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Volume XXIX |
Number 4 |
December 2016 |
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Summaries
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PAEDIATRIC BURN INJURIES REQUIRING HOSPITALIZATION IN FARS, SOUTHERN IRAN
(Marashi S.M., Sanaei-Zadeh H., Taghizadeh Behbahani A., Ayaz M., Akrami M. - Iran)
The aim of this study was to determine the demographic characteristics of burnt children in need of hospitalization, causesof burns and associated complications in Fars province, Iran. This is a retrospective cross-sectional study. Files of all children under 15 years of age who were hospitalized in the only burn referral centre of Fars province were evaluated. Data regarding age, gender, location (urban, rural), burn surface area (BSA), cause of burn, length of hospital stay and complications were extracted from patients' files. Data were analyzed using SPSS, version 22 and the Chi-square test. A p-value of less than 0.05 was considered as statistically significant. A total of 122 patients (54.9% males) were studied. Children from rural areas were hospitalized 1.4 times more often than urban children. Overall, 31.2% of admissions occurred in winter. Burning with hot liquids (scalding) was the most common cause of burns (56.6%, n = 69). Mean BSA was 12.29 ± 21.18% and mean length of hospital stay was 7.59 ± 12.78 days. Burn complications were seen in 19 cases (15.6%). One child died due to inhalational thermal injury. This study showed that burns mostly occur in boys, in the winter and in rural areas of Fars province. Furthermore, scald burns are the most common type of burn injury. Since a significant number of children suffer from permanent complications following burn injuries, special planning is needed to prevent this type of injury.
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| 249 |
MANAGEMENT OF BURNS IN THE ELDERLY
(Abu-Sittah G.S., Chahine F.M., Janom H. - Lebanon)
Burns are one of the most devastating forms of trauma worldwide. While geriatric burns are uncommon in the developing world - accounting for less than 5% of burns in South Asian and Middle Eastern countries - they account for almost 20% of burns in economically developed countries such as the USA. The elderly population in general is at higher risk for burn injury, moreover mortality rate, as well as severity of complications, is more pronounced in this group of patients. A review of the literature was conducted to evaluate risk factors as well as pathophysiological and immunological conditions that affect response to burn injury in the elderly population. Surgical and medical interventions used for the management of geriatric burns remain a field of controversy and ongoing debate. Improvement of burn management with reduction in mortality in this age group warrants addressing survivors' quality of life, with a special focus on rehabilitation and support.
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| 255 |
THE BURNING ISSUES OF MOTOR VEHICLE RADIATOR SCALD INJURIES REVISITED - A FRESH REVIEW AND CHANGING PREVENTION STRATEGIES
(Patel J.N., Tan A., Frew Q., Dziewulski P. - United Kingdom)
A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced.
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| 259 |
PATTERN OF HIGH VOLTAGE ELECTRICAL INJURIES IN THE KASHMIR VALLEY: A 10-YEAR SINGLE CENTRE EXPERIENCE
(Kasana R.A., Baba P.U.F., Wani A.H. - India)
The objective was to study the clinical profile of high voltage electrical injuries in Kashmir, and various prevention and safety measures to bring down the incidence of such injuries in the future. All patients (176) with high voltage electrical injuries reporting to our centre from January 2001 to December 2010 were included in the study. The most common age group was 20-40 years, with mean age of 29.77 ± 8.98 years. Incidence was higher among the rural population (68.75%) than in urban areas (31.25%), and in the winter months. Electricians comprised 47.16% of victims. The most common mode of injury was touching a live wire directly or indirectly, and was seen in 63.64% of victims. Average total body surface burned was 15.27 ± 10.15 percent. Right upper limb was most commonly involved (64.20% of patients). Compartment syndrome was seen in 40.34% of patients, and fasciotomies on all the affected limbs saved around half of them. An average of 3.91 surgical procedures per patient were performed. Around one-third of the victims required major amputations. Reconstructive procedures were required in 49.43% of patients. Average hospital stay was 26.81 days. Average mortality rate was 2.27%. High voltage electrical injuries are not uncommon in the Kashmir Valley, and electrical workers are at higher risk. The incidence of high voltage injuries would not be so high if the workers were properly trained, hazards of high-tension lines were explained and the use of safety equipment was made mandatory.
