Annals of burns and fire disasters最新文献

In Colombia, electrical injuries account for most burn-related deaths. Mitigation of the risks of electrical injury depends on adequate and reliable epidemiologic data, but to date there is no literature describing the epidemiology of electrical injury in Colombia. In this retrospective study, we aim to begin such a literature. A descriptive, cohort study was conducted in the BICU of Simon Bolivar Hospital in Bogota, Colombia. The study enrolled all adult patients with electrical injuries (including lightning), admitted between January 2011 and December 2013. A detailed assessment of hospitalized patients within the first 48 hours after electrical injury was made in order to determine the severity of injury and outcome. 1.470 adult patients were admitted during this time. Of these patients, 357 patients (24.3%) had electrical injury: 84.3% with high-voltage injuries. The mean age was 35.1 years (SD 13.2). The mean total cutaneous burn surface area (TBSA) was 9.4% (SD: 13.1%); 51 patients (14.5%) had TBSA >20%; 289 patients presented within the first 48 hours after injury, for whom 235 charts were available for analysis. Creatine phosphokinase (CPK) was evaluated in 230 patients. 115 patients (50.0%) had rhabdomyolysis. Eleven patients (4.7%) required segmental amputation, and 14 patients (6.0%) developed early acute kidney injury. In this hospital-based study, 14.5% suffered burns >20% TSBA, and 16.1% showed CPK values >10,000 UI/L. In order to decrease morbidity and mortality from electrical burns in Colombia, it is necessary to establish preventive measures at workplaces and homes, where these injuries occur.

The science and treatment of burn shock has continued to evolve in tandem with emerging technologies. Burn resuscitation attempts to deliver the appropriate amount of fluid to counteract the detrimental effects of shock, but advances in data collection, processing and analysis have failed to significantly move the needle. This is because there is little consensus about which markers accurately and dynamically predict the body's intravascular volume, a knowledge gap which only widens as each new technology generates more usable data. Here we review the lessons learned.

Survival outcome of burn patients is increasingly higher with early excision and grafting. The problem after excisional debridement is the need for a skin graft or a temporary dressing. By using an amniotic membrane, which is a biological waste, we can limit the use of auto-skin grafts. A preliminary prospective study was conducted on adult patients with no other comorbidities admitted to dr. Cipto Mangunkusumo Hospital Jakarta Burn Unit between 2021-2022. Patients were divided into three groups, treated with early excision and skin grafting, the amnion bilayer dressing or amniotic bilayer dressings co-cultured with keratinocytes and human amniotic epithelial stem cells (hAESC). The patients were then followed up for two weeks and the resulting epithelization in each group was analyzed, including a skin biopsy for confirmation of the epidermal layer thickness. A total of six patients, two in each group, were included in the study. The amniotic bilayer dressings co-cultured with keratinocytes and stem cell group has a rapid rate of epithelization (10% / day) compared to the early excision and skin grafting and amnion bilayer group (7.14% / day). It also has the thickest epidermal layer (95.7μm - range: 67.4-124.02 μm) and the highest histological score (7.00) at two weeks follow-up. This preliminary study concluded that amniotic bilayer dressings co-cultured with keratinocytes and stem cells had an overall better outcome regarding epithelization rate, suggesting that further study is necessary to evaluate amniotic bilayer dressings co-cultured with keratinocytes and stem cell use in burn patients.

