Burn Deaths Research Articles

Scholarly knowledge fundamentals and dynamic research hotspots in the field of burns and immunology: A bibliometric analysis

BackgroundAn estimated 180,000 burn deaths occur each year, and the immune system plays a vital role in wound healing and burn complications, including inflammatory reactions and oxidative stress. This paper aims to explore the basic knowledge and dynamic hotspots in burns and immunology research with bibliometric methods. MethodsThrough systematic retrieval, we ensured all the documents complied with our retrieval strategy and were included in the Science Citation Index-Expanded of the Web of Science Core Collection. Using bibliometric methodologies, the general information was delineated; and foundational knowledge, as well as dynamic research hotspots, were ascertained through VOSviewer, CiteSpace, and R-bibliometrix. Results8758 publications were identified from January 1st, 2000, to June 17th, 2024. The most productive and collaborative country was the USA; Harvard University was the most productive affiliation; and the most productive author was David N. Herndon. According to source analysis, the highest-impact journal is Burns. Historically, “expression” was the most frequently occurring word. “Delivery” was the most frequently occurring word in recent years. ConclusionThe domain of burns and immunology has reached a zenith, with a modest decline in publication output over the past two years, yet it continues to evolve robustly. The focal points of inquiry have evolved from the initial appraisal of immunotherapeutic interventions for critical burn injuries to the elucidation of immune cell mechanisms in burn patients. Future research trajectory is poised to innovate therapeutic modalities, encompassing anti-inflammatory, antioxidant, and targeted drug delivery systems, to enhance precision in immune modulation.

A Comprehensive Review of a particular Skin Injury: Pathogenesis, triggers, and current Treatment Options

By definition, an open injury is any severe break in the continuity of the skin and deep tissue. Because contusions are healed injuries, the term given above does not apply to them. The classification of injuries is essential for both therapeutic and medico-legal purposes. Burn injuries are comparable to other injuries in that they require the same basic principles for healing and care, but they differ in that they have a greater impact on the patient's overall health and are essential to the patient's eventual survival, the development of deformity, and rehabilitation. Treatment of burn injuries has always been the responsibility of burn specialists. Both local and systemic therapy have long been advised for treating burn injuries and minimizing burn scars. This review summarizes the treatment of burn injuries brought on by a variety of physical and chemical agents requires unique regimens that are completely different from those used to treat any other traumatic injuries. Other acute injuries that undergo entire blood loss result in shock, but major burns that experience significant plasma loss due to increased capillary permeability result in distress. Burn injuries are initially sterile compared to the majority of other injuries, however, due to the immunocompromised state of burn patients and injury infection frequently ends in death in serious burns. We have discussed the pathophysiology, primary care therapies, nanomaterials used in injury healing therapy and various nanoparticles in injury healing process for burn injuries in this review.

Association of inflammatory biomarkers with overall survival in burn patients: a systematic review and meta-analysis

