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THE 2020 BEIRUT EXPLOSION: A HEALTHCARE PERSPECTIVE
(Hajjar M.S., Atallah G.M., Faysal H., Atiyeh B., Bakhach J., Ibrahim A.E. - Lebanon)
On August 4th, 2020, at 6:07pm local time, an explosion took place in Beirut's port near the central district. This tragic event reportedly left more than 204 victims dead, more than 6,500 wounded, and displaced around 300,000 from their homes. Patients were transported to several hospitals, which became quickly overwhelmed within minutes by the large number of patient admissions. This is a retrospective chart review conducted on 292 patients, who presented to the American University of Beirut Medical Center (AUBMC) after sustaining blast-related injuries during the Beirut port explosion on August 4th, 2020. Measures including age, gender, location of the injury, mechanism of blast injury (primary, secondary, tertiary, and quaternary) and outcomes were collected. Time of arrival of the first victim was 10 minutes after the explosion. Patients across all ages presented to the medical center (age range from 3 months to 86 years) and the majority of injuries were in the upper extremity (45.6%), and head and neck region (43.2%). Most blast-related injuries were due to secondary and tertiary types, 78.4% and 24.1% respectively. This study aims to expand the literature and widen the knowledge regarding the mechanism of injury associated with the Beirut port explosion. Moreover, it could be helpful in preparing medical staff, healthcare centers and other communities to work under difficult conditions in similar disasters and improve the global response to devastating events.
MEASUREMENTS OF INJURY-RELATED OUTCOMES: STATISTICAL AND ANALYTICAL DATA FROM ALBANIA
(Belba M.K., Deda L.N., Belba G.P. - Albania)
Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury.
EYELID CHEMICAL BURNS: A MULTIDISCIPLINARY AND CHALLENGING APPROACH
(Keilani C., De Faria A., Baus A., Delbarre M., Schaal J.V., Froussart-Maille F., Bey E., Duhamel P. - France)
During second- and third-degree eyelid sulfuric acid burns, many surgeons prefer to wait until primary wound separation occurs before grafting. However, this approach may miss the chance to recover the eyelids and can cause ectropion, resulting in delayed eyeball healing with exposure keratitis. We propose that early eyelid release and grafting makes a significant difference in long-term outcomes and improves eyeball healing. Here, we present the case of a woman who presented second- and third-degree burns of the eyelids secondary to physical domestic assault with acid, who had an early surgical management with a full-thickness skin graft. Ten days after surgery, we found that the graft had survived totally, and the donor site of the right arm had already healed. Eyelids were successfully grafted and the functions of both eyelids were well recovered, allowing complete cover of the eyeball. Two months after surgery, functional and cosmetic results were satisfying, with no postoperative lagophthalmos or difficulties with exposure-related problems. Case reports of eyelid chemical burns are very few. No specific and codified management of eyelid chemical burns was found in the literature search. This case report demonstrated that a multidisciplinary approach led by both ophthalmologists and plastic surgeons must be decided early (<6h) in order to achieve synergistic and coordinated management between the eye and the eyelid. There is a significant improvement in ocular healing with early excision and grafting of eyelids after sulfuric acid burn.
ENGELURES LIÉES À L'USAGE FESTIF DE PROTOXYDE D'AZOTE. CAS CLINIQUE ET REVUE DE LA LITTÉRATURE
(Defurne A., Duquennoy-Martinot V., Jeanne M., Pasquesoone L. - France)
La consommation récréative de protoxyde d'azote est en constante augmentation ces dernières années. Avant d'être inhalé, le protoxyde d'azote est contenu dans une bonbonne fermement maintenue entre les cuisses puis le gaz est transféré dans un ballon en caoutchouc. Lors des étapes de déconditionnement, la bonbonne se refroidit et cause l'engelure. Nous rapportons le cas de six brûlures de troisième degré à la face interne des cuisses. Initialement superficielle, cette brûlure va s'approfondir et nécessiter une prise en charge chirurgicale.
