Epidemiological profile of burns in children in central and southern Tunisia: A 67-case series

INTRODUCTION

Burns are among the most frequent injuries in children. They are a major cause of morbidity and mortality in low- and middle-income countries. This study aimed to describe the epidemiological aspects of burns in this environment and to propose preventive measures.

PATIENTS AND METHODS

A retrospective study was conducted between 1 January 2012 and 31 December 2013. It included children less than 16 years old who were hospitalized for burn injuries in our department. We adopted the hospitalization criteria proposed by the French Society for the Study and Treatment of Burns. The data were collected from medical records and concerned both patients and burn characteristics.

RESULTS

We recorded 67 cases, with 44.7% under 4 years old and boys (61%) more involved than girls (39%). The incidence of burns peaked in winter (31%) and summer (27%). Burns occurred at home in 95% of the cases. Hot liquids were the leading cause of children's burns. The time lapse between the accident and admission to the hospital was less than 24h in 57% of the cases. The average total body surface area (TBSA) burned was 8.8%. Only five patients presented a TBSA≥20%. The depth of the burns was superficial second-degree burns in 59% of cases. The burn involved mainly the upper limbs (65%). The average length of the hospital stay was 20.5 days. Only one patient died from severe sepsis.

CONCLUSION

The lack of specialized burn centers in Tunisia associated with the low socioeconomic level of our population worsened the outcome of pediatric burns. The best solution lies in prevention.

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Electrical burns are a major cause of bodily harm due to the mechanism and effect of the lesions. This prompts us to study these lesions and their management in order to reduce the morbidity caused by this type of accident. We conducted a retrospective descriptive observational study of patients hospitalized for electrical burns. This study includes 23 patients. The average age was 25.74 years. The most common occurrence was a domestic accident in 13 cases (56.5%), a work accident in 8 cases (34.8%), and a road traffic accident in 2 cases (8.7%). Fasciotomy was performed on six patients: five had high voltage injuries. Necrosis excision was performed at 8.26 days ± 5.55 days. Seven amputations were performed including 6 at the upper limb. Twenty flaps were used on 12 patients. Locoregional flaps were performed for 15 zones, and distant flaps as a solution in the event of locoregional flap failure. Five cases had immediate reconstruction because of exposure of noble elements, 3 showing necrosis of the flap. The average healing time was 45 days. Seven patients who underwent a reconstruction by flap healed after this period. The main results of the study show that conventional emergency decompression does not appear to reduce the amputation rate, the use of local and locoregional flaps in the initial phase (<21 days) carries a significant risk of suffering and necrosis, and that antithrombotic prevention or the use of flaps does not seem to have an impact on healing delays.

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Tissue expansion in burn sequelae has been associated with high complication rates. A critical analysis of 8 years (2008-2015) of experience with 45 expanders placed in 31 consecutive burns sequelae was performed to identify those factors that predispose to complications. Major and minor complications occurred in 33.4% of procedures. The factor associated with a statistically significant increase in complications was limbs localization. In addition, complications were significantly more likely to occur within the second stage. Factors that did not influence complication rate included patient age, the volume of the expander, and aesthetic or functional indications.

Penconazole alters redox status, cholinergic function, and membrane-bound ATPases in the cerebrum and cerebellum of adult rats

Pesticides exposure causes usually harmful effects to the environment and human health. The present study aimed to investigate the potential toxic effects of penconazole, a triazole fungicide, on the cerebrum and cerebellum of adult rats. Penconazole was administered intraperitoneally to male Wistar rats at a dose of 67 mg kg−1 body weight every 2 days during 9 days. Results showed that penconazole induced oxidative stress in rat cerebrum and cerebellum tissues. In fact, we have found a significant increase in malondialdehyde, hydrogen peroxide, and advanced oxidation protein product levels, as well as an alteration of the antioxidant status, enzymatic (superoxide dismutase and catalase) and nonenzymatic (glutathione), the cholinergic function, and membrane-bound ATPases (Na+/K+-ATPase and Mg2+-ATPase). Penconazole also provoked histological alterations marked by pyknotic and vacuolated neurons in the cerebrum and apoptosis and edema in the cerebellum Purkinje cells’ layer. Therefore, the use of this neurotoxicant fungicide must be regularly monitored in the environment.

A statistically inferred microRNA network identifies breast cancer target miR-940 as an actin cytoskeleton regulator

MiRNAs are key regulators of gene expression. By binding to many genes, they create a complex network of gene co-regulation. Here, using a network-based approach, we identified miRNA hub groups by their close connections and common targets. In one cluster containing three miRNAs, miR-612, miR-661 and miR-940, the annotated functions of the co-regulated genes suggested a role in small GTPase signalling. Although the three members of this cluster targeted the same subset of predicted genes, we showed that their overexpression impacted cell fates differently. miR-661 demonstrated enhanced phosphorylation of myosin II and an increase in cell invasion, indicating a possible oncogenic miRNA. On the contrary, miR-612 and miR-940 inhibit phosphorylation of myosin II and cell invasion. Finally, expression profiling in human breast tissues showed that miR-940 was consistently downregulated in breast cancer tissues

Levels of IL-15 in Serum and Cerebrospinal Fluid of Patients with Behçet's Disease

