Hospital Burn Unit Research Articles

Prognostic Scores for Mortality in Invasive Mechanically Ventilated Burn Patients.

Managing burn patients is a challenge requiring a multidisciplinary team with the ability to predict complications and act early to avoid them. There are few studies characterizing the population of critically ill burn patients in need of ventilatory support. This study aimed to describe the population of burn patients in need of invasive mechanical ventilation supportand assess in-hospital mortality and the factors associated with it. A longitudinal retrospective study was conducted, including burn patients admitted to a tertiary hospital burn unit over five consecutive years, who required invasive mechanical ventilation support during their hospitalization. Demographic data, comorbidities, characteristics of the injury scene, etiology, and characteristics of the burn were collected.Length of mechanical ventilation and hospitalization as well as mortality rate were evaluated.The determination of mortality predictors and the prognostic performance of mortality prediction scores were analyzed. A one-year follow-up was performed to evaluate the survival of discharged patients. A total of 141 patients were included in this study; 68.1% patients were malewith a median age of 58 years. The mean percentage of total body surface area (TBSA) burned was 24.5%. Home incidents were the most frequent, and fire was the most common cause of burns (80.9% of patients). The mean Abbreviated Burn Severity Index Score (ABSI) was 7.83, with an area under the curve in receiver operating characteristic curve (ROC) analysis (AUC_ROC) of 0.725; the mean Belgium Outcome of Burn Injury (BOBI) score was 3.45, with AUC_ROC of 0.740 and mean R-Baux of 89.1 and AUC_ROC of 0.834. The mean duration of invasive mechanical ventilation was 16.9±19.3 days. Age (p<0.001), length of mechanical ventilation (p<0.001), length of hospitalization (p<0.001), higher degree of burn (p=0.001), TBSA (p=0.040), and the presence of buttock burn (0.006) were associated with mortality in this sample. In-hospital mortality was 29.8%. The survival group had a 12% death rate at one-year follow-up, mostly in the first three months after discharge. Age, duration of mechanical ventilation, length of hospitalization, higher degree of burn, TBSA, and the presence of buttock burn were associated with mortality in this sample. R-Baux score was the most accurate test score to predict mortality in this challenging group of patients.

In vitro study: methylene blue-based antibacterial photodynamic inactivation of Pseudomonas aeruginosa

Pseudomonas aeruginosa is one of the most antibiotic-resistant and opportunistic pathogens in immunocompromised and debilitated patients. It is considered the cause of most severe skin infections and is frequently found in hospital burn units. Due to its high antibiotic resistance, eliminating P. aeruginosa from skin infections is quite challenging. Therefore, this study aims to assess the novel in vitro antibacterial activity of methylene blue using a 635-nm diode laser to determine the effective power and energy densities for inhibition of P. aeruginosa. The strain was treated with various concentrations of methylene blue and 635-nm diode laser at powers of 300 mW/cm2 and 250 mW/cm2. The diode laser’s potency in the photo-destruction of methylene blue and its degradation through P. aeruginosa were also evaluated. Colony-forming unit (CFU)/ml, fluorescence spectroscopy, optical density, and confocal microscopy were used to measure the bacterial killing effect. As a result, the significant decrease of P. aeruginosa was 2.15-log10, 2.71-log10, and 3.48-log10 at 60, 75, and 90 J/cm2 after excitation of MB for 240, 300, and 360 s at a power of 250 mW/cm2, respectively. However, a maximum decrease in CFU was observed by 2.54-log10 at 72 J/cm2 and 4.32-log10 at 90 and 108 J/cm2 after 300 mW/cm2 of irradiation. Fluorescence images confirmed the elimination of bacteria and showed a high degree of photo-destruction compared to treatment with methylene blue and light alone. In conclusion, MB-induced aPDT demonstrated high efficacy, which could be a potential approach against drug-resistant pathogenic bacteria.Key points• Combination of methylene blue with 635-nm diode laser for antibacterial activity.• Methylene blue photosensitizer is employed as an alternative to antibiotics.• aPDT showed promising antibacterial activity against Pseudomonas aeruginosa.

Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review.

