Acid burns from personal assault in Uganda

Vitriol attack on a young woman in Greece: The story of Ioanna's response

An acid attack is a deliberate act of violence. Sulphuric acid is thrown at a person's face and body with the intention of harming and disfiguring the victim. Sulphuric acid is a dangerous weapon which can cause very serious injuries including severe skin damage, blindness, significant disfigurement and/or permanent disability. We report the case of Ioanna, a 34-year-old woman who was attacked with vitriol by a jealous woman in May 2020. Following her admission to hospital, where Ioanna was an inpatient for 85 days, she underwent nine operations. Since her discharge she has undergone ten more, with further interventions likely in the future. In addition, she has undergone various treatments and procedures to restore her skin. Ioanna's courage and strength has inspired thousands of young children and adults who cope with a variety of health problems.

The impact of accidents during the transport of dangerous good, on people, the environment, and infrastructure and measures for their reduction: a review

Road transport is one of the most dangerous methods of goods transport. Driver errors and poor traffic conditions can cause traffic accidents, which can have a negative impact on people's health, the environment, and infrastructure. The main influence on the level of the consequences is the chemical composition and amount of the transported substance. This paper presents the causes of traffic accidents during the transport of dangerous goods. In addition, how traffic accidents during the transport of dangerous goods affect people's health, the environment, and infrastructure was shown. After that, measures for accidents avoidance and the alleviation and reduction of dangerous goods were given. From the review of studies from the subject field, it can be concluded that the dangerous goods are very harmful to people, the environment, and infrastructure when transport accidents occur. Lessons should be learned from the history of accidents involving the transport of dangerous goods to avoid repeating the same mistakes. The review conclusions indicate that a routes optimization and investment in road infrastructure are needed to reduce risk during the transport of dangerous goods.

Assault burn injuries in adolescents and adults in South Africa: risk factors and characteristics

Assault burns comprise a significant subset of burns, with a greater risk of severe injuries. This South African study used a national dataset from major hospitals to identify risks and injury characteristics of assault burns. The analysis sample comprised 2658 adolescent and adult cases and employed logistic regression with bootstrapping to examine the risk of assault compared to unintentional burns. The study indicates that 17.4% of burns were due to assault. Males were 1.5 times more likely than females to be burn assault victims. Compared to adults 55 years and older, young adults 22-39 years were at greatest risk, followed by youth 13-21 years. Assault injuries were five times more likely due to chemical attacks and three times more likely to scalds than to flame burns. The head, neck and trunk were most affected. Where alcohol was indicated, assault burns were five times more likely than unintentional burns. The findings may indicate the need for targeted prevention strategies such as conflict resolution, alcohol use management and the control of corrosive chemicals.

What is Known About Burns in East Africa? A Scoping Review

BACKGROUND

Burns are a global public health concern, with the majority of the disease burden affecting low- and middle-income countries. Yet, as suggested by previous publications, there is a widespread belief that literature about burns in low- and middle-income countries is lacking. Therefore, we aimed to assess with a scoping review, the extent of the literature output on burns in East Africa, and to investigate patient demographics, injury characteristics, treatment and outcomes, as reported from the existing publications.

METHODS

Studies discussing burns in East Africa were identified by searching PubMed / Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO), and Global Index Medicus on December 12, 2019. Controlled vocabulary terms (i.e., MeSH, EMTREE, Global Health thesaurus terms) were included when available and appropriate. No year restrictions were applied.

RESULTS

A total of 1,044 records were retrieved from the database searches, from which 40 articles from 6 countries published between 1993 and 2019 were included in the final review. No studies were found from five East African countries with the lowest GDP. Most papers focused on pediatric trauma patients or tertiary hospital settings. The total number of burn patients recorded was 44,369, of which the mean proportion of males was 56%. The most common cause of injury was scalds (61%), followed by open flame (17%). Mortality rate ranged from 0-67%. The mean length of stay in hospital was between 9-60 d.

CONCLUSIONS

Burn data is limited in the East African region, with socio-economically weak countries being particularly underrepresented. This scoping review has identified the largest set of literature on burns in East Africa to date, indicating the importance of reviewing data at a regional or local level, as "global" studies tend to be dominated by high-income country data. Data collection in specific registries is needed to better characterize the exact burden of burn injuries in East Africa.

