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Sample records for burn patients admitted

  1. Bacteremia in burned patients admitted to Sina Hospital, Tabriz, Iran

    OpenAIRE

    Parviz Saleh; Hamid Noshad

    2014-01-01

    Introduction: One of the most important causes of mortality and morbidity in burn wards is infection, and it is the major reason of death in burn injuries. There are several reasons that make burn victims predisposed to infection. The current study aimed to investigate the role of different factors that have an effect on bacteremia occurrence in burn patients and factors which are relevant to mortality in these patients. Methods: This descriptive-analytic study conducted in a 1...

  2. Bacteremia in burned patients admitted to Sina Hospital, Tabriz, Iran

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    Parviz Saleh

    2014-11-01

    Full Text Available Introduction: One of the most important causes of mortality and morbidity in burn wards is infection, and it is the major reason of death in burn injuries. There are several reasons that make burn victims predisposed to infection. The current study aimed to investigate the role of different factors that have an effect on bacteremia occurrence in burn patients and factors which are relevant to mortality in these patients. Methods: This descriptive-analytic study conducted in a 1 year period in Sina Hospital, Tabriz University of Medical Sciences, Iran, and 81 burn were included. We collected patients’ data about their age, body weight, cause of burn, lesion color, place and percentage of burn by getting history and studying of their files. Then we documented all interventions. Blood tests and cultures and colonies criteria were recorded. Results: In this study, 39 patients were male (48.1%, and 42 was female (51.9%. Mean age was 32.06 ± 17.46 years. In patients without bacteremia, 57 patients did not need catheterization (89.1%, however in patients with bacteremia 9 patients demanded catheter insertion (52.9%. In patients with bacteremia 12 patients survived (70.9%, however in the without bacteremia group 56 patients survived (92.2%. Then, the relationship between type of burn, wound infection and bacterial species investigated, (P = 0.650, P = 0.210 and P = 0.110 respectively. Conclusion: We concluded, invasive interventions increased bacteremia susceptibility in our studied burned patients. Mortality rate is directly related to bacteremia prevalence and increased by extent of burn area in these patients. The three most frequent microbial agents responsible for bacteremia were Pseudomona aeruginosa, Klebsiella and Staphylococcus aureus.

  3. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

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    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  4. Epidemiology and Outcome of Chemical Burn Patients Admitted in Burn Unit of JNMC Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India: A 5-year Experience

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    Akhtar, Md Sohaib; Ahmad, Imran; Khurram, M. Fahud; Kanungo, Srikanta

    2015-01-01

    Aims and Objective: The objectives of this study were to evaluate the epidemiology, clinical variable of chemical burns, and their outcomes to prevent or reduce the frequency and morbidity of such injuries. Materials and Methods: A retrospective analysis was performed on all the patients with chemical burns admitted at author's center between November 2008 and December 2013. All the patients were evaluated in terms of age, sex, total body surface area, etiology, treatment given, morbidity, mo...

  5. Evaluation of Drug-Resistance Pseudomonas and Staphylococcal Infections in Admitted Burned Patients in

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    E. Nemati, M.Sc

    2007-09-01

    Full Text Available Nosocomial infection is an important prognostic factor in out comes of burned patients. In this descriptive cross. Sectional study, 82 burned patients and related medical equipment were assessed in zareh hospital in 2033-2004. Pseudomonas aeruginosa and staphylococcus areus were found in 69(51.4% and 31 (23.2% of 134 clinical specimens respectively. Hence it is mandatory to plan programs for redusing harmful and resistance bacterial infection in this patients.

  6. Characteristics of Patients Who Admitted to the Emergency Department Because of Burns Due to Dens Liquids Such as Hot Milk/Oil

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    Bayramoglu, Atif; Sener, M. Talip; Cakir, Zeynep; Aslan, Sahin; Emet, Mucahit; Akoz, Ayhan

    2016-01-01

    Objective: Burn is the tissue damage on body caused due to various reasons. Although all burns caused by hot liquids are investigated as scalding burns, dense liquid burns (DLB) caused by such as milk and oil are different from other burns. The aim of this study was to report the properties of DLB. Materials and Methods: Patients admitted to the Emergency Service of Atatürk University Hospital, with DLB from June 2003 to December 2008, were examined retrospectively. Results: During the study, 28 DLB patients were admitted to the emergency service. The most common admission were found in autumn 28.6% (n=8), and in May and June, 17.9% (n=5). The frequency of burns on the right upper extremity was seen in 50% (n=14) of the patients. The burn degree of all patients was determined as 2nd degree. Seventy-five percent (n=21) of the patients were discharged, 14.3% (n=4) were hospitalized. None of the patients died. Conclusion: Dense liquid burns is a burn type that is commonly seen in women, absolutely causing 2nd degree burns, frequently reported in upper extremity and head/neck regions, and in contrast to other studies, in our region it is completely seen in patients living in city centre. PMID:27026759

  7. Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit.

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    Hogan, Brian K; Wolf, Steven E; Hospenthal, Duane R; D'Avignon, Laurie C; Chung, Kevin K; Yun, Heather C; Mann, Elizabeth A; Murray, Clinton K

    2012-01-01

    Severe burn injury is accompanied by a systemic inflammatory response, making traditional indicators of sepsis both insensitive and nonspecific. To address this, the American Burn Association (ABA) published diagnostic criteria in 2007 to standardize the definition of sepsis in these patients. These criteria include temperature (>39°C or 110 beats per minute), progressive tachypnea (>25 breaths per minute not ventilated or minute ventilation >12 L/minute ventilated), thrombocytopenia (200 mg/dl, >7 units of insulin/hr intravenous drip, or >25% increase in insulin requirements over 24 hours), and feed intolerance >24 hours (abdominal distension, residuals two times the feeding rate, or diarrhea >2500 ml/day). Meeting >3 of these criteria should "trigger" concern for infection. In this initial assessment of the ABA sepsis criteria correlation with infection, the authors evaluated the ABA sepsis criteria's correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue infections, and blood cultures are typically obtained due to concern for ongoing infections falling within the definition of "septic." A retrospective electronic records review was performed to evaluate episodes of bacteremia in the United States Army Institute of Research from 2006 through 2007. A total of 196 patients were admitted during the study period who met inclusion criteria. The first positive and negative cultures, if present, from each patient were evaluated. This totaled 101 positive and 181 negative cultures. Temperature, heart rate, insulin resistance, and feed intolerance criteria were significant on univariate analysis. Only heart rate and temperature were found to significantly correlate with bacteremia on multivariate analysis. The receiver operating characteristic curve area for meeting >3 ABA sepsis criteria is 0.638 (95% confidence interval 0.573-0.704; P burn patients, the ABA trigger for sepsis did not

  8. Tissue expander, a modality in the treatment of burn induced deformities: A 6-year study of patients with burn deformities admitted to Plastic Surgery Department of Imam Hospital

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    Farah Vash. MR

    2000-06-01

    Full Text Available Use of tissue expander in the recent decade has revolutionized the plastic surgery. The tissue expansion technique is advantageous in body reconstruction because it makes it possible to resurface the defects resulting from excision of burn scars with neighboring skin similar in color and texture and superior to skin grafts or distant flaps. Treatment of burn alopecia was a major problem in the past, but with the application of tissue expander this deformity is treated. We have learned by experience that tissue expander should not be used in the limbs, because of the high risk of complications. The best locations for tissue expander are in order: Scalp, face, neck and trunk. The incidence of burn induced deformities in Iran is high. In this research, I analyze the use of TE in 130 patients with burn deformities. The variables studied were: Sex of patients (43.1% male, 56.9% female, age groups, level of education, occupation, the anatomical site of burn, extension of burn, volume of tissue expansion, the location of placing the TE and complications.

  9. Burn-Center Quality Improvement: Are Burn Outcomes Dependent On Admitting Facilities and Is There a Volume-Outcome “Sweet-Spot”?

    OpenAIRE

    Hranjec, Tjasa; TURRENTINE, FLORENCE E.; STUKENBORG, GEORGE; Young, Jeffrey S; Sawyer, Robert G.; Calland, James F

    2012-01-01

    Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 ...

  10. CHARACTERISATION OF BACTERIAL ISOLATES FROM INFECTE D BURN WOUNDS OF PATIENTS ADMITTED IN A TERTIARY LEVEL HEA LTH CARE FACILITY IN NORTHERN REGION OF INDIA

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    Antariksh

    2013-04-01

    Full Text Available ABSTRACT: Infection is an important cause of mortality in bur ns. Emergence of multi drug resistant pathogens in hospital setting has seriously constrained the available therapeutic options. This necessitates periodic review of the iso lation pattern and study of antibiogram of the isolates to strengthen surveillance activities. To determine the bacteriological profile and antimic robial susceptibility pattern of pathogens isolated from infected burn wounds of pati ents admitted in the burns care unit. The present study was carried out over a duration of six months. Pus samples from infected burn wounds were processed following standard protocols. A ntimicrobial susceptibility of the bacterial isolates was performed by Kirby- Bauer dis c diffusion method. A total of 408 bacterial pathogens were isolated from 340 samples. The most fr equent cause of infection was found to be Pseudomonas aeruginosa (53%, followed by Staphyl ococcus aureus (9%, Escherichia coli (9%, Enterobacter spp. (8%, Citrobacter spp. (8%, Kl ebsiella spp. (5%, Acinetobacter spp. (3% and Proteus spp. (3%. High level of drug resist ance (95-100% was observed for cefepime, ceftazidime, amoxyclav, cotrimoxazole and doxycycline among gram negative pathogens. Meropenem, amikacin and ciprofloxacin were found to be most effective. Twenty one percent of the S. aureus isolates were resistant to methicillin. The high prevalence of antimicrobial resistance emphasizes the need for str engthening the infection control practices and regular and periodical surveillance activities t o contain the upward trend of resistance.

  11. Burn-Center Quality Improvement: Are Burn Outcomes Dependent On Admitting Facilities and Is There a Volume-Outcome “Sweet-Spot”?

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    HRANJEC, TJASA; TURRENTINE, FLORENCE E.; STUKENBORG, GEORGE; YOUNG, JEFFREY S.; SAWYER, ROBERT G.; CALLAND, JAMES F.

    2012-01-01

    Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes. PMID:22546129

  12. Burns in diabetic patients

    OpenAIRE

    Maghsoudi, Hemmat; Aghamohammadzadeh, Naser; Khalili, Nasim

    2008-01-01

    CONTEXT AND AIMS: Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients. MATERIALS AND METHODS: Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical...

  13. Epidemiological data, outcome, and costs of burn patients in Kermanshah

    OpenAIRE

    Karami Matin, B.; Karami Matin, R.; Ahmadi Joybari, T.; Ghahvehei, N.; M Haghi; M. Ahmadi; S. Rezaei

    2012-01-01

    Burn injuries in both developed and developing countries cause long-term disability, mortality, and socio-economic costs that are imposed on patients, families, and societies. This study was carried out to investigate the epidemiology, outcome, and cost of hospitalization of 388 burn patients admitted to the Imam Khomeini Hospital Burn Center in Kermanshah, Iran, between 21 March 2011 and 20 March 2012. The data about demographics, cause of burns, degree of burns, outcome of burns, burned bod...

  14. Burn epidemiology and cost of medication in paediatric burn patients.

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    Koç, Zeliha; Sağlam, Zeynep

    2012-09-01

    Burns are common injuries that cause problems to societies throughout the world. In order to reduce the cost of burn treatment in children, it is extremely important to determine the burn epidemiology and the cost of medicines used in burn treatment. The present study used a retrospective design, with data collected from medical records of 140 paediatric patients admitted to a burn centre between 1 January 2009 and 31 December 2009. Medical records were examined to determine burn epidemiology, medication administered, dosage, and duration of use. Descriptive statistical analysis was completed for all variables; chi-square was used to examine the relationship between certain variables. It was found that 62.7% of paediatric burns occur in the kitchen, with 70.7% involving boiling water; 55.7% of cases resulted in third-degree burns, 19.3% required grafting, and mean duration of hospital stay was 27.5 ± 1.2 days. Medication costs varied between $1.38 US dollars (USD) and $14,159.09, total drug cost was $46,148.03 and average cost per patient was $329.63. In this study, the medication cost for burn patients was found to be relatively high, with antibiotics comprising the vast majority of medication expenditure. Most paediatric burns are preventable, so it is vital to educate families about potential household hazards that can be addressed to reduce the risk of a burn. Programmes are also recommended to reduce costs and the inappropriate prescribing of medication.

  15. Crusted Scabies in the Burned Patient

    DEFF Research Database (Denmark)

    Berg, Jais Oliver; Alsbjørn, Bjarne

    2011-01-01

    The objectives of this study were 1) to describe a case of crusted scabies (CS) in a burned patient, which was primarily undiagnosed and led to a nosocomial outbreak in the burn unit; 2) to analyze and discuss the difficulties in diagnosing and treating this subset of patients with burn injury......; and 3) to design a treatment strategy for future patients. Case analysis and literature review were performed. The index patient had undiagnosed crusted scabies (sive Scabies norvegica) with the ensuing mite hyperinfestation when admitted to the department with minor acute dermal burns. Conservative...... report of a burned patient with CS in the English language literature. CS is also highly contagious and may lead to a nosocomial outbreak. Furthermore, CS seems to have a detrimental impact on the burned patient's course of treatment. A scabicide treatment is necessary to guarantee successful treatment...

  16. Pattern and outcome of children admitted for burns in Benin City, mid-western Nigeria

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    Oludiran O

    2009-01-01

    Full Text Available Children are a vulnerable to burns, an injury, which is often preventable. A study of the profile of cases of children admitted for burns will provide background information to suggest locally doable preventive strategies as well as supply basic information for future reference. We studied the records of 62 children aged 0-16 years, admitted for burns, at the University of Benin Teaching Hospital, Benin City, between January 2002 and December 2006. There were 34 male and 28 female children. Children under three years constituted 56.5%. Whereas the leading cause of burns in all the children was flame burns from kerosene explosions (52%, scalds were responsible for 68.6% of cases in those under three. The extent of burn injury ranged from 6 to 50% and most of them presented late. 64.6% were discharged within three weeks. Wound sepsis and post burn contractures were the most frequently encountered complications (19.4% and 9.7% respectively. There were two deaths (3.2% related to sepsis. Particular attention to burn safety precautions in children (especially, in the> 3 years age group, safer storage and dispensing of combustible chemicals particularly petroleum products is advocated. Fire safety awareness, correct first aid measures and early presentation in the hospital will reduce morbidity and mortality. Early physiotherapy and splinting strategies will reduce contractures. There is the need locally for the establishment of specialized burn centres both to treat these children and to stimulate interest in burn management.

  17. The Epidemiological and Clinical Assessment of Admitted Burned Pregnant Women in Shahid Mottahary Hospital Burn Center Between January 1998 and October 2003

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    A. Tavassoli-Ashrafi, M.D.

    2007-09-01

    Full Text Available Background and purpose: Treatments of burn pregnant women is a difficult task because the vulnerable fetus is highly dependent on the health of the mother. This study was conducted to determine the epidemiology, etiology, clinical assessment and outcome of pregnant patients between January 1998 and October 2003.Materials and Methods: A 6-year retrospective descriptive study of burns in pregnant women hospitalized at Mottahary hospital (burn center in Tehran was performed. A short structured questionnaire was used to collect data. The questionnaire covered demographic information, etiology, clinical manifestations, and outcomes.Results: 74 (5% of the 1480 women of reproductive age who were admitted for burn treatment during this period were pregnant. The mean age of 74 patients was 22.54 years (SD = 4.78 with a range of 16-35. The majority of the women (50% were between 20 and 30 weeks of gestational age. The most common cause of burn was kerosene fire 52 (70%. Most of the women 50 (68% suffered from severe burns with TIBC>40%. 49 (66% mothers and 50 (67.5% died as a result of the burn damages. Conclusion: Burn size, TIBC, follow up of clinical manifestations for pregnant women, fetus and performance of proportional treatment protocols were the strongest predictor of mortality for mother and fetus.

  18. Pain in burn patients.

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    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  19. Candidemia in major burns patients.

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    Renau Escrig, Ana I; Salavert, Miguel; Vivó, Carmen; Cantón, Emilia; Pérez Del Caz, M Dolores; Pemán, Javier

    2016-06-01

    Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge. PMID:26931414

  20. Managing burn patients in a fire disaster: Experience from a burn unit in Bangladesh

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    Mashreky S

    2010-10-01

    Full Text Available Although burn disaster is not a frequent event, with urbanisation and industrialisation, burn disaster is becoming an emerging problem in Bangladesh. On 3 June 2010, a fire disaster killed 124 people in Neemtali, Dhaka, Bangladesh. This paper narrates the management of burn patients of this disaster in the burn unit of Dhaka Medical College Hospital. The burn unit managed 192 burn victims of the disaster. Forty-two victims were admitted and 150 of them received primary care at the emergency room and were sent back home. Ten patients among 42 in-patients died. The in-patient mortality was 23.8%. Burn unit in Dhaka Medical College Hospital is the only burn management centre in Bangladesh. Proper planning and coordinated effort by all sectors and persons concerned were the key elements in this successful management.

  1. Indications and strategies for Mechanical Ventilation in the Burned Patients

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    Murat Yılmaz

    2011-07-01

    Full Text Available Respiratory tract is one of the most seriously injured system in burned patients. Besides the direct inhalation injury, respiratory organs may be effected by the inflammatory mediators released due to systemic inflammatory response syndrome. As a result, many severely burned patients are needed to be intubated and mechanically ventilated after admitted to ICU. For this purpose, the medical staff working in the ICU’s which admit severely burned patients should be experienced in mechanical ventilation modes, complications related to mechanical ventilation and weaning strategies. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 31-6

  2. Identifying admitted patients at risk of dying

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Knudsen, Torben; Hallas, Jesper

    2013-01-01

    Risk assessment is an important part of emergency patient care. Risk assessment tools based on biochemical data have the advantage that calculation can be automated and results can be easily provided. However, to be used clinically, existing tools have to be validated by independent researchers....... This study involved an independent external validation of four risk stratification systems predicting death that rely primarily on biochemical variables....

  3. Chronic obstructive pulmonary disease in patients admitted with heart failure

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    Iversen, K K; Kjaergaard, J; Akkan, D;

    2008-01-01

    OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study a...

  4. Transdermal fluid loss in severely burned patients

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    Lange, Thomas

    2010-01-01

    Full Text Available Introduction: The skin protects against fluid and electrolyte loss. Burn injury does affect skin integrity and protection against fluid loss is lost. Thus, a systemic dehydration can be provoked by underestimation of fluid loss through burn wounds. Purpose: We wanted to quantify transdermal fluid loss in burn wounds. Method: Retrospective study. 40 patients admitted to a specialized burn unit were analyzed and separated in two groups without (Group A or with (Group B hypernatremia. Means of daily infusion-diuresis-ratio (IDR and the relationship to totally burned surface area (TBSA were analyzed. Results: In Group A 25 patients with a mean age of 47±18 years, a mean TBSA of 23±11%, and a mean abbreviated burned severity index (ABSI score of 6.9±2.1 were summarized. In Group B 15 patients with a mean age of 47±22 years, a mean TBSA of 30±13%, and a mean ABSI score of 8.1±1.7 were included. Statistical analysis of the period from day 3 to day 6 showed a significant higher daily IDR-amount in Group A (Group A vs. Group B: 786±1029 ml vs. –181±1021 ml; p<0.001 and for daily IDR-TBSA-ratio (Group A vs. Group B: 40±41 ml/% vs. –4±36 ml/%; p<0.001. Conclusions: There is a systemic relevant transdermal fluid loss in burn wounds after severe burn injury. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy to avoid water and electrolyte imbalances.

  5. Burn injury in patients with early-onset neurological impairments: 2002 ABA paper.

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    Alden, N E; Rabbitts, A; Rolls, J A; Bessey, P Q; Yurt, R W

    2004-01-01

    Many patients suffer from sensorimotor deficits that may contribute to burn injury. This retrospective study examines burn injuries in the subgroup of patients that suffer from the early onset neurological impairments of mental retardation, cerebral palsy, spina bifida, autism, and attention deficit-hyperactivity disorder. Fifty-one patients who suffered from the above-mentioned early-onset neurological impairments were admitted to our burn center during a 4-year period. The average TBSA burned was 8.9% yet resulted in prolonged hospitalizations. This study describes our burn center's experience in treating patients admitted with early-onset neurological impairments. PMID:14726747

  6. Burn Patient Expectations from Nurses

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    Sibel Yilmaz sahin

    2014-02-01

    Full Text Available AIM: Burn is a kind of painful trauma that requires a long period of treatment and also changes patients body image. For this reason, nursing care of burn patients is very important. In this study in order to provide qualified care to the burned patients, patient and #8217;s expectations from nurses were aimed to be established. METHODS: Patients and #8217; expectations were evaluated on 101 patients with burn in Ministry of Health Ankara Numune Education and Research Hospital Burn Service and Gulhane Military Medical Academy Education and Research Hospital Burn Center. A questionnaire which was developed by the researchers was used for collecting data. The questions on the questionnaire were classified into four groups to evaluate the patients and #8217; expectations about communication, information, care and discharge. Data was evaluated by using SPSS 12 package software. RESULTS: In this study, 48.5% of patients were at 18-28 age group, 79.2% were male and 51.5% of patients were employed. Almost all of patients expect nurses to give them confidence (98% and to give them information about latest developments with the disease. Patients prior expectation from nurses about care was to do their treatments regularly (100% and to take the necessary precautions in order to prevent infection (100%. 97% of patient expect nurses to give them information about the drugs, materials and equipment that they are going to use while discharge. CONCLUSION: As a result we found that burn patient expectations from nurses about communication, information, care and discharge were high. [TAF Prev Med Bull 2014; 13(1.000: 37-46

  7. Profile of self-inflicted burn patients treated at a tertiary burn center in Istanbul.

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    Uygur, Fatih; Sever, Celalettin; Oksüz, Sinan; Duman, Haluk

    2009-01-01

    The factors and demographic features of self-inflicted burns in Eastern and Western cultures differ from each other. In this retrospective study, the authors' aim is to identify the epidemiologic features of self-inflicted burn patients treated at their Tertiary Burn Centre. The Burn Centre provides health care to a large population from Istanbul, which is located at the crossroads between Asia and Europe. The demographic data and information of 32 patients who were admitted to the GATA HEH Burn Center in Istanbul for attempted suicide were retrospectively reviewed over a 7-year period (2001-2008). Twenty-eight of the 32 patients were men, whereas the remaining four patients were women. The average age was 25.9 years. Seventeen patients had a previous history of self-harming and 22 patients were unemployed. History of a psychiatric illness was found in 20 patients. Mean total body burn surface area was 70%. The mortality rate was 43.4%. This study demonstrates that suicide attempts by burning differ from Eastern and Western cultures by factors and demographic features. It has been concluded that the solution to preventing self-inflicted burns calls for the joint efforts of physicians, psychologists, and sociologists. Furthermore, it is necessary to reinstate prevention programs and revise strategies for prevention based on the country and its culture.

  8. Rehabilitation of the burn patient

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    Procter Fiona

    2010-10-01

    Full Text Available Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ′Burns Rehabilitation′ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration

  9. Mortality and causes of death in first admitted schizophrenic patients

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K

    1993-01-01

    Although many studies have shown an increased mortality in schizophrenic patients, the literature provides little information about mortality from specific causes in relation to age, gender, and duration of illness. This study examined mortality and causes of death in a total national sample...... of 9156 first admitted schizophrenic patients. Suicide accounted for 50% of deaths in men and 35% of deaths in women. Suicide risk was particularly increased during the first year of follow-up. Death from natural causes, with the exception of cancer and cerebrovascular diseases, was increased. Suicide...

  10. Outcome of patients admitted to an acute geriatric medical unit

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    Devine, M J; McAleer, J J A; Gallagher, P M; Beirne, J A; McElroy, J G

    1986-01-01

    To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge. PMID:3739060

  11. Protocolized Resuscitation of Burn Patients.

    Science.gov (United States)

    Cancio, Leopoldo C; Salinas, Jose; Kramer, George C

    2016-10-01

    Fluid resuscitation of burn patients is commonly initiated using modified Brooke or Parkland formula. The fluid infusion rate is titrated up or down hourly to maintain adequate urine output and other endpoints. Over-resuscitation leads to morbid complications. Adherence to paper-based protocols, flow sheets, and clinical practice guidelines is associated with decreased fluid resuscitation volumes and complications. Computerized tools assist providers. Although completely autonomous closed-loop control of resuscitation has been demonstrated in animal models of burn shock, the major advantages of open-loop and decision-support systems are identifying trends, enhancing situational awareness, and encouraging burn team communication. PMID:27600131

  12. Wound Care in Burn Patients

    OpenAIRE

    Orhan Çizmeci; Samet Vasfi Kuvat

    2011-01-01

    Wound care in one of the most important prognostic factors in burn victims. Open wound carries risks for infection due to hypothermia, protein and fluid losses. In addition, unhealed wounds are the major risk factors for acute-subacute or chronic complications in burn patients. Although no exact algorithm exists for open wound treatment, early escarectomy or debridement together with grafting is the best option. Ointments together with topical epithelizing agents without dressings are generea...

  13. Cytomegalovirus Colitis in a Burn Patient.

    Science.gov (United States)

    Gibbs, Jeff T; Zieger, Madeline; Sood, Rajiv

    2016-01-01

    The prevalence of cytomegalovirus in the burn population is high. However, its role in the clinical management of burn patients is still being defined. This report documents a 41-year-old man who developed cytomegalovirus (CMV) colitis after being admitted with a 72% burn. Before the administration of ganciclovir, the authors had difficulty controlling his quantitative wound cultures with serial debridements, topical agents, and systemic antibiotics for known pathogens, which led to graft loss. After the ganciclovir was given, his quantitative wound cultures improved without changing the authors' topical agents or systemic antibiotics and had improved graft take. Whether CMV infection alone contributed to an increased morbidity in this patient or the combination of bacteria/fungal infection with CMV led to a synergistic effect is still not clearly understood. CMV may have contributed to a dysfunction in his cell mediated immunity, which, in turn, lowered the bacterial and fungal load necessary to cause graft loss. Patients who continue to do poorly despite adequate treatment for known pathogens may need to be screened for CMV and treated. PMID:26056763

  14. [Ergotherapy of severely burned patients].

    Science.gov (United States)

    Nickerl, U; Resag, I

    1995-04-01

    Occupational therapy for severely burned patients includes individual exercise programmes, activities of daily living (ADL), assessment of the need for technical aids, splinting and pressure bandages, as well as psychological and social support. There are different focal points in the three stages of treatment. In the burn-care unit (first stage), if necessary, the patient is provided with splints. At this time the first contact is made. In the burn-care ward (second stage), the occupational therapy is focused on individual exercise programmes, dynamic splinting, ADL, and preparation for discharge from hospital. In the outpatient department (third stage), the aims of occupational therapy are: providing the patients with pressure bandages, checking of splints, assessment of the need for technical aids and special support if the patients have difficulties at home and work. PMID:7761866

  15. Is location of burns related to outcome? A comparison between burns on extremities and burns on head and/or trunk in patients with low to intermediate TBSA in a burn center in The Netherlands.

    Science.gov (United States)

    Menger, Tirsa; Krijnen, Pieta; Tuinebreijer, Willem E; Breederveld, Roelf S

    2014-01-01

    In the literature no study was found about the effect of location of burns on outcome. The objective of this retrospective study was to investigate the effect of location on outcome parameters of 371 patients, admitted to our burn center from January 2009 to December 2011. The patients were included in the study if more than 80% of the burn(s) was localized either on the extremities or on the head and/or trunk. Two groups of TBSA were elaborated, low: 0 to 5% and intermediate: 5 to 15%. Two-hundred ninety-two patients (78.7%) had a low TBSA (patients died. The patients with an intermediate TBSA were on average 8.0 days longer admitted compared with the patients with a low TBSA adjusted for age and depth (95% confidence interval: 6.5-9.4). The patients with burns on the head and/or trunk were more often admitted to the intensive care unit, mostly as a result of suspected inhalation injury (6.2 vs 0.9%; P = .008). More complications were seen in the intermediate TBSA group. In this study no difference in outcome was found between burns on the head and/or trunk or on extremities. The patients with burns on the head and/or trunk group are more frequently admitted to intensive care.

  16. Factors Related in Suicide Attempts in Admitted Poisoned Patients

    Directory of Open Access Journals (Sweden)

    Bita Dadpour

    2015-07-01

    Full Text Available Introduction Suicide is considered as a public health problem. Approximately 0.9% of all deaths worldwide are due to suicide. This study was performed to identify risk factors of suicide attempts among patients who admitted in a medical toxicology centre during three months. Materials and Methods: A cross sectional study was carried out; all admitted patients in our medical toxicology centre due to suicidal attempt who completed consent form were included from December to March 2013. A researcher designed questionnaire was prepared and its validity and reliability was confirmed; it was fulfilled by a psychologist via clinical interview. Data were analyzed by SPSS software 11.5 and results were discussed. Results:198 participants included; of whom 67.2% were female and 94.9% were less than 45 year old. Among the patients, approximately 48% of the patients were married; 27.77% were employed. More than 96% suffered from severe depression, 3.53% of the patients had psychotic symptoms. Personality disorders, previous suicidal attempt, unemployment, full stressed family, family history of suicidal attempt, moderate to severe depression and a history of dependence on antipsychotic drugs and lack of family support were identified as risk factors for suicide. Conclusion: Attention to personality trait  and family environment can be mainly effective in long-term prevention of suicide, treatment of physical illness in patients with chronic health conditions, evaluation and treatment of psychiatric issues in addition to family and social problems, and organizing educational courses  to families with suicide history can be helpful.

  17. Characteristics of patients with measles admitted to allied hospital rawalpindi

    International Nuclear Information System (INIS)

    Measles, a virus borne droplet infection, is one of the leading causes of death among young children worldwide despite presence of a safe and cost-effective vaccine. Objective of our study was to identify the characteristics of measles patients admitted to Allied Hospitals, Rawalpindi. Methods: This cross-sectional study was conducted amongst patients admitted with measles in paediatric units of Rawalpindi Medical College Allied Hospitals, Rawalpindi. A standard proforma was used to collect data from the respondents. Results: A total of 55 patients (mean age-29.36 months) with measles were included in the study. 65.5% children were vaccinated while 34.5% were not vaccinated. Among those vaccinated 14 were male. Out of the vaccinated children 52.6% were residents of middle class areas, 31.6% lower middle class area, 10.5% upper middle class areas and 5.3% rural areas. In 55.0% of patients who were vaccinated with at least one dose of measles at nine month of age the estimated calendar months of vaccination was March to April while in 30% the overall climatic period of vaccination was of summer (May to September). Twenty one study subjects were exposed to a case of measles in the family and thirty five out of all developed at least one known complication of the disease. Pneumonia was the most common complication reported in patients (63.6%) followed by diarrhoea (27.3%). Conclusion: Majority of the patients suffering from measles were not vaccinated and the most common reason for failure to immunize children was lack of awareness. Educated and well off fathers were more likely to get their children immunized. The vaccinated children who developed measles majority were vaccinated during months of March, April and May. (author)

  18. Fluconazole Pharmacokinetics in Burn Patients

    Science.gov (United States)

    Boucher, Bradley A.; King, Stephen R.; Wandschneider, Heidi L.; Hickerson, William L.; Hanes, Scott D.; Herring, Vanessa L.; Canada, Todd W.; Hess, Mary M.

    1998-01-01

    The pharmacokinetics of fluconazole in nine adult patients with severe (30 to 95% total body surface area) burns were studied. There was no significant difference in half-life (t1/2), clearance (CL), or volume of distribution (V) over time in five patients on days 3 and 8 of the study (P > 0.05). Combined parameter estimates (means ± standard deviations) for all nine patients for the two study periods were as follows: t1/2, 24.4 ± 5.8 h; CL, 0.36 ± 0.09 ml/min/kg; and V, 0.72 ± 0.12 liters/kg. These estimates of t1/2 and CL in burn patients were approximately 13% shorter and 30% more rapid, respectively, than the most extreme estimates reported for other populations. PMID:9559811

  19. The Epidemiological and Clinical Assessment of Admitted Burned Pregnant Women in Shahid Mottahary Hospital Burn Center Between January 1998 and October 2003

    OpenAIRE

    A. Tavassoli-Ashrafi, M.D.; H. Khani, M.D.

    2007-01-01

    Background and purpose: Treatments of burn pregnant women is a difficult task because the vulnerable fetus is highly dependent on the health of the mother. This study was conducted to determine the epidemiology, etiology, clinical assessment and outcome of pregnant patients between January 1998 and October 2003.Materials and Methods: A 6-year retrospective descriptive study of burns in pregnant women hospitalized at Mottahary hospital (burn center) in Tehran was performed. A short structured ...

  20. Antibiotics and the burn patient.

    Science.gov (United States)

    Ravat, François; Le-Floch, Ronan; Vinsonneau, Christophe; Ainaud, Pierre; Bertin-Maghit, Marc; Carsin, Hervé; Perro, Gérard

    2011-02-01

    Infection is a major problem in burn care and especially when it is due to bacteria with hospital-acquired multi-resistance to antibiotics. Moreover, when these bacteria are Gram-negative organisms, the most effective molecules are 20 years old and there is little hope of any new product available even in the distant future. Therefore, it is obvious that currently available antibiotics should not be misused. With this aim in mind, the following review was conducted by a group of experts from the French Society for Burn Injuries (SFETB). It examined key points addressing the management of antibiotics for burn patients: when to use or not, time of onset, bactericidia, combination, adaptation, de-escalation, treatment duration and regimen based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The authors also considered antibioprophylaxis and some other key points such as: infection diagnosis criteria, bacterial inoculae and local treatment. French guidelines for the use of antibiotics in burn patients have been designed up from this work. PMID:20510518

  1. Comparison of mortality in patients with acute myocardial infarction accidentally admitted to non-cardiology departments versus that in patients admitted to coronary care units

    DEFF Research Database (Denmark)

    D'Souza, Maria; Saaby, Lotte; Poulsen, Tina S;

    2014-01-01

    The aim of this study was to prospectively investigate the clinical characteristics including symptoms and long-term mortality in patients with acute myocardial infarction (AMI) accidentally admitted to non-cardiology departments (NCDs). For comparison, similar observations in patients admitted...

  2. BURN SIZE AND SURVIVAL PROBABILITY IN PEDIATRIC PATIENTS IN MODERN BURN CARE

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Al-Mousawi, Ahmed M; Williams, Felicia N; Finnerty, Celeste C; Jeschke, Marc G

    2012-01-01

    Background Patient survival following severe burn injury is largely determined by burn size. Modern developments in burn care have tremendously improved survival and outcomes. However, no large analysis on outcomes in pediatric burn patients with current treatment regimen exists. This study was designed to identify the burn size presently associated with significant increases in morbidity and mortality in pediatric burn patients. Methods Single center prospective observational cohort study utilizing the clinical data of severely burned pediatric patients admitted between 1998 and 2009. This study included 952 severely burned pediatric patients with burns over at least 30% of their total body surface area (TBSA). Patients were stratified by burn size in 10% increments, ranging from 30 to 100%, with a secondary assignment made according to the outcome of a receiver operating characteristic (ROC) analysis. Statistical analysis was performed using Student’s t-test, χ2 test, logistic regression and ROC analysis, as appropriate, with significance set at p<0.05. Findings All groups were comparable in age (age in years: 30–39: 6.1±5.1, 40–49: 7.1±5.2, 50–59: 7.6±5.1, 60–69: 7.2±5.1, 70–79: 8.3±5.9, 80–89: 8.4±5.6, 90–100: 9.6±5.4), and gender distribution (male: 30–39: 68%, 40–49: 64%, 50–59: 65%, 60–69: 59%, 70–79: 71%, 80–89: 62%, 90–100: 82%). Mortality (30–39: 3%, 40–49: 3%, 50–59: 7%, 60–69: 16%, 70–79: 22%, 80–89: 35%, 90–100: 55%), multi-organ failure (30–39: 6%, 40–49: 6%, 50–59: 12%, 60–69: 27%, 70–79: 29%, 80–89: 44%, 90–100: 45%), and sepsis (30–39: 2%, 40–49: 5%, 50–59: 6%, 60–69: 15%, 70–79: 13%, 80–89: 22%, 90–100: 26%), increased significantly (p<0.001) among the groups and at a threshold of 62% TBSA. Comparison of patients with burns larger than 62% with those smaller showed significant differences in inflammatory (Cytokines), acute phase (CRP) and hypermetabolic responses (REE

  3. Wound Care in Burn Patients

    Directory of Open Access Journals (Sweden)

    Orhan Çizmeci

    2011-07-01

    Full Text Available Wound care in one of the most important prognostic factors in burn victims. Open wound carries risks for infection due to hypothermia, protein and fluid losses. In addition, unhealed wounds are the major risk factors for acute-subacute or chronic complications in burn patients. Although no exact algorithm exists for open wound treatment, early escarectomy or debridement together with grafting is the best option. Ointments together with topical epithelizing agents without dressings are genereally adequate for first-degree burns. However, topical antibacterial agents are usually required for second to third-degree wounds. Standart treatment for the open wound without epithelization is autologous skin grafting. In cases where more than 50% of the skin surface in affected, autologus donor skin may not be enough. For these cases, epidermal cell culture in vitro may be used. Mesenchymal stem cell applications which have immunosupressive effects should be utilized in cases where cells need to be prepared as allografts. (Journal of the Turkish Society intensive Care 2011; 9 Suppl: 51-4

  4. Nosocomial Infections in Burned Patients in Motahari Hospital, Tehran, Iran

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    Leila Azimi

    2011-01-01

    Full Text Available Burn patients are at high risk of developing nosocomial infection because of their destroyed skin barrier and suppressed immune system, compounded by prolonged hospitalization and invasive therapeutic and diagnostic procedures. Studies on nosocomial infection in burn patients are not well described. The objective of the present study was to identify the causative bacterial of nosocomial infection and to determine the incidence of nosocomial infection and their changing during hospitalization in burned patients admitted to in the Motahari Hospital, Tehran, Iran. During the second part of 2010, 164 patients were included in this study. Samples were taken the first 48 hours and the fourth week after admission to Motahari Burn hospital. Isolation and identification of microorganisms was performed using the standard procedure. Of the 164 patients, 717 samples were taken and 812 bacteria were identified, 610 patients were culture positive on day 7 while 24 (17.2% on 14 days after admission. The bacteria causing infections were 325 Pseudomonas, 140 Acinetobacter, 132 Staphylococcus aureus, and 215 others. The percentage of mortality was 12%. All of patients had at least 1 positive culture with Pseudomonas and/or with Acinetobacter. Hospitals suggest continuous observationof burn infections and increase strategies for antimicrobial resistance control and treatment of infectious complications.