CHARACTERISTICS OF LIQUEFIED PETROLEUM GAS (LPG) RELATED BURN INJURIES IN HASAN SADIKIN BANDUNG GENERAL HOSPITAL
(Putri A.C., Insani I.B., Hasibuan L., Faried A., Mose J.C. - Indonesia)
The number of liquefied petroleum gas (LPG) related burn injuries has increased over recent years in Indonesia, since the conversion of kerosene to LPG in 2007 (government policy). Based on studies in India and China, LPG-related burn injuries have become a serious public health issue. A 5-year retrospective study was conducted from medical records of patients with LPG-related burn injuries. The data included age, gender, place, occupation, LPG tank size, mechanism, burn classification, burn site and concurrent injury. A total of 169 patients with LPG-related burn were admitted. The yearly incidence was in the range of 24-46% of all burn injury cases. They mostly occurred in males (66.2%) aged 36-55 years (43.1%). The most common place was the home (83.4%) and the most common occupation was merchant (32%). LPG leakage (94.7%) was the main cause of burn, followed by LPG explosion (5.3%). A 3-kilogram LPG tank (96.4%) was the most common cause. Patient burn classification was mostly major burns (62.1%), with the most common site being the head and neck (73%), and concurrent with inhalational injury (16%). Our study showed that the increasing number of LPG-related burn injuries is alarming. The majority of the patients were males in the productive age and they suffered major burns. Some of them suffered inhalation injury that increases the risk of mortality. Since LPG leakage was the main cause and the most common place was the home, there must be regulation with government related prevention strategies.
THE ROLE OF COMORBIDITIES ON OUTCOME PREDICTION IN ACUTE BURN PATIENTS
(Brandão C., Meireles R., Brito I., Ramos S., Cabral L. - Portugal)
Burn trauma is a leading cause of mortality and morbidity. None of the currently available formulas for mortality prediction take into account the impact of comorbidities on burn patients' outcome. In this study, we evaluate the impact of comorbidities on in-hospital mortality and prolonged length of hospital stay (?30 days). A retrospective analysis of burn patients' medical records, over a 5-year period, was undertaken. A total of 677 patients were included. The mortality rate was 6.5%. Deceased patients and survivors with length of hospital stay (LOS) of 30 or more days were significantly older, had larger %TBSA burned, were more likely to have inhalation injury and comorbidities, and had higher Charlson Comorbidity Index (CCI) scores. On the multivariate logistic regression models, age, %TBSA burned, CCI score and the presence of inhalation injury were independently associated with mortality and prolonged LOS. In conclusion, the authors suggest that the inclusion of comorbidities should be considered on burn admission scores in an attempt to better predict burn mortality.
SELECTIVE ENZYMATIC DEBRIDEMENT FOR THE MANAGEMENT OF ACUTE UPPER LIMB BURNS
(Cherubino M., Valdatta L., Baroni T., Pellegatta I., Tamborini F., Garutti L., di Summa P., Adani R. - Italy)
Upper limb burn treatment represents a major medical and surgical challenge. Enzymatic escharolysis is a rather new technique to treat thermal burns in an easy and rapid way, as an alternative to the standard of care. The aim of the study was to investigate and describe the efficacy of treatment of upper limb burns with NexoBrid® in a non-burn referral center. All patients suffering from upper limb burns and admitted within 36 hours to the Hand and Microsurgery Unit of the ASST Sette Laghi from December 2016 to June 2018 were enrolled in the study. A retrospective analysis was performed, evaluating time to wound healing, time of hospitalization, and scar aesthetic appearance with patient and observer scar assessment scale (POSAS) and disabilities of the arm, shoulder and hand score (DASH). A total of 18 patients with burns involving the upper limb from December 2016 to June 2018 were treated. The mean TBSA% involved was 3%; 4 out of 18 patients suffered circumferential burns. The mean POSAS score was 14; the mean DASH score at 6-month follow up was 21, while it reduced to 11 at the last follow up visit. Enzymatic escharolysis is a novel, rapid and selective treatment option that allows early physiotherapy with overall satisfying functional results. We believe that enzymatic escharolysis should be considered, in most cases, as the standard of care in the treatment of upper limb burn wounds in non-burn referral centers.
AUTOLOGOUS ADIPOSE-DERIVED STEM CELL (ADSC) TRANSPLANTATION IN THE MANAGEMENT OF CHRONIC WOUNDS
(Dung T.N., Han V.D., Tien G.N., Lam H.Q. - Vietnam)
Our aim is to characterize chronic wound response to autologous adipose-derived stem cell (ADSC) sheet transplantation. A pilot descriptive longitudinal study was conducted at the Wound Healing Center of the Vietnam National Burn Hospital from July 1, 2019 to August 30, 2020. Thirty patients with 38 chronic wounds were enrolled in the study and were grafted with autologous ADSC sheets on the wound bed. Wound edges, wound bed, wound size and structure using H&E staining, ultrastructure changes by transmission electron microscope at the time of transplantation and at the first, second and third week of follow-up were observed. Results indicated that after ADSC sheet transplantation, the structure and ultrastructure of chronic wounds had improved. The extracellular matrix (ECM), neo-vascular, fibroblast and collagen fibers proliferated and arranged side by side at the dermis layer. Fibroblast proliferated and increased secretion of collagen. Keratinocytes proliferated and immigrated in the epidermis layer. After three weeks of autologous ADSC sheet transplantation, epithelial cells covered 90% of the wound surface. Neo-vascular, fibroblast and collagen proliferation increased weekly. The image of lymphocyte infiltration in connective tissues decreased. Wound size reduced significantly compared to before the experiment, wound beds were cleaner and filled with granulation tissue. Re-epithelialization appeared at the wound edge and throughout the wound. Wound measurements were statistically significant at the second and third weeks after starting treatment (week 2: 12.8±11.56 cm2 [range: 1-47.42 cm2], p<0.05; week 3: 7.44 ± 5.68 cm2 [range: 0.45-20.10 cm2], p<0.001), indicating autologous ADSC treatment enhanced healing of chronic wounds. In conclusion, ADSCs have a beneficial effect on cutaneous regeneration and chronic wound healing.
