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Baiee H, Obaid E. Epidemiological and clinical characteristics of burn injuries among hospitalized patients in Babylon Province. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_70_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Davies P, Davies AK, Kirkham JJ, Young AE. Secondary analysis of data from a core outcome set for burns demonstrated the need for involvement of lower income countries. J Clin Epidemiol 2021; 144:56-71. [PMID: 34906674 PMCID: PMC9094759 DOI: 10.1016/j.jclinepi.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022]
Abstract
Objective To compare the views of participants from different income-status countries on outcome selection for a burn care Core Outcome Set (COS). Methods A retrospective analysis of data collected during a two round Delphi survey to prioritise the most important outcomes in burn care research. Results There was considerable agreement between participants from low- and middle-income countries (LMICs) and high-income countries (HICs) across outcomes. The groups agreed on 91% of 88 outcomes in round 1 and 92% of 100 in round 2. In cases of discordance, the consensus of participants from LMICs was to include the outcome and for participants from HICs to exclude. There was also considerable agreement between the groups for the top-ten ranking outcomes. Discordance in outcome prioritisation gives an insight into the different values clinicians from LMICs place on outcomes compared to those from HICs. Limitations of the study were that outcome rankings from international patients were not available. Healthcare professionals from LMICs were not involved in the final consensus meeting. Conclusion COS developers should consider the need for a COS to be global at protocol stage. Global COS should include equal representation from both LMICs and HICs at all stages of development.
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Affiliation(s)
- P Davies
- Bristol Centre for Surgical Research, Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, United Kingdom
| | - A K Davies
- Centre for Academic Child Health, University of Bristol, United Kingdom
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - A E Young
- Bristol Centre for Surgical Research, Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, United Kingdom.
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Mohammadi AA, Hoghoughi MA, Karoobi M, Ranjbar K, Shahriarirad R, Erfani A, Modarresi MS, Zardosht M. Socioeconomic Features of Burn Injuries in Southern Iran: A Cross-sectional Study. J Burn Care Res 2021; 43:936-941. [PMID: 34894143 DOI: 10.1093/jbcr/irab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn injuries are among the most traumatic incidences which could be associated with substantial morbidity and mortality. The incidence of these injuries differs based on population socioeconomic characteristics. In this study, we aim to evaluate the distribution of burn injuries based on socioeconomic and causative factors. Relative features from the targeted population were obtained and evaluated. Data were extracted in August 2019 and statistical analysis of the data was conducted from February 2020 to April 2020. This cross-sectional record-based study was conducted from 2008 to 2016 in a main referral center for burn injuries in the southern Iran. Participants included burn survivors and burn patients who were registered as outpatients or inpatients. A total of 4919 burn cases with a mean age of 31.91 ± 17.33, including 2926 (59.5%) males and 1993 (40.5%) females was reported. The majority of our cases had an educational level of under diploma (40.72%). A significant correlation between age, gender, and percentage of burn with the level of education was recorded (P < .001). The most frequent cause of burn injuries was flame with 2537 (51.9%) cases. The most susceptible population to burn injuries were reported to be poorly educated individuals, which emphasizes the preventive role of education.
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Affiliation(s)
- Ali Akbar Mohammadi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Hoghoughi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Karoobi
- Student Research Committee, Shiraz University of Medical Sciences, Iran.,Department of surgery, Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Iran
| | - Keivan Ranjbar
- Student Research Committee, Shiraz University of Medical Sciences, Iran.,Department of surgery, Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Iran
| | - Reza Shahriarirad
- Student Research Committee, Shiraz University of Medical Sciences, Iran.,Department of surgery, Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Iran
| | - Amirhossein Erfani
- Student Research Committee, Shiraz University of Medical Sciences, Iran.,Department of surgery, Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Iran
| | - Mahboobeh-Sadat Modarresi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Zardosht
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Chaudhary FA, Ahmad B, Sinor MZ. The severity of facial burns, dental caries, periodontal disease, and oral hygiene impact oral health-related quality of life of burns victims in Pakistan: a cross-sectional study. BMC Oral Health 2021; 21:570. [PMID: 34749722 PMCID: PMC8573980 DOI: 10.1186/s12903-021-01923-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023] Open
Abstract
Background A burn to the face and neck area leaves a visible scar that impacts the victims physically and psychologically. This report was aimed to examine the factors associated with oral health-related quality of life (OHRQoL) in patients with a facial burn injury. Methods Patients with facial burn who attended the Burn Care Centre in Islamabad, Pakistan were systematically and randomly invited to participate in this cross-sectional study. They underwent extra- and intra-oral examinations and, completed self-administered instruments in the Urdu language. The severity of disfigurement, dental caries experience (DMFT), periodontal disease (CPI) and oral hygiene (OHI-S) statuses were assessed. The validated instruments collected information relating to sociodemographic background, oral health behaviours, OHRQoL and satisfaction with appearance (SWAP). Information relating to the time of the incident, cause and severity (type, TBSA) of the burn were obtained from medical records. The OHRQoL prevalence of impact and severity measures were derived and analysed using simple and multiple, logistic and linear regression. Results A total of 271 patients had participated in the study. The OHIP-14 prevalence of impact was 94% with mean severity score = 37 unit (sd = 8.5). The most impacted domains were physical pain (87%), psychological disability (87%), social disability (85%) and physical discomfort (83%). The main determinants of oral health-related quality of life were poor clinical oral conditions - particularly caries, and severity deformity. Other risk factors included poor oral health behaviours, psychological distress and longer time elapsed since the incident, and sex (p < 0.05). Conclusion Dental caries, the severity of the facial deformity, oral health behaviour and time are associated with oral health-related quality of life of patients with facial burns. Oral health behaviour improvement can lower the risk of developing dental problems and oral health-related quality of life impact.
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Affiliation(s)
- Farooq Ahmad Chaudhary
- School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Basaruddin Ahmad
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
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Grant GG, Brady KJS, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Patel KF, Sheldrick RC, Carter A, Sheridan RL, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool 1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile. Burns 2021; 47:1511-1524. [PMID: 33832799 PMCID: PMC8711655 DOI: 10.1016/j.burns.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile.
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Affiliation(s)
- Gabrielle G Grant
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC, United States
| | - Keri J S Brady
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Frederick J Stoddard
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children - Galveston, Galveston, TX, United States
| | - Kathleen S Romanowski
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | | | - Lynda E Painting
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Laura A Fowler
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Judith K Nelson
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Khushbu F Patel
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Alice Carter
- Department of Psychology, University of Massachusetts - Boston, Boston, MA, United States
| | - Robert L Sheridan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Petra Warner
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Tina L Palmieri
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Jeffrey C Schneider
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Spaulding Research Institute, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Natural rubber dressing loaded with silver sulfadiazine for the treatment of burn wounds infected with Candida spp. Int J Biol Macromol 2021; 189:597-606. [PMID: 34418421 DOI: 10.1016/j.ijbiomac.2021.08.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023]
Abstract
Millions of people are burned worldwide every year and 265,000 of the cases are fatal. The development of burn treatment cannot consist only of the administration of a single drug. Due to the infection risk, antibiotics are used in conjunction with gels and damp bandages. In this work, an inexpensive curative based on silver sulfadiazine (SS) and natural rubber latex (NRL) was developed to treat burn wounds. It was produced by the casting method. The infrared spectrum presented no interaction between drug and biopolymer. At the same time, electronic micrographs showed that the SS crystals are inserted on the polymeric dressing surface. Mechanical properties after the drug incorporation were considered suitable for dermal application. About 32.4% of loaded SS was released in 192 h by the dressings that also inhibited the growth of Candida albicans and Candida parapsilosis at 75.0 and 37.5 μg·mL-1, respectively. The curative proved to be biocompatible when applied to fibroblast cells, in addition to enhancing cellular proliferation and, in the hemocompatibility test, no hemolytic effects were observed. The good results in mechanical, antifungal and biological assays, combined with the average bandage cost of $0.10, represent an exciting alternative for treating burn wounds.
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Angelou IK, van Aswegen H, Wilson M, Grobler R. A profile of adult patients with major burns admitted to a Level 1 Trauma Centre and their functional outcomes at discharge: A retrospective review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.4102/sajp.v77i1.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Botman M, Hendriks TCC, de Haas L, Mtui G, Binnerts J, Nuwass E, Niemeijer AS, Jaspers MEH, Winters HAH, Nieuwenhuis MK, van Zuijlen PPM. Access to burn care in low-and middle-income countries: An assessment of timeliness, surgical capacity, and affordability in a regional referral hospital in Tanzania. J Burn Care Res 2021; 43:657-664. [PMID: 34643726 PMCID: PMC9113785 DOI: 10.1093/jbcr/irab191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study investigates patients' access to surgical care for burns in a low-and-middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50 percent reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within three weeks for 74 percent in this group. Of contracture patients, seventy four percent, had sought healthcare after the acute burn injury. Of the same group, only 4 percent had been treated with skin grafts beforehand, and 70 percent never received surgical care or a referral. Combined, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively impacting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socio-economic factors that determine patient mortality and disability.
