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EPIDEMIOLOGY AND ETIOLOGY OF BURNS IN IRAN THROUGH THE EXAMINATION OF THE ECONOMIC, SOCIAL AND EDUCATIONAL SITUATION
(Bagheri T., Fatemi M.J., Hoveidamanesh S., Ghadimi T., Mahboubi O., Asgari M., Rahbar H., Momeni)
Burn accidents continue to cause severe physical, psychological and economic damage to indi- viduals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from Au- gust 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples in- cluded all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country.
EVALUATION OF THE IMPACT OF EXPOSURE TO HEAT AND TO BY-PRODUCTS OF COMBUSTION ON THE HEALTH OF FIREFIGHTERS
(Boggi A.C., Boggi A.C., do Amaral J.B., Bacchi A.L.L., Nascimento V.M., Voegels R.L., dos Santos J.M.B., Grimaldi G., Basseto de Oliveira Arajo K., Pav�o V., Passaretti D.A., Aldred A., Gomes G., Pezato R. - Brazil)
Firefighters are often exposed to high temperatures and by-products of combustion, which can affect their health. In this study, we assessed the impact of acute exposure of firefighters in fire simulators. Twenty male firefighters were exposed to fire simulators, and observed in four phases: pre-exposure (group 0, control) and after the end of the first (group 1), second (group 2), and fourth (group 3) weeks of training. Blood samples were collected and dosed to evaluate the response of the immune, inflammatory (C-reactive protein, IL6, and IL10), and endocrine systems (cortisone, total testosterone, free testosterone, SHBG, bioavailable testosterone, TSH, and free T4). In groups 0, 1, and 3, a thermographic evaluation was also carried out to study the temperature and body heat flow of the participants. Regarding the inflammatory process, an increase in C-reactive protein and a reduction in IL-10 were observed. With respect to hormonal markers, an increase in cortisol and reduced levels of free T4 and bioa- vailable testosterone were found after exposure, with recovery of testosterone levels in the final week of training. Thermoregulatory adaptation of the organism has been associated with changes in heat flow in the organism in people subjected to extreme temperatures, with emphasis on the performance of the lower limbs. Our findings de- monstrate an inflammatory response with hormonal changes after exposure to fire and an adaptive response
SEX-RELATED MORTALITY AFTER BURNS: A SCOPING REVIEW IN THE SADC-REGION
(Murhula G.B., Zeng F.T.A., Bugeme P.M., Cibogo N., Cikomola F.G., Miranda E., Pompermaier L. - Democratic Republic of Congo)
Findings on mortality by sex after burns in low- and middle-income countries (LMICs) are contradictory and, where differences have been described, the reasons are often based on speculation and not on the analysis of factors that could have affected the outcome, such as patient or injury characteristics or provided care. Since the paucity of studies on burns from single LMICs is notorious, merging data from neighboring countries with similar socio-economic backgrounds might provide a larger dataset, contributing to identifying recurrent causes. This scoping review aimed therefore to analyze differences in mortality after burns between the sexes, as well as to identify aspects that could explain possible differences, in countries belonging to the South African Development Community (SADC) region. Studies in English published between 2010 and 2020 were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching PubMed and/or Medline, Clinical Trials and Cochrane Library, and using the screening tool “Covidence”. The 13 included studies could not consistently show association be- tween sex and mortality after burns, but contradictory findings. In the case of differences in outcome between the sexes, explanations were mainly based on speculation (e.g., hormonal differences, self-harm intention), while rarely burn spe- cific factors were reported and included in the analysis of the mortality risk. This study indicates the need for prospective burn specific data collection in LMICs that would contribute to identifying factors associated with death.
PANCRÉATITE AIGUË LIÉE À LA TIGÉCYCLINE CHEZ DES PATIENTS BRÛLÉS EN RÉANIMATION
(Fredj H., Ben Ali H., Mokline A., Ben Saad M., Jami I., Gasri B., Messadi A.A.. - Tunisie)
La pancréatite aiguë (PA) liée à la tigécycline (TGC) est une complication rare. Nous rapportons 5 cas de PA survenue après l’administration de TGC chez des patients septiques hospitalisés dans un service de réanimation de brûlés en Tunisie sur une période de 9 ans. Parmi 303 patients traités par TGC, 5 ont dé- veloppé une PA soit une incidence de 1,65%. L’âge moyen était de 28 ± 6 ans. Un seul patient avait des an- técédents d’alcoolisme chronique. La dose prescrite était de 200 mg en dose de charge suivie de 100 mg deux fois par jour. La PA a été suspectée devant des douleurs abdominales associées à des nausées et vo- missements (n=2), un syndrome occlusif (n=1) ou fortuitement devant l’augmentation des enzymes pan- créatiques chez 2 patients sous ventilation mécanique. Le délai d’apparition des symptômes après l’introduction de la TGC était de 5,4 [2-7] jours. La lipasémie moyenne au moment du diagnostic était de 447 UI ± 135 UI (4,5 à 10 fois la normale). À l’imagerie, il s’agissait d’une pancréatite stade C de Balthazar dans tous les cas. Toutes les autres étiologies de PA ont été éliminées. Le délai moyen de résolution des symptômes après arrêt de TGC était de 4 ± 2 jours [5; 7] et celui de la normalisation des enzymes pancréa- tiques était de 9 jour [2; 20]. En conclusion, une surveillance clinico-biologique s’avère nécessaire chez les patients traités par tigécycline afin d’éviter les formes graves surtout chez les sujets à risque.
