Epidemiology of a decade of Pediatric fatal burns in Colombia, South America

Fire burns matter: A case-control study of severe accidental burns in pediatric patients

<b>Objective: </b>We aimed to identify factors associated with severe accidental burns in patients ≤12 years old.<br /> <b>Materials and methods: </b>We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity.<br /> <b>Results: </b>We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 1.53-6.81). Similarly, these patients were more likely to live in a rural area (OR: 2.96, 95% CI: 1.17-6.19).<br /> <b>Conclusions: </b>In pediatric patients ≤12 years of age severe accidental burns are more likely to be caused by fire compared to boiling water. Public health interventions should focus on populations located in rural areas.

Socioeconomic Features of Burn Injuries in Southern Iran: A Cross-sectional Study

Burn injuries are among the most traumatic incidences which could be associated with substantial morbidity and mortality. The incidence of these injuries differs based on population socioeconomic characteristics. In this study, we aim to evaluate the distribution of burn injuries based on socioeconomic and causative factors. Relative features from the targeted population were obtained and evaluated. Data were extracted in August 2019 and statistical analysis of the data was conducted from February 2020 to April 2020. This cross-sectional record-based study was conducted from 2008 to 2016 in a main referral center for burn injuries in the southern Iran. Participants included burn survivors and burn patients who were registered as outpatients or inpatients. A total of 4919 burn cases with a mean age of 31.91 ± 17.33, including 2926 (59.5%) males and 1993 (40.5%) females was reported. The majority of our cases had an educational level of under diploma (40.72%). A significant correlation between age, gender, and percentage of burn with the level of education was recorded (P < .001). The most frequent cause of burn injuries was flame with 2537 (51.9%) cases. The most susceptible population to burn injuries were reported to be poorly educated individuals, which emphasizes the preventive role of education.

Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review

Real-world evidence (RWE) is emerging as a fundamental component of the post-marketing evaluation of medicinal products. Even though the focus on RWE studies has increased in Colombia, the availability of secondary data sources to perform this type of research is not well documented. Thus, we aimed at identifying and characterizing secondary data sources available in Colombia. We performed a systematic literature review on PubMed, EMBASE, and VHL using a combination of controlled vocabulary and keywords for the concepts of electronic health records, epidemiologic studies and Colombia. A total of 323 publications were included. These comprised 123 identified secondary data sources including pharmacy dispensing databases, government datasets, disease registries, insurance databases, and electronic heath records, among others. These data sources were mostly used for cross-sectional studies focused on disease epidemiology in a specific population. Almost all databases (95%) contained demographic information, followed by pharmacological treatment (44%) and diagnostic tests (39%). Even though the database owner was identifiable in 94%, access information was only available in 44% of the articles. Only a pharmacy-dispensing database, local cancer registries, and government databases included a description regarding the quality of the information available. The diversity of databases identified shows that Colombia has a high potential to continue enhancing its RWE strategy. Greater efforts are required to improve data quality and accessibility. The linkage between databases will expand data pooling and integration to boost the translational potential of RWE.

MitoQ protects against liver injury induced by severe burn plus delayed resuscitation by suppressing the mtDNA-NLRP3 axis

INTRODUCTION

Liver injury induced by burn plus delayed resuscitation (B + DR) is life threatening in clinical settings. Mitochondrial damage and oxidative stress may account for the liver injury. MitoQ is a mitochondria-targeted antioxidant. We aimed to evaluate whether MitoQ protects against B + DR-induced liver injury.

METHODS

Rats were randomly divided into three groups: (1) the sham group; (2) the B + DR group, which was characterized by third-degree burn of 30% of the total body surface area plus delayed resuscitation, and (3) the treatment group, in which rats from the B + DR model received the target treatment. MitoQ was injected intraperitoneally (i.p) at 15 min before resuscitation and shortly after resuscitation. In the vitro experiments, Kupffer cells (KCs) were subjected to hypoxia/reoxygenation (H/R) injury to simulate the B + DR model. Mitochondrial characteristics, oxidative stress, liver function, KCs apoptosis and activation of the NLRP3 inflammasome in KCs were measured.

RESULTS

B + DR caused liver injury and oxidative stress. Excessive ROS lead to liver injury by damaging mitochondrial integrity and activating the mitochondrial DNA (mtDNA)-NLRP3 axis in KCs. The oxidized mtDNA, which was released into the cytosol during KCs apoptosis, directly bound and activated the NLRP3 inflammasome. MitoQ protected against liver injury by scavenging intracellular and mitochondrial ROS, preserving mitochondrial integrity and function, reducing KCs apoptosis, inhibiting the release of mtDNA, and suppressing the mtDNA-NLRP3 axis in KCs.

CONCLUSION

MitoQ protected against B + DR-induced liver injury by suppressing the mtDNA-NLRP3 axis.

Global and regional child deaths due to injuries: an assessment of the evidence

Background

Injuries result in substantial number of deaths among children globally. The burden across many settings is largely unknown. We estimated global and regional child deaths due to injuries from publicly available evidence.

Methods

We searched for community-based studies and nationally representative data reporting on child injury deaths published after year 1990 from CINAHL, EMBASE, IndMed, LILACS, Global Health, MEDLINE, SCOPUS, and Web of Science. Specific and all-cause mortality due to injuries were extracted for three age groups (0-11 months, 1-4 years, and 0-4 years). We conducted random-effects meta-analysis on extracted crude estimates, and developed a meta-regression model to determine the number of deaths due to injuries among children aged 0-4 years globally and across the World Health Organization (WHO) regions.