  5. Mortality rate associated with hospital acquired infections among burn patients

    Directory of Open Access Journals (Sweden)

    Saima Aslam Bharwana

    2016-09-01

    Full Text Available Hospital acquired infections (HAIs are the major contributors of mortality associated with burn injuries. The aim of this research was to document the antecedents affiliated with major burn injuries, hospitalization and mortality in burn patients. We performed a single center prospective study of patients admitted during 3 months period (April-June 2014 in burn wards of government hospital. There were 100 patients in this investigation which were observed weekly. The inclusion criterion was based on the shifting of patients from emergency to the wards after initial treatment of more than 24 h. Variables included were age and gender of the patient, the percent total body surface area (%TBSA burn, the cause of the burn. Mean age of patients was 30.29 years. More females (55.67% were admitted than males (44.32%. The total body surface area (%TBSA burnt were from 15%- 95% respectively moreover children were more sensitive to hospital acquired infections (HAIs and mortality rate was 34% in children with mean age of 5 years and disability of body parts were 42% among 75% were females. Whereas the most common (HAIs were primary blood stream (PBS with mean value of 30.50, wound infections (WIS were at second prevalence with mean value of 27.50, followed by sepsis (S and pneumonia (P 10.33, eye infections (EIs 4.833 and urinary tract infections (UTIs 2.667. Factors significantly (p-value= 0.000 associated with increased duration of hospitalization caught HAIs mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt. It concluded that the mortality was very much dependent on age and gender of the patient, burn causes, affected area as well as %TBSA burnt are considerable factors in determining the relationship of HAIs and whether the patients will survive or knuckle to injuries. Better compliance techniques, stricter control over disinfection and sterilization practices and usage of

  6. Psychological Evaluation of Patients in Critical Care/Intensive Care Unit and Patients Admitted in Wards

    OpenAIRE

    Sharma B, Gaurav; EVS, Maben; MS, Kotian; B., Ganaraja

    2014-01-01

    Background: Psychological assessment for depression, anxiety and stress among ICU patients and the patients admitted to ward in a hospital in India. This aspect did not get much attention in India so far. Such studies were common in developed countries. Therefore we decided in this study, to analyse the psychological status responses from the hospitalised patients in Mangalore using a validated questionnaire.

  7. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline;

    2014-01-01

    OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. METHOD: The study had...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...

  8. Aeromonas hydrophila in a burn patient.

    Science.gov (United States)

    Yasti, Ahmet Cinar; Otan, Emrah; Doganay, Mutlu; Kama, Nuri A

    2009-01-01

    Infectious consequences are still a major problem and leading cause of mortality in burn patients. Among others, aeromonads need special concern because they mimic pseudomonal infections; however, they have a more rapid progression with considerable mortality if undiagnosed promptly. Here, we present a major burn case extinguished with tap water pooled in a tank. With the possibility of aeromonal infection in mind, the patient underwent aggressive debridement with proper antibiotic medication, which resulted in a successful patient management. Aeromonads should always be kept in mind in burn cases that contacted with tanked water or soil after the burn. PMID:19692919

  9. Infection control in severely burned patients

    OpenAIRE

    Coban, Yusuf Kenan

    2012-01-01

    In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood strea...

  10. The epidemiological profile of pediatric patients admitted to the general intensive care unit in an Ethiopian university hospital

    Directory of Open Access Journals (Sweden)

    Abebe T

    2015-01-01

    Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation

  11. Focused cardiac ultrasound in the emergency department for patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...

  12. Nutrition Support in Burn Patients

    Directory of Open Access Journals (Sweden)

    Cem Aydoğan

    2012-08-01

    Full Text Available Severe burn trauma causes serious metabolic derangements. Increased metabolic rate which is apart of a pathophysiologic characteristic of burn trauma results in protein-energy malnutrition. This situation causes impaired wound healing, muscle and fat tissue’s breakdown, growth retardation in children and infections. Nutrition support is vital in the treatment strategies of burn victims to prevent high mortal and disabling complications in this devastating trauma. Our aim in this study is to review management of nutrition in burn victims. (Journal of the Turkish Society Intensive Care 2012; 10: 74-83

  13. Successful treatment of invasive burn wound infection with sepsis in patients with major burns

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To investigate the clinical characteristics of invasive bum wound infection with sepsis in patients with major burns and to summarize the successful expenences in the treatment of such patients. Methods Eight patients with major bums, complicated by invesive bum wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6,IL-8,TNFα and lypopolysaccharibe (LPS) were assayed before and after surgical intervention, as well as when the patient' s vital signs became stable. Results The patients' conditions usually deterieorated abruptly when extensive invasive bum wound infection emerged. While multi-microbial infection was usually found, Pseudomonas aeruginosa was the predominant bactena isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNFα and LPS before surgical intervention wore significantly higher than those after surgical intervention (P<0.05).The lowest levels of the inflammatory mediators were abserved when the patients'conditions became stable,and the values were significantly lower than those before surgical intervention ( P<0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of infected bum wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Athough favorable results should be attributed to compmhessive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.

  14. Factors affecting mortality in patients with burns

    Directory of Open Access Journals (Sweden)

    Halil Erbiş

    2015-09-01

    Full Text Available Objective: The increase in life quality and expectancy causes an increase in the elderly population. Improvements in burn treatment resulted in decreased mortality in children and young adults but in elderly patients burns are still an important trauma that should be handed differently than other age groups. The aim of this study was to evaluate the factors effecting mortality in patients with burns over 45 years old. Methods: Fifty-eight patients over 45 years of age, who were treated in our burns unit in the last 3 years were included in our study. Their age, burn percentage and depth, coexisting diseases and mortality rates were examined retrospectively. Results: The average age of surviving patients was 57.4 years while it was 70 years for nonsurviving patients (p=0.002. The width of burn area was 21.1 % in surviving and 50 % in nonsurviving patients (p<0.01. The effect of additional coexistent diseases on mortality was significant (p=0.001. The most common reasons of mortality were sepsis and congestive heart failure. Conclusion: We found out that the age, percentage of burns and coexistent diseases had a negative effect on success of treatment and mortality. Mortality rates will decrease in these cases with careful follow-up and a multidisciplinary approach. J Clin Exp Invest 2015; 6 (3: 240-243

  15. Infections in critically ill burn patients.

    Science.gov (United States)

    Hidalgo, F; Mas, D; Rubio, M; Garcia-Hierro, P

    2016-04-01

    Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.

  16. Burns ITU admissions: length of stay in specific levels of care for adult and paediatric patients.

    Science.gov (United States)

    Maan, Zeshaan N; Frew, Quentin; Din, Asmat H; Unluer, Zeynep; Smailes, Sarah; Philp, Bruce; El-Muttardi, Naguib; Dziewulski, Peter

    2014-12-01

    Prediction of total length of stay (LOS) for burns patients based on the total burn surface area (TBSA) is well accepted. Total LOS is a poor measure of resource consumption. Our aim was to determine the LOS in specific levels of care to better inform resource allocation. We performed a retrospective review of LOS in intensive treatment unit (ITU), burns high dependency unit (HDU) and burns low dependency unit (LDU) for all patients requiring ITU admission in a regional burns service from 2003 to 2011. During this period, our unit has admitted 1312 paediatric and 1445 adult patients to our Burns ITU. In both groups, ITU comprised 20% of the total LOS (mean 0.23±0.02 [adult] and 0.22±0.02 [paediatric] days per %burn). In adults, 33% of LOS was in HDU (0.52±0.06 days per %burn) and 48% (0.68±0.06 days per %burn) in LDU, while in children, 15% of LOS was in HDU (0.19±0.03 days per %burn) and 65% in LDU (0.70±0.06 days per %burn). When considering Burns ITU admissions, resource allocation ought to be planned according to expected LOS in specific levels of care rather than total LOS. The largest proportion of stay is in low dependency, likely due to social issues.

  17. A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab, India

    Directory of Open Access Journals (Sweden)

    Gupta Ashok

    2011-01-01

    Full Text Available Aim : To analyze the causes, demographic and socio-cultural aspects, and the magnitude of burn injuries prospectively and to evaluate the outcome of treatment of patients admitted to burns ICU of tertiary care hospital. Materials and Methods : A total of 892 burn patients admitted over a period of 6 years from January 2002 to December 2007 at tertiary care hospital in Punjab, India, were analyzed. Results : 54% patients were males. A majority of the patients, 704(79%, were in the age group of 15-45 years. Six hundred and thirty-four patients (72% sustained flame burns, while 17% and 7% sustained electrical and scald burns, respectively. A total of 470(53% patients sustained major two to three degree flame burns involving more than 45% of total body surface area (TBSA. The mortality rate was 40%, i.e. 357 patients died of burns and its related problems, in our study. Six hundred and thirty-nine patients (72% sustained burns in closed space of which 331 patients (52% sustained burns in kitchen. Seven hundred and seventy-nine patients sustained accidental burns. Burn victims were mainly Hindus and Sikhs. The mean hospital stay varied depending upon the percentage of burns. On an average, a patient with >45% TBSA burns received 15 whole blood transfusions. Split skin grafting was done in 416 patients. Most common complication encountered during their hospital stay was wound infection which was seen in 671 patients, followed by ARDS in 221 patients. The most common organisms causing wound infection were Pseudomonas and Acinetobacter. Conclusion : Developing country like India need an aggressive public education program so that people become more literate about various etiological factors causing burns and means of preventing them. Also needed are burn care hospitals which are easily accessible and affordable.

  18. Risk Factors for Recurrent Hypoglycemia in Hospitalized Diabetic Patients Admitted for Severe Hypoglycemia

    OpenAIRE

    Lin, Yen-Yue; Hsu, Chin-Wang; Sheu, Wayne Huey-Herng; Chu, Shi-Jye; Wu, Chin-Pyng; Tsai, Shih-Hung

    2010-01-01

    Purpose Severe hypoglycemia can result in neural damage, impaired cognitive function, coma, seizures, or death. The decision to admit diabetic patients after initial treatment in the emergency department remains unclear. Our purpose is to identify risk factors for developing recurrent hypoglycemia in diabetic patients admitted for severe hypoglycemia. Materials and Methods We reviewed the records of 233 subjects (92 males, 141 females; mean age, 74.1 ± 9.8 years) with type 2 diabetes treated ...

  19. Quality of life and symptoms in patients with malignant diseases admitted to a comprehensive cancer centre

    DEFF Research Database (Denmark)

    Strömgren, Annette Sand; Niemann, Carsten Utoft; Tange, Ulla Brix;

    2014-01-01

    Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer.......Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer....

  20. Risk factors for mortality in patients admitted to intensive care units with pneumonia

    OpenAIRE

    Li, Guowei; Cook, Deborah J.; Thabane, Lehana; Friedrich, Jan O.; Crozier, Tim M.; Muscedere, John; Granton, John; Mehta, Sangeeta; Steven C. Reynolds; Lopes, Renato D.; Francois, Lauzier; Freitag, Andreas P; Levine, Mitchell A. H.; ,

    2016-01-01

    Background Despite the high mortality in patients with pneumonia admitted to an ICU, data on risk factors for death remain limited. Methods In this secondary analysis of PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial), we focused on the patients admitted to ICU with a primary diagnosis of pneumonia. The primary outcome for this study was 90-day hospital mortality and the secondary outcome was 90-day ICU mortality. Cox regression model was conducted to examine the relationship...

  1. Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards

    OpenAIRE

    Morris, R.; Sonibare, A.; Green, D.; Masud, T.

    2000-01-01

    OBJECTIVE—To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards.
METHODS—All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were collected from casenotes, hospital and Family Health Services Authority databases. Where available, pelvic radiographs were graded according to the Singh index.
RESULTS—The casenot...

  2. Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety.

    Science.gov (United States)

    2013-02-01

    To improve safety and patient flow, administrators at Hallmark Health System, based in Melrose, MA, implemented a new patient-centered transfer process for patients admitted through the ED at the health system's two hospitals. Under the new approach, inpatient nurses come down to the ED to take reports on new patients in a process that includes the ED care team as well as family members. The inpatient nurses then accompany the patients up to their designated floors. Since the new patient-transfer process was implemented in June 2012, patient satisfaction has increased by at least one point on patient satisfaction surveys. Administrators anticipate that medical errors or omissions related to the handoff process will show a drop of at least 50%, when data is tabulated.

  3. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action......-four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...

  4. [Invasive yeast infections in severely burned patients].

    Science.gov (United States)

    Renau, Ana Isabel; García-Vidal, Carolina; Salavert, Miguel

    2016-01-01

    Currently, there are few studies on candidaemia in the severely burned patient. These patients share the same risk factors for invasive fungal infections as other critically ill patients, but have certain characteristics that make them particularly susceptible. These include the loss of skin barrier due to extensive burns, fungal colonisation of the latter, and the use of hydrotherapy or other topical therapies (occasionally with antimicrobials). In addition, the increased survival rate achieved in recent decades in critically burned patients due to the advances in treatment has led to the increase of invasive Candida infections. This explains the growing interest in making an earlier and more accurate diagnosis, as well as more effective treatments to reduce morbidity and mortality of candidaemia in severe burned patients. A review is presented on all aspects of the burned patient, including the predisposition and risk factors for invasive candidiasis, pathogenesis of candidaemia, underlying immunodeficiency, local epidemiology and antifungal susceptibility, evolution and prognostic factors, as well as other non-Candida yeast infections. Finally, we include specific data on our local experience in the management of candidaemia in severe burned patients, which may serve to quantify the problem, place it in context, and offer a realistic perspective. PMID:27395025

  5. Incidence of pterygium in patients admitted to a university hospital

    Directory of Open Access Journals (Sweden)

    Fethiye Gülden Turgut

    2013-12-01

    Full Text Available Objectives: This study aimed to investigate the incidence of pterygium in a particular district of Istanbul, its association with age, and gender, and the severity of the disease. Methods: All patients aged ≥ 30 years referred to our outpatient clinics between January 2009 and December 2009 were included in this retrospective study. Age, gender, anterior segment photos, and findings of biomicroscopic eye examination were evaluated. Results: The incidence of pterygium for all age groups was 2.91% (male 1.75%, female 3.67% with an increasing incidence with age. A significant difference was detected in its incidence favoring female patients in 40-49, and 70-79, and male patients in ≥ 80 age groups, respectively. In addition, pterygium was seen in one (75.4% or both eyes (24.6% preferring right or left eye in 50.7%, and 49.3% of the patients, respectively. Pterygium was in nasal or temporal region in 98%, and 2% of the patients, respectively. The disease state in 59.9% of the patients was consistent with Stage 2 pterygium. The distance of pterygium from limbus was observed greatest in 60-69, and at a minimum in 40-49 age groups. No relationship was found between eye colour and development of pterygium. Conclusion: The incidence of pterygium increases with age. Incidence of pterygium differs between genders but without any significant difference. Its occurrence in one or both eyes and in right and left eyes was not influenced by gender of the patients. A statistically significant impact of eye colour of the patient on the development of pterygium was not disclosed. J Clin Exp Invest 2013; 4 (4: 436-442

  6. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    OpenAIRE

    Aktürk, Abdulkadir; Avci, Akkan; Gülen, Müge; Ay, Mehmet Oğuzhan; İçme, Ferhat; Satar, Salim

    2013-01-01

    Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the pat...

  7. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

    OpenAIRE

    Abdulkadir Akturk; Akkan Avci; Muge Gulen; Mehmet Oguzhan Ay; Ferhat Icme; Salim Satar

    2013-01-01

    Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the pati...

  8. Increased mortality in hypernatremic burned patients

    Directory of Open Access Journals (Sweden)

    Lange, Thomas

    2010-01-01

    Full Text Available Introduction: In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia. Purpose: Is a hypernatremic state associated with increased mortality? Method: Retrospective study for the incidence of hypernatremia and survival in 40 patients with a totally burned surface area (TBSA >10%. Age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were analyzed. Patients were separated in two groups without (Group A or with (Group B hypernatremia. Results: Hypernatremia occurred on day 5±1.4. No significant difference for age, sex, TBSA, ABSI-Score and fluid resuscitation within the first 24 hours were calculated. In Group A all patients survived, while 3 of the hypernatremic patient in Group B died during ICU-stay (Odds-ratio = 1.25; 95% CI 0.971–1.61; p=0.046. Conclusion: Burned patients with an in-hospital acquired hypernatremia have an increased mortality risk. In case of a hypernatremic state early intervention is obligatory. There is a need of a fluid removal strategy in severely burned patient to avoid water imbalance.

  9. Increased mortality in hypernatremic burned patients

    OpenAIRE

    de Lange, Thomas; Mailänder, Peter; Stollwerck, Peter. L.; Stang, Felix H.; Siemers, Frank; Namdar, Thomas

    2010-01-01

    Introduction: In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia. Purpose: Is a hypernatremic state associated with increased mortality? Method: Retrospective study for the in...

  10. Increased mortality in hypernatremic burned patients

    OpenAIRE

    Namdar, T; Siemers, F; Stollwerck, PL; Stang, FH; Mailänder, P; de Lange, T

    2010-01-01

    Introduction: In-hospital hypernatremia develops usually iatrogenically from inadequate or inappropriate fluid prescription. In severely burned patient an extensive initial fluid resuscitation is necessary for burn shock survival. After recovering of cellular integrity the circulating volume has to be normalized. Hereby extensive water and electrolyte shifts can provoke hypernatremia.Purpose: Is a hypernatremic state associated with increased mortality?Method: Retrospective study for the i...

  11. Multi-variate analysis of burns patients in the Singapore General Hospital Burns Centre (2003-2005).

    Science.gov (United States)

    Chong, S J; Song, C; Tan, T W; Kusumawijaja, G; Chew, K Y

    2009-03-01

    The Burns Centre at the Singapore General Hospital (SGH) serves as a tertiary referral centre for burns management for Singapore's 4 million residents as well as the Southeast Asia region. Our study is a multivariate analysis of all burns patients admitted between 2003 and 2005. A total of 482 patients were admitted during this period with an average annual admission of 161. This represents a low incidence of 0.04 per 1000 admissions for the Singapore population. 13.3% of the study population were children, which is lower than previous studies. The mean age at admission was 35 years old and the male:female ratio was 1.9:1. We found a significant difference in age between the local and foreign patients, with the latter being younger. Our study demonstrated a 7.3% increase in cases of occupational burns. The bulk of our patients (57.3%) were directly admitted from SGH's Accident and Emergency Department. The patient characteristics of the various referral sources were found to be very different. GP referrals had significantly lower TBSA while overseas patients had significantly higher TBSA and longer length of stay. The mean and median time to admission was 3.05 days (+/-6.26) and 0 (0-60) day, respectively and the mean and median time to surgery was 7.33 days (+/-8.18) and 5 (0-22) days, respectively. The most common cause of burns was due to scalding. The mean extent of burn (TBSA) was 13.5% (+/-18.0), with significant correlation with the social background. Length of stay was dependent on the need for surgery. The overall mortality rate in this study population was 4.5%, with inhalation injury the main aetiological factor. In addition, the mean duration of the first surgery that patients undergo was significantly longer than that of the second one. This information will be useful for estimating operation times in the future. Finally, Acinetobacter baumannii was the most common bacteria in wound cultures. There is a need for periodic reviews of wound cultures in

  12. [The Nutrition Care of Severe Burn Patients].

    Science.gov (United States)

    Hsieh, Yu-Hsiu

    2016-02-01

    In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body's reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively. PMID:26813059

  13. The effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇; 刁力

    2000-01-01

    Objective: To evaluate the effect of extensive excision of invasive burn wound infection on hypermetabolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable. Correlation analysis between REEs and IL-6、IL-8、TNF-α、LPS was respectively made. Results: A total of 8 patients were treated and all of them survived. Values of REE before surgical intervention were significantly higher than those after surgical intervention(P<0.01), and when patients vital signs became stable the values were significantly lower compared with that after surgical intervention(P<0.01). The plasma concentrations of IL-6、 IL-8、TNF-α and LPS after excision of invasive burn wound infection were significantly lower than those before surgical intervention (P<0.05). The lowest levels of these inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower compared with those before surgical intervention (P<0. 001). There was a significant positive correlation between REE level and respective values of plasma IL-6、 IL-8、 TNF-α、 LPS(P <0.01). Conclusions: It is deemed that the extensive excision of invasively infected burn wound in patients with major burn should be performed as early as possible to reduce an increased release of inflammatory mediators, and to control the hypermetabolic response during sepsis.

  14. Bacteriology in acute exacerbation of chronic obstructive pulmonary disease in patients admitted to hospital

    DEFF Research Database (Denmark)

    Larsen, Mette V; Janner, Julie H; Nielsen, Susanne D;

    2009-01-01

    We investigated the bacterial flora and antimicrobial sensitivity in sputum from patients admitted to hospital with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in order to recommend the best empirical treatment for these patients. The survey was a retrospective study of a...... for AECOPD we recommend either cefuroxime for intravenous treatment or amoxicillin-clavulanate for oral treatment....

  15. An epidemiological study of 500 paediatric burn patients in Mumbai, India

    Directory of Open Access Journals (Sweden)

    Verma S

    2007-01-01

    Full Text Available Aim: To study the epidemiological data of paediatric burn patients to determine the role of demographic distribution and epidemiological parameters for assessment of mortality rate and development of burn prevention strategy. Materials and Methods : Epidemiological data of 500 patients admitted to the Burns and Plastic Surgery Unit of B.J. Wadia Hospital, Mumbai over a period of six years (2000-2005 was reviewed from medical records. Age, sex, demographic distribution, seasonal variation, total body surface area (TBSA involved, type and place of burn injury, parental occupation, family size, first aid and mortality rate were studied. Result: Median age group for patient was 3.44 years (range one month to 14 years. The majority (24% of burns occurred in children between the one to two years age group. Male to female sex ratio was 1.38:1. Most of the patients were from the defined demographic region served by the hospital. A significant number of patients however were from outside this region. Burn injury occurred predominantly during winter. Most common type of burn was scalds which occurred mainly in domestic circumstances. In the majority of patients, less than 10% TBSA was involved. All patients were managed as per the unit protocol. Mortality rate was 10.4%. Mortality rate was high in patients having more than 40% TBSA involvement. Seventy-three per cent of the total deaths occurred in the patients coming from regions outside the demographic region served by the hospital. Parental occupation, family size and the first aid did not affect the mortality rate. Conclusion: Availability of a burn care unit in the vicinity can decrease the mortality rates in the paediatric burn patients. An intense and focused burn prevention campaign to educate the general population about dangerous aetiological factors will decrease the incidence of paediatric burns.

  16. Liver stiffness and 30-day mortality in a cohort of patients admitted to hospital

    DEFF Research Database (Denmark)

    Lindvig, Kristoffer; Mössner, Belinda K; Pedersen, Court;

    2012-01-01

    Eur J Clin Invest 2011 ABSTRACT: Background  Transient elastography (TE) is a new noninvasive method to assess the degree of liver fibrosis by measuring liver stiffness. The objective of this study was to determine whether increased liver stiffness in patients admitted to medical wards was associ......Eur J Clin Invest 2011 ABSTRACT: Background  Transient elastography (TE) is a new noninvasive method to assess the degree of liver fibrosis by measuring liver stiffness. The objective of this study was to determine whether increased liver stiffness in patients admitted to medical wards...

  17. A simple tool for mortality prediction in burns patients: APACHE III score and FTSA.

    Science.gov (United States)

    Moore, E C; Pilcher, D V; Bailey, M J; Cleland, H; McNamee, J

    2010-11-01

    Prediction of outcome for patients with major thermal injury is important to inform clinical decision making, alleviate individual suffering and improve hospital resource allocation. Age and burn size are widely accepted as the two largest contributors of mortality amongst burns patients. The APACHE (Acute Physiology and Chronic Health Evaluation) III-j score, which incorporates patient age, is also useful for mortality prediction, of intensive care populations. Validation for the burns specific cohort is unclear. A retrospective cohort study was performed on patients admitted to the Intensive Care Unit (ICU) via the Victorian Adult Burns Service (VABS), to compare observed mortality with burns specific markers of illness severity and APACHE III-j score. Our primary aim was to develop a mortality prediction tool for the burns population. Between January 1, 2002 and December 31, 2008, 228 patients were admitted to the ICU at The Alfred with acute burns. The mean age was 45.6 years and 81% (n=184) were male. Patients had severe injuries: the average percent TBSA (total body surface area) was 28% (IQR 10-40) and percent FTSA (full thickness surface area) was 18% (IQR 10-25). 86% (n=197) had airway involvement. Overall mortality in the 7-year period was 12% (n=27). Non-survivors were older, had larger and deeper burns, a higher incidence of deliberate self-harm, higher APACHE III-j scores and spent less time in hospital (but similar time in ICU), compared with survivors. Independent risk factors for death were percent FTSA (OR 1.03, 95% CI 1.01-1.05, p=0.01) and APACHE III-j score (OR 1.04, 95% CI 1.02-1.07, pAPACHE III-j score and percent FTSA. Prospective validation of our model on different burn populations is necessary.

  18. Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy

    Science.gov (United States)

    Weber, Ralph; Reimann, Gernot; Weimar, Christian; Winkler, Angela; Berger, Klaus; Nordmeyer, Hannes; Hadisurya, Jeffrie; Brassel, Friedhelm; Kitzrow, Martin; Krogias, Christos; Weber, Werner; Busch, Elmar W.; Eyding, Jens

    2015-01-01

    Background: After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. Aims: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. Methods: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. Results: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0–2, 44.0% versus 35.7%, p = 0.08). Conclusions: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging. PMID:27006695

  19. Assisted Vaginal Deliveries in Mothers Admitted as Public or Private Patients in Western Australia

    OpenAIRE

    Einarsdóttir, Kristjana; Haggar, Fatima A; Stock, Sarah; Gunnell, Anthony S.; Stanley, Fiona J.

    2013-01-01

    Background Mothers delivering as private patients in Australia have a high rate of assisted deliveries, which could lead to adverse infant outcomes in this group of patients. We investigated whether the risk of adverse infant outcomes after assisted deliveries was different for mothers admitted as public or private patients for delivery, when compared with unassisted deliveries. Methods and findings We included 158,241 vaginal, singleton, term birth admissions in our study where the infant wa...

  20. Analysis of antibiotic consumption in burn patients.

    Science.gov (United States)

    Soleymanzadeh-Moghadam, Somayeh; Azimi, Leila; Amani, Laleh; Rastegar Lari, Aida; Alinejad, Faranak; Rastegar Lari, Abdolaziz

    2015-01-01

    Infection control is very important in burn care units, because burn wound infection is one of the main causes of morbidity and mortality among burn patients. Thus, the appropriate prescription of antibiotics can be helpful, but unreasonable prescription can have detrimental consequences, including greater expenses to patients and community alike. The aim of this study was to determine the effect of antibiotic therapy on the emergence of antibiotic-resistant bacteria. 525 strains of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus were isolated from 335 hospitalized burn patients. Antibiotic susceptibility tests were performed after identification the strains. The records of patients were audited to find the antibiotic used. The results indicated that P. aeruginosa is the most prevalent Gram-negative bacteria. Further, it showed a relation between abuse of antibiotics and emergence of antibiotic resistance. Control of resistance to antibiotics by appropriate prescription practices not only facilitates prevention of infection caused by multi-drug resistant (MDR) microorganisms, but it can also decrease the cost of treatment. PMID:26124986

  1. Analysis of antibiotic consumption in burn patients

    Directory of Open Access Journals (Sweden)

    Soleymanzadeh-Moghadam, Somayeh

    2015-06-01

    Full Text Available Infection control is very important in burn care units, because burn wound infection is one of the main causes of morbidity and mortality among burn patients. Thus, the appropriate prescription of antibiotics can be helpful, but unreasonable prescription can have detrimental consequences, including greater expenses to patients and community alike. The aim of this study was to determine the effect of antibiotic therapy on the emergence of antibiotic-resistant bacteria. 525 strains of and were isolated from 335 hospitalized burn patients. Antibiotic susceptibility tests were performed after identification the strains. The records of patients were audited to find the antibiotic used.The results indicated that is the most prevalent Gram-negative bacteria. Further, it showed a relation between abuse of antibiotics and emergence of antibiotic resistance. Control of resistance to antibiotics by appropriate prescription practices not only facilitates prevention of infection caused by multi-drug resistant (MDR microorganisms, but it can also decrease the cost of treatment.

  2. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Andersson, Charlotte; Marott, Jacob L;

    2013-01-01

    Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain....

  3. Health Anxiety Levels in Patients Admitted to Internal Medicine Outpatient Clinic for Several Times

    Directory of Open Access Journals (Sweden)

    Ali Gul

    2014-12-01

    Full Text Available Aim: Health anxiety (HA in patients consist of incorrect reference to normal bodily sensations as a signs of a serious disease. The aim of this study is to investigate the HA in patients admitted to internal medicine outpatient clinic for several times within one year. Material and Method: 60 patients who admitted more than one time to internal medicine outpatient clinic within one year and the control group consisted of 60 people were enrolled in this study. Short-form of health anxiety inventory (SAE-KF was given to these groups, The results were compared statistically. Results: SAE-KF scores were significantly higher in the patient group (11.17 ± 6.07 than the control group (10.71±4.44 (Z=-5.96, P

  4. Point-of-care ultrasonography in patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian B; Sloth, Erik; Lassen, Annmarie Touborg;

    2014-01-01

    of the heart, lungs, and deep veins in addition to the usual initial diagnostic testing in this patient population. METHODS: In a prospective, parallel-group trial in the emergency department at Odense University Hospital, Odense, Denmark, patients (≥18 years) with a respiratory rate of more than 20 per min......BACKGROUND: When used with standard diagnostic testing, point-of-care ultrasonography might improve the proportion of patients admitted with respiratory symptoms who are correctly diagnosed 4 h after admission to the emergency department. We therefore assessed point-of-care ultrasonography...... diagnosis within 4 h. It should therefore be considered for routine use as part of the standard diagnostic tests in the emergency department for patients admitted with respiratory symptoms. FUNDING: University of Southern Denmark, Odense University Hospital, and Højbjerg Fund....

  5. Aetiology and Outcome of Elderly Burn Patients in Tabriz, Iran

    OpenAIRE

    H. Maghsoudi; Ghaffari, A

    2009-01-01

    Background. Geriatric patients, usually defined as being 65 years of age or over, now make up about 10% of the major burn population. Main aim. To conduct a prospective study of elderly burn patients, analysing the predictive value of age, gender, total body surface area (TBSA) burned, inhalation trauma, pre-morbid conditions, and mortality. Methods. A 10-year prospective study of burn victims hospitalized in a major burn centre in Iran was conducted to analyse the association between age, pe...

  6. Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

    Science.gov (United States)

    Mann-Salinas, Elizabeth A; Baun, Mara M; Meininger, Janet C; Murray, Clinton K; Aden, James K; Wolf, Steven E; Wade, Charles E

    2013-01-01

    The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P burn patient.

  7. Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Aderoju Emmanuel

    1999-01-01

    Full Text Available To determine the relative frequencies of gastrointestinal diseases (GI in patients admitted to Samtah General Hospital, Gizan, the records of 2,442 adults admitted to the medical and surgical services for gastrointestinal diseases during the period 1413 to 1416 were analyzed retrospectively. 1,028 patients had acute appendicitis. The remaining 1,414 patients were admitted for various other GI diseases. In these 1,414 patients the commonest diseases were gastrointestinal infections (36.4%, peptic ulcer disease (19%, gall bladder disease (18.5%, viral hepatitis and its sequelae (20.7%. Despite the high prevalence of cholelithiasis, acute pancreatitis was uncommon (0.1 %. Inflammatory bowel disease was rare. There was no gender - related difference in the prevalence of gastrointestinal infections, peptic ulcer disease and carcinoma of the stomach. Males were significantly more afflicted than females with viral hepatitis (p< 0.0001, cirrhosis of the liver (p< 0.0001, hepatocellular carcinoma (p< 0.0005, variceal bleeding (p< 0.0005, and peptic ulcer bleeding (p< 0.005. As a large proportion of our patients had preventable diseases, it is expected that immunization and other public health measures will reduce the frequency of these diseases in the future.

  8. Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne;

    2015-01-01

    OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

  9. In-hospital mortality among a cohort of cirrhotic patients admitted to a Tertiary Hospital

    Directory of Open Access Journals (Sweden)

    Mohammad A Alsultan

    2011-01-01

    Full Text Available Background/Aim : To determine the mortality rate in a cohort of hospitalized patients with cirrhosis and examine their resuscitation status at admission. Materials and Methods : A retrospective chart review was conducted of patients with cirrhosis who were admitted to a tertiary care hospital in Riyadh, Saudi Arabia, from January 1, 2009, to December 31, 2009. Results: We reviewed 226 cirrhotic patients during the study period. The hospital mortality rate was 35%. A univariate analysis revealed that worse outcomes were seen in patients with advanced age or who had worse child-turcotte-pugh (CPT scores, worse model for end-stage liver disease (MELD scores, low albumin and high serum creatinine. Using a multivariate analysis, we found that advanced age (P=0.004 and high MELD (P=0.001 scores were independent risk factors for the mortality of cirrhotic patients. The end-of-life decision were made in 34% of cirrhotic patients, and the majority of deceased patients were "no resuscitation" status (90% vs. 4%, P<0.001. Conclusions : The relatively high mortality in cirrhotic patients admitted for care in a tertiary hospital, Saudi Arabia was comparable to that reported in the literature. Furthermore, end-of-life discussions should be addressed early in the hospitalization of cirrhotic patients.

  10. Stressors in the relatives of patients admitted to an intensive care unit

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-01-01

    Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors.

  11. Oral Rehydration Therapy in Burn Patients

    Science.gov (United States)

    2014-04-24

    Burn Any Degree Involving 20-29 Percent of Body Surface; Burn Any Degree Involving 30-39 Percent of Body Surface; Burn Any Degree Involving 40-49 Percent of Body Surface; Burn Any Degree Involving 50-59 Percent of Body Surface; Burn Any Degree Involving 60-65 Percent of Body Surface

  12. The dynamic experience of pain in burn patients: A phenomenological study.

    Science.gov (United States)

    Pérez Boluda, M T; Morales Asencio, J M; Carrera Vela, A; García Mayor, S; León Campos, A; López Leiva, I; Rengel Díaz, C; Kaknani-Uttumchandani, S

    2016-08-01

    Although pain is one of the main sources of suffering during the acute phase and rehabilitation in burn patients, it remains as a major challenge for burn care, and clinical management not always correlates with the experience felt by patients. The aim of this study was to understand the experience of pain from people who has suffered severe burns, to identify personal strategies used to cope with this challenging event. A qualitative phenomenological study with purposive sampling was carried out with severe burn patients admitted to a Burn Unit. Through individual in-depth interviews, verbatim transcription and content analysis, two main categories were isolated: a dynamic and changing experience of pain, from the onset to the hospital discharge, and diverse strategies developed by patients to cope with pain, being distraction the most frequently used. Pain experienced acquires its maximum intensity during wound care, and divergent patients' opinions about sedation are present. This study highlights how understanding subjective experiences is an invaluable aid to improve care in pain assessment and management. Furthermore, it points out the need to guarantee patient involvement in the organization and improvement of burn care, inasmuch as traditional professional centered approach is not ensuring an optimal management.

  13. Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns

    OpenAIRE

    Lu, Guozhong; Huang, Jiren; Yu, Junjie; Zhu, Yugang; Cai, Liangliang; Gu, Zaiqiu; Su, Qinghe

    2011-01-01

    Sepsis commonly occurs in severe post-burn patients, often resulting in death. We aimed to evaluate the influence of early enteral feeding on outcomes in patients with extensive burns, including infection incidence, healing and mortality. We retrospectively reviewed 60 patients with extensive burns, 35 who had received early enteral nutrition and 25 who had received parenteral nutrition. Average healing time, infection incidence and mortality were clinically observed. Hemoglobin and serum alb...

  14. Epidemiologic Evaluation of Ocular Trauma in Patients Admitted to Ophthalmology Ward of Farshchian Hospital in Hamadan in 2012

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    N. Bazzazi

    2014-04-01

    Full Text Available Introduction & Objective: Ocular trauma is one of the important reasons of visual loss which can cause multiple damages to eyelid, eyeball and adenexal tissues. Furthermore, ocular trauma is one of the major causes of unilateral blindness and the third leading cause of hospi-talization in ophthalmology wards. The aim of this study is to determine the prevalence and characteristics of eye trauma at Farshchian hospital in Hamadan in 2012. Material & Methods: In this cross-sectional descriptive study, 70 patients with ocular trauma, admitted to Farshchian hospital, were studied. We assessed the age, sex, job , educational level, location, cause of trauma, its type and site of injury. The data was analyzed by SPSS 16 software and t, ?2 statistical tests. Results: The mean age of patients in this study was 24.01 years (SD= 16.04. Among 70 pa-tients, 58 people (82.1% were males and 12 patients (17.1% were females. The most com-mon cause of trauma was observed in 19 patients (27.1%. The most common location of the trauma in this study was homing, seen in 28 patients (40%. Among the 70 patients, 29 peo-ple (41.4% had open globe injuries, 25 people had (35.7% closed globe injuries, 5 patients (7.1% had burning and 11 patients (15.7% had adenexal injury. Conclusions: The results showed that most ocular traumas occur in the early ages and in males. The most common type of them is open globe injury and the most common cause is a sharp object. (Sci J Hamadan Univ Med Sci 2014; 21 (1:25-31

  15. Prospective Analysis of Geriatric Patients Admitted to Emergency Department With Trauma

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    Abdulkadir Akturk

    2013-08-01

    Full Text Available Objective: The aim of this study is to reveal the demographic characteristics, causes of trauma, physical examination findings, the presence of fractures and the status of the outcome of the geriatric trauma patients admitted to the emergency department of an educational research hospital. Material and Methods: This study covers all the cases over 65 years who were admitted to emergency department with trauma between September 1 2011-31 August 2012. The demographic characteristics of the patients such as, age, gender, date of application and as well as the causes of trauma, physical examination findings and outcome situation in the emergency department were evaluated. The study was performed prospectively. SPSS V.20 was used for statistical analysis of the data obtained. Results: Total 175 patients were included to the study, 74 were male (42.28% and 101 were female (57.72%. The mean age of male patients were 75.01 ± 6.557 while the mean age of female patients were 76.10 ± 7.353. The most common cause of trauma in both gender was falls. This rate was 91.1% in female and 8.9% in male patients. 40.6% of the female patients and 27% of the male patients were admitted to the hospital before because of any trauma. The most common form of trauma according to exposed body localization in both gender was extremity traumas. It was seen in 51.5% of the females and 56.8% of the males. 30 female patients (29.7% and 13 male patients (17.6% had fracture in limbs. 78.3% of all patients were discharged from the emergency department and 21.7% of the patients were hospitalised. None of the patients were died in emergency department and none of the patients were referred to another institution from the emergency department. Total 38 patients were hospitalised, 32 of them were discharged, 2 of them were referred to another institution, and 4 of them were died. 26 of 38 hospitalised patients had undergone surgery while 20 of them were orthopedic surgeries

  16. MORBIDITY AND SURVIVAL PROBABILITY IN BURN PATIENTS IN MODERN BURN CARE

    Science.gov (United States)

    Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

    2014-01-01

    Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers. PMID:25559438

  17. Comparison of the outcome of burn patients using acute-phase plasma base deficit.

    Science.gov (United States)

    Salehi, S H; As'adi, K; Mousavi, J

    2011-12-31

    Background. In recent years, plasma base deficit has been used as a marker to determine the status of tissue perfusion in trauma patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma base deficit in predicting burn patient outcome. Methods. This prospective cohort study was performed from October 2009 to October 2010 in the acute phase of burn patients who were admitted within 6 h post-injury to Motahari Burn Hospital in Iran. The patients were divided into two groups based on the plasma base deficit in the first 24 h post-injury: group A, in which the mean plasma base deficit was less than or equal to -6 (more negative), and group B, in which the mean plasma base deficit greater than -6. Statistical analysis was performed using SPSS v.16 software. Results. Thirty-eight patients were enrolled in each group. The mean plasma base deficit in group A (-7.76 ± 2.18 mmol) was significantly less than that in group B (-1.19 ± 2.82) mmol (p 0.05) and despite removal of interfering factors, there were significant differences between the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome score and the percentage of sepsis between the two groups (p 0.05). Conclusion. The plasma base deficit can be used as a valuable marker in the resuscitation of burn patients, along with clinical criteria. Physiological indicators (burn percentage, age, and mucosal burns) are not sufficient to predict mortality and morbidity in burn patients, and it is necessary to investigate the role of biochemical markers such as base deficit in determining the final outcome of burn patients.

