Burn Severity Research Articles

Analysis of Blood Cultures from Major Burns Patients in a Tertiary Care Burn Unit in Oman.

This study aimed to review the blood stream infections of major burn patients in a tertiary care burn unit to determine the most prevalent infecting organisms in order to have a better empirical therapy protocol. This retrospective study analysed the blood stream infection of 155 major burn (>20% Total Body Surface Area [TBSA]) patients in Khoula Hospital, Muscat, Oman between January 2014 to December 2019. The median age was 33 years and 57.42% of patients were male. The median TBSA was 38%, mortality was 25.16% and 50.9% of patients had positive blood cultures. The expired patients had higher TBSAs, Abbreviated Burns Severity Index scores and earlier first positive blood cultures. Candida was commonly grown in all the blood cultures, but the most prevalent organisms were Acinetobacter, Staphylococci, Klebsiella, Enterococcus and Pseudomonas. All Acinetobacter species are multidrug resistant. Of the 17 patients who had Kelbsiella grown in the blood culture, 8 grew multidrug-resistant Klebsiella. Only 4 patients' blood cultures grew methicillin-resistant Staphylococcus aureus. The number of blood culture samples taken ranged between 1-28 (median = 6). The first positive blood culture showed that Staphylococcus epidermidis and Acinetobacter were the most common infecting organisms. Multidrug-resistant Acinetobacter was the most predominant microorganism grown from the blood cultures of major burn patients in a tertiary care burn unit. Empirical therapy should include antibiotics that are effective against this organism to reduce the mortality.

Psychiatric Risk Factors and Burn Severity in Self-immolation.

Self-immolation, a form of self-harm involving setting oneself on fire, is associated with high mortality, morbidity, and healthcare burden. This study aimed to characterize potential clinical correlates and predisposing factors for self-immolation based on burn severity using TBSA percentage scoring. Additional objectives included identifying motivational elements, associated risk factors, and clinical characteristics to optimize patient care and reduce future self-immolation incidents. A retrospective review of admissions to the Arizona Burn Center from July 2015 to August 2022 identified 103 self-immolation patients for the study. Burn severity was categorized as mild to moderate (TBSA < 20%) or severe (TBSA ≥ 20%) based on TBSA. This study population had a mortality rate of 21%. Positive urine drug screens were found in 44% of subjects, and 63% having chronic substance use, with methamphetamine (37%) and alcohol (30%), being the most prevalent. Underlying psychiatric illnesses were present in 83% of patients. Suicidal intent strongly predicted severe burns (P < .001) among the 68 severe burn cases identified. In conclusion, this study emphasizes that the presence of suicidal intent among self-immolation patients significantly correlates with burn severity. These findings highlight the importance of involving psychiatric services early in patient care to improve outcomes and reduce the recurrence of self-immolation acts.

Fire frequency, intensity, and burn severity in Kalimantan’s threatened Peatland areas over two Decades

Kalimantan, the Indonesian portion of the Island of Borneo, has an estimated 45,000 km2 of tropical peatland and represents one of the largest stocks of tropical peat carbon. However, over the last three decades, the peatlands of Indonesia, and Kalimantan in particular, have been heavily degraded or destroyed by drainage of peatland swamps, deforestation, land cover change for agriculture, and intentional burning. Many studies have examined degradation of peat forests and the associated frequency of fires, often focusing on specific regions of Kalimantan over limited periods. Here, we present our results of a spatially comprehensive, long-term analysis of peatland fires in Kalimantan over more than two decades from early 2001 to the end of 2021. We examined the effects of changing climate conditions, land cover change, and the regulatory framework on the total burned area and frequency and severity of peatland fires over a 21-year period by combining extensive datasets of medium-resolution and high-resolution satellite imagery. Moreover, surface fire intensity was modeled for four dominant land use/land cover types to determine how land use change alters fire behavior. Our results confirm a consistent and strong spatiotemporal correlation between hydro-climatological drivers associated with El Niño conditions on peatland fire frequencies and burned peatland area. Changes in the number of fires and burn severity are visible over time and are caused by a combination of large-scale meteorological patterns and changing regulations. A significant relative increase of the “high” and “very high” severity across all peatland fires in Kalimantan was found for the latest period from 2015 through 2021 by 12.1 and 13.4%, compared to the two previous 7-year periods from 2001 to 2007 period and from 2008 to 2014, respectively, whereas the total peatland area burned decreased in 2015 to 2021 by 28.7% on average compared to the previous periods. The results underline the importance of a comprehensive approach considering physical aspects of overarching climate conditions while improving political and regulatory frameworks to mitigate the negative effects of burning tropical peatlands.