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Affiliation(s)
- Matthijs Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands.,Global Surgery Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute
| | - Thom C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands.,Global Surgery Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute.,Haydom Lutheran Hospital, Department of Surgery, Haydom, Tanzania
| | - Louise de Haas
- Global Surgery Amsterdam, the Netherlands.,Haydom Lutheran Hospital, Department of Surgery, Haydom, Tanzania
| | - Grayson Mtui
- Global Surgery Amsterdam, the Netherlands.,Haydom Lutheran Hospital, Department of Surgery, Haydom, Tanzania
| | - Joost Binnerts
- Global Surgery Amsterdam, the Netherlands.,Haydom Lutheran Hospital, Department of Surgery, Haydom, Tanzania
| | - Emanuel Nuwass
- Global Surgery Amsterdam, the Netherlands.,Haydom Lutheran Hospital, Department of Surgery, Haydom, Tanzania
| | - Anuschka S Niemeijer
- Association of Dutch Burn Centers, Burn Centre Martini Hospital, Groningen, the Netherlands
| | - Mariëlle E H Jaspers
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands.,Global Surgery Amsterdam, the Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands.,Global Surgery Amsterdam, the Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre Martini Hospital, Groningen, the Netherlands.,Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, the Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands.,Global Surgery Amsterdam, the Netherlands.,Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands.,Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
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Robledo Cadavid JM, Salgado Flórez L, Garcés Echeverri JC, Ruiz Santacruz JE, Hernandez Ortiz OH. Characterization of severely burned patients and evaluation of factors associated to mortality. An observational retrospective cohort study in San Vicente Fundación Hospital. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211046464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Burns are common in developing countries and place a large burden on the medical and social care systems. However, information about management and outcomes from such countries is scarce. The purpose of this study was to analyze the epidemiology and main factors related to the mortality in severely burned patients at the Hospital Universitario San Vicente Fundación in Medellín, Colombia. Methods An observational retrospective cohort study was conducted. To establish prognostic factors associated with mortality, we analyzed variables such as age, sex, burned surface, and degree of burn, among others. Demographic, clinic, and management features as well as complications and factors associated with mortality were analyzed using logistic regression. Results 4516 clinical histories were reviewed, 225 were included in the study. 76.9% were men, with a median age of 35 years; 64.9% were fire burns. The median burned body surface area was 42%. There were inhalation injuries in 135 patients and ocular in 106 patients. The main complication was infection followed by rhabdomyolysis. The overall hospital stay was 27 days, and the median length of stay at the intensive care unit was 7 days with in-hospital mortality of 30.7%. The variables associated with mortality were age, burned body surface area, degree of burn, and kidney injury. Surgical intervention was protective. Conclusions Severely burned patients in our hospital have similar outcomes and, in some cases, better outcomes than those reported in the literature in countries with similar characteristics, and we have seen that in the last years, there has been a better experience in the management of these patients. Elderly, extension, and depth of burnt tissue are markers of poor outcomes. Early surgery and intubation have shown better outcomes, probably due to infection control and removal of necrotic tissue, airway management, and ventilatory support for metabolic and hemodynamic derangement.
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Khan N, Kaur S, Knuth CM, Jeschke MG. CNS-Spleen Axis - a Close Interplay in Mediating Inflammatory Responses in Burn Patients and a Key to Novel Burn Therapeutics. Front Immunol 2021; 12:720221. [PMID: 34539655 PMCID: PMC8448279 DOI: 10.3389/fimmu.2021.720221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Severe burn-induced inflammation and subsequent hypermetabolic response can lead to profound infection and sepsis, resulting in multiple organ failure and high mortality risk in patients. This represents an extremely challenging issue for clinicians as sepsis is the leading cause of mortality in burn patients. Since hyperinflammation and immune dysfunction are a result of an immune imbalance, restoring these conditions seem to have promising benefits for burn patients. A key network that modulates the immune balance is the central nervous system (CNS)-spleen axis, which coordinates multiple signaling pathways, including sympathetic and parasympathetic pathways. Modulating inflammation is a key strategy that researchers use to understand neuroimmunomodulation in other hyperinflammatory disease models and modulating the CNS-spleen axis has led to improved clinical outcomes in patients. As the immune balance is paramount for recovery in burn-induced sepsis and patients with hyperinflammatory conditions, it appears that severe burn injuries substantially alter this CNS-spleen axis. Therefore, it is essential to address and discuss the potential therapeutic techniques that target the CNS-spleen axis that aim to restore homeostasis in burn patients. To understand this in detail, we have conducted a systematic review to explore the role of the CNS-spleen axis and its impact on immunomodulation concerning the burn-induced hypermetabolic response and associated sepsis complications. Furthermore, this thorough review explores the role of the spleen, CNS-spleen axis in the ebb and flow phases following a severe burn, how this axis induces metabolic factors and immune dysfunction, and therapeutic techniques and chemical interventions that restore the immune balance via neuroimmunomodulation.
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Affiliation(s)
- Noorisah Khan
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Supreet Kaur
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carly M Knuth
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Sanjar F, Weaver AJ, Peacock TJ, Nguyen JQ, Brandenburg KS, Leung KP. Identification of Metagenomics Structure and Function Associated With Temporal Changes in Rat (Rattus norvegicus) Skin Microbiome During Health and Cutaneous Burn. J Burn Care Res 2021; 41:347-358. [PMID: 31665423 DOI: 10.1093/jbcr/irz165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The cutaneous skin microbiome is host to a vast ensemble of resident microbes that provide essential capabilities including protection of skin barrier integrity and modulation of the host immune response. Cutaneous burn-injury promotes alteration of cutaneous and systemic immune response that can affect both commensal and pathogenic microbes. A cross-sectional study of a limited number of burn patients revealed a difference in the bacteriome of burned versus control participants. Temporal changes of the skin microbiome during health and cutaneous burn-injury remains largely unknown. Furthermore, how this microbial shift relates to community function in the collective metagenome remain elusive. Due to cost considerations and reduced healing time, rodents are frequently used in burn research, despite inherent physiological differences between rodents and human skin. Using a rat burn model, a longitudinal study was conducted to characterize the rat skin bacterial residents and associated community functions in states of health (n = 30) (sham-burned) and when compromised by burn-injury (n = 24). To address the knowledge gap, traumatic thermal injury and disruption of cutaneous surface is associated with genus-level changes in the microbiota, reduced bacterial richness, and altered representation of bacterial genes and associated predicted functions across different skin microbial communities. These findings demonstrate that, upon burn-injury, there is a shift in diversity of the skin's organismal assemblages, yielding a core microbiome that is distinct at the genome and functional level. Moreover, deviations from the core community correlate with temporal changes post-injury and community transition from the state of cutaneous health to disease (burn-injury).
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Affiliation(s)
- Fatemeh Sanjar
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, U.S. Army Institute of Surgical Research, JBSA Fort, Sam Houston, Texas
| | - Alan J Weaver
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, U.S. Army Institute of Surgical Research, JBSA Fort, Sam Houston, Texas
| | | | - Jesse Q Nguyen
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, U.S. Army Institute of Surgical Research, JBSA Fort, Sam Houston, Texas
| | - Kenneth S Brandenburg
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, U.S. Army Institute of Surgical Research, JBSA Fort, Sam Houston, Texas
| | - Kai P Leung
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, U.S. Army Institute of Surgical Research, JBSA Fort, Sam Houston, Texas
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Berger MM, Binz PA, Roux C, Charrière M, Scaletta C, Raffoul W, Applegate LA, Pantet O. Exudative glutamine losses contribute to high needs after burn injury. JPEN J Parenter Enteral Nutr 2021; 46:782-788. [PMID: 34288001 PMCID: PMC9292800 DOI: 10.1002/jpen.2227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Burnpatients characteristically have increased energy, glucose, and protein requirements. Glutamine supplementation is strongly recommended during early‐phase treatment and is associated with improved immunity, wound healing, and reduced mortality. This study evaluated if early burn exudative losses might contribute to higher supplementation needs. Methods Patients admitted to the burn intensive care unit (ICU) had exudate collection from tight bandages applied to arms or legs during the first week (exudate aliquot twice daily). Seven amino acids (alanine, arginine, cystEine, glutamine, leucine, lysine, and methionine) were quantified by liquid chromatography–mass spectrometry. Descriptive analysis of all results is provided as median and interquartile range or in value ranges. Results Eleven patients aged 19–77 years, presenting with burns on 18%–70% of the body surface, with a median simplified acute physiology score II of 33 (range, 16–56) were included during the study period. The highest amino acid losses were observed during the first 3 days with an important interpatient and intrapatient variability. Glutamine and alanine losses were highest, followed by leucine and lysine in all patients; amino acid exudate concentrations were in the range of normal plasma concentrations and were stable over time. Total glutamine losses were correlated to the burned surface (r2 = 0.552, P = .012), but not to enteral glutamine supplements. Conclusions The study shows significant exudative losses during early‐stage burn recovery and particularly for glutamine and alanine. Glutamine loss generally decreased with wound closure, the subsequent decline of exudation, and the evolving size of burn surfaces.
