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INVESTIGATION OF COMMON BURN MECHANISMS, AND TRAINING AND SAFETY CONDITIONS IN THE WORKPLACE
(Bagheri T., Fatemi M.J., Abdollahi Far S., Rahbar A., Asgari M., Hoveidamanesh S., Momeni M.. - Iran)
Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditionsin the workplace. The study is a cross-sectionalstudy that was performed on patients admitted to Shahid Motahari University Hospital in Tehran fromAugust 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms. Of the total burn patients understudy, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were notsafe against the risk of burns. Failure of devices and equipment wasthe cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanismsin the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use ofsafety equipment at work, and the presence of damaged equipment are the main causes of burn accidentsin the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended.
ETIOLOGY OF NEONATAL BURNS: A SYSTEMATIC REVIEW
(Muntean A., Stoica I., Enescu D.M. - Romania)
Burns in neonates are a rare pathology with a significant impact on the patient, the family and the healthcare system. At present, scarce information exists on the etiology of this type of injury. A comprehensive worldwide literature review of all publications, including our personal case series, was conducted in order to analyse the etiology of neonatal burns and summarize the available evidence. A total of 41 publications were identified in the last 4 decades, comprising of 105 cases from 20 countries, thus confirming that neonatal burns are, indeed, a rare pathology. All types of burns were recorded in neonates, the most frequent being contact burns, followed by flames and scalds. Almost 60% of burns occurred in a hospital setting due to human factors, malfunctioning devices, or hospital infrastructure deficiency. Compared to domestic burns, iatrogenic injuries occurred at an earlier age (5.4±9.1 days vs. 15.7±9.8 days, p<0.0001) and in neonates with significantly smaller weights (2102.7±1350g vs. 3197±300.8g, p<0.0001). The number of cases was almost equally distributed between developed and developing countries, but developed countries were characterised by a significantly higher preponderance of iatrogenic burns, while in developing countries domestic burns were more frequent (p<0.0001). We believe that this systematic review outlines the potential causes of neonatal burns and provides essential information for formulating prevention strategies.
BRÛLURE ET ATTEINTE OCULAIRE: INCIDENCE, FACTEURS DE RISQUE ET PRONOSTIC
(Essid J., Mokline A., Fraj H., Aloui A., Mayoufi H., Eljemi I., Saad M.B., Messadi A.A. - Tunisie)
L'atteinte oculaire chez les brûlés est assez fréquente. Son diagnostic est souvent tardif, pouvant engager les pronostics fonctionnel et esthétique. Nous avons mené une étude descriptive rétrospective intéressant des patients brûlés ayant présenté une atteinte oculaire, pris en charge dans le service de réanimation des brûlés de Tunis entre le 01/01/2013 et le 30/09/2020. Vingt-six dossiers associant brûlure et atteinte oculaire ont été revus. L'âge moyen de nos patients était de 26 ans, avec un sex-ratio de 3,3/1. La surface cutanée brûlée moyenne était de 22 +/- 13%, l'origine thermique dans 16 cas. Une brûlure de la face a été retrouvée chez 23 patients, un recours à la ventilation mécanique a été nécessaire pour 10 patients. Le délai médian de découverte de l'atteinte oculaire était de 4,5 heures [1-33 h]. Les principaux signes cliniques évocateurs étaient : une rougeur oculaire (n=5) et un écoulement oculaire (n=4). Les lésions étaient principalement des abcès (n=6) et des ulcères cornéens (n=6). Le traitement était basé sur une antibiothérapie locale (n=16) associée à une antibiothérapie systémique (n=10). Un traitement chirurgical a été nécessaire dans 2 cas. L'évolution a été favorable chez 18 patients, deux patients ont perdu la vue. Les facteurs de risque prédictifs d'atteinte oculaire étaient : la brûlure de la face (p=0,01), la profondeur des brûlures (p=0,02), et la ventilation mécanique (p=0,04).