Forest fire, thinning, and flood in wildland-urban interface: UAV and lidar-based estimate of natural disaster impacts

ContextWildland-urban interface (WUI) areas are facing increased forest fire risks and extreme precipitation events due to climate change, which can lead to post-fire flood events. The city of Flagstaff in northern Arizona, USA experienced WUI forest thinning, fire, and record rainfall events, which collectively contributed to large floods and damages to the urban neighborhoods and city infrastructure.ObjectivesWe demonstrate multi-temporal, high resolution image applications from an unoccupied aerial vehicle (UAV) and terrestrial lidar in estimating landscape disturbance impacts within the WUI. Changes in forest vegetation and bare ground cover in WUIs are particularly challenging to estimate with coarse-resolution satellite images due to fine-scale landscape processes and changes that often result in mixed pixels.MethodsUsing Sentinel-2 satellite images, we document forest fire impacts and burn severity. Using 2016 and 2021 UAV multispectral images and Structure-from-Motion data, we estimate post-thinning changes in forest canopy cover, patch sizes, canopy height distribution, and bare ground cover. Using repeat lidar data within a smaller area of the watershed, we quantify geomorphic effects in the WUI associated with the fire and subsequent flooding.ResultsWe document that thinning significantly reduced forest canopy cover, patch size, tree density, and mean canopy height resulting in substantially reduced active crown fire risks in the future. However, the thinning equipment ignited a forest fire, which burned the WUI at varying severity at the top of the watershed that drains into the city. Moderate-high severity burns occurred within 3 km of downtown Flagstaff threatening the WUI neighborhoods and the city. The upstream burned area then experienced 100-year and 200–500-year rainfall events, which resulted in large runoff-driven floods and sedimentation in the city.ConclusionWe demonstrate that UAV high resolution images and photogrammetry combined with terrestrial lidar data provide detailed and accurate estimates of forest thinning and post-fire flood impacts, which could not be estimated from coarser-resolution satellite images. Communities around the world may need to prepare their WUIs for catastrophic fires and increase capacity to manage sediment-laden stormwater since both fires and extreme weather events are projected to increase.

Predictive value of serum albumin and calcium levels in burn patients with Pseudomonas aeruginosa infection: A comprehensive analysis of clinical outcomes.

In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.

Wildfire burn severity and stream chemistry influence aquatic invertebrate and riparian avian mercury exposure in forested ecosystems.

Terrestrial soils in forested landscapes represent some of the largest mercury (Hg) reserves globally. Wildfire can alter the storage and distribution of terrestrial-bound Hg via reemission to the atmosphere or mobilization in watersheds where it may become available for methylation and uptake into food webs. Using data associated with the 2007 Moonlight and Antelope Fires in California, we examined the long-term direct effects of wildfire burn severity on the distribution and magnitude of Hg concentrations in riparian food webs. Additionally, we quantified the cross-ecosystem transfer of Hg from aquatic invertebrate to riparian bird communities; and assessed the influence of biogeochemical, landscape variables, and ecological factors on Hg concentrations in aquatic and terrestrial food webs. Benthic macroinvertebrate methylmercury (MeHg) and riparian bird blood total mercury (THg) concentrations varied by 710- and 760-fold, respectively, and Hg concentrations were highest in predators. We found inconsistent relationships between Hg concentrations across and within taxa and guilds in response to stream chemical parameters and burn severity. Macroinvertebrate scraper MeHg concentrations were influenced by dissolved organic carbon (DOC); however, that relationship was moderated by burn severity (as burn severity increased the effect of DOC declined). Omnivorous bird Hg concentrations declined with increasing burn severity. Overall, taxa more linked to in situ energetic pathways may be more responsive to the biogeochemical processes that influence MeHg cycling. Remarkably, 8 years post-fire, we still observed evidence of burn severity influencing Hg concentrations within riparian food webs, illustrating its overarching role in altering the storage and redistribution of Hg and influencing biogeochemical processes.