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Affiliation(s)
- Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre-Alain Binz
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Clothilde Roux
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mélanie Charrière
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Corinne Scaletta
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Wassim Raffoul
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Lee Ann Applegate
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Pantet
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Wong L, Rajandram R, Allorto N. Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries. Burns 2021; 47:1705-1713. [PMID: 34303572 DOI: 10.1016/j.burns.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION While the benefits of early excision in burn surgery are clear, the advantages may be lost in low income countries with limited resources. It is important to identify the right timing of excision in different groups of patients, particularly those in low-income countries (LIC), as the burden of disease contributes to the highest global mortality and has the least resources. This systematic review and meta-analysis aims to determine the timing of excision in LICs and the outcomes associated with surgery: (1) mortality, (2) sepsis and (3) length of stay (LOS) compared to high income countries (HICs). METHODOLOGY The PRISMA guidelines and MOOSE checklist were followed for this review. Publications in English from year 1990 to 2017 that included data on the timing and type of burn surgery and outcomes were included. Searches were done using Web of Science, Cochrane collaboration and Pubmed using keywords "Burn and surgery", "Burn and excision", "Burn and excision and grafting" and "burn and skin grafting". Trial quality was evaluated using the Newcastle-Ottawa scale. Outcomes compared for early and late excisions were length of stay (LOS), sepsis and mortality between LICs and HICs. RESULTS From 278 citations, we selected 41 for full text evaluation, and identified 16 eligible trials. LOS is shorter in early excision compared to late excision in both LICs and HICs. Mortality is lower in late excision compared to early excision in both LICs and HICs. Further subgroup analysis of elderly patients in HICs confirmed that mortality is lower in late excision and unchanged if the elderly are excluded. Early excision reduces sepsis in both LIC and HIC. DISCUSSION The variable definitions of age, timing of excision, variable nature of % TBSA comparison, mixed inclusion of inhalation injury, co-morbidities and unquantified access to resources make the data difficult to interpret and it is not possible to draw accurate conclusions on the role of early excision for burns in low-middle income countries. A prospective study is needed in order to answer this question.
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Affiliation(s)
- Lingwei Wong
- Trauma Sciences, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom.
| | - Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Nikki Allorto
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-zulu Natal, South Africa.
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Glucose Metabolism in Burns-What Happens? Int J Mol Sci 2021; 22:ijms22105159. [PMID: 34068151 PMCID: PMC8153015 DOI: 10.3390/ijms22105159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Severe burns represent an important challenge for patients and medical teams. They lead to profound metabolic alterations, trigger a systemic inflammatory response, crush the immune defense, impair the function of the heart, lungs, kidneys, liver, etc. The metabolism is shifted towards a hypermetabolic state, and this situation might persist for years after the burn, having deleterious consequences for the patient's health. Severely burned patients lack energy substrates and react in order to produce and maintain augmented levels of glucose, which is the fuel "ready to use" by cells. In this paper, we discuss biological substances that induce a hyperglycemic response, concur to insulin resistance, and determine cell disturbance after a severe burn. We also focus on the most effective agents that provide pharmacological modulations of the changes in glucose metabolism.
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Wang M, Xu X, Lei X, Tan J, Xie H. Mesenchymal stem cell-based therapy for burn wound healing. BURNS & TRAUMA 2021; 9:tkab002. [PMID: 34212055 PMCID: PMC8240555 DOI: 10.1093/burnst/tkab002] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/14/2020] [Indexed: 02/05/2023]
Abstract
Burns, with their high incidence and mortality rates, have a devastating effect on patients. There are still huge challenges in the management of burns. Mesenchymal stem cells (MSCs), which have multidirectional differentiation potential, have aroused interest in exploring the capacity for treating different intractable diseases due to their strong proliferation, tissue repair, immune tolerance and paracrine abilities, among other features. Currently, several animal studies have shown that MSCs play various roles and have beneficial effects in promoting wound healing, inhibiting burn inflammation and preventing the formation of pathological scars during burn healing process. The substances MSCs secrete can act on peripheral cells and promote burn repair. According to preclinical research, MSC-based treatments can effectively improve burn wound healing and reduce pain. However, due to the small number of patients and the lack of controls, treatment plans and evaluation criteria vary widely, thus limiting the value of these clinical studies. Therefore, to better evaluate the safety and effectiveness of MSC-based burn treatments, standardization of the application scheme and evaluation criteria of MSC therapy in burn treatment is required in the future. In addition, the combination of MSC pretreatment and dressing materials are also conducive to improving the therapeutic effect of MSCs on burns. In this article, we review current animal research and clinical trials based on the use of stem cell therapy for treating burns and discuss the main challenges and coping strategies facing future clinical applications.
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Affiliation(s)
- Mingyao Wang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Xinxuan Xu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Xiongxin Lei
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Jie Tan
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Keyuan Road 4, Gaopeng Street, Chengdu, Sichuan 610041, China
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De Buck E, Vanhove AC, O D, Veys K, Lang E, Vandekerckhove P. Day care as a strategy for drowning prevention in children under 6 years of age in low- and middle-income countries. Cochrane Database Syst Rev 2021; 4:CD014955. [PMID: 33884613 PMCID: PMC8406676 DOI: 10.1002/14651858.cd014955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this. OBJECTIVES Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children. SELECTION CRITERIA We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment. MAIN RESULTS Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported. AUTHORS' CONCLUSIONS This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.
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Affiliation(s)
- Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Cochrane First Aid, Mechelen, Belgium
| | - Anne-Catherine Vanhove
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Belgian Centre for Evidence-Based Medicine - Cochrane Belgium, Leuven, Belgium
| | - Dorien O
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Koen Veys
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
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Puthumana JS, Ngaage LM, Borrelli MR, Rada EM, Caffrey J, Rasko Y. Risk factors for cooking-related burn injuries in children, WHO Global Burn Registry. Bull World Health Organ 2021; 99:439-445. [PMID: 34108754 PMCID: PMC8164180 DOI: 10.2471/blt.20.279786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the characteristics of cooking-related burn injuries in children reported to the World Health Organization Global Burn Registry. Methods On 1 February 2021, we downloaded data from the Global Burn Registry on demographic and clinical characteristics of patients younger than 19 years. We performed multivariate regressions to identify risk factors predictive of mortality and total body surface area affected by burns. Findings Of the 2957 paediatric patients with burn injuries, 974 involved cooking (32.9%). More burns occurred in boys (532 patients; 54.6%) than in girls, and in children 2 years and younger (489 patients; 50.2%). Accidental contact and liquefied petroleum caused most burn injuries (729 patients; 74.8% and 293 patients; 30.1%, respectively). Burn contact by explosions (odds ratio, OR: 2.8; 95% confidence interval, CI: 1.4–5.7) or fires in the cooking area (OR: 3.0; 95% CI: 1.3–6.8), as well as the cooking fuels wood (OR: 2.2; 95 CI%: 1.3–3.4), kerosene (OR: 1.9; 95% CI: 1.0–3.6) or natural gas (OR: 1.5; 95% CI: 1.0–2.2) were associated with larger body surface area affected. Mortality was associated with explosions (OR: 7.5; 95% CI: 2.2–25.9) and fires in the cooking area (OR: 6.9; 95% CI: 1.9–25.7), charcoal (OR: 4.6; 95% CI: 2.0–10.5), kerosene (OR: 3.9; 95% CI: 1.4–10.8), natural gas (OR: 3.0; 95% CI: 1.5–6.1) or wood (OR: 2.8; 95% CI: 1.1–7.1). Conclusion Preventive interventions directed against explosions, fires in cooking areas and hazardous cooking fuels should be implemented to reduce morbidity and mortality from cooking-related burn injuries.
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Affiliation(s)
- Joseph S Puthumana
- Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21230, United States of America (USA)
| | - Ledibabari M Ngaage
- Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21230, United States of America (USA)
| | - Mimi R Borrelli
- Division of Plastic Surgery, Stanford University, Palo Alto, USA
| | - Erin M Rada
- Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21230, United States of America (USA)
| | - Julie Caffrey
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yvonne Rasko
- Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21230, United States of America (USA)
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Kruchevsky D, Arraf M, Levanon S, Capucha T, Ramon Y, Ullmann Y. Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown. J Burn Care Res 2021; 42:135-140. [PMID: 32914186 PMCID: PMC7499677 DOI: 10.1093/jbcr/iraa154] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.
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Affiliation(s)
- Dani Kruchevsky
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Maher Arraf
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Shir Levanon
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Tal Capucha
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Yitzchak Ramon
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
| | - Yehuda Ullmann
- Plastic and Reconstructive Surgery Department, Rambam Health Care Campus, Haifa, Israel
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Blom L. mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments. Glob Health Action 2021; 13:1802951. [PMID: 32814518 PMCID: PMC7480586 DOI: 10.1080/16549716.2020.1802951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.
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Affiliation(s)
- Lisa Blom
- Department of Global Public Health, Karolinska Institutet , Stockholm, Sweden
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70
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The cost of inpatient burn management in Nepal. Burns 2021; 47:1675-1682. [PMID: 33947601 DOI: 10.1016/j.burns.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal. METHODS We conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting. RESULTS Experts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A 'typical' burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively. CONCLUSION This study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.
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Experience of outreach in a resource-constrained environment: 10 years of outcomes in burn care. Burns 2021; 47:1656-1664. [PMID: 33642122 DOI: 10.1016/j.burns.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/09/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this work was to describe an efficient and sustainable outreach model in a resource-constrained environment, with a multifaceted approach focusing on national policy change, telemedicine, injury prevention, education and treatment of burns. SUMMARY BACKGROUND DATA Burn injury constitutes a significant portion of morbidity and mortality worldwide, particularly in children, and in low- and middle-income countries. METHODS We reviewed the impact of ten-years of a burn outreach program. Our focus was on clinical data on burn care within one region of Ukraine. We assessed knowledge of burn prevention/first aid utilizing a large survey, analyzed clinical data from our outreach clinic and telemedicine program, and analyzed data within a newly created burn repository within Ukraine. RESULTS A national burn prevention policy has been implemented through our efforts along with a burn prevention program. Educational efforts have led to improvements of major complication rates (wound infection [7% vs. 16%], pneumonia [2.4% vs. 0.3%], sepsis [1.6% vs. 0.6%], UTI [2% vs. 0.6%], and cellulitis [11% vs. 3.4%]), respiratory support of acutely ill patients [1.3% vs. 0.4%], and blood transfusion triggers. CONCLUSIONS Broadly, our model could be an example of building sustainable outreach programs in resource-constrained environments. Through collaboration with local healthcare providers, we have developed and implemented an outreach program in a resource-constrained environment.
