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delli Santi G, Borgognone A. The use of Epiprotect®, an advanced wound dressing, to heal paediatric patients with burns: A pilot study. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Dental health status and oral health behaviours of patients with facial burn in Pakistan. BMC Oral Health 2019; 19:127. [PMID: 31242898 PMCID: PMC6593519 DOI: 10.1186/s12903-019-0819-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/09/2019] [Indexed: 11/12/2022] Open
Abstract
Background There is a limited understanding about the oral health of patients with facial burn, hence the aim was to describe the oral health status and the related risks factors. Methods This cross-sectional study had randomly and systematically recruited facial burn patients from the Burn Care Center, Pakistan Institute of Medical Sciences, Islamabad, from June of 2016 to July of 2017. Intraoral examination recorded the DMFT, CPI and OHI-S. Information on the socio-demographic status, self-perceived oral health, oral health behaviours were collected using a self-administered questionnaire and; the burn characteristics were obtained from the patients’ medical record. The t-test, ANOVA, SLR, and chi-square test were used to examine the relationship between oral health and each factor. A parameter was derived from the clinical indices using the principal component analysis and used in the multiple linear regression analysis to determine the important factors associated with oral health status. Results A total of 271 burn patients (69% female and 31% male) had participated in the study. All of the participants had caries with mean DMFT = 10.96 (95%CI: 10.67, 11.25). There were 59.0% (95%CI: 53.15, 64.93%) and 66.1% (95%CI: 60.38, 71.73%) of the participants who had periodontitis and poor oral hygiene respectively. About 79 and 80% of the participants rated their dental and periodontal status as poor. About 78% reported brushing once daily and 89% did not practice regular dental visit. The DMFT, CPI and OHI-S were associated with the burn characteristics and oral health behaviours (p < 0.05). Dental anxiety, cost and social issues were the most cited reasons for not utilising oral health services. Greater burn severity, the longer time elapsed since the burn incident, and dental anxiety were associated with poorer oral health status and; brushing twice or more and regular dental visit, with better status (p < 0.01). Conclusion Patients with oro-facial burn injury had a generally poor oral health and, the risks are greater in those with a more severe and wider area of injury, the longer time elapsed since the burn incident and dental anxiety; but a good oral hygiene practice and regular dental visits were protective against the risk.
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Elrod J, Schiestl CM, Mohr C, Landolt MA. Incidence, severity and pattern of burns in children and adolescents: An epidemiological study among immigrant and Swiss patients in Switzerland. Burns 2019; 45:1231-1241. [PMID: 31097353 DOI: 10.1016/j.burns.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/11/2019] [Accepted: 02/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite advances in surgical management and critical care for burn surgery, morbidity and mortality of patients with severe burns remains high. Especially in the pediatric population, burns often lead to devastating consequences such as the necessity of corrective surgery until adulthood. Worldwide, 80%-90% of all severe burns occur in low to middle income countries. But also in high income countries, burns are distributed inequitably. Risk factors include age, sex, socioeconomic status, and ethnicity. AIM The objective of this study was to determine the typical demographics and injury-related data of pediatric burn patients in order to contribute to preventive measures. Special interest was paid to the question of whether the incidence of severe burns is higher among patients with an immigration background. PATIENTS AND METHODS Patient records of the 4373 patients admitted to the Pediatric Burn Unit of the University Children's Hospital of Zurich from 2006 to 2018 were analyzed. Demographic data and injury patterns are presented descriptively. Temporal trends concerning duration of hospitalization and setting (inpatient versus outpatient), differences in relative incidence and in burn mechanism in distinct cohorts (by nation and Human Development Index (HDI)) and seasonal trends were analyzed. Furthermore, risk factors for large burns and for (prolonged) inpatient treatment were examined using a multivariate approach. RESULTS Temporal resolution shows considerable variation between inpatient and outpatient treatment (p>0.001) and with shorter hospital stays (p=0.004). Swiss citizens and patients with an immigration background from very highly developed countries sustain a significantly lower incidence of heat-related injuries than all others (p<0.001). The most common burn causes among all children, independent of their country of citizenship, are related to kitchen items or hot tea and coffee (35.57%±4.01% resp. 32.39%±5.95%). Logistic regression revealed that migration background from a low HDI country is significantly associated with larger burns (>5% TBSA) and with a need for inpatient treatment. CONCLUSION The study emphasizes the need for highly specific measures of burn prevention and indicates the necessity of focusing on certain target groups who are especially vulnerable to burns, such as immigrants from less developed countries.
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Affiliation(s)
- Julia Elrod
- Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75 8032, Zurich, Switzerland.
| | - Clemens M Schiestl
- Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75 8032, Zurich, Switzerland
| | - Christoph Mohr
- Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75 8032, Zurich, Switzerland
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse, 75 8032, Zurich, Switzerland; Division of Child and Adolescence Health Psychology, Department of Psychology, University of Zurich, Steinwiesstrasse, 75 8032, Zurich, Switzerland
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A retrospective analysis of electric burn patients admitted in King Fahad Central Hospital, Jizan, Saudi Arabia. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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105
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Adiliaghdam F, Almpani M, Gharedaghi MH, Najibi M, Hodin RA, Rahme LG. Targeting bacterial quorum sensing shows promise in improving intestinal barrier function following burn‑site infection. Mol Med Rep 2019; 19:4057-4066. [PMID: 30896813 PMCID: PMC6472113 DOI: 10.3892/mmr.2019.10071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
Burn-site infections, commonly due to Pseudomonas aeruginosa, have been associated with deranged intestinal integrity, allowing bacteria and their products to translocate from the gut to the circulatory system. The P. aeruginosa quorum sensing (QS) transcription factor MvfR (PqsR) controls the expression of numerous virulence factors, and the synthesis of several toxic products. However, the role of QS in intestinal integrity alterations, to the best of our knowledge, has not been previously investigated. Using a proven anti-MvfR, anti-virulence agent, the in vivo results of the present study revealed that inhibition of MvfR function significantly decreased Fluorescein Isothiocyanate-Dextran (FITC-Dextran) flow from the intestine to the systemic circulation, diminished bacterial translocation from the intestine to mesenteric lymph nodes (MLNs), and improved tight junction integrity in thermally injured and infected mice. In addition, the MvfR antagonist administration alleviates the intestinal inflammation, as demonstrated by reduced ileal TNF-α and fecal lipocalin-2 concentrations. In addition, it is associated with lower levels of circulating endotoxin and decreased P. aeruginosa dissemination from the burn wound to the ileum. Collectively, these results hold great promise that the inhibition of this QS system mitigates gut hyperpermeability by attenuating the derangement of morphological and immune aspects of the intestinal barrier, suggesting that MvfR function is crucial in the deterioration of intestinal integrity following P. aeruginosa burn-site infection. Therefore, an anti-virulence approach targeting MvfR, could potentially offer a novel therapeutic approach against multi-drug resistant P. aeruginosa infections following thermal injuries. Since this approach is targeting virulence pathways that are non-essential for growth or viability, our strategy is hypothesized to minimize the development of bacterial resistance, and preserve the beneficial enteric microbes, while improving intestinal integrity that is deranged as a result of burn and infection.