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| 264 |
FAST AND SPECIFIC DETECTION OF PSEUDOMONAS AERUGINOSA FROM OTHER PSEUDOMONAS SPECIES BY PCR
(Jami Al-Ahmadi G., Zahmatkesh Roodsari R. - Iran)
Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen that plays a prominent role in wound infections of burned patients. We designed this study to identify the isolates of P. aeruginosa recovered from burned patients at the genus and species level through primers targeting oprI and oprL genes, and analyzed their antimicrobial resistance pattern. Over a 2-month period, wound samples were taken from burned patients and plated on MacConkey agar. All suspected colonies were primarily screened for P. aeruginosa by a combination of phenotypic tests. Molecular identifications of colonies were done using specific primers for oprI and oprL genes. Bacterial isolates were recovered from burn wound infections. Based on phenotypical identification tests, 138 (34%) P. aeruginosa isolates were identified; whereas by molecular techniques, just 128 P. aeruginosa yielded amplicon of oprL gene using species-specific primers, verifying the identity of P. aeruginosa; the others yielded amplicon of oprI gene using genus-specific primers, confirming the identity of fluorescent pseudomonads. This study indicates that molecular detection of P. aeruginosa in burn patients employing the OprL gene target is a useful technique for the early and precise detection of P. aeruginosa. PCR detection should be carried out as well as phenotypic testing for the best aggressive antibiotic treatment of P. aeruginosa strains at an earlier stage. It also has significant benefits on clinical outcomes.
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| 268 |
EFFECT OF PROBIOTIC ADMINISTRATION IN THE THERAPY OF PEDIATRIC THERMAL BURN
(El-Ghazely M.H., Mahmoud W.H., Atia M.A., Eldip E.M. - Egypt)
Oral probiotic administration has been advocated for treatment and prevention of a diverse range of disorders. This study was undertaken to evaluate the effect of probiotic supplementation on outcome of pediatric post-burn patients. Forty thermally-injured pediatric patients with total body surface burns between 20-50% and depth between 5-10% were randomized in a prospective, double-blind, controlled clinical trial into two even groups: probiotic group (n=20), who received probiotic preparations, and placebo control group (n=20). Clinical outcomes, including GIT tolerance, incidence of infection, need for grafting, length of hospital stay and mortality were recorded. Laboratory measurements of serum CRP, serum albumin, serum IgA and total lymphocyte count were done upon admission and on days 4, 7 and 14. There were no significant differences between the groups regarding age (3.67 ± 0.67 vs. 3.56 ± 0.73), sex, %BSA (34.5 ± 1.96 vs. 33.9 ± 1.82) and %deep burns (6.95 ± 0.34 vs. 7.25 ± 0.39). Frequency of diarrhea (3 vs. 9), need for grafting (2 vs. 8) and length of hospital stay (17.25 ± 0.5 days vs. 21.9 ± 2.2 days) were significantly lower in the probiotic group (p=0.038, p=0.028 and p=0.044, respectively). A trend towards a decrease in incidence of infections (7 vs. 12) was noted in the probiotic group (p=0.113). There was no mortality in our series. There was improvement in the patients' overall outcome related to wound healing and length of hospital stay following the use of probiotics. However, their effects on infectious morbidity and mortality remain unclear and require further investigation.
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| 273 |
ENZYMATIC DEBRIDEMENT AFTER MOBILE PHONE EXPLOSION: A CASE REPORT
(Cherubino M., Pellegatta I., Sallam D., Pulerà E., Valdatta L. - Italy)
It is estimated that over 90% of people own a mobile phone. Although rare, lithium-ion battery explosions can cause varying degrees of thermal burn injury. Recently, selective enzymatic debridement has gained importance in the management of burn patients, thanks to its simplicity, minimum invasiveness and safety. In this work, we describe a case of a burn injury caused by the explosion of a lithium-ion battery and treated with selective enzymatic debridement in a paediatric patient.
