Les brûlures oculaires peuvent être de 3 origines : chimiques (par des agents acides ou alcalins), lumineuses par rayonnement ultraviolet ou thermiques. Nous rapportons les cas de 8 patients victimes d’une brûlure oculaire (3 thermiques et 5 chimiques). Parmi ceux-ci, un patient avait une brûlure oculaire de grade 2 selon la classification de Dua, 2 des atteintes de grade 3, 1 de grade 4. Un patient avait une atteinte de grade 3 à l’œil droit et de grade 4 à l’œil gauche. Une tomographie par cohérence optique du segment antérieur (Optical Coherence Tomography, OCT-SA) a été faite chez deux patients, montrant une désépithélialisation cornéenne, un épaississement cornéen et une ligne hyper-réflective au niveau du stroma postérieur. Tous les patients ont bénéficié d’un traitement médical fait d’antibiotique topique, de corticostéroïde topique, de cycloplégique et d’agents mouillants. Cinq patients ont été traités en ambulatoire avec une amélioration clinique. Trois patients ont été hospitalisés dont un a bénéficié d’une greffe de membrane amniotique (GMA), un a eu une GMA suivie d’une kératoplastie transfixiante (KPT) et un est programmé pour une KPT. Les brûlures oculaires sont associées à un risque fonctionnel important, justifiant une prise en charge rapide et efficace.

Le diabète est une pathologie pourvoyeuse de neuropathie périphérique dont la forme clinique la plus fréquente est la polynévrite « en chaussettes » avec perte de la sensibilité des pieds à la douleur, exposant les diabétiques à un risque élevé de brûlure grave des membres inférieurs. Notre étude rétrospective avait pour objectif d’étudier les caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutives des brûlures de pieds survenant chez des patients diabétiques hospitalisés dans le CTB de Tunis, durant une période de 4 ans (2019-2022). Nous avons inclus 34 patients dont 9 avaient des brûlures isolées des pieds. L’âge moyen était de 60 ans (extrêmes : 41-83 ans), avec prédominance masculine (sex-ratio =1,83/1). Un quart des patients (n=9) était sous antidiabétiques oraux (ADO) et la moitié (n=18) souffrait de complications dégénératives. La glycémie à l’admission était supérieure à 10 mmol /L chez 73% des patients. La surface cutanée brûlée moyenne était de 19%. Vingt-deux patients (65%) avaient des brûlures profondes au niveau des pieds dont 5 parmi eux ont eu une incision de décharge pour brûlures profondes et circulaires. Une amputation a été nécessaire chez 15 patients, intéressant les orteils (n=9), une jambe (n=3) et deux jambes (n=3). La durée de séjour en USI a été de 18,31 jours et la mortalité de 20,58%.

L’altération de la sensibilité de la zone opérée est courante dans les suites de nombreuses interventions en chirurgie plastique et favorise les traumatismes accidentels au quotidien. Plusieurs études montrent qu’une perte de sensibilité est constante dans les suites opératoires d’une abdominoplastie. Nous rapportons ici le cas de trois brûlures au 3ème degré au niveau sous-ombilical, par contact avec une bouillotte, dans les suites précoces d’une abdominoplastie et responsables de séquelles esthétiques importantes

DISTRIBUTION GÉOGRAPHIQUE DES CARBAPÉNÉMASES CHEZ LES BRÛLÉS TUNISIENS
(Mokline A Messadi A.A. Zarrouk S.,Jemi I.,Fraj H., Gasri B., Ben Saad M., Thabet L.)

La détection des carbapénémases est d’un grand apport pour mettre en place des mesures d’isolement des sujets porteurs et aider au choix de l’antibiothérapie en cas de sepsis. Chez le brûlé, elle permet en outre de repérer les zones contaminées. Le but de notre travail était d’établir la cartographie du portage des carbapénémases chez les brûlés hospitalisés en réanimation. Il s’agit d’une étude prospective réalisée dans le service de réanimation des brûlés de Tunis sur une durée de 9 mois (avril 2018 - décembre 2018). Une PCR à la recherche de portage de carbapénémases (CBPase), sur échantillon d’écouvillonnage rectal a été effectuée chez tous les patients, dans les 48 h de leur admission. Les enzymes étudiées recherchées étaient Verona Integron Metallo β lactamase (VIM), New Dehli Metallo β lactamase (NDM), Oxacillinase 48 (OXA48). Durant la période d’étude, 221 patients ont été admis, 121 ont bénéficié d’une PCR dont 53 se sont révélées positives (43,8%). Dix-sept patients étaient porteurs d’une seule carbapénémase, 11 en portaient deux, et 25 en portaient trois. Les enzymes détectées étaient VIM (n=41), NDM (n=41) et OXA48 (n=32). La cartographie des enzymes a révélé 2 principales zones de portage au centre- ouest de la Tunisie: Kairouan (NDM/OXA48) et Kasserine (NDM/VIM). Les principaux facteurs prédictifs de ce portage étaient une antibiothérapie préalable (n=24) ou une ventilation mécanique (n=30). Trente et un patients (59%) étaient porteurs d’un cathéter vasculaire (n=31), onze avaient déjà séjourné en réanimation.