IntroductionThe inflammatory response to burn injuries can lead to organ dysfunction that ultimately results in increased mortality and morbidity. This meta-analysis was conducted to determine the efficacy of inflammatory biomarkers, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), procalcitonin (PCT), and C-reactive protein (CRP) as predictive tools of mortality among burn patients.Material and methodsThe biomarker levels of survivors and non-survivors were consolidated according to guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three main databases were searched electronically: PubMed, Web of Science, and Scopus, on December 8, 2022. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to evaluate and score the methodological quality of the included studies. The standard mean difference (SMD) with a 95% confidence interval (CI) was utilized.ResultsTwenty-four studies were included in our systematic review and meta-analysis, (3636 total burn patients), of whom 2878 survived. We found that deceased burn patients had elevated levels of NLR (SMD = 0.60, 95% CI; 0.19–1.00, P < 0.001), CRP (SMD = 0.80, 95% CI; 0.02–1.58, P = 0.04), and PCT (SMD = 0.85, 95% CI; 0.45–1.24, P < 0.001), compared to survivors. However, we found no association between PLR and mortality among burn patients (SMD = 0.00, 95% CI; -0.14–0.15, P < 0.001). In addition, CRP was significantly higher in non-survivors (SMD = 0.80, 95% CI; 0.02–1.58, P =0.04). Similar results were also found about PCT (SMD = 0.85, 95% CI; 0.45–1.24, P < 0.001). When we analyzed the PCT data, collected in the first 24-48 hours, we found similar results; the PCT level was significantly higher in non-survivors in the immediate postinjury-period (SMD = 0.67, 95% CI; 0.31–1.02, P < 0.001). There was no publication bias among studies on the role of NLR in burn (Egger’s test P = 0.91). The based cut-off values for NLR (13), CRP (71), and PCT (1.77) yielded sensitivities of 69.2%, 100%, and 93.33%, and specificities of 76%, 72.22%, and 72.22% respectively.Discussion/ConclusionsPCT is a marker of sepsis, therefore its elevated level is presumably associated with a higher incidence and severity of sepsis among non-survivors. In addition, NLR and CRP are promising biomarkers for predicting and guiding prevention against burn deaths in clinical settings.

High rate of negligence induced burns in children: A rising cause for concern of the world's burn community

One of the most important causes of death in burn patients is burn [1-10]. Accurate evaluation, timely diagnosis, and proper treatment of burn patients can reduce their mortality rate [11-21]. On the other hand, one of the most important causes of injury among children aged 1 to 15 is burns [22]. Usually, children and teenagers are more vulnerable in burn injuries than other age groups [23]. Severe burns can affect children's health both in the acute stage of burns and in the later stages of their lives [24]. Burns in children often occur due to injuries caused by hot liquids. The mechanism of burns among children can be due to exploratory behaviors without understanding the dangers in the environment [25]. Most burn injuries are due to accidental causes, but in some cases, it can be due to negligence in children [22]. It is difficult to distinguish whether the burn was accidental or caused by negligence [24]. Burn hospitalizations and deaths due to negligent burns are more than accidental burns. The interesting point is that some cases of children's burn injuries can be due to misbehavior and negligence that were not diagnosed at the time of admission. Identifying these people is important because preventive efforts by health care teams for children are necessary [22]. Hence, most negligence induced burns in children are preventable because negligence and carelessness are the main causes of burns in them [24]. The consequences of negligence induced burns in children can have physical, mental, and emotional effects on children and their families [23]. Burn scars often persist after healing and lead to functional and aesthetic problems [24]. On the other hand, psychological care after burns should be considered; because, children experience a high level of acute stress, anxiety, and depression after burns, and hospitalization can be scary for children [23]. The negative consequences of negligence induced burns in children in the long term can lead to chronic diseases in childhood and even adulthood. Therefore, special attention should be paid to the timely prevention, diagnosis, and treatment of negligence induced burns in children [22]. However, previous evidence regarding negligence induced burns in children is very limited. Hence, one study showed that 56% of burns in children were due to negligence [24].

Main Pathogens Causing Infections and Antibiotic Resistance Profile in Major Burns in Brazil Comparing Two Periods: 2015/2016 and 2019/2020.

Sepsis is the main cause of death in major burns. In this retrospective study conducted in a reference hospital in Brazil, the main agents causing infection and the resistance profile to antibiotics were identified. In addition, the epidemiological profile, length of hospital stay, type of burn, and total body surface area (TBSA) in major burns were collected from medical records, comparing the years 2015/2016 and 2019/2020. In both time periods, there was a predominance of males with a mean age of 43 years. Burns with less than 30% of TBSA predominated. There was a significant increase in positive cultures (P = .00026), from 58.7% to 80%, and an increase in skin punch culture collection from 25.6% to 43.9% in the years 2019/2020. The predominant etiological agent was Pseudomonas aeruginosa, followed by Acinetobacter baumannii resistant to carbapenems, and Staphylococcus aureus in both evaluated periods. The percentage of deaths was higher in 2019/2020 (26.2% vs. 14.6%; P = .026). The length of hospital stay was shorter in the latter period (P = .0081). Sepsis was the cause of death in 81.2% of cases in 2015/2020 and 78.3% in 2019/2020. Among the deaths, P. aeruginosa was the main agent identified. There was no change in the main pathogens and bacterial antibiotic resistance between the 2 time periods.