Data from national media reports of 'Acid attacks' in England: A new piece in the Jigsaw

INTRODUCTION

There has been considerable concern in the UK with what seems to have been an increase in so-called 'Acid Attacks'. The key data sources (Police data, Hospital admissions and Burns unit data) have limitations in capturing the acid attacks comprehensively. Incidents not reported to the police are missed in the Police data. The more serious injuries are included in the hospital admissions data, with no information on people with less severe injuries, not accessing health care. Burns unit data reveals detailed information on the burns treatment but represents only a small percent of all the acid attacks. Our aim was to explore the role of media reports as an additional data source.

METHODS

Data was obtained from the public domain using generic online search engines along with a formal medical literature review. Search parameters included any news articles on 'Acid Attacks' printed between 01/01/2016 and 31/12/2017 in England and Articles in National Press only. We compared the data from media reports to the only other data sources available on these crimes which were (a) Crime statistics from police (b) the proportion treated in hospital (c) the subgroup treated in the burns service in the highest incidence location in the UK.

RESULTS

Two hundred and Thirty media articles in total were found in the preliminary search. Following the application of the exclusion criteria, sixty attacks were analysed. The demographic data, the geographic data were obtained from the articles and the results were analysed using Microsoft Excel. There were a total of 118 survivors with an average age of 29.5 years and a male to female ratio of 5.1:1. There were no reported deaths. In the assailants group, the average age was 21.6 years with a male to female ratio of 15.7:1. All the data sources revealed higher male survivor predominance. The average age of the survivors was similar in the media reports, police data and the Burns centre data and was higher in the hospital data. Information on assailants and motives, available only on media reports and police data, corroborated well with each other. Media reports gave further information on the circumstances of the incident, the location and the number of survivors per assault, which was not available on any other data source. Though there was a rise in chemical assaults reported in media reports and MPS data in 2017 compared to the previous year, there was no rise in chemical assault related hospital admissions.

CONCLUSION

The majority of the survivors were males, which is consistent between all UK data sources. Media reports revealed that the South east of England had the majority of chemical assaults in England. Data from this source provides a further piece in the jigsaw especially in relation to the circumstances, the geographic location of the chemical assault and number of survivors per incident. We acknowledge the limitations of media reporting. In the absence of a formal database for such injuries and incomplete data from various sources, we have to consider all possible data sources to provide new information. We have discussed the utility, pros & cons of media reports as one of the additional sources of information to better understand these injuries.

Short Runs for a Long Slide: Principalization in Complex Facial Restoration after Acid Attack Burn Injury

Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are responsible for between 2 and 20% of burn injuries seen at burn centers in lower income countries. Women are commonly targeted and the perpetrators are often known to the victims. The combination of a high disease prevalence, limited surgical and anesthetic resources, a vulnerable patient population, and largely disfiguring, nonlethal injuries present unique challenges for the reconstructive surgeon who may not encounter such cases regularly. In this article, we present a case of a 16-year-old female who sustained severe, full-thickness burns to the face including eyelids, neck, abdomen, and upper extremities after an intentional acid attack. She began her treatment course with us approximately 1 year after the injury. The deformities of her oral and periorbital regions presented particularly difficult reconstructive problems, including impending visual loss. Using plastic surgical principalization, we provided our patient adequate restoration of facial form and function through numbers of interventions using fundamental and state-of-the-art techniques.

Blindness as a result of acid attacks in Cambodia

Background: Fifty-three patients who had been attacked with acid were treated over the last three years, and 45% suffered blindness in one or both eyes as a result. Objective: Review the charts of all 53 patients to see if the proximate cause of the blindness could be determined to prevent it happening to others. Results: Three principal causes of blindness were direct damage from acid, limbal stem cell loss leading to later eyeball perforation, and delayed corneal abrasion from eyelid deformity. Only the latter cause could be prevented at this time, since the strength of the acid used in the attack could not be controlled, nor could limbal stem cell transplants be performed. Conclusion: Assessment of the ophthalmic injuries revealed three main categories of visual impairment, only one of which could be treated effectively at this stage.

Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?

BACKGROUND

Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this.

METHODS

The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times.

RESULTS

A total of 624 acute burn cases were treated during the period; among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were  recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons.

CONCLUSION

There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.

A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region

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.

Burns in sub-Saharan Africa: A review

OBJECTIVE

Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region.

METHODS

An online search of publications on burns from sub-Saharan countries was performed.

RESULTS

A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims.

