Annals of burns and fire disasters最新文献

We checked the files of 30 inpatients with diabetes and deep burns to the lower limbs. We looked for a diabetes-related neuropathy (60% had one), the context of the accident, the topography of burns, any delays before the first and possible subsequent surgeries, the length of stay, and return to walking, if achieved. Burns mostly involved distal parts of the lower limbs, were thermal in 90% with an intentional action in 43%, and frequently occurred in a bathing room (48%) during a footbath (54%). Mean time to the first surgery was day 3,35 and, when needed, the second one was performed 6,54 days later. Mean LOS was 14,6 days, eleven patients were walking again by this time. We found a significant (p<0.001) association between the time to the 1st surgery and time elapsed between the burn and hospitalization. The existence of a diabetes-related neuropathy is a risk factor of lower limb burns, provided it suppresses the alarm of pain. Early surgery seems to reduce the LOS.

Advances in burn care have led to an overall improvement in mortality in high-income countries, but in low-middle income countries mortality remains relatively high. In a limited resource setting where temporary wound closure options were unavailable, it was determined whether early excision as a preliminary treatment could improve prognosis. A retrospective cohort study was conducted in Cipto Mangunkusumo Hospital Burn Unit to evaluate the outcomes of acute burn patients admitted from January 2013 to December 2018 using mortality and lethal area 50 (LA50), and to compare the outcomes between groups who underwent early excision without skin graft (EEWG), early excision with skin graft (EESG), delayed excision without skin graft (DEWG), or delayed excision with skin graft (DESG). Out of 390 patients available for screening, 256 were eligible for further study. The overall mortality was 17.9% with an increase linear with age and total body surface area (TBSA). The overall LA50 was 49%. Preliminary data showed the highest percentage of deaths in the no treatment group, with no deaths seen in treatment groups EESG and DESG. The odds ratio for mortality in the EEWG group was 2.11 (p-value 0.201, CI95% = 0.65-6.80) compared to the DEWG group. LA50 is more objective compared to crude mortality and enables future internal and external comparison. The highest mortality was in the no treatment group with mortality in the EEWG group higher than in the DEWG, but not statistically different. Early excision without skin grafting as a preliminary procedure may still be considered in a limited resource setting.

The different formulae for resuscitation therapy after thermal damage recommend 0.5-0.6 mmol sodium for each % TBSA burned, suggesting fluid requirements from 2-4 ml/kg/% burn because of sodium loss in burned and unburned tissues. There is a gap especially in the recommendations regarding dysnatremia in the burn population. Many studies have focused on calculating amount of resuscitation fluids, avoiding the situation of "fluid creep", and not on calculating sodium remaining in the body after resuscitation. The goal of this observational study was to provide data for sodium disturbances in the shock period after burns. Our study underscores the challenge of understanding whether there is a relationship between amount of crystalloid fluids given during resuscitation and meeting sodium needs. We set out to examine sodium balance (sodium deficit, received, excreted, and retained) after burns. The area under the ROC curve was performed by analyzing fluid and sodium load. Moreover, we conducted linear regression to analyze if there was a correlation between sodium retained and sodium excreted. Sodium deficit persisted until the second 24h despite resuscitation. Resuscitation was performed using Parkland formula, but urine output (UO) values were higher than expected. The threshold for fluid administration (ml/kg/%) or fluid load in the first 24h and sodium load (mmol/kg/%) for positive state (sodium received >0.5-0.6 mmol/kg/%) was 3.7 ml/kg/%. With linear regression, it was evident that sodium excreted was responsible for sodium retained, indicating a moderate correlation in the first 24h and a strong correlation in the second 24h. Resuscitation with LR did not correct hypoosmolality hyponatremia, which persisted even after the first 24h, especially in patients with burns >60%. If more than 3.7 ml/kg/% of LR is given, a sodium load higher than the normal level will be introduced, leading to increased urinary output, elevated sodium excretion, and non-correction of plasma sodium at the end of resuscitation. What is important for colleagues in clinical practice is that the focus of burn resuscitation should be expanded with data regarding sodium balance and the impact of dysnatremias in morbidity and mortality.

