History Of Burns Research Articles

Marjolin’s ulcer

A 42-year-old lady presented with complaints of a slow growing fungating growth over the left shoulder of 3 months duration. This was associated with pain of 2 weeks duration and occasional sero-purulent discharge. Past history of burns to the upper torso, neck and back sustained 15 years ago was elicited. Physical examination revealed a large ulcero-proliferative growth involving the left shoulder and upper arm with areas of scarring and contractures adjacent to the lesion (Figure 1). There was no axillary adenopathy. Rest of the examination was unremarkable. Edge wedge biopsy revealed moderately differentiated squamous cell carcinoma. Computerized Tomogram (CT) of the thorax showed the tumor was infiltrating into the adjacent soft tissues, with no regional adenopathy or pulmonary metastases. The patient underwent wide local excision. Histopathological examination confirmed moderately differentiated squamous cell carcinoma with negative margins.

Atypical Symptom and Clinical Features of Right Atrial Myxoma: A Case Report

Cardiac tumors are rare in medicine. Myxomas are the most common benign cardiac tumors. Most myxomas (>80%) are found in the left atrium. The site of 15-20% of cases of myxoma is the right atrium. The incidence of cardiac myxoma peaks at 40 to 60 years of age. Most atrial myxomas occur sporadically and are more common in middle-aged women. Patients with atrial myxoma usually have one of the symptoms in the following tetrad: embolic phenomena, intracardiac flow obstruction, arrhythmias and constitutional symptoms. The modality of choice for diagnosis of cardiac myxoma is an Echocardiography. Surgery should be considered promptly, because embolic complications or sudden death can be occured. This surgery is usually safe with low morbidity and mortality. Operative mortality is reported to be within 5%, and will be increased with myxoma occurring in the ventricle. Our case was a 47-year-old Iranian male with right atrial myxoma and a history of heart burn, he does not mention fever and chill, cough, chest pain or dyspnea. In CT Angiography of pulmonary artery showing pulmonary thromboembolism. After echocardiography and pulmonary CT angiography he underwent cardiac surgery and mass with adhesion to the right atrial wall near the IVC was excised. The patient was discharged after surgery with good general condition and stable vital signs.

Chemical injury with “packet of chunna” (lime) in children: A major ocular health concern in central rural India

Purpose: The purpose of the study is to report the hazardous effect of chunna packet (lime) on ocular surface in terms of pattern of presentation and visual outcome in children. Materials and Methods: Children of age <16 years with definitive history of chemical injury with chunna packet were analyzed. Ocular chemical injury was graded according to Modified Roper Hall grading system. Best corrected visual acuity (BCVA) and anterior segment examination evaluation were compared at time of presentation and at 3 months and categorized on the basis of WHO visual disability classification. Likelihood ratio of BCVA with time of presentation and grade of injuries were calculated using Pearson's correlation coefficient. Results: Eighty eyes of 74 children with a history of ocular burns resulting from lime were included in the study. Of these, 6 patients had bilateral burns. Mean age at the time of injury was 8.44 ± 4.29 years. Many children presented late after 3 weeks of injury (n = 24, 32.4%). The most common grade of injury was Grade 4 (n = 31, 38.8%). Clinical presentations were corneal haze (55%), limbal ischemia (65%), lime particle in fornix (36.2%), corneal scar (33.7%), and symblepharon (22.5%). Surgical intervention was advised in 54 eyes (67.5%) in the form of amniotic membrane grafting, symblepharon release, limbal stem cell transplantation, and tectonic keratoplasty. Mean BCVA at presentation was 1.65 ± 0.99 and at 3 months was 1.39 ± 1.03. Conclusion: Grade of injury and time of presentation were strongly associated with visual outcome in cases of chemical injury with chunna packet.