  18. The pattern of neurological disorders in patients admitted to El shaab teaching hospital

    International Nuclear Information System (INIS)

    This thesis was designed to study the pattern of neurological disorders of admitted patients to the neurology centre at El shaab teaching hospital in the period from january 1997 to december 1998. 402 cases were admitted. (35%) were in the age group 21-40, 30% in 41-60, 20% in 61-80, 14% in 0-20 and 1% in >81 males constituted 72% and females 28%. Cerebrovascular diseases top the list with 18.9%, followed by paraplegia's with 17.4%, peripheral neuropathies 11.7, (guillain barre was the most common). Brain space occupying lesions 10.4% (tumors and tuberculomas was the most common),movement disorders with 10% (Parkinson's disease was the most encountered), muscle disorders 6.2% (myasthenia gravis was the commonest). Ataxias 5.5%, headache and migraine was the least group of disorders

  19. The relationship of air pollution and asthma patients admitted to hospitals in Kermanshah (2008-2009

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    Razieh Khamutian

    2015-01-01

    Full Text Available Background: Industrialization and urbanization have had a devastating impact on public health. Asthma is considered as one of the major challenges of public health. The purpose of this study was to determine the association between air pollution and the number of asthma patients admitted to hospitals in Kermanshah, Iran. Methods: In this cross-sectional and ecological study, the data on the number of asthma patients, the concentration levels of air pollutants and weather conditions were collected from the city of Kermanshah. To determine the association between asthma patients admitted to hospitals and air pollutants, Poisson regression was used (P<0.05. Results: according to the statistical analysis, air pollutants had significant correlation with each other. Based on the results of multiple Poisson regression, among air pollutants CO and O3 were significantly correlated with the number of asthma patients referred to hospitals, with relative risk of 1.18 and 1.016, respectively, and based on the results of single Poisson regression, among air pollutants NOx, NO, NO2 and CO were significantly correlated with the number of asthma patients referred to hospitals with relative risk of 1.011, 1.012, 1.054 and 1.247, respectively. Conclusion: according to the results of the present study, there was a significant association between air pollutants (mainly carbon monoxide and ozone and the total number of asthma patients referred to the hospitals in Kermanshah.

  20. Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients

    DEFF Research Database (Denmark)

    Kolmos, H J; Thuesen, B; Nielsen, S V;

    1993-01-01

    Five patients with extensive deep burns developed septicaemia due to Pseudomonas aeruginosa serogroup O-7.8 and phage type 21 or 21/188 shortly after they had been admitted to hospital. Four other burned patients became colonized with the same strain. The source of infection was contaminated tap...... water used for irrigation of the burns, as part of the first-aid treatment which the patients received when entering the hospital. Contamination was restricted to showers and tubing that were permanently connected to the taps, and the outbreak stopped after they had been disinfected. Tubing and showers...... used for irrigation of burns should be dismantled and heat-disinfected after each patient and not reconnected to the taps until immediately before the next treatment. Taps used for irrigation of burns should be monitored regularly for the presence of P. aeruginosa and other potentially pathogenic...

  1. Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems

    Science.gov (United States)

    Yusof, Nazri Mohd; Rahman, Jamalludin Ab; Zulkifly, Ahmad Hafiz; Che-Ahmad, Aminudin; Khalid, Kamarul Ariffin; Sulong, Ahmad Fadzli; Vijayasingham, Naveen

    2015-01-01

    INTRODUCTION Diabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood. METHODS This cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients’ profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis. RESULTS A total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis. CONCLUSION T2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems. PMID:26668408

  2. Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward

    Directory of Open Access Journals (Sweden)

    de Araújo Carlos José Soares

    2012-11-01

    Full Text Available Abstract Background Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. Methods This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us two times a day for consecutive days until hospital discharge. Results The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p Conclusion The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

  3. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  4. Severe metapneumovirus infections among immunocompetent and immunocompromised patients admitted to hospital with respiratory infection.

    Science.gov (United States)

    Souza, Juliana Sinohara; Watanabe, Aripuana; Carraro, Emerson; Granato, Celso; Bellei, Nancy

    2013-03-01

    Human metapneumovirus (hMPV) is considered an important cause of acute respiratory infections. hMPV can cause morbidity in hematopoietic stem cell transplant recipients and recent research has demonstrated that it is an important virus in patients admitted to hospital with respiratory infections and suspected of having pandemic 2009 influenza A (H1N1pdm09) virus. The purpose of this study was to investigate infections caused by hMPV in two groups of patients admitted to hospital: Immunocompromized patients with a potential risk of severe outcomes and immunocompetent patients with severe acute respiratory syndrome. A total of 288 samples were tested: 165 samples were collected from patients with suspected influenza A (H1N1) pdm09 infection during the first pandemic wave in 2009; and 123 samples were collected from patients of a hematopoietic stem cell transplantation program in 2008-2009. Amplification of the hMPV genes was performed by polymerase chain reaction. This was followed by sequencing and phylogenetic analysis. hMPV was detected in 14.2% (41/288) of all samples: 17% (28/165) of immunocompetent patients with suspected H1N1 infection and 10.6% (13/123) among hematopoietic stem cell transplant recipients. hMPV accounted for 12.1% (8/66) of immunocompetent adults patients with severe respiratory infections (median age, 55.9 years). Two hMPV subtypes were identified, A2 (26.9%; 7/26) and B2 (73.1%; 19/26) but no difference was observed between the patient groups in terms of age or immunosuppression level. This study highlights the significance of hMPV in immunocompetent adult patients with severe infections and further investigations are recommended for understanding the impact of this virus.

  5. Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts

    DEFF Research Database (Denmark)

    Eriksen, Nanna; Vestbo, Jørgen

    2010-01-01

    discharged patients admitted in 2006-2007 with an exacerbation of chronic obstructive pulmonary disease from three respiratory departments. Data were collected from patient charts and compared with a replicate study done in 2001. RESULTS: The mean age was 72.1years; 61.7% were women. Mean forced expiratory...... with strong analgesics. CONCLUSIONS: Over a period of 6years, a significantly higher number of patients are being treated according to guidelines. Survival following discharge increased over the same period....

  6. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  7. Determination of the prevalence of congenital heart disease in the patients admitted to the heart clinic

    Institute of Scientific and Technical Information of China (English)

    Shokoufeh Ahmadipour; Behzad Mohammadpour Ahranjani; Sara Daeichin; Zahra Mirbeig Sabzevari

    2015-01-01

    Objective:To investigate the prevalence of congenital heart disease (CHD) among the patients who refferred to the heart clinic so as to make an early and correct diagnosis. Methods: In this descriptive-cross sectional study, all the patients admitted to the heart clinic who had symptoms or signs ofCHDwere included. The data were collected in one year based on the medical records. The main variables consisted of age, gender, history of folic acid consumption by the mother in pregnancy, clinical signs, symptoms and so on. Results: Among the 763 admitted patients, 498 were males and the rest were females. Infants were the most common group and teenagers were the least one. The most common findings for which the patients had been referred were chest pain and a murmur heard during a normal physical examination. Based on the echocardiography findings, ventricular and atrial septal defects were the most common ones. The history of folic acid consumption was negative in 168 mothers within their pregnancy. Conclusions: Since the causes and risk factors in the incidence ofCHD in children are numerous, we recommended that the information about these diseases should be given to the community and strengthen the referral system, design registration system ofCHD set up in the country round.

  8. Evaluation of pregnant patients admitted to the emergency department with suicide attempt

    Directory of Open Access Journals (Sweden)

    Yılmaz Zengin

    2015-06-01

    Full Text Available Objective: In the pregnancy period, the incidence of suicide attempt is lower compared to other life-periods. However, according to the recent studies, suicide attempts may lead life-threatening consequences in high-risk pregnant women. The aim of this study is to compare pregnant patients admitted to the emergency department for suicide attempt in terms of their sociodemographic and clinical properties and suicide attempt methods. Methods: In this study, 56 patients admitted to the emergency department of university for suicide attempt between January 1, 2009, and December 31, 2014, were included and they were classified according to suicide attempt methods into 2 groups as violent ones. Group 1 included violent methods as hanging, jumping, shooting and Group 2 included non-violent method as drugs. The study was a retrospective cross-sectional study. The sociodemographic, psychiatric and clinical properties of the patients were identified by patient registry system and patient files, and inter-group differences were compared. Results: In this study, 15 (26.7% patients in the violent suicide attempt group, and 41 (73.3% patients in the non-violent suicide attempt group, totally 56 patients were included. In the non-violent suicide attempt group, cigarette smoking, suicide attempt due to boredom, and live birth was significantly higher as compared to violent group; hospitalization period and fetal death was lower (p=0.04; p=0.006; p=0.004; p=0.004, respectively. Conclusion: Most of our pregnant suicide attempt patients are in the non-violent group, however, violent suicide attempt increased hospitalization period and fetal mortality significantly. J Clin Exp Invest 2015; 6 (2: 115-120

  9. Outcome of patients with hematological malignancies admitted to the intensive care with life-threatning complications

    International Nuclear Information System (INIS)

    To access the outcome of patients with hematological malignancies (HM) admitted to medical intensive care unit (MICU) and to identify prognostic factors that may effect patient's outcome. Data were collected in 44 patients with HM admitted to the MICU at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia within a 9-year period from 1993 to 2004. Demographic, physiological, clinical, laboratory and therapeutic data were collected on admission to MICU. Thirty-four percent of patients had acute lymphocytic leukemia; 25% had acute myelocytic leukemia (AML) followed by non-Hodgkin's lymphoma in 20%, only 13.6% of these patients were in remission. The reason for admission of these patients into MICU were shock (34.15%), respiratory failure (31.8%), cardiac arrest (20.4%), neurological causes (9.1%) and for other causes like small bowel perforation, hepatic failure, acute renal failure and metabolic disorders (4.5%). The overall in-hospital mortality was 72.7%, intensive care unit (ICU) mortality 61%, and the mean length of stay in the MICU was 5.4+-4.8 days. A statistically significance association was demonstrated between both remission status and aspartate aminotransferase values on one side and patient's outcome on the other side. Patients with AML had poorer prognosis with mortality rate of 90.9%. Although mortality in patients with HM requiring ICU care is high, our results indicate that critical care support may be lifesaving. Apart from remission status and AML disease, no other prognostic factor could be identified. (author)

  10. Incidence of Osteoporosis in Patients Admitted to our Physical Medicine and Rehabilitation Outpatient Clinics

    Directory of Open Access Journals (Sweden)

    Berat Meryem Alkan

    2011-04-01

    Full Text Available Aim: Osteoporosis is a skeletal disease characterized with decreased bone mass and microarchtitectural deterioration of bone tissue which increases bone fragility and fracture risk. Osteoporosis and osteoporotic fractures constitute an important health problem in general population. This study aimed to determine the incidence of osteoporosis, chronic diseases accompanying osteoporosis and incidence of falls in male and female patients admitted to our out patient clinics retrospectively. Material and Methods: Patient records of the 11624 patients admitted to Ankara Atatürk Education and Research Hospital Physical Medicine and Rehabilitation Outpatient clinics between January 2010 and July 2010 were retrospectively reviewed and 644 patients diagnosed as osteoporosis according to femoral neck and/or lumbar dual energy x ray absoptiometry measurements were included in the study. Ages of the patients, sexes, chronic ilnesses, musculoskeletal sytem complaints and fall histories were also recorded. Results: The incidence of osteoporosis was found to be 7.61% in female patients and it was determined that incidence was 5-fold increased in women than in men. Besides, chronic ilnesses and fall history were accompanying in higher ratios in osteoporotic patients. Conclusion: Heart diseases, hypertension, diabetes, neurological diseases leading to impairment in balance and musculoskelatal system complaints were quite frequent in patients with osteoporosis and these diseases should be taken seriously since they increase the risk of falling. It is important to avoid using drugs which lead to balance impairment, to use walk aids like canes or walkers, to perform exercises including balance and coordination training and endurance exercises in order to prevent falls. (Turkish Journal of Osteoporosis 2011;17:10-3

  11. [Risk factors for development of hypomagnesemia in the burned patient].

    Science.gov (United States)

    Durán-Vega, Héctor César; Romero-Aviña, Francisco Javier; Gutiérrez-Salgado, Jorge Eduardo; Silva-Díaz, Teresita; Ramos-Durón, Luis Ernesto; Carrera-Gómez, Francisco Javier

    2004-01-01

    Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier. PMID:15633562

  12. Short-term mortality in hip fracture patients admitted during weekends and holidays

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kehlet, H

    2006-01-01

    BACKGROUND: Acute surgical admission during weekends, with reduced staffing levels, has been associated with increased risk of mortality, but the effect of longer vacation/holiday periods has not been studied. We therefore examined early postoperative mortality in hip fracture patients admitted...... during weekends and holiday periods, compared with normal weekdays. METHODS: Prospective, descriptive study in 600 consecutive hip fracture patients treated with a well-defined multimodal care plan, in a specialized hip fracture unit between September 2002 and July 2004. Patients were stratified...... independent risk factor for both 5-day (4.34, 95% CI 1.74-10.8) and 30-day mortality (1.84, 95% CI 1.08-3.12). CONCLUSION: Staff reduction during holiday periods in units that care for acute surgical patients may adversely influence postoperative outcome. This may have important consequences both for outcome...

  13. Prevalence of unrecognized diabetes mellitus in patients admitted with acute coronary syndrome.

    Science.gov (United States)

    Abdullatef, W K; Al-Aqeedi, R F; Dabdoob, W; Hajar, H A; Bener, A; Gehani, A A

    2013-01-01

    We assessed the prevalence of unrecognized diabetes mellitus (DM) in patients with acute coronary syndrome (ACS) as determined by elevated glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and random plasma glucose (RPG) levels. This prospective study recruited 583 patients admitted with ACS without previous diagnosis of DM during 1-year period. Glycosylated hemoglobin was checked for most patients especially those with high values of FPG and or RPG. Patients were classified according to their glycemic state into 123 (21.1%) with DM, 82 (14.1%) with prediabetes, and 57(9.8%) with stress hyperglycemia, while 321 (55%) were classified as nondiabetics. Glycosylated hemoglobin estimation in the setting of ACS was helpful in the diagnosis of DM to eliminate the effect of stress-induced hyperglycemia that might accompany this condition. PMID:22550348

  14. Burn patient: emergency treatment and reanimation

    Directory of Open Access Journals (Sweden)

    Berrocal-Revueltas Manuela

    2011-12-01

    Full Text Available Burns are a worldwide public Health Problem. This matter mainly affects the populationsof developing countries, due to their vulnerability and the lack of statistical recordsavailable to acknowledge the truly dimensions of the problem, which are needed todevelop efficient prevention proposals. This trauma or injury of the tissue, produced bythe transference of energy from one body to another, severely affects the quality of lifeof the burn patient, with high risk of morbidity and mortality, if the emergency treatmentof resuscitation or reanimation procedure, performed by the medical or paramedical teamfails to operate in a efficient way. This Guidelines is an easy, updated, effective and safetysupport, designed for physicians and paramedics, since they are the first who go to theplace of the accident to offer the primary support to the burned patient.RESEUMEN:Las quemaduras son un problema de salud pública a nivel mundial, que afecta con mayorgravedad a las poblaciones vulnerables de los países en vías de desarrollo, por la falta deregistros estadísticos que permitan conocer la dimensión del problema, para desarrollarpropuestas eficientes en materia de prevención. Este trauma o lesión tisular, producidapor la transferencia de energía de un cuerpo a otro, puede afectar en forma severa lacalidad de vida del paciente y su familia, con alto riesgo de morbi-mortalidad, si no seaplica en forma oportuna y eficiente un tratamiento de emergencia para la reanimación óresucitación del paciente, por parte del equipo médico y paramédico, asignados en cadacaso. La presente guía de manejo de urgencia del paciente quemado, es de fácil aplicación,efectiva y actualizada, orientada a los médicos generales y paramédicos, quienes son losprimeros en acudir al lugar del accidente para ofrecer los primeros cuidados al pacientequemado.

  15. Ceruloplasmin and Hypoferremia: Studies in Burn and Non-Burn Trauma Patients

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    Michael A. Dubick

    2015-03-01

    Full Text Available Objective: Normal iron handling appears to be disrupted in critically ill patients leading to hypoferremia that may contribute to systemic inflammation. Ceruloplasmin (Cp, an acute phase reactant protein that can convert ferrous iron to its less reactive ferric form facilitating binding to ferritin, has ferroxidase activity that is important to iron handling. Genetic absence of Cp decreases iron export resulting in iron accumulation in many organs. The objective of this study was to characterize iron metabolism and Cp activity in burn and non-burn trauma patients to determine if changes in Cp activity are a potential contributor to the observed hypoferremia. Material and Methods: Under Brooke Army Medical Center Institutional Review Board approved protocols, serum or plasma was collected from burn and non-burn trauma patients on admission to the ICU and at times up to 14 days and measured for indices of iron status, Cp protein and oxidase activity and cytokines. Results: Burn patients showed evidence of anemia and normal or elevated ferritin levels. Plasma Cp oxidase activity in burn and trauma patients were markedly lower than controls on admission and increased to control levels by day 3, particularly in burn patients. Plasma cytokines were elevated throughout the 14 days study along with evidence of an oxidative stress. No significant differences in soluble transferrin receptor were noted among groups on admission, but levels in burn patients were lower than controls for the first 5 days after injury. Conclusion: This study further established the hypoferremia and inflammation associated with burns and trauma. To our knowledge, this is the first study to show an early decrease in Cp oxidase activity in burn and non-burn trauma patients. The results support the hypothesis that transient loss of Cp activity contributes to hypoferremia and inflammation. Further studies are warranted to determine if decreased Cp activity increases the risk of

  16. Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients

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    Mokline, A.; Garsallah, L.; Rahmani, I.; Jerbi, K.; Oueslati, H.; Tlaili, S.; Hammouda, R.; Gasri, B.; Messadi, A.A.

    2015-01-01

    Summary The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. Serum PCT was measured over the entire course of stay in patients with predictive signs of sepsis according to the Americain Burn Association Criteria for the presence of infection. Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy. PMID:27252609

  17. Cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitario Cajuru

    International Nuclear Information System (INIS)

    Objective: to identify and analyze the prevalence of cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitario Cajuru. Materials and methods: cross-sectional study analyzing 200 consecutive non contrast-enhanced cranial computed tomography reports of patients admitted to the emergency unit of Hospital Universitario Cajuru. Results: alterations were observed in 76.5% of the patients. Among them, the following findings were most frequently observed: extracranial soft tissue swelling (22%), bone fracture (16.5%), subarachnoid hemorrhage (15%), nonspecific hypodensity (14.5%), paranasal sinuses opacification (11.5%), diffuse cerebral edema (10.5%), subdural hematoma (9.5%), cerebral contusion (8.5%), hydrocephalus (8%), retractable hypodensity /gliosis/ encephalomalacia (8%). Conclusion: the authors recognize that the most common findings in emergency departments reported in the literature are similar to the ones described in the present study. This information is important for professionals to recognize the main changes to be identified at cranial computed tomography, and for future planning and hospital screening aiming at achieving efficiency and improvement in services. (author)

  18. The effect of hospital volume on mortality in patients admitted with severe sepsis.

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    Sajid Shahul

    Full Text Available IMPORTANCE: The association between hospital volume and inpatient mortality for severe sepsis is unclear. OBJECTIVE: To assess the effect of severe sepsis case volume and inpatient mortality. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011. EXPOSURES: The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles. MAIN OUTCOMES AND MEASURES: Inpatient mortality. RESULTS: Compared with the highest tertile of severe sepsis volume (>60 cases per year, the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year was 1.188 (95% CI: 1.074-1.315, while the odds ratio was 1.090 (95% CI: 1.031-1.152 for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03 for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64 for hospitals with the highest volume. CONCLUSIONS AND RELEVANCE: We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.

  19. Psychological Dimensions in Patients admitted in Imam Khomeini General Hospital in Tehran

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    Ali Reza Shalbafan

    2010-06-01

    Full Text Available "n Objectives:The aim of this study was to assess the mental health of patients admitted in Internal medicine, Surgery and Gynecology wards of Imam Khomeini Hospital of Tehran in 2009. Method:The symptom chec klist-90-R (SCL-90-R questionnaire was administered for 93 patients in internal, surgical and gynecological wards of Imam Khomeini hospital in 2009.  Result: In this study, the mean age was (32.89 ± 12.69 with a range of 14 to 70 years old. 42 patients (44.7% were male and 52 (59.6% were female ; 56 patients (59.6% were married and 37 (40.4% were single. There is a significant relationship between gender& marital status (P<0.04. According to cut of point of Global Severity Index (GSI which was reported in a study (0.7, 58.1 percent of the patients have different levels of psychiatric problems (GSI>0.7. In psychiatric symptoms, somatization has the highest prevalence (90.5% ,and depression (77.9% and anxiety (71.6% have a higher prevalence than other symptoms among patients who suffer from psychiatric problems. "n Conclusion:According to the result of the current study, there is a high prevalence of psychiatric problems among the admitted patients in Internal medicine, Surgery and Gynecology wards of a general hospital according to SCL-90-R questionnaire. This study advises that more attention be given to mental health in general  hospitals.

  20. Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study

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    Steinvall, Ingrid; Bak, Zoltan; Sjöberg, Folke

    2008-01-01

    Introduction: The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors ( age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. Method: We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidne...

  1. Burn patients' experience of pain management: a qualitative study.

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    Yuxiang, Li; Lingjun, Zhou; Lu, Tang; Mengjie, Liu; Xing, Ming; Fengping, Shen; Jing, Cui; Xianli, Meng; Jijun, Zhao

    2012-03-01

    Pain is a major problem after burns and researchers continue to report that pain from burns remains undertreated. The inadequate pain control results in adverse sequalae physically and psychologically in the burn victims. A better understanding of a burn patient's experience is important in identifying the factors responsible for undertreated pain and establishing effective pain management guidelines or recommendation in the practice of pain relief for burn injuries. This study sought to explore and describe the experience that patients have about pain related to burn-injury during hospitalization. Semi-structured interviews were conducted on eight patients with moderate to severe pain from burn injuries recruited from a Burn Centre in Northwest China. Data was collected by in-depth interviews and qualitative description after full transcription of each interview. Analysis involved the identification of themes and the development of a taxonomy of patients' experience of burn pain and its management. Three themes were indentified: (1) patients' experience of pain control, (2) patients' perception on burn pain management, and (3) patients' expectation of burn pain management. Findings from this study suggested that patients experience uncontrolled pain both physically and psychologically which may serve as an alert for awareness of health professionals to recognize and establish a multidisciplinary pain management team for burn victims, including surgeons, critical care specialists, anesthesiologists, nurses, psychologists, and social workers to accomplish safe and effective strategies for pain control to reach an optimal level of pain management in burn patients. It also provides insights and suggestions for future research directions to address this significant clinical problem.

  2. Characteristics of and strategies for patients with severe burn-blast combined injury

    Institute of Scientific and Technical Information of China (English)

    CHAI Jia-ke; SHEN Chuan-an; TUO Xiao-ye; LIANG Li-ming; WANG Shu-jun; SHENG Zhi-yong; LU Jiang-yang; WEN Zhong-guang; YANG Hong-ming; JIA Xiao-ming; LI Li-gen; CAO Wei-hong; HAO Dai-feng

    2007-01-01

    Background Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.Methods Five patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6%±7.2%) of TBSA (full-thickness burns 75%-92%(83.4%±7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.Results One patient died of septic shock 23 hours after admission (four days after injury), the others survived.Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.Conclusions Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients' condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.

  3. Time course of thrombocytes in burn patients and its predictive value for outcome.

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    Marck, Roos Elisabeth; Montagne, Harriet Leonie; Tuinebreijer, Willem Eduard; Breederveld, Roelf Simon

    2013-06-01

    Thrombocytopenia is common in trauma and critically ill patients and is associated with a poor outcomes. The objective of this retrospective study was to investigate the course of thrombocyte concentration changes in burn patients, the influences of various factors on this course, and a possible predictive value of thrombocyte counts on outcome in 244 patients admitted to our burn centre. Their thrombocyte counts were obtained until 50 days after burn. Data on patient demographics, total percentage burned surface area (%TBSA), sepsis and mortality were collected. Multilevel multivariable analysis was performed to investigate the influence of the variables on the platelet course. Cox regression analysis was performed to analyse the predictive value of the variables for mortality. A distinct pattern of thrombocyte counts was observed, with a nadir at day 3 followed by a peak at day 15 and a temporary thrombocytosis. %TBSA and age (p<0.05) influence this course. The mean thrombocyte course of septic and non-surviving patients depicts a significant lower nadir. Furthermore, higher age, %TBSA and low thrombocyte counts at the peak are predictive for 50 day mortality (p<0.05). Platelets follow a distinct course after burn, influenced by %TBSA and age. These factors and a low thrombocyte peak count predict mortality. PMID:23490002

  4. Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

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    Ishimoto Kayo

    2010-12-01

    Full Text Available Abstract Background Patients admitted to a psychiatric hospital with suicidal behavior (SB are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan. Method 155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined. Results The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD. SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range of the total number of SBs in the lifetime history was 7 (1-141. Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified. Conclusions Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission

  5. Prevalence and risk factors of pneumothorax among patients admitted to a Pediatric Intensive Care Unit

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    El-Nawawy, Ahmed Ahmed; Al-Halawany, Amina Sedky; Antonios, Manal Abdelmalik; Newegy, Reem Gamal

    2016-01-01

    Objective: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. Aims: The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period. Settings and Design: Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not. The most common tool for diagnosis used was chest X-ray followed by a clinical examination. Subjects and Methods: Case notes of 1298 patients admitted in PICU over 1-year study. Results: Patients with pneumothorax had higher mortality rate (P pediatric index of mortality 2 score on admission (P pediatric logistic organ dysfunction score (P patients without pneumothorax, ventilated patients who developed pneumothorax had a longer duration of MV care (P patients, especially in those on MV and emphasized the importance of the strict application of protective lung strategies among ventilated patients to minimize the risk of pneumothorax.

  6. Clinical Factors Associated with Morbidity and Mortality in Patients Admitted with Sickle Cell Disease

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    Galloway-Blake, K; Reid, M; Walters, C; Jaggon, J; Lee, MG

    2014-01-01

    ABSTRACT Objective: To determine the clinical factors associated with the length of hospitalization and mortality in patients with sickle cell disease (SCD). Methods: All patients with SCD admitted to the medical wards of the University Hospital of the West Indies, Jamaica, over a five-year period, January 1, 2005 to December 31, 2010, were reviewed. Data were extracted from hospital charts and comprised demographic and clinical information, investigations, interventions, duration of stay, pathological data and outcomes. Results: There were 105 patients reviewed; 84% were genotype Hb SS. Females accounted for 59% and males 41%. Overall mean age was 32.5 years (SD 13.7, range 12–66 years). The mean length of hospitalization was 10.2 days (SD 10.9, range 1–84 days). The main admission diagnoses were painful crisis, acute chest syndrome, severe anaemia, sepsis, hepatic sequestration, congestive cardiac failure and renal failure. The mean values for the following laboratory investigations were: haemoglobin 7.7 g/dL (SD 2.8), total white blood cell count 21.7 × 109/L (SD 14.2), platelet count 320 × 109/L (SD 191.9), blood urea 9.8 mmol/L (SD 11.9) and serum creatinine 198 umol/L (SD 267.9). Medical interventions included: blood transfusions in 20.9%, 55% received antibiotics and 74% received narcotic analgesia. There were 40 deaths with four autopsies done. The mortality rate for SCD was 38%. There were 189 repeat SCD admissions. Conclusion: Sickle cell disease still carries a high morbidity and mortality in patients admitted to hospital. Recurrent admissions are a concern, as they impact on patient's morbidity and quality of life. PMID:25867578

  7. Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.

    Science.gov (United States)

    Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

    2016-01-01

    Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or

  8. Incidence and Impact of Baseline Electrolyte Abnormalities in Patients Admitted with Chemotherapy Induced Febrile Neutropenia

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    Asim Jamal Shaikh, Samira Ahmed Bawany, Nehal Masood, Ausaf Ahmed Khan, Ahmed Nadeem Abbasi, Syed Najeeb Niamutullah, Adnan Zaidi, Salman Adil, Shiyam Kumar

    2011-01-01

    Full Text Available BACKGROUND: Febrile neutropenia (FN and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature.METHODS: This was a prospective, observational study. A total of two hundred and fifteen (215 patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0.RESULTS: Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalitiesCONCLUSION: This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.

  9. Emergency in Burn; Burn in Emergency

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    Yalcin Bayram

    2012-06-01

    Full Text Available Physicians who first meet with burned patients are often emergency service employees. When the patient was admitted to emergency service, especially in patients with major burn injury, is a matter should be dealt with strongly. Before sending the patients to a burn center, some interventions could became life saving which should be done as a first line treatment. Herein, review of the literature related to emergency burn treatment was performed and presented to all physicians as a summary guide. In addition, some questions such as how should be physician, who first meet with the burned patient, evaluated the patient, what should be physician paid attention, which principles should be employed for fluid replacement, how should be approached to burn wound are tried to be addressed. [TAF Prev Med Bull 2012; 11(3.000: 365-368

  10. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

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    Ana Cláudia Giaxa Prosdócimo

    2015-03-01

    Full Text Available Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS. Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods: Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged <65 years, hospitalized with diagnosis of ACS. The Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI, which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE, emotional distancing (EmD, dehumanization (De and professional fulfillment (PF. The Lipp’s Stress Symptoms Inventory for Adults (LSSI was applied to evaluate global stress. Results: Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. Conclusion: We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

  11. Assisted vaginal deliveries in mothers admitted as public or private patients in Western Australia.

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    Kristjana Einarsdóttir

    Full Text Available BACKGROUND: Mothers delivering as private patients in Australia have a high rate of assisted deliveries, which could lead to adverse infant outcomes in this group of patients. We investigated whether the risk of adverse infant outcomes after assisted deliveries was different for mothers admitted as public or private patients for delivery, when compared with unassisted deliveries. METHODS AND FINDINGS: We included 158,241 vaginal, singleton, term birth admissions in our study where the infant was live born and without birth defects. The study population was identified from statutory birth and hospital data collections held by the Western Australian (WA Department of Health. We estimated odds ratios and confidence intervals using logistic regression models adjusted for a range of maternal demographic, pregnancy and birth characteristics. Interaction was assessed by including interaction terms in the models. Outcomes included low Apgar scores at five minutes (< 7, neonatal resuscitation and special care admission. Mothers delivering as private patients had an increased risk of assisted vaginal delivery compared with public patients (adjusted OR 1.74, 95% CI  =  1.68-1.80. Compared with unassisted vaginal deliveries, assisted deliveries were associated with increased risk of Apgar scores at five minutes below 7 (OR 1.25, 1.08-1.45, neonatal resuscitation (OR  =  1.69, 1.42-2.00 and admission to special care nursery (OR  =  1.64, 1.53-1.76. The increased risk of neonatal resuscitation was higher for mothers admitted as private patients for delivery (OR  =  2.13 than public patients (OR  = 1 .55, p(interaction  =  0.03. CONCLUSIONS: Our results suggested that the high risk of neonatal resuscitation following assisted vaginal deliveries compared to unassisted is higher in private patients than public patients. Whether this phenomenon is due to the twofold higher rate of assisted vaginal deliveries in this group of patients or a

  12. Septicemia: The Principal Killer of Burns Patients

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    B. R. Sharma

    2005-01-01

    Full Text Available Burn injury is a major problem in many areas of the world and it has been estimated that 75% of all deaths following burns are related to infection. Burns impair the skin’s normal barrier function thus allowing microbial colonization of the burn wounds and even with the use of topical antimicrobial agents, contamination is almost unavoidable. It is therefore essential for every burn institution to determine its specific pattern of burn wound microbial colonization, time related changes in predominant flora and antimicrobial resistance profiles. This would allow early management of septic episodes with proper empirical systemic antibiotics before the results of microbiologic culture becomes available, thus improving the overall infection-related morbidity and mortality. We attempted to examine the factors affecting risk of infection; strategies for infection control and prevention in burn victims.

  13. Pyoderma gangrenosum in burned patient: Case report

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    Obradović-Tomašev Milana

    2015-01-01

    Full Text Available Introduction. Pyoderma gangrenosum is a rare, chronic, destructive, ulcerating skin disease of uncertain etiology. It develops most frequently in patients between 25-45 years of age and affects both sexes equally. Case report. We present a case of pyoderma gangrenosum in a young female patient who sustained a burn injury of 40% total body surface area. She underwent four operations. She developed a wound infection and urinary infection during her hospital stay. By the end of hospitalization, the papules followed with coalesce of ulcerations formed on the previously epithelized areas of her legs. The patient complained of the intensive pain localized on these surfaces. Since pyoderma gangrenosum was suspected, a dermatologist was included in treatment. Therapy was initiated (methylprednisolone 60 mg per day intravenously with gradual reduction of the dosage. The patient was discharged from hospital two weeks later with almost fully complete cicatrization and epithelization. Conclusion. Pyoderma gangrenosum is still difficult to be diagnosed in the absence of specific and sensitive diagnostic methods; however, it is crucial to be suspected as early as possible and to start treatment immediately. Multidisciplinary approach is essential for optimal results.

  14. Plasmid Mediated Antibiotic Resistance in Isolated Bacteria From Burned Patients

    OpenAIRE

    Beige, Fahimeh; Baseri Salehi, Majid; Bahador, Nima; Mobasherzadeh, Sina

    2014-01-01

    Background: Nowadays, the treatment of burned patients is difficult because of the high frequency of infection with antibiotic resistance bacteria. Objectives: This study was conducted to evaluate the level of antibiotic resistance in Gram-negative bacteria and its relation with the existence of plasmid. Materials and Methods: The samples were collected from two hundred twenty hospitalized burned patients in Isfahan burn hospital during a three-month period (March 2012 to June 2012). The samp...

  15. Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

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    Hocagil H

    2016-02-01

    Full Text Available Hilal Hocagil,1 Filiz Izci,2 Abdullah Cüneyt Hocagil,1 Ebru Findikli,3 Sevda Korkmaz,4 Merve Iris Koc5 1Department of Emergency, School of Medicine, Bulent Ecevit University, Zonguldak, 2Department of Psychiatry, School of Medicine, Istanbul Bilim University, Istanbul, 3Department of Psychiatry, School of Medicine, Sutcu Imam University, Kahramanmaras, 4Department of Psychiatry, School of Medicine, Firat University, Elazig, 5Department of Psychiatry, Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey Background: Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic.Methods: This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients.Results: Of the patients exposed to violence 63% (n=46 were female and 27% (n=27 were male. Of these patients, 68.5% (n=50 were married, 43.8% (n=25 were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41 were primary school, 21.9% (n=16 were high school, and 21.9% (n=16 were university graduates. Smoking and alcohol use rates were 54.8% (n=40 and 17.8% (n=13, respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57. In addition, anxiety scores were high in 42.5% (n=31 and moderate in 9.6% (n=7 of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13 of the patients and 19.2% (n=14 of the patients’ relatives. The correlation between sociodemographic

  16. Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Qazvin, Iran

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    Ghiasian

    2014-08-01

    Full Text Available Background A broad variety of fungi, especially Candida species, are becoming increasingly common causes of urinary tract infections in hospital settings. Objectives The current cross-sectional descriptive study aimed to determine the causative agents, risk factors and incidence rate of candiduria in critically ill patients, hospitalized in intensive care units (ICUs of four Iranian hospitals. Patients and Methods A total of 155 children and adult patients, admitted to ICUs of the four university educational hospitals, who demonstrated Candida-positive urine cultures, were examined. Samples were processed via mycological procedures by direct microscopy and culture. Results Candiduria was confirmed in 50 (32.26 % patients and Candida albicans was the most frequently isolated species representing 60.0% of isolates, followed by 14.0% C. glabrata, 12.0% C. parapsilosis, 10.0% C. krusei, and 4.0% C. tropicalis. Most patients were female (58% with a mean age of 46.7 years old. Generally, 39.7% and 62% of adults and children showed candiduria, respectively. The commonest predisposing factors were antibiotic therapy (98.0%, urinary catheterization (92.0%, corticotherapy (84.0%, being female (42.6 %, use of feeding tube (56%, and extended hospitalization, respectively. Conclusions The high frequency of candiduria in ICU patients can be decreased by shortening the duration of urinary catheterization, avoiding extra antibiotics and corticosteroids, as well as controlling the predisposing factors and underlying conditions.

  17. STUDY OF PENTOXIFYLLINE ROLE ON PROGNOSIS IN PATIENTS WITH ACUTE ALCOHOLIC HEPATITIS ADMITTED IN GGH, GUNTUR

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    Chakradhar Rao

    2015-01-01

    Full Text Available BACKGROUND : Alcoholic hepatitis is an acute form of alcohol induced liver injury . Its severity is measured using Maddrey’s discriminant f unction (DF. DF>32 indicates severe hepatitis and poor outcome. TNF is responsible for liver injury in alcoholic hepatitis. Pentoxifylline (PTX is a nonselective phosphodiesterase inhibitor which inhibits TNF production. The drug is safe, cheap and found effective in improving short term survival in severe acute alcoholic hepatitis. The present study compares the outcome of patients treated with pentoxifylline with other patients who were given only supportive care in the Indian scenario. MATERIALS AND ME THODS : 50 patients with signs and symptoms of acute alcoholic hepatitis admitted at GGH, Guntur were studied. Diagnosis was done based on clinical and biochemical profile. RESULTS : Majority of the patients (54% were in the age group of 40 - 50 years. All th e patients presented with jaundice; others include fever (84%, abdomen distension (74%, generalized weakness (68%. Altered sleep pattern and altered sensorium were present in 34% and 10% of patients respectively. All the patients had hyperbilirubinimia, elevated AST with AST/ALT ratio>2:1 and prolonged prothrombin time. Most of the patients 68% had INR 2.The mortality in pentoxifylline treated group was 16.7% compared to 47.8% in patients who did not receive pentoxifylline, indicating that there is significant difference in the mortality in the above two groups. (p=0.037. CONCLUSIONS: Patients with severe alcoholic hepatitis (Maddrey’s discriminant function, ≥32; or MELD score, ≥21: or GAHS, ≥9 who do not have sepsis should be given a tria l of prednisolone at a dose of 40 mg per day for 28 days. In situations where corticosteroids are contraindicated, pentoxifylline is safe, economical, and useful in improving short term mortality in severe acute alcoholic hepatitis in Indian scenario.

  18. Effect of the full moon on mortality among patients admitted to the intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the lunar effect on mortality among patients admitted to the intensive care unit. Methods: The retrospective study conducted at Rosalind Franklin University of Medicine and Science, North Chicago, and comprised data of 4387 patients in intensive care unit from December 2002 to November 2004. The subjects were divided into two groups: patients who died on full moon days (the 14th, 15th, and 16th days of the lunar month); and patients who died on the other days of the month. The mortality rates were calculated for patients in both groups. Parameters including patients' age, gender, acute physiology and chronic health evaluation scores, predicted mortality rates, type of intensive care unit, and actual mortality were compared, and non-parametric tests were performed to determine whether there were any differences between the groups. Results: Of the 4387 patients who were followed for 23 months, 297 patients died, including 31 on full moon days and 266 patients on the other days of the month. Both groups were similar in terms of mean age (73.6 +-14.59 vs. 71.07+-16.13 years; p=0.599), acute physiology and chronic health evaluation scores (82.06+-24.19 vs. 76.52+-27.42; p=0.258), and predicted mortality (0.405+-0.249 vs. 0.370+-0.268; p=0.305). There was no difference in the frequency of death between the full moon days and the other days (10.33+-0.58 vs. 9.8 +-3.46; p=0.845). Conclusions: The full moon does not affect the mortality of the patients in intensive care unit. (author)

  19. Prognostic indicators in acute burned patients-a review

    Institute of Scientific and Technical Information of China (English)

    Sherif Emara

    2015-01-01

    Burn trauma is in need for prognostic indicators or admission scores. This aims for realistic documentation of the burn injury, expectation of the prognosis, and to facilitate a patient stratification to evaluate therapeutic strategies. A computer search through different medical websites was performed looking for articles correlating prognosis with different burn indices. These were carefully summarized and analyzed for this review. Variable studies were found related to that issue; the reliable indicators found had been classified as general or specific. All of them had certain clinical importance, but limitations are a common feature. All the listed indices are useful to serve in the only special clinical situations. We couldn't claim that they are actual prognostic indicator in burn victims. We believe that we still lack the proper prognostic indicator in burn patients. Researchers are invited for more effort to organize a more reliable prognostic indicator and scoring system for burn patients.