This study aimed to compare factors contributing to a positive outcome of adult burn injury patients managed at two primary and one tertiary level Western Cape hospitals. These patients from the primary hospitals (PLHs) met the referral criteria for specialised care at the Tygerberg Hospital burns unit (TBU) but were not accepted or were accepted late. A total of 1034 adult burn injury patients seen at two primary level ("A" and "B") hospitals and the TBU between 2016 and 2019 were retrospectively analysed. One hundred and eleven (111) primary level patients ("A" 71, "B" 40) met the criteria for referral to the TBU. The outcomes and factors contributing to positive outcome of these patients were compared with the 859 patients treated at the TBU during the same period. Patients treated at the TBU showed longer theatre waiting times, more operations, and higher complication and death rates than their primary level counterparts. The PLHs showed no factors significantly contributing to hospital discharge. At TBU, pregnancy status, younger age, hot water burns, lower abbreviated burns severity index (ABSI) score, and longer time to theatre were associated with hospital discharge. A shortage of beds was the main reason for denial of admission to the TBU. The PLHs showed good outcomes in managing severe burn injuries, although no significant contributors to a positive outcome were identified. Patient- and facility-related factors contributed to positive outcomes at the TBU. Upgrading both the Western Cape's primary level capabilities and the TBU's accessibility and efficiency are necessary to improve burns services.

Outcomes of burns patients in a developing country: A single centre's experience.

Pelonomi Tertiary Hospital is the only hospital in the Free State Province with a burns unit. We do not have official data to assess our performance in the management of burns. To determine the Lethal Area 50 (LA50) index for the Pelonomi Tertiary Hospital's burns unit. Furthermore, to determine the morbidity that affects burns patients at the institution, and the factors associated with outcomes. We used Redcap to capture demographic and clinical data of burn patients admitted to our institution between January 2014 and December 2018. Logistic regression was used to determine significant predictors of the outcomes. The LA50 was calculated by performing a probit regression of survival by total body surface area (TBSA). We used SAS 9.4 statistics software package. Our study had a male preponderance, with 59.7% (601) male, 39.9% (401) female and 0.4% (4) missing sex. We had a mean age of 19.4 years, of which 53.38% (n=537) were paediatric patients and 46.32% (n=469) adults. The mean length of hospital stay was 16.88 days. Our LA50 was 37%, and the overall mortality was 14.63%, with a mean age of 33.96, a mean TBSA of 43.3% and a mean revised Baux score of 80.55 for the mortality group. The paediatric group had a 5.03% (n=27) mortality rate, with 88.88% of these being children under 5 years with an LA50 of 45%, and the adult group had a 25.56% (n=120) mortality rate with an LA50 of 34%. Factors associated with mortality were age (p<0.0001), TBSA (p<0.0001), female sex (p=0.4126), full-thickness burns (p=0.7160) and burns to the head (p=0.9038). The leading cause of injury was hot water (46.5% of patients), followed by fire at 38.6%. HIV was the leading comorbidity, affecting 6.9% (n=67) of patients, followed by hypertension at 4.67% (n=47), and 2.58% (n=26) of patients had epilepsy. The leading complication was sepsis, affecting 14.67% (n=144) of patients. The average waiting time between admission and skin graft was 25.29 days, and for debridement was 3.57 days. The epidemiology of burn patients and working conditions at Pelonomi Tertiary Hospital are similar to other burn units in the country; however, our mortality rate is higher than at most centres. The LA50 is low, but in keeping with the rest of Africa, and our predictors of mortality are in keeping with those found in other studies in other parts of the world.

Prevalence and outcome of acute kidney injury in burn victims at a tertiary centre in Cape Town, South Africa.