Birds of the Burn: Avian Community and Functional Guild Variation Five Years Post-Fire in Warm–Dry Mixed Conifer, Southwest Colorado

Birds contribute to the trophic interactions within mixed conifer ecosystems and provide a suite of services, such as nutrient transport, seed dispersal, habitat creation, and insect regulation. Avian communities vary in response to the structure and composition of their habitat, which may be drastically altered by fire, the predominant disturbance of western mixed conifer forests. We conducted avian point count surveys during the peak breeding season, five years post-fire, across four burn severities (unburned, low, moderate, and high) within the 416 Fire perimeter, a 55,000-acre mixed-severity fire that burned near Durango, Colorado in 2018. Avian communities in each burn severity were evaluated for richness, diversity, differentiation, indicator species, and functional guild composition. Species assemblages were significantly different across all burn severities, excluding the low to moderate areas comparison, with differentiation driven by live tree and snag density. Avian species’ richness and diversity were not significantly different across burn severities, highlighting the importance of utilizing multivariate community analysis. Unburned and high-burn areas had significant variation in functional guilds and numerous indicator species. This study provides evidence of avian community differentiation by burn severity, suggesting that management practices promoting heterogenous stand structure in warm–dry mixed conifer will positively influence avian biodiversity.

What are the triggers for palliative care referral in burn intensive care units? Results from a qualitative study based on healthcare professionals' views, clinical experiences and practices.

Burns are a global public health problem, accounting for around 300,000 deaths annually. Burns have significant consequences for patients, families, healthcare teams and systems. Evidence suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making processes and family care. Research is needed on how to optimise palliative care referrals. To identify triggers for palliative care referral in critically burned patients based on professionals' views, experiences and practices. Qualitative study using in-depth interviews. All five Burn Intensive Care Units reference centres across Portugal were invited; three participated. Inclusion criteria: Professionals with experience/working in these settings. A total of 15 professionals (12 nurses and 3 physicians) participated. Reflexive thematic analysis was performed. Three main triggers for palliative care referral were identified: (i) Burn severity and extension, (ii) Co-morbidities and (iii) Multiorgan failure. Other triggers were also generated: (i) Rehabilitative palliative care related to patients' suffering and changes in body image, (ii) Family suffering and/or dysfunctional and complex family processes, (iii) Long stay in the burn intensive care unit and (iv) Uncontrolled pain. This study identifies triggers for palliative care in burn intensive care units based on professionals' views, clinical experiences and practices. The systematisation and use of triggers could help streamline referral pathways and strengthen the integration of palliative care in burn intensive care units. Research is needed on the use of these triggers in clinical practice to enhance decision-making processes, early and high-quality integrated palliative care and proportionate patient and family centred care.

Thromboelastometric Analysis of the Correlation Between Burn-Induced Coagulopathy and Severity of Burn Injury.

Background In this study, we aimed to analyze the association between the burn index (BI) and burn-induced coagulopathy. Methods Adult burn patients transported to our emergency department who underwent rotational thromboelastometry (ROTEM) between April 1, 2013, and December 31, 2021, were enrolled in this study. The patients were categorized into two groups based on burn severity. Severe burns were defined as BI scores of > 15. Patient demographics, clinical variables of burns, standard laboratory test data, ROTEM data, and clinical outcomes of both groups were evaluated. In addition, the correlation between severe burns and significant variables was evaluated using a univariate analysis. Results Seven patients were enrolled and categorized into the severe (n = 2) and control (n = 5) groups. The severe group had a significantly worse consciousness level and higher mortality rate and showed higher tendencies of burn severity and clinical severity scores. Disseminated intravascular coagulation was confirmed in one patient. All ROTEM variables in the severe group regarding clot firmness in the extrinsic coagulation cascade (EXTEM) and fibrinogen-specific coagulation cascade (FIBTEM) showed a decreasing tendency as compared to those in the control group. Moreover, correlation analyses revealed strong correlations between the BI and clot firmness (rho = -0.946 to -0.721). Conclusions Severe BI was strongly associated with decreased blood clot firmness in EXTEM, FIBTEM, and ROTEM. Future research using viscoelastic devices may provide new possibilities for the treatment of severe burns.