Burn Hemangioma: A New Variant of Hemangioma

Background: Burn hemangioma, also known as scalded pyogenic granuloma, is considered a variant of pyogenic granuloma, but unlike the classic type it presents with rapid progression. Most patients are infants and young children with a history of burns caused by liquids. Objective: The present study aims to present all patients with burn hemangiomas treated at our institutions with a full clinical and histopathological assessment. Patients and Methods: This case series includes 34 cases that were treated during the period from 2016 to 2021. Results: A total of 34 patients (16 female/18 male, mean age of 17.6 years) were included. Two age groups presented: infants and children (n = 22, age range 0.5–8 years, 10 female/12 male), and adults (n = 11, age range 25–44 years, 6 female/6 male). Lesions appeared 1–2 weeks following predominantly second-degree burns, and multiple lesions predominated in infants and children. The lesions evolved to large lesions within weeks, and these appeared to be either static or involute. The histopathology was compatible with hemangioma, rather than pyogenic granuloma. Conclusion: Burn hemangioma should be considered a new variant of hemangioma rather than a type of pyogenic granuloma that follows second-degree burns. They have many similarities with infantile hemangioma, both clinically and histopathologically.

Versatility of Reverse Sural Artery Flap for Coverage of Heel and Proximal Foot Defects in Children

Objective: The objective of the study was to determine the versatility of reverse sural artery flap in terms of its reliability and efficacy for reconstruction of soft-tissue defects of heel and proximal foot in children. Material and Methods: A total of 30 patients aged 5-13 years with ankle and foot defects admitted to the Plastic Surgery and Burn department at the Sheikh Zayed Hospital, Rahim Yar Khan from January 2018 to July 2020 were studied by designing a retrospective cross-sectional case series study. Results: Out of 30 flaps, 26 (86.7%) healed fully, whereas 4 (13.3%) complicated by partial necrosis requiring a secondary procedure. Nineteen (63.3%) patients had wheel spoke injuries, eight (26.6%) sustained degloving injury after a road traffic accident, and three (0.1%) patients were having a history of electric burn. In 22 patients an interpolated flap was used and in 8 cases an islanded flap. Donor sites were skin grafted in all patients. Two patients developed hypertrophic scarring at donor area. All patients showed good functional results, however flap remained insensate throughout the follow-up period that was minimum for 6 months. Conclusion: The reverse sural artery flap is versatile, reliable and a method of choice in reconstructing soft-tissue defects of the hind foot in children. This flap is easy to dissect, has robust blood supply and does not sacrifice any major blood vessel of the leg. Key Words: Reverse Sural Artery Flap, children, Ankle and Foot, Soft-tissue Defects, Wheel Spook Injury

Factors Associated with Non-Melanoma Skin Cancer (NMSC) Among Chronic Lymphocytic Leukemia (CLL) Patients