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Affiliation(s)
- Fatemeh Adiliaghdam
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Mohammad Hadi Gharedaghi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Mehran Najibi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Richard A Hodin
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Marwa NP, Tarimo EAM. Provision of care to hospitalized pediatric burn patients: a qualitative study among nurses at Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Nurs 2019; 18:8. [PMID: 30911285 PMCID: PMC6417030 DOI: 10.1186/s12912-019-0335-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Burn injury is a significant problem in low and middle-income countries. Moreover, across regions children are more affected by burn injury than adults. The outcome of burn injury is greatly influenced by the quality of care patients receive. This care includes meeting nutritional needs, availability of resources such as dressing supplies, and skills among health care providers. This study describes factors that influence provision of nursing care to the hospitalized pediatric patients with burn injuries at Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods A descriptive qualitative study was conducted among registered nurses working in the Pediatric Burn Unit. Purposeful sampling was used to recruit the participants in the study. Five in-depth interviews were done and content analysis approach was used. Results The nurses in the study described how they provided nursing care to pediatric patients with burn injuries. They described the use of closed method wound dressing, as an essential skill that accelerated wound healing, decreased the risk of wound contamination, and the incidence of contractures. The nurses felt gratified when they saw patients who had sustained severe burn injury recover well and be discharged home. They appreciated the influence of teamwork in burn patients’ recovery. However, the interviews revealed systematic deficiencies that hindered provision of quality care to patients with burn injuries. The flaws included: inadequate staffing resulting in increased workload among the nurses; a lack of standard skills in burn care among nurses; lack of access to water, which is the mainstay of infection prevention control, and lack of specimen collection equipment. Conclusions Findings in this study revealed both positive and negative factors which appear to influence care of burn patients. The positive factors (motivation) need to be maintained, and immediate actions should be taken to address the negative (hindering) factors. Large scale studies to quantify these results are deemed necessary, and public health measures are needed to prevent burn injuries in children.
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Affiliation(s)
- Nyakanda P Marwa
- 1Muhimbili National Hospital, P O Box 65000, Dar es Salaam, Tanzania
| | - Edith A M Tarimo
- 2Muhimbili University of Health and Allied Sciences, School of Nursing, P.O Box 65004, Dar es Salaam, Tanzania
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Shokouhi M, Nasiriani K, Khankeh H, Fallahzadeh H, Khorasani-Zavareh D. Exploring barriers and challenges in protecting residential fire-related injuries: a qualitative study. J Inj Violence Res 2019; 11:81-92. [PMID: 30770524 PMCID: PMC6420921 DOI: 10.5249/jivr.v11i1.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Building fires can be a great threat to the safety of residents, and can lead to economic and social damage. Exploring the views of stakeholders is a great source for understanding the factors that affect fires. The purpose of this study was to explore stakeholders’ experiences of unintentional fire-related injuries in residential buildings in Iran. Methods: This qualitative study was carried out using grounded theory. The study was conducted in Iran, in 2017. The study participants consisted of 25 people including stakeholders who had practical experience/or were knowledgeable in the field of preventing and fighting building fires. Purposeful and theoretical sampling were used for data collection. Data were analyzed based on constant comparative analysis and according to recommendations by Strauss and Corbin. Results: "Lack of a comprehensive approach to prevention of fire-related injury" emerged as a core variable which impacted on residents' safety against fires. The findings were classified into four groups of challenges related to the structure of building, socio-economic challenge, residents of the building and rescue services. Conclusions: Based on participants` experiences, unintentional fire-related injuries in residential buildings are affected by cultural context and economic, social and geographical factors. Improving the safety against unintentional fire-related injuries in residential buildings requires multidisciplinary operations including both change and improvement of the building construction and change in the beliefs and practices of residents to increase safety against fires.
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Affiliation(s)
| | | | | | | | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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108
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Endo A, Shiraishi A, Otomo Y, Fushimi K, Murata K. Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database. J Intensive Care 2019; 7:7. [PMID: 30733868 PMCID: PMC6354429 DOI: 10.1186/s40560-019-0363-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care. Methods We conducted a retrospective observational study on severe burn patients, defined by a burn index ≥ 10, using 2010–2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90 days). Generalized linear mixed-effect regression models (GLMMs) in which patient volume was incorporated as a continuous or categorical variable (≤ 5 or > 5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating patients who were directly transported, those with PBI ≤ 120 and those excluding patients who died within 2 days of admission, were also performed. Results We analyzed 5250 eligible severe burn patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in patient volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher volume hospitals. The GLMM model showed that patient volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)] = 1.14 [1.09–1.19]), high healthcare costs (adjusted difference [95% CI] = $4876 [4436–5316]), and few hospital-free days (adjusted difference [95% CI] = − 3.1 days [− 3.4 to − 2.8]). Similar trends were observed in the analyses in which patient volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results. Conclusions Analysis of Japanese nationwide administrative database demonstrated that high burn patient volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results. Electronic supplementary material The online version of this article (10.1186/s40560-019-0363-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akira Endo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Atsushi Shiraishi
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,2Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba Japan
| | - Yasuhiro Otomo
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Kiyohide Fushimi
- 3Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Murata
- 1Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.,The Shock Trauma and Emergency Medical Center, Matsudo City General Hospital, 933-1 Sendabori,, Matsudo, Chiba Japan
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Zia N, Latif A, Mashreky SR, Al-Ibran E, Hashmi M, Rahman AKMF, Khondoker S, Quraishy MS, Hyder AA. Applying quality improvement methods to neglected conditions: development of the South Asia Burn Registry (SABR). BMC Res Notes 2019; 12:64. [PMID: 30696469 PMCID: PMC6352446 DOI: 10.1186/s13104-019-4063-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia. RESULTS The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients.
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Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Asad Latif
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | | | | | - Madiha Hashmi
- Department of Anaesthesia, Aga Khan University, Karachi, 74800 Pakistan
| | | | - Sazzad Khondoker
- National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | | | - Adnan A. Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC USA
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Evaluation of the Treatment Effect of Aloe vera Fermentation in Burn Injury Healing Using a Rat Model. Mediators Inflamm 2019; 2019:2020858. [PMID: 30837795 PMCID: PMC6374857 DOI: 10.1155/2019/2020858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022] Open
Abstract
Burn injury is a growing medical problem associated with public health, and few effective agents are available for treatment of this disease. In the present study, a burn injury rat model was developed and the accelerated effect of Aloe vera fermentation on burn injury healing was evaluated. Our results indicated that Aloe vera fermentation could markedly reduce the DPPH (56.12%), O2·− (93.5%), ·OH (76.12%), Fe2+ chelation (82%), and oxygen-reduction activity (0.28 μg/ml) and significantly inhibited the growth of pathogens S. typhimurium ATCC 13311 (inhibition zone diameter: 14 mm), S. enteritidis ATCC13076 (IZD: 13 mm), S. flexneri ATCC 12022 (IZD: 18 mm), E. coli 44102 (IZD: 10 mm), L. monocytogenes ATCC 19111 (IZD: 18 mm), S. dysenteriae 301 (IZD: 20 mm), S. aureus COWAN1 (IZD: 19 mm), and P. acnes ATCC 11827 (IZD: 25 mm) in vitro. The in vivo results indicated that Aloe vera fermentation produced more eosinophils and fibroblasts and less vessel proliferation compared with the model group on the 14th day, which had greatly accelerated burn injury healing via shedding of the scab and promoting hair growth. ELISA results indicated that Aloe vera fermentation had significantly reduced the production of proinflammatory factors TNF-α and IL-1β (p < 0.05) and greatly enhanced the yield of anti-inflammatory factor IL-4 in animal serum (p < 0.05). In addition, the high-throughput sequencing results indicated that Aloe vera fermentation obviously increased the percentage of Firmicutes (65.86% vs. 49.76%), while reducing the number of Bacteroidetes (27.60% vs. 45.15%) compared with the M group at the phylum level. At the genus level, Aloe vera fermentation increased the probiotic bacteria Lactobacillus (3.13% vs. 2.09%) and reduced the pathogens Prevotella (10.60% vs.18.24%) and Blautia (2.91% vs. 16.41%) compared with the M group. Therefore, we concluded that the use of Aloe vera fermentation significantly accelerates burn injury healing via reduction of the severity of inflammation and through modification of gut microbiota.