Burn victims commonly experience acute kidney injury (AKI), which can lead to significant morbidity and mortality. To investigate the prevalence of AKI in burn patients, the causes of AKI and the rate of in-hospital mortality. A retrospective cohort study was conducted on patients admitted to the Tygerberg Hospital Burn Unit between 1 April 2018, and 31 March 2019. The study included all burn patients >18 years old, except for those with end-stage kidney disease or cold burn wounds, skin donors or readmissions. AKI was defined using the Kidney Disease Improving Global Outcomes criteria, and multivariable logistic regression was used to identify predictors of AKI and death, along with Kaplan-Meier survival analysis. The prevalence of AKI was 27% (58/215). The most common causes of burns were open fires (37%) and shack fires (17%). Patients with AKI had higher scores on the abbreviated burn severity index (ABSI) (7 v. 5, p<0.01), required more mechanical ventilation (69% v. 33%, p<0.01) and experienced more sepsis (35% v. 12%, p<0.01). Predictors of AKI included ABSI score (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.21 - 1.80, p<0.01), mechanical ventilation (aOR 7.75, 95% CI 1.23 - 48.65, p=0.03) and high admission lactate (aOR 1.57, 95% CI 1.04 - 2.39, p=0.03). Mortality was higher in patients with AKI (34% v. 6%, p<0.01). ABSI score (aOR 2.16, 95% CI 1.56 - 2.99, p<0.01) and vasopressor use (aOR 7.71, 95% CI 2.15 - 27.60, p<0.01) were identified as predictors of death. The survival analysis revealed that AKI was associated with higher mortality (log rank, p<0.01). The study highlights the high prevalence of AKI among burn victims requiring tertiary care and its association with high mortality rates. Improving living conditions in informal settlements could help prevent burns and their complications.

Burns among adults in a major Malawian burn unit: epidemiology and factors associated with prolonged hospital stay.

This study sought to describe the epidemiology of burns and factors associated with prolonged hospital stay among adult patients admitted in the Queen Elizabeth Central Hospital burns unit. All files of patients aged at least 17 years and admitted in the Queen Elizabeth Central Hospital burns unit between 1 June 2007 and 31 May 2017 with acute burns, were reviewed. Data on socio-demographic characteristics, injuries sustained, comorbidities, length of hospital stay, and clinical outcomes were extracted from the files. Summary statistics, independent sample T-test, and odds ratios were computed to determine the distribution and associations of the variables collected. A total of 515 patient files, all from rural or informal urban settlements, were reviewed. The median age at the time of presentation was 32 years (IQR: 25-45), and 52% (n=279) were male. Most of the burns occurred at home (81.0%; n=379), were of flame etiology (75.7%; n=385), and were reported to have been accidental (94.7%, n=445). The mean monthly rate of new burn injury patients was highest in the cool-dry season, and epileptic seizures were a common precedent of burn injury (30.7%; n=158). Most (62.7%) of the patients with recorded burn sites sustained multiple burns injuries, and more than half of the patients had upper and lower limb burns (64.6% & 59.5% respectively). Thirty patients sustained additional non-burn injuries, and 26.4% (n=132) of all patients with recorded outcomes died in the hospital. The data on burn injuries among adults presenting at the QECH burns unit suggests the existence of socio-economic inequalities associated with burn incidence. There is also a need for improvement in the quality and uptake of epilepsy care in primary care facilities.

A CLINICAL TRIAL OF VIRTUAL REALITY IN PHYSICAL THERAPY FOR BURN PATIENTS: EFFECTS ON PAIN PERCEPTION

In clinical contexts, virtual reality (VR) has demonstrated potential as a cognitive diversion technique to alleviate discomfort among patients undergoing challenging procedures, including physical rehabilitation for burn victims. However, the extent of research investigating the effectiveness of VR in reducing pain during physical therapy for burn patients is limited. This clinical trial was conducted at Civil Hospital's burns unit in Hyderabad and involved 68 participants. Each participant underwent two 6-minute physical therapy sessions, one utilizing VR and the other without VR. After each session, participants provided feedback on their pain experience, which the treating therapist documented. Analysis of graphic rating scores revealed a significant decrease in pain levels during physical therapy with VR compared to physical therapy without VR. The average scores for pain rumination, worst pain intensity, and unpleasantness decreased from 5.99 to 3.88, 6.24 to 3.41, and 6.18 to 3.82, respectively. The paired t-test indicated a highly significant p-value of less than 0.001. The results of this study suggest that VR is a valuable tool for reducing pain during physical therapy for burn patients. Further research is necessary to explore the long-term effects of VR on pain management and its potential application in other clinical settings.

