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Hu G, Shu Z, Li Y, Song H. A Rare Case of Extensive Hydrofluoric Acid Burn. J Burn Care Res 2024; 45:1321-1324. [PMID: 38842582 DOI: 10.1093/jbcr/irae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 06/07/2024]
Abstract
Hydrofluoric acid (HF) is a strongly corrosive, highly toxic, and highly dangerous mineral acid. Burns with over 1% TBSA caused by anhydrous HF can lead to deep tissue damage, hypocalcemia, poisoning, and even death. In recent years, HF has become one of the most common substances causing chemical burns and ranks as the leading cause of death from chemical burns. Herein, we report a rare case with 91% TBSA burns caused by 35% HF. The patient developed complications such as shock, severe hypocalcemia, metabolic acidosis, and respiratory failure. Multidisciplinary team consultation (burns, respiratory medicine, nephrology, infectious disease, and pharmacy) was performed immediately after admission. An individualized diagnosis and treatment plan were developed for the patient. The patient was given intensive care, blood volume monitoring, tracheotomy, fluid resuscitation, continuous blood purification, anti-infective and analgesic treatments, intravenous and percutaneous calcium supplementation, early rehabilitation training, psychological rehabilitation, and other treatments. To prevent the wound from deepening, large-area debridement and skin grafting were performed early after the injury. A large dose of 10% calcium gluconate was injected into the patient in divided doses, and the wound was continuously treated with wet dressings. Multiple surgical debridements, negative pressure wound treatment, biological dressings, and Meek skin grafting were performed. After most of the wounds (approximately 85% TBSA) healed, the patient was discharged from the hospital and continued to undergo dressing changes at a local hospital. The patient was followed up 3 months after discharge. All the wounds healed well, and the patient basically regained functional independence in daily life.
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Affiliation(s)
- Gaozhong Hu
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Ziqin Shu
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yuan Li
- Second Department of Surgery, Gansu General Hospital of Armed Police Force, Lanzhou 730050, China
| | - Huapei Song
- Department of Burns, State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
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2
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Sica S, Mastroianni V, Ciamarra P, Giugliano P, Campobasso CP. Neonatal chemical burns and child neglect. Leg Med (Tokyo) 2024; 71:102520. [PMID: 39151244 DOI: 10.1016/j.legalmed.2024.102520] [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: 06/25/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
Differential diagnosis of agents of chemical burns can be challenging in neonates, especially in absence of a clear history of the event. A wide variety of chemical agents, from acids to basics, can be involved. Massive chemical burns over 21% of the body surface of a four-day-old male neonate were observed. At the physical examination, lower chest, abdomen, genital area and upper limbs showed full-thickness contact burns with a clear demarcation line of the skin breakdown related to necrosis of the subcutaneous layer. Head and fingers exhibited small hard brownish eschars. No clear history was referred by the parents, raising the suspect of a child neglect. Due to the critical conditions, it was not possible to identify the chemical agents causing the burns. The prompt excision and synthetic skin grafting was successfull and the baby survived. Considering all the different chemical agents found in the domestic environment, a combination of acid-basic agents may have been involved. Both parents were sentenced to nine years imprisonment for child neglect and wounding with intent.
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Affiliation(s)
- Stefania Sica
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni, 5, 80138, Naples, Italy
| | | | - Paola Ciamarra
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni, 5, 80138, Naples, Italy.
| | | | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni, 5, 80138, Naples, Italy
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3
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Matar H, Vuddanda PR, Chilcott RP. Evaluation of emergency skin decontamination protocols in response to an acid attack (vitreolage). Burns 2024:S0305-4179(24)00205-5. [PMID: 38991894 DOI: 10.1016/j.burns.2024.07.003] [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: 02/12/2024] [Revised: 04/24/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
The incidence of "acid attacks" (vitreolage) is a global concern, with those affected often receiving lifelong medical care due to physical and psychological damage. The purpose of this study was to evaluate the effectiveness of several emergency skin decontamination approaches against concentrated (>99 %) sulphuric acid and to identify the effective window of opportunity for decontamination. The effects of four decontamination methods (dry, wet, combined dry & wet and cotton cloth) were assessed using an in vitro diffusion cell system containing dermatomed porcine skin. Sulphuric acid (H2SO4) was applied to the skin with decontamination protocols performed at 10 s, 30 s, 8 min, and 30 min post exposure. Skin damage was quantified by tritiated water (3H2O) penetration, receptor fluid pH and photometric stereo imaging (PSI), with quantification of residual sulphur (by SEM-EDS) to determine overall decontamination efficiency. Skin translucency (quantified by PSI) demonstrated a time-dependent loss of dermal tissue integrity from 10 s. Quantification of dermal sulphur content confirmed the rapid (exponential) decrease in decontamination efficiency with time. The pH of the water effluent indicated complete neutralisation of acid from the skin surface after 90 s of irrigation. Wet decontamination (either alone or immediately following dry decontamination) was the most effective intervention evaluated, although no decontamination technique was statistically effective after 30 s exposure to the acid. These data demonstrate the time-critical consequences of dermal exposure to concentrated sulphuric acid: we find no practical window of opportunity for acid decontamination, as physical damage is virtually instantaneous.
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Affiliation(s)
- H Matar
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK..
| | - P R Vuddanda
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - R P Chilcott
- Research Centre for Topical Drug Delivery and Toxicology, University of Hertfordshire, Hatfield AL10 9AB, UK
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4
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Wang AB, Chuang KJ, Wang VS, Chang TY. Personal Exposure to Sulfuric Acid in the Electroplating Industry: Development and Validation of a Predictive Model. TOXICS 2024; 12:489. [PMID: 39058141 PMCID: PMC11281176 DOI: 10.3390/toxics12070489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
This study aimed to measure personal exposure to sulfuric acid in the electroplating industry to establish a predictive model and test its validation. We collected indoor air parameters and related information from four electroplating plants. Silica gel sorbents were used to collect air samples using high-performance ion chromatography. We collected air samples from three plants (i.e., Plant B, Plant C, and Plant D) and applied multiple linear regressions to build a predictive model. Eight samples collected from the fourth plant (i.e., Plant A) were used to validate the model. A total of 41 samples were collected with a mean of 25.0 ± 9.8 μg/m3 (range 12.1-51.7 μg/m3) in this study, including Plant A (8 samples, 17.5 ± 2.8 μg/m3, 13.0-22.0 μg/m3), Plant B (11 samples, 36.5 ± 9.7 μg/m3, 23.1-51.7 μg/m3), Plant C (11 samples, 16.4 ± 1.7 μg/m3, 12.1-17.8 μg/m3), and Plant D (11 samples, 27.4 ± 1.7 μg/m3, 24.1-29.9 μg/m3). Plant B was significantly higher in sulfuric acid than the other plants. Workers from the electroplating process plants were exposed to sulfuric acid at 29.0 ± 11.5 μg/m3. The predictive model for personal exposure to sulfuric acid fit the data well (r2 = 0.853; adjusted r2 = 0.837) and had an accuracy of 5.52 μg/m3 (bias ± precision; 4.98 ± 2.38 μg/m3), validated by the personal sampling of the fourth plant. This study observed that sulfuric acid exposure was lower than the permissible exposure level of 1000 μg/m3 in Taiwan and the United States, and only two samples were lower than the European Union standard of 50 μg/m3. The developed model can be applied in epidemiological studies to predict personal exposure to sulfuric acid in plants using electroplating.
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Affiliation(s)
- Austin B. Wang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd. Beitun Dist., Taichung City 406040, Taiwan; (A.B.W.); (V.-S.W.)
- Department of Public Health, College of Public Health, China Medical University, Taichung City 406040, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City 110, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Ven-Shing Wang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd. Beitun Dist., Taichung City 406040, Taiwan; (A.B.W.); (V.-S.W.)
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd. Beitun Dist., Taichung City 406040, Taiwan; (A.B.W.); (V.-S.W.)