Background: The incidence of NMSC in patients with CLL is significantly higher compared to age- and sex- matched controls. Herein, we evaluate factors associated with risk of NMSC post-CLL diagnosis, including CLL clinical and prognostic characteristics, history of UV radiation exposure, severe sunburn, and combined genetic score of single nucleotide polymorphisms (SNPs) associated with NMSC.Methods: CLL patients newly diagnosed from 2002-2015 were enrolled and systematically followed by the Mayo Clinic/University of Iowa Lymphoma SPORE. Clinical and prognostic CLL data were obtained from the Mayo Clinic CLL database. NMSCs were abstracted both from medical records and from patient self-report. Self-reported history of the extent of mid-day sun exposure (h/week) at various ages (<13, 13-21, 22-40, >40 yrs) and severe sunburn were obtained from a risk factor questionnaire. The CLL International Prognostic Index (CLL-IPI) was computed as established using a weighted average of five independent CLL prognostic factors (IGHV mutational status, serum b2-microglobulin, Rai stage, age at CLL diagnosis and FISH 17p deletion/ TP53 status). CLL treatment was classified as positive if a person received T-cell immunosuppressive treatments that are purine analogue and/or alemtuzumab based treatments. All other therapies were combined into an “other category”. We computed a polygenetic risk score (PRS), a weighted average of the number of risk alleles across 13 SNPs that are known to be associated with NMSC, with the weights being the log of the odds ratio reported for each SNP. To evaluate associations with risk of NMSC post-CLL diagnosis we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). CLL treatment was considered a time-dependent covariate in the analysis.Results: Among 1269 CLL patients, the median age at diagnosis was 63 years (range 24-91), 68% were male, and 6% had Rai stage III-IV at diagnosis. Based on the CLL-IPI, 44% were low risk, 34% intermediate risk, and 22% high/very-high risk. 9% of the CLL cases had prior history of NMSC and 44% reported history of severe sun burn. At a median follow-up of 7 years from CLL diagnosis, 196 patients had ≥1 NMSCs post-CLL diagnosis. Among these patients, 45 also had NMSC before CLL diagnosis. The most frequent NMSC was squamous cell carcinoma (63%), followed by basal cell (55%), and Merkel cell (1%). 264 patients received T-cell immunosuppressive treatments prior to NMSC diagnosis or prior to last follow up. Significant associations of clinical and prognostic characteristics with risk of NMSC post-CLL diagnosis were observed for age (HR=1.42 per 10 year increase, CI=1.24-1.62), male sex (HR=1.43, CI=1.04-1.97), prior history of NMSC (HR=3.85, CI=2.75-5.39), and CLL-IPI (HR=1.36, CI=1.13-1.64, adjusted for sex and prior NMSC). Mid-day sun exposures for each of the age groups considered showed no evidence of association with risk of NMSC post-CLL diagnosis; however, history of severe sunburn was significantly associated (HR=1.58, CI=1.06-2.36, adjusted for sex, CLL-IPI and prior NMSC). We observed an association between T-cell immunosuppressive treatments with risk of NMSC post-CLL diagnosis (HR=1.65, CI=1.14-2.40, adjusted for age, sex and prior NMSC). PRS was also associated with the risk of NMSC post-CLL diagnosis (HR=1.82, CI=1.21-2.72, adjusted for sex, CLL-IPI and prior NMSC).Conclusion: Screening for NMSC is important in CLL patients, and our data suggest that it is particularly important among patients with aggressive CLL according to CLL-IPI score, those receiving T-cell immunosuppressive treatments that are purine analogue and/or alemtuzumab based treatments, those who have a prior history of NMSC, or history of severe sunburn. PRS was also a significant factor in the risk of NMSC among CLL patients. Future studies should develop prediction models that include these factors. [Display omitted] DisclosuresKay:Tolero Corporation: Research Funding; Gilead: Research Funding; Agios: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Research Funding. Shanafelt:Genentech, Celgene, Pharamacyclics, Jansen, GlaxoSmithKline, AbbVie, Hospira, and Cephalon: Research Funding. Cerhan:Janssen: Other: Multiple Myeloma Registry Steering ; Janssen: Other: Scientific Advisory Board (REMICADELYM4001).

Investigating factors affecting the interval between a burn and the start of treatment using data mining methods and logistic regression

BackgroundBurn is a tragic event for an individual, the family, and community. It can cause irreparable physical, mental, economic, and social injury. Researches well documented that a quick visit to a healthcare center can greatly reduce burn injuries. Therefore, the aim of this study is to identify the effective factors in the interval between a burn and start of treatment in burn patients by comparing three classification data mining methods and logistic regression.MethodsThis cross-sectional study conducted on 389 hospitalized patients in Imam Khomeini Hospital of Kermanshah city since 2012 to 2015. The data collection instrument was a three-part questionnaire, including demographic information, geographical information, and burn information. Four classification methods (decision tree (DT), random forest (RF), support vector machine (SVM) and logistic regression (LR)) were used to identify the effective factors in the interval between burn and start of treatment (less than two hours and equal or more than two hours).ResultsThe mean total accuracy of all models is higher than 0.8. The DT model has the highest mean total accuracy (0.87), sensitivity (0.44), positive likelihood ratio (14.58), negative predictive value (0.89) and positive predictive value (0.71). However, the specificity of the SVM model and RF model (0.99) was higher than other models, and the mean negative likelihood ratio (0.98) of the SVM model are higher than other models.ConclusionsThe results of this study shows that DT model performed better that data mining models in terms of total accuracy, sensitivity, positive likelihood ratio, negative predictive value and positive predictive value. Therefore, this method is a promising classifier for investigating the factors affecting the interval between a burn and the start of treatment in burn patients. Also, key factors based on DT model were location of transfer to hospital, place of occurrence, time of accident, religion, history and degree of burn, income, province of residence, burnt limbs and education.