L’échec d’extubation est défini comme la nécessité d’une réintubation dans les 48-72 heures dans les suites d’une extubation programmée. Peu d’études se sont intéressées à ce sujet chez les brûlés. Pour déterminer l’incidence, les causes, les facteurs de risque et l’évolution des patients brûlés ayant subi un échec d’extubation, nous avons conduit une étude monocentrique rétrospective cas - témoin sur une période de 3 ans (janvier 2018 - décembre 2021). Tous les patients brûlés âgés de plus de 16 ans, ventilés pendant au moins 24 heures et ayant eu au moins une tentative d’extubation ont été inclus. Quatre-vingt-dix-huit patients ont eu une extubation programmée. Ces patients ont été répartis en 2 groupes comparables en termes d’âge et de sexe. Groupe « échec » : inclut les patients qui ont échoué l’extubation (N=34), groupe succès : inclut les patients qui l’ont réussie (N=64). L’incidence de l’échec d’extubation était donc de 36,6%. L’hypophosphorémie, l’anémie <8g/dl et les secrétions abondantes en péri - extubation étaient identifiés comme facteurs de risque d’échec d’extubation (p<0,05). Une durée de ventilation mécanique (VM) de 8,5 jours a été identifiée comme prédictive d’échec. La cause principale d’échec d’extubation était la rétention de sécrétions ( n=17 : 50%). L’échec d’extubation a été associé à une prolongation de la durée de séjour (34 vs 19 jours, p=0,005), à une augmentation des complications infectieuses (p=0,007) et du taux de mortalité (79,4% vs 1,5%, P< 0,001).

The aim of this study was to evaluate the characteristics and prognostic value of the neutrophil/lymphocyte ratio (NLR) in patients with severe burns. A retrospective study was conducted on 245 burn patients over 18 years old without comorbidity or combined injury, burn extent ≥20% TBSA, hospitalized within 24 hours after burn. The collected criteria included patient characteristics, NLR on admission, 3 rd and 7 th day after burn, and outcome. The results showed that NLR was higher than the normal value at all collected times. In addition, compared to the survivor group, NLR on admission, 3 rd and 7 th day after burn was significantly higher in the mortality group (p <.01). Multivariate analysis found that the NLR on the 7th day postburn was an independent factor associated with mortality (p <.05), along with the increase in age, burn extent, and presence of inhalation injury (AUC = .85; cut off: 14.13; sensitivity: 75% and specificity: 83.43%). In conclusion, NLR on the 7th day post burn may be used as a predictive factor for mortality amongst severe burn patients.

Carbon monoxide poisoning is one of the leading causes of mortality and morbidity by poisoning in the world. Signs and symptoms are nonspecific and related to impaired oxygen delivery to tissues, with the brain being the most affected organ due to its high oxygen demand. CO-Hb is a poor indicator of severity and long-term outcome, with clinicians relying more on clinical features such as level of consciousness and need for intubation, organ dysfunction and shock and also pH level. A 45-year-old female was found unconscious in her home with the fireplace lit and smoke all over the house. She was last seen well 18 hours before. She was brought to the emergency department and was admitted to the ICU in coma and cardiogenic shock, with a metabolic acidosis with hyperlactacidemia and a CO-Hb level of 15.5%. Laboratorial investigation revealed hepatic cytolysis, acute renal failure, rhabdomyolysis and a troponin I level of 338 ng/L. ECG showed no acute myocardial ischemia. Echocardiogram revealed diffuse hypokinesia with an ejection fraction of 25%. Head CT scan showed bilateral and symmetrical hypodensities of the globus pallidus. The patient underwent hyperbaric oxygen treatment with full neurological and cardiac recovery, allowing extubation 48 hours after admission. This rare severe case of coma due to carbon monoxide intoxication with globus pallidus injury and cardiogenic shock was successfully treated with hyperbaric oxygen, showing that it can be the right treatment choice in these cases, with an excellent impact on neurological and cardiac outcome.

Burns are a major public health issue. Psychiatric issues require special attention. According to research, lowering stigma and anxiety and raising self-esteem are efficient ways to encourage the social reintegration of burn patients. The current study was aimed at investigating the association between burn patients’ anxiety, depression, low self-esteem levels and the total body surface area (TBSA) affected by burn injuries. This single-center, cross-sectional study was conducted from January to June 2022. A sample size of 200 burn patients was calculated. Any patient with a prior psychiatric diagnosis was disqualified from the trial except for nicotine dependency. The patients were evaluated for anxiety, depression and self-esteem using specific scales. The data were tabulated and statistically analyzed using SPSS 25.0. There was male predominance as 55% (n=110) of participants were males. The age range was 18-70 years, and the average age of participants was 36.4±8.6 years. About 68.50% of participants were married, 29.50% were unmarried and 2% were divorced/widowed. Men tended to experience anxiety symptoms more frequently. More than half (58.0%) suffered from burns involving 20-39% of total body surface area (TBSA). No significant relationship was found between TBSA and anxiety, depression or self-esteem. Psychiatric issues are highly prevalent in burn victims. More research is necessary to determine the extent and determinants of psychological issues in burn patients.