Development of an electronic burns register: Digitisation of routinely collected hospital data for global burns surveillance

IntroductionBurn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings. MethodsData quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification. ResultsProcess mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all-cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry. ConclusionWe have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings.

Futile care in Kirkuk teaching hospital burn unit.

Background; Futile care; a medical term applied when there is no reasonable hope of improvement or cure in spite of expense of medical or surgical care. Futile care decision governed by a variety of scoring systems to evaluate clinical situation and direct medical effort in respecting the patient requirement, surrogate allowance. Where and when the medical treatment being futile is another view must be sought for afflicted patient. &#x0D; Materials &amp; methods; This is a retrospective study about admitted patient over 7 years (since January 2012-until December 2018) were 2076 patient (total admission number) in Kirkuk teaching hospital burn unit, of them (1284 female, 762 male burns casualty) 74% of them are saved but (26%) 538 patient are dead out of total number of admission , (21%) 435 patient were with expected death, but (5%) 103 {(79 pediatric less than 12 years) and (24 patient age more than 56 years)} with un expected death the latter were succumbed to sepsis even with our best available rescue management.&#x0D; Result; This study on those (21%) 435 patients (with more than 55% BSAB. &amp; mostly associated with inhalational injury) sex variation{23 male (25-55 years) , 412 female (13-45years)}most of them self-immolation; who are falls under the known guide lines {DNR=Do Not Resuscitate} comfort care applied to them, we depend on R-Baux score to predict the probability of death after burn injury was calculated for each patient by following formula:&#x0D; (TBSA + age + [17×R]). {R=1 if patient has inhalation injury and R=0 if not}.&#x0D; Aim; of our study is to evaluating our working in spite of our challenges in Iraq circumstances.&#x0D; we used different formulae to predict mortality in burn casualties to reach best results we could approach to it.&#x0D; Conclusion; our results show more increases in the mortality % than American and European studies because we have less facilities and limited resources.

Who Gets Burned in Brazil?

Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.

Detection of Extended spectrum β -lactamases (ESBLs) produced by Acinetobacter baumannii isolated from burn patients in Al- Nasiriyah city Iraq.

The aim of present study is to isolate and identify of Acinetobacter baumannii from burns infect as well as study their production for Extended spectrum β -lactamases (ESBLs).This study included 205 burn patients at Al-Hussien Teaching Hospital and other burn care units in Al-Nasiriyah city . The specimens were collected during period from August 2018 to February 2019. It were taken by burn swabs from pus of the burned area and then inoculated on blood agar and MacConkey agar. The isolates were diagnosed by microscopic examination, biochemical tests , API 20 E and Vitek- 2 system . It was found that 20 isolates of A.baumannii and 2 isolates of A. loffii . Where identified from this study . The study showed 18 (90%) out of 20 isolates of A. baumannii were appeared resistance to cefotaxime and ceftazidime(screening test of ESBLs) . Seven (35%) of isolates were producing ESBLs by confirmatory test(Modified double –disk synergy test (MDDST)) , and 13(65%) of isolates were negative results to production of the ESBLs.&#x0D;

Knowledge, attitude, and practice towards burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia. A cross-sectional study

BackgroundBurn injuries are thought to be preventable but are still a prevalent global health problem, especially in low- and middle-income countries. It continues to remain a leading cause of morbidity and mortality in Ethiopia. Proper knowledge about burn first aid minimizes the overall impact of the injury. PurposeThis study aimed to assess the knowledge, attitude, and practice toward burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia, 2021/22. MethodsA hospital-based cross-sectional study was conducted among caregivers of burn patients attending Yekatit 12 hospital medical college and Addis Ababa Burn Emergency and Trauma (AaBET) hospital burn units. A total of 305 caregivers were recruited by a simple random sampling method from both hospitals. Data was collected using a standard interviewer-administrated questionnaire, cleaned, coded, and entered into EPI data version 6, and then exported to SPSS version 26 for further analysis. The generated data were compiled by frequency tables, charts, and graphs. A logistic regression model was used to measure the association between independent versus outcome variables, considering the AOR, 95% CI, and p < 0.05 as significant for all the independent variables. ResultA total of 305 participants responded to this study. Among these, the majority, 185(60.7%) of caregivers were females, while 120(39.3%) were Males. The main source of knowledge for those who had previous information on a burn and its first aid treatment were families, friends, colleagues, and guardians. A significant portion of 246(80.7%) respondents did not take any form of burn first aid training. The study indicates that 202(66.2%) and 195(63.9%) of the study participants have poor knowledge and practice, respectively, despite the majority. 225(73.8%) of responders have a favorable attitude regarding burn first aid. Conclusion and recommendationThis study showed an explicit knowledge and practice gap among caregivers towards burn first aid even though the majorities have a favorable attitude. Developing an effective nationwide burn prevention program and early burn first aid treatment in Ethiopia and promoting a consistent guideline for burn first aid.

