Electrical Injury Groups Research Articles

Prevalence of Cardiac Arrhythmias, Clinical Spectrum and Complications of Electrical Injury

Background: Electrical accidents (EA) are rare, but can cause serious and potentially life-threatening injuries to multiple organs. The majority of epidemiological data refers to workplace accidents which account for a significant share of such accidents in adults. Exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. Objective: To evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury. Methods: This was observational prospective study was carried out at the Dept. of Cardiology, Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from January to June 2021. 51 consecutive patients with electrical injury who were admitted. Admission criteria were age ≥15 years, loss of consciousness, cardiac arrest, electrocardiographic abnormalities, soft tissue damage and burns. Patients were categorized into high and low voltage injury group and their variables were compared. Results: The mean age of the patients was 32.3±10.4 years among them 41 (82.3%) were male. Patients who sustain high voltage electrical injury (>1000V) were 18 (35.2%) and low voltage injury (<1000V) were 33 (64.7%).Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.0%, p=0.054), sinus bradycardia (11.1% vs 3.0% p=0.254), ventricular premature beats (5.6% vs3.0%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 81.8% p=0.560) and fatigue (55.6% vs 39.3%, p=0.328). Conclusion: In this study few non-fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. Parameters considered to be risk factors such as known structural heart disease, loss of consciousness, high voltage electric shock, burn and soft tissue injuries were also not significant predictors of the occurrence of arrhythmias. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.

Establishing the base rate of performance invalidity in a clinical electrical injury sample: Implications for neuropsychological test performance

ABSTRACT Objective: The base rate of neuropsychological performance invalidity in electrical injury, a clinically-distinct and frequently compensation-seeking population, is not well established. This study determined the base rate of performance invalidity in a large electrical injury sample, and examined patient characteristics, injury parameters, and neuropsychological test performance based on validity status. Method: This cross-sectional study included data from 101 patients with electrical injury consecutively referred for post-acute neuropsychological evaluation. Eighty-five percent of the sample was compensation-seeking. Multiple performance validity tests (PVTs) were administered as part of standard clinical evaluation. For patients with four or more PVTs, valid performance was operationalized as less than or equal to one PVT failure and invalid performance as two or more failures. Results: Frequency analysis revealed 66% (n = 67) had valid performance while 29% (n = 29) demonstrated probable invalid performance; the remaining 5% (n = 5) had indeterminate validity. No significant differences in demographics or injury parameters emerged between validity groups (0 vs. 1 vs. ≥2 PVT failures). In contrast, the electrical injury group with invalid performance performed significantly worse across tests of processing speed and executive abilities than those with valid performance (ps< .05, ηp 2 = .19-.25). Conclusions: The current study is the first to establish the base rate of neuropsychological performance invalidity in electrical injury survivors using empirical methods and current practice standards. Patient and clinical variables, including compensation-seeking status, did not differ between validity groups; however, neuropsychological test performance did, supporting the need for multi-method, objective performance validity assessment.

Cardiac Arrhythmias in Patients with Electrical Injury: Hospital Based Study

Background: Electrical injury and its consequences after exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. The aim of this study was to evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury.&#x0D; Methods: All 50 consecutive patients who were admitted in Chitwan Medical College from April 2018 to March 2020 were prospectively studied. Patients were categorized into high and low voltage injury group and their variables were compared.&#x0D; Results: The mean age of the patients was 32.3±10.4 years among them 41 (82%) were male. Patients who sustain high voltage electrical injury (&gt;1000V) were 18 (36%) and low voltage injury (&lt;1000V) were 32 (64%). Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.2%, p=0.054), sinus bradycardia (11.1% vs 3.1% p=0.254), ventricular premature beats (5.6% vs3.1%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 84.4% p=0.560) and fatigue (55.6% vs 40.6%, p=0.328).&#x0D; Conclusion: In this study few non fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.

