Annals of burns and fire disasters最新文献

The unfolding pandemic necessitated optimalization of treatment methods and assurance of the highest precautionary standards to prevent transmission of COVID-19 to burn patients. One of them included an expanded access treatment with the minimally invasive method - enzymatic burn wound debridement using Nexobrid concentrate. The study assessed the effectiveness and usefulness of the expanded treatment project using enzymatic burn wound debridement with Nexobrid concentrate in patients (n=11) during the pandemic (2020) when compared with the results of the same method in a corresponding period of 2019. The concentrate was applied to the wound on the third day following injury at the latest. All patients were treated with the same accepted standards, including initial debridement of the wound, application of Nexobrid concentrate, and removal of devitalized tissue and dressing. Clinical visual assessment of the wound sites confirmed successful debridement of dead tissue following the application of the concentrate. No allergic or adverse reaction, nor significant deterioration of CBC parameters were observed in any patient. Although surgical excision of necrosis is recognized as the method of choice, enzymatic wound debridement using Nexobrid concentrate may contribute to a reduction in epidemiological risk when treating burn patients for several reasons; the procedure can be performed at the patient's bedside, it limits the number of required surgeries, helps to improve medical equipment and supplies management, and saves human resources.

The recreational consumption of nitrous oxide has steadily increased in recent years. Before being inhaled, the nitrous oxide is contained in a gas cylinder held firmly between the thighs and then the gas is transferred to a rubber balloon. During the deconditioning steps, the cylinder cools down and causes frostbite. We report the case of six third-degree burns on the inner side of the thighs. At first superficial, this burn will deepen and require surgical management.

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.

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.

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.

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.

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.