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5
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Jameel F, Irfan F, Salim A, Khan I, Khalil EA. Alpha terpineol preconditioning enhances regenerative potential of mesenchymal stem cells in full thickness acid burn wounds. Regen Ther 2024; 26:188-202. [PMID: 38948132 PMCID: PMC11214267 DOI: 10.1016/j.reth.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/06/2024] [Accepted: 05/19/2024] [Indexed: 07/02/2024] Open
Abstract
Regeneration of full thickness burn wounds is a significant clinical challenge. Direct stem cell transplantation at the wound site has a promising effect on wound regeneration. However, stem cell survival within the harsh wound environment is critically compromised. In this regard, preconditioning of stem cells with cytoprotective compounds can improve the efficiency of transplanted cells. This study evaluated the possible effect of alpha terpineol (αT) preconditioned mesenchymal stem cells (αT-MSCs) in full thickness acid burn wound. An optimized concentration of 10 μM αT was used for MSC preconditioning, followed by scratch assay analysis. A novel rat model of full thickness acid burn wound was developed and characterized via macroscopic and histological examinations. Treatment (normal and αT-MSCs) was given after 48 h of burn wound induction, and the healing pattern was examined till day 40. Skin tissues were harvested at the early (day 10) and late (day 40) wound healing phases and examined by histological grading, neovascularization, and gene expression profiling of healing mediators. In scratch assay, αT-MSCs exhibited enhanced cell migration and wound closure (scratch gap) compared to normal MSCs. In vivo findings revealed enhanced regeneration in the wound treated with αT-MSCs compared to normal MSCs and untreated control. Histology revealed enhanced collagen deposition with regenerated skin layers in normal MSC- and αT-MSC treated groups compared to the untreated control. These findings were correlated with enhanced expression of α-SMA as shown by immunohistochemistry. Additionally, αT-MSC group showed reduced inflammation and oxidative stress, and enhanced regeneration, as witnessed by a decrease in IL-1β, IL-6, TNF-α, and Bax and an increase in BCL-2, PRDX-4, GPX-7, SOD-1, VEGF, EGF, FGF, MMP-9, PDGF, and TGF-β gene expression levels at early and late phases, respectively. Overall findings demonstrated that αT exerts its therapeutic effect by mitigating excessive inflammation and oxidative stress while concurrently enhancing neovascularization. Thus, this study offers new perspectives on managing full thickness acid burn wounds in future clinical settings.
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Affiliation(s)
- Fatima Jameel
- Stem Cell Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Fatima Irfan
- Stem Cell Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Asmat Salim
- Stem Cell Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Irfan Khan
- Stem Cell Research Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Enam A. Khalil
- Department of Pharmacy, The University of Jordan, Amman, 11942, Jordan
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Levine JM, Parekh NS, Cooper ML. Contact with Wet Cement-A Preventable Cause of Chemical Burn: Case Report and Discussion. Adv Skin Wound Care 2024; 37:292-296. [PMID: 38767420 DOI: 10.1097/asw.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
GENERAL PURPOSE To review the management of a patient with a chemical burn from wet cement. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Recognize the clinical presentation of a patient with a chemical burn from contact with wet cement.2. Describe features related to the pathophysiology of alkali burns from wet cement.3. Select the proper decontamination procedure after exposure to wet cement.4. Identify steps in the treatment of a patient with a chemical burn from contact with wet cement.
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7
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Bélanger A, Pichette A, Gauthier M, Legault J. Diphoterine, an amphoteric rinsing solution, reduces hydrofluoric acid injuries in an ex vivo pigskin model. Burns 2024; 50:488-494. [PMID: 38087660 DOI: 10.1016/j.burns.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 02/24/2024]
Abstract
Hydrofluoric acid (HF) is a ubiquitous industrial chemical that is particularly hazardous because of the potential for systemic effects and the induction of severe cutaneous necrosis after contact with the skin. Minimizing skin injury requires decontaminating the affected area promptly with an emergency rinsing solution. Few experimental studies have objectively characterized rinsing solutions such as Diphoterine (DP). Here we develop an ex vivo pigskin model to study and compare the efficacy of rinsing solutions as initial decontaminating agents to stop the progression of skin lesions after HF splashing. The pigskin model shows an immediate local response to HF at varying concentrations and exposure times. We then exposed the pigskin biopsies to 3.75% HF for 1 min and rinsed them with different solutions, including water, 0.9% NaCl solution (saline), 10% calcium gluconate (CaG), Hexafluorine (HXF), and DP. We found DP to be a more effective agent for decontaminating HF lesions than water, saline, and CaG. DP had a similar efficacy as HXF, an emergency rinsing solution used specifically for decontaminating HF-exposed skin. This study shows that skin exposed to HF must be treated quickly from the first minute of exposure.
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Affiliation(s)
- Audrey Bélanger
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - André Pichette
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Marcel Gauthier
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
| | - Jean Legault
- Laboratoire d'Analyse et de Séparation des Essences végétales (LASEVE), Département des Sciences fondamentales, Centre de recherche sur la boréalie (CREB), Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada.
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8
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Pham TT, Heidari AE, Hong EM, Steward E, Qu Y, Chen LY, Dunn BS, Seo SH, Syed A, Dilley K, Lee L, Hutchison DM, Hansen KD, Patel U, Kim S, Hill MG, Wong BJF. Electrochemical Lipolysis Induces Adipocyte Death and Fat Necrosis: In Vivo Pilot Study in Pigs. Plast Reconstr Surg 2024; 153:334e-347e. [PMID: 37163479 DOI: 10.1097/prs.0000000000010645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Current minimally invasive fat reduction modalities use equipment that can cost thousands of U.S. dollars. Electrochemical lipolysis (ECLL), using low-cost battery and electrodes (approximately $10), creates acid/base within fat (width, approximately 3 mm), damaging adipocytes. Longitudinal effects of ECLL have not been studied. In this pilot study, the authors hypothesize that in vivo ECLL induces fat necrosis, decreases adipocyte number/viability, and forms lipid droplets. METHODS Two female Yorkshire pigs (50 to 60 kg) received ECLL. In pig 1, 10 sites received ECLL, and 10 sites were untreated. In pig 2, 12 sites received ECLL and 12 sites were untreated. For ECLL, two electrodes were inserted into dorsal subcutaneous fat and direct current was applied for 5 minutes. Adverse effects of excessive pain, bleeding, infection, and agitation were monitored. Histology, live-dead (calcein, Hoechst, ethidium homodimer-1), and morphology (Bodipy and Hoechst) assays were performed on day 0 and postprocedure days 1, 2, 7, 14 (pig 1 and pig 2), and 28 (pig 2). Average particle area, fluorescence signal areas, and adipocytes and lipid droplet numbers were compared. RESULTS No adverse effects occurred. Live-dead assays showed adipocyte death on the anode on days 0 to 7 and the cathode on days 1 to 2 (not significant). Bodipy showed significant adipocyte loss at all sites ( P < 0.001) and lipid droplet formation at the cathode site on day 2 ( P = 0.0046). Histology revealed fat necrosis with significant increases in average particle area at the anode and cathode sites by day 14 (+277.3% change compared with untreated, P < 0.0001; +143.4%, P < 0.0001) and day 28 (+498.6%, P < 0.0001; +354.5%, P < 0.0001). CONCLUSIONS In vivo ECLL induces fat necrosis in pigs. Further studies are needed to evaluate volumetric fat reduction. CLINICAL RELEVANCE STATEMENT In vivo ECLL induces adipocyte death and fat necrosis. ECLL has the potential to be utilized in body fat contouring.
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Affiliation(s)
- Tiffany T Pham
- From the Beckman Laser Institute & Medical Clinic
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, School of Medicine
| | - Andrew E Heidari
- From the Beckman Laser Institute & Medical Clinic
- Department of Biomedical Engineering
| | - Ellen M Hong
- From the Beckman Laser Institute & Medical Clinic
| | | | - Yueqiao Qu
- From the Beckman Laser Institute & Medical Clinic
- Department of Biomedical Engineering
| | - Lily Y Chen
- From the Beckman Laser Institute & Medical Clinic
| | - Brandyn S Dunn
- From the Beckman Laser Institute & Medical Clinic
- Otolaryngology-Head and Neck Surgery, University of California, Irvine, School of Medicine
| | - Soo Hong Seo
- Department of Dermatology, Korea University, College of Medicine
| | - Adeela Syed
- Department of Developmental and Cell Biology, University of California, Irvine
| | | | - Lauren Lee
- From the Beckman Laser Institute & Medical Clinic
| | | | | | - Urja Patel
- From the Beckman Laser Institute & Medical Clinic
| | - Sehwan Kim
- Beckman Laser Institute-Korea, Dankook University
| | | | - Brian J F Wong
- From the Beckman Laser Institute & Medical Clinic
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, School of Medicine
- Departments of Surgery
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9
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Allahham A, Rowe G, Stevenson A, Fear MW, Vallence AM, Wood FM. The impact of burn injury on the central nervous system. BURNS & TRAUMA 2024; 12:tkad037. [PMID: 38312739 PMCID: PMC10835674 DOI: 10.1093/burnst/tkad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 02/06/2024]
Abstract
Burn injuries can be devastating, with life-long impacts including an increased risk of hospitalization for a wide range of secondary morbidities. One area that remains not fully understood is the impact of burn trauma on the central nervous system (CNS). This review will outline the current findings on the physiological impact that burns have on the CNS and how this may contribute to the development of neural comorbidities including mental health conditions. This review highlights the damaging effects caused by burn injuries on the CNS, characterized by changes to metabolism, molecular damage to cells and their organelles, and disturbance to sensory, motor and cognitive functions in the CNS. This damage is likely initiated by the inflammatory response that accompanies burn injury, and it is often long-lasting. Treatments used to relieve the symptoms of damage to the CNS due to burn injury often target inflammatory pathways. However, there are non-invasive treatments for burn patients that target the functional and cognitive damage caused by the burn, including transcranial magnetic stimulation and virtual reality. Future research should focus on understanding the mechanisms that underpin the impact of a burn injury on the CNS, burn severity thresholds required to inflict damage to the CNS, and acute and long-term therapies to ameliorate deleterious CNS changes after a burn.