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Yucel B, Coruh A, Deniz K. Salvaging the Zone of Stasis in Burns by Pentoxifylline: An Experimental Study in Rats. J Burn Care Res 2019; 40:211-219. [DOI: 10.1093/jbcr/irz005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bora Yucel
- Department of Plastic Reconstructive and Aesthetic Surgery, Ministry of Health, Elmali State Hospital, Elmali/Antalya, Turkey
| | - Atilla Coruh
- Medical Faculty, Department of Plastic Surgery, Erciyes University, Kayseri, Turkey
| | - Kemal Deniz
- Medical Faculty, Department of Pathology, Erciyes University, Kayseri, Turkey
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Newberry JA, Bills CB, Pirrotta EA, Barry M, Ramana Rao GV, Mahadevan SV, Strehlow MC. Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emerg Med J 2019; 36:176-182. [PMID: 30635272 PMCID: PMC6580756 DOI: 10.1136/emermed-2018-207900] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Background Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India. Methods We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Χ2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables. Results We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2 hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2). Discussion Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.
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Affiliation(s)
- Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Corey B Bills
- Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth A Pirrotta
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michele Barry
- Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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Kumar P, Choudhary V, Kumar P, Kumar P, Kumar S. Epidemiological study of burn admissions in a tertiary burn care center of Bihar, India. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_21_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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114
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Sailo S, Chenkual S, Chawngthu V, Chawngthu R. Burn scenario in a single North-Eastern State of India: A 5-year retrospective study. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_23_18] [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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115
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Sinha S, Nuñez Martinez CM, Hartley RL, Quintana Alvarez RJ, Yoon G, Biernaskie JA, Nickerson D, Gabriel VA. Epidemiological analysis of pediatric burns in the Dominican Republic reveals a demographic profile at significant risk for electrical burns. Burns 2018; 45:471-478. [PMID: 30573295 DOI: 10.1016/j.burns.2018.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/23/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository. METHODS A retrospective audit of 1600 patients admitted to the Unidad de Niños Quemados Dra. Thelma Rosario Hospital, the island's only major pediatric burn center, between January 2010 to March 2017 was performed. Epidemiological variables analyzed included age, gender, burn mechanism, year, month, city, admission duration, nationality, mortality, and %TBSA. RESULTS Pediatric burn patients in the DR sustained larger burns (8.2% vs. 6.5% TBSA) and spent more days in the hospital (10 vs. 6 days). Females were overrepresented (M:F=1:1.5) and mortality amongst admitted patients was 4-fold higher (2.8% vs. 0.7%). Electrical burns were significantly overrepresented in DR (21%) compared to age-matched North American patients (2%). Although electrical burns were smaller (4% TBSA), compared to scald (14% TBSA), and flame (19% TBSA), these burns preferred hands and had a high mortality rate (3%). No significant seasonality in burn mechanisms were observed. Finally, we report geographical and age group differences in the distribution of burn mechanisms and highlight particularly vulnerable subpopulations. CONCLUSION This investigation identifies a demographical profile where electrical burns account for a significant percentage of the burn population. This provides a basis for concentrating preventative efforts in vulnerable populations.
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Affiliation(s)
- Sarthak Sinha
- Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Pediatrics and Surgery, Faculty of Medicine, University of Calgary, Canada; Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Canada.
| | | | - Rebecca L Hartley
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Canada.
| | | | - Grace Yoon
- Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Canada.
| | - Jeff A Biernaskie
- Department of Comparative Biology & Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Canada.
| | - Duncan Nickerson
- Section of Plastic Surgery, Department of Surgery, University of Calgary, Canada; Calgary Firefighters' Burn Treatment Centre, Canada.
| | - Vincent A Gabriel
- Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Pediatrics and Surgery, Faculty of Medicine, University of Calgary, Canada; Calgary Firefighters' Burn Treatment Centre, Canada.
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Jibeen T, Mahfooz M, Fatima S. Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients. JOURNAL OF RELIGION AND HEALTH 2018; 57:1618-1633. [PMID: 28856506 DOI: 10.1007/s10943-017-0484-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.
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Affiliation(s)
- Tahira Jibeen
- Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia.
| | - Musferah Mahfooz
- Humanities Department (Psychology), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Shamem Fatima
- Humanities Department (Psychology), COMSATS Institute of Information Technology, Lahore, Pakistan
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Sadeghian F, Saeedi Moghaddam S, Saadat S, Niloofar P, Rezaei N, Amirzade-Iranaq MH, Mehdipour P, Abbaszadeh Kasbi A, Ghodsi Z, Mansouri A, Sharif-Alhoseini M, Jazayeri SB, Aryannejad A, Ehyaee V, Naghdi K, Derakhshan P, Moradi-Lakeh M, Mokdad AH, O'Reilly G, Rahimi-Movaghar V. The trend of burn mortality in Iran - A study of fire, heat and hot substance-related fatal injuries from 1990 to 2015. Burns 2018; 45:228-240. [PMID: 30274812 DOI: 10.1016/j.burns.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Burn injuries are a major cause of preventable mortality worldwide. To implement preventive strategies, a detailed understanding of the rate and trend of fatal burn injuries is needed. The aim of this study was to determine the rate and trend of burn mortality at national and province level in Iran from 1990 to 2015. MATERIALS AND METHODS The data were retrieved from various sources: the Death Registration System, cemetery databases, the Demographic and Health Survey and three national population and housing censuses. ICD-10 codes were converted to Global Burden of Disease (GBD) codes for comparability. After addressing the incompleteness of death data, statistical methods such as spatio-temporal modelling and Gaussian Process Regression (GPR) were applied to estimate the levels and trend of death and cause specific mortality. RESULTS The number of deaths due to burning across Iran was 80,625, with a male to female ratio of 0.88, 0.94 and 1.14 in 1990, 1995 and 2015, respectively. The annual percentage change of age-standardized death rate from 1990 to 2015 was -5.42% and -4.22% in women and men, respectively. The burn-related age-standardized mortality rate decreased considerably from 5.97 in 1990 to 1.74 per 100,000 in 2015. The mortality rate due to burns was highest among those aged more than 85 years, especially in Ilam province. CONCLUSION This study showed a decline in burn mortality in Iran from 1990 to 2015. Continued efforts to reduce the burden of burns are needed to accelerate this progress and prevent injuries.