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Hendriks TCC, Botman M, de Haas LEM, Mtui GS, Nuwass EQ, Jaspers MEH, Niemeijer AS, Nieuwenhuis MK, Winters HAH, van Zuijlen PPM. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country. Burns 2021; 47:1285-1294. [PMID: 33485727 DOI: 10.1016/j.burns.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Burn scar contractures limit range of motion (ROM) of joints and have substantial impact on disability and the quality of life (QoL) of patients, particularly in a Low- and Middle-Income Country (LMIC) setting. Studies on the long-term outcome are lacking globally; this study describes the long-term impact of contracture release surgery performed in an LMIC. METHODS This is a pre-post cohort study, conducted in a referral hospital in Tanzania. Patients who underwent burn scar contracture release surgery in 2017-2018 were eligible. ROM (goniometry), disability (WHODAS 2.0) and QoL (EQ-5D) were assessed. The ROM data were compared to the ROM that is required to perform activities of daily living without compensation, i.e. functional ROM. Assessments were performed preoperatively and at 1, 3, 6 and 12 months postoperatively. RESULTS In total, 44 patients underwent surgery on 115 affected joints. At 12 months, the follow-up rate was 86%. The mean preoperative ROM was 37.3% of functional ROM (SD 31.2). This improved up to 108.7% at 12 months postoperatively (SD 42.0, p < 0.001). Disability-free survival improved from 55% preoperatively to 97% at 12 months (p < 0.001) postoperatively. QoL improved from 0.69 preoperatively, to 0.93 (max 1.0) at 12 months postoperatively (p < 0.001). Patients who regained functional ROM in all affected joints reported significantly less disability (p < 0.001) and higher QoL (p < 0.001) compared to patients without functional ROM. CONCLUSIONS Contracture release surgery performed in an LMIC significantly improved functional ROM, disability and QoL. Results showed that regaining a functional joint is associated with less disability and higher QoL.
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Affiliation(s)
- T C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.
| | - M Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | - L E M de Haas
- Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | - G S Mtui
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - E Q Nuwass
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - M E H Jaspers
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - A S Niemeijer
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - M K Nieuwenhuis
- Burn Center, Martini Hospital, Groningen, The Netherlands; Association of Dutch Burn Centers, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - P P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Amsterdam Movement Sciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Hashemi SS, Mahmoodi M, Tohidinik HR, Mohammadi AA, Mehrabani D. The Epidemiology of Burn and Lethal Area of Fifty Percentage (LA50) in Children in Shiraz, Southern Iran. World J Plast Surg 2021; 10:66-70. [PMID: 33833956 PMCID: PMC8016374 DOI: 10.29252/wjps.10.1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study was conducted to assess the epidemiology of burn and lethal area of fifty percentage (LA50) in children in Shiraz, Southern Iran. METHODS In this case series study, 619 hospitalized burn children from burn centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2012 to 2016 were enrolled. Demographic characteristics of patients such as age, gender, place and cause of burn, and morality rate were evaluated. LA50 was measured using Probit analysis. RESULTS The mean age of patients was 4.4±3.4 years. The mortality rate in burn patients was 8.7% and LA50 of total body surface area (TBSA%) ranged from 40.1% in 2012 to 68.3% in 2016. Although the number of male burn patients (65%) was more than females (35%), the mortality rate in females was more than males (11.4% vs. 7.2%). Scald and flame were the most common causes of burn. CONCLUSION The findings in our burn center comparing burn patients to developed countries showed that LA50 and survival rate were lower denoting to an urgent necessity to promote current policies in burn care and prevention and to decrease the mortality rate too.
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Affiliation(s)
- Seyedeh-Sara Hashemi
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Mahdukht Mahmoodi
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Hamid Reza Tohidinik
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Davood Mehrabani
- Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tupetz A, Friedman K, Zhao D, Liao H, Isenburg MV, Keating EM, Vissoci JRN, Staton CA. Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243464. [PMID: 33373371 PMCID: PMC7771986 DOI: 10.1371/journal.pone.0243464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022] Open
Abstract
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duan Zhao
- Duke Kunshan University, Kunshan, Suzhou, Jiangsu, China
| | - Huipeng Liao
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Megan Von Isenburg
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Gurbuz K, Demir M. The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-Specific Mortality Patterns. J Burn Care Res 2020; 42:743-751. [PMID: 33301559 DOI: 10.1093/jbcr/iraa206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital. Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into 10 sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70 to 79 years had the highest mortality rate of 33.3%; followed by 60 to 69, 80+, 18 to 29, 10 to 17, and <5 sub-age groups, whose mortality rates were 13.0%, 7.8%, 7.2%, 2.4%, and 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, TBSA burned ≥20% (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (P < .0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (P < .0001), whose had 5.84 times more likely death; followed by 29 to 59 and 18 to 29 sub-age groups, with the odds ratios of 2.12 (95% confidence interval = 1.25-3.61) and 2.08 (95% confidence interval = 1.90-4.05), respectively. Oppose to these findings; the 0 to 17 sub-age group was not found to have a statistically significant effect in predicting mortality.
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Affiliation(s)
- Kayhan Gurbuz
- Burn Center, Department of General Surgery, Adana City Training and Research Hospital, Turkey
| | - Mete Demir
- Burn Center, Department of General Surgery, Adana City Training and Research Hospital, Turkey
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76
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The effect of burn mechanism on pediatric mortality in Malawi: A propensity weighted analysis. Burns 2020; 47:222-227. [PMID: 33277092 DOI: 10.1016/j.burns.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/24/2019] [Accepted: 12/31/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated. METHODS This is a retrospective analysis of prospectively collected data, utilizing the Kamuzu Central Hospital (KCH) Burn Surveillance Registry from May 2011 to August 2019. Pediatric patients (≤12 years) with flame and scald burns were included in the study. Basic demographic variables including sex, age, time to presentation, %TBSA, surgical intervention, burn mechanism, and in-hospital mortality outcome was collected. Bivariate analysis comparing demographic, burn characteristics, surgical intervention, and patient outcomes were performed. Standardized estimates were adjusted using inverse-probability of treatment weights (IPTW) to account for confounding. Following weighting, logistic regression modeling was performed to determine the odds of in-hospital mortality based on burn mechanism. RESULTS During the study period, 2364 patients presented to KCH for burns and included in the database with 1794 (75.9%) pediatric patients. Of these, 488 (27.6%) and 1280 (72.4%) were injured by flame and scald burns, respectively. Males were 47.2% (n = 230) and 59.2% (n = 755) of the flame and scald burn cohorts, respectively (p < 0.001.) Patients presenting with flame burns compared to scald burns were older (4. 7 ± 3.1 vs. 2.7 ± 2.3 years, p < 0.001) with greater %TBSA burns (17.8 [IQR 10-28] vs 12 [IQR 7-20], p < 0.001). Surgery was performed for 42.2% (n = 206) and 19.9% (n = 140) of the flame and scald burn cohorts, respectively (p < 0.001.) Flame burns had a 2.6x greater odds of in-hospital mortality compared to scald burns (p < 0.001) after controlling for sex, %TBSA, age, time to presentation, and surgical status. CONCLUSION In this propensity-weighted analysis, we show that burn mechanism, specifically flame burns, resulted in a nearly 3-fold increase in odds of in-hospital mortality compared to scald burns. Our results emphasize flame and scald burns have major differences in the inflammatory response, metabolic profile over time, and outcomes. We may further utilize these differences to develop specialized treatments for each burn mechanism to potentially prevent metabolic dysfunction and improve clinical outcomes.
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Tsiampouris I, Charcharidou M, Dousis E, Oikonomidi N, Makrygianni P, Vasilopoulos G, Castana O, Koutelekos I. Investigating the Six-Month Incidence Rate of Burn Disease in Children in Greece. Cureus 2020; 12:e11192. [PMID: 33269123 PMCID: PMC7703708 DOI: 10.7759/cureus.11192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Burns in children are painful, can be fatal, and involve a significant risk of complications, along with physical and psychological consequences. This study aimed to investigate the incidence of burns in children, for six months, and the most common causative factors, along with the existing correlations between demographic data and the characteristics of burn injuries. Methods The study was descriptive and prospective, and the sample consisted of minors up to 14 years old with burns in any areas of the body. The research was carried out in the Attica pediatric hospitals’ selected departments for six months (from July to December 2018). Sources for completing the created database were the patients, their guardians, and their medical-nursing documentation and records. Results The cumulative six-month incidence rate of childhood burn disease was 4.9%. The most affected age group appeared to be younger than two years (60%), while liquid heat appeared to be the primary form of the burn factor (76%). The average duration of hospitalization for children with a deep partial-thickness to a total-thickness burn degree was 16.5 days. The correlations that emerged related to the extent of the burn were directly related to the accident’s site, and patients with an increased likelihood of future additional surgeries had an increased mean total body surface area that was burned. Conclusion Continuous surveillance and removal of hazardous materials from the home environment is of utmost need. Early education/understanding of correct behaviors and proper attention to outdoor activities or excursions can significantly reduce burns. Training courses on burn prevention for parents are needed, as the best form of treatment is prevention.