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Affiliation(s)
- Amira Allahham
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Grant Rowe
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
| | - Andrew Stevenson
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Mark W Fear
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
| | - Ann-Maree Vallence
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South Street, Murdoch Perth 6150, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B), Level 4, 102-118 Murdoch Drive, Murdoch, Perth, WA 6150, Australia
| | - Fiona M Wood
- Burn injury research unit, School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
- Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch WA 6150, Australia
- School of Psychology, College of Health and Education, Murdoch University, 90 South Street, Murdoch, Perth 6150, Australia
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10
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Zahoor H, Javed N, Epperson JK, Ganguly D, Chung S, Khaja M. Cement-Induced Chemical Burn in a Middle-Aged Male: A Case Report and Review of Literature. Cureus 2024; 16:e53636. [PMID: 38449938 PMCID: PMC10917359 DOI: 10.7759/cureus.53636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
This case study reviews a 48-year-old Hispanic male working in construction who presented with left upper medial thigh pain, redness, and swelling after exposure to hazardous chemicals during cement processing. Initially diagnosed with cellulitis and adjacent myositis, the patient met sepsis criteria and received empiric antibiotics. However, negative cultures and an evolving wound appearance shifted the diagnosis towards bullous diseases and chemical injury. Occupational history and physical exam findings pointed towards injury secondary to chemical exposure, common in cement workers with inadequate protective gear. Cement burns, often insidious, are underreported due to their slow progression, mainly affecting the lower extremities. These burns involve chemical, mechanical, and hypersensitivity mechanisms that can mimic infection on imaging. This case highlights the importance of recognizing and managing cement burns promptly, emphasizing protective measures, decontamination, and potential early intervention by burn specialists.
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Affiliation(s)
- Hafsa Zahoor
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Jacob K Epperson
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Darshana Ganguly
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Susan Chung
- Surgery, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
| | - Misbahuddin Khaja
- Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, Bronx, USA
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11
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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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12
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Hermans MHE. An Introduction to Burn Care: The Sequel. Adv Skin Wound Care 2024; 37:9-18. [PMID: 38117166 DOI: 10.1097/asw.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
GENERAL PURPOSE To review burn care, with an emphasis on burn-specific issues and treatment. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Select the appropriate treatment guidelines for patients who have burn injuries.2. Identify common complications of major burns.3. Choose the recommended pharmacologic approaches to burn care.
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Affiliation(s)
- Michel H E Hermans
- Founder and President, Hermans Medical Consulting, Hoorn, the Netherlands
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13
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Amidi M, Salehi E. Calcined Chitosan/Cellulous Aerogel Modified with Copper Oxide Nanoparticles as an Efficient Sorbent for the Optimized Removal of Formic Acid from Water. ACS APPLIED BIO MATERIALS 2023; 6:4217-4225. [PMID: 37769283 DOI: 10.1021/acsabm.3c00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
A porous aerogel sorbent was prepared by the carbonization of a biohydrogel consisting of cellulose and chitosan (CS/CE) biopolymers. The adsorbent was also modified with copper oxide nanoparticles to effectively remove formic acid from water in batch mode. Characterization techniques, including scanning electron microscopy, Fourier transform infrared, Brunauer-Emmett-Teller, and X-ray diffraction, were employed to study the prepared sorbents. The concentration of formic acid in the solution was exactly determined by using liquid chromatography. To achieve maximum removal efficiency, important process variables were optimized using a central composite design data-based algorithm. Under optimal conditions, i.e., the initial concentration of 167.98 mg/L, the amount of sorbent equal to 75.28 mg, the contact time of 10.41 min, and the sample volume of 22.56 mL, a maximum acid removal efficiency of 84% was obtained. The Langmuir isotherm model was appropriately fitted to the experimental data, which indicates the chemical interaction of the sorbent active sites with formic acid. An adsorption capacity of 116.28 mg/g was also attained. The adsorption followed a pseudo-second-order kinetic pattern. According to the thermodynamic criteria, the adsorption of formic acid on the copper oxide-modified aerogel was exothermic, entropy-reducing, and favorable at temperatures lower than 290 K. Based on the results, CS/CE hydrogels comprising CuO nanoparticles are promising precursors for synthesizing carbonized aerogel sorbents that are successful in removing formic acid from aqueous environments.
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Affiliation(s)
- Mohammadali Amidi
- Department of Chemical Engineering, Faculty of Engineering, Arak University, Arak 38156-8-8349, Iran
| | - Ehsan Salehi
- Department of Chemical Engineering, Faculty of Engineering, Arak University, Arak 38156-8-8349, Iran
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14
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Gaffari J, Akbarzadeh K, Baniardalani M, Hosseini R, Masoumi S, Amiri ZS, Shabani Kordshouli R, Rafinejad J, Dahmardehei M. Larval therapy vs conventional silver dressings for full-thickness burns: a randomized controlled trial. BMC Med 2023; 21:361. [PMID: 37726738 PMCID: PMC10510148 DOI: 10.1186/s12916-023-03063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND This is the first clinical trial to investigate the effectiveness of maggot debridement therapy (MDT) for full-thickness burn injuries in comparison to conventional silver dressings. METHODS Thirty-one cases with full-thickness (grade III based on ICD-10 classifications version 2019) burns were assigned into larval therapy (15 cases) and conventional treatment (16 cases) groups. Participants in the MDT group have received loose larvae on days 0, 2, 4, and 6, while controls received a conventional regimen comprised of sharp debridement, silver sulfadiazine, antibiotic therapy, and offloading every day. The primary and secondary outcomes were defined as the time to debridement (from admission to skin autograft) and time to healing (from admission to complete healing post-skin autograft). Patients in two groups were also compared in terms of necrosis resolution, granulation, and granulation/necrosis (g/n) ratio during study time periods. RESULTS Participants who received larvae had significantly decreased necrosis on days 2 (p = 0.028) and 4 (p = 0.023) compared to those who received control treatment. Significant differences (p < 0.001) were also observed for granulation between the two groups in favor of MDT and the fold changes of g/n in the larvae group were 5, 15, and 13 times higher than that for the conventional regimen on days 2, 4, and 6 of treatment, respectively. Strikingly, a subgroup analysis of high necrotic burns (necrosis > 50%) revealed a significant improvement (p < 0.001) for MDT compared to the control treatment. There were also significant differences (p < 0.001) for the time to debridement and time to healing between the two groups. However, bacterial contamination did not show significant changes between the two treatment regimens. CONCLUSIONS Our findings revealed that MDT has a favorable superiority over conventional regimen for the treatment of grade-III burns, and thus further clinical trials with larger sample size are warranted to confirm these results.
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Affiliation(s)
- Jasem Gaffari
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Akbarzadeh
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Baniardalani
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hosseini
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Zahra Sadat Amiri
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Shabani Kordshouli
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Rafinejad
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Mahadevan A, Warnecke B, Chiao E, Nafissi N, Parajuli K, Rijal N, Parajuli R. Goserelin-Induced Chemical Burn: A Case Report and Review of the Literature. Cureus 2023; 15:e45692. [PMID: 37745751 PMCID: PMC10513001 DOI: 10.7759/cureus.45692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
A chemical burn resulting from luteinizing hormone-releasing hormone agonists (LHRHa) is a rare adverse effect that has not been well-documented in prior literature. In this case report, we report a partial-thickness burn that developed following a single subcutaneous injection of goserelin. To our knowledge, this is the first description of goserelin-induced chemical burn in the literature. The importance of early identification and treatment of LHRHa-associated cutaneous reactions must be highlighted to ensure optimal oncologic management and patient comfort.
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Affiliation(s)
- Aditya Mahadevan
- Department of Hematology and Oncology, University of California Irvine School of Medicine, Orange, USA
| | - Brian Warnecke
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
| | - Elaine Chiao
- Department of Hematology and Oncology, University of California Irvine School of Medicine, Orange, USA
| | - Nellie Nafissi
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
| | - Kritisha Parajuli
- Department of Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, NPL
| | - Nejina Rijal
- Department of Medicine, Kathmandu Medical College, Kathmandu, NPL
| | - Ritesh Parajuli
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
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16
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Shah NR, Palackic A, Brondeel KC, Walters ET, Wolf SE. The Burn Wound. Surg Clin North Am 2023; 103:453-462. [PMID: 37149381 DOI: 10.1016/j.suc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Skin serves as a protective barrier against infection, prevents excessive fluid and electrolyte losses, performs crucial thermoregulation, and provides tactile feedback of surroundings. The skin also plays an essential role in human perception of body image, personal appearance, and self-confidence. With these many diverse functions, understanding normal anatomic composition of skin is pivotal to evaluating the extent of its disruption from burn injury. This article discusses the pathophysiology, initial evaluation, subsequent progression, and healing of burn wounds. By delineating the various microcellular and macrocellular alterations of burn injury, this review also augments providers' capacity to deliver patient-centered, evidence-based burn care.