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Affiliation(s)
- Farideh Sadeghian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Niloofar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Amirzade-Iranaq
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anita Mansouri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behzad Jazayeri
- Department of Surgery, Kaiser Permanente, Fontana, CA, USA; Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Armin Aryannejad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Ehyaee
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Derakhshan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, WA, USA
| | - Gerard O'Reilly
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Cambiaso-Daniel J, Rontoyanni VG, Foncerrada G, Nguyen A, Capek KD, Wurzer P, Lee JO, Hundeshagen G, Voigt CD, Branski LK, Finnerty CC, Herndon DN. Correlation between invasive and noninvasive blood pressure measurements in severely burned children. Burns 2018; 44:1787-1791. [PMID: 30153960 DOI: 10.1016/j.burns.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/05/2018] [Accepted: 03/03/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. METHODS Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). RESULTS We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8±5years with burns covering 52±20% of the total body surface area and a hospitalization lasting 33±31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, -6.4 (-7.0, -5.7) mmHg for DBP, and -5.8 (-6.4, -5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (-22.5, 25.1) mmHg for SBP, 9.9 (-25.8, 13.0) mmHg for DBP, and 8.7 (-22.8, 11.1) mmHg for MAP. CONCLUSIONS Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Victoria G Rontoyanni
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Metabolism Unit, Shriners Hospitals for Children, Galveston, TX, USA.
| | - Guillermo Foncerrada
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Anthony Nguyen
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Karel D Capek
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany.
| | - Charles D Voigt
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, TX USA.
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Acceptability and functionality of the “Kettle Strap”: An attempt to decrease kettle related burns in children. Burns 2018; 44:1361-1365. [DOI: 10.1016/j.burns.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022]
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Jagnoor J, Lukaszyk C, Fraser S, Chamania S, Harvey L, Potokar T, Ivers R. Rehabilitation practices for burn survivors in low and middle income countries: A literature review. Burns 2018; 44:1052-1064. [DOI: 10.1016/j.burns.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/15/2017] [Accepted: 10/13/2017] [Indexed: 12/21/2022]
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Nímia HH, Carvalho VF, Isaac C, Souza FÁ, Gemperli R, Paggiaro AO. Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis. Burns 2018; 45:282-292. [PMID: 29903603 DOI: 10.1016/j.burns.2018.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/11/2018] [Accepted: 05/17/2018] [Indexed: 01/09/2023]
Abstract
The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.
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Affiliation(s)
- Heloisa Helena Nímia
- Guarulhos University, Nursing Post, Graduation Program, Praça Tereza Cristina, 88, Centro, Guarulhos, SP, 07020-071, Brazil.
| | - Viviane Fernandes Carvalho
- Guarulhos University, Nursing Post, Graduation Program, Praça Tereza Cristina, 88, Centro, Guarulhos, SP, 07020-071, Brazil.
| | - Cesar Isaac
- São Paulo University, Plastic Surgery Division, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Francisley Ávila Souza
- Dentistry College, UNESP, Rua José Bonifácio, 1193, Araçatuba, São Paulo, SP, 16015-050, Brazil.
| | - Rolf Gemperli
- São Paulo University, Plastic Surgery Division, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - André Oliveira Paggiaro
- Guarulhos University, Nursing Post, Graduation Program, Praça Tereza Cristina, 88, Centro, Guarulhos, SP, 07020-071, Brazil.
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Effective interventions for unintentional injuries: a systematic review and mortality impact assessment among the poorest billion. LANCET GLOBAL HEALTH 2018; 6:e523-e534. [DOI: 10.1016/s2214-109x(18)30107-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/19/2022]
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Zissman S, Orgil M, Ben-Amotz O, Gur E, Arad E, Leshem D. Pediatric burns in Israeli natives versus asylum seekers living in Israel: Lessons learned. Burns 2018; 44:1322-1329. [PMID: 29605224 DOI: 10.1016/j.burns.2018.02.027] [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: 09/27/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Burn injuries are one of the leading causes of morbidity and mortality in the pediatric population. In early childhood, burns have a wide range of adverse long-term consequences ranging from functional impairment to psychological implications. Children from low-income and middle-income countries are at a higher risk of suffering from burn injuries. In the last 10 years the population of asylum seekers from low-income countries in Israel has increased dramatically. About 25,000 or 60% of asylum seekers are living in the Tel Aviv area, making up roughly 6% of the city's total population (about 405,000). AIM A retrospective study aimed to profile the pediatric burn injuries treated at the Tel Aviv Sourasky Medical Center over the last 9 years in an effort to examine the distinct characteristics of African asylum seekers who suffer burn injuries in comparison with Israeli nationals. PATIENTS & METHODS Medical records of 876 patients under the age of 18 years presenting between 2007-2015 were retrospectively reviewed. The parameters collected included gender, causality, total body surface area (TBSA), burn depth and patient outcome. CONCLUSIONS There was no significant difference regarding: age; male-female ratio; scald-types burns; limb involvement. However, hospitalization and length of hospital stay were significantly higher among asylum seekers, as was family burden. Questions may be raised regarding prevention, education & social support. Our research provides a small glimpse into the world of asylum seekers in Israel. We hope it will serve as a window into the much grander problems that this population faces on a daily basis.
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Affiliation(s)
- Sivan Zissman
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Orgil
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oded Ben-Amotz
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Gur
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Leshem
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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van Niekerk G, Adams S, Rode H. Scalp as a donor site in children: Is it really the best option? Burns 2018; 44:1259-1268. [PMID: 29548863 DOI: 10.1016/j.burns.2018.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since 2003 we have used the scalp as a donor site for split skin grafts (SSGs) in major burns when there was a shortage of conventional donor areas. However, we seen a high incidence of complications, contrary to international experience. OBJECTIVE The aim of this study was to analyze the results and complications related to the scalp as a donor site and to determine whether there is an association between our specific patient population and the complications encountered. METHODS A retrospective review of our scalp donor site outcomes over a 12-year period was conducted. The cohort included 25 patients, 15 of black African descent, nine of mixed race and one Caucasian. The various hair types were identified based on ethnicity and classified into eight types. Most of our patients had hair types VI-VIII. None of these patients had scalp burns and all received standard burn treatment. The SSGs were taken with an electric dermatome with a standard micrometric setting of 0.2mm. Complications were categorized into short- or long-term, with a mean follow-up time of 1.59years. RESULTS The mean age of the 25 children was 5.7years. Nineteen sustained flame burns and 6 sustained hot water burns, with a mean total body surface area of 44.9%. A total of 43 scalp procurements were performed in the 25 patients studied. The group of 15 black African patients (hair types VI-VIII) had a total of 22 procurements, the nine patients of mixed race (hair types III-V) had 18 procurements and the single Caucasian patient (hair types II-III) had two procurements. The median healing time was 15days, 11.8days and 8.5days, respectively, per group. Significant complications were encountered, including folliculitis 44%, non-healing wounds 52%, alopecia 16% and visible, hypopigmented scars 3%. One patient had a hypertrophic scar and no hair transfers to the recipient areas were observed. The various hair types correlated with the complications encountered. Five children, with an average burn size of 65.2% (range: 40-85%) died of sepsis. Due to the small sample size, the only statistically significant findings were related to the total body surface area of the burn and the number of times skin was harvested from the scalp, with a p-value of 0.005. The p-values for the healing times related to the first, second and third croppings, were p=0.022, p=0.00032 and p<0.001 respectively. CONCLUSION Our study suggests that in pediatric patients of black African descent (hair types VI-VIII) the scalp is not an ideal donor area, due to the unacceptably high incidence of complications. Hence, every precaution should be taken when it becomes necessary to harvest donor skin from the scalp.
