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Lórez Carrero MF, Cruz Romero DJ, Agudelo Quiroga A. Situación nutricional en la primera infancia en el departamento de Guainía-Colombia. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introducción: la apremiante situación de desamparo de la niñez en el país reflejada en los problemas nutricionales que presentan en la primera infancia en el territorio colombiano, representa un tema de gran preocupación por tratarse de la población del futuro de la nación. Objetivo: la presente investigación buscó identificar el estado nutricional en menores de 6 años en la región de Guainía a partir de la información antropométrica obtenida de la única empresa prestadora de servicios de salud presente en la región. Método y resultados: mediante un estudio transversal se encontró que el género masculino está ligeramente más afectado (51.01%), la mayoría residen en la capital Inírida (71.74%), con mayor prevalencia de desnutrición moderada (91.86%) y diferencias estadísticamente significativas entre la edad y el riesgo de desnutrición aguda y la aguda moderada, más no entre el género y estas mismas variables. Conclusiones: es necesario implementar acciones que mejoren el estado nutricional de la niñez tan vulnerable, por lo que alertamos a las entidades de salud de la región dado que se encuentra ad portas de una situación de desnutrición crónica que afectará tanto a la población, como al futuro de la región.
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Msokera C, Xepoleas M, Collier ZJ, Naidu P, Magee W. A plastic and reconstructive surgery landscape assessment of Malawi: a scoping review of Malawian literature. Eur J Med Res 2022; 27:119. [PMID: 35820981 PMCID: PMC9277806 DOI: 10.1186/s40001-022-00714-y] [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: 12/02/2021] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background Plastic and reconstructive surgery (PRS) remains highly relevant to the unmet need for surgery in Malawi. Better understanding the current PRS landscape and its barriers may help address some of these challenges. This scoping review aimed to describe: (1) the scope and focus of the PRS literature being produced in Malawi and (2) the challenges, deficits, and barriers to providing accessible, high-quality PRS in Malawi. Methods This scoping review was conducted on four databases (SCOPUS, PubMed, Web of Science, EMBASE) from inception through September 1, 2020 following the PRISMA-ScR guidelines. Results The database search retrieved 3852 articles, of which 31 were included that examined the burden of PRS-related conditions in Malawi. Of these 31 articles, 25 primarily discussed burn-related care. Burns injuries have a high mortality rate; between 27 and 75% in the studies. The literature revealed that there are only two burn units nationally with one PRS specialist in each unit, compounded by a lack of interest in PRS specialization by Malawian medical students. Congenital anomalies were the only other PRS-related condition examined and reported in the literature, accounting for 23% of all pediatric surgeries in tertiary facilities. Conclusions There is a need to increase the country's capacity to handle burn reconstruction and other PRS-related conditions to reduce overall morbidity and mortality. Additional publicly funded research at the district and community level is warranted to determine the true burden of PRS disease in Malawi to derive health system strengthening and workforce capacity building strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00714-y.
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Affiliation(s)
- Chifundo Msokera
- Operation Smile Inc, Virginia Beach, Virginia, USA. .,University of Malawi College of Medicine, Blantyre, Malawi. .,Operation Smile Malawi, Area 6, P.O BOX 484, Lilongwe, Malawi.
| | | | - Zachary J Collier
- Operation Smile Inc, Virginia Beach, Virginia, USA.,Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - William Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA, USA
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Purcell LN, Banda W, Akinkuotu A, Phillips M, Hayes-Jordan A, Charles A. Characteristics and predictors of mortality in-hospital mortality following burn injury in infants in a resource-limited setting. Burns 2022; 48:602-607. [PMID: 34284937 PMCID: PMC8755851 DOI: 10.1016/j.burns.2021.07.004] [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: 08/31/2020] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Burn outcome data in infants is lacking from sub-Saharan Africa. We, therefore, sought to assess the characteristics and predictors of in-hospital burn mortality in a resource-limited setting. METHODS We performed a retrospective study of the prospectively collected Burn Injury Surveillance database from June 2011 to December 2019. We performed bivariate analysis and Poisson regression to assess risk factors for mortality in our infant burn population. RESULTS 115 (7.3%) infants met inclusion criteria. The median age of 8 months (IQR: 6-10) and primarily male (n = 67, 58.8%). Most burns were from scald (n = 62, 53.9%). Infant burn mortality was 12.2%. Poisson multivariable regression to determine burn mortality risk in infants showed that increased %TBSA burns (RR 1.04, 95% CI 1.01-1.07) and flame burns (RR 3.08, 95%CI 1.16-8.16) had a higher risk of mortality. Having surgery reduced the relative risk of death for infants with burns. CONCLUSION We show that factors that increase infant burn mortality risk include percent total body surface area burn, flame burn mechanism, and lack of operative intervention. Increasing burn operative capability, particularly for infants and other children, is imperative.