Determination of factors affecting prevention of burns among children under five years old using PRECEDE model: A cross-sectional study in urban and rural populations

BackgroundBurns are one of the most important childhood injuries that can be controlled and prevented. Mothers play an important role in preventing child burns. Health education and promotional theories facilitate a precise recognition of the behavioral factors in mothers that help preventing burn injury in their children. Burns in children under five years old and the factors in prevention of burn by their mothers were examined using PRECEDE Model. The study environment was rural and urban areas of Kermanshah, Iran. MethodsThis cross-sectional study was conducted on 330 mothers in urban and rural areas of Kermanshah County in the west of Iran. The participants were randomly selected among mothers who had at least one child younger than five years old. Data was collected through interviewing the mothers using a valid and reliable questionnaire. The questionnaire included questions on demographic characteristics, PRECEDE Model, and history of burn. The data were analyzed using SPSS-16. ResultsThe mean age of the mothers in urban areas (29.33 ± 5.987) was higher than that of those in rural areas (28.77 ± 6.236). More than 90% of the mothers were housewives, both in urban and rural areas. The rate of a history of burn in rural children under the age of five (8.3%) was greater than that in urban children (5.2%). Most of the burn cases in urban areas were mild whereas those in rural areas were moderate. The majority of burn cases had happened at home in children 1−3 years’ age range; this rate was higher in boys. The majority of burns cases had happened when the child was playing (urban: 64.3%, rural: 100%). In addition, liquids and hot objects were the main causes of the burns (urban: 78.5%, rural: 100%). Among the constructs of PRECEDE models in the urban areas, knowledge (P < 0.001), attitudes (P = 0.027), and environmental factors (P = 0.03) had a significant relationship with burn-preventive behaviors in mothers. In addition, in the rural areas, attitudes (P = 0.038) had a significant relationship with burn-preventive behaviors in mothers. ConclusionBurn was an important injury in the study population, especially in the rural areas. The PRECEDE model can help us to identify the factors in burn injuries in children and the preventive behaviors in mothers. The findings can be used to develop preventive interventional programs to better protect this vulnerable group in society.

A deviant behaviour of squamous cell carcinoma of eyelid: Rare case report

Squamous cell carcinoma (SCC) is a malignant tumour of the squamous cell layer of the epidermis accounting for about 9.2% of all eyelid malignancies. We report a case of a 45 year old female patient presented with itching, sticky discharge and swelling over the right upper eyelid (RUL) for 20 days. Initially, it was diagnosed as a case of blepharitis of Right Eye and antibiotic eye ointment and lubricants were prescribed. And 2 months later she presented with a mass over the same site. Past history of trauma, burn and chronic exposure to sunlight was absent. Examination revealed a mass of 1.25cm -1.50cm width &amp; 1cm - 1.25cm in height approximately, shape was irregular &amp; firm in consistency. Eyelid margin contour was lost with loss of eyelashes. Other ocular structures were within normal limits. No associated lymphadenopathy was noted. Incisional biopsy of the mass was suggestive of moderately differentiated SCC. Wide excision of the mass was done. Full thickness defect of the upper eyelid was reconstructed with Cutler - Beard technique. : Wide variation at presentation, delay in diagnosis and high propensity to recur with risk of perineural spread leads to difficulty in management. Therefore, any suspicious lesion eyelid lesion should be excised and biopsied.

Anxiety and Depression Among Non-Facial Burn Patients at a Tertiary Care Center in Pakistan.