  20. Management and survival of patients admitted with an exacerbation of COPD: comparison of two Danish patient cohorts

    DEFF Research Database (Denmark)

    Eriksen, Nanna; Vestbo, Jørgen

    2010-01-01

    discharged patients admitted in 2006-2007 with an exacerbation of chronic obstructive pulmonary disease from three respiratory departments. Data were collected from patient charts and compared with a replicate study done in 2001. RESULTS:  The mean age was 72.1years; 61.7% were women. Mean forced expiratory...... with strong analgesics. CONCLUSIONS:  Over a period of 6years, a significantly higher number of patients are being treated according to guidelines. Survival following discharge increased over the same period....

  1. Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Henriksen, Daniel Pilsgaard; Hallas, Peter;

    2014-01-01

    -day all-cause mortality in a cohort of acutely admitted medical patients. METHODS: We included all acutely admitted adult medical patients from the medical admission unit at a regional teaching hospital in Denmark. Data on mortality was extracted from the Danish Civil Register to ensure complete...... (precision of predictions) for hypoalbuminemia was determined. RESULTS: We included 5,894 patients and albumin was available in 5,451 (92.5%). A total of 332 (5.6%) patients died within 30 days of admission. Median plasma albumin was 40 g/L (IQR 37-43). Crude 30-day mortality in patients with low albumin...... was 16.3% compared to 4.3% among patients with normal albumin (pday mortality, were younger and were admitted for a shorter period...

  2. Acceptance of NCPAP in a sample of patients admitted for geriatric rehabilitation

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    Frohnhofen H

    2009-12-01

    Full Text Available Abstract Objective Sleep apnea syndrome (SAS is common in older people. Nasal continuous airway pressure (NCPAP therapy is the treatment of choice for sleep apnea, but is not always accepted by patients. The rate of successful initiation of NCPAP is unknown in geriatric patients. Methods All patients admitted for geriatric rehabilitation were considered for sleep studies. Sleep apnea was assessed using an Edentrace (Nellcor, Hayward, CA multi-channel recording system. SAS was defined as an apnea-hypopnea-index (AHI of more than five events per hour plus excessive daytime sleepiness, or an AHI of more than fifteen events per hour regardless of reported sleepiness. Disability was assessed using the Barthel Index of Activities of Daily Living. Results Two hundred sixty nine of 322 consecutive patients (84% had adequate sleep studies and gave informed consent. SAS was found in 169 subjects (68%. There was no gender difference in the prevalence of SAS. Six subjects (4% accepted NCPAP therapy. Individuals who accepted NCPAP were younger and less disabled (p Conclusion NCPAP should not be withheld in the elderly. However, initiation of treatment for SAS remains to be a great challenge in those patients. Geriatric assessment procedures may help better manage older subjects with sleep apnea syndrome.

  3. Patients with hypertensive crises who are admitted to a coronary care unit: clinical characteristics and outcomes.

    Science.gov (United States)

    González Pacheco, Héctor; Morales Victorino, Neisser; Núñez Urquiza, Juan Pablo; Altamirano Castillo, Alfredo; Juárez Herrera, Ursulo; Arias Mendoza, Alexandra; Azar Manzur, Francisco; Briseño de la Cruz, Jose Luis; Martínez Sánchez, Carlos

    2013-03-01

    Patients with hypertensive crises, especially hypertensive emergencies, require immediate admittance to an intensive care unit for rapid blood pressure (BP) control. The authors analyzed the prevalence of hypertensive crisis, the clinical characteristics, and the evolution of patients with hypertensive emergencies and urgencies. Patients were divided into 3 groups according to their BP values: group I, predominant systolic hypertension (≥180/≤119 mm Hg); group II, severe systolic and diastolic hypertension (≥180/≥120 mm Hg); and group III, predominant diastolic hypertension (≤179/≥120 mm Hg). Of all of the patients admitted to a coronary care unit, 538 experienced a hypertensive crisis, which represented 5.08% of all admissions. Hypertensive emergency was predominant in 76.6% of the cases, which corresponded to acute coronary syndrome and acute decompensated heart failure in 59.5% and 25.2% of the cases, respectively. A pattern of predominant systolic hypertension (≥180/≤119 mm Hg) was most commonly observed in the hypertensive crisis group (71.4%) and the hypertensive emergency group (72.1%). The medications that were most commonly used at onset included intravenous vasodilators (nitroglycerin in 63.4% and sodium nitroprusside in 16.4% of the patients). The overall mortality rate was 3.7%. The mortality rate was 4.6% for hypertensive emergency cases and 0.8% for hypertensive urgencies cases.

  4. The outcomes of patients with severe dengue admitted to intensive care units

    Science.gov (United States)

    Chen, Chin-Ming; Chan, Khee-Siang; Yu, Wen-Liang; Cheng, Kuo-Chen; Chao, Hui-Chun; Yeh, Chiu-Yin; Lai, Chih-Cheng

    2016-01-01

    Abstract Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue. This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality. During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures. The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections. PMID:27495047

  5. The outcomes of patients with severe dengue admitted to intensive care units.

    Science.gov (United States)

    Chen, Chin-Ming; Chan, Khee-Siang; Yu, Wen-Liang; Cheng, Kuo-Chen; Chao, Hui-Chun; Yeh, Chiu-Yin; Lai, Chih-Cheng

    2016-08-01

    Outcomes of adult patients with dengue infections requiring intensive care unit (ICU) admissions remain unclear. We assessed the clinical manifestations and prognostic factors of patients critically ill with severe dengue.This retrospective study was done in a tertiary referral hospital with 96 adult ICU beds. All of the patients with laboratory-confirmed severe dengue infections and admitted to the ICU were enrolled between July 31 and November 31, 2015, during the large outbreak period. The medical records of all the recruited patients were reviewed for the following information: age, gender, clinical manifestations, disease severity scores, underlying conditions, laboratory examinations, and outcomes. The primary endpoint was to find the predictors of ICU mortality.During the study period, 4787 patients with dengue infections required ICU admission. One hundred forty-three (2.99%) were critically ill (mean age: 69.7 years). Hypertension (n = 90, 62.9%) and diabetes mellitus (n = 70, 49.0%) were the 2 most common underlying diseases. Eighty critically ill patients (55.9%) had cobacterial infections, and 33 had cobacteremia. The hematologic system failed most often, followed by thoracic and cardiovascular systems. Fever was the most common presentation (n = 112; 78.3%), followed by anorexia (n = 47; 32.9%) and abdominal pain (n = 46; 32.2%). Overall, 33 patients died (mortality rate: 23.1%). Multivariate analysis showed that ICU mortality was significantly associated with lower Glasgow Coma Scale (GCS) scores, lower platelet counts before ICU discharge, and more organ failures.The number of severe dengue patients who require ICU admission remains high. The mortality rate was associated with lower GCS scores, lower platelet counts, and more organ failures. In addition, more than half of the critically ill dengue patients had comorbid bacterial infections. PMID:27495047

  6. The satisfaction levels of the patients admitted to a university hospital

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    Abdurrahim Emhan

    2010-09-01

    Full Text Available Objectives: The aim of this study was to determine various aspects of satisfaction levels and related socio-demographical variables of both inpatients and outpatients admitted to a university hospital.Material and Method: Two different questionnaires were prepared to evaluate the satisfaction levels of both inpa-tients and outpatients. Face to face interview was conducted with a total of 820 patients; 379 (%46.2 inpatients and 441 (%53.8 outpatients, to fill out the prepared questionnaires.Results: Among the inpatients 79.5% reported that they were generally satisfied at the level of or above their expec-tations, whereas it was the case for 76.2% of outpatients in the study. When the satisfaction levels of the inpatients and outpatients were compared; inpatients were more satisfied with the care provided by their doctors, the radiology services and patient security than the outpatients. In terms of general hospital hygiene outpatients reported a greater satisfaction than the inpatients. Among inpatients, the patients with advanced age were found to be more satisfied in terms of meal quality and hygiene of the clinic than the younger patients. Literate patients reported higher degrees of satisfaction of general hygiene and intent to re-prefer the hospital than high school graduates. Almost half of the pa-tients in the study (48% were from lower socioeconomical status and in some dimensions they reported less satis-faction than the patients from higher socioeconomical status.Conclusion: Low socioeconomical status is associated with decreased patient satisfaction. Although general satis-faction levels of inpatients and outpatients are similar, the care provided by doctors, the radiology services, patient security and general hospital hygiene may show some differences between these two groups.

  7. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti.

    Science.gov (United States)

    Valcin, Claude-Lyne; Severe, Karine; Riche, Claudia T; Anglade, Benedict S; Moise, Colette Guiteau; Woodworth, Michael; Charles, Macarthur; Li, Zhongze; Joseph, Patrice; Pape, Jean W; Wright, Peter F

    2013-10-01

    Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010-July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.

  8. Study of Bacterial Infections among Burn Patients Hospitalized in Isfahan Burn Center

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    J. Faghri

    2007-10-01

    Full Text Available Introduction & Objective: Burn patients are at risk of acquiring infection because of destroy skin barrier, suppression of immunity, prolonged hospitalization, and invasive therapeutic and diagnostic procedure, risk of acquiring infection is high among burned patients. The aim of this study was to assess the incidence rate of bacterial etiology and infections among burn patients in the burn center of Isfahan. Materials & Methods: The study was conducted descriptive – cross sectional during a period of one year, (from august 2004 until September 2005. A total of 106 patients presenting with no signs and symptoms of infection within the first 48 hours of admission were included. CDC definition for nosocomial infections was applied. Each patient’s clinical examinations and records investigated daily. Swab culture, blood culture (during fever time, tissue culture from biopsy specimen of burn wound and urine culture obtained. The data were analyzed and interpreted using SPSS 10 Software, using Chi – square and Kappa Coefficient. P.value < 0.05 was significant. Results: One-hundred and six patients met the inclusion criteria, 91 (85/8% acquired at least one type of infection, including, urinary tract 28 (26/4%, blood stream 30 (28/3%, and burn wound 91(85/8%. Pseudomonas aeroginosa was the most common causative agent isolated from blood culture and swab culture, 27/42% and 54/4% respectively. Also, E.coli was the major casautive agent of urinary tract infections (6.4% isolated from urine culture of these burn patients.Conclusion: The results indicated that, biopsy from burn wounds and study of histopathologic specimen day by other day depends on blood and urine culture conditions overall can be effective for early detection of burn wounds infections.

  9. Admission Patterns and Outcomes of Paediatric Patients Admitted at the Diarrhea Unit of Muhimbili National Hospital (MNH )

    OpenAIRE

    Sanyiwa, John; Penza, Nuru

    2008-01-01

    To determine patterns of admissions due to diarrhea and their outcomes of paediatric patients at uhimbili National Hospital (MNH). A hospital-based prospective study including all children admitted to the Diarrhea Unit during the study period. Data was collected using content analysis checklists. Ethical clearance was sought from MNH and confidentiality in handling the information was observed. Data was analyzed using Epi-info 2002 statistical software. A total of 50 children were admitted d...

  10. Epidemiological and socio-cultural study of burn patients in M. Y. Hospital, Indore, India

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    Jaiswal Ashish

    2007-01-01

    Full Text Available Background: Developing countries have a high incidence of burn injuries, creating a formidable public health problem. The exact number of cases is difficult to determine: however in a country like India, with a population of over 1 billion, we would estimate 700,000 to 800,000 burn admissions annually. Objective: The study was done to investigate the epidemiology of various causations and their outcomes in terms of morbidity and mortality. Also, the effect of social stigma and cultural issues associated with burns on the victim and his family was assessed. Materials and Methods: All burn cases (n=412 admitted to the burns unit of M. Y. Hospital, Indore over a period of one year (2005-2006 were investigated. The data regarding sex, age predisposition, geographical origin, mode and nature of injury were obtained by questionnaire-interview with the patient themselves. Clinical assessment was done in the form of depth and extent of injury and complications. In case of mortality, again various factors like age, sex and cause of death were analyzed. The data was analyzed by SPSS 11.0 version. The interrelationship between various factors was studied using multivariate logistic regression analysis. Results: Burns were found more commonly in middle-aged groups. The incidence was more in females as an absolute number (70.3% as well as when stratified by age. Most burns were domestic, with cooking being the most prevalent activity. Flame (80.3% was the most common agent. Most of the cases of burn were accidental (67.7%. Moreover, the patients had third degree burn that leads to more mortality in our circumstances. Death occurred in more than one-half (62.3% of cases with septicaemia and disseminated intravascular coagulation (35.4% as the leading causes. When using logistic regression analysis, the outcome of the burn injury was significantly associated with degree, depth, extent and mode of injury. Conclusion: This series provides an overview of the most

  11. Ultrasound assessed thickness of burn scars in association with laser Doppler imaging determined depth of burns in paediatric patients.

    Science.gov (United States)

    Wang, Xue-Qing; Mill, Julie; Kravchuk, Olena; Kimble, Roy M

    2010-12-01

    This study describes the ultrasound assessment of burn scars in paediatric patients and the association of these scar thickness with laser Doppler imaging (LDI) determined burn depth. A total of 60 ultrasound scar assessments were conducted on 33 scars from 21 paediatric burn patients at 3, 6 and 9 months after-burn. The mean of peak scar thickness was 0.39±0.032 cm, with the thickest at 6 months (0.40±0.036 cm). There were 17 scald burn scars (0.34±0.045 cm), 4 contact burn scars (0.61±0.092 cm), and 10 flame burn scars (0.42±0.058 cm). Each group of scars followed normal distributions. Twenty-three scars had original burns successfully scanned by LDI and various depths of burns were presented by different colours according to blood perfusion units (PU), with dark blue burns, with the thinnest scars for green coloured burns and the thickest for dark blue coloured burns. Within light blue burns, grafted burns healed with significantly thinner scars than non-grafted burns. This study indicates that LDI can be used for predicting the risk of hypertrophic scarring and for guiding burn care. To our knowledge, this is the first study to correlate the thickness of burns scars by ultrasound scan with burn depth determined by LDI.

  12. Factors influencing resilience in patients with burns during rehabilitation period

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    Zhen Yang

    2014-03-01

    Conclusion: During psychological crisis intervention, medical staff should guide burn patients according to their individual coping styles. Such guidance would achieve a better effect, improve patient resilience, and promote positive psychological adaptation.

  13. Post-traumatic stress disorder in patients with acute burn injury

    International Nuclear Information System (INIS)

    Objective: To determine the risk of PTSD in patients with acute burn incidents. Method: This was an observational prospective cross-sectional study conducted in admitted patients in Burns Ward of Civil Hospital, Karachi during a period of 6 months from January 1 to June 30, 2011. Data was collected through questionnaire having socio demographic variables and the Impact of Event-Scale (IES-R) was used to determine the risk of PTSD. Results: Out of 145 patients, 12 (77.3%) were at risk of PTSD with 75 (66.9%) males and 37 (33%) females. Out of these 112 cases, 50% belonged to age group 16-29 years. All burn patients with more than 60% total body surface area (TBSA) involved in injury were at risk. Conclusion: The study reports an astronomic number of burns patients with PTSD risk. PTSD drastically affects the quality of life. The earlier this disorder is diagnosed and assessed; better chances are there for enhanced treatment and better recovery. (author)

  14. Evaluating Fluoroquinolone Use in Patients Admitted to the Tuberculosis Outpatient Clinic

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    Sinem İliaz

    2016-08-01

    Full Text Available Objective: Inelaborate use of new quinolones with strong anti-tuberculosis (TB activity leads to difficulty in diagnosis and more importantly, quinolone-resistant Mycobacterium tuberculosis. We aimed to determine the frequency of quinolone use in patients who were referred to our hospital for suspected TB and to evaluate the association between quinolone use and different clinical laboratory parameters. Methods: Between November 15 and December 15, 2013, all patients who were admitted to the TB outpatient clinic with no previous diagnosis of TB were included in this study. Demographic and clinical laboratory findings and history of antibiotic use were recorded. Patients’ quinolone use were questioned by showing fluoroquinolone antibiotic boxes’ photographs available on the market. The departments of the doctors who prescribed quinolones were recorded. Results: The mean age of 179 patients included in the study was 37±16 (15–89 years. Among these, 113 patients (63.1% were male. Seventy five patients (41.9% were diagnosed as tuberculosis according to the clinical-radiological and/or bacteriological findings. Of 179 patients, 58.1% (n=104 had been prescribed antibiotics for current complaints before referral to our clinic. Sixteen patients (15% had been recommended fluoroquinolones. Fluoroquinolones were prescribed by seven internal medicine specialists, five pulmonologists, three emergency medicine specialists, and one family medicine practitioner. Among 16 fluoroquinolones prescribed, nine were moxifloxacin, four were levofloxacin, and three were gemifloxacin. Quinolone use revealed a significant inverse relationship only with the presence of hemoptysis (p=0.04. Conclusion: Besides increased educational activities regarding the rational use of antibiotics in recent years, the quinolone group of antibiotics is still prescribed for suspected TB cases. To avoid quinolone-resistant M. tuberculosis strains, further education is required.

  15. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

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    Sørgaard Knut W

    2013-01-01

    Full Text Available Abstract Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP. Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”. Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

  16. Skin Dendritic Cells in Burn Patients

    OpenAIRE

    D’Arpa, N.; D’Amelio, L.; Accardo-Palumbo, A.; Pileri, D.; Mogavero, R.; Amato, G.; Napoli, B.; Alessandro, G.; Lombardo, C.; F. Conte

    2009-01-01

    The body's immunological response to burn injury has been a subject of great inquiry in recent years. Burn injury disturbs the immune system, resulting in a progressive suppression of the immune response that is thought to contribute to the development of sepsis. Dendritic cells (DCs) are potent antigen-presenting cells that possess the ability to stimulate naïve T cells.

  17. Dengue fever in patients admitted in tertiary care hospitals in Pakistan

    International Nuclear Information System (INIS)

    Objectives: To assess the gaps in the diagnosis and management of dengue fever cases. Methods: The retrospective descriptive analytical study was done with a case record analysis of patients with dengue fever admitted from January to December 2010 at five tertiary care hospitals in different Pakistani cities. Using a questionnaire, information was gathered on demography, haematological profile, management, use of blood and platelet transfusions and the outcome. For comparison, data of serologically-confirmed dengue patients from a private laboratory in Islamabad was collected to see the age, gender and month-wise distribution of cases tested over the same period. SPSS 16 was used for statistical analysis. Results: Out of the 841 confirmed dengue cases, 514 (79%) were males and 139 (21%) females. The overall mean age was 31.3+-14.0 years. Dengue fever was seen in 653 (78%) and dengue haemorrhagic fever (DHF) in 188 (22%) patients. Most cases were between 20 and 49 years of age. A gradual increase in dengue fever and dengue haemorrhagic fever was seen from August, with a peak in October/November. Tourniquet test was done only in 20 (2.3%) cases, out of which 11 (55%) were positive and 9 (45%) were negative. Serial haematocrit was not done in any case. Total deaths were 5 (0.6%). Conclusions: Most cases were seen in October/November with the majority being in the 20-39 age group. Tourniquet test and serial haematocrit were infrequently used. No standard national guidelines were employed. (author)

  18. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Brabrand, Mikkel; Lassen, Annmarie Touborg

    2014-01-01

    OBJECTIVE: Patients that initially appear stable on arrival to the hospital often have less intensive monitoring of their vital signs, possibly leading to excess mortality. The aim was to describe risk factors for deterioration in vital signs and the related prognosis among patients with normal...... presentation, 1440/4292 (33.6%) had all normal vital signs and were included in study, 44.0% were male, median age 64 years (5th/95th percentile: 21-90 years) and 446/1440 (31.0%) deteriorated within 24 hours. Independent risk factors for deterioration included age 65-84 years odds ratio (OR): 1.79 (95.......2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10). CONCLUSIONS: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open...

  19. STUDY OF SEVERITY OF HYPONATRAEMIA AND ITS CLINICAL OUTCOME IN PATIENTS ADMITTED TO TERTIARY CARE ICU

    Directory of Open Access Journals (Sweden)

    Hareesh

    2016-06-01

    Full Text Available BACKGROUND OF THE STUDY Hyponatraemia is a commonly encountered plasma electrolyte abnormality noticed in the patients admitted to ICU, which has a diverse variety of manifestations. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life-threatening and is associated with increased mortality and morbidity. OBJECTIVES To study the clinical profile at different levels of hyponatraemia in ICU patients and its clinical outcome at different levels. METHODOLOGY A retrospective descriptional study was done at Intensive Care Unit of Dr. B.R. Ambedkar Medical College and Hospital during the period from April 2015 to March 2016 among the patients having serum sodium levels less than 135 mEq/L. RESULTS Commonly involved age group is between 50 to 70 years. Severe form of Hyponatraemia is seen in elderly males. The most common underlying predisposing factor for hyponatraemia in our case series was sepsis (26% followed by gastrointestinal fluid loss (15.5%, diabetic ketoacidosis (10% and cirrhosis of liver (10%. Mortality was highest with severe hyponatraemia (10.5% who had pulmonary sepsis, metabolic encephalopathy, diabetic ketoacidosis and cirrhosis of liver. CONCLUSIONS Hyponatraemia is one of the good predictor of ICU mortality in association with wide variety of systemic diseases and wide spectrum of clinical profile.

  20. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    LENUS (Irish Health Repository)

    Owens, C

    2012-02-01

    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  1. Determination of burn patient outcome by large-scale quantitative discovery proteomics

    Science.gov (United States)

    Finnerty, Celeste C.; Jeschke, Marc G.; Qian, Wei-Jun; Kaushal, Amit; Xiao, Wenzhong; Liu, Tao; Gritsenko, Marina A.; Moore, Ronald J.; Camp, David G.; Moldawer, Lyle L.; Elson, Constance; Schoenfeld, David; Gamelli, Richard; Gibran, Nicole; Klein, Matthew; Arnoldo, Brett; Remick, Daniel; Smith, Richard D.; Davis, Ronald; Tompkins, Ronald G.; Herndon, David N.

    2013-01-01

    Objective Emerging proteomics techniques can be used to establish proteomic outcome signatures and to identify candidate biomarkers for survival following traumatic injury. We applied high-resolution liquid chromatography-mass spectrometry (LC-MS) and multiplex cytokine analysis to profile the plasma proteome of survivors and non-survivors of massive burn injury to determine the proteomic survival signature following a major burn injury. Design Proteomic discovery study. Setting Five burn hospitals across the U.S. Patients Thirty-two burn patients (16 non-survivors and 16 survivors), 19–89 years of age, were admitted within 96 h of injury to the participating hospitals with burns covering >20% of the total body surface area and required at least one surgical intervention. Interventions None. Measurements and Main Results We found differences in circulating levels of 43 proteins involved in the acute phase response, hepatic signaling, the complement cascade, inflammation, and insulin resistance. Thirty-two of the proteins identified were not previously known to play a role in the response to burn. IL-4, IL-8, GM-CSF, MCP-1, and β2-microglobulin correlated well with survival and may serve as clinical biomarkers. Conclusions These results demonstrate the utility of these techniques for establishing proteomic survival signatures and for use as a discovery tool to identify candidate biomarkers for survival. This is the first clinical application of a high-throughput, large-scale LC-MS-based quantitative plasma proteomic approach for biomarker discovery for the prediction of patient outcome following burn, trauma or critical illness. PMID:23507713

  2. Etiology and Outcome of Patients with HIV Infection and Respiratory Failure Admitted to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Jose Orsini

    2013-01-01

    Full Text Available Background. Although access to HAART has prolonged survival and improved quality of life, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support. Our objective is to evaluate the etiology of respiratory failure in patients with HIV infection admitted to the ICU, its relationship with the T-lymphocytes cell count as well as the use of HAART, and its impact on outcome. Methods. A single-center, prospective, and observational study among all patients with HIV-infection and respiratory failure admitted to the ICU from December 1, 2011, to February 28, 2013, was conducted. Results. A total of 42 patients were admitted during the study period. Their median CD4 cell count was 123 cells/μL (mean 205.7, range 2.0–694.0, with a median HIV viral load of 203.5 copies/mL (mean 58,676, range <20–367,649. At the time of admission, 23 patients (54.8% were receiving HAART. Use of antiretroviral therapy at ICU admission was not associated with survival, but it was associated with higher CD4 cell counts and lower HIV viral loads. Twenty-five patients (59.5% had respiratory failure secondary to non-HIV-related diseases. Mechanical ventilation was required in 36 patients (85.1%. Thirteen patients (31.0% died. Conclusions. Noninfectious etiologies of respiratory failure account for majority of HIV-infected patients admitted to ICU. Increased mortality was observed among patients with sepsis as etiology of respiratory failure (HIV related and non-AIDS related, in those receiving mechanical ventilation, and in patients with decreased CD4 cell count. Survival was not associated with the use of HAART. Complementary studies are warranted to address the impact of HAART on outcomes of HIV-infected patients with respiratory failure admitted to ICU.

  3. In-hospital mortality and long-term survival of patients with acute intoxication admitted to the ICU

    NARCIS (Netherlands)

    Brandenburg, Raya; Brinkman, Sylvia; De Keizer, Nicolette F.; Meulenbelt, Jan; De Lange, Dylan W.

    2014-01-01

    OBJECTIVE: To assess in-hospital and long-term mortality of Dutch ICU patients admitted with an acute intoxication. DESIGN: Cohort of ICU admissions from a national ICU registry linked to records from an insurance claims database. SETTING: Eighty-one ICUs (85% of all Dutch ICUs). PATIENTS: Seven tho

  4. Development of an algorithm for early clarification of isolation indication for acutely admitted patients with gastroenteritis (GE)

    DEFF Research Database (Denmark)

    Skyum, Florence; Backer Mogensen, Christian; Chen, Ming;

    factors for identification of contagious GE in the patient history, examination and laboratory investigations. Design: The study is a questionnaire survey over 18-month. Metod: All acutely admitted patients due to the suspicion of GE will be interviewed concerning symptoms of defecation, travel activity...

  5. Reduced consumption of analgesics in patients with diabetes mellitus admitted to hospital for acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Gram-Hansen, P; Christensen, J H;

    1991-01-01

    .05). There was no statistically significant trend for the duration of pain to be shorter in the diabetes group. There was no difference between the two groups with respect to number of patients with Q-wave infarct, initial heart rate-blood pressure product or body weight, all of which are possible confounders. We conclude......In a case-control study, the consumption of analgesics was analysed in 39 patients with diabetes, admitted with acute myocardial infarction (MI). The control group comprised of non-diabetics with MI was computer-matched to the diabetic group with respect to age and sex as well as enzyme......-estimated size of the infarction. The median number of injections of opioid analgesics in the diabetes and non-diabetes groups was 2 and 5, respectively (0.01 less than P less than 0.05), and the median consumption of morphine was 20 mg and 35 mg, respectively (0.01 less than P less than 0...

  6. Assessment of medical resident's attention to the health literacy level of newly admitted patients

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    Cecile Karsenty

    2013-12-01

    Full Text Available Objectives: The objective of this study was to assess communication at the bedside in the emergency room between residents and their patients in order to identify common communication gaps. We also intended to evaluate whether residents for whom English is a second language (ESL residents communicate less effectively. Methods: A scorable checklist was developed in order to assess and identify communication gaps between the residents and their patients. Medical students observed the internal medicine and family medicine residents while they admitted patients to the medical service in the Emergency Room. Before this, medical students were trained for two weeks with a senior internist. The role of the medical student was not revealed; rather they were self-described as observers of the admission process. Results: Over an 8 week period, 71 observations were made of 27 medicine residents. 71 patient intakes were observed, evaluating 27 residents. In 52.1% of these interactions, the residents used medical acronyms when communicating with the patients. During 66.2% of interactions, technical medical terms or expressions were used during the history taking and in only 27.6% of those cases were the terms explained at least partially. Teach back technique was not observed in any of the interactions evaluated. Data was also analyzed based on whether the doctors were ESL residents or native English speakers. ESL residents tended to use significantly more technical language than the native English speakers, but the native English speakers tended to use more acronyms. Conclusions: How much patients understand of what their doctor says is called “health literacy.” Resident physicians often overestimate their patients’ health literacy, and this leads to communication gaps which have the potential to result in poorer health outcomes for the patients. The checklist developed for this pilot study assessed how well residents tailor their communication to

  7. Neuroendocrine system response modulates oxidative cellular damage in burn patients.

    Science.gov (United States)

    Xie, Xiao-Qi; Shinozawa, Yotaro; Sasaki, Junichi; Takuma, Kiyotsugu; Akaishi, Satoshi; Yamanouchi, Satoshi; Endo, Tomoyuki; Nomura, Ryosuke; Kobayashi, Michio; Kudo, Daisuke; Hojo, Nobuko

    2007-02-01

    Oxygen-derived free radicals play important roles in pathophysiological processes in critically ill patients, but the data characterizing relationships between radicals and neuroendocrine system response are sparse. To search the cue to reduce the oxidative cellular damage from the point of view of neuroendocrine system response, we studied the indicators of neuroendocrine and inflammatory responses excreted in urine in 14 burn patients (42.3 +/- 31.4 years old, and 32.3 +/- 27.6% burn of total body surface area [%TBSA]) during the first seven days post burn. The daily mean amounts of urinary excretion of 8-hydroxy-2'-deoxy-guanosine (8-OHdG), a marker of oxidative cellular damage, were above the upper limit of the standard value during the studied period. The total amount of urinary excretion of 8-OHdG in the first day post burn correlated with burn severity indices: %TBSA (r = 0.63, p = 0.021) and burn index (r = 0.70, p = 0.008). The daily urinary excretion of 8-OHdG correlated with the daily urinary excretion of norepinephrine and nitrite plus nitrate (NOx) during the studied period except day 2 post burn, and correlated with the daily urinary excretion of 17-hydroxycorticosteriod (17-OHCS) in days 2, 3, and 7 post burn. These data suggest that oxidative cellular damage correlates with burn severity and neuroendocrine system response modulates inflammation and oxidative cellular damage. Modulation of neuroendocrine system response and inflammation in the treatment in the early phase of burn may be useful to reduce the oxidative cellular damage and to prevent multiple organ failures in patients with extensive burn.

  8. Progressive fluid removal can avoid electrolyte disorders in severely burned patients

    Directory of Open Access Journals (Sweden)

    Mailänder, Peter

    2011-01-01

    Full Text Available Introduction: Extensive burn injury has systemic consequences due to capillary leak. After restoration of cellular integrity, infused fluid volume has to be removed partially. This can provoke electrolyte disorders. Purpose: We investigated the effect of progressive fluid removal on serum sodium level. Method: Retrospective study. Patients admitted to a burn unit were analyzed and separated in two groups without (Group A or with (Group B prolonged hypernatremia. Daily infusion-diuresis-ratio (IDR was analyzed. Results: Fourty (12 female; 28 male patients with a mean age of 47±19 years, a total burn surface area (TBSA of 26±12%, and a mean abbreviated burned severity index (ABSI score of 7.3±2 were included. In Group A 25 patients with a mean age of 47±18 years, a mean TBSA of 23±11%, and a mean ABSI score of 6.9±2.1 were summarized. In Group B 15 patients with a mean age of 47±22 years, a mean TBSA of 30±13%, and a mean ABSI score of 8.1±1.7 were included. Hypernatremia occurred on day 5±1.4. There was no significant difference between both groups for fluid resuscitation amount within the first 24 hours. Statistical analysis of the first 7 days after burn injury showed a significantly higher percentage of removed fluid in Group B for day 3, day 4, day 5, day 6 and day 7. Conclusions: Amount and velocity of fluid removal regimen after burn injury can provoke electrolyte disorders. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy.

  9. Neuropsychological outcomes of pediatric burn patients who sustained hypoxic episodes.

    Science.gov (United States)

    Rosenberg, Marta; Robertson, Carrie; Murphy, Kevin D; Rosenberg, Laura; Mlcak, Ronald; Robert, Rhonda S; Herndon, David N; Meyer, Walter J

    2005-11-01

    The neuropsychological outcomes of children who suffered hypoxic episodes following their burns are not completely understood and vary depending on the nature and severity of the episode. A retrospective review of youth that were admitted to this acute burn care facility over the past 20 years was conducted to identify the extent of cognitive and affective difficulties. Thirty-nine children who sustained hypoxic injuries related to their burns were compared with 21 controls that were matched for age, TBSA, and time of injury. Approximately a third of the children who survived from the hypoxia group continued to have long-term cognitive and emotional difficulties. For those who recovered reasonably well, no differences were found from the matched burned controls. These results probably underestimate the true extent of neuropsychological difficulties experienced by these youth given that detailed cognitive testing was not routinely performed. Prospective studies are needed to further characterize the full nature of difficulties and outcomes associated with burn related hypoxic injuries.

  10. Effect of White Noise on Sleep in Patients Admitted to a Coronary Care

    Science.gov (United States)

    Farokhnezhad Afshar, Pouya; Bahramnezhad, Fatemeh; Asgari, Parvaneh; Shiri, Mahmoud

    2016-01-01

    Introduction: Sleep disorders are a common problem in patients in the critical care unit. The objective of the present study was to determine the effect of white noise on the quality of sleep in patients admitted to the CCU. Methods: The present study was single-blind, quasi-experimental study. A total of 60 patients were selected using the purposive sampling method. Quality of sleep was measured with PSQI on the first day in admission, then after three nights of admission without any intervention for control group and for the experimental group quality of sleep measured by white noise with intensity of 50-60 dB then Quality of sleep was measured with PSQI. Data were analyzed by SPSS 13 software. Results: The average total sleep time in the control group before the study reached from 7.08 (0.8) to 4.75 (0.66) hours after three nights of hospitalization, while in the experimental group, no significant changes were seen in the average sleep hours (6.69 ± 0.84 vs. 6.92 ± 0.89, P = 0.15).The average minutes of sleep in the control group before the study reached from 12.66 (7.51) to 25.83 (11.75) minutes after a three- night stay, while in the experimental group, no significant changes were observed in the average sleep duration (12.16 ± 7.50 vs. 11 ±6. 07, P = 0.16). Conclusion: The use of white noise is recommended as a method for masking environmental noises, improving sleep, and maintaining sleep in the coronary care unit. PMID:27354974

  11. Epidemiology of patients admitted to a major trauma centre in northern India

    Directory of Open Access Journals (Sweden)

    Rastogi Devarshi

    2014-04-01

    Full Text Available Objective: Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northern India. Methods: An observational study of 748 patients chosen by random assortment was carried out over a period of 1 year (August 2008 to July 2009. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results:Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6:1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries (94.92% were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common (40.3%. Most spinal cord injuries were caused by falls from height (51.09%. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than upper limb fractures. Conclusion: Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends. Key words: Wounds and injuries; Epidemiology; Accidents, traffic; India

  12. Epidemiology of patients admitted to a major trauma centre in northern India

    Institute of Scientific and Technical Information of China (English)

    Devarshi Rastogi; Sanjay Meena; Vineet Sharma; Girish Kumar Singh

    2014-01-01

    Objective:Trauma in India is an increasingly significant problem,particularly in light of rapid development and increasing motorization.Social changes are resulting in alterations in the epidemiology of trauma.The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northern India.Methods:An observational study of 748 patients chosen by random assortment was carried out over a period of 1 year (August 2008 to July 2009).Age,sex,injury type and pattern were noted.Injury mode of upper and lower limbs was also noted.Results:Injuries occur predominately in the age group of 15-30 years.Males incurred more injury with male to female ratio of 6:1.The most vulnerable group was motorcycle users.Among the injured,farmers were the most commonly involved.Blunt injuries (94.92%) were much more common than penetrating injuries.Among patients with head injury,two wheelers related accidents were the most common (40.3%).Most spinal cord injuries were caused by falls from height (51.09%).Most lower limb fractures were simple type.Compound fractures of the lower limb were more common than upper limb fractures.Conclusion:Strict enforcement of traffic rules,combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries.This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity,and planning appropriate interventions for this major challenge.Preventive strategies should be made on the basis of these epidemiological trends.

  13. Factors predicting early outcome in patients admitted at emergency department with severe head trauma

    Institute of Scientific and Technical Information of China (English)

    Rejeb Belfekih Imen; Chakroun Olfa; Chtara Kamilia; Boujelbene Meriam; Ksibi Hichem; Chaari Adel; Bahloul Mabrouk; Rekik Noureddine

    2015-01-01

    Objective:To determine predictive factors of early mortality among severe traumatic brain injury in emergency department. Methods: This study is based on a retrospective analysis of 198 admitted in emergency depatment with severe head injury (Glasgow coma scale score≤8) of an university hospital (Sfax, Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during emergency department stay. Results: Forty two patients were died. Univariate analysis showed that the presence of shock, cardiac arrest, bilateral mydriasis, high value of injury severity score and low value of Glasgow coma scale were associated with mortality. Moreover, meningeal hemorrhage, cerebral and subdural haematoma were associated with poorer outcome. Multivariate analysis showed that factors associated with a poor prognosis were cardiac arrest cerebral and the presence of cerebral haematoma. Conclusions: Improving pre-hospital care and ovoid futile resuscitation to given priority in resource allocation and urgent CT scan of the head to look for operable mass lesions as early detection should improve the prognosis of severe head injury at emergency department.

  14. AETIOLOGICAL PROFILE AND OUTCOME IN PATIENTS WITH ACUTE KIDNEY INJURY (AKI ADMITTED TO VIMS, BELLARY

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    Ramamurthy

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: This was a study about the various causes of ARF, in our hospital (VIMS, Bellary during a specified period, and to find out the incidence of Pre-renal, Renal and Post-renal causes by using renal failure indices and to analyze outcome of ARF pertaining to the aetiology. MATERIALS AND METHODS: 70 cases admitted at VIMS, Bellary during the period January 2012 to june 2013, with clinical evidence of acute renal failure were included in the study. They were evaluated for various etiological, prognostic factors and its outcome. RESULTS: Among the various aetiologies in our study, snake bite (28.6%, ADD (27.1%, RPGN (7.1% were the most common. Most common type of renal failure was prerenal (50%, among them ADD was the predominant cause followed by intrinsic failure (47%, among them snake bite was leading cause. Patients presenting with Anuria, late presentation to hospital, blood pressure 3mg had poor outcome. CONCLUSION: Amongst the etiological factors snake bite and ADD ranked first. Prognosis was determined by age, aetiology of renal failure, initial creatinine value, blood pressure, time of presentation to. Even though both snake bite and ADD are equally common causes, morbidity is more in snake bite and cost of treatment also more in snake bite as many of them require dialysis.

  15. Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital.

    Science.gov (United States)

    Abbott, Joel; Tomassen, Sylvia; Lane, Laura; Bishop, Katie; Thomas, Nibu

    2016-08-01

    Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice. PMID:27481376

  16. Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

    Directory of Open Access Journals (Sweden)

    Anne Opsal

    2011-12-01

    Full Text Available Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions.Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay.Results: Overall, 33.2% (n=1,187 of the total patient population (3,506 were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26% of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40% or multiple mental disorders (29%. Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%. Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3.Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.

  17. Re: Infection control in burn patients: are fungal infections underestimated?

    OpenAIRE

    Dries David J

    2009-01-01

    Abstract A response to Struck MF. Infection control in burn patients: are fungal infections underestimated? Scand J Trauma Resusc Emerg Med. 2009 Oct 9;17(1):51. [Epub ahead of print] PubMed PMID: 19818134.