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Affiliation(s)
- Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Kimberley C Brondeel
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
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17
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Papadopoulou S, Nikolaidou E, Joycey AP, Tzimorota Z, Karagergou E. Reconstruction of Bilateral Upper and Lower Eyelid Ectropion Caused by a Liquid Unblocker Chemical Burn. Cureus 2023; 15:e40880. [PMID: 37492843 PMCID: PMC10363769 DOI: 10.7759/cureus.40880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Liquid drain unblockers, although meant to be used by professionals with protective equipment, are sometimes used in the household without any precautions. This could lead to severe chemical burns, as in the case we present with severe eyelid ectropion. This study aims to stress the need for preventive measures regarding the use of chemicals and for close observation and timely surgical intervention in chemical burn patients to prevent and limit disfigurement. A 45-year-old woman was injured while using an unblocker (90% sulfuric acid) at home. Accidentally, a quantity of the liquid was spilled on her face. She was initially examined in ophthalmology emergencies because of the obvious ocular involvement, and the cutaneous component was underestimated. On the third post-burn day, she was referred as an outpatient to our clinic, and because of the soft consistency and patchy pattern of the burn, she was asked to revisit in a week. Unfortunately, she reappeared two months post-burn with severe ectropion of all four eyelids and a high risk of corneal abrasion, desiccation, and further damage to the already injured left eye as well as the right eye. She underwent three operations in six months and a fourth 15 months after the accident, with the release of the scarred eyelids with full-thickness skin grafts, Z-plasties, and V-Y plasties. After four operations and sessions of triamcinolone acetonide intralesional injection, the patient has a satisfactory eyelid position and function with adequate closure and scar maturation. Domestic use of strong industrial chemicals is dangerous, and public education for prevention is urgently needed. On the other hand, it is mandatory to follow up very closely with chemical burn patients to prevent severe sequelae, especially in the delicate and contraction-prone periocular and perioral areas. Reconstruction, in these cases, is a complex task. Often, several surgeries are needed to restore acceptable function and appearance. Burn disfigurement and self-stigma will follow the patients to some extent throughout their lives.
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Affiliation(s)
- Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eirini Nikolaidou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Andrew P Joycey
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Zoi Tzimorota
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
| | - Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC
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18
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Williams JM, Ingle CL, Schauer SG, Maddry JK. Prehospital and Emergency Management. Surg Clin North Am 2023; 103:389-401. [PMID: 37149376 DOI: 10.1016/j.suc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.
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Affiliation(s)
| | | | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 59th Medical Wing, JBSA Lackland, TX, USA
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19
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Fatal hydrofluoric acid poisoning: histologic findings and review of the literature. Forensic Sci Med Pathol 2023; 19:67-71. [PMID: 36334175 DOI: 10.1007/s12024-022-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
Hydrofluoric acid (HF), the inorganic acid of elemental fluorine, is a highly dangerous substance and death can result from a very small exposure. In addition to local toxicity, HF can trigger fatal systemic reactions by its high affinity for calcium and magnesium. The authors report the autopsy case of a male worker who was exposed to 50% HF while repairing the leakage from an HF tank valve in a semi-conductor washing factory. His colleagues found blisters on his neck after 6 h of work and he was sent to the hospital. However, he expired from cardiac arrest despite an immediate calcium gluconate injection. At autopsy, burns with eschar covering less than 5% of the total body surface were identified on the neck and around both ears, and microscopic examination of the affected skin revealed extensive necrosis of the epidermis and dermis with pustule formation. In chemical analysis, no fluoride ions were detected in blood, vitreous humor, urine, pleural fluid, bile, or skin tissue from the neck. Considering the chemical burns on the neck and the circumstantial information, the cause of death was determined to be HF poisoning. This article presents the clinical manifestations of local and systemic toxicity after the accidental exposure to a high concentration of HF, with histologic demonstrations of chemical burns.
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20
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Volkova MV, Shen N, Polyanskaya A, Qi X, Boyarintsev VV, Kovaleva EV, Trofimenko AV, Filkov GI, Mezentsev AV, Rybalkin SP, Durymanov MO. Tissue-Oxygen-Adaptation of Bone Marrow-Derived Mesenchymal Stromal Cells Enhances Their Immunomodulatory and Pro-Angiogenic Capacity, Resulting in Accelerated Healing of Chemical Burns. Int J Mol Sci 2023; 24:4102. [PMID: 36835513 PMCID: PMC9963537 DOI: 10.3390/ijms24044102] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Transplantation of mesenchymal stromal cells (MSCs) provides a powerful tool for the management of multiple tissue injuries. However, poor survival of exogenous cells at the site of injury is a major complication that impairs MSC therapeutic efficacy. It has been found that tissue-oxygen adaptation or hypoxic pre-conditioning of MSCs could improve the healing process. Here, we investigated the effect of low oxygen tension on the regenerative potential of bone-marrow MSCs. It turned out that incubation of MSCs under a 5% oxygen atmosphere resulted in increased proliferative activity and enhanced expression of multiple cytokines and growth factors. Conditioned growth medium from low-oxygen-adapted MSCs modulated the pro-inflammatory activity of LPS-activated macrophages and stimulated tube formation by endotheliocytes to a much higher extent than conditioned medium from MSCs cultured in a 21% oxygen atmosphere. Moreover, we examined the regenerative potential of tissue-oxygen-adapted and normoxic MSCs in an alkali-burn injury model on mice. It has been revealed that tissue-oxygen adaptation of MSCs accelerated wound re-epithelialization and improved the tissue histology of the healed wounds in comparison with normoxic MSC-treated and non-treated wounds. Overall, this study suggests that MSC adaptation to 'physiological hypoxia' could be a promising approach for facilitating skin injuries, including chemical burns.
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Affiliation(s)
- Marina V. Volkova
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Ningfei Shen
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Anna Polyanskaya
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Xiaoli Qi
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Valery V. Boyarintsev
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Elena V. Kovaleva
- Department of Pathomorphology and Reproductive Toxicology, Research Center of Toxicology and Hygienic Regulation of Biopreparations, NRC Institute of Immunology FMBA of Russia, Ul. Lenina 102A, Serpukhov 142253, Russia
| | - Alexander V. Trofimenko
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Gleb I. Filkov
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Alexandre V. Mezentsev
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
| | - Sergey P. Rybalkin
- Department of Pathomorphology and Reproductive Toxicology, Research Center of Toxicology and Hygienic Regulation of Biopreparations, NRC Institute of Immunology FMBA of Russia, Ul. Lenina 102A, Serpukhov 142253, Russia
| | - Mikhail O. Durymanov
- School of Biological and Medical Physics, Moscow Institute of Physics and Technology, National Research University, Dolgoprudny 141701, Russia
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21
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Lindén J, Taponen S, Talvitie V, Leppävuori E, Hänninen L. Histopathological findings in a pilot study of dairy calves disbudded with hot cauterization or caustic paste. J Comp Pathol 2023; 201:118-122. [PMID: 36806891 DOI: 10.1016/j.jcpa.2023.01.003] [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: 05/19/2022] [Revised: 11/03/2022] [Accepted: 01/07/2023] [Indexed: 02/17/2023]
Abstract
We describe the histological tissue damage and compare the healing process in 16 dairy calves disbudded at a mean age of 6 days by cauterization or alkaline caustic paste application. Biopsies were taken 2 days (T2) and 2 weeks (T14) after disbudding from sedated calves treated with local anaesthetic and non-steroidal anti-inflammatory drugs. At T2, the cauterized horn buds generally had eosinophilic coagulative necrosis of the epidermis and superficial dermis, bordered basally by a neutrophilic demarcation zone. Lateral to the direct heat contact area, dermal blood vessels were thrombosed, with wall damage and perivascular neutrophils. In the caustic paste-treated horn buds, the epidermis and dermis had diffuse full-thickness liquefactive necrosis directly under the paste contact area. The necrosis spread laterally in the dermis beyond the area of paste contact and was bordered by a neutrophilic infiltrate. At T14, the cauterized horn buds had epidermal to superficial dermal ulceration and crusting, dermal neutrophilic infiltration and granulation tissue formation. In contrast, most of the caustic paste-treated horn buds consisted of a superficial dermal crust or predominantly necrotic tissue fragments. The remaining viable areas had histiocytic inflammation with peripheral neutrophils and early granulation tissue formation. Caustic paste disbudding caused poorly demarcated lesions that were more severe and extensive and took longer to heal than those due to cautery. Cauterization induced a more intense acute reaction adjacent to the primary lesion compared with caustic paste.