Introduction: A patient who suffers from burn injuries can be subjected to various mental and psychological conditions that can adversely affect their health and wellbeing.Material and methods: A cross-sectional study was conducted between 1st September 2019 and 30th March 2020 in a tertiary care hospital in Pakistan. Patients were selected in the outpatient department and follow-up was done at two and four weeks following definitive. Some 225 patients in our study fulfilled the inclusion criteria. Patients were assessed using Urdu translated scales. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used. Data were analyzed with the help of SSPS software version 13.0.Result: Out of 119 (52.8 %) male patients, the highest percentage was of accidental injuries 106 (89%) followed by suicidal burns 9 (7.5%). A similar trend was seen in females; out of n=106 females, 92 (86%) presented with accidental burn injuries and only 11 (10%) patients have a history of suicidal burns. A fraction of the sample had a history of homicidal burn injuries, with 4 (3%) male and 3 (2%) female patients.The variation of anxiety level and depth of burn varied considerably. Among patients who suffered superficial thickness burns (n=105, 47%), 69.5% of patients experienced mild anxiety symptoms. Only 28 (26.6%) patients had moderate anxiety and severe anxiety was the lowest, at only 3.8% (n=4). A similar trend was observed in deep burn patients, but the level of severe anxiety was significantly higher at 26%. This was statistically significant (p < 0.05).Deep burn patients had the highest percentage (n=54, 45.3%) of very severe depression compared to only 10% in superficial burns. The variation between the two categories was statistically significant (p < 0.05). The majority of (35.2%) patients experienced mild symptoms of depression and this correlated with superficial burn injuries.Conclusion: A burn injury can seriously affect the mental wellbeing of patients. With the severity of burn injury we saw that severe depression was prevalent. This aspect must be taken into consideration when treating such patients and it warrants a multidisciplinary team (MDT) strategy.

MANAGEMENT OF ACCIDENTAL THERMAL BURNS DUE TO BURNING OF HOUSEHOLD WASTE IN RURAL AREAS OF KERALA: AN INSTITUTIONAL STUDY

Aim: The aim of this study was to and out epidemiology and treatment of thermal injuries due to burning of household waste, a common practice in rural areas of Kerala. Material And Methods: Prospective study was carried out in the department of burns and plastic surgery from 1stJanuary 2018 to 29th February 2020. All patients with history of burns due to burning of household waste in rural areas of Kerala during this period were included in our study.Patients were managed with conservative management or surgical debridement and split thickness skin graft. Hyperbaric oxygen therapy was given as an adjunct. Results: A total of 670 patients were admitted in our burnsdepartment out of which 75 patients were due to burning of householdwaste. Thirty-three patients were male and Forty-two patients were female. Most of them had around 10-30 percent thermal burns. Mortality was 6.6 percent. Most of the burns involved lower extremity and upper extremity. Conclusions: Burning of household waste is a common practice in outskirts of Kerala which leads to accidental burns resulting in a signicant number of admissions in our hospital. Proper awareness and facility for waste disposal is needed to avoid burn injuries due to burning of waste in rural areas.

Opposite-Running Double Abdominal Flap on Single Pivot Point (Udaipur Flap) for Circumferential Coverage of Wrist and Hand.

Complete or near circumferential defects over wrist and hand are difficult situations. They need flaps so long that available adjacent, distant or free flaps often seem inadequate. Hence, this innovative solution was designed. Twin axial flaps were elevated along an oblique axis over abdomen, extending in opposite directions while being pedicled and pivoted at about the same transverse plane. The flaps wrapped the limb from either side and gave complete coverage. Donor sites were closed directly or skin grafted. Three weeks later flap division was done, often after a delay procedure. The technique was used in 6 cases. All patients were young males with history of electrical burns or trauma resulting in total or near circumferential defect. Required length of flaps ranged from 15 to 26 cm with length/breadth ratio ranging from 3:1 to 5:1. Double abdominal flaps could cover all the exposed structures. Limb positioning was comfortable. All flaps survived; all limbs were salvaged. The cover was soft, supple, and pinchable. This is a simple yet effective flap design to address the difficult problem of circumferential defects at hand. The conceptualization and success of this flap system may be attributed to the understanding of patterns of cutaneous vasculature discovered by Ian Taylor. When the vascular axes in a region are known, the same can be exploited to design more than 1 flap in desired orientation. In conclusion, this "Undulate-design Double Abdominal flaps Insertion-Pouch for Upper limb Reconstruction" is a new and effective solution for circumferential defects of wrist and hand.