BRÛLURES PROFONDES DES MEMBRES INFÉRIEURS CHEZ LES PATIENTS DIABÉTIQUES: À PROPOS DE 30 CAS
(Privé S., Benyamina M., Mimoun M., Chaouat M. - France)
Nous avons revu les dossiers des 30 patients diabétiques hospitalisés dans notre centre pour des brûlures profondes des membres inférieurs. Pour chacun de nos patients nous avons relevé: la présence d'une neuropathie diabétique, le contexte, la localisation des brûlures, le délai de première intervention chirurgicale ainsi que le délai de reprise chirurgicale éventuelle, la durée totale d'hospitalisation et la reprise de la marche. Soixante pour cent des patients avaient une neuropathie diabétique. Les brûlures étaient majoritairement localisées aux extrémités distales des membres inférieurs. Elles étaient d'origine thermique dans 90% des cas avec un contact intentionnel dans 43% des cas. Elles survenaient lors d'un séjour dans une salle d'eau (48%) et notamment à la suite de bains de pieds (54%). Le délai moyen de la première intervention chirurgicale était de 3,35 jours et de 6,54 jours pour la reprise. La durée totale d'hospitalisation était de 14,6 jours en moyenne. Onze patients avaient complétement repris la marche en sortie d'hospitalisation. Nous avons mis en évidence une association significative entre le délai d'hospitalisation et le délai de première intervention chirurgicale (p<0,001). La présence d'une neuropathie diabétique favorise l'apparition des brûlures aux membres inférieurs, en supprimant le signal d'alarme de la douleur. Une prise en charge chirurgicale précoce semble raccourcir la durée d'hospitalisation.
INFLUENCE OF "OPEN LUNG" RECRUITMENT ON ARDS IN BURN PATIENTS WITH INHALATION INJURY
(Hung T.D., Lam N.N. - Viet Nam)
The aim of this study was to determine the safety and impact of open lung strategy ventilation on inhalation injury patients complicated with ARDS. A prospective study was conducted in 33 inhalation injury patients with ARDS who were randomly divided into a control group (ventilated as ARDS net) and a study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning. The results indicated that open lung procedure was safe in most patients with optimal PEEP of 14.31±1.89 cm H2O. Within the first week of ventilation, respiratory system static compliances and PaO2/FiO2 ratio significantly increased in both groups (p<.05) but at a faster rate for the study group (p<.05). Ventilation duration and length of ICU stay were not significantly different across groups (p>.05). Duration time from ARDS onset to death and from admission to death were remarkably longer in the study group (p<.05). However, mortality rate and cause of death were not significantly different within 28 days post burn injury. Open lung recruitment is feasible and could be applied for inhalation injury induced ARDS to improve oxygenation and survival time. Further trials need to be conducted to find out the effectiveness of this strategy on mortality.
CONSERVATIVE MANAGEMENT OF PARTIAL-THICKNESS SCALD BURNS IN CHILDREN USING CULTURED ALLOGENIC KERATINOCYTE SPRAY: INITIAL EXPERIENCE OF 18 PATIENTS TREATED IN AN OUTPATIENT SETTING
(Louri N.A., Dey N., Elsakka M., Gulreez R., AlHasan R.N., Kadalmani B., Abdelhamid M.M. - Bahrain)
The objective of this study was to describe our clinical experience with the use of cultured allogeneic keratinocyte (CAK) using a simplified cell delivery method in the treatment of pediatric partial-thickness scald burns treated as outpatients in a Burn Unit. An actuator fitted onto a 3ml syringe was used for cell spray. Eighteen patients having active mixed partial-thickness burn wound areas of <10% total body surface area (TBSA), treated between 2017 and 2019, were included in the study. The wounds were managed conservatively with a combination of burn dressings using hydrogels and CAK application. The timing of the CAK application was decided by the treating plastic surgeon based on his clinical judgment and the clinical status of the wound. The primary study endpoints were the number of days and dressing changesrequired for complete wound reepithelialization.All ofthe eighteen patients'woundsreepithelialized completely with CAK application, with a mean reepithelialization time of 10.33 (±4.95) days after the application of CAK. The median value forthe number ofCAK applications and total dressing sessionsrequired to achieve complete healing were 3 and 4 times,respectively. Wounds treated with CAK application between 8-21 days after burn injury required fewer cell application sessions and fewer dressing changes than wounds treated within seven days and after 21 days from the burn injury. None of the patients reported any adverse reaction related toCAK use.The presentstudy suggeststhat non-extensive mixed partial-thicknessscald burn in children can be successfully treated conservatively using CAK as an adjunct in addition to standard dressing in the outpatient setting.