The effect of oral N-acetylcystein on prevention of extensive tissue destruction in electrical burn injury

BackgroundElectric burn patients usually suffer permanent injury and sequelae. Salvage of the zone of stasis is an important topic in the treatment of burn patients. N-Acetylcysteine (NAC), as an antioxidant, has effect on the saving zone of stasis and extensive rhabdomyolisis. The aim of this study was therefore to evaluate the effect of oral NAC on tissue destruction indicators in an electric burn rat model. Material and methodsAn experimental study was conducted with thirty six male Wistar albino rats divided into 2 groups. Group A (n=18) and group B (n=18) were electrical burn injury groups without and with NAC therapy, respectively. The extent of burn wounds were evaluated by planimetry using a digital wound measuring device. Blood samples were obtained to analyze creatine kinase (CK) levels as a marker of extensive rhabdomiolysis on the first hour after electric injury (baseline) and on the 7th day to see the antioxidant effect of NAC. ResultsA significant decrease in tissue destruction was seen by the necrotic area on day 7 in the NAC therapy group compared to the control group (mean 2.26±1.05cm2 versus mean 7.12±3.30cm2 respectively; p=0.001), which was confirmed by the level of serum CK (day 7: group A, mean 140±51U/L versus Group B, mean 102±6U/L; p=0.007). ConclusionA decrease in electric burn necrotic area and tissue damage in the group using NAC treatment was demonstrated. NAC might have a beneficial effect in the treatment of electrical burns. Further experimental and clinical studies with NAC treatment are necessary to confirm these results.

Changes in the expression of large-conductance calcium-activated potassium channels in dorsal root ganglion neurons after electrical injury in rats' sciatic nerves and its influence on sensory conduction function

Changes in the expression of large-conductance calcium-activated potassium channels in dorsal root ganglion neurons after electrical injury in rats' sciatic nerves and its influence on sensory conduction function

The Clinical and Medicolegal Analysis of Electrical Shocked Rats: Based on the Serological and Histological Methods

This research was aimed at discovering the serological and histological changes in cardiac and hepatic tissue after electric shock. The CK-MB, ALT, and AMS indexes were tested with serological methods. Moreover, the Bcl-2, Bax, and Hsp-60 expression levels were carefully measured. An electrical injury model was established by giving rats electric shocks at 110 V with alternating electric current. Blood samples from the rats were analyzed for the biochemical indexes. The degrees of pathological changes in the heart and liver were evaluated using IHC staining for Bcl-2, Bax, and Hsp-60. The levels of CK-MB in the electrical injury group rapidly peaked at 0.5 hours after the electric shock. Additionally, the levels of Bcl-2, Bax, and Hsp-60 in the cardiac and hepatic tissues changed regularly after the electrical injury and exhibited apparent differences from the levels in the control group. CK-MB, ALT, and AMS were altered regularly after electric shock, and these results provide significant information for clinical and medicolegal practice. This research has shed light on the assessment of electrical injury without obvious electrical burns. Furthermore, the findings obtained for Bcl-2/Bax and Hsp-60 can also facilitate pathological diagnosis and the identification of antemortem and postmortem electrical injury.

The effects of bromelain on angiogenesis, nitric oxide, and matrix metalloproteinase-3 and -9 in rats exposed to electrical burn injury

Abstract This study was aimed to investigate the effects of bromelain on angiogenesis, nitric oxide, and matrix metalloproteinase-3 and -9 in rats exposed to 1200 mV electrical burn injury. Thirty-five, male Wistar albino rats was divided into five groups (n = 7 each), including control (untreated) group; electrical burn injury (EI) group; electrical burn injury + 21.25 mg/kg BW bromelain group (EIB1); electrical burn injury + 42.50 mg/kg BW bromelain group (EIB2); and electrical burn injury + 85.00 mg/kg BW bromelain group (EIB3). Rat models of electrical burns done by providing electricity in rats that had been anesthetized, a voltage of 1200 mV and strong currents 15 mA for 10 s. The VEFG, NO, and MMP-9 levels were significantly greater in the EI group compared to the untreated group. Out of the 21.25 mg/kg BW, 42.50 mg/kg BW, and 85 mg/kg BW doses of Bromelain extract, only the lowest doses prevented EI-induced increase in NO and MMP-9 level (P

Changes in FABP1 and gastrin receptor expression in the testes of rats that have undergone electrical injury.