Reasons for Initiation of Areca Nut and Related Products in Patients with Oral Submucous Fibrosis within an Endemic Area in Gujarat, India

Background: While the patterns of consumption of areca nut and its by-products (ANBP) vary across South Asia and the rest of the world, all users share the probable severe outcome of oral submucous fibrosis (OSMF), and this is well reported. The role of psychosocial drivers of habit initiation and addiction is reported less. Objective: To reveal the burden of ANBP abuse, exploring the psychosocial relationship between sex, age at first exposure (AFE), the reason for initiation (RFI) with the type of habit (TOH). Methodology: Data came from the prospective hospital-based study conducted at K.M. Shah Dental College and Hospital covering years 2017 and 2018. Patients with oral lesions were assessed with complete history recording demographics, TOH, AFE, RFI, duration of habit, and clinical diagnosis of any oral and systemic diseases. Patients with a history of scleroderma, facial burns, and oral malignancy were excluded. Results: Of the 13,874 patients, 9.89% reported ANBP. We included 1000 OSMF patients. The mean age of the study cohort was 38.97 ± 14.29 years, with a range of 17–75 years. Males constituted the majority (80.1%). The most common TOH reported was regular use of gutkha (60.1%) followed by mawa (31.4%) with tension and stress (30.3%) being the most common RFI among the cohort. TOH was notably different in relation to AFE. Interestingly, mawa chewing (38.69%) was observed more in females. Importance: This study reveals the burden of ANBP abuse and reports the complex psychosocial relationships between sex, AFE, and RFI with TOH in OSMF patients in this high incidence population.

Recurrence Rate of Primary Pterygium Following Excision with Mitomycin C versus Excision with Amniotic Membrane Transplant

Purpose: To compare recurrence rate of primary pterygium following excision with mitomycin c verses excisionwith amniotic membrane transplant.Study Design: Quasi experimental study.Place and Duration of Study: Qazi Hussain Ahmad Medical Complex, Nowshera, from January 2019 to June2019.Material and Methods: One hundred and two patients presenting for the first time with pterygium were includedin the study and were divided into two groups. Patients having conjunctivitis, blephritis, keratitis or any otherocular inflammatory condition and patients having history of chemical burns and symblepharon were excludedfrom the study. Group A underwent surgical excision with 0.02% mitomycin–C application for 3 minutes andGroup B was surgically treated with application of amniotic membrane. Patients of both groups were followed upfor six months to detect recurrence of pterygium. Data was analyzed using SPSS version 20. Frequency andpercentages were calculated for categorical data like age, gender and recurrence rate. Recurrence rate wasstratified among age and sex to see the effect modifiers.Results: Mean age in both groups was 39.98 ± 9.11 years. In group A, 64.70% patients were males and in groupB, 62.74% patients were male. Recurrence of Pterygium was seen in 21.5% patients in group A and 7.84% ingroup B. The difference was statistically significant with a p value of 0.05.Conclusion: Recurrence rate of primary pterygium following excision with mitomycin C is higher than excisionwith amniotic membrane transplant

Awareness and attitude of general population regarding allograft skin donation in Riyadh, Saudi Arabia: Cross-sectional study

IntroductionBurns are one of the major health issues that considerably affect variable groups of the population, varying in age and severity. Despite advances in burn surgical and non-surgical treatments, patient's appearance still represents public health issue. In regards to surgical treatment of burns, skin grafting is still considered the gold standard. One of the major burdens in the burn surgical treatments is the availability of the skin for grafting. As for the non-surgical treatment different modalities of skin dressings or substitutes are still available as an option. MethodsA validated questionnaire based study was utilized to acquire assessment of the overall general population knowledge, awareness and attitude toward skin donation. In addition, it surveyed community personal willingness to donate their skin to a skin bank after being deceased, to help solve skin shortages due to the lack of skin banks in Saudi Arabia. ResultsA total of 698 individuals completed the questionnaire over the period of 5 months, from February 2018 till June 2018. Married, postgraduate females, with a history of burn in close family members or similar individuals showed a positive attitude toward skin donation. However, 22% of the participants did not agree to donate their skin due to religious reasons. ConclusionThe study concluded that the majority of participants were willing to donate their skin, and they were aware of the concept of skin donation and its crucial importance in surgical burn management. The current study showed the majority of participants were aware of skin donation and skin use for burn treatment, in addition to having positive attitude toward skin donation. Men were more aware than the women of skin donation. Religious concern was a major reason for participants’ skin donation refusal, an issue that can be addressed by contacting Islamic scholars to issue a Fatwa approving the cause.