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Affiliation(s)
- G van Niekerk
- Division of Plastic and Reconstructive Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
| | - S Adams
- Division of Plastic and Reconstructive Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - H Rode
- Division of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
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Mirza Aghazadeh A, Lotfi M, Ghahramanian A, Ahadi F. Lethal Area 50 in Patients with Burn Injuries in North West, Iran. J Caring Sci 2018; 7:53-58. [PMID: 29637058 PMCID: PMC5889799 DOI: 10.15171/jcs.2018.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/03/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction: In view of their considerably high rates of mortality and morbidity, burns are still viewed as one of the most important health-threatening environmental hazards imposing a significant burden on the health care system in low and middle-income countries. This study seeks to determine the lethal area fifty percent (LA50) in all burn patients admitted over a period of five years and the factors influencing mortality in burn injuries. Methods: This study was a cross-sectional carried out from 2010 to 2014 in Sina Hospital of Tabriz, 1226 participant including 319 women, 346 men, 272 girls, and 289 boys were selected through stratified sampling. The demographic and clinical data of patients ( their age, gender, burn type, TBSA, the season and consequences of burning) were all extracted and then analyzed, using descriptive statistics (measures of central tendency and variability) and inferential statistics(chi-square and linear regression)at a significance level of 0.05. The LA50 was calculated through determining the relationship between the total body surface area and mortality rate (The extent of the body burns measured and recorded based on Lando Chart in hospitals). Results: The highest (47.6%) and the lowest (3.8%) rates of burns were observed among those aged below 16 and above 65, respectively. The majority of the participants were residents of cities (55.4%), married (34.6%), illiterate (56.6%), and housewives (14.8%). Most burns were caused by accidents (98.4%) at home (90.6%). Most patients had suffered first- and second-degree burns (68.4%), with no inhalation damages (99.5%). Hot liquids were the main culprit in most of the burns (58.7%) and the upper extremities were the most frequently affected areas (34.8%). There was .99 rise in mortality for every percent increase in TBSA, and there seemed to be a significant relationship between the age level and the eventual outcome- the higher the age, the more likely for the incident to end in death.LA50 was also determined 43.73 percent for five years. Finally, the study findings showed that female gender, TBSA and age are associated with death from burn. Conclusion: Given the high LA50 index at this center, it is of high priority in our country to enhance the public knowledge and the quality of the care provided for the burn patients. Patients at risk including women, children, elderly and extensive burns should be considered.
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Affiliation(s)
- Ahmad Mirza Aghazadeh
- Department of Basic Sciences, Paramedical Faculty, Tabriz University of Medial Sciences, Tabriz, Iran
| | - Mojgan Lotfi
- Department of Medical-Surgical, Nursing and Midwifery Faculty, Tabriz University of Medial Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical-Surgical, Nursing and Midwifery Faculty, Tabriz University of Medial Sciences, Tabriz, Iran
| | - Farideh Ahadi
- Department of Medical-Surgical, Nursing and Midwifery Faculty, Tabriz University of Medial Sciences, Tabriz, Iran
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Abstract
BACKGROUND Burns are a major public health concern, affecting mostly low- and middle-income countries. However, there is a lack of epidemiological studies on burns in these countries, particularly in Latin American countries. Our aim was to analyze nationwide demographic, epidemiological and economic characteristics of hospitalized burn patients in Brazil. METHODS A retrospective study was conducted including inpatients admitted with a diagnosis of burns (ICD-10:T20-T31) from all hospitals in Brazil from 2000 to 2014. We calculated hospitalization and in-hospital mortality rates. Length of stay (LoS), charges and premature mortality were also assessed. RESULTS A total of 412,541 burn hospitalizations were found, with a hospitalization rate of 14.56 hospitalizations/100,000 inhabitants/year. This rate is decreasing since 2003, mostly due to the reduction among children and elderly. Children below 5 years old accounted for 24% of all admissions. In-hospital mortality rate was 8.1% and median LoS was 5 days. Mean hospitalization charge was 856 international dollars. Substantial regional discrepancies were found in several indicators. CONCLUSION In this first Latin American nationwide study of burn patients, a decreasing trend of hospitalization rate and a low charge contrasted with a high in-hospital mortality rate. This latter indicator, associated with a low LoS, may raise concerns regarding the quality of healthcare. Important discrepancies were found between regions, which may indicate important differences in regard to healthcare access and risk of burns. Targeting effective prevention, improving healthcare quality and providing more widespread and accurate burn registry are recommended.
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Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns 2018; 44:1228-1234. [PMID: 29475744 DOI: 10.1016/j.burns.2018.01.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies. METHODS The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care. RESULTS Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively. CONCLUSIONS Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care.
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Affiliation(s)
- Dattesh R Davé
- Department of Surgery, University of California San Diego, San Diego, CA, USA.
| | - Neeraja Nagarjan
- Department of General Surgery, Brigham and Women's Boston Hospital and Medical Center, Boston, MA, USA
| | - Joseph K Canner
- Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam L Kushner
- Surgeons OverSeas, New York, NY, USA; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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128
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Gerelmaa G, Tumen-Ulzii B, Nakahara S, Ichikawa M. Patterns of burns and scalds in Mongolian children: a hospital-based prospective study. Trop Med Int Health 2018; 23:334-340. [DOI: 10.1111/tmi.13034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gunsmaa Gerelmaa
- Doctoral Program in Human Care Science; Graduate School of Comprehensive Human Sciences; University of Tsukuba; Ibaraki Japan
| | | | - Shinji Nakahara
- Department of Emergency Medicine; Teikyo University School of Medicine; Tokyo Japan
| | - Masao Ichikawa
- Department of Global Public Health; University of Tsukuba; Ibaraki Japan
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Alonge O, Agrawal P, Talab A, Rahman QS, Rahman AF, Arifeen SE, Hyder AA. Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh. LANCET GLOBAL HEALTH 2018; 5:e818-e827. [PMID: 28716352 DOI: 10.1016/s2214-109x(17)30244-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND 90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. METHODS In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. FINDINGS The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. INTERPRETATION The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1-4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh. FUNDING Bloomberg Philanthropies.
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Affiliation(s)
- Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Priyanka Agrawal
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abu Talab
- Center for Injury Prevention and Research, Mohakhali, Dhaka, Bangladesh
| | - Qazi S Rahman
- International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Akm Fazlur Rahman
- Center for Injury Prevention and Research, Mohakhali, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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130
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Udy AA, Roberts JA, Lipman J, Blot S. The effects of major burn related pathophysiological changes on the pharmacokinetics and pharmacodynamics of drug use: An appraisal utilizing antibiotics. Adv Drug Deliv Rev 2018; 123:65-74. [PMID: 28964882 DOI: 10.1016/j.addr.2017.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 12/13/2022]
Abstract
Patients suffering major burn injury represent a unique population of critically ill patients. Widespread skin and tissue damage causes release of systemic inflammatory mediators that promote endothelial leak, extravascular fluid shifts, and cardiovascular derangement. This phase is characterized by relative intra-vascular hypovolaemia and poor peripheral perfusion. Large volume intravenous fluid resuscitation is generally required. The patients' clinical course is then typically complicated by ongoing inflammation, protein catabolism, and marked haemodynamic perturbation. At all times, drug distribution, metabolism, and elimination are grossly distorted. For hydrophilic agents, changes in volume of distribution and clearance are marked, resulting in potentially sub-optimal drug exposure. In the case of antibiotics, this may then promote treatment failure, or the development of bacterial drug resistance. As such, empirical dose selection and pharmaceutical development must consider these features, with the application of strategies that attempt to counter the unique pharmacokinetic changes encountered in this setting.