Ocular Chemical Burns: Epidemiological Trends in a Colombian Medical Center.

Ocular chemical burns are a significant cause of visual impairment. This study aims to characterize the ocular chemical burns in a southwestern Colombia referral center and identify associated factors with low vision. A retrospective cohort study was carried out based on the review of medical records of patients diagnosed with chemical eye burns who consulted the emergency ophthalmology service between January 2016 and December 2019. Descriptive statistics were performed. Associations with low vision (Best-Corrected Visual Acuity, ≥20/70 in Snellen chart) in the last follow-up appointment were identified using a multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). About 219 eyes affected by chemical burns were identified from 174 patients with a mean age of 39 years (SD ± 20), of which 57.5% (n = 100) were men. We ran a multivariate model adjusted by sex, eye wash, type of chemical, and Dua's classification. We found that the odds of low vision for patients without eyewash before the consult were 3 times the odds of those who had it (adjusted OR [aOR] = 3.5, 95% CI = 1.3-9.4) and almost 5 times for those with Dua's classification >1 (aOR = 4.7, 95% CI = 1.7-12.9). The ocular chemical burns reported in this study occurred more in young people of productive age. Acids were the principal causal agent. The association between lack of early management and the severity of the chemical burn with low vision has been highlighted. Ocular burns remain a relevant cause of consultation on the ophthalmology service in Cali, and prevention strategies are required.

The Importance of Initial Management in Ocular Chemical Burn: A Case Series

Introduction : Ocular chemical injuries are true emergency which requires immediate intervention. Delayed management may result in severe eye injuries. This report aims to describe the effectivity of initial management and medical treatment of ocular chemical burns.&#x0D; Case Illustration : We reported four cases of ocular chemical injuries due to alkaline, acidic, and unspecified chemical compound. All subjects were men, aged 30 to 50 years old. They had injuries at work and none of them used eyewear protector. Each was brought to emergency unit in less than 2 hours. They were given initial timely irrigation until pH neutralized. Ocular damages were evaluated using Roper-Hall Classification, three cases were Roper-Hall 2 and other was Roper-Hall 3. After initial management, all cases were treated with medical treatment and showed significant improvement. After 6 months follow up, there weren’t any long-term sequelae in all subjects.&#x0D; Discussion : Serious eye damage results from strongly alkaline or acidic compounds. Most critical factor is timely delivery of irrigating fluid. Irrigation should ideally be performed with isotonic saline or lactate ringer solution and continued until the pH neutralized to a physiological level. Any method of irrigating the eye is preferable than delay in elimination of the destructive chemical. Medical treatments in acute management of severe ocular chemical burns are anti-inflammatory therapy, halting epithelial and stromal breakdown, promoting re-epithelialization and promoting corneal stromal healing.&#x0D; Conclusion : Timely irrigation of the eye effectively reduces severity of chemical burns, reduces need for surgical intervention, and improves final visual acuity if combined with medical treatment in golden period.