Global Burn Prevention: Ukraine.

Burn injury accounts for a large proportion of surgically treatable disease. It is estimated that over 180,000 flame burn deaths occur annually across the globe, with roughly 95% occurring in low- or middle-income countries (LMIC). Within these countries children account for a disproportionately high number of burn injuries. As such, the WHO has identified burn prevention as a topic of interest, with an increased need in low- and middle-income countries. Here we describe the creation and implementation of a burn prevention program in Ukraine. We instituted a five-step burn prevention initiative consisting of; data gathering, program design, implementation, outcome evaluation, program maintenance, and expansion. The burn prevention initiative has been adopted nationally leading to policy change. Active education and an information campaign were used to target pediatric scald injuries and improve first aid care. The authors have successfully implemented a targeted multi-faceted, national, burn prevention program within Ukraine. The described approach may be used as a guide and adapted to create similar prevention programs within other countries or regions. At this time the Russo-Ukrainian War has caused an abrupt hold on our role in the prevention program and left the healthcare system in havoc. Moving forward, our team is prepared to reevaluate the impact of the war on social life and the medical system and aid in redesigning the prevention program when appropriate.

A RETROSPECTIVE STUDY OF PATTERN OF MEDICOLEGAL AUTOPSIES CONDUCTED AT KADAPA, ANDHRA PRADESH

Background: Death of an individual is a serious and grave loss to the family and community at large in whatever form it occurs whether natural or unnatural. Analysis of unnatural deaths helps in understanding the causes, manner, and modes of deaths thereby formulating and implementing a proper policy to reduce them. Methods: This is a retrospective study of autopsies conducted over 3 years (2020–2022) in the mortuary of Government Medical College, Kadapa. During this period, 1857 autopsies were performed. All the necessary data were collected from the police requisitions, inquest reports, hospital case sheets, medicolegal register, and postmortem reports in a performed pro forma. Results: Out of the 1857 cases, high proportion was in the age group of 21–30 years (40.26%), followed by 31–40 years (18.68%). Ratio of male to female was 2.57:1. Majority belonged to Hindu community (67.69%) and most of the subjects hailed from the rural areas (63.14%). Majority were married (70.86%). The most common cause of death was road traffic accidents (45.07%), followed by poisoning (15.67%). The manner of deaths was accidental deaths in most cases (57.78%) followed by suicidal deaths (36.02%). Conclusion: The present study reveals that most cases were in 21–30 years age group. The proportion of males outnumbered females and the subjects were mostly married and were from rural areas. Road traffic accidents were common cause of death in males and burns were the common cause of death in females.

AUTOPSY BASED PROFILE OF FLAME BURN DEATHS: A ONE - YEAR PROSPECTIVE STUDY

Background:Burn is one of the most common and the most catastrophic forms of trauma among people, leading to severe mortality and morbidity. The incidence of burn injury varies greatly between cultures. The majority of these occur in low and middle-income countries and almost twothirds occur in the African and South-East Asia regions. Materials and Methods: The study is an autopsy based prospective study on ame burn cases carried out at Gauhati Medical College and Hospital, Guwahati, Assam, during a particular period of a calendar year i.e., 1st May, 2021 to 30th April 2022 in a specied population. The purpose of the study is to evaluate the various socio-demographic factors related to ame burn deaths. Results: Among 245 cases studied, majority of the victims were females (63.27%). Most of the incidents took place at home (53.87%). Majority of incidents took place in winter season (53.06%) and toxaemia (56.33%) was the most common cause of death. Conclusion: Thermal burns and related injuries are major cause of death and disability all over the world. Hence, detailed study of ame burn injuries and its associated factors is essential to plan future strategies for burn prevention

Rajindra Singh Gill

<h3>Background</h3> Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical...