Shewanella putrefaciens is an opportunistic pathogen rarely responsible for human infection. However, it has been reported that it causes skin and soft tissue infections and bacteremia in immune-compromised patients, such as cellulitis, abscesses, bacteremia, and wound infection. It is an oxidase and catalase-positive non-fermenter gram-negative rod that produces hydrogen sulfide. We report the case of a 90-year-old woman, who presented an invasive infectious burn wound associated with Shewanella putrefaciens bacteremia. She was admitted into the burn center of the military hospital M.S Nekkache of Algiers, suffering from 40% TBSA with a history of diabetes. After one week of admission, the patient complained of a high fever. Microbiological culture of the catheter tip was positive and showed pale colonies on the MacConkey agar, non-lactose fermenting plate. Nutritive agar medium culture showed red pale tan colonies with a concentration >10³ CFU. Identification and antibiotic susceptibility were obtained by the Phoenix system (Becton-Dickinson, USA) as Shewanella putrefaciens. This was confirmed by standards and semi-automated microbiological techniques. Gram stain showed Gram-negative bacilli with positive oxidase and catalase reactions. Production of hydrogen sulfide was confirmed by the semi-automated API 20NE method (biomerieux, France). The isolate was resistant to gentamicin, amikacin, ceftazidime, aztreonam, amoxicillin- clavulanic acid, cefepime, trimethoprim/sulfamethoxazole, and nitrofurantoin. In our case, S. putrefaciens was found in a mixed culture with Klebsiella pneumoniae. No earlier exposure of the patient to marine water had been noticed. Blood culture indicated colonies growth of Acinetobacter baumannii. No further isolation of this bacteria was noticed after treatment. The patient was given imipenem, vancomycin and colistin. Despite our best efforts, the patient could not be saved because of sepsis and renal function failure.

The objective of this study is to assess the quality of life and how to return to work after burns in adults. We conducted a monocentric, observational, prospective and open study in an intensive care burn unit. Patients aged between 18 and 65 years old were enrolled. Quality of life was assessed with Burn Specific Health Scale-Brief (BSHS-B). A total 118 patients were included with one delayed death. There were 55 flame burns. Median age was 39 years, median total burn surface area (TBSA) was 5% and median length of stay was 11 days. After management in the intensive care burn unit, 84 patients were discharged home and 33 to a rehabilitation care department. We sent 117 queries and got 56 answers. Median BSHS-B score ratio was 142/160. The most impacted items were heat sensitivity, body image, treatment regimens and work. Simple abilities were also affected with up to 28% of patients having difficulties with everyday actions such as cleaning oneself. Regarding return to work, 32% of workers lost their full-time job and 18% were downgraded as disabled. The outcome was worse for those patients who had to go to rehabilitation. Our data suggest that even small burns may strongly impact quality of life and limit the ability to return to work. Our results are consistent with previous published studies, which found greater alteration of quality of life with larger TBSA. These results call for care in specialized centers even for limited burns, especially in the case of functional area involvement.

When compared to standard surgical management, rapid enzymatic debridement of deep burns reduces the need for surgery while achieving similar long-term results. However, few studies have directly compared the costs of standard surgical and enzymatic burn care. We conducted a study comparing the care costs of 44 adult burn patients treated before (n=22) and after (n=22) introducing rapid bromelain-based enzymatic debridement (BED) of deep burns. Mean age was 59 years, 54% were male, and mean total body surface area (TBSA) was 23.5%. Burn etiology included flame and scalding burns (8). Groups treated with standard of care and enzymatic debridement were comparable in terms of age, sex and TBSA. Burn management with BED significantly reduced total debridement costs as well as grand total costs when compared with traditional surgical care. Such reduction was mostly related to lower costs associated with reduced surgical care and less facilities and resources consumption in the BED group.

Susceptibility to infection and increased antibiotic resistance place burn patients at risk of infection caused by multidrug-resistant organisms (MDRO). This condition can progress to sepsis, which can increase mor- bidity and mortality. A retrospective cohort study using medical record data of patients treated at RSUPN dr. Cipto Mangunkusumo in the period January 2020 to June 2022 was conducted. Of a total 160 subjects in the study period, 82.5% were aged <60 years, 16.88% had comorbidities, the most common cause of burns was fire (86.25%), the use of medical devices was 90.63%, with a median length of stay of 14 days. The most common Gram-negative MDRO pathogens were K. pneumoniae (29.91%), Enterobacter sp (22.32%) and Acinetobacter (20.54%): 45% of MDRO infected patients died. Bivariate analysis was conducted to find the effect of MDRO infection on burn patient mortality (RR 1,103; 95% CI 1,004-1,211, p=0.046). After adjusting for the role variables, namely: age, comorbidities, TBSA, use of medical devices, length of stay and multivariate analysis, it was found that the variables that had an effect on MDRO infection mortality were length of stay and age. MDRO infection has an effect on the mortality rate of burn patients. Mortality of burn patients due to MDRO infection is greater (45%) compared to non MDRO (21.43%). The most common Gram-negative MDRO pathogen is K. pneumoniae.