Stevens-Johnson syndrome and Lyell syndrome are severe bullous drug reactions that can be life-threatening. The aim of this study is to describe the epidemiological, etiological, clinical, therapeutic and evolutionary data of patients hospitalized in our Dermatology Department. This is a retrospective descriptive study over a period of 10 years. All records of patients admitted to the Dermatology Department for these cutaneous adverse drug reactions were included. A total of 30 patients were recorded, with a male predominance. There were 18 cases of Lyell syndrome, 8 cases of Stevens-Johnson syndrome and 4 cases of overlap syndrome. The mean time to onset after drug administration was 7.5 days. The average skin area detached was 48%. Visceral involvement was frequently observed: pulmonary involvement, renal involvement, hepatic cytolysis and hematological involvement. The notion of medication was found in all our patients, with self-medication in 23% of cases. The reason for prescription was dominated by post-surgical anticonvulsant prophylaxis. All our patients received symptomatic treatment, and corticosteroid therapy was administered in only one patient for macrophagic activation syndrome. The mortality rate was of 17%. Skin area involved, presence of renal failure or respiratory distress were the main prognostic factors.

Armenia and Azerbaijan fought between September and November 2020 in Nagorno-Karabagh. Several surgical missions were scheduled by Assistance Publique- Hôpitaux de Paris to help care for the warinjured Armenians. These missions included the evaluation of Armenian soldiers suspected of having been injured by phosphorus. Facing, during these missions, such infrequent burns, we were interested in their pathophysiology, care and complications. Repeated up-to-date information is necessary in order to better take care of phosphorus burns. Therefore, we conducted a literature review, using PubMed and the Mesh Terms "phosphorus" and "burns", without setting any date limit. The review acknowledges that phosphorus burns are deep, tend to spread and may be the cause of systemic toxicity including hypocalcaemia, which can lead to heart rate disturbance and even death. In the acute phase, burns should be extensively washed with normal saline or water before a mechanical decontamination. One should not use oily dressings, given the liposolubility of phosphorus. Subsequently, one or many debridements are necessary before starting wound coverage, for which any kind of plastic surgery may be used. Phosphorus burns are infrequent but serious. They mainly occur in warfare and should be known by any caregiver acting in this context.

Fire safety has become a major issue of public concern in the ready-made garments (RMG) sector, encouraging the Government of Bangladesh and the garment industry to step forward to rebuild consumer confidence. This thesis gathered information on the cost-effectiveness of the protection systems from several garment factories in Bangladesh. A four-step methodology was used in an attempt to adopt a systemic approach to constructing a fire safety management system (FSMS) for an offshore platform which, although the approach is general nowadays, has been applied to the case of the RMG industry. Significant changes have been made in fire safety management in the ready-made garment factories over the past few years. However, fire safety still tends to be analyzed in isolation through all fire loss that affects the garment industry. Fire loss may be seen as a set of 'systematic' failures, not as a result of only one reason. This study proposes an FSMS for the ready-made garment industry. It is hoped that this approach will lead not only to more effective management of fire safety, but also to the more effective management of safety, health and the environment for any organization. This study discussed the problems encountered by the management, and proposed a way to quantitatively evaluate fire risk and identify the cost-effectiveness of undertaking fire safety measures for the RMG sector of Bangladesh.

Even though coagulopathy is a familiar entity in trauma, its relationship to burn injury remains unclear. Literature appears inconsistent as to the conclusions of the use of coagulation assays, either routine methods or newer viscoelastic coagulation assays (VCAs), thromboelastography (TEG) and rotational thromboelastometry (ROTEM), for prediction of patients' coagulation status and mortality. The use of diagnostic assays as mortality markers will be of great importance, since they would recognize at early stages patients with great medical demands and objectify burn injury severity. The aim of this study was to review the literature and evaluate burn patients' characteristics and coagulation markers in the early post burn period. The secondary outcome was to investigate the role of different coagulation assays in mortality prognosis. Literature search was performed using PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Proquest Dissertation and Theses Global, Scopus and Cochrane Library databases. All types of articles referring to adults with any type of burn injury admitted in the first 24h assessing coagulation and mortality were included. PRISMA guidelines ensured the evidence-based process. Eleven studies met the eligibility criteria. This review demonstrated the indubitable relationship of coagulopathy with burn injury and its significant impact on mortality. The rapid and dynamic process of coagulation makes standard coagulation assays unable to detect short-lived haemostatic changes. More susceptible markers such as VCAs need to be applied to the routine assessment of burn patients in order to obtain an overview on coagulopathy and standardize the gained knowledge.