Early debridement with physiotherapy for prevention of postburn contracture of neck: a case series

Hypertrophic scars and contractures are well known sequelae after burns. They result in high morbidity in severely burned patients who are surviving. Present case study was done to establish the usefulness of early debridement and physiotherapy in preventing these sequelae. Present study was conducted on patients admitted in a tertiary care hospital on patients with alleged history of thermal burns to neck and upper chest over a period of 6 months. These patients were subjected to early debridement, daily dressings and early neck physiotherapy. They were assessed for neck mobility and development of neck contracture. Three patients were studied, two had a favourable outcome due to adherence to above measures while one developed contracture due to her late presentation and non-compliance to early physiotherapy. Post burn contractures are common sequelae of thermal burns involving the neck region. Early Debridement, daily dressing of the raw areas with starting of early neck physiotherapy are important and prove beneficial in preventing neck contractures with early return to normal daily activity.

Current problems in burn hypermetabolism

Hypermetabolism remains a significant clinical problem after burn. Every organ system is transformed metabolically in response to severe burn trauma. With long-term consequences including cardiac dysfunction in as many as 60% long term,1 growth arrest for nearly a year after burn in children,2 and high incidence rates of depression, anxiety, and posttraumatic stress disorder(PTSD),3 the metabolic changes after burn clearly have far reaching and long lasting detrimental effects. The history and recognition of burn (and traumatic) hypermetabolism has an extensive history, with the principal changes beginning in the 1930s. Cuthbertson and colleagues monitored metabolism via nitrogen balances in healthy humans, patients with fractures, and patients with sepsis. Their preliminary studies revealed that increased nitrogen losses and temperature changes between the groups were not simply localized to the exact source of infection/trauma but involved a systemic response.4, 5 This concept of a systemic hypermetabolic response to trauma was extended to burns in the 1940s with various authors. Cope and colleagues monitored various aspects of burn hypermetabolism including oxygen consumption and thyroid function, while Truman Blocker monitored muscle protein breakdown using radiolabeled albumin.6, 7 Francis D. Moore and others then furthered the understanding of burn hypermetabolism in the early 1940s by further quantifying the causes of hypermetabolism, including sources of nitrogen and exudative ion losses.8, 9 Subsequently, Dr. Moore began using patient weights to guide fluid resuscitation and feeding, noting that weight loss signified a dire situation in trauma and burn patients, in part reflecting severe electrolyte and nutritional deficiencies.10 Based on their research, resuscitative protocols for severely burned individuals emerged.9 In the 1960s and 1970s, research continued to define key mediators of the systemic responses to trauma and burns. Moore and colleagues observed endocrine alterations in response to trauma, including elevated cortisol and catecholamine levels and decreased growth hormone levels.10-12 These contributions spawned further investigation in the field of burn hypermetabolism that would eventually provide a better understanding of this stress response while leading to therapeutic strategies that improve survival of patients with severe burns. The initial response to burns has 2 specific phases. An initial “ebb” phase during the first 1 to 3 days after-burn is characterized by a decrease in tissue perfusion and temporary decrease in metabolic rate similar to a short lived “fight or flight” response, possibly to preserve vital organ functions and central blood flow. Thereafter, a the hypermetabolic “flow” phase is initiated (Fig. 1), characterized by increased perfusion of superficial tissues, increased adrenergic stress, increased glucocorticoid levels, and increased levels of inflammatory cytokines. These alterations in hormone and cytokine levels drive many energy dependent biochemical processes in response to severe burn trauma, collectively resulting in a hypermetabolic response that necessitates a drastic increase in the caloric needs of severely burned individuals.13, 14 Therefore, the hypermetabolic response can be defined as an increase in the whole body oxygen consumption and resting metabolic rate. This response is created by various modifications in protein turnover, hepatic acute phase response, mitochondrial uncoupling, and various other metabolic pathway modifications, and has now been shown to last up to 2 years after-burn (Table 1).15 Open in a separate window Figure 1: Simulation of the overall timeline of the hypermetabolic response, with the ebb phase occurring in the first 1-3 days, and the flow phase occurring subsequently, and resolution (depending on which hormone/aspect is examined) occurring at some point during the next 2 years.