Interleukin-15 (IL-15) is a novel proinflammatory cytokine, involved in the pathogenesis of inflammatory/autoimmune disease. The objective of our study was to measure serum and cerebrospinal fluid (CSF) IL-15 levels in patients with Behçet's disease (BD). CSF/serum IL-15 ratio was introduced to assess the origin of elevated IL-15 levels. We measured serum and CSF-IL-15 levels in 40 patients with BD (20 patients in active stage). Inflammatory and non-inflammatory neurological disease patients acted as controls. Active BD patients have significantly higher serum IL-15 levels (median 10.4 pg/ml; range 5.3-17.4) compared with BD in remission (6.05 pg/ml; 4-10.4) and healthy controls (4.65 pg/ml; 3.9-6.2). Similar serum IL-15 levels were found in active neuro-BD and inflammatory neurological disease (9.5 pg/ml; 5-13). Elevated levels of IL-15 were observed in CSF samples from neuro-BD patients (11 pg/ml; 8.5-15) and inflammatory neurological disease patients (10 pg/ml; 6.5-14) compared with patients with non-inflammatory neurological disease (4 pg/ml; 4-5.5; P < 0.001). Vascular cerebral BD lesions were associated with high CSF/serum IL-15 ratio. Our findings suggest that IL-15 is involved in BD inflammatory process, particularly in vasculitis foci, as an elevated CSF/serum IL-15 ratio characterizes vascular cerebral lesions.

Traitement des décollements de rétine par déchirure géante

PURPOSE

Report of anatomic and functional results of retinal detachment with giant retinal tear.

PATIENTS AND METHODS

Retrospective study of 23 cases of retinal detachment resulting from retinal tear of 90 degrees or more: five had a history of ocular trauma, 14 had myopia, and six had no risk for giant retinal tear. Episcleral surgery was performed on cases of giant retinal tear less than 180 degrees , with no advanced proliferative vitreoretinopathy and no inversion of the retinal flap. A vitrectomy was performed on other cases. Scleral buckle was associated with vitrectomy in cases of advanced vitreoretinopathy.

RESULTS

The degree of success in the primary surgery was 50% in vitreoretinal surgery, 75% in vitreoretinal surgery with an encircling scleral buckle, and 86.4% in episcleral surgery. Of the seven failed cases, six patients underwent second-intention surgery: vitrectomy in four cases (primary surgery: the first case, episcleral surgery; the next two cases, vitrectomy; and in the fourth, vitrectomy with an encircling scleral buckle). In the last two cases, vitrectomy with scleral buckle was used (the primary surgery in both cases was vitreoretinal surgery). The final success rate was 78.2%, and the average follow-up was 32 months. Through the last test, postsurgery acute vision improved in 16 cases.

CONCLUSION

Vitrectomy is often recommended to repair retinal detachment with giant retinal tear. However, episcleral surgery can be used if the giant tear is less than 180 degrees , the proliferative vitreoretinopathy is not advanced, and the retina flap is not inverted. The scleral buckle must be associated with the vitrectomy in cases of inferior giant retinal tear even if the proliferative vitreoretinopathy is not advanced.

[Pseudotumoral gastric amyloidosis]

INTRODUCTION

Localized gastric amyloidosis is rare. It should be considered in differentiation of gastric tumors, in which biopsy is the only means to confirm the diagnosis.

CASE REPORT

A 56-year old male patient presented dysphagia and vomiting. A plastic linitis was suggested by endoscopic ultrasonography. Total gastrectomy and clearance of perigastric lymph nodes were performed. The postoperative pathological diagnosis determined the lesion to be localized gastric amyloidosis and no malignant tumor was found. No sign of recurrence has been found one year after surgical resection.

DISCUSSION

Currently, surgical resection of pathological tissue and circumambient lymph nodes may be a preferable therapeutic strategy for the localized amyloidosis to prevent possible complications.

Blépharite mycosique à Malassezia : à propos d’un cas

PURPOSE

Blepharitis is a very common disorder but the role of certain mycoses in the etiopathogenesis of blepharitis remains controversial.

OBSERVATION

We report the case of a 29-year-old man presenting with bilateral redness and intense itching of the edge of the eyelid. Slit-lamp examination showed vasodilation of the vessels of the edge of the eyelid associated with seborrhea and a sticky yellowish substance at the roots of the eyelashes. When the substance dried and fell, microulcerations were seen at the base of the eyelids, characteristic of follicular-seborrheic blepharitis. Otherwise the ophthalmological examination was normal. Treatment with eye drops (antibiotics, antiseptics, corticoids, antihistamines) was tried several times. The blepharoconjunctivitis regressed during these treatments without totally disappearing, recurring after the treatment was discontinued. Bacteriological and fungal exams were conducted, showing numerous Malassezia furfur spores and hyphae. Given that there was no antifungal eye drop preparation on the market, topical ketoconazole (Nizoral) was prescribed. Two weeks later, the condition had cleared, with no recurrence after 5 months of follow-up.

DISCUSSION

Malassezia is a saprophyte species that may play a role in certain cases of chronic blepharitis, either through a reaction of intolerance and hypersensitivity or occasional proliferation. Treatment consists in eradicating the causal fungus using an antifungal agent associated with symptomatic treatment. We stress that fungal exams should be conducted whenever blepharitis recurs.