LA PROCALCITONINE: BIOMARQUEUR DE CHOIX POUR GUIDER L’INITIATION, LA MODIFICATION ET L’ARRÊT DE L’ANTIBIOTHÉRAPIE CHEZ LES BRÛLÉS SEPTIQUES
(Mokline A., Sboui S., Fredj H., Ben Saad M., Eljemi I., Gasri B., Thabet L., Messadi A.A. - Tunisie)
Le but de ce travail était d’évaluer l’interêt du monitorage de la PCT chez les brûlés septiques en réanimation. Le sepsis était retenu selon les critères de la Société Francophone de Brûlologie pour la pré- sence de l’infection. Nous avons mené une étude prospective dans une unité de soins intensifs des brûlés en Tunisie. Un total de 120 patients a été retenu. L’âge moyen était de 32 +/- 17 ans avec une surface brûlée de 32 +/- 14%. La PCT a été mesurée toutes les 48h jusqu’à résolution de l’épisode septique (critères cliniques et baisse de la PCT de 80% par rapport à sa valeur initiale). Les patients ont été répartis en deux groupes en fonction de l’évolution clinique: Groupe A = patients à évolution favorable; Groupe B = patients à évolution défavorable. Le suivi de la cinétique de la PCT a permis de juger de l’éfficacité de l’antibiothérapie initiale, un seuil de baisse de 43,5% à J3 du traitement ayant les meilleures sensibilité et spécificité, de 79,6% et 87,7% respectivement. Le monitorage de la PCT a permis une réduction de la durée de l’antibiothérapie à 5 +/- 2,8 jours versus 8 à 10 jours avant.
A REVIEW OF ELECTROCARDIOGRAPHY CHANGES IN ELECTRICAL BURN INJURY: IS IT TIME TO REVISE PROTOCOL?
(Farzan R., Ziaziabari S.M., Jafaryparvar Z., Homaierad E., Ismaili Shoja E., Tolouei M. - Iran)
This descriptive cross-sectional study aimed to evaluate electrocardiography (ECG) changes in patients with electrical burn injury and determine their predictive extent during hospitalization. The study population consisted of all patients with electrical injury admitted to Velayat Hospital, Rasht, Iran, during 2007-2019. The ECG information of all patients assessed by a cardiologist in terms of dysrhythmic and is- chemic changes at the time of admission, demographic information including age, gender, voltage, the sever- ity and path of the current, and degree of burn were recorded in the relevant checklist. The data were analyzed using the SPSS software version 18 (IBM, USA). Out of 192 studied patients, 183 (95%) were male, and the mean age of patients was 32 years. The ECGs of 167 patients were normal (86%), 13 cases had arrhyth- mia (6.7%), and 12 individuals had ischemia (6.2%). Arrhythmic and ischemic abnormalities in the ECGs of patients had no predictive value during hospitalization. Heart injury caused by electrical injury may be deadly in some cases, and it can be complicated to save the patient. Moreover, the predictive value of ECG in predicting the consequences and duration of hospitalization is weak.
EFFECTS OF PLATELET-RICH PLASMA (PRP) AND STROMAL VASCULAR FRACTION (SVF) ADDITION ON EPIDERMAL GROWTH FACTOR (EGF) SERUM LEVELS IN FULL-THICKNESS BURN HEALING IN RATS
(Wijaya J., Josh F., Laidding S., Soekamto T.H., Hendarto J. - Indonesia)
Platelet-rich plasma (PRP) and stromal vascular fraction (SVF) cells are clinically proven to aid in cellular regeneration and accelerate wound healing. The healing effect can be measured by epidermal growth factor (EGF) levels. This study aims to determine the effect of a combination of PRP and SVF injections on EGF levels during the healing of full-thickness burns in Wistar rats. Forty-eight adult Wistar rats were divided into 4 groups. Group A consisted of healthy rats. Groups B, C and D underwent modified full-thickness dermal burns. Group B was treated with local injections of PRP and SVF, Group C was treated with topical Vaseline, and Group D was treated with local injections of sterile water. EGF levels were subsequently assessed on days 1, 4, 7, 14 and 21 post-burn. EGF levels were generally increased in all groups, with the largest increase observed in the PRP and SVF injection group. A one-way ANOVA showed a significant increase in EGF levels on all days Based on the results of the linear regression test, local injection of PRP and SVF after full-thickness burns increases EGF levels by 27.3%. Combination PRP and SVF injections can increase EGF levels during the healing process of full-thickness burns. EGF is a critical growth factor in accelerating the healing process of full-thickness burns.
