévention de ce type de brûlures méconnues.
136 Use of Xe-Derma®, a novel biological cover, in a female patient with toxic epidermal necrolysis
(Lipový B., Rihová H., Kaloudová Y., Mager R., Suchánek I. - Czech Republic)
Toxic epidermal necrolysis is a rare condition involving the skin at the dermoepidermal junction, with possible inclusion of mucous membranes. The condition is associated with systemic toxicity and high mortality rates. Successful treatment requires optimization of local as well as systemic therapy. We report the case of a young woman who developed toxic epidermal necrolysis, possibly resulting from lamotrigine therapy. Local therapy included a combination of a biological cover and alginate together with a synthetic cover (Aquacel Ag®).
141 Skin graft fixation in severe burns: use of topical negative pressure
(Kamolz L.P., Lumenta D.B., Parvizi D., Wiedner M., Justich I., Keck M., Pfurtscheller K., Schintler M. - Austria)
Over the last 50 years, the evolution of burn care has led to a significant decrease in mortality. The biggest impact on survival has been the change in the approach to burn surgery. Early excision and grafting has become a standard of care for the majority of patients with deep burns; the survival of a given patient suffering from major burns is invariably linked to the take rate and survival of skin grafts. The application of topical negative pressure (TNP) therapy devices has demonstrated improved graft take in comparison to conventional dressing methods alone. The aim of this study was to analyze the impact of TNP therapy on skin graft fixation in large burns. In all patients, we applied TNP dressings covering a %TBSA of >25. The following parameters were recorded and documented using BurnCase 3D: age, gender, %TBSA, burn depth, hospital length-of-stay, Baux score, survival, as well as duration and incidence of TNP dressings. After a burn depth adapted wound debridement, coverage was simultaneously performed using split-thickness skin grafts, which were fixed with staples and covered with fatty gauzes and TNP foam. The TNP foam was again fixed with staples to prevent displacement and finally covered with the supplied transparent adhesive film. A continuous subatmospheric pressure between 75-120 mm Hg was applied (VAC®, KCI, Vienna, Austria). The first dressing change was performed on day 4. Thirty-six out of 37 patients, suffering from full thickness burns, were discharged with complete wound closure; only one patient succumbed to their injuries. The overall skin graft take rate was over 95%. In conclusion, we consider that split thickness skin graft fixation by TNP is an efficient method in major burns, notably in areas with irregular wound surfaces or subject to movement (e.g. joint proximity), and is worth considering for the treatment of aged patients.
146 Sulfur mustard gas exposure: case report and review of the literature
(Goverman J., Montecino R., Ibrahim A., Sarhane K.A., Tompkins R.G., Fagan S.P. - USA)
This report describes a case of burn injury following exposure to sulfur mustard, a chemical agent used in war. A review of the diagnostic characteristics, clinical manifestations, and therapeutic measures used to treat this uncommon, yet extremely toxic, entity is presented. The aim of this report is to highlight the importance of considering this diagnosis in any war victim, especially during these unfortunate times of rising terrorist activities.
151 CASE REPORT: A cause of severe chemical burn: topical application of herbal medicines
(Karacor-Altuntas Z., Ince B., Dadaci M., Altuntas M. - Turkey)
We report a 73-year-old male patient with progressive chemical burn on his lower extremities following topical application of a mixture of the oils derived from Rosmarinus officinalis, Brassica nigra alba and Laurus nobilis. It should be kept in mind that herbal medicines which seem harmless can sometimes be dangerous and life-threatening, especially in elderly and diabetic patients.
154 The burn registry program in Iran - First report
(Karimi H., Momeni M., Motevalian A., Bahar M.A., Boddouhi N., Alinejad F. - Iran)
Burn injury is still a major problem in Iran, resulting in many reports which are usually dispersed, uncoordinated and probably unreliable. We created a burn registry comprised of a data entry program with 222 variables for each admitted burn patient. This program was established in August 2010 at the Iran University of Medical Sciences, Motahari Burn Hospital. We had 14,277 burn patients from August 2010 to August 2011, 877 of whom were admitted to the hospital. Of the patients, 65.9% were male and 34.1% were female. The age was 28.85 years (SD = 19.77). The most prevalent cause of burn was flame 78.5% (pipe propane gas 57.2; kerosene 19.9%). The mean total body surface area (TBSA) involvement was 23%. A total of 77.8% of patients were discharged with partial recovery, while mortality was 8.9%. The mean hospital stay was 14.63 days (SD =11.07). The program is designed to help understand the scope of burn injury in Iran, providing information on patients, etiology, and course of treatment. It also highlights differences between various parts of the country in terms of the causes and frequency of burn injuries. Moreover, the burn registry provides a basis for further research and surveys for treatment and preventive programs. Our results showed that, although Emergency Medical Services (EMS) staff are highly capable and well-trained, their coverage seems to be less than 50% and needs to be increased. Marriage status was shown to have no influence on the occurrence of burns, and among our patients, 57.0 % were poorly educated.
160 LETTER TO THE EDITOR: Paediatric burns severity index scoring to predict mortality
(K. Mathangi Ramakrishnan, Mathivanan, Mary Babu, Bala Ramachandran, Janani Shankar, Sulochana Putlibai, Amith Toshnival, Padmanabhan Srinivasan - India)
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