  18. The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life.

    Science.gov (United States)

    Mercadante, Sebastiano; Masedu, Francesco; Valenti, Marco; Mercadante, Alessandro; Aielli, Federica

    2016-08-01

    Information regarding advanced cancer patients followed at home who are admitted to the hospital in the last days of life are lacking. The aim of this study was to assess the characteristics of patients who were hospitalized in the last days of life after being assisted by a home palliative care team. The secondary outcome was to identify possible risk factors for hospitalization. The charts were analyzed of a consecutive sample of advanced cancer patients admitted to hospital wards in the last days of life after being followed at home by a palliative care team. Of 550 consecutive patients followed at home, 138 (25.1 %) were admitted to the hospital. Younger patients were more likely to die in the hospital. In a logistic risk analysis adjusted for age, patients with lung and head-neck cancer were more likely to die in the hospital. Patients having a female relative or a female consort as a caregiver were more likely to die at home. CAGE-positive patients (7.25 %), and patients with a shorter period of home assistance were more likely transported to hospital before dying (p = 0.00 and p risk factors of hospitalization at the end of life for advanced cancer patients followed at home. PMID:26895033

  19. Application of spiral nasointestinal tube in enteral nutrition support for patients with extensive burn

    Institute of Scientific and Technical Information of China (English)

    Lai-Ping Wang; Hong-Fei Jia; Yan-Li Cao

    2016-01-01

    Objective:To observe the effect of spiral nasointestinal tube on enteral nutrition support in patients with extensive burn.Methods: A total of 60 patients with extensive burn who were admitted in our hospital from January, 2014 to June, 2015 were included in the study and divided into the observation group and the control group with 30 cases in each group according to different catheter indwelling methods. The patients in the observation group were given spiral nasointestinal tube for enteral nutrition support, while the patients in the control group were given routine gastric tube for enteral nutrition support. The nutrition status and the occurrence rate of complications before catheter indwelling, 3, 6, and 10 d after catheter indwelling in the two groups were recorded.Results:The levels of ALB, HB, PA, and Scr 6, 10 d after catheter indwelling in the observation group were significantly higher than those in the control group (P<0.05). The occurrence rate of complications during the treatment period in the observation group was significantly lower than that in the control group (P<0.05). Conclusions:The spiral nasointestinal tube can provide the patients with extensive burn a better effective enteral nutrition support and improve the nutrition support, with a lower occurrence rate of complications, which is beneficial for the patients’ rehabilitation.

  20. Acute intoxication patients presenting to an emergency department in The Netherlands: admit or not? Prospective testing of two algorithms.

    NARCIS (Netherlands)

    Ambrosius, R.G.; Vroegop, M.P.; Jansman, F.G.A.; Hoedemaekers, C.W.E.; Aarnoutse, R.E.; Wilt, G.J. van der; Kramers, C.

    2012-01-01

    STUDY OBJECTIVE: After acute intoxication, most patients presenting to the emergency department (ED)--76% of them in The Netherlands--are admitted to hospital. Many will not need medical treatment on the ward. The authors tested two algorithms in the ED, based on vital parameters, ECG findings, and

  1. Prospective cohort study of a pharmacological follow-up program of anticoagulated patients admitted to nursing homes

    Directory of Open Access Journals (Sweden)

    Lluís Cuixart Costa

    2013-02-01

    Full Text Available Introduction. Anticoagulant treatment, despite providing a clear benefit to prevent and treat thrombo-embolic disease, is difficult to manage in routine practice. This is due to individual variability of dosing, narrow therapeutic margin, drug interactions, and side effects. An increasing number of patients admitted to nursing homes are under oral anticoagulant therapy because of deep venous thrombosis and, especially, atrial fibrillation. These are patients with a profile that makes prescription of anticoagulant treatment more difficult - elderly, taking multiple concomitant medications and with multiple ailments. Objetive. We hypothesized that the implementation of a primary care pharmacological follow-up program of oral anticoagulant therapy in patients admitted to nursing homes, with the purpose of coordinating the different professionals and care levels, would lead to greater benefit and reduction of side effects. Methods. A one-year descriptive prospective cohort study was conducted of 27 patients admitted to nursing homes who are under anticoagulation therapy followed by the primary care team. We analyzed different variables obtained from computerized medical records, from which indicators on the program were established (coverage and registration as well as outcome indicators (as defined by the British Committee for Standards in Haematology. Results. The profile of patients under anticoagulation and admitted to nursing homes is elderly (84 years, with a predominance of women (70%, atrial fibrillation as most frequent indication (70.4%, hypertension as major cardiovascular risk factor (92% and most of them on multiple drugs (92%. The analysis of the program results showed excellent coverage and registration indicators (100%. Outcome indicators also showed good results, with percentages of optimal international normalized ratio of 78% (exceeding the defined minimum standard and very low rates of complications (3%. Conclusions. The

  2. One fourth of acutely admitted patients use over-the-counter-drugs 24 hours prior to hospitalisation

    DEFF Research Database (Denmark)

    Pedersen, Magnus; Brabrand, Mikkel

    2014-01-01

    to hospitalisation and the effects of this intake. MATERIAL AND METHODS: Junior physicians on call interviewed patients admitted to the medical admission unit at South-West Jutland Hospital in Esbjerg using a modified chart template. Adult patients aged 15 and older admitted during a two-week period in August 2012...... were included. Patients were asked about consumed OTC drugs, dosage, indication and effect. RESULTS: From a total of 349 admissions, 188 usable chart templates were registered (54%), and information on OTC usage was registered on 165 of these (88%). The patients where elderly (median: 70 years) and 43...... reported use of OTC drugs (26%). A total of 22 different OTC drugs had been consumed with analgesics being the most widely used OTC drugs (74%). The majority had taken the drugs on a relevant indication (88%), most commonly pain. Half of the patients had taken the drugs in a relevant dosage (51%). In all...

  3. Incidence of flap procedures in the management of burn patients.

    Science.gov (United States)

    Lineaweaver, William C; Craft-Coffman, Beretta; Oswald, Tanya M

    2015-03-01

    Increased survival of burn patients presents opportunities for reconstructive strategies to improve outcomes in management of acute and secondary burn injuries. To assess one such strategy, namely flap reconstruction, we reviewed cases performed during the first 4.5 years of the JMS Burn and Reconstruction Center. We found that flap procedures accounted for 0.8% of acute cases (23 of 2723 procedures) and 33% of secondary cases (260 of 790 procedures). This initial finding shows that in this practice flap procedures are applied to a small number of acute problems while flap procedures comprise 33% of secondary procedures. Reconstructive flap surgery plays a measurable role in burn treatment at this center. Further study of outcomes and timing could lead to better understanding of optimal strategies for flap reconstruction in burns.

  4. Enteral nutrition intolerance in critically ill septic burn patients.

    Science.gov (United States)

    Lavrentieva, Athina; Kontakiotis, Theodore; Bitzani, Militsa

    2014-01-01

    The purpose of this study was to investigate the frequency of enteral feeding intolerance in critically ill septic burn patients, the effect of enteral feeding intolerance on the efficacy of feeding, the correlation between the infection marker (procalcitonin [PCT]) and the nutrition status marker (prealbumin) and the impact of feeding intolerance on the outcome of septic burn patients. From January 2009 to December 2012 the data of all burn patients with the diagnosis of sepsis who were placed on enteral nutrition were analyzed. Septic patients were divided into two groups: group A, septic patients who developed feeding intolerance; group B, septic patients who did not develop feeding intolerance. Demographic and clinical characteristics of patients were analyzed and compared. The diagnosis of sepsis was applied to 29% of all patients. Of these patients 35% developed intolerance to enteral feeding throughout the septic period. A statistically significant increase in mean PCT level and a decrease in prealbumin level was observed during the sepsis period. Group A patients had statistically significant lower mean caloric intake, higher PCT:prealbumin ratio, higher pneumonia incidence, higher Sequential Organ Failure Assessment Maximum Score, a longer duration of mechanical ventilation, and a higher mortality rate in comparison with the septic patients without gastric feeding intolerance. The authors concluded that a high percentage of septic burn patients developed enteral feeding intolerance. Enteral feeding intolerance seems to have a negative impact on the patients' nutritional status, morbidity, and mortality. PMID:24879397

  5. Historical review: First facial pain patient admitted to Massachusetts General Hospital, February 1823 and first case series.

    Science.gov (United States)

    Keith, David A; Dodson, Thomas B; Kaban, Leonard B

    2013-08-01

    Founded in 1811, the Massachusetts General Hospital recently celebrated its bicentennial. The War of 1812 delayed construction of the building so the first patient actually was admitted to the hospital 10 years later, on September 3, 1821. By 1823, the 60 hospital beds were full. Patient 66 was admitted on February 28, 1823, and his hospital course, as described in the admissions book, was transcribed for the Massachusetts General Hospital bicentennial celebration. That case history is reproduced and a case series of 6 similar patients published in 1828 by Dr John Warren, surgeon-in-chief and a founder of the hospital, is presented. In this report, the authors comment on the diagnosis, treatment, and outcome of these patients in the context of the contemporaneous health care environment and in light of the current knowledge of facial pain disorders. This article was adapted from the authors' commentary for the bicentennial celebration. PMID:23866949

  6. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

    OpenAIRE

    Sean M Bagshaw; Webb, Steve AR; Delaney, Anthony; George, Carol; Pilcher, David; Hart, Graeme K; Bellomo, Rinaldo

    2009-01-01

    Introduction Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to intensive care. The primary objective was to evaluate the rate, characteristics and outcomes of very old (age ≥ 80 years) patients admitted to intensive care units (ICUs). Methods Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data we...

  7. HYPNOTHERAPY AS A TREATMENT FOR PAIN IN PATIENTS WITH BURNS

    Directory of Open Access Journals (Sweden)

    F SHAKIBAEI

    2002-03-01

    Full Text Available Introduction. Burning is an event with many psychosomatic complications. Pain is one of the most trouble matter in these patients that affect on their psychologic features. This study presents a hypnotherapeutics intervention for controlling pain in patients suffered from burning. Methods. In a randomized clinical trial (without placebo, two 22 members group burned patients were selected. In interventional group we conduct a 5 sessions hypnotherapy course. Severity of pain and itching were assessed by visual analogue scale before and after intervention and results were compaired between two groups. Results. All pain parameters were decreased more in interventional group (P < 0.05. Discussion. It seems that hypnotherapy can playa positive role in pain reduction of patients. It is recommended that it would be applied in adjunct to current medications in these patients.

  8. Two cases of jugular vein thrombosis in severely burned patients

    Directory of Open Access Journals (Sweden)

    Cen H

    2013-07-01

    Full Text Available Hanghui Cen, Xiaojie HeDepartment of Burn, The Second Affiliated Hospital, Zhejiang University Medical College, Hangzhou, People’s Republic of ChinaAbstract: Here we present two cases of jugular vein thrombosis in burn patients, with diagnosis, risk factor analysis, and treatment approaches. Severely burned patients have high risk of deep vein thrombosis occurrence due to multiple surgeries. The deep vein catheter should be carefully performed. Once deep vein thrombosis is detected, a wide ultrasonography helps to find other thrombosis sites. During the acute phase, low molecular weight heparin can be used. Upon long-term anti-thrombosis treatment, combined use of herbal medicine during rehabilitation is helpful.Keywords: burn, heparin, combined treatment

  9. Benchmarking Outcomes in the Critically Injured Burn Patient

    Science.gov (United States)

    Klein, Matthew B.; Goverman, Jeremy; Hayden, Douglas L.; Fagan, Shawn P.; McDonald-Smith, Grace P.; Alexander, Andrew K.; Gamelli, Richard L.; Gibran, Nicole S.; Finnerty, Celeste C.; Jeschke, Marc G.; Arnoldo, Brett; Wispelwey, Bram; Mindrinos, Michael N.; Xiao, Wenzhong; Honari, Shari E.; Mason, Philip H.; Schoenfeld, David A.; Herndon, David N.; Tompkins, Ronald G.

    2014-01-01

    Objective To determine and compare outcomes with accepted benchmarks in burn care at six academic burn centers. Background Since the 1960s, U.S. morbidity and mortality rates have declined tremendously for burn patients, likely related to improvements in surgical and critical care treatment. We describe the baseline patient characteristics and well-defined outcomes for major burn injuries. Methods We followed 300 adults and 241 children from 2003–2009 through hospitalization using standard operating procedures developed at study onset. We created an extensive database on patient and injury characteristics, anatomic and physiological derangement, clinical treatment, and outcomes. These data were compared with existing benchmarks in burn care. Results Study patients were critically injured as demonstrated by mean %TBSA (41.2±18.3 for adults and 57.8±18.2 for children) and presence of inhalation injury in 38% of the adults and 54.8% of the children. Mortality in adults was 14.1% for those less than 55 years old and 38.5% for those age ≥55 years. Mortality in patients less than 17 years old was 7.9%. Overall, the multiple organ failure rate was 27%. When controlling for age and %TBSA, presence of inhalation injury was not significant. Conclusions This study provides the current benchmark for major burn patients. Mortality rates, notwithstanding significant % TBSA and presence of inhalation injury, have significantly declined compared to previous benchmarks. Modern day surgical and medically intensive management has markedly improved to the point where we can expect patients less than 55 years old with severe burn injuries and inhalation injury to survive these devastating conditions. PMID:24722222

  10. An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure.

    Science.gov (United States)

    Mayes, Theresa; Gottschlich, Michele M; Kagan, Richard J

    2008-01-01

    Respiratory failure is associated with a high mortality rate in burned children. Recently, a specialized pulmonary enteral formula (SPEF) was commercially introduced as an adjunct intervention in acute lung injury management. SPEF contains condition-specific nutrients to modulate the inflammatory response. The study examined SPEF impact in critically ill, pediatric burn patients with respiratory failure. Medical records of acute burn patients admitted December 1997 to October 2006 were reviewed for SPEF treatment. Respiratory and renal indices were compared on the first and final days of SPEF use. Nineteen patients with respiratory failure received SPEF for a mean of 10.8 +/- 0.9 days during their acute burn course. Mean age was 5.3 +/- 1.5 years. Mean total body surface area burn was 44.3 +/- 5.4% with 32.5 +/- 6.4% full thickness. Patients were admitted 2.3 +/- 0.9 days postburn. Significant improvements in peak pressure, PEEP, FiO2, P:F ratio, Pco2, Po2, and ETco2 were noted. Seventeen of the 19 patients survived despite the fact that 9 of the 19 patients developed severe barotrauma requiring multiple tube thoracotomies, and all 19 had extremely poor prognoses at SPEF initiation. Adult SPEF formula for critically ill, pediatric burn patients with respiratory failure is safe and well tolerated. SPEF seems to facilitate recovery from acute lung injury as evidenced by improvements in oxygenation and pulmonary compliance.

  11. Focused Sonographic Examination of the Heart, Lungs and Deep Veins in Acute Admitted Patients with Respiratory Symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg; Sloth, Erik; Lassen, Annmarie Touborg;

    2012-01-01

    the use of sonographic examination of the heart, lungs and deep veins, performed within one hour of the primary evaluation, in acute admitted patients with respiratory symptoms. Methods: We performed a prospective cross sectional blinded observational study, conducted in a medical emergency department....... Patients were included if one or more of the following symptoms or clinical findings were present: respiratory rate > 20, saturation lungs and deep veins...... with pulmonary oedema, 1 had pericardial effusion, 1 had massive pleural effusion, 5 had empyema and 4 had pulmonary embolism. Conclusion: Focused sonography of the heart, lungs and deep veins is a highly feasible and non-invasive bedside method. In acute admitted patients with respiratory symptoms, it may help...

  12. [Follow-up of extensive burns in an HIV positive patient. Case report].

    Science.gov (United States)

    de Roche, R; Lüscher, N J; Zimmerli, W

    1990-02-01

    The case of a 33-year-old HIV-positive patient who suffered from second- and third-degree burn injuries involving 30% of the body surface is reported. She was treated by early tangential excision of the burnt skin and split-thickness mesh grafting. The burn wounds healed without complications within the usual time, with excellent cosmetic and functional results. In spite of the successful treatment, she suffered from fever and various infections for several months. With the appearance of these constitutional symptoms, we recognized the AIDS-related complex. Her general condition deteriorated continuously and 10 months after the accident she had to be admitted to a hospital again. The skin had nevertheless healed perfectly and in spite of not having compression treatment for the grafts or physiotherapy, she did not show any signs of hypertrophic scars. Some important conclusions drawn from this case are discussed. The fact that healing occurred without complications is in contrast to the results reported in the literature concerning impaired wound healing in AIDS patients with anorectal surgery. We therefore believe that the reluctant and perhaps even anxious attitude of the medical and nursing staff towards performing technical and expensive procedures in HIV-positive burn patients is not justified. PMID:2315721

  13. [Amylase-creatinine clearance ratios in burned patients (author's transl)].

    Science.gov (United States)

    Minaire, Y; Marichy, J; Forichon, J; Motin, J

    1978-09-01

    The amylase/creatinine clearance ratio (ACCR) has been examined every 3 days, in 34 burned patients during the 20 days following the accident. This ratio was often abnormal since it was found increased at least on one occasion, in 75% of these patients, to be compared with 23 and 13% for amylase in serum and urine respectively. In another group of 9 burned patients, the ACCR was monitored for time-period between 10 to 52 days. It was observed that a high frequency in increased ACCR was associated with a fatal outcome. Finally simultaneous measurements of ACCR and of the beta2 microglobulin/creatinine clearance ratio (MCCR) showed that increased ACCR were statistically associated with increased MCCR suggesting a decreased renal tubular reabsorption of low molecular weight proteins in these burned patients.

  14. [Amylase-creatinine clearance ratios in burned patients (author's transl)].

    Science.gov (United States)

    Minaire, Y; Marichy, J; Forichon, J; Motin, J

    1978-09-01

    The amylase/creatinine clearance ratio (ACCR) has been examined every 3 days, in 34 burned patients during the 20 days following the accident. This ratio was often abnormal since it was found increased at least on one occasion, in 75% of these patients, to be compared with 23 and 13% for amylase in serum and urine respectively. In another group of 9 burned patients, the ACCR was monitored for time-period between 10 to 52 days. It was observed that a high frequency in increased ACCR was associated with a fatal outcome. Finally simultaneous measurements of ACCR and of the beta2 microglobulin/creatinine clearance ratio (MCCR) showed that increased ACCR were statistically associated with increased MCCR suggesting a decreased renal tubular reabsorption of low molecular weight proteins in these burned patients. PMID:360162

  15. Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury.

    Science.gov (United States)

    Maile, Robert; Jones, Samuel; Pan, Yinghao; Zhou, Haibo; Jaspers, Ilona; Peden, David B; Cairns, Bruce A; Noah, Terry L

    2015-05-01

    Bacterial infection is a major cause of morbidity affecting outcome following burn and inhalation injury. While experimental burn and inhalation injury animal models have suggested that mediators of cell damage and inflammation increase the risk of infection, few studies have been done on humans. This is a prospective, observational study of patients admitted to the North Carolina Jaycee Burn Center at the University of North Carolina who were intubated and on mechanical ventilation for treatment of burn and inhalational injury. Subjects were enrolled over a 2-yr period and followed till discharge or death. Serial bronchial washings from clinically indicated bronchoscopies were collected and analyzed for markers of tissue injury and inflammation. These include damage-associated molecular patterns (DAMPs) such as hyaluronic acid (HA), double-stranded DNA (dsDNA), heat-shock protein 70 (HSP-70), and high-mobility group protein B-1 (HMGB-1). The study population was comprised of 72 patients who had bacterial cultures obtained for clinical indications. Elevated HA, dsDNA, and IL-10 levels in bronchial washings obtained early (the first 72 h after injury) were significantly associated with positive bacterial respiratory cultures obtained during the first 14 days postinjury. Independent of initial inhalation injury severity and extent of surface burn, elevated levels of HA dsDNA and IL-10 in the central airways obtained early after injury are associated with subsequent positive bacterial respiratory cultures in patients intubated after acute burn/inhalation injury.

  16. OPTIMIZED FLUID MANAGEMENT IMPROVES OUTCOMES OF PEDIATRIC BURN PATIENTS

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Branski, Ludwik K; Finnerty, Celeste C; Leonard, Katrina R; Jeschke, Marc G

    2012-01-01

    Background One of the major determinants for survival of severely burned patients is appropriate fluid resuscitation. At present, fluid resuscitation is calculated based on bodyweight or body surface area, burn size, and urinary output. However, recent evidence suggests that fluid calculation is inadequate and that over- and under-resuscitation is associated with increased morbidity and mortality. We hypothesize that optimizing fluid administration during the critical initial phase using a transcardiopulmonary thermo-dilution monitoring device (PiCCO) would have beneficial effects on the outcome of burned patients. Methods A cohort of seventy-six severely burned pediatric patients with burns over 30% total body surface area (TBSA) who received adjusted fluid resuscitation using the PiCCO (P) system were compared to 76 conventionally monitored patients (C). Clinical hemodynamic measurements, organ function (DENVER2 score), and biomarkers were recorded prospectively for the first 20 days after burn injury. Results Both cohorts were similar in demographic and injury characteristics. Patients in the PiCCO group received significantly less fluids (p<0.05) with similar urinary output, resulting in a significantly lower positive fluid balance (p<0.05). The central venous pressure (CVP) in the P group was maintained in a more controlled range (p<0.05), associated with a significantly lower heart rate and significantly lower incidence of cardiac and renal failure, p<0.05. Conclusions Fluid resuscitation guided by transcardiopulmonary thermo-dilution during hospitalization represents an effective adjunct and is associated with beneficial effects on post-burn morbidity. PMID:22703982

  17. Transesophageal echocardiography in the management of burn patients.

    Science.gov (United States)

    Maybauer, Marc O; Asmussen, Sven; Platts, David G; Fraser, John F; Sanfilippo, Filippo; Maybauer, Dirk M

    2014-06-01

    A systematic review was conducted to assess the level of evidence for the use of transesophageal echocardiography (TEE) in the management of burn patients. We searched any article published before and including June 30, 2013. Our search yielded 118 total publications, 11 met the inclusion criteria of burn injury and TEE. Available studies published in any language were rated and included. At the present time, there are no available systematic reviews/meta-analyses published that met our search criteria. Only a small number of clinical trials, all with a limited number of patients were available. Therefore, a meta-analysis on outcome parameters was not performed. However, the major pathologic findings in burn patients were reduced left ventricular (LV) systolic and diastolic function, mitral valve vegetation, pulmonary hypertension, pericardial effusion, fluid overload, and right heart failure. The advantages of TEE include offering direct assessment of cardiac valve competency, myocardial contractility, and most importantly real time assessment of adequacy of hemodynamic resuscitation and preload in the acute phase of resuscitation, with minimal additional risk. TEE serves multiple diagnostic purposes and is being used to better understand the fluid status and cardiac physiology of the critically ill burn patient. Randomized controlled trials especially on fluid resuscitation and cardiac performance in acute burns are warranted to potentially further improve outcome.

  18. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

    OpenAIRE

    Ana Cláudia Giaxa Prosdócimo; Luciane Boreki Lucina; Olandoski Marcia; Priscila Megda João Jobs; Nicolle Amboni Schio; Fernanda Fachin Baldanzi; Costantino Ortiz Costantini; Ana Maria Teresa Benevides-Pereira; Luiz Cesar Guarita-Souza; José Rocha Faria-Neto

    2015-01-01

    Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically act...

  19. Suicidal Behavior in a Patient with Burning Mouth Syndrome

    Directory of Open Access Journals (Sweden)

    Konstantinos Kontoangelos

    2014-01-01

    Full Text Available Introduction. Chronic pain of the oral cavity is a long-term condition and like all other types of chronic pain is associated with numerous comorbidities such as depression or anxiety. Case Presentation. This is a case of a 93-year-old patient suffering from chronic oral cavity pain who repeatedly stabbed his palate due to ongoing local pain, over the last few months, which he could not further tolerate. The patient was suffering from depression and also a diagnosis of “burning mouth syndrome” (BMS was made. Discussion. Burning mouth syndrome (BMS is characterized by a burning sensation in the tongue or other oral sites. BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnosis. Patients with multiple forms of pain must be considered as potential candidates for underdiagnosed depression (major and suicidal thoughts.

  20. Bacteriological evaluation of wounds in seriously burned hospitalized patients

    Directory of Open Access Journals (Sweden)

    Sueli de Lourdes Nogueira Vilela Silva

    1991-09-01

    Full Text Available During the period between May and December 1988, 21 patients were studied bacteriologically at Hospital João XXIII's burn's unit which belongs to "Fundação Hospitalar do Estado de Minas Gerais" in Belo Horizonte, Brazil. A qualitative and quantitative evaluation of aerobic and facultative bacteria from burn wounds was carried out by the standard filter paper disc technique, including antibiotic susceptibility. At the same time an evaluation of those bacteria isolated from the environmental unit was performed. The most common organisms recovered from wounds of patients were: Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. P. pseudomallei was the most frequent strain recovered from environmental specimens. In nearly all patients specimens (16 in total from whom P. aeruginosa was isolated, the rate of CFU/cm² of skin was above 10². In nine of these, it reached 10(5, wich is equivalent to 10(7 CFU/g of burned tissue.

  1. Scales for evaluating self-perceived anxiety levels in patients admitted to intensive care units: a review

    OpenAIRE

    Perpiñá Galvañ, Juana; Richart Martínez, Miguel

    2009-01-01

    Objective: To review studies of anxiety in critically ill patients admitted to an intensive care unit to describe the level of anxiety and synthesize the psychometric properties of the instruments used to measure anxiety. Methods: The CUIDEN, IME, ISOC, CINAHL, MEDLINE, and PSYCINFO databases for 1995 to 2005 were searched. The search focused on 3 concepts: anxiety, intensive care, and mechanical ventilation for the English-language databases and ansiedad, cuidados intensivos, and ventilación...

  2. Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

    OpenAIRE

    Mohammad Reza Rafiei; Omid Aghadavoudi; Babak Shekarchi; Seyed Sajed Sajjadi; Mehrdad Masoudifar

    2013-01-01

    Background: Increased intra-abdominal pressure (IAP) results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. Methods: In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure (BIPAP) group, synchronize intermittent mandatory ventilation (SI...

  3. Chest physiotherapy on intracranial pressure of critically ill patients admitted to the intensive care unit: a systematic review

    OpenAIRE

    Ferreira, Lucas Lima; Valenti, Vitor Engrácia; Vanderlei, Luiz Carlos Marques

    2013-01-01

    Objective To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on critically ill patients admitted to the intensive care unit. Methods Through a systematic review of the literature, clinical trials published between 2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and PEDro databases using the keywords "physical therapy", "physiotherapy", "respiratory ther...

  4. Pattern of Pulmonary Involvement and Outcome of Aspiration Pneumonia in Patients with Altered Consciousness Admitted in Dhaka Medical College Hospital.

    Science.gov (United States)

    Chowdhury, R A; Azad, A K; Sardar, H; Siddiqui, M R; Saad, S; Rahman, S; Sikder, A S

    2016-01-01

    Aspiration is well recognized as a cause of pulmonary disease and is not uncommon in patients with altered consciousness.The mortality rate of aspiration pneumonia is approximately 1% in outpatient setting and upto 25% in those requiring hospitalization. This study was done to see the pattern of pulmonary involvement and outcome of aspiration pneumonia in patients with altered consciousness admitted in medicine department of a tertiary care hospital in our country. This was a prospective observational study conducted among the 52 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of Dhaka Medical College Hospital (DMCH), during June 2010 to December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Hematologic measurements (TC of WBC, Hb%, ESR, platelet count), chest X-ray, blood gas analysis, blood urea, creatinine and random blood sugar, sputum for Gram staining, sputum for culture sensitivity and blood culture were done in all patients.Assessment of altered conscious patient was done by application of the Glasgow Coma Scale. Case record forms with appropriate questionnaire were filled for all patients. The mean±SD age was 57.42±13.63 years with ranged from 25 to 90 years. Out of 52 patients, 37(71.15%) patients were male and 15(28.85%) patients were female. Following aspiration 76.92% patients developed pneumonitis, 13.46% patients developed lung abscess and only 9.62% patients developed ARDS. Most (33) of the patients had opacity in right lower zone and 13 patients had opacity in the left lower zone, 6 patients had opacity in right mid zone. Only 10 patients had opacity in both lower zones. In this study overall mortality rate was 23%. If only one lobe was involved radiologically, mortality was 8.33%. If two or more lobes on one or both sides were involved, mortality was in the range of 25-91%.

  5. Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine

    Science.gov (United States)

    Hominick, Kathryn; McLeod, Victoria; Rockwood, Kenneth

    2016-01-01

    Background Frail older adults present to the Emergency Department (ED) with complex medical, functional, and social needs. When these needs can be addressed promptly, discharge is possible, and when they cannot, hospital admission is required. We evaluated the care needs of frail older adults in the ED who were consulted to internal medicine and seen by a geriatrician to determine, under current practices, which factors were associated with hospitalization and which allowed discharge. Methods We preformed a chart-based, exploratory study. Data were abstracted from consultation records and ED charts. All cases had a standard Comprehensive Geriatric Assessment (CGA which records a Clinical Frailty Scale (CFA) and allows calculation of a Frailty Index (FI). Results Of 100 consecutive patients, 2 died in the ED, 75 were admitted, and 23 were discharged, including one urgent placement. Compared with discharged patients (0.39 ± SD 0.16), those admitted had a higher mean FI-CGA (0.48 ± 0.13; p < .01). Greater mobility dependence (2% in discharged vs. 32% in admitted; p < .05) was notable. Conclusions Discharge decisions require assessment of medical, functional, and social problems. Ill, frail patients often can be discharged home when social and nursing support can be provided. The degree of frailty, impaired mobility, and likely delirium must be taken into account when planning for their care. PMID:27076860

  6. National trends in burn and inhalation injury in burn patients: results of analysis of the nationwide inpatient sample database.

    Science.gov (United States)

    Veeravagu, Anand; Yoon, Byung C; Jiang, Bowen; Carvalho, Carla M; Rincon, Fred; Maltenfort, Mitchell; Jallo, Jack; Ratliff, John K

    2015-01-01

    The aim of this study was describe national trends in prevalence, demographics, hospital length of stay (LOS), hospital charges, and mortality for burn patients with and without inhalational injury and to compare to the National Burn Repository. Burns and inhalation injury cause considerable mortality and morbidity in the United States. There remains insufficient reporting of the demographics and outcomes surrounding such injuries. The National Inpatient Sample database, the nation's largest all-payer inpatient care data repository, was utilized to select 506,628 admissions for burns from 1988 to 2008 based on ICD-9-CM recording. The data were stratified based on the extent of injury (%TBSA) and presence or absence of inhalational injury. Inhalation injury was observed in only 2.2% of burns with burns with 80 to 99% TBSA. Burn patients with inhalation injury were more likely to expire in-hospital compared to those without (odds ratio, 3.6; 95% confidence interval, 2.7-5.0; P Patients treated at rural facilities and patients with hyperglycemia had lower mortality rates. Each increase in percent of TBSA of burns increased LOS by 2.5%. Patients with burns covering 50 to 59% of TBSA had the longest hospital stay at a median of 24 days (range, 17-55). The median in-hospital charge for a burn patient with inhalation injury was US$32,070, compared to US$17,600 for those without. Overall, patients who expired from burn injury accrued higher in-hospital charges (median, US$50,690 vs US$17,510). Geographically, California and New Jersey were the states with the highest charges, whereas Vermont and Maryland were states with the lowest charges. The study analysis provides a broad sampling of nationwide demographics, LOS, and in-hospital charges for patients with burns and inhalation injury.

  7. Fluid resuscitation management in patients with burns: update.

    Science.gov (United States)

    Guilabert, P; Usúa, G; Martín, N; Abarca, L; Barret, J P; Colomina, M J

    2016-09-01

    Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge. PMID:27543523

  8. Site of infection and mortality in patients with severe sepsis or septic shock. A cohort study of patients admitted to a Danish general intensive care unit

    DEFF Research Database (Denmark)

    Klastrup, Vibeke; Hvass, Anne Mette; Mackenhauer, Julie;

    2016-01-01

    BACKGROUND: The search for the site of infection has high priority in patients with severe sepsis and septic shock. However, it is questionable whether mortality is associated with the specific site of infection in patients admitted to an intensive care unit (ICU). Therefore, the 30-day and 90-day...... mortalities in ICU patients admitted with suspected or confirmed community-acquired infection were studied. METHODS: A retrospective cohort study was conducted, including all adult patients admitted to a multi-specialty tertiary ICU with severe sepsis or septic shock from November 2008 to October 2010....... The site of infection was classified according to criteria set for healthcare associated infections and infections in the acute care setting by Centers for Disease Control and Prevention (CDC). Kaplan-Meier curves and Poisson regression analysis were used to evaluate the association between site...

  9. The Value and Prognostic Role of the CT Scan versus Chest Radiography in the Follow-up of Intubated Burn Patients with Possible Inhalation Injury

    OpenAIRE

    Spyropoulou, G.A.; Iconomou, T.; Tsagarakis, M.; Tsoutsos, D.

    2005-01-01

    The admission and follow-up chest radiographs as well as the follow-up CT scans of 13 burn patients admitted to our clinic requiring ventilatory support were analysed for signs of inhalation injury and pulmonary complications. The findings were compared with the results of the clinical examination, the blood gas tests, and bronchoscopy. Eleven out of the 13 patients underwent bronchoscopy revealing inhalation injury. The CT scan detected pleural effusion in two patients with a normal chest ra...

  10. Intensive Insulin Therapy in Severely Burned Pediatric Patients

    Science.gov (United States)

    Jeschke, Marc G.; Kulp, Gabriela A.; Kraft, Robert; Finnerty, Celeste C.; Mlcak, Ron; Lee, Jong O.; Herndon, David N.

    2010-01-01

    Rationale: Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. Objectives: To determine whether intensive insulin therapy is associated with improved post-burn morbidity. Methods: A total of 239 severely burned pediatric patients with burns over greater than 30% of their total body surface area were randomized (block randomization 1:3) to intensive insulin treatment (n = 60) or control (n = 179). Measurements and Main Results: Demographics, clinical outcomes, sepsis, glucose metabolism, organ function, and inflammatory, acute-phase, and hypermetabolic responses were determined. Demographics were similar in both groups. Intensive insulin treatment significantly decreased the incidence of infections and sepsis compared with controls (P < 0.05). Furthermore, intensive insulin therapy improved organ function as indicated by improved serum markers, DENVER2 scores, and ultrasound (P < 0.05). Intensive insulin therapy alleviated post-burn insulin resistance and the vast catabolic response of the body (P < 0.05). Intensive insulin treatment dampened inflammatory and acute-phase responses by deceasing IL-6 and acute-phase proteins compared with controls (P < 0.05). Mortality was 4% in the intensive insulin therapy group and 11% in the control group (P = 0.14). Conclusions: In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309). PMID:20395554

  11. The Effect of Shiatsu Massage on Pain Reduction in Burn Patients

    OpenAIRE

    Ardabili, Fatemeh Mohaddes; Purhajari, Soybeh; Najafi Ghezeljeh, Tahereh; Haghani, Hamid

    2014-01-01

    BACKGROUND Burn is a tragedy that follows multiple problems in a patient including pain, anxiety and lack of confidence into medical team. This study evaluated the effect of shiatsu massage on pain intensity of burn patients. METHODS A total of 120 burn patients from Motahhari Burn Hospital and of both genders were randomly divided into 4 groups of undergoing hand massage, leg massage, both hand and leg massages, and the control group. The effect of shiatsu massage in pain relief of burned pa...

  12. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

    DEFF Research Database (Denmark)

    Matzen, Lars E; Jepsen, Ditte B; Ryg, Jesper;

    2012-01-01

    ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS......: All first admissions of patients with age >65 years between January 1st 2005 and December31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved fromthe hospital patient administrative system, and data on survival until September 6th 2010 wereretrieved from the Civil...... Personal Registry. Co-morbidity was measured with Charlson ComorbidityIndex (CCI). Patients were followed until death or end of study. RESULTS: 5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age(SD) 82.0 (6.8) and 84.0 (7.0) years respectively. The median [IQR] length...

  13. Treatment of severe burn injury of 98% TBSA with 95% full-thickness burn and severe inhalation injury: a case report

    Institute of Scientific and Technical Information of China (English)

    杨磊; 王甲汉; 周一平

    2003-01-01

    @@ The treatment of extensive severe burn injury is very difficult, especially when some complications are involved. A burned patient sustained 98% total body surface area (TBSA) with 95% full thickness burn and severe inhalation injury was admitted to our hospital in 08- 2000. After aggressive treatment, the patient recovered fully. This paper reports the treatment of the patient.

  14. The Comparison of Procalcitonin Guidance Administer Antibiotics with Empiric Antibiotic Therapy in Critically Ill Patients Admitted in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Atabak Najafi

    2015-10-01

    Full Text Available The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU with systemic inflammatory response syndrome (SIRS.  A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30 and patients who undergoing antibiotic empiric therapy as control group (n=30. Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03. Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88. Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01. However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23.  Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups.

  15. Constipation - prevalence and incidence among medical patients acutely admitted to hospital with a medical condition

    DEFF Research Database (Denmark)

    Noiesen, Eline; Trosborg, Ingelise; Bager, Louise;

    2014-01-01

    To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients.......To examine the prevalence and incidence of patient-reported symptoms of constipation in acutely hospitalised medical patients....

  16. [On the rehabilitation of pediatric burn patients in China].

    Science.gov (United States)

    Jia, Chi-yu

    2013-02-01

    Rehabilitation medicine is an emerging discipline. At present, there are many problems in rehabilitation of pediatric burn patients in China, including idea lag, weak technical force, lack of standardized technology, disunity in evaluation indexes, etc. The new era of reformation of health system and development and flourish of medical insurance business bring good opportunity for the development of rehabilitation medicine.

  17. Nutritional, immunological and microbiological profiles of burn patients

    Directory of Open Access Journals (Sweden)

    ASAA Barbosa

    2009-01-01

    Full Text Available A burn is a lesion on an organic tissue resultant from direct or indirect action of heat on the organism. The present study aimed to evaluate the nutritional, immunological and microbiological status of burn patients at the Bauru State Hospital, São Paulo state, Brazil, in 2007. Eight patients, aged more than 18 years and injured up to 24 hours, were evaluated at the moment of hospitalization and seven days later. All victims were males with a mean age of 38 years. On average, 17.5% of their body surfaces were burned and 50% of the patients were eutrophic. There were significant alterations in levels of erythrocytes, hemoglobin, hematocrit, total protein and albumin due to increased endothelial permeability, direct destruction of proteins in the heat-affected area and blood loss from lesions or debridement. At a second moment, cytokines IL-6 and TNF-α had augmented significantly, with IL-6 presenting elevated levels in relation to controls at the first moment. Microbiological analysis showed that 100% of the samples collected at hospital admission were negative and after one week Staphylococcus aureus was found in all cultures. Therefore, a burn patient may be considered immunosuppressed and these results indicate significant nutritional, immunological and microbiological alterations that can interfere in his recovery.

  18. The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units

    Directory of Open Access Journals (Sweden)

    Hojat Rezaie

    2015-12-01

    Full Text Available Background: Visitation of patients admitted at intensive care units (ICUs is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. Aim: This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. Method: This experimental study was conducted on 90 conscious patients admitted at the ICU of Ganjavian Hospital in Dezful, Iran in 2014. Patients were randomly divided into two groups of intervention and control. In the control group, patient visits were carried out in accordance with normal procedures of the ward. In the intervention group, patients were visited by relatives and family members for 30 minutes, preferably in evening shifts. Physiological indices of the patients were recorded before, during and after scheduled visitation. Data analysis was performed in SPSS V.18 using independent T-test and one-way ANOVA with repeated measures. Results: In this study, mean age of patients in the intervention and control groups was 42.1±19.1 and 39.4±19.6 years, respectively. In the intervention group, systolic blood pressure had a more significant reduction at 10 and 30 minutes after visitation compared to the control group (independent T-test, P0.05. Implications for Practice: According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.