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| 276 |
STUDY ON BIOFILM FORMATION IN BURN WOUND INFECTION IN A PEDIATRIC HOSPITAL IN CHENNAI, INDIA
(Ramakrishnan M., Putli Bai S., Babu M. - India)
Infection is one of the major causes of death in pediatric burns in India. This work was conducted in an exclusive Children's Hospital (KKCTH) with a total of 220 beds, of which ten beds in the burn unit and two isolation beds in the 28-bed PICU are for burns patients (more than 20% TBSA burns) with sepsis. In this study, 30 burn wound swab isolates obtained from 14 pediatric burns patients (admitted to the burns ward and transferred to PICU) from November 2013 to March 2014 were investigated. Cultures were done on the first day for all patients and empirical antibiotic administration was started for those with septic burns (14 in total) with piperacillin-tazobactam and vancomycin. Antibiotics were changed according to antibiotic sensitivity reports. Cultures were repeated for culture positive cases on the fifth day. Further antibiotic treatment was based on this culture report. When the general condition of the patient did not respond to highlevel antibiotics, biofilm formation was suspected and evaluated as the possible cause of antibiotic resistance. For these patients, an enhanced method of wound debridement and albumin transfusions were used to improve their general condition. Microbial identification and antimicrobial sensitivity testing was done for all 30 isolates. The predominant bacteria were Pseudomonas aeruginosa, Acinetobacter and Staphylococcus aureus. Most of the Acinetobacter and Staphylococcus aureus showed multidrug resistance. Biofilm formation was studied using the Tissue Culture Plate (TCP) method for all bacterial isolates, and results showed that most of the MDR isolates formed biofilm.
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| 281 |
THE ALEXANDER SURGICAL TECHNIQUE FOR THE TREATMENT OF SEVERE BURNS
(Gasperoni M., Neri R., Carboni A., Purpura V., Morselli P.G., Melandri D. - Italy)
The extensive loss of skin in burned patients is a critical clinical condition, and the choice of an effective technique to cover and protect the damaged area has always been a challenge in the surgical field. Despite its wide clinical use, there is little data in the literature on using the Alexander technique to treat severe burns, while several studies have focused on alternative approaches. The present study aims to evaluate the effectiveness of the Alexander surgical technique on 117 patients with severe burns. The characteristics of the burned patients, factors related to etiology of burns as well as adverse prognostic factors and their incidence in discharged versus deceased patients were also taken into account. Finally, a comparison is made with an alternative surgical procedure described in the literature. Our results show a satisfactory level of survival for patients with severe burns surgically treated with the Alexander technique, accounting for 63% of all clinical cases reported here. This treatment is also less expensive and more rapid than the alternative approach we compared it with. The Alexander technique is a lifesaving method for the treatment of severe burns that provides a satisfactory chance of survival at lower cost than the alternative surgical procedure examined.
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| 286 |
COMPLICATIONS INATTENDUES DE LA CHIRURGIE: DEUX CAS DE BRÛLURE PAR PLAQUE DE BISTOURI ÉLECTRIQUE
(Diop B., Sy A., Ba P.A., MBaye B., Wane Y., Sarre S.M. - Sénégal)
Les risques d'accidents électriques sont une réalité dans les blocs opératoires avec le nombre croissant d'équipements électriques, électroniques et de liquides inflammables utilisés. Le bistouri électrique demeure le dispositif le plus utilisé pour son effet électrochirurgical de coagulation ou section tissulaire. Lorsque qu'elle est défectueuse ou mal placée sur une surface réduite de la peau, la plaque du bistouri peut être à l'origine de brûlure cutanée classiquement profonde, de cicatrisation lente. Elle ajoute à l'affection initiale une surmorbidité iatrogène, inattendue, aux conséquences dévastatrices pour le patient, le chirurgien et parfois la structure hospitalière. Nous rapportons deux cas de brûlure cutanée par plaque de bistouri survenue en peropératoire lors de l'utilisation du bistouri électrique en mode monopolaire et discutons les aspects étiologiques, cliniques et préventifs.