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Affiliation(s)
| | | | | | | | | | | | - Ourania Castana
- Plastic and Reconstructive Surgery, Evangelismos General Hospital, Athens, GRC
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78
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James SL, Lucchesi LR, Bisignano C, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Henry NJ, McCracken D, Roberts NLS, Sylte DO, Ahmadi A, Ahmed MB, Alahdab F, Alipour V, Andualem Z, Antonio CAT, Arabloo J, Badiye AD, Bagherzadeh M, Banstola A, Bärnighausen TW, Barzegar A, Bayati M, Bhaumik S, Bijani A, Bukhman G, Carvalho F, Crowe CS, Dalal K, Daryani A, Nasab MD, Do HT, Do HP, Endries AY, Fernandes E, Filip I, Fischer F, Fukumoto T, Gebremedhin KBB, Gebremeskel GG, Gilani SA, Haagsma JA, Hamidi S, Hostiuc S, Househ M, Igumbor EU, Ilesanmi OS, Irvani SSN, Jayatilleke AU, Kahsay A, Kapoor N, Kasaeian A, Khader YS, Khalil IA, Khan EA, Khazaee-Pool M, Kokubo Y, Lopez AD, Madadin M, Majdan M, Maled V, Malekzadeh R, Manafi N, Manafi A, Mangalam S, Massenburg BB, Meles HG, Menezes RG, Meretoja TJ, Miazgowski B, Miller TR, Mohammadian-Hafshejani A, Mohammadpourhodki R, Morrison SD, Negoi I, Nguyen TH, Nguyen SH, Nguyen CT, Nixon MR, Olagunju AT, Olagunju TO, Padubidri JR, Polinder S, Rabiee N, Rabiee M, Radfar A, Rahimi-Movaghar V, Rawaf S, Rawaf DL, Rezapour A, Rickard J, Roro EM, Roy N, Safari-Faramani R, Salamati P, Samy AM, Satpathy M, Sawhney M, Schwebel DC, Senthilkumaran S, Sepanlou SG, Shigematsu M, Soheili A, Stokes MA, Tohidinik HR, Tran BX, Valdez PR, Wijeratne T, Yisma E, Zaidi Z, Zamani M, Zhang ZJ, Hay SI, Mokdad AH. Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study. Inj Prev 2020; 26:i36-i45. [PMID: 31857422 PMCID: PMC7571358 DOI: 10.1136/injuryprev-2019-043299] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. METHODS We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. RESULTS Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). CONCLUSIONS The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
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Affiliation(s)
- Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Lydia R Lucchesi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Erin B Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Darrah McCracken
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Alireza Ahmadi
- Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Vahid Alipour
- Health Management and Economics Research Center, Tehran, Iran
- Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
| | - Zewudu Andualem
- Environmental and Occupational Health and Safety Department, University of Gondar, Gondar, Ethiopia
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ashish D Badiye
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | | | - Amrit Banstola
- Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan, Nepal
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Akbar Barzegar
- Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Félix Carvalho
- Applied Molecular Biosciences Unit, University of Porto, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | | | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Huyen Phuc Do
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Aman Yesuf Endries
- Public Health Department, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, California, USA
- School of Health Sciences, A.T. Still University, Mesa, Missouri, USA
| | - Florian Fischer
- School of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, Cancer Institute (W.I.A), Philadelphia, Pennsylvania, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | | | - Gebreamlak Gebremedhn Gebremeskel
- Nursing Department College of Health Science, Aksum University, Aksum, Ethiopia
- Nursing Department, Mekelle University, Mekelle, Ethiopia
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Chairman BOG, Afro-Asian Institute Lahore, Pakistan
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Sorin Hostiuc
- Faculty of Dentistry, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation for Education, Science, and Community Development, Doha, Qatar
| | - Ehimario U Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Department of Public Health, Walter Sisulu University, Mthatha, South Africa
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Achala Upendra Jayatilleke
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Neeti Kapoor
- Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Ibrahim A Khalil
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Maryam Khazaee-Pool
- Department of Public Health, School of Health, Mazandaran University of Sciences, Sari, Iran
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Madadin
- Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Venkatesh Maled
- Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
- Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Manafi
- Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Srikanth Mangalam
- Public Risk Management Institute, Mississauga, Ontario, Canada
- Trade and Competitiveness, World Bank, New York city, New York, USA
| | | | | | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | | | | | - Ionut Negoi
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Trang Huyen Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jagadish Rao Padubidri
- Forensic Medicine and Toxicology Department, Manipal Academy of Higher Education, Mangaluru, India
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Mohammad Rabiee
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Amir Radfar
- College of G raduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
- Medichem, Barcelona, Spain
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health Department, Public Health England, London, UK
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
- University College London Hospitals, London, UK
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jennifer Rickard
- Surgery Department, University of Minnesota, Minneapolis, Minnesota, USA
- Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Elias Merdassa Roro
- Public Health Department, Wollega University, Nekemte, Ethiopia
- Public Health Department, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nobhojit Roy
- Public Health Planning and Evidence Practice Area, National Health Systems Resource Centre, New Delhi, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Health and Policy Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amin Soheili
- Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran
- Emergency Nursing Department, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mark A Stokes
- Department of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Hamid Reza Tohidinik
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Tissa Wijeratne
- Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Al-Shaqsi S, Al-Busaidi S, Al-Kashmiri A, Hashish AM, Mheisin A, Al-Barashdi J. Beyond skin deep: understanding the physical and psychological sufferings of burn survivors in the Sultanate of Oman. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gross-Amat O, Guillen M, Salmon D, Nataf S, Auxenfans C. Characterization of a Topically Testable Model of Burn Injury on Human Skin Explants. Int J Mol Sci 2020; 21:ijms21186956. [PMID: 32971882 PMCID: PMC7554828 DOI: 10.3390/ijms21186956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 01/25/2023] Open
Abstract
Severe burn injuries remain a major health problem due to high rates of mortality, residual morbidity, and/or aesthetic damages. To find new therapies aimed at promoting a harmonious healing of skin burns, it is important to develop models which take into account the unique properties of the human skin. Based on previously described models of burn injury performed on human skin explants, we hypothesized that maintaining explants under constant tension forces would allow to more closely reproduce the pathophysiological processes of skin remodeling. We thus. Here, we set up and characterized an improved model of deep second-degree burn injury on ex vivo cultured human skin explants at air-liquid interface and maintained under conditions of constant tension forces. A spontaneous re-epithelialization of the lesion was observed 8 to 9 days post burn and was found to rely on the proliferation of basal keratinocytes at the wound edges. Collagen VII at the dermo-epidermal junction reformed along with the progression of re-epithelializatio and a synthesis of procollagen III was observed in the dermis at the wound site. These findings indicate that our model is suitable for the assessment of clinically-relevant therapies aimed at modulating the kinetics of re-epithelialization and/or the activation of fibroblasts following skin burn injuries. In this regard, we evaluated the use of a thermoreversible poloxamer hydrogel as a vehicle for topically-testable therapeutic molecules. Our data showed that, although useful for drug formulation, the p407/p188 poloxamer hydrogel induces a delay of skin re-epithelialization in humans skin explants submitted to experimental burn injury.
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Affiliation(s)
- Olivia Gross-Amat
- Lyon-Est School of Medicine, University Claude Bernard Lyon-1, 69100 Villeurbanne, France; (M.G.); (S.N.)
- Bank of Tissues and Cells, Lyon University Hospital (Hospices Civils de Lyon), 69003 Lyon, France;
- CarMeN Laboratory, INSERM U1060, INRA U1397, INSA de Lyon, 69600 Oullins, France
- Correspondence:
| | - Marine Guillen
- Lyon-Est School of Medicine, University Claude Bernard Lyon-1, 69100 Villeurbanne, France; (M.G.); (S.N.)
- Bank of Tissues and Cells, Lyon University Hospital (Hospices Civils de Lyon), 69003 Lyon, France;
| | - Damien Salmon
- Fundamental, Clinical and Therapeutic Aspects of Skin Barrier Function, EA4169, University of Lyon 1, 69008 Lyon, France;
| | - Serge Nataf
- Lyon-Est School of Medicine, University Claude Bernard Lyon-1, 69100 Villeurbanne, France; (M.G.); (S.N.)
- Bank of Tissues and Cells, Lyon University Hospital (Hospices Civils de Lyon), 69003 Lyon, France;
- CarMeN Laboratory, INSERM U1060, INRA U1397, INSA de Lyon, 69600 Oullins, France
| | - Céline Auxenfans
- Bank of Tissues and Cells, Lyon University Hospital (Hospices Civils de Lyon), 69003 Lyon, France;
- Tissue Biology and Therapeutic Engineering Laboratory, UMR 5305, 69007 Lyon, France
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81
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Thomson IK, Iverson KR, Innocent SHS, Kaseje N, Johnson WD. Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool. Int Health 2020; 12:499-506. [PMID: 31613329 DOI: 10.1093/inthealth/ihz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 04/18/2019] [Accepted: 07/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Burns are a leading cause of global disease burden, with children in low- and middle-income countries (LMICs) disproportionately affected. Effective management improves outcomes; however, the availability of necessary resources in LMICs remains unclear. We evaluated surgical centres in LMICs using the WHO Surgical Assessment Tool (SAT) to identify opportunities to optimize paediatric burn care. METHODS We reviewed WHO SAT database entries for 2010-2015. A total of 1121 facilities from 57 countries met the inclusion criteria: facilities with surgical capacity in LMICs operating on children. Human resources, equipment and infrastructure relevant to paediatric burn care were analysed by WHO Regional and World Bank Income Classifications and facility type. RESULTS Facilities had an average of 147 beds and performed 485 paediatric operations annually. Discrepancies existed between procedures performed and resource availability; 86% of facilities performed acute burn care, but only 37% could consistently provide intravenous fluids. Many, particularly tertiary, centres performed contracture release and skin grafting (41%) and amputation (50%). CONCLUSIONS LMICs have limited resources to provide paediatric burn care but widely perform many interventions necessary to address the burden of burns. The SAT may not capture innovative and traditional approaches to burn care. There remains an opportunity to improve paediatric burn care globally.