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Affiliation(s)
- Jere Lindén
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine and Finnish Centre for Laboratory Animal Pathology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Suvi Taponen
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - Vera Talvitie
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine and Finnish Centre for Laboratory Animal Pathology, HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Eveliina Leppävuori
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Hänninen
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland; Research Centre for Animal Welfare, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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22
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Lacroix G, Jeanne M, Martinot V, Pasquesoone L. "Extensive necrosis following extravasation of alkali in the crease of the elbow after voluntary intravenous injection: A case report". ANN CHIR PLAST ESTH 2023; 68:81-85. [PMID: 35902288 DOI: 10.1016/j.anplas.2022.07.002] [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: 05/19/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
Chemical burns are often deep with difficult initial clinical evaluation, especially those due to alkalic agents, which have a strong penetrating power. They therefore require specialized care in a Burn Unit. Self-inflicted burns are infrequent but their management represents a real challenge. We report the case of a 47-year-old referred to our Burn Center for the evaluation of a self-inflicted corrosion with an alkalic agent (soda), injected at the crease of the left elbow. The patient, right handed, was a nurse and had notably a psychiatric history of depressive syndrome. We observed a deep, well-defined necrosis area, associated with intense peri-lesional inflammation and extensive cellulitis. Faced with this unusual clinical appearance for a chemical burn, the patient's questioning was repeated and the patient finally admitted to having injected himself with a basic caustic product intravenously. Surgical treatment was carried out in two stages: debridement with exposure of vascular and neural structures then coverage with a free anterolateral thigh flap. The postoperative consequences were uneventful with a satisfactory functional result. Factitious disorders are underestimated and often misleading. Among factitious disorders, self-inflicted wounds remain a real challenge requiring multidisciplinary management. Many etiologies exist, among which injection of drugs or substances, in any anatomical localization, leading to variable loss of substance. The use of a free flap for acute extravasation is rare but sometimes essential. The anterolateral thigh flap allows good resurfacing on areas with important functional requirements.
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Affiliation(s)
- G Lacroix
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France.
| | - M Jeanne
- Anesthesia and Critical Care, Burn Centre, CHU de Lille, 59000 Lille, France; Inserm, CIC 1403 - centre d'investigations cliniques, University of Lille, 59000 Lille, France; ULR 7365, GRITA - groupe de recherche sur les formes injectables et les technologies associées, University of Lille, 59000 Lille, France
| | - V Martinot
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France
| | - L Pasquesoone
- Plastic Surgery and Burn Centre, CHU de Lille, 59000 Lille, France
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23
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Wang X, He J, Li Z, Zhu J, Wu J. The early association of water irrigation with negative pressure wound therapy does not more efficiently reduce the depth of the alkali infiltration progress into the burn. Int Wound J 2022; 20:351-358. [PMID: 35854477 PMCID: PMC9885477 DOI: 10.1111/iwj.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Water irrigation is an efficacious decontaminating method for dermis exposures to corrosive agents and hence has been widely applied to treat especially alkali burns. Nevertheless, once alkali has infiltrated the deep subcutaneous tissue, washing the tissue surface with water irrigation does not attenuate the damage progress. Therefore, significant efforts have been devoted to promising strategies aimed at removing the deeply infiltrated lye. According to a recent report, the negative pressure wound therapy (NPWT) reduces the pH value of the exudate from alkali-provoked burns thus accelerating wound healing. However, it remains to be ascertained whether or not NPWT coupled with water irrigation, that is, iNPWT, more effectively hinders the alkali injury deepening. In this study, we compared the effectiveness of an early application of water irrigation with or without NPWT in preventing the progressive deepening of the alkali burn in an animal model. Our histological examination results showed no appreciable difference in tissue injury depth, dermal retention, inflammatory cell infiltration, re-epithelization, and cellular function between iNPWT and water irrigation alone treatments. Thus, our results prove that the more expensive NPWT coupled with water irrigation does not more effectively hinder the alkali's injury deepening. Hence, iNPWT use should be more cautious in clinical practice.
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Affiliation(s)
- Xiaoyan Wang
- Department of Burn Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Jinqing He
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational MedicineThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenPeople's Republic of China
| | - Zhibin Li
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational MedicineThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenPeople's Republic of China
| | - Jiayuan Zhu
- Department of Burn Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Jun Wu
- Department of Burn and Plastic Surgery, Shenzhen Institute of Translational MedicineThe First Affiliated Hospital of Shenzhen University, Shenzhen Second People's HospitalShenzhenPeople's Republic of China,Section of Human Histology & Embryology, Department of Surgery, Dentistry, Paediatrics & ObstetricsUniversity of VeronaVerona, VenetiaItaly
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24
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Yeganeh PM, Tahmasebi S, Esmaeilzadeh A. Cellular and biological factors involved in healing wounds and burns and treatment options in tissue engineering. Regen Med 2022; 17:401-418. [PMID: 35545963 DOI: 10.2217/rme-2022-0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Severe traumatic wounds and burns have a high chance of mortality and can leave survivors with many functional disabilities and cosmetic problems, including scars. The healing process requires a harmonious interplay of various cells and growth factors. Different structures of the skin house numerous cells, matrix components and growth factors. Any disturbance in the balance between these components can impair the healing process. The function of cells and growth factors can be manipulated and facilitated to aid tissue repair. In the current review, the authors focus on the importance of the skin microenvironment, the pathophysiology of various types of burns, mechanisms and factors involved in skin repair and wound healing and regeneration of the skin using tissue engineering approaches.
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Affiliation(s)
| | - Safa Tahmasebi
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Esmaeilzadeh
- Department of immunology, School of Medicine, Zanjan University of Medical Science, Zanjan, 4513956111, Iran.,Cancer Gene Therapy Research Center, Zanjan University of Medical Science, Zanjan, Iran
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25
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Chai H, Chaudhari N, Kornhaber R, Cuttle L, Fear M, Wood F, Martin L. Chemical burn to the skin: A systematic review of first aid impacts on clinical outcomes. Burns 2022; 48:1527-1543. [DOI: 10.1016/j.burns.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
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26
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Microscopic changes over time in human dermis after exposure to sodium hydroxide. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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27
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Abstract
Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.
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Affiliation(s)
- Karl Walsh
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Isabel Hughes
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Baljit Dheansa
- Department of Burns and Plastics, Queen Victoria Hospital, East Grinstead, UK
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28
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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29
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Expert consensus on the prevention and first-aid management of burns in children. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1191-1199. [PMID: 34911600 PMCID: PMC8690712 DOI: 10.7499/j.issn.1008-8830.2109026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023]
Abstract
Burns are the second leading cause of unintentional injuries in children and are one of the major causes of disability in children. Timely and effective first-aid management of burns can have a major impact on the prognosis, but there is still a lack of the knowledge on burn management in the general public. With reference to expert opinions and related literature, this consensus summarizes the causes of burns, preventive measures, first-aid methods for common types of burns, and the prevention and treatment of serious complications of burns. It also provides recommendations on the most appropriate pre-hospital treatment. This consensus aims to emphasize the importance of burn prevention, improve the ability of first-aid treatment among witnesses and rescuers, avoid further injury caused by inappropriate treatment, and reduce the mortality and disability rates of burns and the harm to family and society. It can be used as guidance for pre-hospital treatment of childhood burns by first responders, parents, and passers-by.
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30
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Díaz-Criollo S, Varona-Uribe ME, Téllez-Avila EM, Palma-Parra M, Palencia-Flórez D, Idrovo AJ. Does sulfuric acid have a 'protective' effect on battery recyclers exposed to lead? INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:755-761. [PMID: 31693421 DOI: 10.1080/09603123.2019.1687659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
Culturally significant interventions to prevent lead exposure of battery recyclers are required. Sulfuric acid used in batteries causes skin lesions and could facilitate the recognition of hazards. This study explored whether joint exposure to lead and sulfuric acid can be used in interventions to manage hazardous work conditions. Data were collected from 120 informal workers, and the blood lead level was measured. Predictors of blood lead levels were explored using a tobit model. The median blood lead level was 9.45 µg/dL (Q75-Q25: 48.9 µg/dL); when lead and sulfuric acid exposure occurred, the level increased to 11.44 µg/dL, and when exposure to lead and other substances occurred, the level was 11.50 µg/dL. Workers are unaware of the risks of obvious and acute silent chronic exposure. Future preventive interventions could confront the economic benefits of battery recycling with the recognition of susceptibility and severity related to lead and sulfuric acid exposure.
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Affiliation(s)
- Sonia Díaz-Criollo
- Environmental and Labor Health Group, Research in Public Health Direction, National Institute of Health, Bogotá DC, Colombia
| | | | - Eliana M Téllez-Avila
- Environmental and Labor Health Group, Research in Public Health Direction, National Institute of Health, Bogotá DC, Colombia
| | | | | | - Alvaro J Idrovo
- Public Health Department, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
- Occupational Health Program, Universidad Manuela Beltrán, Bucaramanga, Colombia
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31
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Abbasi H, Dehghani A, Mohammadi AA, Ghadimi T, Keshavarzi A. The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018. Bull Emerg Trauma 2021; 9:195-200. [PMID: 34692871 PMCID: PMC8525699 DOI: 10.30476/beat.2021.90754.1261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/13/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the prevalence of chemical burns among the patients admitted to Shiraz burn treatment centers. Methods: It is a descriptive study that was conducted on 62 patients with chemical burns who were admitted between 2008 and 2018. The patients’ records were used in the research using the census sampling process. A questionnaire with questions about age, sex, the extent of the burn, the cause of the burn, duration of hospital stay, level of education, incident location, and clinical outcome was used to collect data (survival-death). The data was analyzed by using descriptive statistical methods. Results: The prevalence of chemical burns was 1% during 2008-2018. Acid and alkali burns were accounted for 93.5% and 6.5% of burns, respectively. 77.4% of patients were male, and 22.6% were female. The mean age of patients was 27 years. The average burn percentage was 16%. 70.6% of patients were illiterate or had primary education. Burns occurred at the workplace and home in 12.9% and 66.1% of cases, respectively. Moreover, Burns occurred due to accident (61%), acid attack (29%), and self-immolation (10%). The average length of hospital stay was 20 days. One patient (1.6%) died from burns. Conclusion: The study’s findings revealed that chemical burns were more common in men than women, and the majority of chemical burns occurred at home. To minimize the occurrence of chemical burns and acid attacks, teaching methods of preventing burns is important at home and work, as well as restricting non-specialists’ access to chemicals.