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131
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Grudziak J, Snock C, Mjuweni S, Gallaher J, Cairns B, Charles A. The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit. Burns 2017; 43:1486-1492. [DOI: 10.1016/j.burns.2017.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/10/2017] [Accepted: 03/25/2017] [Indexed: 11/15/2022]
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Grudziak J, Snock C, Zalinga T, Banda W, Gallaher J, Purcell L, Cairns B, Charles A. Pre-burn malnutrition increases operative mortality in burn patients who undergo early excision and grafting in a sub-Saharan African burn unit. Burns 2017; 44:692-699. [PMID: 29089206 DOI: 10.1016/j.burns.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/12/2017] [Accepted: 10/04/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In the developed world, pre-existing malnutrition in the burn population influences operative outcomes. However, studies on pre-existing malnutrition and operative outcomes of burn patients in the developing world are lacking. We therefore sought to characterize the burn injury outcomes following operative intervention based on nutritional status. METHODS This is a retrospective review of operative patients admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we constructed a fully adjusted logistic regression model of significant predictors of post-operative mortality, both overall and for specific age categories. RESULTS Of the 1356 admitted patients, 393 received operative intervention (29%). Of those, 205 (52.2%) were male, and the median age was 6 years (3, 25), with 265 patients (67%) aged ≤16 years. The median TBSA was 15.4% (10%-25%) and open flames caused the majority of burns (64%), though in children under 5, scalds were the predominant cause of burn (52.2%). Overall mortality was 14.5% (57 patients) and ranged from 9.09% for patients aged 6-16, to 33.3% for adults ≥50years. Increased time from injury to operative intervention was protective (OR: 0.90, 95% CI: 0.83, 0.99). In post-operative patients with z-scores, increasing %TBSA burned (OR: 1.11, 95% CI: 1.05, 1.17) and increasing malnutrition (OR: 1.46, 95% CI: 1.03, 1.91) predicted death in the adjusted model. CONCLUSION Poor nutrition is an important risk factor for post-operative mortality in burned patients in resource-poor settings. Screening for malnutrition and designing effective interventions to optimize nutritional status may improve surgical outcomes in LMIC burn patients.
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Affiliation(s)
- Joana Grudziak
- Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi
| | - Carolyn Snock
- Department of Nutrition and Dietetics, University of North Carolina Hospitals, United States
| | | | - Wone Banda
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi
| | - Laura Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi.
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Mudawarima T, Chiwaridzo M, Jelsma J, Grimmer K, Muchemwa FC. A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Syst Rev 2017; 6:207. [PMID: 29058641 PMCID: PMC5651576 DOI: 10.1186/s13643-017-0592-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. METHODS/DESIGN A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. DISCUSSION Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. SYSTEMATIC REVIEW REGISTRATION PROSPERO CDR42016048370 .
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Affiliation(s)
- Tapfuma Mudawarima
- Rehabilitation Department, Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Observatory, University of Cape Town, Cape Town, South Africa
| | - Matthew Chiwaridzo
- University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Jennifer Jelsma
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Observatory, University of Cape Town, Cape Town, South Africa
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Wasiak J, Tyack Z, Ware R, Goodwin N, Faggion CM. Poor methodological quality and reporting standards of systematic reviews in burn care management. Int Wound J 2017; 14:754-763. [PMID: 27990772 PMCID: PMC7949759 DOI: 10.1111/iwj.12692] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/02/2016] [Indexed: 12/18/2022] Open
Abstract
The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.
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Affiliation(s)
- Jason Wasiak
- Epworth HealthCareRichmondVAAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Children's Health Research CentreThe University of Queensland & Centre for Functioning and Health Research Metro South HealthBrisbaneQLDAustralia
| | - Robert Ware
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
| | | | - Clovis M Faggion
- Department of Periodontology and Restorative Dentistry, Faculty of DentistryUniversity of MunsterMunsterGermany
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Kaufman T, Magosevich D, Moreno MC, Guzman MA, D'Atri LP, Carestia A, Fandiño ME, Fondevila C, Schattner M. Nucleosomes and neutrophil extracellular traps in septic and burn patients. Clin Immunol 2017; 183:254-262. [PMID: 28863968 DOI: 10.1016/j.clim.2017.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/28/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Abstract
NETosis is a host defense mechanism associated with inflammation and tissue damage. Experimental models show that platelets and von Willebrand factor (VWF) are key elements for intravascular NETosis. We determined NETosis in septic and burn patients at 1 and 4days post-admission (dpa). Nucleosomes were elevated in patients. In septics, they correlated with Human Neutrophil Elastase (HNE)-DNA complexes and SOFA score at 1dpa, and were associated with mortality. Patient's neutrophils had spontaneous NETosis and were unresponsive to stimulation. Although platelet P-selectin and TNF-α were increased in both groups, higher platelet TLR-4 expression, VWF levels and IL-6 were found in septics at 1dpa. Neither platelet activation markers nor cytokines correlated with nucleosomes or HNE-DNA. Nucleosomes could be indicators of organ damage and predictors of mortality in septic but not in burn patients. Platelet activation, VWF and cytokines do not appear to be key mediators of NETosis in these patient groups.
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Affiliation(s)
- Tomás Kaufman
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | - Débora Magosevich
- Sagrado Corazón Clinic, Bartolomé Mitre 1955, Buenos Aires, Argentina
| | | | | | - Lina Paola D'Atri
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | - Agostina Carestia
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina
| | | | | | - Mirta Schattner
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, José Andrés Pacheco de Melo 3081, Buenos Aires, Argentina.
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136
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Hoque DME, Islam MI, Sharmin Salam S, Rahman QSU, Agrawal P, Rahman A, Rahman F, El-Arifeen S, Hyder AA, Alonge O. Impact of First Aid on Treatment Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and Demographic Census. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070762. [PMID: 28704972 PMCID: PMC5551200 DOI: 10.3390/ijerph14070762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/03/2017] [Accepted: 07/09/2017] [Indexed: 11/16/2022]
Abstract
Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.
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Affiliation(s)
- Dewan Md Emdadul Hoque
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Md Irteja Islam
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Shumona Sharmin Salam
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Priyanka Agrawal
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Aminur Rahman
- Centre for Injury Prevention and Research, House #B-162, Road #23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Fazlur Rahman
- Centre for Injury Prevention and Research, House #B-162, Road #23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Shams El-Arifeen
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abstract
Measuring the extent and impact of a health problem is key to being able to address it appropriately. This review uses available information within the framework of the Global Burden of Disease studies to estimate the disease burden due to burn injuries of the hands. The GBD indicates that since 1990 there has been an approximately 30% decrease in the disease burden related to burn injuries. The GBD methods have not been applied specifically to hand burns, but from available data, it is estimated that about 18 million people in the world suffer from sequelae of burns to the hands.
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Affiliation(s)
- Daniel S Corlew
- Resurge International, 145 Wolfe Road, Sunnyvale, CA 94086, USA; St. Thomas Rutherford Hospital, 1700 Medical Center Parkway, Murfreesboro, TN 37129, USA.
| | - K A Kelly McQueen
- Department of Anesthesiology, Vanderbilt Global Anesthesia Fellowship, Vanderbilt Anesthesia Global Health & Development, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 1301 Medical Center Drive, MCE 3161C, Nashville, TN 37232, USA; Department of Surgery, Vanderbilt Global Anesthesia Fellowship, Vanderbilt Anesthesia Global Health & Development, Affiliate Faculty, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 1301 Medical Center Drive, MCE 3161C, Nashville, TN 37232, USA
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Abstract
This article examines the societal impact of thermal injury in low- and middle-income countries. The authors describe the unique challenges of these health care systems in providing care for burned patients, focusing on resuscitation, excision and grafting, rehabilitation, and reconstruction.