Assessing spatial patterns of burn severity for guiding post-fire salvage logging in boreal forests of Eastern Canada

Areas affected by forest fires are increasing worldwide, making salvage logging (i.e., harvesting fire-affected trees) an increasingly used practice to reduce the economic impacts of fire on forestry. However, salvage logging can have strong ecological impacts, notably on post-fire forest regeneration and biodiversity. Burn severity (i.e., the degree to which fires impact the vegetation and soil) is also a central element that interacts with pre-fire forest characteristics and salvages logging to control post-fire forest dynamics and biodiversity. In an ecosystem-based forest management context, spatial patterns of burn severity should thus be considered when planning salvage logging operations. This study presents a simple and innovative method to generate burn severity maps with Landsat and Sentinel-2 multispectral imageries to support salvage logging operations rapidly after a fire event. We assembled a unique dataset involving 330 plots from 10 burns (from 2010 to 2020) in which burn severity has been estimated on the field using the composite burn index (CBI) approach in eastern North America. CBI values were modelled as a univariate function of changes in spectral indices using the first cloud-free post-fire satellite images taken after the burns. Our results demonstrate that using free satellite images with straightforward methods can produce reliable and ecologically meaningful burn severity maps within the few weeks following a fire event. The method was then applied to a case study with salvage logging that illustrates how our burn severity maps could be a useful tool for guiding post-fire forestry operations in an ecosystem-based management context. We combined burn severity maps with pre-fire forest composition and age maps to assess immediate post-fire forest. We discuss how such an approach helps to guide salvage planning and maintain residual forests that are representative of the initial post-fire spatial variability in burn severity and pre-fire vegetation. We conclude that rapid mapping of burn severity after a forest fire event may offer many other applications for identifying and managing recently burned forests.

Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial.

Hand eczema (HE) is a common and heterogeneous condition. It has a wide range of etiologies and clinical manifestations. In this study the efficacy of triamcinolone 0.1% cream and sulfur 2% creams was compared in treating patients with HE. This randomized, triple-blind clinical trial was performed on 70 patients with HE (including 70 right and 70 left hands). In this study, two creams were used including triamcinolone 0.1% and sulfur 2.0%. Patients were treated with these creams twice a day (once in every 12 h) for 4 weeks. Follow-up was 4 weeks after treatment. Hand Eczema Severity Index (HECSI), itching, dryness, burning sensation, and erythema scores were collected three times during the study and compared between treatment regimens. Findings showed that both triamcinolone (0.1%) and sulfur (2.0%) creams could significantly reduce the scores of HECSI, itching, dryness, burning sensation, and erythema, and the therapeutic effects lasted for at least 4 weeks after cessation of topical treatment. Topical sulfur cream (2.0%) is as effective as triamcinolone (0.1%) cream in treatment of HE without any prominent adverse reactions.

Effects of burn severity and postfire salvage logging on carnivore communities in montane forests

Abstract Wildfire and postfire salvage logging are major drivers of forest succession in western North America. Although postfire landscapes support a variety of carnivore species, it is unclear how these animals respond to differing patterns and severities of burning, or to additional landscape change from postfire salvage logging. Open, early-seral habitats created by these disturbances are predicted to benefit generalists such as coyotes (Canis latrans) and weasels (Mustela spp.), but restrict the activity of forest specialists such as Canadaian Lynx (Lynx canadensis) and Pacific Marten (Martes caurina). We used winter track surveys, supplemented with remote cameras, to examine carnivore habitat use in and around large, mixed-severity burns in north-central Washington, United States (burned in 2006), and central British Columbia, Canada (burned in 2010, then partially salvage-logged; some areas reburned in 2017). At 10 to 13 years postfire, marten had similar detection rates across lightly and severely burned areas of the 2006 burn, as did coyotes. Marten selected lightly burned areas of the 2010 burn (6 to 9 years postfire) over higher burn severities, and selected burns over adjacent unburned forests. Weasels selected areas of higher burn severity on both landscapes, while Lynx selected lower burn severities. Weasels and coyotes selected areas with a greater proportion of salvage-logged habitat in the 2010 burn, while marten, lynx, and wolves (Canis lupus) avoided areas with salvage logging. Fishers (Pekania pennanti) showed no clear patterns of selection or avoidance in relation to burn severity or salvage logging. Burn severity strongly influences wildlife activity postfire; lightly burned residual habitats are critical for forest specialists. Postfire salvage logging alters carnivore communities and may hinder species that require structurally complex landscapes.