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Affiliation(s)
- Laura N. Purcell
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Wone Banda
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Michael Phillips
- Department of Surgery, University of North Carolina at Chapel Hill
| | | | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill,Kamuzu Central Hospital, Lilongwe, Malawi,Anthony Charles MD, MPH, UNC School of Medicine, 4008 Burnett Womack Building, CB 7228, P:9199664388, F:9199660369,
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DEMİR YİĞİT Y, YİĞİT E. Türkiye Güneydoğu Anadolu bölgesinde pediatrik yanık vakalarının analizi:10 yıllık retrospektif çalışma. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1024318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Burns continue to be a serious global public health problem all over the world, especially in developing countries.
Materials and Methods: The age, gender, cause of injury, and total body surface area (TBSA) of the burn, complications, and mortality rate of 1,038 patients who were hospitalized in our burn center between January 1, 2010, and January 1, 2020, were analyzed.
Results: The burned surface area was greater in boys than in girls. The mean burned body surface area for all patients was 9.2 ± 6.35, and the mortality rate was 1.45%. Hot liquids, such as tea, hot milk, hot water, and oily food, were the causes of burns in 84.7% of the patients. Hot objects, hot melted nylon, hot tandoor and embers, and hot asphalt accounted for 7.7% of the burns. Moreover, flame burns, electrical burns and frostbite, and other burn causes accounted for 5.6%, 1.2 %, and 0.8% of burn injuries, respectively.
Conclusions: In our region, pediatric burns occurred mostly in boys under the age of three and in children whose parents had low educational levels living in rural areas. We believe that the burn prevention program should be adjusted according to these results.
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Affiliation(s)
- Yasemin DEMİR YİĞİT
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER
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Matsuo M, Muramatsu K, Matsuda S, Fushimi K, Kaizuka Y, Kamochi M. Age-dependent influence of premorbid underweight status on mortality in severe burn patients: An administrative database study. Burns 2020; 47:1314-1321. [PMID: 33358396 DOI: 10.1016/j.burns.2020.12.004] [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: 05/14/2020] [Revised: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the associations between premorbid nutritional status and in-hospital mortality in severe burn patients according to age in Japan. METHODS We retrospectively extracted the data of 14,345 patients aged 18-84 years admitted for burns from April 1, 2014, to March 31, 2018, using the Japanese Diagnosis Procedure Combination database. The exclusion criteria were out-of-hospital cardiac arrest, death in the emergency room, readmission, and planned admission. We collected data on age, sex, height, weight, comorbidities, burn index, and mechanical ventilation use and performed age-stratified multilevel logistic regression analyses to estimate associations between premorbid body mass index (BMI) and in-hospital mortality. RESULTS We analyzed 2968 patients with a burn index ≥10, including 831 elderly aged 75-84 years. In patients aged 18-74 years, being underweight (BMI < 18.5) significantly decreased mortality (0.34 [0.15-0.77]; P = 0.010). In contrast, in patients aged 75-84 years, being underweight significantly increased mortality (2.11 [1.05-4.25]; P = 0.036). Being overweight (BMI >25) increased mortality in both age groups, but not significantly. CONCLUSIONS The results suggest that pre-morbidly underweight elderly patients aged 75-84 years with severe burns have high mortality risks. Further research is needed to identify optimal care strategies for this population.