Results

Twenty-nine studies from 16 countries met the selection criteria. A total of 230 data-points on 15 causes of injury deaths were retrieved from all studies. Eighteen studies were rated as high quality, although heterogeneity was high (I² = 99.7%, P < 0.001) reflecting variable data sources and study designs. For children aged 0-11 months, the pooled crude injury mortality rate was 29.6 (95% confidence interval (CI) = 21.1-38.1) per 100 000 child population, with asphyxiation being the leading cause of death (neonatal) at 189.1 (95% CI = 142.7-235.4) per 100 000 followed by suffocation (post-neonatal) at 18.7 (95% CI = 11.8-25.7) per 100 000. Among children aged 1-4 years, the pooled crude injury mortality rate was 32.7 (95% CI = 27.3-38.1) per 100 000, with traffic injuries and drowning the leading causes of deaths at 10.8 (95% CI = 8.9-12.8) and 8.8 (95% CI = 7.5-10.2) per 100 000, respectively. Among children under five years, the pooled injury mortality rate was 37.7 (95% CI = 32.7-42.7) per 100 000, with traffic injuries and drowning also the leading causes of deaths at 10.3 (95% CI = 8.8-11.8) and 8.9 (95% CI = 7.8-9.9) per 100 000 respectively. When crude mortality changes over age, WHO regions, and study period were accounted for in our model, we estimated that in 2015 there were 522 167 (95% CI = 395 823-648 630) deaths among children aged 0-4 years, with South East Asia (SEARO) recording the highest number of deaths at 195 084 (95% CI = 159476-230502), closely followed by the Africa region (AFRO) with 176523 (95% CI = 115 040-237 831) deaths. Globally, traffic injuries and drowning were the leading causes of under-five injury fatalities in 2015 with 142 661 (22.0/100 000) and 123 270 (19.0/100 000) child deaths, respectively. The exception being burns in AFRO with 57 784 deaths (38.6/100 000).

Conclusions

Varying study designs, case definitions, and particularly limited country representation from Africa and South-East Asia (where we reported higher estimates), imply a need for more studies for better population representative estimates. This study may have however provided improved understanding on child injury death profiles needed to guide further research, policy reforms and relevant strategies globally.

Burden of Burns in Brazil from 2000 to 2014: A Nationwide Hospital-Based Study

BACKGROUND

Burns are a major public health concern, affecting mostly low- and middle-income countries. However, there is a lack of epidemiological studies on burns in these countries, particularly in Latin American countries. Our aim was to analyze nationwide demographic, epidemiological and economic characteristics of hospitalized burn patients in Brazil.

METHODS

A retrospective study was conducted including inpatients admitted with a diagnosis of burns (ICD-10:T20-T31) from all hospitals in Brazil from 2000 to 2014. We calculated hospitalization and in-hospital mortality rates. Length of stay (LoS), charges and premature mortality were also assessed.

RESULTS

A total of 412,541 burn hospitalizations were found, with a hospitalization rate of 14.56 hospitalizations/100,000 inhabitants/year. This rate is decreasing since 2003, mostly due to the reduction among children and elderly. Children below 5 years old accounted for 24% of all admissions. In-hospital mortality rate was 8.1% and median LoS was 5 days. Mean hospitalization charge was 856 international dollars. Substantial regional discrepancies were found in several indicators.

CONCLUSION

In this first Latin American nationwide study of burn patients, a decreasing trend of hospitalization rate and a low charge contrasted with a high in-hospital mortality rate. This latter indicator, associated with a low LoS, may raise concerns regarding the quality of healthcare. Important discrepancies were found between regions, which may indicate important differences in regard to healthcare access and risk of burns. Targeting effective prevention, improving healthcare quality and providing more widespread and accurate burn registry are recommended.

Manner of Death Determination in Fire Fatalities: 5-Year Autopsy Data of Istanbul City

Death resulting from burns is an important social problem and a frequent accident. However, because approximately 10% of cases are estimated to result from a fire that was deliberately started, all fire-related deaths should be treated as suspicious, and the cause of a fire should be investigated. For the bodies recovered from the scene of a fire, the manner of death could also be suicide or homicide. The objective of this study was to contribute to the clarification of controversial data present in the literature on the manner of death determination of fire-related deaths, through evaluation of autopsy findings of bodies recovered from fires. We reviewed 20,135 autopsies performed in a 5-year period, in Istanbul, as the whole autopsy data of the city and found 133 fire-related deaths. The death scene investigation reports and other judicial documents, autopsy findings, and toxicological analysis results were evaluated to determine the parameters of age, sex, level of the burn, vital signs [red flare; soot in the lower respiratory tract, esophagus, and/or stomach; and screening of carboxyhemoglobin (COHb) levels in the blood], toxicological substances, presence of accelerants, cause of death, and manner of death. The manner of death was determined to be an accident in 98 (73.7%) and homicide in 12 (9%) cases, whereas there was no suicide. In addition, it could not be determined in 23 (17.2%) cases. In accidental deaths, the most frequent cause of death was COHb poisoning with statistically significant blood COHb levels greater than 10%. Further, the presence of soot in the lower respiratory tract, esophagus, and/or stomach and the existence of at least 1 or 2 vital signs together were found to be valid deterministic criteria with statistical significance in terms of identifying the manner of death.