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Affiliation(s)
| | - Ali Dehghani
- Department of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolkhalegh Keshavarzi
- Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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32
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Burnett LR, Hughes RT, Rejeski AF, Moffatt LT, Shupp JW, Christy RJ, Winkfield KM. Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization. Technol Cancer Res Treat 2021; 20:15330338211039681. [PMID: 34613833 PMCID: PMC8504211 DOI: 10.1177/15330338211039681] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ionizing radiation causes injury to the skin that produces a complex clinical presentation that is managed by various paradigms without clear standards. The situation is further complicated by the fact that clinicians and researchers often use different terms and billing codes to describe the spectrum of cutaneous injury. There is, however, general agreement between the two most commonly-used diagnostic scales, the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, and in their use to describe skin injury following radiation therapy. These scales are typically used by radiation oncologists to quantify radiation dermatitis, a component of the radiation-related disorders of the skin and subcutaneous tissue family of diagnoses. In rare cases, patients with severe injury may require treatment by wound care or burn specialists, in which case the disease is described as a “radiation burn” and coded as a burn or corrosion. Further compounding the issue, most US government agencies use the term Cutaneous Radiation Injury to indicate skin damage resulting from large, whole-body exposures. In contrast, the US Food and Drug Administration approves products for radiation dermatitis or “burns caused by radiation oncology procedures.” A review of the literature and comparison of clinical presentations shows that each of these terms represents a similar injury, and can be used interchangeably. Herein we provide a comparative review of the commonly used terminology for radiation-induced skin injury. Further, we recommend standardization across clinicians, providers, and researchers involved in the diagnosis, care, and investigation of radiation-induced skin injury. This will facilitate collaboration and broader inclusion criteria for grant-research and clinical trials and will assist in assessing therapeutic options particularly relevant to patient skin pigmentation response differences.
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Affiliation(s)
| | - Ryan T Hughes
- 12279Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Lauren T Moffatt
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA
| | - Jeffrey W Shupp
- 121577MedStar Health Research Institute, Washington, DC, USA.,12230Georgetown University School of Medicine, Washington, DC, USA.,8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Christy
- 110230US Army Institute for Surgical Research, San Antonio Texas, USA
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33
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Gong J, Tracy LM, Edgar DW, Wood FM, Singer Y, Gabbe BJ. Poorer first aid after burn is associated with remoteness in Australia: Where to from here? Aust J Rural Health 2021; 29:521-529. [PMID: 34423511 DOI: 10.1111/ajr.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. DESIGN Registry-based cohort study. SETTING Binational clinical quality registry. PARTICIPANTS Burn-injured patients admitted to a specialist Australian burn service. MAIN OUTCOME MEASURES Receiving gold standard first aid following a burn injury. RESULTS Approximately two-thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. CONCLUSIONS Nearly two-thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required.
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Affiliation(s)
- Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia.,Burn Injury Research Node, The University of Notre Dame, Fremantle, WA, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Vic., Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Heath Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
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34
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PREVALENCE, TREATMENT, AND SURVIVAL OF BURNED WILDLIFE PRESENTING TO REHABILITATION FACILITIES FROM 2015 TO 2018. J Zoo Wildl Med 2021; 52:555-563. [PMID: 34130398 DOI: 10.1638/2020-0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/21/2022] Open
Abstract
In recent decades, wildfires have increased in frequency and geographic scale across the globe. The human health implications and ecological succession after wildfires are well documented and studied, but there is a lack of empirical research about the direct effects of wildfires on wildlife. Recent wildfires have demonstrated the need to better understand animal burn injuries and innovations in veterinary burn treatment. An online survey was distributed to wildlife rehabilitation facilities internationally to collect baseline information about the number and type of burned wildlife cases admitted, treatments used, and survivorship of wildlife affected by wildfires. Approximately 80% (n = 49) of all respondents (n = 61) reported admitting cases of burned wildlife from 2015 to 2018. Respondents included facilities from six different countries and roughly 43% of facilities reported having a veterinarian on staff. Electrical burns were most commonly reported with 89% of respondents stating that they had seen electrical burns while 38% of respondents reported seeing wildfire-source thermal burns in wildlife patients. Respondents were asked about their frequency of use of different treatment methods. Bandages, colloid fluids, and opioids were used at significantly higher rates at facilities with veterinarians compared with facilities that did not report having a veterinarian; however, survival of burned wildlife patients did not significantly differ based on the factor of having a veterinarian on staff. Long-term and short-term complications were commonly reported for wildlife burn patients; 88% of facilities reported scarring, 81% reported alopecia, and 61% reported sepsis. Burned animals admitted to facilities were reported to have equal odds of dying and surviving. Burn care recommendations have changed considerably in recent decades. This study provided a unique opportunity to compare contemporary recommendations in human medicine with current methods used in wildlife rehabilitation facilities to identify potential areas of further investigation and improvement for wildlife medicine.
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35
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Bresesti I, Ciolfi C, Messina M, Isoletta E, Brazzelli V. Acute adverse reaction to self-prescribed potassium hydroxide 5% solution in a child with papular acrodermatitis of childhood. Ital J Dermatol Venerol 2021; 157:209-210. [PMID: 34159773 DOI: 10.23736/s2784-8671.21.07010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ilia Bresesti
- Department of Pediatrics, Ospedale Civile, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Christian Ciolfi
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Marco Messina
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Eugenio Isoletta
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy -
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36
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McLure M, Macneil F, Wood FM, Cuttle L, Eastwood K, Bray J, Tracy LM. A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines? Cureus 2021; 13:e15779. [PMID: 34295589 PMCID: PMC8291991 DOI: 10.7759/cureus.15779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
We conducted a rapid review of current international and Australian/New Zealand guidelines on first aid for burns to identify any critical variation and any recent major changes in the literature that would warrant a significant change to current recommendations. A search was conducted to identify Australian/New Zealand and international first aid guidelines for burn care using guideline databases, and we compared key recommendations from each guideline relating to burns first aid. A literature search of relevant databases (Medline, Embase, Cochrane Database of Systematic Reviews, PROSPERO international register of systematic reviews, and ClinicalTrials.gov databases) was conducted to identify existing and in-progress research published on the topic of first aid for burn injuries. Seven guidelines were identified from the Australia/New Zealand region, and 11 international guidelines were identified from the United States of America and Europe. All Australian and New Zealand guidelines recommended a cooling duration of 20 minutes and made some mention of when to refer a burn for medical evaluation, while international guidelines saw cooling duration variation, a number of guidelines failed to mention referral criteria. The review of published systematic reviews and clinical trials revealed a lack of new evidence in the last six years. Our rapid review identified key variation between first aid guidelines for burns that would benefit from the development of an international consensus on management. We identified no new significant evidence that would alter guideline recommendations and did not identify any upcoming reviews or clinical trials on this subject.
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Affiliation(s)
- Michael McLure
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
| | - Finlay Macneil
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, AUS
- Faculty of Medicine, University of Newcastle, Newcastle, AUS
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, AUS
- Burn Injury Research Unit, University of Western Australia, Perth, AUS
| | - Leila Cuttle
- School of Biomedical Science, Queensland University of Technology, South Brisbane, AUS
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, AUS
- Children's Health Research Centre, Queensland University of Technology, South Brisbane, AUS
| | - Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Bentley, AUS
| | - Lincoln M Tracy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
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37
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Paediatric chemical burns: a clinical review. Eur J Pediatr 2021; 180:1359-1369. [PMID: 33403450 DOI: 10.1007/s00431-020-03905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.