LB1126 Sunburn history in relation to melanocytic nevus count in children: A systematic review and meta-analysis

Melanocytic nevus count is a major risk factor for potentially fatal cutaneous melanoma, but its association with sunburns has not been well established in young children. We sought to review the literature on sunburn history and nevus development in young children. Of the total 197 publications that resulted from our PubMed search in February 2019, eight met inclusion criteria of case-control or cohort study design; included data on nevus count and lifetime history of sun burns; studied children, over half of whom were under the age of twelve years; and was published in English. We further conducted a meta-analysis of studies that provided risk estimates for continuous nevus counts (outcome) and dichotomous history of sunburn (exposure). Our preliminary meta-analysis using random effects model generated a pooled estimate of standardized mean differences (SMD) from three studies, and another pooled estimate of rate ratios (RR) from the five other studies. Due to the skewed nature of nevus counts, both estimates were created using natural logarithmic scale and then transformed to the linear scale for ease of interpretation. The results of this review support the association between positive history of sunburn and nevus count: SMD of 1.44[95%CI 1.33,1.56] and RR of 1.16[95%CI 1.12,1.18], respectively). Based on the available evidence, our results support childhood as being a vulnerable window for later nevus development, but further data are needed to determine the timing in which this occurs.

Impact of childhood burn injuries on breastfeeding: a case report

BackgroundPre-pubescent girls with chest burns are at risk of complication associated with scarring and impairment in breast development. This case illustrates how burn injuries in childhood in a first-time mother have affected her in terms of breastfeeding.Case presentationIn May 2015, a 20 year old first-time mother at 36 weeks gestation was seen in a district health clinic in Kuching, Sarawak in regards to her ability to breastfeed. She had a history of a flame burn at the age of 5 years old to her chest, abdomen, upper limb and part of her trunk. A skin graft was done on her whole chest and abdomen. Despite the injuries, she had pubertal and antenatal breast development. Her abdomen was able to stretch to accommodate her pregnancy. Physical examination showed a pregnancy which corresponded to date. The skin over her chest and abdomen appeared tight with areas of hyperpigmentation and hypopigmentation due to scarring from the skin graft. Breast tissues were palpable over her chest. The areola and nipple tissue were completely absent with complete scarring of the nipple-areolar complex. There was no duct opening to the areola for milk expression or leakage. Counselling regarding her breastfeeding issues was done. She delivered her baby at full term via spontaneous vaginal delivery with no complication. Oral cabergoline 1 mg was given on the first day postpartum. The baby was given infant formula via bottle feeding as the feeding method of choice.ConclusionCounselling plays an important part in the management of a mother with breastfeeding difficulty. Allaying the possible guilty feelings of not being able to breastfeed will fulfil the emotional gap which may arise in a mother with these challenges.

The evaluation of spontaneous Descemet's membrane reattachment using swept-source optical coherence tomography: a case report.

A 29-year old man presented with a history of facial burn in August of 2017. Slit lamp examination revealed significant central corneal stromal scarring in the right eye. The patient received deep anterior lamellar keratoplasty (DALK) in the right eye. Three weeks post operatively, the patient was found to have recurrent corneal edema on slit lamp exam, and standard anterior segment optical coherence tomography (OCT) revealed a central detachment of Descemet’s membrane.