  19. A STUDY ON ROLE OF VARIOUS TYPES OF TOPICAL OINTMENT AND ITS OUTCOME AMONG BURN PATIENTS : AN INTERESTING FOLLOW UP STUDY

    Directory of Open Access Journals (Sweden)

    Sunita

    2015-08-01

    Full Text Available Burn injury causes major bulk of the surgical emergencies. Burn infection makes the burn wound complicated causes considerable mortality and morbidity. Timely and effective use of antimicrobial and topical dressings revolutionizes burn care by decreasing invasive wound infection. The administration of broad - spectrum antibiotics on routine basis is likely to en courage. The emergence of resistant organism therefore, timely and judicial use of antibiotics is essential for better result. MATERIAL AND METHOD S: The present study was carried out in 160 burns and scald admitted in surgical wards in Department of General Surgery, SGMH and S.S. Medical College, Rewa ( M. P. during period of one year. The cases are fully recorded and thoroughly studied with the aim of establishing the incidence, mode of burn and causes of burn, source of burn, clothing at timed incidence, time and place of incidence and detail clinical assessment. On admission resuscitation started with intravenous fluid, calculated according to the Parkland formula and prophylactic antibiotic giv en in all the patients after sampling for culture and sensitivity. Symptomatic and supportive treatment added as per need. RESULTS : Out of 160 patients, majority of the patient belong to 21 – 40 year 48.1%. Majority of patient ( 34.4% had total body surfac e burn area burnt between 21 - 40% and 12.5% patient had burnt area 61 - 80%. Maximum ( 50.0% complain of irritation was reported by the patients to whom Silver sulphadizine was applied while least ( 10% by the patients to whom nadoxin e was applied. CONCLUSION : The incident of invasive infection and overall mortality was significantly reduced after the introduction into clinical practice of topical burn wound anti - microbial agent, our study shows that the most effective topical antimicrobial agent in burn patie nt is Nadoxine.

  20. Boiling wax burn in mid-autumn festival in Hong Kong.

    Science.gov (United States)

    Chan, E S; Chan, E C; Ho, W S; King, W W

    1997-01-01

    An unusual cause of burn, contact with boiling wax by children and adolescents during the annual mid-autumn festival in Hong Kong is presented. 57 patients who suffered from hot wax burn over the period 1986-1996 were admitted to the Burns Unit of the Prince of Wales Hospital. This special burn should be preventable by public education.

  1. Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

    Institute of Scientific and Technical Information of China (English)

    柴家科; 盛志勇; 杨红明

    2000-01-01

    Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P<0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P<0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.

  2. Comparison of the General Health, Self-Esteem and Social Support in Self-Inflicted Burn Patients and Non Self Inflicted Burn Patients of the Choromy Accidental and Burning Hospital of Ganaveh

    OpenAIRE

    MS Enayati; A Heidarei; Malekzadeh, M.; Y Abolfathi

    2006-01-01

    ABSTRACT: Introduction & Objective: Self-inflicted burn is a violent method of suicide. Since our society faces lots of psychological, social, personal and economical problems due to self-inflicted burn, more survey for this event can assist us to know its causes and prevent from its occurrence. This research was carried out to compare general health, self- esteem and social support in patient's self-inflicted burn and non-self-inflicted burn of the Choromy accidental and burning hospital...

  3. Cognitive Investigation Study of Patients Admitted for Cosmetic Surgery: Information, Expectations, and Consent for Treatment

    OpenAIRE

    Barone, Mauro; Cogliandro, Annalisa; La Monaca, Giuseppe; Tambone, Vittoradolfo; Persichetti, Paolo

    2015-01-01

    Background In all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient. Methods An experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planne...

  4. Few Young U.S. Burn Patients Transferred to Specialized Centers

    Science.gov (United States)

    ... gov/news/fullstory_160791.html Few Young U.S. Burn Patients Transferred to Specialized Centers Researchers call for clearer ... guidelines are needed on the care of pediatric burn patients, said the researchers after analyzing 2012 data from ...

  5. Health related quality of life in Critically ill Patients A study of health related quality of life in critically ill patients admitted on the Intensive Care

    OpenAIRE

    Hofhuis, José

    2008-01-01

    textabstractHealth related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the intensive care unit (ICU). Long term outcome for physical and psychological factors, functional status and social interactions are becoming more and more important both for doctors and nurses as well as for patients and their relatives (1;2). Therefore doctors and nurses want to know what a “reasonable” quality of life means to their patients. The main reason for HRQOL research descri...

  6. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients)

    OpenAIRE

    Mussi Chiara; Galizia Gianluigi; Abete Pasquale; Morrione Alessandro; Maraviglia Alice; Noro Gabriele; Cavagnaro Paolo; Ghirelli Loredana; Tava Giovanni; Rengo Franco; Masotti Giulio; Salvioli Gianfranco; Marchionni Niccolò; Ungar Andrea

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65–101). Falls were defined “accidental” (fall explained by a definite accidental cause), “medical” (fall caused directly by a specific medical disease), “dementia-related” (fall in patients affected by moderate-severe dementia), and “unexplained” (nonaccidental falls, not related ...

  7. Early and Late Acute Kidney Injury in Severely Burned Patients

    Science.gov (United States)

    Witkowski, Wojciech; Kawecki, Marek; Surowiecka-Pastewka, Agnieszka; Klimm, Wojciech; Szamotulska, Katarzyna; Niemczyk, Stanisław

    2016-01-01

    Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR burns, respiratory failure, low protein concentration (for all ppatients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

  8. Use of sugammadex on burn patients: descriptive study

    Directory of Open Access Journals (Sweden)

    Eduardo Rodríguez Sánchez M.

    2015-08-01

    Full Text Available OBJECTIVES: A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population.MATERIALS AND METHODS: It was a prospectively descriptive study, including 4 patients, and all of them were considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation.RESULTS: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95 min 95% CI (3.25-6.64, p= .53.CONCLUSIONS: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies of larger populations would be necessary to confirm these data.

  9. Assessment of Substances Abuse in Burn Patients by Using Drug Abuse Screening Test

    OpenAIRE

    Kobra Gaseminegad; Bita Kamranfar; Parviz Nemazi; Faride Ahrari; Jaber Musavi; Kamran As'adi; Seyed Hamid Salehi; Somaie Faramarzi; Saeed Shoar

    2012-01-01

    There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20). We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We ch...

  10. Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

    2014-01-01

    of a possible PTSD diagnosis with symptoms of pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic pain rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission. METHOD......BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association...... were admitted to further multidisciplinary treatment and included in the outcome study. RESULTS: A high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems...

  11. Rorschach Inkblot Method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Andersen, Palle Bent; Knudsen, Per Bjerregaard;

    2012-01-01

    Background: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. Aims: To describe relevant...... Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other......'s Rorschach Comprehensive System at inclusion and after 2 years. Results: Core variables of the Rorschach, assumed to show changes (e.g. reality testing, perceptual and thought disorders) in patients with a first episode of schizophrenia, all improved but revealed no significant changes after 2 years...

  12. Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Torp-Pedersen, Christian; Seibaek, Marie;

    2004-01-01

    age was 71.7+/-10.2 years, 60% were male and 63% were in NYHA class III-IV. Moderate to severe left ventricular (LV) systolic dysfunction was present in 41%. Short and long-term survival status was obtained after 30 days and 5-8 years, respectively. Older patients less frequently had LV systolic......AIMS: To describe the association between age and risk factors in patients hospitalised with congestive heart failure (CHF) and to determine the effect of age on mortality. METHODS AND RESULTS: Consecutive patients admitted to 34 hospitals with CHF during a period of 2 years were registered. Mean...... dysfunction, were under treated with ACE-inhibitors and were more often female. The prevalence of hypertension, diabetes and ischaemic heart disease increased with age, until the oldest age group (>80 years). Age was an independent predictor of short-term mortality (risk ratio (RR) per 10-year increase was 1...

  13. Health related quality of life in Critically ill Patients A study of health related quality of life in critically ill patients admitted on the Intensive Care

    NARCIS (Netherlands)

    J.G.M. Hofhuis (José)

    2008-01-01

    textabstractHealth related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the intensive care unit (ICU). Long term outcome for physical and psychological factors, functional status and social interactions are becoming more and more important both for doctors and nurse

  14. Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial

    DEFF Research Database (Denmark)

    Jakobsen, Anna Svarre; Laursen, Lars C; Østergaard, Birte;

    2013-01-01

    Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable...... phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional...

  15. Profile of patients admitted to a triage dermatology clinic at a tertiary hospital in São Paulo, Brazil*

    Science.gov (United States)

    Bertanha, Fernanda; Nelumba, Erica Judite Pimentel; Freiberg, Alyne Korukian; Samorano, Luciana Paula; Festa Neto, Cyro

    2016-01-01

    Background Knowledge of epidemiological data on skin diseases is important in planning preventive strategies in healthcare services. Objective To assess data from patients admitted to a triage dermatology clinic. Methods A retrospective study was performed of patients admitted over a one-year period to the Triage Dermatology Clinic at the Hospital das Clínicas of the University of São Paulo Medical School. Data were obtained from record books. The variables analyzed were: patient age, gender, dermatologic disease (initial diagnosis), origin (from where the patient was referred) and destination (where the patient was referred to). Results A total of 16,399 patients and 17,454 diseases were identified for analysis. The most frequent skin disorders were eczema (18%), cutaneous infections (13.1%), erythematous squamous diseases (6.8%) and malignant cutaneous neoplasms (6.1%). Atopic dermatitis was the most common disease in children. Acne was more common among children and adults, as were viral warts. Basal cell carcinoma and squamous cell carcinoma were more common in the elderly. Contact dermatitis and acne predominated in women. The most frequent origins were: the primary/secondary health system (26.6%), other outpatient specialties (25.5%), emergency care (14.9%); while the destinations were: discharged (27.5%), follow-up in our Dermatology Division (24.1%), return (14.1%) and the primary/secondary health system (20.7%). Conclusion Understanding the incidence of skin diseases is fundamental in making decisions regarding resource allocation for clinical care and research. Thus, we believe our findings can contribute to improving public health policies. PMID:27438199

  16. A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care

    DEFF Research Database (Denmark)

    Houmann, Lise Jul; Chochinov, Harvey M; Kristjanson, Linda J;

    2014-01-01

    and a hospital palliative medicine unit.Results:Over 2 years, 80 of 341 eligible patients completed Dignity Therapy. At T1, 55 patients completed evaluations, of whom 73%-89% found Dignity Therapy helpful, satisfactory and of help to relatives; 47%-56% reported that it heightened their sense of purpose, dignity......Background:Dignity Therapy is a brief, psychosocial intervention for patients with incurable disease.Aim:To investigate participation in and evaluation of Dignity Therapy and longitudinal changes in patient-rated outcomes.Design:A prospective (pre/post) evaluation design was employed. Evaluation.......02)) improved. Patients with children and lower performance status, emotional functioning and quality of life were more likely to report benefit.Conclusions:This study adds to the growing body of evidence supporting Dignity Therapy as a valuable intervention in palliative care; a substantial subset of patients...

  17. Outcome of critically ill hyperglycemic stroke patients admitted to the intensive care unit

    Directory of Open Access Journals (Sweden)

    Kamel Abdelaziz Mohamed

    2013-01-01

    Conclusion Our current study showed that nondiabetic patients with hyperglycemia had a 1.6 times higher relative risk of in-hospital 28-day mortality than diabetic patients. Stress hyperglycemia predicts an increased risk of in-hospital mortality after ischemic stroke; thus, we should not underestimate the potential harm, as patients with the highest admission glucose levels would have most likely been treated earlier and more aggressively.

  18. NT-ProBNP Independently Predicts Long-Term Mortality in Patients Admitted for Coronary Angiography

    DEFF Research Database (Denmark)

    Ruwald, Martin Huth; Goetze, Jens Peter; Bech, Jan;

    2014-01-01

    Recently, research interests are focussed on biomarkers to predict the outcome in patients with coronary artery disease (CAD). We examined whether the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict outcome in patients who underwent elective or acute coronary......%) patients died and 88 (26%) patients reached the combined end point. Preprocedural NT-proBNP above 32 pmol/L independently predicted ACM (hazard ratio [HR] 3.11; confidence interval [CI]: 1.60-6.07; P = .001) and the combined end point (HR 2.44 [CI: 1.50-3.97]; P NT...

  19. A STUDY OF METALLO-BETA-LACTAMASE PRODUCING PSEUDOMONAS AERUGINOSA IN BLOOD SAMPLES OF BURNED PATIENTS

    Directory of Open Access Journals (Sweden)

    Piyali

    2014-11-01

    Full Text Available : BACKGROUND: Septicaemia is a life threatening complication of severely burned patients. Among many organisms invading blood stream Pseudomonas aeruginosa is a well-known for its powerful antibiotic resistance mechanisms which increasingly limit the choices for treatment. Among many such resistance mechanisms it is the metallo-beta-lactamase (MBL which confers resistance to Carbapenem group of antibiotics, one of the final resorts to fight them. The present study was undertaken to detect MBL producing P. aeruginosa using phenotypic method from blood samples of burned patients as well as to know their drug sensitivity pattern. MATERIALS AND METHODS: For this purpose 67 Pseudomonas aeruginosa isolates from blood samples of admitted burned patients were subjected to susceptibility testing to antipseudomonal drugs by disc diffusion test and those found to be Carbapenem resistant were subjected to Imipenem - EDTA combined disk synergy test for MBL detection. RESULT: Out of 67 isolates of P.aeruginosa, 19 (28.4% were found to be Carbapenem resistant and 11 (16.4% were MBL producers. A particularly important feature was that the MBL producers were highly resistant to the antibiotics tested than the non-producers. However all of them were susceptible to Colistin and Polymixin B. CONCLUSION: This study has made us to think that a constant vigil and careful selection of antibiotics are necessary to keep prevalence of MBL producing P.aeruginosa in check. The accurate identification and reporting of MBL producing P. aeruginosa will aid infection control practitioners in preventing the spread of these multidrug-resistant isolates

  20. Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Schou, Morten; Kjaergaard, Jesper; Torp-Pedersen, Christian;

    2013-01-01

    Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed...... to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction....

  1. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    OpenAIRE

    Mehrdad Masoudifar; Omid Aghadavoudi; Lida Nasrollahi

    2012-01-01

    Background: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. Materials and Methods: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Is...

  2. Intensified microbiological investigations in adult patients admitted to hospital with lower respiratory tract infections

    DEFF Research Database (Denmark)

    Korsgaard, Jens; Rasmussen, TR; Sommer, T;

    2002-01-01

    The objective of this study was to investigate the diagnostic yield of a programme with intensified microbiological investigations in immunocompetent adult patients with lower respiratory tract infections (LRTI). Patients in the study group were included prospectively and consecutively from...... lavage (BAL). Only 7% in the historic control group were discharged with an aetiological diagnosis of their infections; while the diagnostic yield in the study group increased to 51% of patients. In the study group the presence of new infiltrates on chest X-ray increased the detection...... of a microbiological aetiology from 37% with no infiltrates to 62% with infiltrates and recent antibiotic therapy reduced the detection of a microbiological cause of infection from 61% in 36 patients who had not received antibiotic therapy to 39% in 31 patients who had received recent antibiotic therapy prior...

  3. [Management of the patient with serious burns at admission].

    Science.gov (United States)

    Meunier, David; Dupré, Aurélie

    2012-01-01

    The first hours of care and treatment are determined by the quality of the preparation on a logistical, organisational and environmental level. The future of a patient with serious burns is at stake in these first few hours. The risk of threat to life is linked to potential vascular compressions, as well as cardio-respiratory failure.The occurrence of these complications can be prevented by the setting up of codified instrumental and clinical monitoring. PMID:22916393

  4. Spectrum of Opportunistic Infections and Risk Factors for In-Hospital Mortality of Admitted AIDS Patients in Shanghai.

    Science.gov (United States)

    Luo, Bin; Sun, Jianjun; Cai, Rentian; Shen, Yinzhong; Liu, Li; Wang, Jiangrong; Zhang, Renfang; Shen, Jiayin; Lu, Hongzhou

    2016-05-01

    To investigate the frequency and the spectrum of major opportunistic infections (OIs), evaluate the major clinical factors associated with each specific OI, and identify the risk factors for in-hospital death among HIV patients in East China.A retrospective cohort study was made including all the HIV-infected patients who were admitted for the first time to the Shanghai Public Health Clinical Center during June 1, 2013 to June 1, 2015. The demographic and clinical data were collected. Comparison of continuous variables was analyzed by one-way ANOVA and rank sum test. Person χ test and Fisher exact test were applied to analyze the categorical variables. A Cox proportional hazards regression model was used to determine the risk for the occurrence of in-hospital death.In total, 920 patients were enrolled with age of 41.59 ± 13.36 years and 91% male. Median CD4 was 34 (IQR, 13-94) cells/μL. Among these patients, 94.7% acquired OIs while the rest developed malignancies. Pneumocystis pneumonia and bacterial coinfection (42.1%) was found to be the most common OIs, followed by tuberculosis (31.4%), CMV (20.9%), Cryptococcosis (9.0%), and MAC infection (5.2%). Of the above 5 major OIs, CMV-infected patients had the lowest median CD4 cell count 22.50 (IQR, 7.50-82.00) while the patients with tuberculosis infection had the highest count 61.00 (IQR, 27.00-176.00). In-hospital death rate was 4.2 per 100 person-years among these patients. Of note, admitted patients with 2 types of OIs (2.20, 95% CI 1.39-3.48) and those patients who were 40-year old or older (1.75, 95% CI 1.10-2.78) had a higher risk of such death.Pneumocystis pneumonia and tuberculosis were still the leading causes for the admission of HIV-infected patients in East China, and these patients tended to have very low CD4 cell counts. It is believed that expanding the HIV screening test and pushing the infected ones get ART earlier is required for generating a more successful HIV management strategy.

  5. Detection and characterization of carbapenemase-producing Enterobacteriaceae in wounded Syrian patients admitted to hospitals in northern Israel.

    Science.gov (United States)

    Lerner, A; Solter, E; Rachi, E; Adler, A; Rechnitzer, H; Miron, D; Krupnick, L; Sela, S; Aga, E; Ziv, Y; Peretz, A; Labay, K; Rahav, G; Geffen, Y; Hussein, K; Eluk, O; Carmeli, Y; Schwaber, M J

    2016-01-01

    Since 2013, four hospitals in northern Israel have been providing care for Syrian nationals, primarily those wounded in the ongoing civil war. We analyzed carbapenemase-producing Enterobacteriaceae (CPE) isolates obtained from these patients. Isolate identification was performed using the VITEK 2 system. Polymerase chain reaction (PCR) was performed for the presence of bla KPC, bla NDM, and bla OXA-48. Susceptibility testing and genotyping were performed on selected isolates. During the study period, 595 Syrian patients were hospitalized, most of them young men. Thirty-two confirmed CPE isolates were grown from cultures taken from 30 patients. All but five isolates were identified as Klebsiella pneumoniae and Escherichia coli. Nineteen isolates produced NDM and 13 produced OXA-48. Among a further 29 isolates tested, multilocus sequence typing (MLST) showed that ST278 and ST38 were the major sequence types among the NDM-producing K. pneumoniae and OXA-48-producing E. coli isolates, respectively. Most were resistant to all three carbapenems in use in Israel and to gentamicin, but susceptible to colistin and fosfomycin. The source for bacterial acquisition could not be determined; however, some patients admitted to different medical centers were found to carry the same sequence type. CPE containing bla NDM and bla OXA-48 were prevalent among Syrian wounded hospitalized patients in northern Israel. The finding of the same sequence type among patients at different medical centers implies a common, prehospital source for these patients. These findings have implications for public health throughout the region. PMID:26581423

  6. Assessment of Mental Disorders in Cerebral Stroke Patients Admitted at Rasool Hospital

    Directory of Open Access Journals (Sweden)

    B Farzinrad

    2009-07-01

    Full Text Available Introduction: Cerebrovascular disorders are the third leading cause of death in individuals over the age of 50; mental disorders of this origin are reported in up to 50 and even 78 percent of patients. The global goal of this study was to assess mental disorders of stroke patients. Methods: In a cross-sectional study, 100 consecutive stroke patients in the neurology clinic of Rasool hospital were evaluated by accidental sampling and use of Neuropsychotic Inventory (NPI. Data was analyzed using Chi square and t-test. Results: 37 men and 63 women with mean age of 62.5 years were assessed over 1 to 12 months after their stroke. The results of Chi square suggested men patients had higher frequency in subscales of delusion, aphaty, disinhibition and sleep disorders and women patients in subscale of anxiety. The results of t-test reported that there was a correlation between right hemisphere lesions and euphory. Conclusion: Depression, anxiety and aggression were the most common mental disorders after stroke, respectively.

  7. The Relationship of Osteoporosis Risk Factors with Bone Mineral Density in Patients Admitted Our Outpatient Clinic in Trabzon

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    Münevver Serdaroğlu Beyazal

    2016-04-01

    Full Text Available Objective: Our aim was to identify the relationship of osteoporosis (OP risk factors with bone mineral density (BMD in patients admitted our outpatient clinic in Trabzon. Materials and Methods: Two hundred one patients with OP or osteopenia were included in this study. Sociodemographic characteristics of the patients were recorded and a standardized interview was employed by the researcher physician. BMD values were measured by dual energy X-ray absorptiometry at lumbar spine and femoral neck. Results: The mean age of the patients was 61.47±10.57 years (182 females/19 males. One hundred fifteen patients (57.2% were osteoporotic and 86 (42.8% were osteopenic. A significant negative correlation was found between age and femoral neck T scores. The number of pregnancies showed a significant negative correlation with lumbar T scores. Body mass index and daily tea consumption showed a negligible positive correlation with femoral neck T scores. No association was found between age at menarche, age at menopause, total lactation duration, daily calcium intake and T scores of lumbar spine and femoral neck. Conclusions: Identification of regional OP risk factors may be useful for the OP risk management of patients in clinical practice.

  8. Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas".

    Science.gov (United States)

    Gouveia, Emy Akiyama; Alves, Mayra Fernanda; Mantovani, Elenice; Oyafuso, Luiza Keiko; Bonoldi, Virgínia Lucia Nazario; Yoshinari, Natalino Hajime

    2010-01-01

    The aim of this study was to evaluate the epidemiological, clinical and laboratorial profile of patients with Baggio-Yoshinari Syndrome (BYS), who underwent internment at the Instituto de Infectologia Emilio Ribas in São Paulo, Brazil, during the period from July 1990 to July 2006. BYS is a new Brazilian tick-borne disease caused by Borrelia burgdorferi sensu lato microorganisms that resembles features of Lyme disease (LD), except for its epidemiological, clinical and laboratorial particularities. From 60 patients' records with positive serology to B. burgdorferi done by ELISA and Western-blotting methods, 19 cases were diagnosed as having BYS, according to criteria adopted at LIM-17 HCFMUSP, the Brazilian Reference Laboratory for the research of BYS. The other 41 remaining patients displayed miscellaneous infections or auto-immune processes. The beginning of symptoms in BYS group varied from one day to six years, from the onset of the disease. Four of 19 patients were included in acute disease stage, and 15 in latent. General unspecific symptoms were identified in almost all cases, with high frequencies of fever (78.9%) and lymphadenomegaly (36.8%). Six patients had skin lesions (31.5%); six arthralgia or arthritis (31.5%) and eight neurological symptoms (42%). Interestingly, two patients showed antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid. Since BYS is a new emergent Brazilian zoonosis and its diagnosis is sometimes complex, all the new knowledge about BYS must be scattered to Brazilian Medical specialists, aiming to teach them how to diagnose this amazing tick-borne disease and to avoid its progression to chronic irreversible sequels.

  9. Health status of diabetes type 2 patients in Thailand contradicts their perception and admitted compliance.

    Science.gov (United States)

    Srivanichakorn, Supattra; Sukpordee, Nattaporn; Yana, Tassanee; Sachchaisuriya, Pattara; Schelp, Frank Peter

    2011-10-01

    A nationwide data set about the health status of diabetes mellitus type 2 (DM) patients and a questionnaire of a sub-sample of the DM patients about their know-how, behavior and perception about health care had been re-assessed. Laboratory results revealed that in average 70% of the patients had been over nourished, over 50% had abnormal cholesterol-, over 55% had high triglyceride levels and 51% had high density lipid (HDL) values below 45 mg/dl. Sixty percent of patients had glycated hemoglobin (HbA1c) levels over 7%. About 60% of study participants answered a questionnaire. In contrast to the laboratory findings about 90% claimed to take the medicine as the doctor advised, 60% said that they adjusted their food intake as advised and more than 80% said that they know well how to take care of themselves. They were only superficially informed about the complications of DM. Almost 95% were satisfied with the health service they receive and over 70% were satisfied with their health status. The results are discussed in connection with the need to control DM on the basis of primary health care (PHC). It is argued that the assessment of health programs solely through questionnaires might be misleading, if the findings are not confirmed by clinical and biochemical parameters.

  10. Povidone-iodine in the treatment of burn patients.

    Science.gov (United States)

    Zellner, P R; Bugyi, S

    1985-03-01

    The improvement in infusion therapy of burn patients in the last decades has led to a marked reduction of the early mortality rate and to an increase in the importance of severe wound infection and septicaemia. For the control of infection, detailed bacteriological monitoring is recommended. The main therapeutic fields for prevention of infection are: immunotherapy, antisepsis, aseptic techniques, and rapid restoration of the destroyed body surface. The most important part of antisepsis in burns is topical treatment. The good bacteriological and clinical results with povidone-iodine (PVP-I), in combination with open treatment are described. A possible disadvantage of this therapy was the extensive iodine resorption. However, no disorders of thyroid function were revealed, and the TRH test indicated no abnormal reactions of the hypothalamus-pituitary axis. The high serum and urine iodine levels returned rapidly to normal after discontinuing the PVP-I application.

  11. An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

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    Margari Francesco

    2007-01-01

    Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20

  12. BIPAP protocol usage in patients admitted to the Internal Medicine unit

    OpenAIRE

    Óscar Bautista Villaécija; Fernando Campaña Castillo

    2013-01-01

    The use of noninvasive mechanical ventilation equipment becomes more common in internal medicine units. Due to its indications, such as severe respiratory failure, or hypoxemic respiratory failure, it means a great help in these units. Within the multidisciplinary team, the medical staff is responsible for the prescription and programming of the device parameters, and the nursing staff handles such equipment and provides care to the patients requiring noninvasive mechanical ventilation.The ob...

  13. Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

    Science.gov (United States)

    Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman

    2016-01-01

    Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

  14. Metabolic alkalosis in children: Study of patients admitted to pediatrics center

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    Sobhani A

    2001-07-01

    Full Text Available Metabolic alkalosis is characterized by high HCO3- as it is seen in chronic respiratory acidosis, but PH differentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely. We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized Pediatric Medical Center in Tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent. 64 precent male and 36 percent female. Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height. More than 60 percent had hypokalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis should be considered in every pediatric patient presented with projectile vomitting.

  15. Acute Bronchiolitis. Which Patients Should Be Admitted to Intensive Care Units?

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    Ariel Efrén Uriarte Méndez

    2014-12-01

    Full Text Available Bronchiolitis is the most common viral infection of the lower respiratory tract in childhood; it is considered the most severe respiratory condition that affects children under 2 years of age. In general, mortality from bronchiolitis is low, but it can reach up to 30% in patients at risk. Twenty children have died from this condition in the pediatric hospital of Cienfuegos in the last 30 years. Bronchiolitis-related deaths account for approximately 4 % of all deaths from 2010 to date. This fact has led to the implementation of administrative measures to reduce deaths from this cause, which have not solved the problem. The aim of this paper is to present a set of criteria for admission of bronchiolitis patients to intensive care units in order to be considered by the administrators of the institution. These criteria based on the authors’ experience and scientific evidence reflected in the literature focus on preventing overcrowding of this service with patients not showing signs of serious condition, and on the contrary, timely identifying those likely to have an unfavourable outcome.

  16. Etiology and Viral Genotype in Patients with End-Stage Liver Diseases admitted to a Hepatology Unit in Colombia

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    Fabian Cortes-Mancera

    2011-01-01

    Full Text Available Hepatitis B virus (HBV and hepatitis C virus (HCV infections are the principal risk factor associated to end-stage liver diseases in the world. A study was carried out on end-stage liver disease cases admitted to an important hepatology unit in Medellin, the second largest city in Colombia. From 131 patients recruited in this prospective study, 71% of cases were diagnosed as cirrhosis, 12.2% as HCC, and 16.8% as cirrhosis and HCC. Regarding the risk factors of these patients, alcohol consumption was the most frequent (37.4%, followed by viral etiology (17.6%. Blood and/or hepatic tissue samples from patients with serological markers for HCV or HBV infection were characterized; on the basis of the phylogenetic analysis of HCV 5′ UTR and HBV S gene, isolates belonged to HCV/1 and HBV/F3, respectively. These results confirm the presence of strains associated with poor clinical outcome, in patients with liver disease in Colombia; additionally, HBV basal core promoter double mutant was identified in HCC cases. Here we show the first study of cirrhosis and/or HCC in Colombian and HBV and HCV molecular characterization of these patients. Viral aetiology was not the main risk factor in this cohort but alcohol consumption.

  17. How Disabling Are Pediatric Burns? Functional Independence in Dutch Pediatric Patients with Burns

    Science.gov (United States)

    Disseldorp, Laurien M.; Niemeijer, Anuschka S.; Van Baar, Margriet E.; Reinders-Messelink, Heleen A.; Mouton, Leonora J.; Nieuwenhuis, Marianne K.

    2013-01-01

    Although the attention for functional outcomes after burn injury has grown over the past decades, little is known about functional independence in performing activities of daily living in children after burn injury. Therefore, in this prospective cohort study functional independence was measured by burn care professionals with the WeeFIM[R]…

  18. Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    CHEN Ya-hong; YAO Wan-zhen; CAI Bai-qiang; WANG Hong; DENG Xiao-mei; GAO Hui-li; HUANG Jia-sheng; WANG Xin-mao

    2008-01-01

    Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease(AECoPD)in Beijing is not fully understood.The study investigated the hospitalization cost in patients with AECOPD and the associated factors.Methods A multi-center,retrospective study was conducted jn the four hospitals in Beijing including two level Ⅲ hospitals and two level Ⅱ hospitals.Patients with AECOPD admixed to the hospitals between January and December in 2006 were enrolled.The hosDitalization cost and its relationship with disease severity and treatment were analyzed.Results Totally 439 patients were enrolled with 294 men(67.0%)and a mean age 73.4 years.The mean hospital stay was 20.7 days.A total of 204 patients(46.5%)had respiratory failure,153(34.9%)with cor pulmonale,123(28.0%)with coronary artery disease,231(52.6%) with hypertension,70(15.9%)with cerebrovascuIar disease and 32(7.3%)with renal failure.The percentage of drug cost to total cost was the highest(71.2%),followed by laboratory cost(16.7%),therapy cost(9.7%),oxygen cost(7.3%),radiology cost(4.5%),examination cost(4.5%),bed cost(4.1%).Correlation analysis showed that cost was positively correlated with age,hospitalization days,co-morbidities such as respiratory failure and cor pulmonale,hypertension.Three hundred and twenty-one patients were further analyzed.The hospitalization cost increased in patients with non-invasive ventilation(P<0.01),invasive mechanical ventilation(P<0.01),ICU stay(P<0.01),antibiotics(P<0.05),systemic steroids(P<0.01),and poor prognosis(P<0.05).Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second (FEV1%)(r=0.149,P<0.05),Ph(r=-0.258,P<0.01),and PaO2(r=-0.131,P<0.05),positively correlated with PaCO2 (r=0.319,P<0.01),non-invasive positive pressure ventilation(r=0.375,P<0.01)and duration(r=0.463,P<0.01),invasive mechanical ventilation(r=0.416,P<0.01)and duration

  19. Incidence and prevalence of hospital-acquired infections in a cohort of patients admitted to medical departments

    DEFF Research Database (Denmark)

    Petersen, Martin Haubro; Holm, Morten Olskjær; Pedersen, Svend Stenvang;

    2010-01-01

    INTRODUCTION: Hospital-acquired infections (HAI) are a significant cause of morbidity and mortality. Only point prevalence analyses of HAI have been recorded in Denmark. The aim of this study was to investigate the incidence and prevalence of HAI in patients admitted to departments of internal.......7-10.6). Exposure to bladder catheter was associated with an increased risk of urinary tract infection, incidence rate ratio 4.9; (95% CI 1.8-11.5). For the initial 14 days of hospitalization, the incidence of HAI was independent, while the prevalence increased linearly with duration of admittance. CONCLUSION......: The incidence of HAI was relatively constant during the initial 14-day-period of hospitalization, suggesting that shortening the period will have no major impact on the incidence of HAI. The prevalence was 9.7%, which is in line with results from prior studies....

  20. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette;

    2015-01-01

    of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS: The qualitative methodological approach was interpretive description. Data were...... participants, whereas the less frail experienced this less. CONCLUSION AND DISCUSSION: Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical...... disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged...

  1. Use of non-invasive ventilation is increasing in patients admitted with a chronic obstructive pulmonary disease exacerbation

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Johnsen, Søren Paaske; Thomsen, Reimar Wernich;

    2013-01-01

    INTRODUCTION: A nationwide chronic obstructive pulmonary disease (COPD) quality improvement programme - DrCOPD - was initiated in Denmark in 2008. We examined subsequent national and regional trends in the use of non-invasive ventilation (NIV) and trends in mortality following NIV and invasive...... mechanical ventilation among patients acutely admitted with a COPD exacerbation. MATERIALS AND METHODS: We did a nationwide, population-based prospective study using DrCOPD to identify all incident hospitalizations with COPD from 2008 through 2011 (n = 24,982) and to record the use of NIV during.......8% to 7.0% (adjusted for age, sex and co-morbidity, relative risk (RR): 1.21, 95% confidence interval (CI): 1.05-1.38). Concurrently, a statistically significant increase from 1.3% to 1.8% (RR: 1.36; 95% CI: 1.03-1.80) in NIV given together with invasive mechanical ventilation was observed. During...

  2. BIPAP protocol usage in patients admitted to the Internal Medicine unit

    Directory of Open Access Journals (Sweden)

    Óscar Bautista Villaécija

    2013-06-01

    Full Text Available The use of noninvasive mechanical ventilation equipment becomes more common in internal medicine units. Due to its indications, such as severe respiratory failure, or hypoxemic respiratory failure, it means a great help in these units. Within the multidisciplinary team, the medical staff is responsible for the prescription and programming of the device parameters, and the nursing staff handles such equipment and provides care to the patients requiring noninvasive mechanical ventilation.The objective of this protocol is to show in a clear and simple way, the noninvasive mechanical ventilation system, as well as its advantages and complications, and the nursing diagnoses that should be considered.

  3. Epidemiology of major burns at the Lebanese Burn Center in Geitawi, Lebanon

    OpenAIRE

    Ghanimé, G.; Rizkallah, N.; Said, J.M.

    2013-01-01

    Burn care is one of the few areas in medicine considered both medically and surgically challenging, with burn injuries affecting people of all ages and both sexes. Between May 1992 and March 2012, 1,524 patients were admitted to the Lebanese Burn Center in Geitawi, with an average length of stay (LOS) of 36.5 days. The most frequently encountered injuries were thermal burns, generally resulting from domestic accidents. Of our patients, 47% were from rural areas and burned body surface (BBS) w...

  4. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian B; Sloth, Erik; Lambrechtsen, Jess;

    2013-01-01

    Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute ...

  5. A STUDY ON HYPERTENSION AMONG CHRONIC KIDNEY DISEASE PATIENTS ADMITTED IN THE NEPHROLOGY DEPARTMENT OF GGH, KURNOOL

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    Padma Sri

    2015-04-01

    Full Text Available BACKGROUND: Hypertension is both a risk factor and complication of chronic renal disease. Managing hypertension plays a significant role in preventing complications and slowing down the progression as well. OBJECTIVES: 1. To study the association between hypertension and CKD. 2. To study the other known risk factors associated with hypertension. METHODOLOGY: Study design - Cross sectional descriptive study period - June to November 2012, Study area - The Department of Nephrology, Government General Hospital, Kurnool. STUDY SUBJECTS: All the chronic kidney disease patients admitted in the Nephrology ward from June to November 2012 are included in the study and are interviewed with a Pre - designed semi structured questionnaire. STATISTICAL ANALYSIS: proportions, percentages, chi - square . RESULTS: A total of 153 subjects were included in the study. T heir mean age was 4 7 . 96±11 . 14 years. Hyper tension was present in 126 (82. 35% of the patients with CKD. CONCLUSIONS: Smoking and Alcohol consumption had a significant association with hypertension among CKD patients. Presence of hypertension had an increased risk for heart d isease among CKD patients. Inadequately controlled hypertension had significant association with occurrence of heart disease.

  6. Epidemiological investigation on Wenchuan earthquake-struck trauma patients admitted to two hospitals of Chongqing

    Institute of Scientific and Technical Information of China (English)

    JIAN Hua-sheng; L(U) Zu-ming; LI Yin-yan

    2010-01-01

    Objective: To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster.Methods: The clinical data of 196 cases were collected from 2 hospitals of Chongqing city, including age, sex, occupation, injury site, dwelling and injury severity score.Results: In this series, 31.63% victims' age was over 60 years, and 54.08% were farmers.Multiple trauma ac-counted for 35.71%, and lower limb injury for 33.67%.There was no significant difference on injury severity score be-tween city dwellers and rural ones (P>0.05).Conclusion: The earthquake injury is influenced by many factors.More attention should be paid to the treat-ment at first 5 days after injury and high risk population.

  7. Evaluation on antibiotic resistance of helicobacter pylori isolated from patients admitted to tooba medical center, Sari

    Directory of Open Access Journals (Sweden)

    Amin Talebi BezminAbadi

    2009-01-01

    Full Text Available (Received 17 March, 2009; Accepted 8 July, 2009AbstractBackground and purpose: Helicobacter pylori, which infect approximately one half of the world’s population, are an important risk factor in chronic gastritis, peptic ulcer disease, and gastric cancer. H. pylori eradication is now widely recommended as the most effective treatment of peptic ulcer disease. One of the most important reasons for treatment failure is H. pylori resistance to the antimicrobials usage in therapy. The aim of this study was to determine susceptibility patterns of H. pylori isolates in 6 routine anti-microbial agents in Northern Iran.Materials and methods: 125 patients from Tooba Medical Center in Sari with endoscopic evidence of dyspepsia complaints were used for obtaining gastric biopsies specimens. Biopsies were sent to the laboratory in thioglycolate broth (transport medium. Bacteria were primarily cultured on Columbia agar supplemented with 7% horse blood, 7% fetal calf serum. Urease, Catalase and Oxidase activities were used for H. pylori identification. Bacterial suspensions equivalent to 3 Mc. Farlands were spread on plates, along with antibiotic disks and placed in the diameter zone. Inhibition was measured after 3 days of incubation in micro-aerophilic condition.Results: H. pylori were isolated from 116(92.8% subjects, a total of 125 biopsy specimens. Resistance to metronidazole, amoxicillin, clarithromycin, tetracycline, furazolidone and ciprofloxacin were 71%, 35%, 25%, 9%, 24% and 25%, respectively. Multiple resistance (amoxicillin-clarithromycin-metronidazole were found in (65% of the isolates.Conclusion: Comparison of our data with previous results showed that prevalence of H. pylori resistance to clarithromycin, furazolidone and metronidazole has increased in Iran considerably. Resistance to amoxicillin in our study was too high in comparison with foreign studies. The present study demonstrates the need for continuous monitoring of the antimicrobial

  8. Burn Patients Infected With Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa: Multidrug-Resistant Strains

    OpenAIRE

    Anvarinejad, Mojtaba; Japoni, Aziz; Rafaatpour, Noroddin; Mardaneh, Jalal; Abbasi, Pejman; Amin Shahidi, Maneli; Dehyadegari, Mohammad Ali; Alipour, Ebrahim

    2014-01-01

    Background: Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa in the burn patients is a leading cause of morbidity and mortality and remains a serious health concern among the clinicians. Objectives: The aim of this study was to detect MBL-producing P. aeruginosa in burn patients and determine multidrug-resistant (MDR) strains, and respective resistance patterns. Patients and Methods: In this cross-sectional study, 270 strains of P. aeruginosa were isolated from the burn patients ...