Testicular trauma may occur due to accidental electrical injury. The aim of this study was to investigate alterations in the levels of fatty acid-binding protein 1 (FABP1) and gastrin receptor (gastrin R) in the testes following electrical injury. Sprague-Dawley rats were divided into control, fatal electrocution (220 V, 50 Hz, 60 sec) and electrical injury (220 V, 50 Hz, 60 sec) groups (n=8 per group). The animals in the fatal electrocution and electrical injury groups were deeply anesthetized with sodium pentobarbital prior to each treatment, in which the current was delivered via an anode connected to the left foreleg and a cathode to the right hindleg. The rats that survived were subsequently sacrificed by cervical dislocation. Control animals received cervical dislocation alone. Immunohistochemical analysis was performed to evaluate the protein expression of FABP1 and gastrin R in the testes. Sections were evaluated by digital image analysis. The expression levels of FABP1 and gastrin R were significantly increased following electrical injury, supported by an increase in the integrated optical density (IOD) when compared with that in the control group (P<0.05). However, no significant difference was found in FABP1 and gastrin R expression levels between the fatal electrocution and control groups. In summary, the protein expression levels of FABP1 and gastrin R were found to be significantly altered by electrical injury, suggesting that these two proteins may be important in underlying mechanisms of testicular injury during electrical injury. The findings indicate that such alterations would be reflected in abnormal testicular function.

Endothelial progenitor cells lowering effect and compensative mechanism in electrical burn injury models of rat

This study aimed to investigate the effects of electrical injury on vascular damage and on matrix metalloproteinase (MMPs) levels. Thirty male Wistar albino rats were divided into five groups (n = 6), including a control group (untreated group), a 600 mv electrical burn injury group, a 900 mv electrical burn injury group, a 1200 mv electrical burn injury group, and a 1500 mv electrical burn injury group. Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were analyzed using flow cytometry. The levels of MMP-9, MMP-3, nitric oxide (NO), vascular endothelial growth factor (VEGF), and vascular cell adhesion molecule (VCAM) were assayed using an enzyme linked immunosorbent assay. Levels of EPCs were significantly lower in all electrical burn injury groups compared with the control group (p < 0.05). The levels of NO and VEGF were significantly increased in all electrical burn injury groups compared with the control group (p < 0.05). The levels of MMP-9 were significantly higher in the 1200 mv electrical burn injury group compared with the control group or the 900 mv electrical burn injury group (p < 0.05). There were no significant differences in MMP-3, VCAM, and CECs levels between groups (p > 0.05). This electrical burn injury model shows a significant decrease in endothelial progenitor cells and an increase in VEGF, NO, and MMP-9 as the compensating mechanism.

Connexin 43, Angiotensin II, Endothelin 1, and Type III Collagen Alterations in Heart of Rats Having Undergone Fatal Electrocution

Death due to accidental electrocution occurs frequently. The aim of this study was to investigate alterations in cardiac connexin 43 (Cx43), angiotensin II (Ang II), endothelin 1 (ET-1), and type III collagen associated with fatal electrocution.Twenty-four Sprague-Dawley rats were divided into control, fatal electrocution (220 V, 50 Hz, 60 seconds), and electrical injury (220 V, 50 Hz, 60 seconds) groups. Animals were deeply anesthetized with sodium pentobarbital before each treatment, with the anode connected to the left foreleg and the cathode to the right hindleg, followed by cervical dislocation. Control animals received cervical dislocation alone. Immunohistochemical analysis was performed to evaluate the cardiac protein expression of Cx43, Ang II, ET-1, and type III collagen. Sections were analyzed by digital image analysis.The expression of Cx43 was significantly reduced after fatal electrocution, with the integrated optical density also lower when compared with control (P < 0.05). Expression of both Ang II and ET-1 was significantly increased after fatal electrocution, supported by integrated optical density when compared with control (P < 0.05). But no significant difference was found in type III collagen expression between the fatal electrocution group and the control group.In summary, cardiac protein expression of Cx43, Ang II, and ET-1 was found to be significantly altered with fatal electrocution, suggesting that these 3 proteins may be important underlying mechanisms of death during fatal electrocution. The current findings indicate that such alterations would be reflected in abnormal cardiac function and a possible cause of sudden death.

Effect of Lidocaine on Reducing Injury in a Rat Electrical Burn Model

Electrical injuries induce progressive tissue loss. We evaluated the effect of lidocaine on tissue necrosis after electrical burn injuries. Forty-two male Wistar albino rats (250-300 g) were divided into 3 groups [Group A (n=6), control group without an electrical burn injury; and Groups B (n=18) and C (n=18), electrical burn injury groups without and with lidocaine therapy, respectively]. Three separate analyses were performed at different time points on 6 of 18 rats from Groups B and C at each time point. Electrical burns were induced by applying 220 V AC between the left upper and right lower extremities for 10 seconds. Myeloperoxidase and malondialdehyde levels were measured in skin and muscle biopsy specimens after the first hour, fresh and dry weight differences in the amputated extremities were calculated after 24 hours, and live and necrotic tissue areas were measured at 7 days after burn injury. We found that lidocaine reduced edema, the number of neutrophils, and neutrophil damage in tissues. We conclude that lidocaine decreased the amount of necrotic tissue caused by electric injury.