Upper gastrointestinal bleeding (UGIB) is a rare complication of the ICU stay. Our objective was to study the epidemiological, clinical manifestations, and evolutionary characteristics of UGIB, and identify its risk factors in severely burned patients. This is a retrospective case-control study of burned patients in the ICU in Tunisia over a period of 6 years, including all adult patients with severe burns who presented at least one episode of gastrointestinal bleeding. The control group consisted of severely burned patients with no gastrointestinal bleeding during their ICU stay. The two groups were matched according to age, gender and extent of burns. The incidence of gastrointestinal bleeding was 2.3% with an average time of onset of 19±17 days. Esophagogastroduodenoscopy was performed in 45 patients showing bulbar ulcer, gastric ulcer, and oesophageal ulcerations in respectively 28, 8 and 3 patients. In the multivariate study, acute kidney injury (OR 13.8, CI [2.9-67], p=0.001), fluid intake <2 ml/kg/%TBSA over the first 24h (OR 10, IC [1.5-68.5], p=0.019), and length of ICU stay >10 days (OR 48.2, IC [4.4-530], p=0.002) were independent risk factors for the occurrence of gastrointestinal bleeding. Mortality in the UGIB group was higher (55.8% vs 25%, p=0.001). Upper gastrointestinal bleeding is a serious complication of a burn patient's ICU stay. Acute renal failure, low fluid intake in the first 24h, and a long duration of ICU stay were independent risk factors for its occurrence.

Loss of substance is the second most common reason, after burns, for which plastic surgeons are called to the emergency room in our context. Although not very frequent, loss of substance in the dorsal skin of the fingers has certain characteristics and remains complex. There are numerous coverage techniques available using local and locoregional flaps and their dissection requires a good knowledge of the dorsal vascularization of the fingers and hand. This review article is the result of the experience of the team of reconstructive, plastic, aesthetic and burn surgery of the University Hospital of Tangier - Tetouan - Al Hoceima with this type of lesion in a patient treated by the abdominal flap.

Antibiotic resistance is an escalating public health challenge, particularly among Enterobacteriaceae and Pseudomonas aeruginosa. In this study conducted at a burn center in Tunisia, we collected 307 non-redundant strains of Enterobacteriaceae from predominantly hospitalized patients, with a majority in the burn intensive care unit (59%), the primary identified species being Klebsiella pneumoniae (34.8%). We evaluated the efficacy of two antibiotics, ceftazidime-avibactam (CZA) and ceftolozane-tazobactam (CT). The results revealed that the overall resistance to CZA was 11.7%, while to CT it was 25.7%. CZA proved to be the second most sensitive molecule among all tested antibiotics, following fosfomycin. Among strains resistant to third-generation cephalosporins, 73.3% were sensitive to CZA, and 41.5% to CT. Out of seventy-nine CT-resistant strains, eight were ESBL producers, twenty-two were high-level cephalosporinases, thirty-three carried blaNDM, twelve carried blaOXA48, and four carried both blaNDM and blaOXA-48. Indeed, blaNDM were the most prevalent carbapenemases. For Pseudomonas aeruginosa strains (n=161), resistance to CZA was 42.2%, and to CT it was 47.8%. These antibiotics ranked as the second and third most active beta-lactams after aztreonam. Among the 71 strains of CZA and carbapenem-resistant P. aeruginosa, 54.1% produced VIM2. Resistance to enterobacteriaceae against CZA and CT is relatively high in our study. However, CZA remains a salvage therapy for infections caused by carbapenem-resistant organisms, and its use should be considered only after documentation and in the absence of other alternatives among β-lactams. For P. aeruginosa, CZA currently represents the most active β-lactam against CAZ-R strains and the second most active molecule overall, including those producing carbapenemases.

Large substance loss of the patellar tendon is rare and thus its treatment does not benefit from a consensus. These tendon destructions associated with a vast loss of substance in the surrounding soft tissues make reconstruction a dual challenge because tendon reconstruction and skin coverage must be achieved at the same time. The precocity of the repair and the use of autologous tissue appear to be the determining factors for recovery of the knee function at term. They seem to be independent of the technique used. We report the case of a 36-year-old patient who was diagnosed with purpura fulminans due to strep throat. She was taking non-steroidal anti-inflammatory drugs. The case was complicated by extensive necrosis of the extremities that necessitated a quadruple amputation, notably on the lower extremity: trans femoral on the left and trans tibial on the right. For functional reasons it was imperative to keep the knee straight despite the exposure of the entire extensor system, precarious bone vitality of the patella and necrosis of the patellar tendon. The therapeutic objective was to cover the entire extensor system and reconstruct the patellar tendon by combining the ipsilateral iliotibial tract band and the medial gastrocnemius pedicled flap. At six months follow-up, active flexion and extension of the knee allows walking with suitable prosthetics and without crutches.