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Affiliation(s)
| | - Katie R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Cambridge, MA, USA.,University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Neema Kaseje
- Global Initiative for Children's Surgery, CH.,Tropical Institute of Community Health and Development, Kisumu, KE
| | - Walter D Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, CH
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82
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Rencken CA, Allorto N, Harrison AD, McGarvey ST, Aluisio AR. Factors associated with adherence to follow-up care after burn injuries. Burns 2020; 47:240-248. [PMID: 32718731 DOI: 10.1016/j.burns.2020.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In South Africa, burns result in excessive morbidity which can be mitigated via follow-up treatments. This study evaluated factors associated with care retention for after burn injuries. METHODS A retrospective chart review was performed for twelve months of care at the public burn facility in Kwazulu-Natal, South Africa. All inpatients were eligible, although those who were transferred or died during care were excluded. The primary outcome was return for initial appointment one-week after discharge. The population was analyzed descriptively, and multivariable logistic regression was employed to yield adjusted odds ratios (aOR) with associated 95% confidence intervals (CIs). RESULTS From 354 patients 310 were analyzed. Of these, 177 (57.47%) were children (<12 years). One third (33.12%) of patients were non-adherent to follow-up (n = 102). In multivariable analysis, children ≤12 years of age were more likely to follow up (aOR = 1.87; 95% CI: 1.07-3.25, p = 0.028), as were those who underwent an operation (aOR = 2.69; 95% CI: 1.47-4.91, p = 0.001). Residing ≥50 km from the health center was associated with lower likelihood of follow up (aOR = 0.52; 95% CI: 0.29-0.93, p = 0.027). CONCLUSION High follow up attrition suggests the need for enhanced engagement in the high-risk burn population studied, and the identified factors could be leveraged in such programming.
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Affiliation(s)
- Camerin A Rencken
- Brown University, 121 South Main Street, Providence, RI, United States.
| | - Nikki Allorto
- Burn Surgeon, University of KwaZulu-Natal, KZN, South Africa
| | - Abigail D Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, United States
| | - Stephen T McGarvey
- International Health Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI, United States
| | - Adam R Aluisio
- Department of Emergency Medicine, Brown University, 55 Claverick Street, Providence, RI, United States
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83
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Roberson JL, Pham J, Shen J, Stewart K, Hoyte-Williams PE, Mehta K, Rai S, Pedraza JM, Allorto N, Pham TN, Stewart BT. Lessons Learned From Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-Income Countries: A Systematic Review. J Burn Care Res 2020; 41:1271-1278. [PMID: 32504535 DOI: 10.1093/jbcr/iraa093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to the limited survival of patients with large burns in these settings. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning and organization. PubMed, MEDLINE, CINAHL, and World Health Organization Catalog were systematically searched with database-specific language to represent a priori terms (eg, skin, allograft, and tissue bank) and all LMICs as defined by the World Bank. Data regarding tissue banking programs were extracted and described in a narrative synthesis. The search returned 3346 records, and 33 reports from 17 countries were analyzed. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, insufficient training opportunities, opt-in donation schemes, and sociocultural stigma around donation and transplantation. Many lessons were learned from the implementation and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in governance and regulatory structures, international cooperation initiatives, training programs, standardized protocols, and inclusive public awareness campaigns. Furthermore, capacity-building efforts that involve key stakeholders may increase rates of pledges, donations, and transplantations. Some issues were ubiquitously reported and could be addressed by current and future tissue banking programs to ensure allograft availability for patients living in countries of all income levels.
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Affiliation(s)
- Jeffrey L Roberson
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia
| | - Julie Pham
- School of Medicine, University of Washington, Seattle
| | - Jolie Shen
- School of Medicine, University of Washington, Seattle
| | - Kelly Stewart
- School of Medicine, University of Washington, Seattle
| | - Paa Ekow Hoyte-Williams
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Reconstructive Plastic Surgery and Burns Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kajal Mehta
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington
| | - Shankar Rai
- Nepal Cleft and Burn Center, Kirtipur, Nepal
| | | | - Nikki Allorto
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Burns Unit, Edendale Hospital, Pietermaritzburg, South Africa
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington
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84
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Banerjee S, Shumba C. A systematic review of epidemiological patterns and proposed interventions to address pediatric burns in Nigeria. Afr Health Sci 2020; 20:991-999. [PMID: 33163068 PMCID: PMC7609082 DOI: 10.4314/ahs.v20i2.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Unintentional injuries from burns comprise a significant proportion of public health morbidity in Nigeria. In order to understand the type and impact of burns on youth in Low-and-Middle-Income countries, the epidemiology of burns must be adequately assessed. Methods: This review describes the epidemiological patterns of burn occurrences in the pediatric populations and proposes interventions using the Haddon Matrix to address injuries in specific populations in Nigeria. A literature search was conducted using the Proquest, CINAHL, and PubMed databases at the Johns Hopkins University library (January 1, 1990 to August 14, 2018), on burns or thermal injury among pediatric populations in Nigeria. The review focused on the forms of injury, risk factors and potential interventions. Results: Ten studies were identified and the main risk factors for burns were socioeconomic status, overcrowding, and involving young girls in traditional cooking roles. The main types of injuries include scald injuries (50%) and fire burns (45%) affecting mainly children aged 14 and below with significant regional epidemiological variations. We created a novel intervention to develop countermeasures and reduce the number of pediatric burns based on biological, physical and sociocultural environment.. Conclusion: Interventions such as improved supervision of children, improved emergency infrastructure and culturally sensitive first aid education and treatment can help ensure a reduction in morbidity and mortality resulting from burns. Epidemiological studies can provide an accurate depiction of the burden of burn injuries in different regions of Nigeria.
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Affiliation(s)
- Srikanta Banerjee
- Walden University School of Health Sciences, 100 S Washington Ave #900, Minneapolis, MN 55401
- Corresponding author: Srikanta Banerjee, Walden University School of Health Sciences 100 S Washington Ave #900 Minneapolis, MN 55401
| | - Constance Shumba
- Aga Khan University Department of Population Health and School of Nursing and Midwifery airobi, Kenya
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85
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Chang ET, Lin CL, Chen SF, Shen YC. Risk of Burn Injury in Patients With Narcolepsy: A Nationwide Population-Based Cohort Study. J Burn Care Res 2020; 41:663-667. [PMID: 31927592 DOI: 10.1093/jbcr/iraa004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13-3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions.
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Affiliation(s)
- En-Ting Chang
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, and College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Fen Chen
- Center of Medical Genetics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Chih Shen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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86
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Odondi RN, Shitsinzi R, Emarah A. Clinical patterns and early outcomes of burn injuries in patients admitted at the Moi Teaching and Referral Hospital in Eldoret, Western Kenya. Heliyon 2020; 6:e03629. [PMID: 32258478 PMCID: PMC7096742 DOI: 10.1016/j.heliyon.2020.e03629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Burns are the fourth most common type of trauma worldwide and a major cause of mortality and disability in developing countries. Although burns are common in Kenya, the mortality and morbidity patterns are yet to be well studied and documented comprehensively. OBJECTIVE To evaluate burn clinical patterns, early outcomes and their associations among patients admitted with burn injuries at Moi Teaching and Referral Hospital (MTRH). METHODS A cross-sectional descriptive study was conducted at MTRH between January 2016 and June 2017. A total of 189 patients admitted to the hospital with burns were recruited into the study. An interviewer-administered structured questionnaire and chart reviews were used to collect data on sociodemographic variables, burn clinical characteristics and early burn outcomes. Associations between patient characteristics and early burn outcomes were assessed by multivariable logistic regression. RESULTS Of the 182 burn patients whose data was analyzed, the median age was 2.4 years (IQR = 5.8) years and 149 (82%) were children below 18 years. Majority (76%) of burns were due to scalds. The commonest burn locations were the trunk and upper limbs (56%). Only 40% of patients received prehospital intervention. The median Total Burn Surface Area (TBSA) was 14.5% and 74% of the patients had 2nd degree burns. The median length of hospital stay was 16 days (IQR = 28) and commonest complication was wound infection. Proportion of deaths due to burns accounted for 9.3% of the patients. A TBSA of 20%-30% (p = 0.01) was associated with presence of burn complications while a TBSA of >10% (p = 0.03) and time from burn to admission (p = 0.03) were associated with the length of hospital stay. CONCLUSIONS In our study, death was likely to occur in one in ten patients admitted with burns and TBSA was a predictor of presence of burn complications and length of hospital stay. There is a need for continued health education of the public on fire safety within the home environment for children and other vulnerable persons. Timely hospital intervention would also reduce burn complications as well as length of hospital stay.