603 VTE Prophylaxis Compliance on The Burns Unit

Abstract Aim To assess if VTE risk assessments are correctly completed and implemented on the Burns Unit. Method 2-week prospective analysis of all inpatients admitted to the adult Burns Unit. Data was collected from patient files and drug Kardexs. Variables including TBSA, date of injury, date of admission, date of VTE risk assessment score, correct prescription according to score and implementation were compiled in an excel spread sheet. Audited against Trust and NICE Guideline 89. Results The first cycle identified errors in risk assessment completion related to inaccurate BMI assessment and failure to identify the burn as a risk factor. The risk assessment was only re-assessed 71% of the time post operatively or following change in condition. An action plan included re-education of medical staff, reminder posters in theatre and re-designing the burns operation note to include a VTE re-assessment tick box. A re-audit showed an improvement in correct VTE scoring from 65% to 100% and VTE reassessment from 71% to 100%. Conclusions Following the first cycle, Wythenshawe Hospital Burns Unit has improved in compliance with the NICE and Trust Guidelines. The two most frequent errors identified on completion of the risk assessment form have not been seen in the second cycle following education of medical staff. All patients should continue to be prescribed the prophylaxis indicated, unless contraindicated. For those patients who cannot wear AES due to a burn to their lower legs, flowtrons and/or enoxaparin should be considered instead. For those patients who refuse treatment an incident form must be completed.

Incidence and immediate consequences of electrical shocks among Danish electricians: a cohort study

ObjectivesThe health-related consequences of electrical shocks are mostly studied in patients from selected cohorts in hospital burn units, by making internal comparisons of subgroups, but without comparing them to unexposed...

Clinical Profiles and the Outcomes of Burn Patients Admitted to the Burn Unit of Jimma Medical Center.

BackgroundBurn is a serious public health problem and a leading cause of disability and disfigurement. However, there was no published study from our Hospital Burn Unit that assessed the clinical profiles and the outcomes of burn patients.ObjectiveThis study was aimed to assess the clinical profiles and the outcomes of patients admitted with burn injuries.MethodsHospital-based retrospective cross-sectional study was conducted at the Burn Unit of JMC. Systematic random sampling was used to include the burn patients. Data were analyzed using SPSS version 25. Descriptive statistics, chi-square (χ2), and student-t-test were performed to describe and assess the relationships between the variables. Multivariate logistic regression was performed to determine the factors affecting the length of hospital stays.ResultsOne hundred twenty-four burn patients (51.6% female) were included. The majority (79.84%) of the patients were in the age category of less than 29 years. Scalds (47.6%) were the most common cause of burns with three times in females. The extremities (93.5%) were the most frequently affected areas. Patients with second-degree superficial burns accounted for 61.3% of all patients. In 95.88% of the patients, the total body surface area burn (TBSA) was below 20%. Lactated ringers (69.4%) and tramadol (71.0%) were the most frequently used IV fluid for resuscitation and analgesic agent for pain, respectively. Patients who undergo any of the surgical procedures stayed in the hospital for greater than 30 days more than 4 times likely (OR = 4.8, 95% CI 2.08–11.2, P < 0.001).ConclusionScalds are the most common cause of burn injury, particularly in patients aged less than 14 years. Educating the community about the risk groups, household safety precautions, and early seeking medical care may reduce the incidence and morbidity of burn injuries.