Acid throwing (vitriolage) is a form of violent assault. It is described as an act of throwing acid or corrosives on the body of a person with the intention of injuring or disfiguring them. It is a crime like no other and represents the amalgamation of social evils like patriarchy, gender bias, disdain for the laws of the land, and individual deficiencies like jealousy, anger and sexism. Its incidence has increased over the years and it is soundly entrenched in our society. On the brighter side, surgical care has improved, laws have evolved and, most importantly, society is now aware and is playing an active role against this sacrilege. This study intends to analyze the various aspects of vitriolage in the Indian context, i.e. the extent of the problem, how it affects more than one life, and how the laws have evolved to protect the victims. Secondly, the challenges encountered, from the point of view of a health care worker, specifically a Burns/Reconstructive surgeon, are addressed. It is an attempt to bring on board issues that are medical, administrative or legal and are intricately connected with care and support of victims and survivors of vitriolage. The specific questions discussed in this study are related to the dilemmas faced by the medical community/healthcare institutions while dealing with patients of vitriolage and how the laws have evolved over a period of time.

Experimental studies have shown that the effects of stromal vascular fractions and platelet-rich plasma on deep dermal burn healing were encouraging. By measuring the blood level of platelet-derived growth factor (PDGF)-BB, we evaluated their effect on full-thickness burns in this study. Forty-eight Wistar rats were separated into four main groups: group A rats were administered combined SVF and PRP injections, group B rats were topically administered Vaseline, group C rats were administered placebo injections, and group D rats were without burns. Depending on the day of euthanasia, these groups were further divided into subgroups (8th hour, 4th day, 7th day, 14th day, and 21st day). Using enzyme-linked immunosorbent assay, the serum level of platelet-derived growth factor-BB was determined. Friedman's test or the analysis of variance test was applied, and p-values under 0.05 were regarded as significant. The PRP+SVFs group had the highest mean PDGF-BB levels overall on days 4, 7, 14 and 21 (1.81±1.04 pg/ml, 1.24±0.41 pg/ml, 2.21±0.60 pg/ml, and 3.10±1.02 pg/ml, respectively). The repeated ANOVA test (Mauchly's test of sphericity) resulted in a p-value of 0.556 (>0.05), indicating that the variance of the PDGF-BB data was the same. Additionally, a p-value of 0.001 demonstrated a significant difference in the levels of PDGF-BB between the groups. Overall, the mean PDGF-BB level by day differed significantly between the PRP+SVFs group and the Vaseline group, the negative control group, and the group of healthy rats.

Burns are considered a preventable cause of injury in children, associated with significant morbidity and mortality. We conducted a retrospective descriptive study including burned children managed in the burns resuscitation service of Tunis between January 2018 and July 2022. Three hundred burned children were included, representing 14% of admissions. The mean age was 8±5.4 years, with an age below 5 years in 36% of the cases. The majority of patients were male (61%) and the most frequent cause of injury was domestic accident (79%). Immolation by fire was noted only in adolescents. Burns were thermal in 90% of cases, caused by flames (44%) and hot liquids (38%). Electrical burns were noted in 10% of cases. The location of the burns was the home in 80% of cases, mainly the kitchen (44%). The average total burned skin area was 21±16%. The burns involved the trunk and limbs in 50% of cases. Initial cooling was performed in only 25% of cases. Mechanical ventilation was indicated in 22.7% of cases. Amputation of at least one limb was performed in eleven patients with electrical burns (3.7%). The median hospital stay was 14 days [1-172] with a mortality rate of 16%.