Population Profile of Children in Romania Affected by Burns.

Burns in children represent a significant challenge in the global health domain. The research aims to analyze the profile of children in Romania affected by burns, focusing on demographic characteristics, severity of burns, applied treatment, and impact on parents. Through this analysis, we aim to better understand the factors involved in these cases and provide relevant information for improving the management and care of children with burns. This study aims to explore various aspects related to the healing of burn injuries in pediatric patients in Romania, analyzing data collected through a questionnaire administered to 107 parents. The profile of children in Romania affected by burns is primarily composed of relatively young children, with an average age of 8.7 years and an even distribution between genders. Most come from rural areas, and the degree of burns ranges from first to fourth degree, reflecting a wide range of severity of injuries. Treatment is diverse, with a tendency towards conservative approaches and a significant proportion of cases without complications. Parental satisfaction is not significantly influenced by the type of treatment, indicating a similar perception regardless of the mode of medical intervention. Improving the management and care of children with burns is achieved through adopting a multidisciplinary and integrative perspective. This involves the use of non-pharmacological therapies such as hypnosis and regional anesthesia for pain and anxiety control. Additionally, the inclusion of adjunctive therapies, such as the use of mesenchymal stromal cells and tilapia skin xenograft, contributes to improving the healing process.

The Current Pattern of Pediatric Burn Injuries in an Australian Major Burns Center.

Burns are a common mechanism of pediatric injury worldwide and a notable cause of disability-adjusted life-years. Burns in children represent a unique challenge due to the differences from adults regarding physical characteristics, physiology, and psychology. This retrospective cohort study examined trends of pediatric burns in New South Wales (NSW), Australia, from 2010 to 2022. It specifically focused on the changes in burn etiology and patient characteristics, body area affected, TBSA, first aid, location, and management. It also compared a "Pre-COVID-19" and "Peri-COVID-19" era to analyze the impact of COVID-19 on the pattern of pediatric burns, as children are at higher risk of injury during times of social disruption. The study found that burns in children continue to be concentrated in the toddler and preschooler age group, and the main mechanisms of injury remain as scald and contact burns. In recent years, there has been a rising trend of friction burns, alongside a fall in flame burns and severe burns. Management of pediatric burns has also evolved, with predominant use of ambulatory care and low rates of admission and operative intervention. Trends in burn injury continue to evolve with time, and over the last decade in NSW, key changes in the pattern of pediatric burns have been observed, with evolving mechanisms of injury, reduced severity of burns, and a shift toward ambulatory care.

Are fire intensity and burn severity associated? Advancing our understanding of FRP and NBR metrics from Himawari-8/9 and Sentinel-2

Burn severity has been widely studied. Typical approaches use spectral differencing indices from remotely sensed data to extrapolate in-situ severity assessments. Next generation geostationary data offer near-continuous fire behaviour information, which has been used for fire detection and monitoring but remains underutilized for fire impact estimation. Here, we explore the association between remotely sensed fire intensity metrics and spectral differencing severity indices to understand whether and where they describe similar wildfire effects. The commonly used Differenced Normalised Burn Ratio (dNBR) severity index was calculated for Advanced Himawari Imager (AHI − 2 km) and Sentinel-2 (20 m) data and compared to different Fire Radiative Power (FRP) metrics derived from fire hotspot detections from AHI data across Australia. The comparison was implemented through different stratifications based on biogeographical region, land cover, fire type, and percentage of AHI pixel burned (fire fractional cover). The results indicate that FRP and dNBR metrics do not correlate in most scenarios, noting correlations being marginally stronger for hotter fires. However, correlations become significantly stronger when data are grouped using fire type information and fire fractional cover, with correlations peaking (R = 0.75) for large fires that burned 41–60 % of an AHI pixel. In conclusion, remotely sensed fire intensity and severity proxies capture different aspects of wildfire impact, that only correlate with each other after using auxiliary data. Spectral differencing severity metrics have been used extensively during the past decades, however high-frequency fire intensity estimations have the potential to augment the existing information and reveal new ways of characterizing wildfire impact over large areas.