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Affiliation(s)
- Anthony G Charles
- Department of Surgery, North Carolina Jaycee Burn Center, School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA.
| | - Jared Gallaher
- Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, 4004 Burnett Womack Building, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Bruce A Cairns
- Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, 4004 Burnett Womack Building, 101 Manning Drive, Chapel Hill, NC 27599, USA
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Abouie A, Salamati P, Hafezi-Nejad N, Rahimi-Movaghar A, Saadat S, Amin-Esmaeili M, Sharifi V, Hajebi A, Rahimi-Movaghar V. Incidence and cost of non-fatal burns in Iran: a nationwide population-based study. Int J Inj Contr Saf Promot 2017; 25:23-30. [PMID: 28387170 DOI: 10.1080/17457300.2017.1310739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To determine the incidence and cost of non-fatal burns in Iran; this cross-sectional household survey of a nationally representative sample of 15-64 years old was conducted. Through face-to-face interviews and telephone calls, the data on the demographics, history and cost of burns were collected. The annual incidence rate of burns was estimated 129.85 per 1000 population. Burns occurred higher in younger age, female gender and urban residency. The most common burn description was as follows: unpaid work (activity during burn), home (place of burn), heat and hot substances (mechanism of burn) and upper limb (site of burn). The average total cost of burn includes victims seeking medical care was US$124 per case. The main findings of this study suggest that burns are a major public health concern in Iran. To stop this important health issue, a national program for burn prevention and education must be developed.
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Affiliation(s)
- Abolfazl Abouie
- a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Payman Salamati
- a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Nima Hafezi-Nejad
- a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Afarin Rahimi-Movaghar
- b Iranian National Center for Addiction Studies (INCAS) , Iranian Institute for Reduction of High-Risk Behaviors , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Soheil Saadat
- a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Masoumeh Amin-Esmaeili
- b Iranian National Center for Addiction Studies (INCAS) , Iranian Institute for Reduction of High-Risk Behaviors , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Vandad Sharifi
- c Department of Psychiatry , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
| | - Ahmad Hajebi
- d Research Center for Addiction and Risky Behavior (ReCARB), Psychiatric Department , Iran University of Medical Sciences , Tehran , Iran
| | - Vafa Rahimi-Movaghar
- a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran
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He S, Alonge O, Agrawal P, Sharmin S, Islam I, Mashreky SR, Arifeen SE. Epidemiology of Burns in Rural Bangladesh: An Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040381. [PMID: 28379160 PMCID: PMC5409582 DOI: 10.3390/ijerph14040381] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 12/23/2022]
Abstract
Each year, approximately 265,000 deaths occur due to burns on a global scale. In Bangladesh, around 173,000 children under 18 sustain a burn injury. Since most epidemiological studies on burn injuries in low and middle-income countries are based on small-scale surveys or hospital records, this study aims to derive burn mortality and morbidity measures and risk factors at a population level in Bangladesh. A household survey was conducted in seven rural sub-districts of Bangladesh in 2013 to assess injury outcomes. Burn injuries were one of the external causes of injury. Epidemiological characteristics and risk factors were described using descriptive as well as univariate and multivariate logistic regression analyses. The overall mortality and morbidity rates were 2 deaths and 528 injuries per 100,000 populations. Females had a higher burn rate. More than 50% of injuries were seen in adults 25 to 64 years of age. Most injuries occurred in the kitchen while preparing food. 88% of all burns occurred due to flame. Children 1 to 4 years of age were four times more likely to sustain burn injuries as compared to infants. Age-targeted interventions, awareness of first aid protocols, and improvement of acute care management would be potential leads to curb death and disability due to burn injuries.
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Affiliation(s)
- Siran He
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Olakunle Alonge
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Priyanka Agrawal
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Shumona Sharmin
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Irteja Islam
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
| | - Saidur Rahman Mashreky
- Center for Injury Prevention and Research, House # B-162, Road # 23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Shams El Arifeen
- International Center for Diarrheal Disease Research, GPO Box 128, Dhaka 1000, Bangladesh.
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Botchey IM, Hung YW, Bachani AM, Paruk F, Mehmood A, Saidi H, Hyder AA. Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study. Surgery 2017; 162:S45-S53. [PMID: 28385178 DOI: 10.1016/j.surg.2017.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low- and middle-income countries where more than 90% of injury-related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low- and middle-income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital-based trauma registries. METHODS From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes. RESULTS A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale ≤12, estimated injury severity score ≥9, burns, and gunshot injuries. CONCLUSION Hospital-based trauma registries can be important sources of data to study the epidemiology of injuries in low- and middle-income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality-of-care improvement programs.
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Affiliation(s)
- Isaac M Botchey
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yuen W Hung
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Fatima Paruk
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amber Mehmood
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hassan Saidi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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Tripathee S, Basnet SJ. Epidemiology of burn injuries in Nepal: a systemic review. BURNS & TRAUMA 2017; 5:10. [PMID: 28413803 PMCID: PMC5389177 DOI: 10.1186/s41038-017-0075-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
Burn is a global public health problem associated with significant morbidity and mortality, mostly in low- and middle-income countries. Southeast-Asian countries share a big burden of burn injuries, and Nepal is not an exception. We performed a systemic review to examine the epidemiological characteristics of burn injures in Nepal. Relevant epidemiological studies were identified through systemic search in PubMed, EMBASE, and Google Scholar. Reference lists from relevant review articles were also searched. Studies were included if they meet our selection criteria. Eight studies were included in our systemic review. Most of the burn victims belong to the working age group between 15–60 years old. Flame burns were found to be the most common cause of burn injury followed by scald burns, whereas scald burns were the most common cause of burn injury among the pediatric population. Most patients sustained less severe burn injuries, with home being the most common place of burn injury. The average hospital stay among the burn victims ranged from 13 to 60 days. Mortality among the burn victims ranged from 4.5 to 23.5%, with highest mortality among the flame burn patients. Developed nations have significantly reduced the burn incidence through effective intervention program. Although, burn injuries are the leading cause of morbidity and mortality in Nepal, effective intervention programs are lacking due to the limited epidemiological data related to burn injuries. Further large scale research is imperative to investigate the problem and assess the effectiveness of an intervention program.
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Rahmani F, Ebrahimi Bakhtavar H, Zamani A, Abdollahi F, Rahmani F. Demographic features of pediatric patients with burn injuries referred to the emergency department of Sina hospital in Tabriz, Iran, in 2014. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2017. [DOI: 10.15171/jarcm.2017.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Manzano-Nunez R, García-Perdomo HA, Ferrada P, Ordoñez Delgado CA, Gomez DA, Foianini JE. Safety and effectiveness of propranolol in severely burned patients: systematic review and meta-analysis. World J Emerg Surg 2017; 12:11. [PMID: 28265298 PMCID: PMC5335497 DOI: 10.1186/s13017-017-0124-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA >20%). METHODS Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (>20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We conducted a meta-analysis using a random-effects model. RESULTS We included ten studies in our systematic review. These studies randomized a total of 1236 participants. There were no significant differences between propranolol and placebo with respect to mortality (RD -0.02 [95% CI -0.06 to 0.02]), sepsis (RD -0.03 [95% CI -0.09 to 0.04]), and the overall hospital stay (MD -0.37 [-4.52 to 3.78]). Propranolol-treated adults had a decrease in requirements of blood transfusions (MD -185.64 [95% CI -331.06 to -40.43]) and a decreased heart rate (MD -26.85 [95% CI -39.95 to -13.75]). CONCLUSIONS Our analysis indicates that there were no differences in mortality or sepsis in severely burned patients treated with propranolol compared with those who had usual care or placebo. However, the use of propranolol in these patients resulted in lower requirements of blood transfusion and lower values of heart rate. The evidence synthesized in this systematic review is limited to conclude that propranolol reduces the length of hospital stay among severely burned patients. Future trials should assess the impact of propranolol on clinically relevant outcomes such as mortality and adverse events.