Foot burns: A comparative analysis of diabetic and non-diabetic patients

IntroductionFoot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae. Our aim is to analyse epidemiological trends of foot burns and examine the differences between diabetic and non-diabetics at Concord hospital from 2014 to 2019. MethodsA retrospective audit from 2014–19 at Concord General Repatriation Hospital Burns Unit summarised patient demographics, burn injury, diabetic status, operations and length of stay. All foot burn injuries from 2014–19 of all ages and gender that attended Concord burns hospital were included in this study. ResultsWe treated 797 patients who presented with foot burns, of which 16.2% were diabetic. The average age was higher in diabetics (60.72 years) than non-diabetics (39.72 years) and more males suffered burns compared to females in both groups (p < 0.001). There was a larger portion of elderly patients (greater than 65 years old, 15.1% of total) who sustained foot burns in the diabetic group compared to the non-diabetic group (p < 0.001). The most affected season was summer (27.0%), but diabetic patients were 1.7 times more likely to sustain injury in winter than non-diabetics. Diabetics were 3.8 times more likely to have contact burns compared to non-diabetic patients (p < 0.001). In a multivariable linear regression analysis, factors that contributed to increased length of stay included elderly status, place of event, diabetic status, number of operations, ICU admission, wound infection, amputation, and admission [F (16, 757 = 41.149, p < 0.001, R2 = 0.465]. ConclusionsWith the increase of diabetes, our multidisciplinary approach to diabetic foot care should include nursing, medical and surgical disciplines to identify patients at risk. The data highlights that a focus on prevention and education for diabetes is central to optimize glycaemic control and burn management, whilst providing a multidisciplinary network on discharge.

Sex dimorphism in pediatric burn mortality in Malawi: A propensity matched analysis

IntroductionThere is increasing evidence that sex differences may influence pathophysiology after thermal injury and affect clinical outcomes. This study aimed to assess the relationships between sex, thermal injury, and inpatient mortality in a pediatric burn cohort in a resource-limited setting. MethodThis is a retrospective analysis of data collected from the Kamuzu Central Hospital Burns Unit, in Lilongwe, Malawi, from May 2011 to December 2019 on all pediatric patients (≤12 years). We performed a bivariate analysis by sex comparing demographics, burn characteristics, surgical intervention, and mortality. Standardized estimates were adjusted using the inverse probability of treatment weights to account for confounding. Following weighting, odds of mortality based on sex were obtained via logistic regression modeling. ResultsA total of 1904 children were admitted with a male preponderance (n = 1065, 55.9 %). Overall, the median age was 3 years (IQR1−4). Females had a higher percent total body surface area (%TBSA) burn than males, 15 % vs. 13 % (p = 0.03), respectively. Flame burns were more frequent in females compared to males, 32 % and 23 %, respectively (p < 0.001). There were higher rates of surgical intervention in females than males (20.9 % vs. 16.7 %, p = 0.02). The propensity score weighted logistic regression predicting mortality revealed no difference in the odds of mortality based on sex (OR 1.12, 95 % CI 0.82–1.52, p = 0.5). ConclusionWe show males are just as likely to die from burns compared to females with similar injuries in this propensity-matched analysis. A lack of difference in mortality may be attributable to the similarities in the hormonal profile in the prepubescent child.