TREATMENT OF POST-BURN LEUCODERMA WITH SUPERFICIAL DERMABRASION FOLLOWED BY SUCTION BLISTER EPIDERMAL GRAFTING: A CLINICAL PROSPECTIVE STUDY
(Ali A.S., Mahmoud W.H., Elsawaf M.I., Elmelegy N. - Egypt)
Post-burn leucoderma patients remain the most challenging to treat because they have two distinct issues: textural changes and hypopigmentation that must be managed simultaneously. A variety of surgical techniques have been used with variable outcome. This prospective study evaluated the efficacy of superficial dermabrasion followed by suction blister epidermal grafting (SBEG) in post-burn leucoderma treatment. Twenty patients, 15 females and 5 males, ages ranging from 18 to 52 years, all having post-burn leucoderma ranging from 10 to 36 months, were included. The recipient sites were prepared by superficial dermabrasion. The Chinese cupping device was used for blister induction. Blister formation times, as well as the number of blisters, were noted. Complications, extent of the repigmentation, treatment efficacy and color matching were recorded. The mean time taken for blister formation was 91.75±10.29 min. The number of blisters harvested for each case ranged from 2 to 9. Re- garding complications, 1 had partial graft loss, 3 developed perigraft halo at the recipient site, and all patients had temporary hy- perpigmented circular macules at the donor sites. After a mean follow up period of 8.5±1.73 months, repigmentation percentage ranged from 40 to 100% with good color matching. Treatment efficacy was excellent in 3 cases (15%), good in 12 cases (60%), fair in 4 cases (20%), and poor in 1 case (5%). As regards patient satisfaction, 15 patients (75%) were satisfied, while 5 patients (25%) weren’t. Combined superficial dermabrasion and SBEG appears to be a simple and cost-effective surgical treatment modal- ity for localized post-burn leucoderma.
PRESENTATION AND MANAGEMENT OUTCOME OF CHILDHOOD SCALD BURNS MANAGED WITH HYDROCOLLOID DRESSINGS COMPARED WITH SILVER SULPHADIAZINE DRESSINGS
(Saaiq M. - Pakistan)
Scalds constitute the most common type of childhood burns. Given their potential for sponta- neous healing, a variety of dressings are used to promote healing and prevent infection. This comparative study was carried out to document the clinical presentation of pediatric scald burns and evaluate their mana- gement outcome with hydrocolloid dressings versus silver sulphadiazine (SSD) in terms of complete healing, healing time, mean number of dressings required to achieve healing, and any need for split thickness skin grafting at three weeks. The study included all pediatric scald patients (aged ≤15 years) who presented with superficial partial-thickness and deep partial-thickness wounds during the study period. Exclusion criteria included children over the age of 15 years, facial scalds and full thickness scalds. Half of the patients were randomly assigned to the hydrocolloid group and half to the SSD group. Out of a total of 100 patients, 66% (n=66) were males whereas 34% (n=34) were females. Age ranged from 3 months to 15 years, with a mean of 2.88±2.86 years. Total body surface area (TBSA) affected ranged from 3% to 17% with a mean of 7.00±4.76%. The majority of the children (75%) were managed on an outpatient basis whereas 25% were hospitalized. Hydrocolloid dressings yielded superior results in terms of complete healing of the scalds, hea- ling time, the mean number of dressings required to achieve healing, and less frequent need for split thickness skin grafting at three weeks. Given the observed benefits, hydrocolloid dressings should constitute the pre- ferred choice of dressing for managing superficial and deep partial thickness scalds in the pediatric population.
FLIR ONE ® AS A PREDICTING FACTOR FOR BURN WOUND CONVERSION: A PRELIMINARY REPORT
(Wardhana A., Sukasah C.L., Syarif A.N., Tanjunga S.F., Winarno G.A., Apriza R.P., Aurora L. - Indonesia)
Burn area may progress into a more profound wound, known as burn wound conversion. Early pre- diction of burn wound conversion guides clinicians in their treatment decision. This study aimed to assess the re- liability of FLIR One ® in predicting burn wound conversion. We conducted a prospective cohort study, including patients who were admitted to our tertiary hospital from December 2018 to December 2019. All adult patients with mid-dermal burn injury of less than 40% TBSA that occurred within 72 hours were included in our study. Thermal imaging FLIR One ® was used to evaluate the difference between burn wound and healthy skin in the same area (DT1), and ImageJ software objectively measured the burn’s extension. The examinations were done by a plastic surgeon on the 1 st and the 3 rd day of admission. Data were later compared and statistically analyzed. A total of 157 wound samples were collected from 40 patients - a slightly higher number were found in males (57.5%). The major cause of burn was gas explosion (50%), mostly with less than 20% TBSA (55%). The area under the curve (AUC) for DT1 was 0.884 (95% CI: 0.822 - 0.945) with a cut-off point at DT1 more than 1.25°C lower than un- burned skin. However, there was no correlation between DT1 and extension of the wound area. Thermal difference (DT1), measured using thermal imaging FLIR One ® could be considered as a predictor of burn wound conversion from mid-dermal to deep dermal, with the optimal cut-off point of 1.25°C lower than unburned skin.
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