  9. Clinical Study of Obesity and associated morbidities in patients admitted to College of Medical Sciences Teaching-Hospital, Bharatpur

    Directory of Open Access Journals (Sweden)

    Manohar Pradhan

    2015-12-01

    Full Text Available Background and Objectives: The present study was conducted with objective to study the incidence of obesity and associated co-morbidities in patients admitted to CMS-TH, Bharatpur.Materials and Methods: One hundred and fifty consecutive overweight patients from the January 2009 to December 2012 with Basal metabolic index (BMI>25 and obese patients (BMI>30 were included in this hospital based prospective study. Detailed evaluation of risk factors and family history of other diseases were taken, other obesity related indicators like WPRO, 2000 for BMI, waist circumference (NCEP ATP III and NCEP for South Asian ethnicity NCEP– National Cholesterol Education Program and waist hip ratio (WHO criteria were measured and comparison done in order to detect best method for application. These cases were evaluated for associated co-morbid condition and metabolic syndrome which were diagnosed using NCEP ATP III criteria.Results: The mean age of patients was 52.7 years. Commonest co-existing risk factors were alcohol consumption, smoking, hypertension and type 2 diabetes mellitus. Evaluation based on WHO criteria revealed that 56.7% patients were overweight, 38.7 % were obese class II and 4.6 % were class II. While 45.1% male and 69.1% female patients had central obesity. The figure was 81.7 % for males and 94.1% for females with WHO criteria using waist hip ratio. Risk factors like alcohol consumption (52.7%, smoking (52.7% and fatty liver disease (22.66% were the commonest co-morbid conditions.Conclusion: In the present study, risk factors of alcohol, smoking and hypertension and co-morbid conditions diabetes mellitus, dyslipidemia, ischemic heart disease, stroke and fatty liver were noted. Waist hip ratio was the best indicator to detect central obesity and co-morbid conditions and recommended to be used for Nepali population.JCMS Nepal. 2015;11(3:16-19

  10. Risk Factors for Hospital and Long-Term Mortality of Critically Ill Elderly Patients Admitted to an Intensive Care Unit

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    A. Mukhopadhyay

    2014-01-01

    Full Text Available Background. Data on long-term outcomes of elderly (≥65 years patients in ICU are sparse. Materials and Methods. Adult patients (n=1563, 45.4% elderly admitted over 28 months were analyzed by competing risks regression model to determine independent factors related to in-hospital and long-term mortality. Results. 414 (26.5% and 337 (21.6% patients died in-hospital and during the 52 months following discharge, respectively; the elderly group had higher mortality during both periods. After discharge, elderly patients had 2.3 times higher mortality compared to the general population of the same age-group. In-hospital mortality was independently associated with mechanical ventilation (subdistribution hazard ratio (SHR 2.74, vasopressors (SHR 2.56, neurological disease (SHR 1.77, and Mortality Prediction Model II score (SHR 1.01 regardless of age and with malignancy (SHR, hematological 3.65, nonhematological 3.4 and prior renal replacement therapy (RRT, SHR 2.21 only in the elderly. Long-term mortality was associated with low hemoglobin concentration (SHR 0.94, airway disease (SHR 2.23, and malignancy (SHR hematological 1.11, nonhematological 2.31 regardless of age and with comorbidities especially among the nonelderly. Conclusions. Following discharge, elderly ICU patients have higher mortality compared to the nonelderly and general population. In the elderly group, prior RRT and malignancy contribute additionally to in-hospital mortality risk. In the long-term, comorbidities (age-related, anemia, airway disease, and malignancy were significantly associated with mortality.

  11. Acute Respiratory Distress Syndrome in Burn Patients: A Comparison of the Berlin and American-European Definitions.

    Science.gov (United States)

    Sine, Christy R; Belenkiy, Slava M; Buel, Allison R; Waters, J Alan; Lundy, Jonathan B; Henderson, Jonathan L; Stewart, Ian J; Aden, James K; Liu, Nehemiah T; Batchinsky, Andriy; Cannon, Jeremy W; Cancio, Leopoldo C; Chung, Kevin K

    2016-01-01

    The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. The median age, % TBSA burn, and injury severity score (interquartile ranges) were 35 (24-51), 25 (11-45), and 18 (9-26), respectively. Inhalation injury was present in 35.5%. The prevalence of ARDS was 34% using the Berlin definition and 30.5% using the AECC definition (combined acute lung injury and ARDS), with associated mortality rates of 40.9 and 42.9%, respectively. Under the Berlin definition, mortality rose with increased ARDS severity (14.6% no ARDS; 16.7% mild; 44% moderate; and 59.7% severe, P Berlin definition was not different from patients without ARDS (P = .91). The Berlin definition better stratifies ARDS in terms of severity and correctly excludes those with minimal disease previously captured by the AECC.

  12. Comparison of the number of patients admitted with renal colic during various stages of peri-ramadan month

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    Norouzy Abdolreza

    2011-01-01

    Full Text Available Ramadan fasting for Muslims means abstinence from eating, drinking, and smoking from sunrise to sunset. There are concerns whether the occurrence of renal colic increases during the month of Ramadan. In view of the importance of fasting among Muslims, the occurrence of renal colic during Ramadan fasting has been compared during the following periods: two weeks before commencement of Ramadan (stage-1, during the first two weeks (stage-2, the last two weeks (stage-3, and, two weeks after Ramadan (stage-4. This was a prospective observational study, which was carried out in patients with symptoms of renal colic who were referred to the emergency wards in two major hospitals in Iran. During the study period, 610 subjects were admitted with renal colic during the four periods of study; there were 441 males (72.3% and 169 females (27.7%. The number of patients with renal colic was highest during the first two weeks of Ramadan in comparison with the other periods (stage-1: 157, stage-2: 195, stage-3: 139, stage-4: 119, P < 0.05]. Results from this study show that the number of admissions due to renal colic was high during the first two weeks of Ramadan. However, the number of admissions decreased during the last two weeks of Ramadan and this trend continued after Ramadan.

  13. Airway management in patients with burn contractures of the neck.

    Science.gov (United States)

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented.

  14. ED handles 30 burn patients after plant fire and explosion in Georgia.

    Science.gov (United States)

    2008-04-01

    Dealing with a mass casualty event involving a high number of burn victims requires strategic use of ED resources. The ED at Memorial University Medical Center in Savannah, GA, was praised by the receiving burn center for the care it gave victims of a recent plant disaster. Here are some of their key strategies: After making your primary concern the patient's airway, turn to fluid resuscitation and pain management. Be certain burn victims are placed in warm rooms and are covered with blankets. Have a pre-plan with a regional burn center, then establish contact with that center in multiple-burn patient incidents.

  15. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    OpenAIRE

    Kraft, Robert; Herndon, David N; Williams, Felicia N.; Al-Mousawi, Ahmed M.; Finnerty, Celeste C.; Jeschke, Marc G.

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on bod...

  16. Effects of early physiotherapy with respect to severity of pneumonia of elderly patients admitted to an intensive care unit: a single center study in Japan

    OpenAIRE

    Chigira, Yusuke; Takai, Tomoko; Igusa, Hironobu; Dobashi, Kunio

    2015-01-01

    [Purpose] We performed early physiotherapy for elderly patients with pneumonia admitted to an intensive care unit (ICU), and examined the effects of this early physiotherapy on the severity of pneumonia. [Subjects and Methods] Patients for whom physiotherapy was started the day after admission to the ICU (acute phase) were assigned to the early intervention group and compared with patients in the standard intervention group. All patients were divided into three groups (Groups I, II, and III) ...

  17. Sepsis in burned patients Sepse em pacientes queimados

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    Jefferson Lessa S. de Macedo

    2003-12-01

    Full Text Available A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4% developed clinically and microbiologically proven sepsis. Twenty-six (53.1% were males and 23 (46.9% females with a mean age of 22 years (range one to 89 years and mean burned body surface area of 37.7 ± 18.4% (range 7 to 84%. Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6% patients had only one and nine (18.4% had up to three episodes of sepsis. Thirty (61.2% patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococcus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9% episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 ( 24.2% episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5% patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.Um estudo prospectivo foi realizado de junho de 2001 a maio de 2002, na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília, Brasil. Durante o período do estudo, 252 pacientes foram tratados na Unidade de Queimados, 49 (19

  18. S-C复合制剂在临床的应用和研究%Application and Study of the S-C Compound Agent in Burned Patients

    Institute of Scientific and Technical Information of China (English)

    严根荣; 陈国华

    2003-01-01

    173 patients with burn injury were admitted to Shanghai Power Hosptial from 2001 to 2002.These patients include 116 malesand 57 females with a mean age of 33 years. Ther bum injury involved 15% ± 2.3% per cent of TBSA(Total Body Surface Area). With fullthickness burn of 5.5 % ± 1.2% per cent of TBSA.These patients with burn injury were charged medicine by the S. C compound agent,57 casesof burned patients were changed medicine by silver sulfadiazin as a control. S. C compound agent is consisted of cerium nitrate,silver salt andsome additive agent etc. It is possessed of good anti - infection curative effects. Therefore many bacteriums that include Staphylococcus aureus,pseudomonas, aeruginosa, E. coli, E. cloacae, proteus, and some C. albicans etc have been killed by S. C compound agent in vitro, anantimicrobial susceptibility testing in vitro that includes a disk agar diffusion test and a dilution test namely minimal inhibitory concentration, MIChas approved it. Therefore, the wound healing time of partial thickness bum in an experimmt group was significant in statistics ( P < 0.05) ascompared with a control; group. No side - effects, no allergic reactions occurred in all course of applyning S. C compound agent for burned patients.

  19. Pandemic Influenza A H1N1 in Oman: Epidemiology, Clinical Features, and Outcome of Patients Admitted to Sultan Qaboos University Hospital in 2009

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    Mujahid Al-Busaidi

    2016-07-01

    Full Text Available Objectives: Oman experienced the H1N1 pandemic in 2009 that initially started in Mexico and the United States. We present the epidemiology, clinical features, and outcome of cases admitted to Sultan Qaboos University Hospital. Methods: We retrospectively reviewed all patients admitted with confirmed influenza A H1N1 infection from August to December 2009. The study included adults and pediatric patients. We looked at the clinical and laboratory factors associated with increased length of hospital stay. Results: There were 68 patients admitted with influenza A H1N1 infection, and their median age was 23 years. The most common symptoms were fever (100% and cough (79.4%. The most common reason for admission was the severity of illness (69.1%. Lymphopenia was the most common hematological abnormality (41.8%. All patients received treatment with oseltamivir. One patient died secondary to multi-organ failure. On multivariate analysis, severity of illness, use of steroids, anemia, lymphopenia, and abnormal alanine amino transferase levels were associated with increased length of stay. Conclusions: The H1N1 pandemic in Oman followed the international trends in terms of clinical presentation and laboratory values for patients admitted to the hospital.

  20. Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury

    DEFF Research Database (Denmark)

    Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid;

    2013-01-01

    Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute re......Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub......-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive...... was documented among patients with severe traumatic brain injury during the first year post-trauma. The results of the current study suggest that absence of consciousness at discharge from acute care should not preclude patients from being referred to specialized sub-acute rehabilitation....

  1. Pandemic Influenza A H1N1 in Oman: Epidemiology, Clinical Features, and Outcome of Patients Admitted to Sultan Qaboos University Hospital in 2009

    Science.gov (United States)

    Al-Busaidi, Mujahid; Al Maamari, Khuloud; Al’Adawi, Badriya; Alawi, Fatma Ba; Al-Wahaibi, Adil; Belkhair, Abdullah

    2016-01-01

    Objectives Oman experienced the H1N1 pandemic in 2009 that initially started in Mexico and the United States. We present the epidemiology, clinical features, and outcome of cases admitted to Sultan Qaboos University Hospital. Methods We retrospectively reviewed all patients admitted with confirmed influenza A H1N1 infection from August to December 2009. The study included adults and pediatric patients. We looked at the clinical and laboratory factors associated with increased length of hospital stay. Results There were 68 patients admitted with influenza A H1N1 infection, and their median age was 23 years. The most common symptoms were fever (100%) and cough (79.4%). The most common reason for admission was the severity of illness (69.1%). Lymphopenia was the most common hematological abnormality (41.8%). All patients received treatment with oseltamivir. One patient died secondary to multi-organ failure. On multivariate analysis, severity of illness, use of steroids, anemia, lymphopenia, and abnormal alanine amino transferase levels were associated with increased length of stay. Conclusions The H1N1 pandemic in Oman followed the international trends in terms of clinical presentation and laboratory values for patients admitted to the hospital. PMID:27403242

  2. EFFECTIVENESS OF BETA-GLUCAN COLLAGEN FOR TREATMENT OF PARTIAL THICKNESS BURNS IN PEDIATRIC AGE GROUP PATIENTS: A RANDOMIZED CONTROLLED TRIAL AT TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Sanjay

    2014-12-01

    Full Text Available SUMMARY: BACKGROUND: Burn injuries present a major public health problem for children. In India this constitutes about one-fourth of total burn injuries. This article deals with situations that need to be addressed in the care of partial thickness wounds in children to provide optimal conditions for wound protection and repair while minimizing the morbidity and complications. AIM: To compare outcomes for pediatric age group patients who were applied beta-glucan collagen or anti-microbial dressing as primary wound covering in respect to pain, infection rate and healing time. DESIGN OF STUDY: Randomized controlled trial. SETTINGS AND DESIGN: Tertiary care hospital of central India from 2008-2010. METHODS: Patients admitted at tertiary care centre with partial thickness burns at first presentation were recruited to randomized controlled trial. Patients in trial were randomly allocated for beta-glucan collagen or anti-microbial dressings. RESULTS: Seventy-two patients were recruited over 28 months. Two were excluded from final analysis due to premature demise. Out of seventy subjects thirty-five were in BGC group while remaining thirty-five were in SSD group. Subjects were in 1-11 age range with majority being in 1-5 age groups. Out of total seventy patients thirty-three were male and thirty-three were females. Flame burns and scald burns were equally distributed in both groups and difference was not significant. Most of the patients presented within 6 hrs of initial injury (54.7%. TBSA% in BGC group was 16.4 while it was 18.2 in control group. Most of the patients in both the groups had burn injury over upper limb followed by anterior trunk. Partial thickness burns in children can be cost effectively treated with BGC with decreased pain, mean healing time and hospital stay with good cosmetic results.

  3. Bacteriological evaluation of wounds in seriously burned hospitalized patients

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    Sueli de Lourdes Nogueira Vilela Silva

    1991-09-01

    Full Text Available During the period between May and December 1988, 21 patients were studied bacteriologically at Hospital João XXIII's burn's unit which belongs to "Fundação Hospitalar do Estado de Minas Gerais" in Belo Horizonte, Brazil. A qualitative and quantitative evaluation of aerobic and facultative bacteria from burn wounds was carried out by the standard filter paper disc technique, including antibiotic susceptibility. At the same time an evaluation of those bacteria isolated from the environmental unit was performed. The most common organisms recovered from wounds of patients were: Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. P. pseudomallei was the most frequent strain recovered from environmental specimens. In nearly all patients specimens (16 in total from whom P. aeruginosa was isolated, the rate of CFU/cm² of skin was above 10². In nine of these, it reached 10(5, wich is equivalent to 10(7 CFU/g of burned tissue.No período de maio a dezembro de 1988, foram avaliados bacteriologicamente 21 pacientes da Unidade de Queimados do Hospital João XXIII pertencente à Fundação Hospitalar do Estado de Minas Gerais, em Belo Horizonte, Brasil. A avaliação qualitativa e quantitativa de bactérias aeróbicas e facultativas de queimaduras foi realizada através da técnica do disco de papel de filtro padronizado, incluindo a susceptibilidade a antimicrobianos. Ao mesmo tempo, foi realizada uma avaliação das bactérias isoladas do ambiente da Unidade. Os microrganismos mais frequentemente recuperados das feridas dos pacientes foram: Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis. A espécie P. pseudomallei foi a mais frequente nos espécimes ambientais. Em quase todos os espécimes de pacientes dos quais P. aeruginosa (16 pacientes foi isolada, a taxa CFU/cm² de pele estava acima de 10². Em nove destes, alcançou 10(5, o que equivale a 10(7 CFU/g de tecido queimado.

  4. Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

    Institute of Scientific and Technical Information of China (English)

    Sima Sheikhghomi; Vafa Rahimi-Movaghar; Saba Jafarpour; Soheil Saadat

    2015-01-01

    Purpose:Trauma is an inevitable part of the health burden in every country.Both the preventive and rehabilitative aspects of traumatic injuries are expensive.Since most of the injuries happen in low-and middle-income developing countries,a judicious allocation of the limited resources to the most costefficient strategies is necessary.The present study was designed to report the causes of trauma,injured body regions,trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran,Iran.Methods:We chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital,a major University Teaching Hospital in Tehran,Iran.Patients who stayed at the hospital for less than 24 h were excluded.In total,73 traumatic patients were registered.The mean age was (40.19 ± 20.34) years and 67.1% of them were male.Results:In general,the most common cause of injury was falls (47.9g),followed by road traffic crashes (RTCs,40.8%).Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries.The only cause of injury in ages of more than 65 years was fall.The most common cause of injury in ages between 15 and 45 years was RTCs.During the study,two deaths occurred:one was at ICU and the other was at home.The most commonly injured body region was the head (23.8%),followed by the elbow and forearm (19%),hip and thigh (15.9%),and multiple body regions (14.3%).The mean abbreviated injury score was 2.23 ± 1.02;injury severity index was 7.26 ± 7.06;and revised trauma score was 7.84,calculated for 38 patients.Conclusion:Prevention strategy of traumatic injury should focus on falls and RTCs,which are respectively the most common cause of trauma in older aged people and young males.

  5. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    Science.gov (United States)

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury. PMID:23533394

  6. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients

    Directory of Open Access Journals (Sweden)

    Mussi Chiara

    2013-01-01

    Full Text Available To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82±7 years, range 65–101. Falls were defined “accidental” (fall explained by a definite accidental cause, “medical” (fall caused directly by a specific medical disease, “dementia-related” (fall in patients affected by moderate-severe dementia, and “unexplained” (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause. According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  7. Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients).

    Science.gov (United States)

    Chiara, Mussi; Gianluigi, Galizia; Pasquale, Abete; Alessandro, Morrione; Alice, Maraviglia; Gabriele, Noro; Paolo, Cavagnaro; Loredana, Ghirelli; Giovanni, Tava; Franco, Rengo; Giulio, Masotti; Gianfranco, Salvioli; Niccolò, Marchionni; Andrea, Ungar

    2013-01-01

    To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 ± 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury.

  8. Trends in incidence rate, health care consumption, and costs for patients admitted with a humeral fracture in The Netherlands between 1986 and 2012

    NARCIS (Netherlands)

    K.C. Mahabier (Kiran); D. den Hartog (Dennis); M.J.M. Panneman (Martien); J.R. van Veldhuizen (Joyce); S. Polinder (Suzanne); M.H.J. Verhofstad (Michiel); E.M.M. van Lieshout (Esther)

    2015-01-01

    textabstractIntroduction: This study aimed to examine long-term population-based trends in the incidence rate of patients with a humeral fracture admitted to a hospital in the Netherlands from 1986 to 2012 and to give a detailed overview of the health care consumption and productivity loss with asso

  9. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study.

    NARCIS (Netherlands)

    Peelen, L.; Keizer, N.F. de; Peek, N.; Scheffer, G.J.; Voort, P.H. van der; Jonge, E. de

    2007-01-01

    INTRODUCTION: The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis. METHODS: A retrospective cohort study was conducted using the database of the

  10. DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

    Directory of Open Access Journals (Sweden)

    Tapan

    2016-03-01

    Full Text Available INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD. Acute myocardial infarction (AMI is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991 as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72

  11. Neuronal Plasticity Associated with Burn Injury and Its Relevance for Perception and Management of Pain in Burn Patients

    Directory of Open Access Journals (Sweden)

    Terence J Coderre

    2000-01-01

    Full Text Available Through the introduction of the gate control theory and various subsequent works, Ronald Melzack has inspired many investigators worldwide to realize two important facts about pain. First, incoming pain messages are subject to both negative and positive modulation, which significantly affect its perception. Second, the progression of knowledge about the basic mechanisms underlying persistent and chronic pain is critically dependent on the increased understanding of the complexity of the symptoms experienced by pain patients. The present paper examines these two very important issues in an effort to understand better the mechanisms that underlie the pain suffered by burn patients. The physiological responses to burn injury involve many different mediators and mechanisms, all of which contribute to pain perception and development of neuronal plasticity underlying short and long term changes in pain sensitivity. While experimental burn injuries in humans and animals are typically well controlled and mild, in burn victims, the severity is much more variable, and clinical care involves repeated traumas and manipulations of the injured sites. Recurrent inputs from damaged and redamaged tissue impinge on a nervous system that becomes an active participant in the initiation of changes in sensory perception and maintenance of long term sensory disturbances. Recently acquired experimental evidence on postburn hyperalgesia, central hyperexcitability and changes in opioid sensitivity provides strong support that burn patients need an analgesic approach aimed at preventing or reducing the 'neural' memory of pain, including the use of more than one treatment modality. Burn injuries offer a unique opportunity to combine experimental and clinical research to understand pain mechanisms better. Over the years, Ronald Melzack has insisted that one of the most laudable enterprises in research is to span the gap between these two often separate worlds.

  12. Antibiotic resistance of Helycobacter pylori isolated from patients admitted to Imam Hospital, Sari, IRAN, 2002-2003

    Directory of Open Access Journals (Sweden)

    F. Naghshvar

    2005-01-01

    Full Text Available Background and purpose : -Helicobacter pylori is a gram negative spiral bacilus which infects gastric mucosa and causes a wide range of gastro intestinal diseases.Unfortunately the prevalence of the infection by this organism in developing countries is high and despite numerous existing drug regimens, treatment fails to eradicate the organism in many occasions. To reach an effective and curative regimen, invitro determination of suscepibility and resistance of the organism, to various antimicrobials, is pradent. The goal of this study was to determine the prevalence of antimicrobial resistance in Helicobacter pylori,s isolated from cultures. Biopsies from 67 patients admitted to the Sari Imam Hospital were used to cultur Helicobacter pylori and determine their susceptibility and resistance to metronidazole, claritromycin and amoxycillin.Materials and methods : Disc diffusion tecniqu was used to determine the minimum inhibitory concentration , (MIC and resistance pattern of the isolated Helicobacter pylori.In this method we used the cutoff point of MIC 90 ie , a concentration at which 90% or more of culture plates show inhibition zone around the antimicrobial test disc. Results : MIC 90 for amoxycillin and claritramycin in our study was 0.25 g/ml and all isolates were susceptible to amoxycillin. Only one isolate was resistant to claritramycin. MIC 90 for metronidzole was 16 and 4 resistant cases were isolated.Conclusion : This stndy showed low level of resistance to metronidazole and claritramycin which were comparable to the reported results from other studies. No resistance was observed to amoxycillin which was also the same as other reported results. According to the pattern of antimicrobial resistance, we can recommend the studied drugs, against Helicobacter pylori.

  13. AN OBSERVATIONAL STUDY REGARDING PREVALENCE OF S UPERSTITIOUS BELIEFS AMONG PATIENTS ADMITTED AT A TERTIARY HOSPITAL IN INDORE

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    Bansal

    2015-03-01

    Full Text Available INTRODUCTION: Superstitions have always been deep rooted in the Indian culture, and an integral part of everyday lives. Moreover, the people are t ightly locked up in religious taboos thus taking useless Practices. A ny cure for this disease brought about by means other than medical treatment, has a dramatic effect on people and strengthens their belief in supernatural powers. Ignorance of scientific reasons behind these phenomena increases the mystery and consequently gives a boost to superstition. MATERIALS AND METHODS: The present study was conducted to find out the prevalence of superstitious practices pertaining to medical conditions - i.e. typhoid, jaundice and psychiatric illness among 300 patients admitted at tertiary care hospital as studied in an interval of 3 months. A pre tested semi - structured questionnaire framed to assess the prevalence of superstitious practices in them. RESULTS: Superstit ious practices were found more common in literate /Uneducated/Unemployed peoples. The most common age group involved was found to be 20 - 40 yr. group. Males are more involved in superstitious practices. The main reason found for the ignorance of scientific m edical care are like - large distance from medical care, poor financial condition, fear of investigations, less trust on doctors, more belief on faith healing mid - way . However at last they convinced that the cure of any grave illness is not possible with me ans of faith healing alone. CONCLUSION: The present study clearly shows that superstitious beliefs still prevail in this modern world. This prevalence may block the wellbeing of the individuals and hinder their positive personal growth. Thus, steps should be taken to alleviate or at least reduce such superstitious beliefs, thus urging the people to think rationally and logically.

  14. Demographics of pediatric burns in Vellore, India.

    Science.gov (United States)

    Light, Timothy D; Latenser, Barbara A; Heinle, Jackie A; Stolpen, Margaret S; Quinn, Keely A; Ravindran, Vinitha; Chacko, Jacob

    2009-01-01

    The American Burn Association, Children's Burn Foundation, and Christian Medical College in Vellore, India have partnered together to improve pediatric burn care in Southern India. We report the demographics and outcomes of burns in this center, and create a benchmark to measure the effect of the partnership. A comparison to the National Burn Repository is made to allow for generalization and assessment to other burn centers, and to control for known confounders such as burn size, age, and mechanism. Charts from the pediatric burn center in Vellore, India were retrospectively reviewed and compared with data in the American Burn Association National Burn Registry (NBR) for patients younger than 16 years. One hundred nineteen pediatric patients with burns were admitted from January 2004 through April 2007. Average age was 3.8 years; average total body surface area burn was 24%: 64% scald, 30% flame, 6% electric. Annual death rate was 10%, with average fatal total body surface area burn was 40%. Average lengths of stay for survivors was 15 days. Delay of presentation was common (45% of all patients). Thirty-five of 119 patients received operations (29%). Flame burn patients were older (6.1 years vs 2.6 years), larger (30 vs 21%), had a higher fatality rate (19.4 vs 7.7%), and more of them were female (55 vs 47%) compared with scald burn patients. Electric burn patients were oldest (8.3 years) and all male. When compared with data in the NBR, average burn size was larger in Vellore (24 vs 9%). The mortality rate was higher in Vellore (10.1 vs 0.5%). The average mortal burn size in Vellore was smaller (40 vs 51%). Electric burns were more common in Vellore (6.0 vs 1.6%). Contact burns were almost nonexistent in Vellore (0.9 vs 13.1%). The differences in pediatric burn care from developing health care systems to burn centers in the US are manifold. Nonpresentation of smaller cases, and incomplete data in the NBR explain many of the differences. However, burns at this

  15. Successful skin homografting from an identical twin in a severely burned patient.

    Science.gov (United States)

    Turk, Emin; Karagulle, Erdal; Turan, Hale; Oguz, Hakan; Abali, Ebru Sakallioglu; Ozcay, Necdet; Moray, Gokhan; Haberal, Mehmet

    2014-01-01

    Flame burns are a serious condition and usually have high morbidity and mortality because they affect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patient's identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.

  16. Impact of hyperhydration on the mortality risk in critically ill patients admitted in intensive care units: comparison between bioelectrical impedance vector analysis and cumulative fluid balance recording

    OpenAIRE

    Samoni, Sara; Vigo, Valentina; Reséndiz, Luis Ignacio Bonilla; Villa, Gianluca; De Rosa, Silvia; Nalesso, Federico; Ferrari, Fiorenza; Meola, Mario; Brendolan, Alessandra; Malacarne, Paolo; Forfori, Francesco; Bonato, Raffaele; Donadio, Carlo; Ronco, Claudio

    2016-01-01

    Background Studies have demonstrated a positive correlation between fluid overload (FO) and adverse outcomes in critically ill patients. The present study aims at defining the impact of hyperhydration on the Intensive Care Unit (ICU) mortality risk, comparing Bioelectrical Impedance Vector Analysis (BIVA) assessment with cumulative fluid balance (CFB) recording. Methods We performed a prospective, dual-centre, clinician-blinded, observational study of consecutive patients admitted to ICU with...

  17. Pharmacokinetic/pharmacodynamic profiling of imipenem in patients admitted to an intensive care unit in India: A nonrandomized, cross-sectional, analytical, open-labeled study

    OpenAIRE

    B Abhilash; Chakra Dhar Tripathi; Anoop Raj Gogia; Girish Gulab Meshram; Manu Kumar; Suraj, B.

    2015-01-01

    Background and Aim: Widespread use of imipenem in intensive care units (ICUs) in India has led to the development of numerous carbapenemase-producing strains of pathogens. The altered pathophysiological state in critically ill patients could lead to subtherapeutic antibiotic levels. Hence, the aim of this study was to investigate the variability in the pharmacokinetic and pharmacodynamic profile of imipenem in critically ill patients admitted to an ICU in India. Materials and Methods: Plasma ...

  18. Factors affecting the discharge destination of hip fracture patients who live alone and have been admitted to an inpatient rehabilitation unit

    OpenAIRE

    Hayashi, Hiroyuki; Iwai, Midori; Matsuoka, Hiroka; Nakashima, Daiki; Nakamura, Shugo; Kubo, Ayumi; Tomiyama, Naoki

    2016-01-01

    [Purpose] (1) The aim of this study was to examine relations between clinical and functional assessment and discharge destination and (2) to identify the optimal cutoff point for estimating discharge to home after inpatient rehabilitation. [Subjects] The subjects were 54 hip fracture patients (15 males, 39 females; mean age 81.3 ± 7.4 years) living alone. [Methods] The patients were classified into two groups: those discharged to home and those admitted to an institution. Age, gender, side of...

  19. The Feasibility of Computer-Based Prism Adaptation to Ameliorate Neglect in Sub-Acute Stroke Patients Admitted to a Rehabilitation Center

    OpenAIRE

    Smit, Miranda; Van der Stigchel, Stefan; Visser-Meily, Johanna M. A.; Kouwenhoven, Mirjam; Eijsackers, Anja L. H.; Nijboer, Tanja C. W.

    2013-01-01

    Introduction: There is wide interest in transferring paper-and-pencil tests to a computer-based setting, resulting in more precise recording of performance. Here, we investigated the feasibility of computer-based testing and computer-based prism adaptation (PA) to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center. Methods: Thirty-three neglect patients were included. PA was performed with a pair of goggles with wide-field point-to-point prismatic lenses in...

  20. The feasibility of computer-based prism adaptation to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center.

    OpenAIRE

    Miranda Smit; Johanna MA Visser-Meily; Tanja CW Nijboer

    2013-01-01

    Abstract Introduction: There is wide interest in transferring paper-and-pencil tests to a computer-based setting, resulting in more precise recording of performance. Here, we investigated the feasibility of computer-based testing and computer-based prism adaptation (PA) to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center. Methods: 33 neglect patients were included. PA was performed with a pair of goggles with wide-field point-to-point prismatic lens...

  1. The Clinical Analysis of 47 Patients with Burning Mouth Syndrome

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    目的:研究灼口综合征的临床特征及精神因素分析.方法:对47例灼口综合征患者的临床资料进行分析并用HAD记分方法对其精神因素进行评估.结果:BMS患者中女性患病率高,男女比率1:6.5,舌部发病最为多见,平均发病年龄为53岁,BMS患者均有不同程度的精神因素的影响.%Objective:To analyse the clinical nature and psychiatric assessment.Methods:47 patients with burning mouth syndrome (BMS) were investigated.The clinical nature including distribution of orafacial sites affected by BMS and psychiatric assessment by the way of the Hospital Anxiety and Depression (HAD) scale were determined.Result:BMS affected females much more frequently than males, with a ratio of about 6.5∶1.The mean age of patients was around 53 years old. The most often affected site was the tongue and anxiety was a more important psychological factor in BMS than depression.

  2. Assessment of Substances Abuse in Burn Patients by Using Drug Abuse Screening Test

    Directory of Open Access Journals (Sweden)

    Kobra Gaseminegad

    2012-04-01

    Full Text Available There has been an increase in the frequency of substance abuse among hospitalized burn injury patients. However, few studies have investigated substance abuse among burn patients. This study was aimed to identify the incidence of substance abuse in burn injury patients using the "Drug Abuse Screening Test" (DAST-20. We determined the validity of DAST-20 in spring 2010. Subsequently, this descriptive study was performed on 203 burn injury patients who fit the study's inclusion criteria. We chose a score of 6 as the cutoff and thus achieved a sensitivity of 89% and a specificity of 85% for the DAST-20. During the study, we gathered demographic data, burn features and DAST-20 results for all patients. Patients with scores of 6 or more were considered to be substances abusers. A statistical analysis was conducted using SPSS v16 software. According to the DAST-20 results, 33% of the patients were in the user group. The mean score of DAST-20 was significantly higher among users than it was among nonusers (P<0.05. The level of substance abuse was severe in 77% of users. No significant differences were found among the substances, with the exception of alcohol. Substance abuse is an important risk factor for burn patients. In addition, this study showed that DAST-20 is a valid screening measure for studies on burn patients.

  3. Fire Service Training. Immediate Care of the Burn Patient.

    Science.gov (United States)

    North Carolina State Dept. of Community Colleges, Raleigh.

    Part of a series of instructional outlines intended for use in a training program for firemen with no previous formal training, this curriculum guide discusses the emergency treatment of thermal, chemical, and electrical burns. The topics covered are as follow: (1) evaluation of the degree and extent of the burn; (2) shock, its signs and…

  4. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study

    OpenAIRE

    Nilgün Aksoy; Senay Arli; Ozlem Yigit

    2014-01-01

    Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ r...

  5. Effect of Antioxidants on the Incidence of Wound Infection in Burn Patients

    OpenAIRE

    Sahib, A.S.; Al-Jawad, F.H.; Alkaisy, A.A.

    2010-01-01

    Background. Thermal injury causes the destruction of the physical skin barrier that normally protects the body from invasion by micro-organisms and induces an immunocompromised state that predisposes burn patients to infection, sepsis, and multiple organ failure. Reactive oxygen species contribute to burn-mediated immune suppression, and as the use of antioxidants has a positive effect on immune function, this may reduce the incidence of wound infection and related complications in burn patie...

  6. [Advances in the research of effects of music therapy on pain and anxiety in burn patients].

    Science.gov (United States)

    Jinyi, Li; Yungui, Wang

    2015-06-01

    Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.

  7. Fast resuscitation and care of the burn patients by telemedicine: A review

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2014-01-01

    Full Text Available Background: In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients′ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients. Materials and Methods: This study was a narrative review. The literature was searched on fast resuscitation and care of the patients′ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. Results: In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. Conclusion: Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.

  8. Unplanned decannulation of tracheotomy tube in massive burn patients: a retrospective case series study

    Institute of Scientific and Technical Information of China (English)

    BEN Dao-feng; MA bing; XIA Zhao-fan; L(U) Kai-yang; CHEN Xu-lin; YU Xi-ya; XI Hui-Jun; CHANG Fei; ZHU Shi-hui; TANG Hong-tai; LU Wei

    2011-01-01

    Background Unplanned extubation is associated with adverse outcomes in intensive care unit.The massive burn patient differs from other critically ill patients in many ways.However,little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit.This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.Methods A case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively.A total of 21 patients with 29 UD events were identified.Demographic data,diagnosis,intervention,UD events and outcome of UD patients were collected.Differences in proportions were compared using the chi-square (X2) or Fisher's exact test.Results Patients with UD were often burned with head and neck (67%) and combined with inhalation injury (62%).The majority of them (76%) were transferred patients,occurred early (55%) and were accidental UD (79%).UD events tended to happen in day shift (90%) and to be associated with the medical procedure that was performing by caregivers at besides (79%).Loose of the stabilizing rope,medical procedure and tracheotomy malposition were the main causes of UD.Early UD and reintubation failure were associated with patients' death.Conclusions UD happened to massive burn patients can lead to patient death.Careful management of respiratory tract was essential for massive burn patients.

  9. Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use.

    Science.gov (United States)

    Eiroa-Orosa, Francisco Jose; Giannoni-Pastor, Anna; Fidel-Kinori, Sara Guila; Argüello, José María

    2016-01-01

    The authors aimed to test whether the three classical hypotheses of the interaction between post-traumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for post-traumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a burn unit and enrolled in a longitudinal observational study were analyzed. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a 6-month follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco, and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay "cleaning" effect, but severity of symptoms was linked to the amount of caffeine, nicotine, alcohol, and cannabis use after discharge. It was found that the 3 classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient's risk for trauma exposure and emergence of symptomatology. PMID:26670348

  10. Care of burns in Scotland: 3-year data from the managed clinical network national registry

    OpenAIRE

    Gilhooly, Charlotte; Kinsella, John

    2014-01-01

    Introduction The Managed Clinical Network for Care of Burns in Scotland (COBIS) was launched in April 2007. Primary aims included establishing and maintaining a registry of complex burn injury in Scotland and setting mechanisms to regularly audit outcome of burn treatment against nationally agreed standards of care. On behalf of COBIS, we present 3-year incidence and mortality data of Scottish patients admitted with a complex burn injury in this abstract. Methods From January 2010 o...

  11. HYPOGLYCEMIA IS ASSOCIATED WITH INCREASED POST-BURN MORBIDITY AND MORTALITY IN PEDIATRIC PATIENTS

    Science.gov (United States)

    Jeschke, Marc G; Pinto, Ruxandra; Herndon, David N; Finnerty, Celeste C; Kraft, Robert

    2014-01-01

    Objective The objective of this study was to determine the incidence of hypoglycemia after burn injury and whether hypoglycemia is associated with increased post-burn morbidity and mortality. Design Cohort analysis. Setting Academic pediatric burn hospital. Patients This analysis included 760 pediatric burn patients, who were stratified according the number of hypoglycemic episodes (<60 mg/dl glucose) they experienced while in the intensive care unit. Clinical outcomes as well as metabolic and inflammatory biomarkers were analyzed during the first 60 days post admission. Patients with one or more hypoglycemic events were matched with patients not experiencing any event using propensity score matching, and outcomes and biomarker expression were compared between groups. Measurements and main results Eighty-four patients had one episode of hypoglycemia, 108 patients had two or more episodes of hypoglycemia, and 568 patients never experienced hypoglycemia. Patients with one or more hypoglycemic episodes had longer hospitalization as well as more frequent infections, sepsis, multiple organ failure (MOF), and death (p<0.05). The 166 propensity score-matched patients with one or more hypoglycemic events had greater inflammatory and metabolic responses, incidence of sepsis, MOF, and mortality than burn patients without hypoglycemic (p<0.05). Conclusions Hypoglycemic episodes correlate with injury severity and inhalation injury. When adjusted for injury severity, hypoglycemia is associated with significantly higher post-burn morbidity and mortality. PMID:24368343

  12. Zolpidem and Sleep in Pediatric Burn Patients with Attention Deficit/Hyperactivity Disorder.

    Science.gov (United States)

    Cronin, Stephanie D; Gottschlich, Michele M; Gose, Lacy M; Kagan, Richard J

    2015-01-01

    Existing research shows that hospitalized patients, especially pediatric burn patients, are often sleep deprived. A pre-existing diagnosis of attention deficit/hyperactivity disorder (ADHD) further compounds a burn patient's inability to sleep. This retrospective study compared the effectiveness of zolpidem on patients with acute burns with ADHD (n = 23) and patients with acute burns without ADHD (n = 23). Effectiveness was defined based on the need for a change in the sleep medication or an increase in the zolpidem dose during the first 12 days of treatment. This study found that sleep dysfunction was similar in pediatric burn patients with and without a concurrent diagnosis of ADHD. Sixteen (69.6%) patients with and 13 (56.5%) patients without ADHD required a sleep medication change (p = 0.541). Further, while patients with ADHD required a sleep medication change (median = 5 days) sooner than those without ADHD (median = 9 days), it appears that zolpidem is not an effective drug for managing sleep in pediatric burn patients with or without ADHD. PMID:26201171

  13. Intensive Insulin Therapy in Severely Burned Pediatric Patients: A Prospective Randomized Trial

    OpenAIRE

    Jeschke, Marc G.; Kulp, Gabriela A; Kraft, Robert; Finnerty, Celeste C.; Mlcak, Ron; Lee, Jong O; Herndon, David N

    2010-01-01

    Rationale: Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality.