Evaluation of the Cases Hospitalized in our Burn Unit

Aim: A burn is a physiopathological process where damage occurs in the skin and subcutaneous tissues and can affect the entire body depending on its depth and surface area and the reason causing the burn. Burns are most common in children and in the home environment according to a large number of studies. We compared the clinical and demographic features and the treatment protocols of our cases who were diagnosed with a burn in this study. Material and Methods: A total of 52 patients who presented to the Erzincan State Hospital's Burn Unit between July 2008 and June 2010 and were diagnosed with a burn were included in our study. The charts of our cases were retrospectively evaluated. The demographic findings, burn surface area and burn degree determined during the physical examination were recorded from the charts. Results The group of 52 subjects presenting to the burn unit consisted of 33 pediatric and 19 adult patients. The mean age was 18.2 years. There were 17 female and 16 male pediatric patients. The adult patients consisted of 12 females and 7 males. A first-degree burn with an area between 10% to 15% of the body surface was found in 12 of our pediatric patients and 8 of our adult patients. All the burns were hot water burns or sunburns. These subjects were prescribed medical treatment for one week and were referred to the outpatient department where the follow-up was performed. The mean duration until recovery was 7 to 10 days. A second-degree burn with a surface area between 25% and 40% was found in 15 pediatric patients and 6 adult patients. All these burns had been caused by hot water. Our cases were admitted to the burn unit and treated by dressing the wound. The mean duration until recovery was 4 to 6 weeks. The patients were discharged with full recovery and without any complications. A third-degree burn was found in 6 (18.18%) of our pediatric patients and in 4 (21.05%) of our adult patients. The patients were admitted to the burn unit and dressings alone or with debridement were used for treatment according to the burn healing status. Conclusion Burn patients should be evaluated in detail. Deepening of the burn, infection and fluid loss can be prevented by appropriate intervention in the early period. The appropriate treatment plan should be arranged and the patients who require treatment at a burn center should be referred. DOI: 10.7176/JSTR/5-12-17

To evaluate how early operative intervention will increase the chances of limb survival in electrical burns-At a tertiary Burn care centre

Background: Electrical burns incidence is increasing due to increased industrialization and increased use of electricity and electric domestic appliances. High morbidity and mortality associated with increasing incidence of electric injury may consume alarming is high amount of resources and healthcare budget. Objective:To evaluate how early operative intervention will increase the chances of limb survival in electrical burns-at Safdarjung hospital burn unit over period of one year from January 2011 to December 2011 was reviewed and data about personal details, cause of burn, percentage of burn, treatment given, complication and final outcome were analyzed using descriptive statistics. Results: Fasciotomies were done in 156 patients in 180 limbs. 1 patient had undergone laparotomy for ligation of RT external iliac artery. 58 out of the total 266 electric contact injured patients, represents that nearly 22% had to undergo amputations. Early flap cover after conservative debarment was done in 25 cases patients. Out of these 20 flap covers were done for upper limb defects. Minimal flap necrosis was noticed in 7 patients but the wounds healed without any further surgical intervention. In the 25 flaps done, 19 were distant flaps and 6 were local flaps. CT and MRI angiography was done in 24 patients during our study period. Out of these except for 2 CT angiography for lower limbs, all were for upper limbs. Out of 438 electric injury patients in our study, there was a mortality of 58 patients. 5 were brought dead and 53 patients expired while undergoing treatment in the hospital. This represents nearly 13% mortality rate from electrical related injuries. Conclusion: Electric burn causes significant morbidity and mortality and can be prevented easily. It was emphasized that most of the electrical injuries can be prevented by education, policy implementation and use of safety. Patients survived with morbidity due to amputation. Initial management of electrical burn is imperative to optimize function and minimize long-term scarring. However, further studies are required regarding flap repair and microsurgery to minimize in electrical.

The bacteriological study of Acinetobacter baumannii isolated from burn patients in Al- Nasiriyah city - Iraq

The aim of present study was to investigated some virulence factors of Acinetobacter baumannii as well as study their&nbsp; tolerance to some environmental factors. It was identified 20 isolates of A.baumannii. burn patients in Al-Hussien Teaching Hospital and other burn care units in Al-Nasiriyah city . The specimens were collected during period from August&nbsp; 2018 to February 2019. It were taken by swabs from pus of the burned area and then inoculated on blood agar and MacConkey agar. The isolates were diagnosed by microscopic examination, biochemical tests , API 20 E and Vitek- 2 system . some virulence factors of bacteria detected such as capsule , biofilm formation , colony factor antigens and gelatin liquification , the results revealed that100%, 85% ,75% and 65% of isolates were positive to capsule, biofilm formation , colony factor antigens producing and gelatin liquification respectively .The effect of some environmental factors on bacterial growth are studied .It is found that the optimal range of pH for bacterial growth is 6-10 ,and the optimal growth of bacteria in a concentration 5% of NaCl , as well as , it shows that all bacterial isolates have the ability to grow in 44 °C. Due to the spread of these bacteria in our hospitale ,especially in the burns unite , this study was doen o detecated its properties and virulence factors .