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Affiliation(s)
| | - Rose Shitsinzi
- Moi University, School of Medicine, Eldoret, Kenya
- The Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ashraf Emarah
- Moi University, School of Medicine, Eldoret, Kenya
- The Moi Teaching and Referral Hospital, Eldoret, Kenya
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87
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Santiso L, Tapking C, Lee JO, Zapata-Sirvent R, Pittelli CA, Suman OE. The Epidemiology of Burns in Children in Guatemala: A Single Center Report. J Burn Care Res 2020; 41:248-253. [PMID: 31504607 DOI: 10.1093/jbcr/irz157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children in low- to middle-income countries are at high risk for sustaining severe burns. This study aimed to analyze the characteristics of pediatric burns in Guatemala that could help identify risk factors and guide prevention efforts. A retrospective review of the characteristics of patients < 18 years of age that were burned in Guatemala between 2015 and 2018 and treated at the Hospital Roosevelt Burn Unit in Guatemala City was performed. The medical records of 949 patients were reviewed (year 2015: 224, year 2016: 238, year 2017: 251, year 2018: 236). Mean age of the patients was 4.0 ± 3.6 years. Majority of the patients were male (54.2%) and suffered from scald burns (68.5%) due to spilling or falling into hot water. Children under the age of 9 years predominantly suffered from scald burns, whereas older children more frequently sustained flame burns. The mortality rate over the 4-year period was 5.2%. As in other low-income countries, pediatric burns in Guatemala are frequent and usually due to scald. Demographic characteristics have to be taken into account when developing strategies for improvements of prevention and treatment or transferring these from high-income countries. Especially education of parents and safety of daily tasks are crucial. Special attention and focusing of efforts in areas of higher incidence should be sought.
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Affiliation(s)
- Lourdes Santiso
- Hospital Roosevelt, Unidad de Quemaduras, Ciudad de Guatemala, Guatemala
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children - Galveston, Galveston, Texas
| | - Ramon Zapata-Sirvent
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children - Galveston, Galveston, Texas
| | | | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children - Galveston, Galveston, Texas
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88
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Johnson DM, White LJ, Gilstrap J, Short TC. Fireworks and Seafood Boils: The Epidemiology of Burns in Louisiana. J Burn Care Res 2020; 41:280-288. [PMID: 31504623 DOI: 10.1093/jbcr/irz159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Epidemiological trends provide a means for targeting efforts in burn prevention. There have been but few regional-specific studies concerning burns in the southern United States. This study describes burn injury trends experienced by a single burn center in Louisiana. We also investigate the temporal relationships of several activities informally known for having a high risk for burn injury among local providers. Data were retrospectively extracted from the records of all patients treated for burn injuries at the regional burn center from 2012 to 2018 in both inpatient and outpatient settings. Demographical data and burn injury characteristics were noted. A total of 6,498 patients were included (1,593 inpatient, 4,905 outpatient). The most common burn etiologies were scald and flame, with flame being associated with more severe injuries. Overall incidence was disproportionally high in males and children less than 4 years of age. Total incidence was highest in Caucasians, though African Americans held the highest annual incidence rate specific to this population. The most common situation at the time of burn injury involved the consumption or preparation of food or beverages. Significant variation was observed in the rates of different injury situations throughout the year. Notably, burns related to seafood, heating, and firework activity occurred more often during crawfish season, colder months, and the months of January and July, respectively. In addition to establishing preliminary trends, these data may be useful in guiding the development of future evidence-based prevention efforts to target the most detrimental burn injuries in this population.
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Affiliation(s)
- Dylan M Johnson
- Department of General Surgery, Brandon Regional Hospital-HCA West Florida Division/USF Health Consortium, Brandon, Florida
| | - Levi J White
- Department of General Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York
| | - Jameson Gilstrap
- Department of Clinical Sciences, American University of the Caribbean School of Medicine, Pembroke Pines, Florida
| | - Tracee C Short
- Department of Burn Care and Surgery, Baton Rouge General Regional Burn Center, Baton Rouge, Louisiana
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89
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Alemayehu S, Afera B, Kidanu K, Belete T. Management Outcome of Burn Injury and Associated Factors among Hospitalized Children at Ayder Referral Hospital, Tigray, Ethiopia. Int J Pediatr 2020; 2020:9136256. [PMID: 32148527 PMCID: PMC7049818 DOI: 10.1155/2020/9136256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Burn injuries are a global public health problem, accounting for an estimated 265,000 deaths. Globally, over half of the disability-adjusted life years lost from fire-related burns which occurred between the ages of 0 and 14 years. The rate of child deaths from burns is currently over 7 times higher in low- and middle-income countries than in high-income countries. In Ethiopia, burn was the second leading cause of death among children from the unintentional injuries. So far, no research had been conducted in terms of assessing the outcome of burn injury in children in Ethiopia and particularly in Tigray region. The aim of this study was to assess the outcome of burn injury and associated factors among hospitalized children of under 18 years at Ayder Referral Hospital in Mekelle, Ethiopia. METHOD A retrospective document review was used to assess the outcome of burn injury and associated factors in Ayder Referral Hospital. A total of 382 hospitalized children's chart from 2011 to 2015 were reviewed using a structured check list. To select the patients' chart, a simple random sampling technique was used and a sampling frame was prepared based on a registration book. Data was entered, cleaned, and analyzed using SPSS version 20. RESULT Almost 70% of the burns were caused by scald, and 45.3% of the burns were confined to the upper extremities. Eighty-two percent of the patients were discharged without complication. Lack of fluid resuscitation within 24 hours (AOR = 2.767; 95% CI (1.276-5.999)) and a burn patient with malnutrition (AOR = 0.252; 95% CI (0.069-0.923)) were statically significant with the outcome of burn injury. CONCLUSION Majority of the pediatric burn patients were discharged without complication. The most causative agent of these accidents was scald; upper extremities also were the most affected area. The factors associated with the outcome of burn injury according to this study were lack of fluid resuscitation and malnourishment of burn patients.
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Affiliation(s)
- Sielu Alemayehu
- Mekelle University, School of Nursing, Mekelle, Tigray, Ethiopia
| | - Bhafta Afera
- Mekelle University, School of Nursing, Mekelle, Tigray, Ethiopia
| | - Kalayou Kidanu
- Mekelle University, School of Nursing, Mekelle, Tigray, Ethiopia
| | - Tilahun Belete
- Mekelle University, School of Nursing, Mekelle, Tigray, Ethiopia
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90
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Goswami P, Sahu S, Singodia P, Kumar M, Tudu T, Kumar A, Sinha PK. Early Excision and Grafting in Burns: An Experience in a Tertiary Care Industrial Hospital of Eastern India. Indian J Plast Surg 2019; 52:337-342. [PMID: 31908372 PMCID: PMC6938413 DOI: 10.1055/s-0039-3402707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction To compare the burn patients undergoing early excision and grafting (within 7 days of burn injury) with the patients undergoing late surgeries (more than 7 days after burn injury) to see if there was any difference in surgical and outcome parameters including length of stay, expenditure, and overall outcome of the patients. Material and Methods A retrospective analysis of the data collected from the burn care unit records over a period of one year was done. Fifty-eight patients who matched with our inclusion criteria were divided into two groups. An early excision group who underwent surgery within 7 days of sustaining burn injury ( n = 24) and a late excision group who underwent excision and grafting/debridement after 7 days of sustaining burn ( n = 34). Data recorded included demographic variables like age, sex, percentage total body surface area (TBSA) burn; nature of burn; date of sustaining burn; date of admission to the burn care unit; and treatment and outcome parameters like date of surgery, days from burn injury to first surgery, number of surgeries, type of surgery, percentage of TBSA resurfaced with skin graft, blood products used, length of stay, outcome, and total expenditure incurred by patients. Results There was no statistically significant difference in the number of surgeries done, the units of packed cell used, and the number of fresh frozen plasma (FFP) used between the early excision group and the late excision group. The length of stay was significantly low in the early excision group as compared with the late excision group. The expenditure incurred in the treatment of the early excision group was significantly lower than the cost of treatment of the late excision group. Conclusion Early excision and grafting in burn cases reduces the length of the stay of burn patients and, in turn, reduces the cost of treatment. However, having a dedicated burn care unit is important for the hospitals and both public and private hospitals should make a move in that direction.
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Affiliation(s)
- Prasenjit Goswami
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Seelora Sahu
- Department of Anesthesiology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Pankaj Singodia
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Manjeet Kumar
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Tukulu Tudu
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Abinash Kumar
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Pankaj Kumar Sinha
- Department of Plastic Surgery and Burns, Tata Main Hospital, Jamshedpur, Jharkhand, India
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91
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Dreckmann SC, Amini-Nik S, Tompkins RG, Vojvodic M, Jeschke MG. Genome-wide comparisons of gene expression in adult versus elderly burn patients. PLoS One 2019; 14:e0226425. [PMID: 31834907 PMCID: PMC6910697 DOI: 10.1371/journal.pone.0226425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Mortality and morbidity rates of elderly burn patients remain high despite numerous advancements in modern burn care. While prior studies have offered first insights on the biochemical changes in elderly burn patients compared to adults, the underlying cellular responses remain largely unknown. In this study, we aim to characterize the transcriptome of elderly burn patients and compare it to adult burn patients to obtain insights into the underlying molecular responses post-burn and to elucidate the effect of advanced age on the acute burn response. Materials and methods Microarray data obtained from the Glue Grant Trauma-Related Database was obtained from blood specimens for ten elderly patients (n = 10), each with a set of two sex and total body surface area (TBSA) matched adult controls (n = 20), during the acute phase post-burn. Adult and elderly demographics and clinical outcomes were contrasted using using the Chi-Square test, Fisher’s Exact Test, or two-sample t-tests, as appropriate (p<0.05). Enrichment and heat maps were generated to compare gene expression in elderly versus adult burn patients. Results Supervised analysis identified multiple genes that were differentially expressed between the elderly and adult groups. Pathway analysis and heatmap generation suggest that elderly patients share a distinct hypo-inflammatory response in the acute post-burn phase with downregulation of a number of immune-related pathways, including those related to antigen processing, specifically via MHC class I, ubiquitination and proteasome degradation (p<0.001, FDR < .001). Cell signalling pathways, such as NF-κB, C-type lectin receptor, and T cell receptor signalling were also significantly downregulated in elderly burn patients, as well as those relating to antiviral immunity (p<0.001, FDR < .001). Many genes which were observed to be upregulated in elderly patients with high TBSA burn injuries were associated with destruction-related cellular pathways such as complement activation and immunoglobulin production (p<0.005, FDR <0.01). Conclusions The altered inflammatory and immune responses at the transcriptome level in elderly patients after burn are indicative of a failure in elderly burn patients to initiate an appropriate inflammatory and stress response during the acute phase post-burn.