The epidemiological characteristic and trends of burns globally

BackgroundBurns is a type of injury, caused by unintentional exposure to substances of high temperature, including hot liquid, solid, and objects radiating heat energy, placing a high burden not only on patients’ families but also on national healthcare systems globally. It is difficult for policymakers and clinicians to formulate targeted management strategies for burns because data on current epidemiological patterns worldwide are lacking.MethodsData on burns were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of burns in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. All analyses were performed using R software, version 4.1.1, with 2-sided P-values < .05 indicating a statistically significant difference.ResultsA total of 8,378,122 new cases (95% UI, 6,531,887–10,363,109cases) of burns were identified globally in 2019, which is almost evenly split between men and women, and most of the new cases were concentrated in the 10–19-year age group. Besides, burns account for 111,292 deaths (95% UI, 132,392–88,188) globally in 2019, most of which were concentrated in those aged 1–4 years. The burden of burns measured in DALYs was 7,460,448.65 (95% UI, 5,794,505.89–9,478,717.81) in 2019, of which 67% and 33% could be attributed to YLLs and YLDs, respectively. The EAPC of incidence, DALYs, and deaths were negative, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with SDI levels, universal health coverage (UHC), and gross domestic product (GDP).ConclusionGlobally, the age-standardized rates of burn incidence, DALYs, and mortality, as well as the number of burn DALYs and death cases will continuously decrease, but the number of new burn cases has an increasing tendency globally. In addition, the EAPCs of burns in incidence, DALYs, and deaths indicated that the burden of burns was considered to be decreasing in most of the regions. And from the relationship of EAPCs with SDI, UHC index, and GDP, indicate that prevention burns not only depend on health spending per capita but also depend on the education level per capita and healthcare system performance, but it does not mean higher health spending corresponds to higher UHC index, which needs high efficiency of translating health spending into individuals health gains.

57 Understanding the Burden of Burn Injury in Latin America &amp; the Caribbean

IntroductionBurn injuries are a global health problem disproportionately affecting low- and middle-income countries, especially in Latin America and Caribbean (LAC) where cooking methods, dangerous work conditions, and minimal housing regulations place people at increased risk of burn injury. Until recently, there was limited global epidemiological data on burn injuries. Following publication of the 2017 Global Burden of Disease (GBD17) database, we obtained objective and comparable data on burn injuries while specifically focusing on LAC countries.MethodsData from all 35 LAC countries were collected from GBD17 for fire, heat, and hot substance-related injuries to calculate burn incidence, deaths, and Disability-Adjusted Life Years (DALYs) with respect to country, age, and gender from 1990 to 2017. Incidence and deaths were reported as rates per 100,000 persons. Mortality rate was reported as a percentage of deaths-to-incidence. DALYs were reported in years per 100,000 persons. Incidence, death, DALY, and mortality rate trends were assessed using age-standardized, age-stratified, and gender-specific cohorts. All statistical analyses were performed using Excel.ResultsOver 27 years, LAC’s rates for burn incidence (-19%), deaths (-63%), DALYs (-62%), and mortality (-54%) all decreased with the greatest improvements seen in Brazil and Paraguay. All indicators improved around 15% more than the global averages during the same period with LAC’s rates 30-40% below global rates by 2017. The highest burn incidence (227 cases/100,000) was in Southern Latin America (Argentina, Chile, Uruguay). The Caribbean had the worst DALYs (124 years/100,000). In 2017, LAC accounted for 7% of global burns, 5.5% of deaths, and 5.1% of DALYs with Central America contributing the greatest numbers. For 27 years, Chile had the highest burn incidence but Haiti had the greatest death, DALY, and mortality rates of all LAC. Children under 14 years of age and males were disproportionately affected compared to other regional and global cohorts.ConclusionsDespite a relatively greater reduction in burn severity and lifelong disability within LAC compared to the world, certain regions and countries exhibited significantly higher rates of burn injury, morbidity, and mortality. Central America (e.g. Costa Rica, Belize, Mexico) and the Caribbean (e.g. Haiti, Cuba) were particularly affected, comprising the majority of cases, deaths, and DALYs. This study provides essential analyses for developing regional and country-specific strategies to reduce the burden of burns through targeted interventions for prevention, workforce, and capacity building efforts.