CHANGING TRENDS IN ELECTRICAL BURNS FROM A TERTIARY CARE CENTRE - EPIDEMIOLOGY AND OUTCOME ANALYSIS
(Arumugam P.K., Thakur P., Sarabahi S. - India)
Electrical burn injuries result in significant mortality and morbidity. Most of these injuries are preventable. We conducted a retrospective analysis of various aspects of electrical injuries presenting to our center over a period of 1 year from September 2018 to August 2019. Demographic characteristics of patients along with burn characteristics and associated injuries were analysed. Outcomes including length of hospital stay, need for fasciotomy, amputation, renal failure and mortality were also analysed. A total of 6380 patients presented to our center during the study period, of which 471 (7.38%) had electrical burns. Total burn admissions were 1530, of which 283 (18.49%) patients were admitted with electrical burns. The mean age in our cohort was 25.31±12.76 years and mean TBSA was 29.22±23.81%. The most common cause of electrical burns was occupational (33.3%), followed by those that occurred on the rooftop of houses (31%). A historical comparison with data published from our center in 2011 showed a significant increase in occupational burns (18.72% vs. 33.3%) and rooftop electrical burns (8.21% vs. 31%), and a decrease in agriculture-related (42.46% vs. 9.1%) and domestic electrical burns (26.02% vs. 6.7%). There was also a significant rise in proportion of high voltage injuries (71.23% vs. 86.90%). Logistic regression analysis showed electric contact burn to be a risk factor for fasciotomy and limb gangrene. Risk factors for renal failure were age, percentage burn, electric contact burn and rural residence, and those for mortality were percentage burn and renal failure. Emphasis on preventive strategies, especially against occupational injuries and injuries occurring on rooftops, is necessary to prevent such devastating injuries.
THE COST OF ACUTE BURN PATIENTS TREATED IN A MOROCCAN INTENSIVE BURN CARE UNIT
(Aitbenlaassel O., Zine-eddine I., Elatiqi O., Laamrani D., Benchamkha Y. - Morocco)
Eighty-five percent of burns occur in low- and middle-income countries, but reports on the cost of burn treatment in these countries are still rare. It is important for patients, their families, the government, society and insurance companies to be aware of the costs of burn treatment. Burn care in specialized burn units requires trained doctors and staff, specialist equipment, facilities, special tissue banks and specific dressings, and is thus very expensive. Burn care in Morocco is not as expensive as in other countries but nonetheless proves to be a high financial burden for patients, their families and the wider society. In this report we comprehensively calculate almost all the direct costs of managing in-hospital acute burns. The mean burn cost per patient in our country is US$ 16 975. We also compare the results of treatment with other reports. In this way, governmental and burn hospital authorities can have a better estimation of the direct costs of a burn center and the total budget that may be required for the whole country to cover the annual costs of treating burn patients.
COOPERATION BETWEEN THE RESCUE AND FIRE BRIGADE CORPS AND THE MEDICAL RESCUE SERVICE REPRESENTING A BASIS FOR AN EFFECTIVE INTEGRATED RESCUE SYSTEM IN THE SLOVAK REPUBLIC
(Drotárová J.,Mesáros M., Losonczi P. - Slovakia)
The aim of this paper is to identify the legislative basis referring to the position and activities of the Rescue and Fire Brigade Corps, the Medical Rescue Service and the Voluntary Municipal Fire Brigade in Slovakia. The paper deals with the results of an analysis based on a questionnaire research focusing on cooperation between professional and voluntary fire brigades and the Medical Rescue Service during common interventions. The research includes answers from 97 respondents. The analysis shows that cooperation between the afore-mentioned rescue units is in general good, however it has some shortcomings and problems, such as poor communication and insufficient common training. In favour of improving cooperation, members of the rescue units recommend not only frequent tactical training focusing on particular situations, but also professional training and other similar common meetings.
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