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Affiliation(s)
- Mizue Matsuo
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; Occupational Health Data Science Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Yasuo Kaizuka
- Department of Emergency and ICU, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-8508, Japan.
| | - Masayuki Kamochi
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
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Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa. World J Surg 2020; 44:3629-3635. [PMID: 32666267 DOI: 10.1007/s00268-020-05684-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Early excision and grafting remains the standard of care after burn injury. However, in a resource-limited setting, operative capacity often limits patient access to surgical intervention. This study sought to describe access to excision and grafting for adult burn patients in a sub-Saharan African burn unit and its relationship with burn-associated mortality. METHODS We analyzed patients recorded in the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi from 2011-2019. We examined patient characteristics, interventions, and outcomes for adults aged ≥16 years. Modified Poisson regression modeling was used to identify risk factors for mortality. RESULTS Five hundred and seventy-three patients were included. Median age was 30 years (IQR 23-40) with a male preponderance (63%). Median percent total body surface area burned (%TBSA) was 15% (IQR 8-26) and 68% of burns were caused by flame. 27% (n = 154) had burn excision with skin grafting, with a median time to operation of 18 days (IQR 9-38). When adjusted for age, %TBSA, and time to presentation, operative intervention conferred a survival benefit for patients with flame burns with a RR 0.16 (95% CI 0.06, 0.42). CONCLUSIONS In a resource-limiting setting, access to the operating room is inadequate, and burn patients are not prioritized. While many scald burn patients may be managed with wound care alone, patients with flame burn require surgical intervention to improve clinical outcomes. Burn injury in this region continues to confer a high risk of mortality, and more investment in operative capacity is imperative.
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Aggarwal K, Singh K, Singh B. Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review. INDIAN JOURNAL OF BURNS 2020. [DOI: 10.4103/ijb.ijb_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Clearance of Indocyanine Green in Severe Pediatric Burns. J Trauma Acute Care Surg 2018; 86:817-822. [PMID: 30589752 DOI: 10.1097/ta.0000000000002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clearance of indocyanine green dye (ICGc) reflects sinusoidal perfusion and hepatocyte cell membrane function. Thus, ICGc is a reflection of the functional reserve of intact hepatocytes. The purpose of this study was to identify predictors of ICGc in severely burned children during the acute hospitalization and at the time of discharge from the intensive care unit (ICU). A secondary aim was to determine the relationship between liver size and patient ICGc. METHODS Twenty-six children (0.8-17 years old) with 35% or greater total body surface area burned (%TBSA-B) were included. Assessment of ICGc (in milliliters per minute per meter squared) was done during the acute hospitalization (median: 6 days after admission, median: 14 days postburn) and at the time of discharge from the ICU (median: 19 days after admission, median: 27 days postburn). Age, TBSA-B, % third-degree burns, inhalation injury, preexisting chronic malnutrition, hematocrit, liver dysfunction, and time from burn injury were incorporated in multiple linear regressions as predictive variables of ICGc. Only variables with p < 0.05 were retained in the final models. RESULTS Time from injury and age were the strongest predictors of ICGc during the acute admission but not at the time of discharge from the ICU. Time from injury was negatively associated with ICGc, whereas age was positively associated. At the time of discharge from the ICU, ICGc was increased in proportion to the %TBSA-B, whereas inhalation injury and preexisting chronic malnutrition were associated with lower ICGc. There was no correlation between change-to-predicted liver length and ICGc. CONCLUSIONS The intrinsic ability of the liver to extract ICG from plasma was lower in younger burned patients during the acute admission and in those with preexisting chronic malnutrition and inhalation injury at the time of discharge from the ICU. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III.
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Ready FL, Gebremedhem YD, Worku M, Mehta K, Eshte M, GoldenMerry YPL, Nwariaku FE, Wolf SE, Phelan HA. Epidemiologic shifts for burn injury in Ethiopia from 2001 to 2016: Implications for public health measures. Burns 2018; 44:1839-1843. [PMID: 30072197 DOI: 10.1016/j.burns.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/13/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The last generation has seen Ethiopia, a low income country with a population of 100 million people, undergo a marked increase in urbanization and development. The effects of these demographic changes on the epidemiology of burn risk and thermal injury in Ethiopia are unknown. This gap constitutes a major barrier to the creation of effective burn prevention programs. METHODS Yekatit 12 Hospital in Addis Ababa is the only burn unit in Ethiopia. In this cross sectional retrospective study, we identified and reviewed all admissions due to burn injury at that facility between 1/1/2016 and 12/31/2016. We then compared them to a previously published burn cohort treated at the same facility between 7/1/2001 and 9/31/2002. Chi square was used to compare proportions between the two samples. Continuous covariates are reported as descriptive data due to missing variance data in the 2001-02 publication. RESULTS There were a total of 121 subjects in the 2001-02 sample and 176 subjects in the 2016 sample. The 2016 sample was found to have a significantly larger proportion of males (57%) as compared to the 2001-02 sample (36%) (p=0.0003) and a significantly higher proportion of electrical injuries (27%) than the previous cohort (5%) (p<0.0001). No significant differences were seen in mortality rates between the 2016 and 2001-02 cohorts (8% vs 12%, respectively, p=0.29) or in the regions of origin (44% outside Addis Ababa vs 54%, p=0.09) For the 2016 sample, the highest surviving Baux score was 76 while the mean Baux score for survivors was 29.6±20.11. CONCLUSION As Ethiopia has become more industrialized over the last 15 years, the demographic pattern of burn injury has changed accordingly as electrical injuries have increased five-fold with males now constituting a majority of burn cases.