Fucoidin, a neutrophil rolling inhibitor, reduces damage in a rat electrical burn injury model

Background Electrical injuries induce progressive tissue loss caused by free oxygen radicals released from neutrophil aggregates. Fucoidin, a potent inhibitor of L-selectin function, reduces the aggregation of neutrophils. The aim of this study was to evaluate the effect of fucoidin on tissue damage in rat electrical burn injury model. Methods Forty-two male Wistar albino rats (250–300 g) were divided into 3 groups (Group A ( n = 6), control group without electrical burn injury; Groups B ( n = 18) and C ( n = 18), electrical burn injury groups without and with fucoidin therapy, respectively). Three separate analyses were performed at different time points on 6 out of 18 mice from Group B and C at each time point. Biochemistry (myeloperoxidase and malondialdehyde levels) and histopathology (number of neutrophils) of the skin and muscle biopsies at 1st hour; tissue edema (ratio of wet weight/dry weight of extremities) at 24th hour; and necrotic areas at 7th day after electrical injury were evaluated. The electrical burn was induced by exposing rats to 220 V AC between their left upper extremity and right lower extremity for 10 s. Fucoidin was administered as 25 mg/kg intravenous bolus injection at 15 min after electrical burn injury. Results Myeloperoxidase and malondialdehyde levels, number of neutrophils, tissue edema, and necrotic area were significantly less in fucoidin-applied rats than the group without fucoidin therapy. Conclusions Fucoidin inhibits tissue damage induced by electrical burn injury in rats by reducing necrotic area, edema and number of neutrophils.

Electrical Injury, Part II: Consequences

Electrical Injury, Part II: Consequences

MMPI-2 Patterns in Electrical Injury: A Controlled Investigation

The psychological consequences of electrical injury (EI) are many. Depression, posttraumatic stress disorder, anxiety, and somatic preoccupation are often concomitant with this type of injury (Kelley, Pliskin, Meyer, & Lee, 1994). The present study utilized the MMPI-2 as a tool for characterizing profiles of psychological distress in EI. We examined MMPI-2 profiles in 79 EI patients and their relationship to both injury parameters (i.e., time since injury, LOC, voltage), and extra-diagnostic factors, such as litigation status. EI patient profiles were also compared to individuals with mild traumatic brain injury (TBI), and chronic pain sufferers (CP). Results indicated that in EI, clinical elevations (T ≥ 65) were found on the Hs and Hy scales, and approached clinical levels on the D scale. The injury parameter of time since injury was predictive of a distinctive profile, with individuals in the post acute phase experiencing more distress. Compared to other clinical groups, MMPI-2 scores on the Hs and Hy scales were significantly higher within the EI cohort as compared with their CP peers, with higher scores on the Pd scale for CP than EI. No statistically significant differences emerged between the EI and TBI groups. However, TBI patients showed significant elevations on Hy and D compared to CP, and EI patients endorsed more somatic symptoms than CP patients. Implications of these findings and future directions will be discussed.

Neuropsychological symptom presentation after electrical injury.

This study explored the relationship of neuropsychological complaints to accident- and injury-related characteristics, affective state, and work status in a group of electrical injury (EI) patients. Sixty-three EI patients and 22 electricians with no history of electrical shock completed the Neuropsychological Symptom Checklist and the Beck Depression Inventory as part of an extensive neuropsychological evaluation. The EI group endorsed significantly more physical, cognitive, and emotional symptoms than did the controls. Symptom complaints were not related to injury parameters or litigation status. Only the time interval between injury and assessment accounted for differences in symptom presentation, with patients in the postacute stages of recovery showing the most cognitive and emotional complaints. The neuropsychological syndrome of electrical injury survival includes physical, cognitive, and emotional complaints. Considering that most electrically injured patients are treated within the acute medical setting, greater attention needs to be directed early in the course of treatment toward addressing neuropsychologic and psychiatric issues.