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Affiliation(s)
- Stephanie C. Dreckmann
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Toronto, ON, Canada
- Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada
| | - Saeid Amini-Nik
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Toronto, ON, Canada
| | - Ronald G. Tompkins
- Division of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Miliana Vojvodic
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Toronto, ON, Canada
- Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada
| | - Marc G. Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Toronto, ON, Canada
- Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada
- * E-mail:
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92
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Meng F, Zuo KJ, Amar-Zifkin A, Baird R, Cugno S, Poenaru D. Pediatric burn contractures in low- and lower middle-income countries: A systematic review of causes and factors affecting outcome. Burns 2019; 46:993-1004. [PMID: 31813620 DOI: 10.1016/j.burns.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/16/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
In low- and lower middle-income countries (LMICs), timely access to primary care following thermal injury is challenging. Children with deep burns often fail to receive specialized burn care until months or years post-injury, thus suffering impairments from hypertrophic scarring or joint and soft tissue contractures. We aimed to examine the correlation between limited access to care following burn injury and long-term disability in children in LMICs and to identify specific factors affecting the occurrence of late burn complications. A systematic literature search was conducted to retrieve articles on pediatric burns in LMICs using Medline, Embase, the Cochrane Library, LILACS, Global Health, African Index Medicus, and others. Articles were assessed by two reviewers and reported in accordance with PRISMA guidelines. Of 2896 articles initially identified, 103 underwent full-text review and 14 met inclusion criteria. A total of 991 children who developed long-term burn sequelae were included. Time from injury to consultation ranged from a few months to 17 years. Factors associated with late complications included total body surface area burned, burn depth, low socio-economic status, limited infrastructure, perceived inability to pay, lack of awareness of surgical treatment, low level of maternal education, and time elapsed between burn injury and reconstructive surgery.
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Affiliation(s)
- Fanyi Meng
- Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Robert Baird
- Division of Pediatric General Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Dan Poenaru
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QC, Canada.
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93
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Kaur P, Gondil VS, Chhibber S. A novel wound dressing consisting of PVA-SA hybrid hydrogel membrane for topical delivery of bacteriophages and antibiotics. Int J Pharm 2019; 572:118779. [DOI: 10.1016/j.ijpharm.2019.118779] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
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Outwater AH, Van Braekel T. Prehospital care of burn injuries in Africa: A review, 1990-2018. Burns 2019; 46:1737-1745. [PMID: 31785926 DOI: 10.1016/j.burns.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/21/2019] [Accepted: 08/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Administration of appropriate first aid immediately after a burn injury is crucial to averting further harm to the victim, physically and psychologically. The aim of this review is to enable the design of better interventions by describing what is known about prehospital care of burn victims in Africa. RESULTS This review is based on 17 articles from 5 countries. For the purposes of the review, first responders are defined as those nearest the victim when a burn occurs. First responders include nonclinicians, most typically the mother of a young burn victim. Forty-five different substances, sometimes used in combination, are reported to have been applied to burn injuries: water, 15 food items (especially oils and egg), 14 pharmaceutical products, 9 traditional treatments, 5 minerals (petroleum products being the most common), and charcoal. Appropriate treatment, defined as the application of cool water for 10 min, was achieved about 0.5% of the time, most frequently in Cape Town, South Africa. Most victims do not have their wounds covered while they are transported to a health-care facility. Treatment delays are common. Pain management is hardly addressed. CONCLUSIONS Appropriate prehospital care for burn injury generally is not practiced in Africa. Yet best practices for prehospital care are affordable, available, and easily understood. The greatest risk factor for poor care is first responders' lack of knowledge. Awareness and education campaigns focusing on the lay public, as well as educational institutions for health workers, are urgently needed throughout the continent.
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Affiliation(s)
- Anne H Outwater
- Muhimbili University of Health and Allied Sciences, School of Nursing, PO Box 105211, Dar es Salaam, Tanzania.
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95
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First aid management of paediatric burn and scald injuries in Southern Malawi: A mixed methods study. Burns 2019; 46:727-736. [PMID: 31732221 DOI: 10.1016/j.burns.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/06/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi; and (b) explore factors affecting the choice of first aid used. METHODS ANDFINDINGS We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036); however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and prevent peeling of the skin. By comparison, there was a strong underlying fear of using water on burn injuries due to its association with peeling of the skin. Intergenerational learning appeared to play a strong role in influencing what is used at the time of injury, and mothers were the key source of this information. CONCLUSIONS This study provides the largest description of first aid use in sub-Saharan Africa, strengthening the evidence that remedies aside from water are commonly used and that higher parental education levels do not translate to increased use of water, but rather use of alternative treatments. Our qualitative findings allow improved understanding of how first aid for paediatric burns is perceived in rural Malawi communities, providing insight as to why certain first aid choices are made and the possible barriers and facilitators to the adoption of water as a first aid treatment.
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Al-Hajj S, Pike I, Oneissi A, Zheng A, Abu-Sittah G. Pediatric Burns Among Refugee Communities in Lebanon: Evidence to Inform Policies and Programs. J Burn Care Res 2019; 40:769-775. [PMID: 31368496 DOI: 10.1093/jbcr/irz080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn-related injury is a global public health problem with significant rates of morbidity and mortality. The adverse effect of burn leads to substantial functional, psychological, and economic repercussions. Low- and middle-income countries, including Lebanon, carry a disproportionately greater burden of burn injuries. This study adopted a mixed method approach to explore burn-related injuries in a sample (n = 347) of refugee children settling in Lebanon. We reviewed 179 cases of patients records that met the criteria of a child aged 0 to 19 years and has sustained a burn due to living conditions. War-related burn injuries were excluded. The findings demonstrate that there is a significantly higher proportion of 0- to 4-year-olds with burn injuries (53.6%) compared with the older age groups. Scald burns, caused by boiling liquid, were the most common cause of burns (58.6%), followed by fire/open flame (12.8%) and heat contact (6.7%). Upper trunk and arm burns were significantly higher than other body parts (35.2%), females were among the potential at-risk group with due to boiling liquids caused by food preparation and serving. Fifteen to nineteen years showed a high proportion of fire/flame burn caused by labor accident. Qualitative analysis of case reports further confirmed our findings and emphasized the impact of low socioeconomic status, overcrowded living conditions and open floor cooking and heating on increasing risk of pediatric burns. Additional research is needed to increase understanding on risk factors pertaining to pediatric burns in the refugee community with a view to integrating appropriate preventive measures and informing evidence-based policies and programs.
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Affiliation(s)
- Samar Al-Hajj
- Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ian Pike
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ahmad Oneissi
- Surgery Department, American University of Beirut Medical Center, Lebanon
| | - Alex Zheng
- British Columbia Injury Research and Prevention Unit, British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Ghassan Abu-Sittah
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
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97
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Rezaie L, Schwebel DC. Psychological needs of the families of patients who attempted suicide by self-immolation: An overlooked issue. Burns 2019; 45:1938-1939. [PMID: 31543220 DOI: 10.1016/j.burns.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, USA.
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98
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Noor DM, Wicaksana A, Fauzi AR, Seswandhana R. Comparison between revised Baux score and abbreviated burn severity index as a predictor of mortality in burn patients at a tertiary care center in Yogyakarta, Indonesia. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01578-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Toppi J, Cleland H, Gabbe B. Severe burns in Australian and New Zealand adults: Epidemiology and burn centre care. Burns 2019; 45:1456-1461. [DOI: 10.1016/j.burns.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/04/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022]
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100
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Abstract
Burn injury is the most devastating of survivable injuries and is a worldwide public health crisis. Burn injury is among the most severe metabolic stresses a patient can sustain. A major burn leads to an inflammatory response and catabolism that, when compounded by burn wound nutrient losses, can lead to severe nutrition losses and deficiencies. These losses can impair immune function and wound healing and place burn patients at high risk for organ injury and mortality. Experimental data indicate glutamine (GLN) is well positioned mechanistically, perhaps above and beyond in any other intensive care unit setting, to improve outcome in burn-injured patients. Initial clinical trial data have also shown a consistent signal of reduced mortality and reduced hospital length of stay in burn-injured subjects, without signals of clinical risk. A number of GLN clinical trials demonstrate significant reductions of gram-negative bacteremia in burn injury, perhaps via maintenance of the gut barrier or gut immune function. Current societal recommendations continue to suggest the use of GLN in burn injury. The promising clinical data in burn-injured patients, with no signals of harm, have warranted study of GLN in the definitive RE-ENERGIZE trial, which is now ongoing.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology and Duke Clinical Research Institute, Duke University Hospital, Durham, North Carolina, USA
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