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38
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Knuth CM, Auger C, Jeschke MG. Burn-induced hypermetabolism and skeletal muscle dysfunction. Am J Physiol Cell Physiol 2021; 321:C58-C71. [PMID: 33909503 DOI: 10.1152/ajpcell.00106.2021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Critical illnesses, including sepsis, cancer cachexia, and burn injury, invoke a milieu of systemic metabolic and inflammatory derangements that ultimately results in increased energy expenditure leading to fat and lean mass catabolism. Burn injuries present a unique clinical challenge given the magnitude and duration of the hypermetabolic response compared with other forms of critical illness, which drastically increase the risk of morbidity and mortality. Skeletal muscle metabolism is particularly altered as a consequence of burn-induced hypermetabolism, as it primarily provides a main source of fuel in support of wound healing. Interestingly, muscle catabolism is sustained long after the wound has healed, indicating that additional mechanisms beyond wound healing are involved. In this review, we discuss the distinctive pathophysiological response to burn injury with a focus on skeletal muscle function and metabolism. We first examine the diverse consequences on skeletal muscle dysfunction between thermal, electrical, and chemical burns. We then provide a comprehensive overview of the known mechanisms underlying skeletal muscle dysfunction that may be attributed to hypermetabolism. Finally, we review the most promising current treatment options to mitigate muscle catabolism, and by extension improve morbidity and mortality, and end with future directions that have the potential to significantly improve patient care.
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Affiliation(s)
- Carly M Knuth
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Auger
- Department of Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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39
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Niculescu AG, Chircov C, Grumezescu AM. Magnetite nanoparticles: Synthesis methods - A comparative review. Methods 2021; 199:16-27. [PMID: 33915292 DOI: 10.1016/j.ymeth.2021.04.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/28/2022] Open
Abstract
Iron oxide-based nanoparticles have gathered tremendous scientific interest towards their application in a variety of fields. Magnetite has been particularly investigated due to its readily availability, versatility, biocompatibility, biodegradability, and special magnetic properties. As the behavior of nano-scale magnetite is in direct relation to its shape, size, and surface chemistry, accurate control over the nanoparticle synthesis process is essential in obtaining quality products for the intended end uses. Several chemical, physical, and biological methods are found in the literature and implemented in the laboratory or industrial practice. However, non-conventional methods emerged in recent years to bring unprecedented synthesis performances in terms of better-controlled morphologies, sizes, and size distribution. Particularly, microfluidic methods represent a promising technology towards smaller reagent volume use, waste reduction, precise control of fluid mixing, and ease of automation, overcoming some of the major drawbacks of conventional bulk methods. This review aims to present the main properties, applications, and synthesis methods of magnetite, together with the newest advancements in this field.
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Affiliation(s)
| | - Cristina Chircov
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania.
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania; Research Institute of the University of Bucharest-ICUB, University of Bucharest, 050657 Bucharest, Romania.
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40
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Schicchi A, Tresoldi MM, Petrolini VM, Lonati D, Perrone M, Locatelli CA. Guttate psoriasis: a case of unusual evolution of an occupation-related skin chemical burns. LA MEDICINA DEL LAVORO 2021; 112:168-170. [PMID: 33881011 PMCID: PMC8095325 DOI: 10.23749/mdl.v112i2.11113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Introduction: Chemical burns are a risk in domestic and occupational accidents due to the common use of caustic agents. Long-term sequelae are normally due to the amount of skin and underlying tissues damaged. We describe a case of work-related chemical burns with unusual evolution in guttate psoriasis. Case Report: A 36 years-old man was admitted to the Emergency Department (ED) three-hours after a work accident. During the cleaning of an industrial hydraulic system, a jet of hydrochloric acid 20% injured his face and upper limbs. At ED admission, he presented first and second-degree skin burns on the frontal region, on the scalp, on the right forearm, and earlobe. Plastic surgery management consisted in wound topical dressing with silver sulfadiazine and paraffin gauze twice a week for one month. Forty-eight hours after the latter topical treatment (45-days after the work accident), in the same anatomical regions of the previous burn scars, he developed a skin reaction with itchy erythema. The application of topical products was suspended without improvement, excluding an allergic reaction. Within few days, a generalized guttate psoriasis was evident on the whole body. Discussion: Despite many prevention actions, work-related burns are a relatively common cause of hospitalization and may involve up to 80% of patients admitted to a burn unit. Guttate psoriasis has not been described as a sequelae of chemical burns. In our case, the others most frequent factors causing guttate psoriasis have been ruled out. Considering the temporal link between the development of guttate psoriasis and the work accident, hydrochloric acid skin burns might have promoted the systemic inflammatory mediators’ mechanism involved in the development of guttate psoriasis lesion’s after the dermal injury.
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Affiliation(s)
- Azzurra Schicchi
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
| | - Marco M Tresoldi
- Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Department of Surgery, Istituti Clinici Scientifici Maugeri, Pavia, Italy..
| | - Valeria M Petrolini
- 1. Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
| | - Davide Lonati
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
| | - Maria Perrone
- Emergency Department, IRCCS Policlinico San Matteo, Pavia (Italy).
| | - Carlo A Locatelli
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
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41
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He JJ, McCarthy C, Camci-Unal G. Development of Hydrogel‐Based Sprayable Wound Dressings for Second‐ and Third‐Degree Burns. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jacqueline Jialu He
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
- Biomedical Engineering and Biotechnology Program University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
| | - Colleen McCarthy
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
| | - Gulden Camci-Unal
- Department of Chemical Engineering University of Massachusetts Lowell One University Avenue Lowell MA 01854 USA
- Department of Surgery University of Massachusetts Medical School 55 Lake Avenue Worcester MA 01655 USA
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Shin H, Oh SK, Lee HY, Chung H, Yoon SY, Choi SY, Kim JH. Lessons learned from reviewing a hospital's disaster response to the hydrofluoric acid leak in Gumi city in 2012. BMC Emerg Med 2021; 21:34. [PMID: 33752618 PMCID: PMC7986510 DOI: 10.1186/s12873-021-00427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study analyzed the characteristics of hydrogen fluoride-exposed patients (HFEPs) treated in the emergency department (ED) of a local university hospital, and reviewed the hospital’s disaster response according to space, staff, supplies, and systems (4Ss). Methods This retrospective observational chart review and descriptive study included 199 HFEPs among 2588 total ED patients who visited a local university emergency medical center for treatment between September 27, 2012 and October 20, 2012, following a hydrofluoric acid leak at the Hube Globe factory in Gumi City, Republic of Korea. Descriptive results concerning the 4Ss were obtained by interviewing ED specialist staff physicians on duty during the study period. In accordance with American Burn Association criteria, patients requiring burn center referral were assigned to the major burn group (MBG) as severe condition. Results During the acute phase (within 8 h after leak initiation), there were 43 patients in the ED, which was staffed with 3 doctors and 3 nurses, without 4S resources. Of these 43 patients, there were 8 HFEPs (100%) in the MBG and 0 in the non-MBG (NMBG). During the subacute phase (24 h after the acute phase), there were 262 patients in the ED including 167 HFEPs, of whom 45 (26.95%) were in the MBG and 122 (73.05%) were in the NMBG. The ED was then staffed with 6 doctors (3 on day shift and 3 on night shift) and 10 nurses (3 on day shift, 4 on evening shift, and 3 on night shift), and no 4S resources were available. Throughout the study period, no 4Ss were available. First, there was no expansion of ED space or secured disaster reserve beds. Second, there was no increase in manpower with duty time adjustments or duty relocation for ED working personnel. Third, there was no logistics reinforcement (e.g., antidote or personal protective equipment). Fourth, there were no disaster-related measures for the administration department, decontamination zone setup, safety diagnostic testing, or designated disaster triage implementation. Conclusions The hospital’s disaster response was insufficient for all aspects of the 4Ss. Detailed guidance concerning a hospital disaster management plan is required.
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Affiliation(s)
- Heejun Shin
- Environmental Health Center, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea. .,Department of Emergency Medicine, Soonchunhyang University Hospital, Bucheon, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea.
| | - Se Kwang Oh
- Environmental Health Center, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea.,Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Han You Lee
- Environmental Health Center, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea.,Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Heajin Chung
- Environmental Health Center, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea.,Department of Emergency Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Seong Yong Yoon
- Environmental Health Center, Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
| | - Sung Yong Choi
- Environmental Health Center, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
| | - Jae Hyuk Kim
- Department of Emergency Medicine, Mokpo Hankook Hospital, Mokpo, Republic of Korea
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Park Y, Kim DG, Ku HO, Kang HG. Fluoride levels and biochemical assessments in cattle accidentally exposed to hydrofluoric acid in Korea. Toxicol Res 2021; 37:379-384. [PMID: 34295801 DOI: 10.1007/s43188-020-00076-9] [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: 09/22/2020] [Revised: 10/28/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
On September 27, 2012, an explosion from hydrofluoric acid occurred in Gumi city of Gyeongbuk province, Republic of Korea, exposing livestock animals nearby to Hydrofluoric acid (HF). This study aimed at evaluating the HF exposure among cattle raised near the accident site by determining the fluoride ion (F-1) levels and other biochemical parameters in the animals' urine and serum. The study groups included 90 cattle raised on farms near the accident site and, as controls, 21 cattle raised on a farm more than 100 km away from the accident site. Urine and blood serum samples were taken from 10% to 20% of the cattle on each farm that were present 17 days after the accident. The F-1 concentrations in the samples were analysed by the fluoride-ion-selective electrode method or a biochemistry analyser. The mean F-1 levels in the cattle serum samples (expressed as mg/L) were 0.23 (100 m), 0.15 (500 m), 0.23 (800 m), 0.11 (900 m), 0.07 (1.2 km), 0.16 (1.5 km), and 0.10 in the control group. The mean F-1 levels in the cattle urine samples (expressed as F-1 mg/g creatinine) were 27.8 (100 m), 24.4 (500 m), 11.1 (800 m), 16.3 (900 m), 3.02 (1.2 km), 9.16 (1.5 km), and 3.58 in the control group. The mean ± SD concentrations of calcium ions in serum (expressed as mg/dL) were 9.72 ± 0.41 (100 m), 9.54 ± 0.57 (500 m), 8.31 ± 0.44 (800 m), 9.06 ± 0.40 (900 m), 8.36 ± 0.89 (1.2 km), 9.13 ± 0.98 (1.5 km), and 10.48 ± 1.43 in the control group. The serum and urine F-1 levels in cattle exposed to HF decreased with the distance from the accident site, suggesting that the relative F-1 levels in urine after normalization through concentration of urinary creatinine could be a more reliable biomarker for HF exposure in cattle than the urine F-1 level alone.