CONCLUSIONS

These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children.

Assaults from corrosive substances and medico legal considerations in a large regional burn centre in the United Kingdom: calls for increased vigilance and enforced legislation

Burn injuries from corrosive substances have been recognised as a common method of assault in low and middle income countries (LMICs) motivated by various factors. Such injuries often leave survivors with severely debilitating physical and psychological injuries and scars. The number of reported cases of acid assaults within the United Kingdom (UK) appears to be on the rise. As one of the largest regional burn centres in the UK, we have reviewed our experience of chemical burns from assault. This study aims to: (1) review the demographics, incidence and patient outcomes; (2) evaluate the long-term psychosocial support provided; and (3) review current criminal litigation proceedings and preventative legislations in the UK specific to assault by corrosive substances. A 15-year retrospective review of 21 burn injuries from assault with corrosive substances presenting to a regional burn unit was conducted. Victims were mostly young men; male perpetrators were more common. The most common motive cited was assault. The most common anatomical region affected was the face and neck. The number of victims who pursue litigation is disproportionately lower than the number of total cases at presentation. In an effort to better understand the legal considerations surrounding such assaults, we also collaborated with lawyers experienced in this particular field. We hope that our work will help educate healthcare professionals regarding the legal assistance and existing laws available to protect these patients.

Acid violence in Cambodia: the human, medical and surgical implications

INTRODUCTION

Acid violence is the deliberate use of acid to attack another human being. Such attacks leave a terrible human, medical and surgical legacy. This study, from one of the largest cohorts of acid attack victims to date, provides insights into Cambodia's unique demographics of such attacks, as well as the human cost and necessary surgical interventions.

METHODS

A retrospective cohort consisting of all patients presenting to the Children's Surgical Centre, Phnom Penh with acid burns from 1 January 2000 to 1 January 2013 was identified and information retrieved from their hospital records.

RESULTS

254 patients were identified. Males and females were almost equally likely to be victims of an acid attack (48.4% and 51.6% respectively). There was no significant association between victim and assailant gender (p=0.475). The face (78.0%), neck (51.5%) and chest (49.0%) were the most frequently affected body areas. The median total surface body area affected by acid burns was 7.0%. The mortality rate from acid assault was 2.0%. Patients required an average of 2.0 operations, ranging from 0 to 18.

CONCLUSIONS

Acid violence in Cambodia has a complex demographic which is different to many other developing countries and requires more investigation. Tougher legislation is required to reduce the incidence of these horrific crimes.

Fatal corrosive attack: a study of 13 cases from central Delhi, India

The present study is a retrospective analysis of 13 cases of deaths, which resulted from throwing of corrosives over the body. The cases were autopsied at the Department of Forensic Medicine, Maulana Azad Medical College & Associated Hospitals, Delhi, India, during a period of 13 years from July 1998 to June 2011. The cases represented approximately 0.1% of all autopsy cases during the same period. Data were analyzed with regard to the age, sex, place of occurrence, pattern of injury, survival period, and cause of death. Of these cases, 8 (61.54%) were male, and 5 (38.46%) were female. The most common age group of the victim was 21 to 30 years (46.15%). Six of the victims were attacked on the road side. Face and thorax were involved in all cases (100%). The average total body surface area of burn was 56.69%.The mean survival period was 28.2 days. In 53.85% of cases, the cause of death was septicemia.

Severe metabolic acidosis following assault chemical burn

Assault chemical burns are uncommon in northern Europe. Besides local toxicity, systemic manifestations are possible after strong acid exposure. A 40-year-old woman was admitted 1 h after a criminal assault with sulfuric acid. The total burned surface area was 35%, third degree. Injury was due to sulfuric acid (measured pH 0.9) obtained from a car battery. Immediate complications were obstructive dyspnea and metabolic acidosis. The admission arterial pH was 6.92, with total bicarbonate 8.6 mEq/l and base deficit 23.4 mEq/l. The correction of metabolic acidosis was achieved after several hours by the administration of bicarbonate and lactate buffers. The patient developed several burns-related complications (sepsis and acute renal failure). Cutaneous projections of strong acids may cause severe metabolic acidosis, particularly when copious irrigation and clothes removal cannot be immediately performed at the scene.

Epidemiology of burns throughout the World. Part II: intentional burns in adults

A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.