EFFICACY OF SKIN SUBSTITUTES FOR MANAGEMENT OF ACUTE BURN CASES: A SYSTEMATIC REVIEW
(Wardhana A., Valeria M.. - Indonesia)
The early management of burn cases has always been a challenging medical problem. Skin substitutes have been consistently studied and employed as the prospective treatment modality for burn cases worldwide. However, this treatment method remains uncommon in many developing countries. This systematic review is designed to weigh the efficacy of skin substitutes compared to standard treatment for managing acute burn cases. A literature search was conducted using PubMed, Scopus and Cochrane database up to February 2020 combined with additional reference searching. Studies were restricted to randomized controlled trials (RCTs), with no date and language restrictions. We evaluated the risk of bias with a revised risk of bias tool for randomized trials (RoB2). Data were categorized based on skin substitutes with further subgroup analysis for each skin substitute. We included 13 studies with six types of skin substitutes, Biobrane®, TransCyte®, Integra®, Glyaderm®, Suprathel ® and Apligraft ®. Outcomes measured included wound healing time, pain, length of hospitalization and scar formation. The findings for all skin substitutes demonstrated less severe pain compared to the control group. Faster wound healing time, scar formation and length of hospitalization were identified as heterogeneous depending on the type of skin substitutes used. All of the skin substitutes studied exhibited at least non-inferior to superior performance compared to standard treatment in terms of efficacy in treating acute burn wounds, not limited to burn depth, size, location or patient age.
REVERSE LIP LIFT FOR DEEP FACE BURN SEQUELAE WITH BILATERAL NOSTRIL STENOSIS AND LIP CONTRACTURE: AN ORIGINAL TECHNIQUE. A CASE AND LITERATURE REVIEW
(Lancien U., Kanlagna A., Verdier J., Aubrit J., Perrot P. - France)
. Bilateral nostril stenosis resulting from deep facial burn that occurred on an oxygen-requiring patient with tobacco use is life threatening with obstruction of the airway and impossibility of oxygen supplementation use. We report the case of a deep burn involving the nose and the upper lip during oxygen and tobacco use with a severe bilateral nostrilstenosis and upper lip retraction. We did a reverse bullhorn lip lift with bilateral alar base transposition realized in a one-stage surgery with nasal conformer for 4 months. Surgery allowed a significant opening of the nostril stenosis with a 9mm and 11mm major axis on the right and left side respectively. It brought restoration of the ability to nose breath and use an oxygen device, and was considered satisfactory by the patient and the operators. There was no recurrence at 18-month follow-up. Literature provides few examples of management ofsevere bilateral nostrilstenosisfollowing facial deep burn. Nasal conformers with progressive diameter augmentation, rhinoplasty procedure, local plasties, dermal flap,skin and composite grafts can treat this situation but there is no gold standard procedure. Reverse bullhorn lip lift with bilateral alar base transposition makesit possible to correct thissevere deep burn sequela. With this clinical case, we show the possibility to treat it in a one-stage procedure through an aesthetic procedure inspiration, with an acceptable scar on the donor site.
PHOENIX ON FIRE: A PHENOMENOLOGICAL STUDY OF A PSYCHIATRIC HOSPITAL FIRE IN IRAN
(Nouri M., Ostadtaghizadeh A., Fallah-Aliabadi S., Pashaei-Asl Y., AlJasem M., Azami Aghdash S. - Iran)
Psychiatric hospitals and centers have more complex conditions than other hospitals in responding to emergencies, given the differences in the design of their buildings and in non-structural elements. This is a qualitative study aimed at reviewing and investigating the experiences and challenges faced by psychiatric hospital staff in response to different fire incidents. A phenomenological approach was employed to conduct the study, believing that human experiences and beliefs are substances in phenomena and can be understood and examined. The contents of interviews and focus group discussion (FGD) sessions were extracted and classified into five categories, 14 themes, and 49 sub-categories. Many psychiatric hospitals in Iran are not ready to respond properly to incidents like fires. The study revealed that in order to ensure appropriate management of incidents and disasters in the hospitals, it is necessary to focus on five areas called the 5s framework, which includes structures, staff, supplies (facilities, equipment etc.), sick persons and systems. This framework is proposed to enhance preparedness, reduce vulnerability, and provoke an effective response to incidents in psychiatric hospitals.
BRÛLURE PAR FOUDRE: A PROPOS D'UN CAS
(Yafi I., Elatiqi O., Mahrouch E.M., Aitbenlaassel O., Zine-Eddine I., Sahibi-Moulay E., El Amrani D., Benchamkha Y. - Maroc)
La foudre est un accident rare mais grave, potentiellement mortel. Ses conséquences sur le corps humain sont variables et les manifestations cliniques sont encore mal connues. L'arrêt cardio-respiratoire représente la cause principale de la mort. Des séquelles d'ordre neurologiques et psychologiques doivent être systématiquement recherchées. Les signes spécifiques d'un accident par foudre rapportés par la littérature sont les kéraunoparalysies et les figures de Lichtenberg. La prise en charge d'un brûlé par foudroiement se base essentiellement sur les mesures de secourisme. La littérature ne rapporte que des cas isolés. Nous rapportons le cas d'un patient victime d'une brûlure par foudre et nous détaillerons son cas en passant par une revue de la littérature.
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