58 Burn Injuries in Asia: A Global Burden of Disease Study

IntroductionBurn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed.MethodsThe 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators.ResultsFrom 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%).ConclusionsIn 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death.

504 Starting a Pediatric Burn Center: Challenges Faced in an Underserved Patient Population

IntroductionBurn injury is the third most common cause of childhood injury resulting in death. The CDC recognizing the South as having the highest rate of pediatric burn deaths in the U.S. Unfortunately, 10% of all child abuse cases involve burn injuries and 20% of all pediatric burn admissions are due to nonaccidental trauma. Our study demonstrated that aftercare was a major challenge in starting a pediatric burn center. We analyzed the rate of lost to follow-up in burn-injured children following surgery and our steps to address this need in our community through key partnerships within our state.MethodsOur study is a single center review of pediatric burn-injured children undergoing surgery from 01/01/2021 through 09/30/2021. Lost to follow-up was defined as three or more consecutive months without clinic or telemedicine visits despite three of more documented communication attempts by attending surgeons and/or clinic staff. Children requiring child protective services (CPS) for suspected nonaccidental trauma were compared to those where nonaccidental trauma was not suspected. All children sustained burn injuries of sufficient severity to require excision and autograft with follow-up in the outpatient clinic. Families were provided with an after-visit summary reviewing the clinic appointment, transportation and meal assistance, and they received a call prior to clinic to remind them of the scheduled appointment.ResultsA total of 35 children required surgery with outpatient follow-up per protocol. 23% of the patients required CPS investigations. We reviewed 151 subsequent clinic visits and the associated cancellations, rescheduled appointments, and no-show visits. Children under the care of CPS had a higher rate of being lost to follow-up (50%) compared to other children (17%). Parents undergoing CPS investigation were 4x less likely to provide cancellation notice. Children placed in foster care had no cancellations, reschedules appointments, or missed visits despite a higher number of clinic visits overall.ConclusionsChildren suffering nonaccidental injuries represent an exceptionally vulnerable portion of our population. Burn injuries often are a public and personal reminder of severe trauma. CPS works to find a balance in securing a safe home while attempting to maintain a family unit. Our work demonstrated an unacceptably high rate of loss to follow-up for children requiring surgical intervention after injury especially in those with concerns for nonaccidental etiologies. As a result, our burn surgeons led an initiative with statewide burn directors and our state’s emergency response network to engage the state’s CPS department. Our goal was to raise awareness and increase education for CPS social workers and foster families on burn injury and aftercare needs.

A 3-Years Pneumonia Incidence in Burn Cases with Inhalation Injury at the Burn Center of Dr. Soetomo General Hospital Surabaya in 2015-2018

Introduction: Inhalation injury is one of burns impact. Airway burns due to inhalation injury is a non-specific term which refer to all respiratory tract injuries occurred due to irritative chemicals, including heat and smoke during inspiration. Inhalation injury increases the risk of death in burns. Pneumonia is one of burns-related inhalation injury complications.Methods: This was a descriptive retrospective study aiming to determine the incidence of pneumonia in burn patients with inhalation injury using secondary data at Burn Center Dr. Soetomo General Hospital Surabaya in the period of January 2015 - December 2018.Results: There were 5 cases of pneumonia in 14 burn cases with inhalation injury (35.71%). Respectively, 2 and 3 cases were found in 2017 and 2018. There were 2 female (40%) and 3 male (60%) patients, with age varied within 28-73 years old. The burn area of burn patients with inhalation injury and pneumonia were found by 15%, 20%, 24%, 32% and 71%, or within the classification of 11-20% burn area, and most complication found was hypoalbuminemia, as much as 3 cases (60%).\Conclusion: Most pneumonia in burn cases with inhalation injury was occurred in 2018, dominated by male patients. The age of the patient were ranging from early adulthood to elderly. Most burns were in the range of 11-20% burn area with the most complication found was hypoalbuminemia.