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Affiliation(s)
- Freda L Ready
- University of Texas-Southwestern, Department of Surgery, United States
| | | | | | - Kajal Mehta
- University of Texas-Southwestern, Department of Surgery, United States
| | - Mekonen Eshte
- Addis Ababa University, Plastic Surgery Unit, Ethiopia
| | | | - Fiemu E Nwariaku
- University of Texas-Southwestern, Department of Surgery, United States; University of Texas-Southwestern, Department of Global Health, United States
| | - Steven E Wolf
- University of Texas-Southwestern, Department of Surgery, United States
| | - Herb A Phelan
- University of Texas-Southwestern, Department of Surgery, United States.
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Ashrafi-Asgarabad A, Safiri S. Pre-burn malnutrition increases operative mortality in burn patients who undergo early excision and grafting in a sub-Saharan African burn unit: Methodological issues. Burns 2018; 44:1615. [PMID: 29884530 DOI: 10.1016/j.burns.2017.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ahad Ashrafi-Asgarabad
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology, Bam University of Medical Sciences, Bam, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Kortz TB, Blair A, Scarr E, Mguntha AM, Bandawe G, Schell E, Rankin S, Baltzell K. Characterizing Pediatric Non-Malarial Fever and Identifying the At-Risk Child in Rural Malawi. Glob Pediatr Health 2018; 5:2333794X17750415. [PMID: 29372177 PMCID: PMC5772500 DOI: 10.1177/2333794x17750415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
Objective. To characterize children with non–malarial fever at risk of nonrecovery or worsening in rural Malawi. Methods. This is a subgroup analysis of patients ≤14 years of age from a prospective cohort study in non–malarial fever subjects (temperature ≥37.5°C, or fever within 48 hours, and malaria negative) in southern Malawi cared for at a mobile clinic during the 2016 dry (August to September) or wet (November to December) season. Data collection included chart review and questionnaires; 14-day follow-up was conducted. We conducted univariate descriptive statistics on cohort characteristics, bivariate analyses to examine associations between characteristics and outcomes, and multivariate logistic regressions to explore factors associated with nonrecovery. Results. A total of 2893 patients were screened, 401 were enrolled, 286 of these were children, and 280 children completed follow-up. Eighty-seven percent reported symptom resolution, 12.9% reported no improvement, and there were no deaths or hospitalizations. No improvement was associated with dry season presentation (42.6% vs 75.0%, P < .0003), >2 days of symptoms (51.6% vs 72.2%, P = .03), and food insecurity (62.3% vs 86.1%, P = .007). Dry season subjects had a 4.35 times greater likelihood of nonimprovement (95% confidence interval [CI] = 1.96-11.11). Household food insecurity and being >2 hours from a permanent clinic were associated with no improvement (adjusted odds ratio [AOR] = 4.61, 95% CI = 1.81-14.29; and AOR = 2.38, 95% CI = 1.11-5.36, respectively). Conclusion. Outcomes were generally excellent in this rural, outpatient pediatric cohort, though risk factors for nonrecovery included food insecurity, access to a standing clinic, and seasonality. Ideally, this study will inform clinic- and policy-level changes aimed at ameliorating the modifiable risk factors in Malawi and throughout rural Africa.
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Affiliation(s)
| | - Alden Blair
- University of California, San Francisco, CA, USA
| | - Ellen Scarr
- University of California, San Francisco, CA, USA
| | | | - Gama Bandawe
- Malawi University of Science and Technology, Thyolo, Malawi
| | - Ellen Schell
- University of California, San Francisco, CA, USA.,Global AIDS Interfaith Alliance, San Rafael, CA, USA
| | - Sally Rankin
- University of California, San Francisco, CA, USA
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