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| 289 |
BRÛLOLOGIE ET MÉDECINE LÉGALE: LES VICTIMES D'INCENDIE
(Costagliola R., Campana J-P., Costagliola M. - France)
Lors d'une enquête judiciaire, le médecin légiste est fréquemment requis pour examiner la victime d'incendie hospitalisée. Il doit établir un certificat descriptif des brûlures en précisant leur origine, leur gravité et le pronostic vital. L'évaluation des séquelles en vue de leur indemnisation ne peut s'effectuer qu'au terme d'une longue période de soins nécessaire à la cicatrisation. L'expertise nécessite de connaître les règles médico-légales qui permettent d'apprécier les spécificités des séquelles cutanées chez les victimes de brûlure grave. Lors de la découverte d'un cadavre sur les lieux d'un incendie, le but de l'autopsie médico-légale est de vérifier que les brûlures sont bien la cause du décès. Les lésions les plus fréquemment observées sont des brûlures graves d'origine thermique. Elles sont souvent associées à une inhalation de fumées. La carbonisation du corps étant souvent utilisée pour dissimuler un homicide, la confrontation des constatations post mortem aux données de l'enquête de police est alors indispensable. Les modifications entraînées par le feu impliquent l'utilisation d'un protocole précis pour l'identification, notamment en situation de catastrophe.
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| 295 |
LONG-TERM STUDY OF HEALTH AND QUALITY OF LIFE AFTER BURN INJURY
(Moi A.L., Haugsmyr E., Heisterkamp H. - Norway)
The aim of the present study was to examine burn patient health status, quality of life and work status 16.2 (1.7) [mean (SD)] years after burn injury, and to compare the findings with similar questionnaire data from the same people obtained 11.5 years earlier. Data on burn-specific health (BSHS-N), generic health (SF-36), overall quality of life (QOLS), injury characteristics, socio-demography and work were obtained in 2001 from 95 adult burn patients. In 2013, 78 participants were still eligible, and 34 of them (age: 53.4 [9.4] [mean (SD)], total body surface burn: 17.8% [12.7%]; full thickness injury: 4.4% [5.1%]) answered a follow up study. In 2001, the burn patients reported impaired health status, but an overall quality of life comparable to the Norwegian general population. In particular, the participants were satisfied with their close relationships. At follow up 11.5 years later, the perceived burn-specific and generic health remained unchanged, whereas overall quality of life had improved significantly (QOLS score 77.2 (10.2) vs. 73.1 (12.1), p=0.003), with the largest improvements in the items related to satisfaction with helping others, work, physical active pastimes and independence. The results indicate that self-perceived functioning and wellbeing expressed by burn-specific and generic health status remain stable after the first years post injury. The improvement in overall quality of life 16.2 years post injury suggests long-term processes of growth.
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| 300 |
COMPTE RENDU DE LA TABLE RONDE DU 36ÈME CONGRÈS DE LA SFB À CASSIS (1-3 JUIN 2016), PREMIÈRE PARTIE: BRÛLURES CHIMIQUES, BRÛLURES ÉLECTRIQUES
(Le Floch R., Laguerre J., Perrot P. - France)
La table ronde du congrès 2016 de la SFB a duré toute la journée du 2 juin et portait sur les brûlures non thermiques. A la différence du résumé concernant les brûlures radiques, qui est en cours de réalisation par les auteurs des communications, celui-ci a été commis par les auteurs de cet article, à partir des notes prises en séance et de la vidéo réalisée pendant la communication. Le lecteur voulant approfondir le sujet pourra se rapprocher de l'auteur de la communication, systématiquement cité.
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