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Affiliation(s)
- Ramiro Manzano-Nunez
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- UROGIV Research Group, Universidad Del Valle, Cali, Colombia
| | | | - Paula Ferrada
- Surgical Critical Care, Virginia Commonwealth University, Richmond, VA USA
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Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, Carlson LC, Jacquet GA. A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region. Afr J Emerg Med 2017; 7:30-37. [PMID: 30456103 PMCID: PMC6234151 DOI: 10.1016/j.afjem.2017.01.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. METHODS We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. RESULTS The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. DISCUSSION While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Courtney M. Elm
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Shashank Sarvepalli
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Pavan A. Vaswani
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kamna S. Balhara
- Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Lucas C. Carlson
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
- Boston University Center for Global Health and Development, Boston, MA, United States
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Murphy RA, Nisenbaum L, Labar AS, Sheridan RL, Ronat JB, Dilworth K, Pena J, Kilborn E, Teicher C. Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti. World J Surg 2017; 40:1550-7. [PMID: 26913733 DOI: 10.1007/s00268-016-3458-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Compare to high-income settings, survival in burn units in low-income settings is lower with invasive infections one leading cause of death. Médecins Sans Frontières is involved in the treatment of large burns in adults and children in Haiti. METHODS In 2014, we performed a review of 228 patients admitted consecutively with burn injury during a 6-month period to determine patient outcomes and infectious complications. Microbiology was available through a linkage with a Haitian organization. Regression analysis was performed to determine covariates associated with bloodstream infection and mortality. RESULTS 102 (45 %) patients were male, the median age was 8 years (IQR, 2-28), and the majority of patients (60 %) were admitted to the unit within 6 h of injury. There were 20 patients (9 %) with culture-proven bacteremia. Among organisms in blood, common isolates were Staphylococcus aureus (42 %), Pseudomonas aeruginosa (23 %), and Acinetobacter baumannii (15 %). Among patients with burns involving <40 % total body area, 4 (2 %) of 192 died and 20 (65 %) of 31 with ≥40 % body surface area involvement died. Factors associated with mortality included involvement of ≥40 % of body surface, depth, and flame as the mechanism. Multidrug-resistant infections were common; 18 % of S. aureus isolates were methicillin resistant, and 83 % of P. aeruginosa isolates were imipenem resistant. CONCLUSIONS A low mortality rate was observed in a humanitarian burn surgery project in patients with burns involving <40 % of total body surface. Invasive infection was common and alarming rates of antibiotic resistance were observed, including infections not treatable with antibiotics available locally.
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Affiliation(s)
- Richard A Murphy
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson St, Box 466, Torrance, CA, 90509, USA.
| | - Luba Nisenbaum
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France.,Rowan University School of Osteopathic Medicine, One Medical Center Drive, Stratford, NJ, 08084-1501, USA
| | | | - Robert L Sheridan
- Division of Burns, Massachusetts General Hospital, 55 Blossom St., Boston, MA, 02114, USA
| | - Jean-Baptiste Ronat
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Kelly Dilworth
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Jade Pena
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
| | - Erin Kilborn
- Médecins Sans Frontières/Doctors Without Borders, 8, Rue Saint Sabin, 75011, Paris, France
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Sadeghi-Bazargani H, Mohammadi R, Ayubi E, Almasi-Hashiani A, Pakzad R, Sullman MJM, Safiri S. Caregiver-related predictors of thermal burn injuries among Iranian children: A case-control study. PLoS One 2017; 12:e0170982. [PMID: 28151942 PMCID: PMC5289537 DOI: 10.1371/journal.pone.0170982] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/14/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Burns are a common and preventable cause of injury in children. The aim of this study was to investigate child and caregiver characteristics which may predict childhood burn injuries among Iranian children and to examine whether confounding exists among these predictors. METHODS A hospital based case-control study was conducted using 281 burn victims and 273 hospital-based controls, which were matched by age, gender and place of residence (rural/urban). The characteristics of the children and their caregivers were analyzed using crude and adjusted models to test whether these were predictors of childhood burn injuries. RESULTS The age of the caregiver was significantly lower for burn victims than for the controls (P<0.05). Further, the amount of time the caregiver spent outdoors with the child and their economic status had a significant positive association with the odds of a burn injury (P<0.05). A multivariate logistic regression found that Type A behaviour among caregivers was independently associated with the child's odds of suffering a burn injury (OR = 1.12, 95% CI: 1.04-1.21). The research also found that children with ADHD (Inattentive subscale: Crude OR = 2.14, 95% CI: 1.16-3.95, Adjusted OR = 5.65, 95% CI: 2.53-12.61; Hyperactive subscale: Crude OR = 1.73, 95% CI: 1.23-2.41, Adjusted OR = 2.53, 95% CI: 1.65-3.87) also had increased odds of suffering a burn injury. However, several variables were identified as possible negative confounder variables, as the associations were stronger in the multivariate model than in the crude models. CONCLUSION The caregiver's characteristics which were predictors of burn injuries among Iranian children were: being younger, high socio-economic status, Type A behavioural pattern and spending more time outdoors. In addition, the relationship between a child's ADHD scores and the odds of a burn injury may be negatively confounded by the caregivers predictor variables.
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Affiliation(s)
- Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
- WHO Collaborating Center on Community Safety Promotion, Karolinska Institute, Stockholm, Sweden
| | - Reza Mohammadi
- WHO Collaborating Center on Community Safety Promotion, Karolinska Institute, Stockholm, Sweden
| | - Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Reza Pakzad
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Mark J. M. Sullman
- Driving Research Group, Cranfield University, Bedfordshire, United Kingdom
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
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148
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Dhopte A, Tiwari VK, Patel P, Bamal R. Epidemiology of pediatric burns and future prevention strategies-a study of 475 patients from a high-volume burn center in North India. BURNS & TRAUMA 2017; 5:1. [PMID: 28164140 PMCID: PMC5286678 DOI: 10.1186/s41038-016-0067-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/13/2016] [Indexed: 11/26/2022]
Abstract
Background Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Methods Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. Results There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. Conclusions This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.
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Affiliation(s)
- Amol Dhopte
- Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, India
| | - V K Tiwari
- Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, India ; Present Address: Department of Burns & Plastic Surgery, PGIMER & RML Hospital, New Delhi, India
| | - Pankaj Patel
- Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, India
| | - Rahul Bamal
- Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, India
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Cox SG, Burahee A, Albertyn R, Makahabane J, Rode H. Parent knowledge on paediatric burn prevention related to the home environment. Burns 2016; 42:1854-1860. [DOI: 10.1016/j.burns.2016.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
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150
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Patel DD, Rosenberg L, Rosenberg M, Leal J, Andersen CR, Foncerrada G, Lee JO, Jimenez CJ, Branski L, Meyer WJ, Herndon DN. The epidemiology of burns in young children from Mexico treated at a U.S. hospital. Burns 2016; 42:1825-1830. [DOI: 10.1016/j.burns.2016.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
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