Epidemiological and Clinical Characteristics of Burn Injuries among Hospitalized Patients in Babylon Province

Background: Burns form the fourth most common cause of injury after road traffic injuries, falls, and interpersonal conflicts and are usually correlated with devastating physical, mental, social, and financial harms, particularly in low and middle-income countries like Iraq. Objectives: To investigate the epidemiological and clinical characteristics of burn injury patients, to measure the mortality rate (case fatality rate) for burns, and to explain the main determinants of deaths among hospitalized burn injury patients. Patients and Methods: This was an observational descriptive cross-sectional study conducted on all acute burn injury cases who were admitted to the biggest teaching hospital in Babylon Province, Iraq. Data were collected from patients themselves or their companions and from patients’ hospital records using a pretested questionnaire designed for collecting the requested information that included demographic data, burn characteristics, burn determinants, and burn outcomes. Results: A sample of 120 patients with burn injuries were investigated. The mean age ± standard deviation was 18.9 ± 17.9 years. The mean age of burn death victims was 24.5 ± 17.66 years. The young age group (15–24 years) represented the highest proportion. Male to female ratio was 1:1.4. Most of the patients had low educational and income levels. The case fatality rate was 26.6% (32/120). The majority of cases were from rural areas; 67% of suicidal burn deaths had more than 50% of total body surface area. Intentional burn death victims had significantly severe burns (third-degree burn and high body surface area) as compared to accidental burn death victims. There was a statistically significant difference as regards the mode of burns between the intentional and accidental burn deaths; all intentional death victims were burnt with flame. Conclusions: The case fatality rate of burn injuries was high, females outnumbered males, the majority of the victims had low educational and income levels, and suicidal burn deaths were significantly associated with severe burn as compared to the accidental ones.

A Study of Burn Death Cases of Rural Areas of Ranchi Conducted at RIMS, Ranchi, Jharkhand: A Postmortem Study

Burn injury is one of the most common cause of unnatural deaths worldwide. Survival after occurrence of burn injury has drastically increased in past decades especially in developed countries. Though both males and females may be victims of burn, females are more susceptible as they are more involved in household activities. Often the manner of burn is closed in mystery and unreliable statements, the reason behind this may be domestic, personal, occupational or social tragedy and more recently dowry deaths.

Plasmin drives burn-induced systemic inflammatory response syndrome

Severe injuries, such as burns, provoke a systemic inflammatory response syndrome (SIRS) that imposes pathology on all organs. Simultaneously, severe injury also elicits activation of the fibrinolytic protease plasmin. While the principal adverse outcome of plasmin activation in severe injury is compromised hemostasis, plasmin also possesses proinflammatory properties. We hypothesized that, following a severe injury, early activation of plasmin drives SIRS. Plasmin activation was measured and related to injury severity, SIRS, coagulopathy, and outcomes prospectively in burn patients who are not at risk of hemorrhage. Patients exhibited early, significant activation of plasmin that correlated with burn severity, cytokines, coagulopathy, and death. Burn with a concomitant, remote muscle injury was employed in mice to determine the role of plasmin in the cytokine storm and inflammatory cascades in injured tissue distant from the burn injury. Genetic and pharmacologic inhibition of plasmin reduced the burn-induced cytokine storm and inflammatory signaling in injured tissue. These findings demonstrate (a) that severe injury–induced plasmin activation is a key pathologic component of the SIRS-driven cytokine storm and SIRS-activated inflammatory cascades in tissues distant from the inciting injury and (b) that targeted inhibition of plasmin activation may be effective for limiting both hemorrhage and tissue-damaging inflammation following injury.