Chemical assault and skin/eye burns: two representative cases, report from the Acid Survivors Foundation, and literature review

Chemical assault is a significant problem throughout the world, resulting in disfigurement, sometime blindness or vision impairment, and constituting a major economic burden on otherwise overwhelmed health services in developing countries. Two representative cases are presented here. One involved domestic spouse abuse with an acid and the second involved a teen-aged female assaulted with an acid, perhaps for retribution over a local judicial matter. Such atrocities have a world-wide scope, which is reviewed here. Preventive measures are the most appropriate response. However, when such chemical assaults do occur, active measures to mitigate or negate their effects deserve consideration.

Epidemiology of burn injuries: highlighting cultural and socio-demographic aspects

Burns are devastating injuries that disproportionately affect people in developing countries, including children. In addition to a high mortality rate, survivors are burdened with life-long physical and emotional scars. The etiology and nature of burn injuries varies significantly by country, and this chapter explores the predominant causes and patterns of burn injury in both the developing and industrialized worlds. Gender differences play a significant role in the risk of burn injuries, across a spectrum with a predominance of women injured in fires from cooking and heating fuels in the developing world and industrial accidents primarily affecting men in developed nations. Children are particularly vulnerable to burn injuries, accounting for almost 50% of all burn patients in some studies. A majority of pediatric burns are scald injuries usually affecting very young children below the age of 5 years, and we discuss the behavioral patterns underlying this finding. Finally, the elderly form a rapidly increasing proportion of the population in many countries, and are often burdened with comorbidities that are likely to pose significant challenges in burn care.

Epidemiology of burn injuries II: psychiatric and behavioural perspectives

Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

Cologne burn centre experience with assault burn injuries

OBJECTIVE

To evaluate demographic and socioeconomic factors associated with assault burn injuries.

BACKGROUND

Assault by burning demonstrates a rare but severe public health issue and accounts for unique injury characteristics in the burn intensive care unit (BICU).

METHODS

We conducted a retrospective cohort study involving patients with thermal injuries admitted to the BICU of a university hospital. The patient cohort was divided into two groups (ABI group: patients with assault burns, n=41;

CONTROL GROUP

population of all other burned patients admitted to the BICU, n=1202). Bivariate and multivariate analyses including demographic and socioeconomic data were used to identify factors associated with assault burns.

RESULTS

Forty-one assault-related burn victims were identified in the study period. This represents 3.3% of all significant burns admitted. Comparing battery victims with the control population, assault patients were more likely to be young (mean age 36.2 years vs. 42.2 years) and immigrants (41.5% vs. 15.1%). Furthermore, marital status (65.9% vs. 40.8% singles), employment status (36.6% vs. 9.7% unemployed) and insurance status (41.5% vs. 12.3% social insurance) were significantly different in the bivariate analysis. Logistic regression evaluation identified three variables that were independently associated with assault burns: younger age (< or =25 years) (odds ratio, 2.54 [95% confidence interval, 1.29-5.02]; p=0.007), ethnic minority (odds ratio, 3.71 [95% confidence interval, 1.91-7.20]; p<0.001) and unemployment (odds ratio, 4.02 [95% confidence interval, 2.03-7.97]; p<0.001).

CONCLUSIONS

The high incidence of youngsters, unemployment and the great proportion of immigrants in victims of assault might provide several opportunities for community-based psychosocial and occupational programs. A multidisciplinary approach targeting issues specific to the violent nature of the injury and the socioeconomic background of the victims may be of benefit to improve their perspectives for rehabilitation.

Cases of chemical assault worldwide: A literature review

We reviewed 24 studies of chemical burns by means of assault in the last 40 years. We describe 771 cases of chemical assault in total. Jamaica had the largest absolute number of cases. Bangladesh had the highest reported incidence. Male victims were more common, with the exception of Bangladesh and Taiwan. The youngest cohort was from Bangladesh. The role of gender, agents used and legislation were discussed. We identified two broad motives; increases in violent crime and use as a crime of passion in disputes between men and women.

Skin torture

The inhumanity of human beings to other human beings has transcended all continents and every civilization from time immemorial. No amount of prohibitions, be they religious or legal edicts, has prevented cruel and inhuman punishment inflicted by human beings on others to subjugate them. Torture continues to be a common method to subdue and intimidate people. The forms of bodily harm can take any number of ways, some of which might even defy the imagination of any civilized people. We need only to recall the Holocaust and the decimations of thousands in Africa in more recent times.