Assessing resuscitation in burn patients with varying degrees of liver disease

We find minimal literature and lack of consensus among burn practitioners over how to resuscitate thermally injured patients with pre-existing liver disease. Our objective was to assess burn severity in patients with a previous history of liver disease. We attempted to stratify resuscitation therapy utilised, using it as an indicator of burn shock severity. We hypothesized that as severity of liver disease increased, more fluid therapy is needed. We retrospectively studied adult patients with a total body surface area (TBSA) of burn greater than or equal to 20% (n = 314). We determined the severity of liver disease by calculating admission Model for End-Stage Liver Disease (MELD) scores and measured resuscitation adequacy via urine output within the first 24 h. We performed stepwise, multivariable linear regression with backward selection to test our hypothesis with α = 0.05 defined a priori. After controlling for important confounders including age, TBSA, baseline serum albumin, total crystalloids, colloids, blood products, diuretics, and steroids given in first 24 h, we found a statistically significant reduction in urine output as MELD score increased (p < 0.000). In our study, severity of liver disease correlated with declining urine output during first 24-hour resuscitation more so than burn size or burn depth. While resuscitation is standardized for all patients, lack of urine output with increased liver disease suggests a new strategy is of benefit. This may involve investigation of alternate markers of adequacy of resuscitation, or developing modified resuscitation protocols for use in patients with liver disease. More investigation is necessary into how resuscitation protocols may best be modified.

Employing Copernicus Land Service and Sentinel-2 Satellite Mission Data to Assess the Spatial Dynamics and Distribution of the Extreme Forest Fires of 2023 in Greece

In 2023, Greece faced its worst wildfire season, with nine major fires causing unprecedented environmental damage of 1470.31 km2. This article uses Copernicus Land Monitoring Service and Sentinel-2 data, employing advanced remote sensing and GIS techniques to analyze spatial dynamics, map burn severity, assess fire extent, and highlight pre-fire tree density and land cover. The study focuses on the catastrophic fire in the Evros region and the damage to the National Forest Park of Dadia–Lefkimmi–Soufli. It also analyzes significant fires in Rhodes, Attica, Thessaly, Evia, Corfu, and Magnesia, emphasizing the compounded challenges posed by terrain, climate, and human factors in those areas. Additionally, the climate data for each affected area were compared with the weather conditions prevailing at the time of the fires. Copernicus Land Cover and Tree Density data are integrated to aid future management, assessment, and restoration. The analysis of maps and fire statistics underscores a notable pattern: areas with higher pre-fire tree density experienced correspondingly higher burn severity. This research underscores the crucial role of such data in assessing wildfire impact. In addition, compared with Copernicus Emergency Management Service, the burned area maps validate the accuracy and reliability of the utilized satellite data. The total burned area was assessed with a high accuracy rate of 96.28%.

Impacts of wildfire on soil characteristics in subtropical Chir Pine forests of Murree, Pakistan

Wildfires are a natural component of forest ecosystem. These fires are a major cause of significant perturbations in the forest habitat due to temperature extremes and drought conditions particularly in summer. Wildfires occur frequently during summer in the subtropical Chir pine forests of Murree, Pakistan. These fires influence soil characteristics as well as tree-species growth and survival. The present study was thus conducted to investigate soil characteristics of wildfire-affected and non-affected areas. Four sites were selected based on wildfire incidents in the study area. Soil samples were collected from the fire-affected and adjacent non-affected areas. The collected soil samples were analyzed for physical and chemical characteristics using appropriate methods. The study showed that bulk density, moisture content, electrical conductivity, and soil nitrogen and soil carbon content declined in the burnt soil. However, soil pH, and phosphorus and potassium contents were higher in the burnt soils than those in the non-burnt soils. Generally, low intensity forest fire (surface fire) is an important component of forest ecosystem and it enhances natural regeneration as well as soil fertility. It is suggested that government forest departments should take into account burn severity while developing hazard reduction and restoration strategies of wildfire affected areas.