Mortality from Burn: An Autopsy Based Study from Nepal

Introduction: In developing countries like Nepal burn deaths are a major public health problem due to their increased mortality, morbidity and long-term disability. A few clinical studies on burns have been reported from Nepal however, autopsy based studies on burns are limited.&#x0D; Objectives: To study the socio-demographic characteristics of victims of burns and evaluate the cause and magnitude of fatal burn injuries retrospectively.&#x0D; Methodology: A two years retrospective analysis of burn deaths brought for autopsy was conducted from January 2017 to December 2018 in a central level hospital of Nepal.&#x0D; Results: Out of 775 total cases autopsied 38 (4.90%) cases were burn related deaths. The majority of the deaths 17(44.70%) occurred in the age group 21-30 years with a preponderance in females 22(57.89%). Majority of the victims were married females 25(65.78%) and most of them were housewives 14(36.84%). Flame burn 23(60.52%) was the most common cause of all burns. The Total Body Surface Area (TBSA) Burn between 50-69% was observed in majority of the cases 27(71.05%).Most of the victims 15(39.47%) survived over 10 days post injury. Burn incidents were mainly accidental 33(86.84%) in nature followed by suicidal burns 5(13.15%). The main cause of burn death was septicemic shock 16(42.10%) followed by neurogenic shock 10(26.31%).&#x0D; Conclusion: The results of this study show that burns injuries are mostly accidental in nature; therefore, the risks of burn injuries should be rightly addressed and appropriate burn prevention strategies should be developed to reduce the frequency and burn related deaths.

A prospective study of medicolegal autopsies to establish profile of burn deaths

Burns injuries have been a one of the major cause of concern since prehistoric time to the present era of modern medicine. Burn is considered to be the commonest cause of unnatural death in India.Burns are injuries produced by application of dry heat such as flame, radiant heat or some heated solid substance like metal or glass to the body. Dry heat, application of hot bodies, licking by flames resulting in simple burns causes local injury to the body. Moist heat leading to scalds, corrosive poisons resulting in corrosive burns. Electric spark, discharges, flashes and lightning leads to electric burns.Present study aim to know the magnitude of burn deaths in the region of southern marathwada region. Two years prospective study was conducted at Government Medical College Latur. Study of medico legal autopsies to establish the profile of burn deaths was carried out. In the present study, it is found that burns are commonly found in female (72.04%) than in females. Housewives (43.52%) were common victims followed by works (9.80%). Most of the incidences took place in morning hours (45.53%). Most common place of incidence was house (83%). Kerosene (57.63%) was the most common accelerant used to cause burn. If percentage of burn increases, the survival period decreases and vice versa. Most common alleged manner of death was accident (53, 6%).

A Prospective Study of Burn Deaths with Special Reference to Manner of Death and Duration of Survival

Around 0.2 million people are admitted in hospital due to burns, of which about 5000 people die every year.4Extent of Total Body Surface Area involved is an important parameter, that affects the prognosis in case ofburn injury. The majority of fire related deaths are accidental, usually due to carelessness. Suicidal burns aremostly seen in domestic situations and in females. Homicidal burns are rare; mostly accomplished to takerevenge or to conceal crime. So, this study was carried out with the aim to estimate the total body surfacearea affected &amp; duration of survival / hospital stay and to find out the manner of death in burn cases.It was found that 79.00% cases had burn injuries covering 60– 100% of the total body surface area (TBSA).Maximum percentage of burns was seen in females (30.00% cases) with TBSA of 80-90%. 95% cases werehospitalized with 75.00% having the hospitalization period of 1 – 10 days and maximum number of cases(33%) survived for a period of 3 to 5 days. In most of the cases (64.00%), the manner of death was accidentalfollowed by suicidal (34.00%), with only 2% cases of homicidal burns.