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Affiliation(s)
- Youngil Park
- Veterinary Drugs and Biologics Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro Gyeongsangbuk-do, Gimcheon-si, 39660 Korea.,Toxicology Lab, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Korea
| | - Dong-Gyu Kim
- Veterinary Drugs and Biologics Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro Gyeongsangbuk-do, Gimcheon-si, 39660 Korea.,Department of Agricultural Biotechnology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 Korea
| | - Hyun-Ok Ku
- Veterinary Drugs and Biologics Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro Gyeongsangbuk-do, Gimcheon-si, 39660 Korea
| | - Hwan-Goo Kang
- Veterinary Drugs and Biologics Division, Animal and Plant Quarantine Agency, 177, Hyeoksin 8-ro Gyeongsangbuk-do, Gimcheon-si, 39660 Korea.,Present Address: Department of Animal Health and Welfare, Semyung University, 65, Semyung ro, Jecheon, Chungcheongbuk-do Korea
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44
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Little A, Dietze-Fiedler M, Fernstrum C, Mancera N, Wilcox R, Do V. Magnesium ocular injury – A case report. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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45
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Pham TT, Stokolosa AM, Borden PA, Hansen KD, Hong EM, Krasieva TB, Sivoraphonh RH, Moy WJ, Heidari AE, Lee LH, Kim EH, Sun CH, Jia W, Mo JH, Kim S, Hill MG, Wong BJF. Electrochemical degradation and saponification of porcine adipose tissue. Sci Rep 2020; 10:20745. [PMID: 33247200 PMCID: PMC7695738 DOI: 10.1038/s41598-020-76678-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Body contouring achieved via subcutaneous adipose tissue reduction has notably advanced over the past century, from suction assisted lipectomy to techniques with reduced degrees of invasiveness including laser, radiofrequency, high frequency focused ultrasound, cryolipolysis, and drug-based injection approaches. These costly techniques have focused on damaging adipocyte cell membranes, hydrolyzing triglycerides (TGs), or inducing apoptosis. Here, we present a simple, low-cost technique, termed electrochemical lipolysis (ECLL). During ECLL, saline is injected into the subcutaneous adipose tissue, followed by insertion of needle electrodes and application of an electrical potential. Electrolysis of saline creates localized pH gradients that drive adipocyte death and saponification of TGs. Using pH mapping, various optical imaging techniques, and biochemical assays, we demonstrate the ability of ECLL to induce acid and base injury, cell death, and the saponification of triglycerides in ex vivo porcine adipose tissue. We define ECLL's potential role as a minimally-invasive, ultra-low-cost technology for reducing and contouring adipose tissue, and present ECLL as a potential new application of an emerging electrochemical redox based treatment modality.
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Affiliation(s)
- Tiffany T Pham
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Anna M Stokolosa
- Department of Chemistry, Occidental College, Los Angeles, CA, 90041, USA
| | - Pamela A Borden
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
- Department of Biomedical Engineering, Beckman Laser Institute, University of California - Irvine, 1002 Health Sciences Road, Irvine, CA, 92697, USA
| | - Kyle D Hansen
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
- Department of Biomedical Engineering, Beckman Laser Institute, University of California - Irvine, 1002 Health Sciences Road, Irvine, CA, 92697, USA
| | - Ellen M Hong
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Tatiana B Krasieva
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Ryan H Sivoraphonh
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Wesley J Moy
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
- Department of Biomedical Engineering, Beckman Laser Institute, University of California - Irvine, 1002 Health Sciences Road, Irvine, CA, 92697, USA
| | - Andrew E Heidari
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
- Department of Biomedical Engineering, Beckman Laser Institute, University of California - Irvine, 1002 Health Sciences Road, Irvine, CA, 92697, USA
| | - Lauren H Lee
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Eun-Hee Kim
- Beckman Laser Institute-Korea, Dankook University College of Medicine, Cheonan-si, Chungnam, 31116, Republic of Korea
| | - Chung- Ho Sun
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Wangcun Jia
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA
| | - Ji -Hun Mo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan-siChungnam, 31116, Republic of Korea
| | - Sehwan Kim
- Department of Biomedical Engineering, Dankook University College of Medicine, Cheonan-siChungnam, 31116, Republic of Korea
| | - Michael G Hill
- Department of Chemistry, Occidental College, Los Angeles, CA, 90041, USA
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California - Irvine, Irvine, CA, 92612, USA.
- Department of Biomedical Engineering, Beckman Laser Institute, University of California - Irvine, 1002 Health Sciences Road, Irvine, CA, 92697, USA.
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, University of California - Irvine, Orange, CA, 92868, USA.
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Abstract
: Here we reported a one-year-old infant with tissue damage in the scrotum area, in which a small button cell battery had been found in his diaper. Evidence suggested that the lesion was caused by contact with the leaky battery with the scrotal skin. The treatment procedure was prescribed by a dermatologist. The healing process was tracked over the examination times. After two months, the site of the lesion showed complete remission. The findings suggested that in such cases, after removing the chemical agent, blisters, and necrotic tissues, therapeutic measures should be performed similarly to the thermal burns.
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Deps PD, Aborghetti HP, Zambon TL, Costa VC, Dadalto dos Santos J, Collin SM, Charlier P. Assessing signs of torture: a review of clinical forensic dermatology. J Am Acad Dermatol 2020; 87:375-380. [DOI: 10.1016/j.jaad.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
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48
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Schiefer JL, Schuller H, Fuchs PC, Grigutsch D, Klein M, Ribitsch B, Schulz A. Burn first aid knowledge in Germany and the influences of social-economic factors. Burns 2020; 46:1458-1465. [DOI: 10.1016/j.burns.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/08/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
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D'Alessandro AD, Sikon JR, Lacy AJ, Smith AT, Shah KS. Vitriolage by Sulfuric Acid: Unique Challenges and Considerations in Patient Resuscitation. J Emerg Med 2020; 59:e123-e126. [PMID: 32807582 DOI: 10.1016/j.jemermed.2020.06.038] [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: 04/10/2020] [Revised: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the United States, over 1 million burns require medical treatment each year. Chemical burns represent an infrequent but devastating percentage of all burns, which account for a large proportion of all burn-related deaths. Of the various causes of chemical burns, sulfuric acid is most commonly involved in occupational and accidental burns, and even cases of assault. CASE REPORT We describe the case of a 27-year-old man who presented to our Emergency Department (ED) after an assault with sulfuric acid. During his presentation, particular attention and care was given to his decontamination, airway management, and correction of life-threatening metabolic derangements. After stabilization in the ED he survived an extensive hospital admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patient outcomes and prognosis after chemical burns are dependent on prompt recognition/suspicion and rapid initiation of treatment. Even with prompt treatment, severe physiologic and psychologic injuries often afflict the patient. While encountering these devastating injuries, the emergency physician must carry a heightened sense of care and protection for both patient and staff to ensure optimum outcomes.
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Affiliation(s)
- Andrew D D'Alessandro
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph R Sikon
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron J Lacy
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Austin T Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karan S Shah
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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50
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Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, Nakanishi T, Maekawa T, Tachibana T, Amano M, Hayashi M, Ishii T, Iwata Y, Kawakami T, Sarayama Y, Hasegawa M, Matsuo K, Ihn H, Omoto Y, Madokoro N, Isei T, Otsuka M, Kukino R, Shintani Y, Hirosaki K, Motegi S, Kawaguchi M, Asai J, Isogai Z, Kato H, Kono T, Tanioka M, Fujita H, Yatsushiro H, Sakai K, Asano Y, Ito T, Kadono T, Koga M, Tanizaki H, Fujimoto M, Yamasaki O, Doi N, Abe M, Inoue Y, Kaneko S, Kodera M, Tsujita J, Fujiwara H, Le Pavoux A. Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition. J Dermatol 2020; 47:1207-1235. [DOI: 10.1111/1346-8138.15335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
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