  14. Opioid Analgesics and Depressive Symptoms in Burn Patients: What Is the Real Relationship?

    Science.gov (United States)

    Hong, Narei; Jung, Myung Hun; Kim, Jee Wook; Chun, Wook; Choi, Ihn-Geun; Kang, Tae-Cheon; Kee, Baik Seok; Lee, Boung-Chul

    2016-01-01

    Objective Major burn injuries are strongly associated with both psychological trauma and severe pain, and opioids are the mainstay analgesics for the treatment of severe burn pain. The objectives of this study are to find the complex relationship between opioid dose, depression, and post-traumatic stress disorder (PTSD) symptoms during the acute management of pain in burn patients. Methods The symptoms of depression and PTSD were assessed in 43 burn patients immediately following wound stabilization and 2 weeks after the initial evaluation. Results Total opioid doses and Hamilton Depression Scale (HAMD) scores obtained during the second evaluation were positively but weakly correlated after controlling for age and total burn surface area (R=0.33, p=0.03). Moreover, pain management with opioids was significantly more common in burn patients with low Clinician Administered PTSD Scale scores (evaluation 1) and high HAMD scores (evaluation 2) (F=6.66, p=0.001). Conclusion High opioid dose following acute burn trauma might have correlation with depressive symptoms. Monitoring of depressive symptoms may be important following acute burn trauma and consequent opioids pain management, particularly when PTSD symptoms appear minimal during the early stabilization of patients. PMID:27489384

  15. An overview of acute burn management in the Emergency Centre

    Directory of Open Access Journals (Sweden)

    Adaira Landry

    2013-03-01

    Full Text Available Despite the frequency and severity of burns in Low Income Countries, including many in Africa, there is a paucity of research and funding for these populations to aid in prevention, treatment and recovery of burn patients. The objectives of this paper are four-fold. First, by addressing the pathophysiology of burns the reader may strengthen understanding of the clinical progression of burns. Second, through describing proper assessment of burn patients one will learn how to decide if patients can be discharged, admitted or transferred to burn centre. Third, the inclusion of treatments solidifies the steps necessary to manage a patient in a hospital setting. Lastly, the overall goal of the paper, is to raise awareness that more research, publication and funding is required to create a better understanding of burns in Africa and why they continue to be devastating social and economic burdens.

  16. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

    Directory of Open Access Journals (Sweden)

    Banga Amit

    2004-11-01

    Full Text Available Abstract Background Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD commonly require hospitalization and admission to intensive care unit (ICU. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. Methods Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. Results Invasive ventilation was required in 69 patients (84.1%. Fifty-two patients survived to hospital discharge (63.4%. APACHE II score at the time of admission to ICU {odds ratio (95 % CI: 1.32 (1.138–1.532; p Conclusion APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

  17. Burns, hypertrophic scar and galactorrhea

    Directory of Open Access Journals (Sweden)

    Hamid Karimi

    2013-07-01

    Full Text Available An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs .At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients.

  18. Plasma suPAR levels are associated with mortality, admission time, and Charlson Comorbidity Index in the acutely admitted medical patient

    DEFF Research Database (Denmark)

    Haupt, Thomas Huneck; Petersen, Janne; Ellekilde, Gertrude;

    2012-01-01

    . METHODS: We included 543 patients with various diseases from a Danish Acute Medical Unit during a two month period. A triage unit ensured that only medical patients were admitted to the Acute Medical Unit. SuPAR was measured on plasma samples drawn upon admission. Patients were followed-up for three...... with these endpoints. RESULTS: Increased suPAR was significantly associated with 90-day mortality (4.87 ng/ml in survivors versus 7.29 ng/ml in non-survivors, P

  19. Determination of Potential Parameters Effective on the Outcomes of Admitted Patients with Primary Varicella Infections in Tehran Aliasghar Children Hospital (1996-2009

    Directory of Open Access Journals (Sweden)

    A.R. Nateghian

    2011-07-01

    Full Text Available Introduction & Objective: There is a need to study the outcomes of admitted patients with primary varicella infections especially for immunocompromised cases like patients with various cancers in our country in which there is no routine vaccination against such a virus.Materials & Methods: We performed a retrospective descriptive-analytic study on the admitted cases with primary varicella infections in Aliasghar children hospital, Tehran, since 1996 to 2009;The patients were put in two different groups for comparison:1Immunosuppressed patients including patients with acute lymphoblastic leukemia ,patients with other types of cancers ,and patients who were receiving high doses of corticosteroids 2previously healthy patients. Demographic as well as some indicators of poor general condition on admission like respiratory distress ,hypotension and decreased level of consciousness were compared within the groups; we also looked for ataxia as an important indication of admission and the time period since the onset of disease up to admission in each group; appropriate statistical methods were used for statistical analysis.Results: 88 cases including 24 cases of ALL (27%,9 cases with various types of cancers (10.5%,and 13 cases who were receiving high dose of corticosteroid were included. Mean age of the patients was 6 years(SD=3.5.47 cases(53.4%were male. Hypotension on admission was significantly more common in patients under four years of age(P=0.006; The patients in the first 3 groups were admitted significantly earlier(P=0.027; Hypotension and ataxia were more significantly seen in the previously healthy group(P=0.01 and 0.04 respectively. Just one case of mortality occurred in a case of ALL during the study period.Conclusion: We concluded that immunocompromised cases comprise more than half of the admissions due to primary varicella infections in our referral center; interestingly ,however, in comparison with previously healthy cases they have been

  20. Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?

    OpenAIRE

    Gauglitz, Gerd G.; Finnerty, Celeste C.; Herndon, David N; Mlcak, Ronald P.; Jeschke, Marc G.

    2008-01-01

    Introduction Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different s...

  1. [The treatment of burn patients. What are the prospects for the northern area of Portugal?].

    Science.gov (United States)

    Santa-Comba, A; Amarante, J; Malheiro, E

    1993-11-01

    The AA studied the distribution of age, sex, aetiology, and destiny of the 173 in-patients at the S. João Hospital (Central hospital that has no Burn Unit). In what concerns age, 38.1% are children less than 10 years old; the male/female ratio was 1.7:1. The fire and scalds are the most important aetiology. These findings are similar to those found in other countries (except in the Arabian Countries). Of these 99 burn patients have been treated in S. João Hospital, 71 patients were sent to the Burn Unit of Prelada Hospital and 3 to the Burn Unit of Coimbra University Hospital. These findings were compared to a Burn Unit of a Spanish Hospital (Alicante) which has 18 beds for adults and children, normally interning 132 patients per year. As the WHO suggest one special bed per 30,000 persons, we should be expected to have at least 110 beds for burn patients (we only have 9 beds at Prelada Hospital), the AA suggest the establishment of a Burn Unit at S. João Hospital, also due to the fact that is the only hospital that has a permanent emergency care for Plastic Surgery. PMID:8140918

  2. Efficacy of silver sulfadiazine phonophoresis on wound healing in acute burn patients

    DEFF Research Database (Denmark)

    Omar, Ghada Said Mohammed

    2003-01-01

    The purpose of the current study was to evaluate the efficacy of SSD phonophoresis approaches (continuous and pulsed modes on the rate of healing following acute burn injury . forty female patients with second degree burn in thrir anterior aspect of the dominant foream were divided randomly...... into two groups : patients in group I received pulsed SSD phonophoresis for 15 min with a frequency of 1MHz , intensity of 1 w/ cm2 , and with the pulse ratio was set at 1 : 4 , and the pulsed duration was set at 2 m.s., while pationts in group II received continuous SSD phonophoresis for 5 min...... with a frequency of 1 MHz , and intensity of 1 W/cm2 . the parameters investigated inclding 1.burn surface area measured by tracing the burn wound parameters , and 2.determination of glycosaminoglycan in urine by using cetylpyridinuin chloride turbidity method . both parameters are measured 24 hours post-burn...

  3. Burn injuries in eastern Zambia: impact of multidisciplinary teaching teams.

    Science.gov (United States)

    Edwards, Dianna; Heard, Jason; Latenser, Barbara A; Quinn, Keely Y; van Bruggen, Jaap; Jovic, Goran

    2011-01-01

    The American Burn Association/Children's Burn Foundation (ABA/CBF) sponsors teams who offer burn education to healthcare providers in Zambia, a sub-Saharan country. The goals of this study are 1) to acquire burn-patient demographics for the Eastern Province, Zambia and 2) to assess the early impact of the ABA/CBF-sponsored burn teams. This is a retrospective chart review of burn patients admitted in one mission hospital in Katete, Zambia, July 2002 to June 2009. July 2002 to December 2006 = data before ABA/CBF burn teams and January 2007 to June 2009 = burn care data during/after burn outreach. There were 510 burn patients hospitalized, male:female ratio 1.2:1. Average age = 15.6 years, with 44% younger than 5 years. Average TBSA burned = 11% and mean fatal TBSA = 25%. Average hospital length of stay = 16.9 days survivors and 11.6 days nonsurvivors. Most common mechanisms of burn injuries: flame (52%) and scald (41%). Ninety-two patients (18%) died and 23 (4.5%) left against medical advice. There were 191 (37.4%) patients who underwent 410 surgical procedures (range 1-13/patient). There were 138 (33.7%) sloughectomies, 118 (28.7%) skin grafts, 39 (9.5%) amputations, and 115 (28.1%) other procedures. Changes noted in the 2007 to 2009 time period: more patients had burn diagrams (48.6 vs 27.6%, P set for a sub-Saharan region in Africa. There has been a statistically significant improvement in documentation of burn size as well as administration of analgesics, validating the efficacy of the ABA/CBF-sponsored burn teams. Continued contact with burn teams may lead to increased use of resuscitation fluids, topical antimicrobials, and more patients undergoing operative intervention, translating into improved burn patient outcomes. PMID:21131848

  4. Pulmonary Histopathologic Abnormalities and Predictor Variables in Autopsies of Burned Pediatric Patients

    Science.gov (United States)

    Sousse, Linda E.; Herndon, David N.; Andersen, Clark R.; Zovath, Andrew; Finnerty, Celeste C.; Mlcak, Ronald P.; Cox, Robert A.; Traber, Daniel L.; Hawkins, Hal K.

    2014-01-01

    Pulmonary abnormalities occur in 30–80% of fatalities after burn injury. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. METHODS Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002–2012 (n=43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. RESULTS Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p<0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p<0.01). The scores for protein were significantly higher in cases with longer survival after burn (p<0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p<0.01), and in cases with the presence of inhalation injury (p<0.01). CONCLUSIONS Histological findings associated with Diffuse Alveolar Damage (DAD), which is the pathological correlate of the Acute Respiratory Distress Syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury. PMID:25445004

  5. Serum Interleukin-6 in Patients with Burning Mouth Syndrome and Relationship with Depression and Perceived Pain

    Directory of Open Access Journals (Sweden)

    Qianming Chen

    2007-01-01

    Conclusions. Serum interleukin-6 in patients with burning mouth syndrome is decreased and negatively correlated to chronic pain. Both psychological and neuropathic disorders might act as precipitating factors in BMS etiopathogenesis.

  6. Medical Treatment for Burn Patients with Eating Disorders: A Case Report

    Directory of Open Access Journals (Sweden)

    Minekatsu Akimoto

    2011-01-01

    Full Text Available There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5% of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa cause emaciation and malnutrition, and consent for hospitalization from the patient and/or family is often difficult. During the medical treatment of burns for these patients, consideration not only of physical symptoms caused by malnutrition but also the psychiatric issues is required. Therefore, multifaceted and complex care must be given to burn patients with eating disorders.

  7. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  8. Declining trend in the use of repeat computed tomography for trauma patients admitted to a level I trauma center for traffic-related injuries

    Energy Technology Data Exchange (ETDEWEB)

    Psoter, Kevin J., E-mail: kevinp2@u.washington.edu [Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195 (United States); Roudsari, Bahman S., E-mail: roudsari@u.washington.edu [Department of Radiology, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Graves, Janessa M., E-mail: janessa@u.washington.edu [Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Mack, Christopher, E-mail: cdmack@uw.edu [Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Jarvik, Jeffrey G., E-mail: jarvikj@u.washington.edu [Department of Radiology and Department of Neurological Surgery, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States)

    2013-06-15

    Objective: To evaluate the trend in utilization of repeat (i.e. ≥2) computed tomography (CT) and to compare utilization patterns across body regions for trauma patients admitted to a level I trauma center for traffic-related injuries (TRI). Materials and Methods: We linked the Harborview Medical Center trauma registry (1996–2010) to the billing department data. We extracted the following variables: type and frequency of CTs performed, age, gender, race/ethnicity, insurance status, injury mechanism and severity, length of hospitalization, intensive care unit (ICU) admission and final disposition. TRIs were defined as motor vehicle collisions, motorcycle, bicycle and pedestrian-related injuries. Logistic regression was used to evaluate the association between utilization of different body region repeat (i.e. ≥2) CTs and year of admission, adjusting for patient and injury-related characteristics that could influence utilization patterns. Results: A total of 28,431 patients were admitted for TRIs over the study period and 9499 (33%) received repeat CTs. From 1996 to 2010, the proportion of patients receiving repeat CTs decreased by 33%. Relative to 2000 and adjusting for other covariates, patients with TRIs admitted in 2010 had significantly lower odds of undergoing repeat head (OR = 0.61; 95% CI: 0.49–0.76), pelvis (OR = 0.37; 95% CI: 0.27–0.52), cervical spine (OR = 0.23; 95% CI: 0.12–0.43), and maxillofacial CTs (OR = 0.24; 95% CI: 0.10–0.57). However, they had higher odds of receiving repeat thoracic CTs (OR = 1.86; 95% CI: 1.02–3.38). Conclusion: A significant decrease in the utilization of repeat CTs was observed in trauma patients presenting with traffic-related injuries over a 15-year period.

  9. Successful treatment of severe burn patients with multiple organ dysfunction syndrome:A case rep ort

    Institute of Scientific and Technical Information of China (English)

    Lingfeng Wang ∗; Yongdong Li; Xiyuan Xu; Ji Chen; Weiqing Wang; Zaiqing Huang; Lihua Zhang

    2014-01-01

    Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma, burn, shock and infection. In this case, the patient with burn area amounted to 95%and the third-degree burn was up to 90%. He underwent gastrointestinal tract, blood clotting, lung, brain, heart, liver dysfunction, and cardiac arrest for 30 minutes during the courses of treatment, and was discharged from the hospital after 108 days on the basis of comprehensive treatment and repeated skin grafting.

  10. CLINICAL PRESENTATION, RADIOLOGICAL FEATURES AND COURSE OF THE DISEASE IN SWINE FLU POSITIVE PATIENTS ADMITTED IN THE RESPIRATORY INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Aruna

    2015-06-01

    Full Text Available BACKGROUND : Since the 2009 pandemic of H1N1 or Swine Flu influenza , there have been respiratory emergencies every year throughout India , but in the early part of this year that is between January and April 2015 an explosion of cases was seen throughout the country , and so also in our state , Andhra Pradesh. The study of clinical presentation , radiological features and course of the disease helps in early suspicion , isolation , detection and institution of treatment in swine flu positive patients so that further spread of the disease can be co ntrolled and the patients saved . MATERIAL AND METHODS : This is a cross - sectional study conducted at the Department of Pulmonary Medicine , S.V.R.R. Govt. General Hospital , Tirupathi , between January 2015 and April 2015. Study sample was the total number of swine flu suspects who were admitted in the Respiratory Intensive Care Unit and swine flu wards of the Department of Pulmonary Medicine. SUMMARY : Out of 32 suspects admitted , 13 tested positive for swine flu. 8 of the 13 were females (61% and 5 were males (39%. Cold , cough and breathlessness were present in all the patients (100%. Sore throat was present in only 4 patients (30%. 11 out of the 13 patients were in respiratory failure (85%. 9 out of the 13 had comorbidities like diabetes , bronchial asthma and chronic kidney disease (70%. Chest X - ray and CT chest showed ARDS like pic ture and pneumonia in 11 out of the 13 patients (85%.

  11. Case Report: Treatment of Open Femoral Shaft Fracture in a Severely Burned Patient

    OpenAIRE

    Chang, Tai-Li; Spence, Robert J.; Mears, Simon C

    2008-01-01

    Objective: To present a case report of a patient with an open fracture and severe burns and review the literature. Methods: The patient was treated with intubation, intravenous antibiotics, and debridement and intramedullary nailing for the femur fracture. He later underwent multiple burn excision procedures with allograft and autograft skin coverage. The wound over the fracture was treated with dressing changes. The fracture was treated with nail exchange and bone grafting for atrophic nonun...

  12. The Effect of Shiatsu Massage on Underlying Anxiety in Burn Patients

    OpenAIRE

    Mohaddes Ardabili, Fatemeh; Purhajari, Soybeh; Najafi Ghzeljeh, Tahereh; Haghani, Hamid

    2015-01-01

    BACKGROUND Burn patients experience high levels of predictable anxiety during dressing changes while anti-anxiety drugs cannot control these anxieties. The nurses can limit the side effects of medications by undertaking complementary therapies. Hand pressure massage was introduced as a technique that can reduce these anxieties. This study aimed to investigate the effect of hand pressure massage using Shiatsu method on underlying anxiety in burn patients. METHODS In an available randomized stu...

  13. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients: rationale and design of the TRIAGE III cluster randomized interventional trial

    DEFF Research Database (Denmark)

    Sandø, Andreas; Schultz, Martin; Eugen-Olsen, Jesper;

    2016-01-01

    complications or deaths. Our aim is to determine whether measurement of the blood level of the biomarker soluble urokinase plasminogen activator receptor (suPAR) can enhance early risk stratification leading to reduced mortality, lower rate of complications, and improved patient flow in acutely admitted adult......) 2016 and ends June 6(th) 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. DISCUSSION: The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability...

  14. 老年烧伤患者流行病学分析及护理%Nursing care and epidemiological analyse of elderly burn patients

    Institute of Scientific and Technical Information of China (English)

    吕月; 凌峭; 廖青玲; 张庆庆

    2012-01-01

    目的 探讨531例老年烧伤患者的流行病学特点并提出防治经验.方法 选取2002-2010年收治于某两家医院烧伤科的531例年龄在60岁以上老年烧伤患者为对象,对其一般资料、致伤原因、占同期入院人数比例和疾病转归等进行回顾性分析,总结流行病学特点并提出防治措施.结果 在531例患者中,患者的平均年龄为72.86岁;家庭烧伤患者占72.50%,意外事故伤占16.70%;老年烧伤的临床治愈率为82.11%,死亡率为2.33%;老年烧伤入院患者占同期总住院人数比例从2002年的5.13%上升至2010年的5.64%;患者的平均年龄从2002年的72.53岁上升到2010年的73.58岁.结论 2002-2010年老年烧伤住院患者人数占同期总住院人数比例和平均住院年龄整体呈上升趋势,家庭生活烧伤是老年患者烧伤的主要原因,需要加强对家庭生活烧伤的预防和宣传教育.%Objective To explore the epidemiological character of elderly burn patients and to provide the experience of prevention and treatment.Methods The retrospective study method was used,and totals of 531 elderly patients with burn from January 2002 to December 2010 in two hospitals were selected.Cases information such as demographics,clinical diagnosis,treatments,causes of injury,mortality rate and causes of death since admission and so on was recorded and analysed,then,the epidemiological character was summarized and the prevention and treatment were proposed.Results Among 531 patients with burn,the average age was 72.86,the rate of burn in home was 72.5% and in accident was 16.70%.The clinical cure rate was 82.11%and the mortality rate was 2.33%.The proportion of the elderly burn patients account for the total admitted patients in the same period was 5.13% in 2002 and 5.64% in 2010,and the average age of elderly burn patients was higher from 72.53 years old in 2002 to 73.58 years old in 2010.Conclusions The proportion of the elderly

  15. Comparison of the General Health, Self-Esteem and Social Support in Self-Inflicted Burn Patients and Non Self Inflicted Burn Patients of the Choromy Accidental and Burning Hospital of Ganaveh

    Directory of Open Access Journals (Sweden)

    MS Enayati

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Self-inflicted burn is a violent method of suicide. Since our society faces lots of psychological, social, personal and economical problems due to self-inflicted burn, more survey for this event can assist us to know its causes and prevent from its occurrence. This research was carried out to compare general health, self- esteem and social support in patient's self-inflicted burn and non-self-inflicted burn of the Choromy accidental and burning hospital in Ganaveh. Materials & Methods: This is a descriptive – analytic study. The sample consisted of 60 inpatients burnt (males & females of the Choromy accidental and burning hospital (Ganaveh. The method of sampling was simple random. Participants completed the General Health Questionnaire (G.H.Q- 28 of Goldberg, Cooper Smith’s questionnaire of self–esteem and Philip’s social support scale. Multivariate analysis of variance (MANOVA and T-test were the major statistical analysis in this research. Results: The mean and standard deviation of the general health were 44.57 ± 14.65 for self-inflicted burn persons and for non - self inflicted burn they were 10.83 ± 6.27. In the self–esteem variable, the mean and the standard deviation were 57.90 ± 4.94 for self-inflicted burn persons and 55.47 ± 6.04 for non-self inflicted burn ones. Mean and standard deviation of whole social supporting were 20.40 ± 4.94 for self-inflicted burn persons and 23.73 ± 1.17 for non-self inflicted burn group. The findings showed significant differences between the two groups from viewpoint of general health and social supporting while there were no significant differences between two groups in case of self–esteem. Conclusion: There are a significant relationship between general health, social supporting and self-inflicted burn.Therefore, in order to prevent self inflicted burn it is suggested that we make a relationship between persons and societies, families, groups and

  16. The effect of levamisole on mortality rate among patients with severe burn injuries

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Fatemi

    2013-01-01

    Full Text Available Background: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. Materials and Methods: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. Results: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years was 33.29 ± 11.39 years (Mean ± SD, and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8% patients in the control group and 50 (58.8% patients in the treatment group (P = 0.8. Conclusion: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption.

  17. Improvement of survival in patients with extensive burns involving the perineum with use of a faecal management system

    OpenAIRE

    Farroha, A.; Frew, Q.; Philp, B.; Dziewulski, P.

    2014-01-01

    The purpose of this study is to assess the effectiveness of faecal management systems in improving survival of patients with extensive burns involving the perineum. All adults with burns of more than 30% total body surface area (TBSA) who were actively treated in our regional burn service between December 2008 and July 2012 were reviewed and compared to an historical cohort of 18 adult patients with similar injury involving the perineum, treated in our regional burn service between 1999 and 2...

  18. Infection control in burn patients: are fungal infections underestimated?

    OpenAIRE

    Struck Manuel F

    2009-01-01

    Abstract With great interest, I read the paper of David J. Dries about recent developments, infection control and outcomes research in the management of burn injuries 1. I have some comments about an important, however missing, topic in the paragraphs concerning infection control.

  19. Early markers of renal injury in predicting outcome in thermal burn patients

    International Nuclear Information System (INIS)

    Acute renal failure (ARF) is a well known complication of severe burn and is an important factor that can increase mortality. To determine the predictors of acute renal failure that occur in major burns, we studied 40 patients with moderate to severe thermal burn injury - second to third degree with > 20% of total body surface area. All patients were subjected to routine investigations including: Serum creatinine, blood urea nitrogen, fractional excretion of sodium, uri-nary malondialdehyde and microalbuminuria on day 0, 3, 7, 14 and 21 of hospitalization. Nine patients (22.5 %) developed acute renal failure; 4 patients required supportive dialysis. The group that developed ARF showed an increase of markers of glomerular damage with appearance of microalbuminuria on day 0 that reached 3 - 4 folds above its normal level on day 14 and remained constant with elevated serum creatinine and burn size in the 3 rd week of ARF, and progressed to overt proteinuria in 3 cases. Urinary malondialdehyde increased 3 folds above normal values before developing acute renal failure, and gradually increased on day 14, which coincided with the increased of microalbuminuria. Two cases (22.2%) in the ARF group who developed septicemia and required dialysis died on the 32nd and 36th days post-burn. Burn size and occurrence of septicemia were the only predictors of acute renal failure using multiple regression analysis (P value < 0.001 and < 0.0371, respectively). We conclude that acute renal failure complicates burn patients and is related to the size and depth of burn and occurrence of septicemia. Microalbuminuria and urinary malondialdehyde are useful markers for prediction of renal outcome in such group of patients. (author)

  20. Temporal Cytokine Profiles in Severely Burned Patients: A Comparison of Adults and Children

    Science.gov (United States)

    Finnerty, Celeste C; Jeschke, Marc G; Herndon, David N; Gamelli, Richard; Gibran, Nicole; Klein, Matthew; Silver, Geoff; Arnoldo, Brett; Remick, Daniel; Tompkins, Ronald G

    2008-01-01

    A severe burn leads to hypermetabolism and catabolism resulting in compromised function and structural changes of essential organs. The release of cytokines has been implicated in this hypermetabolic response. The severity of the hypermetabolic response following burn injury increases with age, as does the mortality rate. Due to the relationship between the hypermetabolic and inflammatory responses, we sought to compare the plasma cytokine profiles following a severe burn in adults and in children. We enrolled 25 adults and 24 children who survived a flame burn covering more than 20% of total body surface area (TBSA). The concentrations of 22 cytokines were measured using the Linco multiplex array system (St. Charles, MO, USA). Large perturbations in the expression of pro- and anti-inflammatory cytokines were seen following thermal injury. During the first week following burn injury, IFN-γ, IL-10, IL-17, IL-4, IL-6, and IL-8 were detected at significantly higher levels in adults compared with children, P < 0.05. Significant differences were measured during the second week post-burn for IL-1β (higher in children) and IL-5 (higher in adults), P < 0.05. IL-18 was more abundant in children compared with adults during the third week post-burn, P < 0.05. Between post-burn d 21 and d 66, IL-1α was detected at higher concentrations in pediatric compared with adult patients, P < 0.05. Only GM-CSF expression was significantly different at all time points; it was detected at lower levels in pediatric patients, P < 0.05. Eotaxin, G-CSF, IL-13, IL-15, IP-10, MCP-1, and MIP-1α were detected at significantly different concentrations in adult compared with pediatric patients at multiple time points, P < 0.05. There were no differences in IL-12, IL-2, IL-7, or TNF levels in adult compared with pediatric burn patients at any of these time points. Following severe flame burns, the cytokine profiles in pediatric patients differ compared with those in adult patients, which may

  1. [A discussion regarding reconstruction and rehabilitation of patients with deep burn wound].

    Science.gov (United States)

    Hu, Da-hai

    2009-12-01

    With the advances in resuscitation, infection control, and metabolic management, the treatment strategies for burn patients have improved remarkably in the last half century. As a result, more patients with deep burn wound survived, and how to optimize the burn wound care aiming at recovery of the normal appearance and physiologic function of patients has been investigated and discussed widely through both the whole treatment strategy making and the new techniques performing. In the present discussion, early tissue reconstruction as well as early wound covering and repair are emphasized by summarizing the improved aesthetic and functional effects obtained by applying the principles of plastic surgery in early burn wound repair, the use of composite skin grafting, the grafting with split-thickness autografts on the preserved denatured dermis or on the preserved healthy fat tissue, etc. Besides these, more attention should be given to the repair and reconstruction in specialized functional parts of the body, such as head and face, neck, hand, female breast, perineum, and joint areas, after a deep burn. The role of rehabilitation during and after the burn wound treatment process is elucidated by demonstrating its potential biophysical mechanism and preventing scar deformity. Adequate treatment of deep burn wound demands a number of important measures including the timing of surgery, adoption of essential techniques, suitable types of wound covering materials, motivated rehabilitation, and necessary psychological therapy. The optimal recovery of damaged part of body after burn should depend on the similarity of rebuild tissue structure to simulate the nature of the original tissue in the cellular, histological, anatomic characteristics, which is the aim of all burn wound care and the basis of the appearance and function repair or reconstruction.

  2. The influence of episodic mood disorders on length of stay among patients admitted to private and non-profit hospitals with alcohol dependence syndrome.

    Science.gov (United States)

    Dickerson, Justin B

    2011-02-22

    Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358). Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders (β=0.31, P=0.001), referral to a hospital by a physician (β=0.35, P=0.014), and increasing age (β= 0.01, P=0.001) were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62). Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.

  3. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

    Directory of Open Access Journals (Sweden)

    Cynthia Chen

    Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

  4. Pharmacokinetic/pharmacodynamic profiling of imipenem in patients admitted to an intensive care unit in India: A nonrandomized, cross-sectional, analytical, open-labeled study

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    B Abhilash

    2015-01-01

    Full Text Available Background and Aim: Widespread use of imipenem in intensive care units (ICUs in India has led to the development of numerous carbapenemase-producing strains of pathogens. The altered pathophysiological state in critically ill patients could lead to subtherapeutic antibiotic levels. Hence, the aim of this study was to investigate the variability in the pharmacokinetic and pharmacodynamic profile of imipenem in critically ill patients admitted to an ICU in India. Materials and Methods: Plasma concentration of imipenem was determined in critically ill patients using high performance liquid chromatography, at different time points, by grouping them according to their locus of infection. The elimination half-life (t΍ and volume of distribution (V d values were also computed. The patients with imipenem trough concentration values below the minimum inhibitory concentration (MIC and 5 times the MIC for the isolated pathogen were determined. Results: The difference in the plasma imipenem concentration between the gastrointestinal and the nongastrointestinal groups was significant at 2 h (P = 0.015 following drug dosing; while the difference was significant between the skin/cellulitis and nonskin/cellulitus groups at 2 h (P = 0.008, after drug dosing. The imipenem levels were above the MIC and 5 times the MIC for the isolated organism in 96.67% and 50% of the patients, respectively. Conclusions: The pharmacokinetic profile of imipenem does not vary according to the locus of an infection in critically ill patients. Imipenem, 3 g/day intermittent dosing, maintains a plasma concentration which is adequate to treat most infections encountered in patients admitted to an ICU. However, a change in the dosing regimen is suggested for patients infected with organisms having MIC values above 4 mg/L.

  5. Pharmacokinetic/pharmacodynamic profiling of imipenem in patients admitted to an intensive care unit in India: A nonrandomized, cross-sectional, analytical, open-labeled study

    Science.gov (United States)

    Abhilash, B.; Tripathi, Chakra Dhar; Gogia, Anoop Raj; Meshram, Girish Gulab; Kumar, Manu; Suraj, B.

    2015-01-01

    Background and Aim: Widespread use of imipenem in intensive care units (ICUs) in India has led to the development of numerous carbapenemase-producing strains of pathogens. The altered pathophysiological state in critically ill patients could lead to subtherapeutic antibiotic levels. Hence, the aim of this study was to investigate the variability in the pharmacokinetic and pharmacodynamic profile of imipenem in critically ill patients admitted to an ICU in India. Materials and Methods: Plasma concentration of imipenem was determined in critically ill patients using high performance liquid chromatography, at different time points, by grouping them according to their locus of infection. The elimination half-life (t΍) and volume of distribution (Vd) values were also computed. The patients with imipenem trough concentration values below the minimum inhibitory concentration (MIC) and 5 times the MIC for the isolated pathogen were determined. Results: The difference in the plasma imipenem concentration between the gastrointestinal and the nongastrointestinal groups was significant at 2 h (P = 0.015) following drug dosing; while the difference was significant between the skin/cellulitis and nonskin/cellulitus groups at 2 h (P = 0.008), after drug dosing. The imipenem levels were above the MIC and 5 times the MIC for the isolated organism in 96.67% and 50% of the patients, respectively. Conclusions: The pharmacokinetic profile of imipenem does not vary according to the locus of an infection in critically ill patients. Imipenem, 3 g/day intermittent dosing, maintains a plasma concentration which is adequate to treat most infections encountered in patients admitted to an ICU. However, a change in the dosing regimen is suggested for patients infected with organisms having MIC values above 4 mg/L. PMID:26628823

  6. Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets

    OpenAIRE

    Samira Sharma; Ramesh K Sharma; Atul Parashar

    2014-01-01

    Background: The importance of adequate nutritional support in burned patients cannot be overemphasised. For adequate long-term compliance by the patients, diet should be formulated in accordance with their pre-burn dietary habits, religious beliefs, and tastes. Patients and Methods: A study was conducted in 42 consecutive patients suffering from 10% to 50% of 2 nd and 3 rd degree thermal burns with the aim to compare nutritional status, clinical outcome, and cost-effectiveness of vegetarian a...

  7. Focused sonographic examination of the heart, lungs and deep veins in an unselected population of acute admitted patients with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg; Sloth, Erik; Lassen, Annmarie Touborg;

    2012-01-01

    symptoms, can be diagnosed with sonography. The protocol describes a prospective, blinded, randomised controlled trial that aims to assess the diagnostic impact of a pragmatic implementation of focused sonography of the heart, lungs and deep veins as a diagnostic modality in acute admitted patients...... diagnostic work up is supplemented by focused sonographic examination of the heart, lungs and deep veins of the legs. In the control group, usual diagnostic work up is performed. The χ(2) test, alternatively the Fischer exact test will be used, to establish whether there is a difference in the distribution...

  8. A comparison of cardiovascular risk factors among Indo-Asian and caucasian patients admitted with acute myocardial infarction in Kuala Lumpur, Malaysia and Birmingham, England.

    Science.gov (United States)

    Dhanjal, T S; Lal, M; Haynes, R; Lip, G

    2001-12-01

    Indo-Asians in the UK are at an increased risk of coronary artery disease (CAD); this may be a reflection of their cardiovascular risk factor profile as well as of a more sedentary lifestyle. We hypothesised that Indo-Asians in Malaysia and the UK may exhibit a similar cardiovascular risk factor and physical activity profile, which would be more adverse compared with caucasians. We studied 70 consecutive Indo-Asian patients admitted to hospitals in Kuala Lumpur, Malaysia (n=42; 35 males; mean age 60.6 years, SD 11.8); and Birmingham, England (n=28; 20 males; mean age 60.8 years, SD 12.9). Both groups of Indo-Asian patients were compared with 20 caucasian patients (13 males; mean age 62.7 years, SD 9.4) admitted with myocardial infarction from Birmingham. There was a higher prevalence of diabetes among Indo-Asians in both countries than among caucasians (p=0.0225). By contrast, caucasians had a higher prevalence of hypercholesterolaemia (p=0.0113), peripheral vascular disease (p=0.0008), regular alcohol consumption (pMalaysia and the UK, may in part contribute to the high incidence of CAD in this ethnic group.

  9. Post-burn facial contractures in pediatric patients: Challenging aspects of difficult airway management

    OpenAIRE

    Sukhminder Jit Singh Bajwa; Jasbir Kaur; Amarjit Singh; Gurpratap Singh

    2012-01-01

    Pediatric burn injuries are the most challenging to handle especially when they involve the face as the airway compromise invariably occurs due to edema and inflammation of the soft tissues of pharynx and larynx. The healing of the facial burns causes development of contractures and deformities after survival from the initial insults. Such patients when presented for surgery of the affected area or for that matter any surgery under general anesthesia, poses unique challenges to the attending ...

  10. Long-Term Administration of Oxandrolone Improves Lung Function in Pediatric Burned Patients.

    Science.gov (United States)

    Sousse, Linda E; Herndon, David N; Mlcak, Ronald P; Lee, Jong O; Andersen, Clark R; Zovath, Andrew J; Finnerty, Celeste C; Suman, Oscar E

    2016-01-01

    Pulmonary dysfunction is a significant contributor to morbidity and mortality in the pediatric burned population. We have previously reported that the administration of a synthetic testosterone derivative, oxandrolone, significantly reduced hypermetabolism, and significantly increased height percentile, bone mineral content, lean body mass, and strength in pediatric burned patients. We hypothesize that the administration of oxandrolone will improve pulmonary function in burned pediatric subjects. A subset of severely burned pediatric subjects from a prospective clinical trial (n = 222) were included in our study (n = 54, 7-18 years, ≥30% TBSA burn). The subjects were previously randomized to either the control arm (n = 35) or the oxandrolone arm (0.1 mg/kg twice/day for 12 months, n = 19). Maximum voluntary ventilation, the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects. Subjects treated with oxandrolone had a significantly higher maximum voluntary ventilation (98 ± 53 L/min vs 115 ± 56 with treatment, P = .03). During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects (32.0 ± 8.7 L/min vs 43.7 ± 13.6 with treatment, P = .02). The administration of oxandrolone was associated with improved lung function in pediatric burned patients. PMID:27171844

  11. Does informed consent influence therapeutic outcome? A clinical trial of the hypnotic activity of placebo in patients admitted to hospital.

    OpenAIRE

    Dahan, R.; Caulin, C; Figea, L; Kanis, J. A.; Caulin, F; Segrestaa, J M

    1986-01-01

    To examine whether written informed consent might influence the results of clinical trials the effect of placebo when given with or without informed consent to patients suffering from insomnia was studied. The study was a single blind observer blinded trial, and patients were paired according to sex, age, and hospital environment. Randomisation assigned the first patient of each pair to the control group (without informed consent) or the group to give informed consent. Of the 56 patients, 26 ...

  12. Long-Term Propranolol Use in Severely Burned Pediatric Patients: A Randomized Controlled Study

    Science.gov (United States)

    Herndon, David N.; Rodriguez, Noe A.; Diaz, Eva C.; Hegde, Sachin; Jennings, Kristofer; Mlcak, Ronald P.; Suri, Jaipreet S.; Lee, Jong O.; Williams, Felicia N.; Meyer, Walter; Suman, Oscar E.; Barrow, Robert E.; Jeschke, Marc G.; Finnerty, Celeste C.

    2012-01-01

    Objective To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective randomized single-center controlled study in pediatric patients with large burns. Summary Background Data Severe burns trigger a hypermetabolic response that persists for up to 2 years after burn. Propranolol given for 1 month post burn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear. Methods One-hundred seventy nine pediatric patients with >30% total body surface area burns were randomized to receive control (n = 89) or 4 mg/kg/d propranolol (n = 90) for 12 months after burn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjust for non-normality, repeated measures, and regression analyses. P <0.05 was considered significant. Results Long-term propranolol treatment significantly reduced the percent of the predicted heart rate and percent of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used. Conclusions Propranolol treatment for 12 months, following thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov, NCT00675714. PMID:22895351

  13. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review.

    Science.gov (United States)

    Adjepong, Mary; Agbenorku, Pius; Brown, Patricia; Oduro, Ibok

    2016-01-01

    Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations. PMID:27574687

  14. Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian University Hospital

    OpenAIRE

    Sabzghabaee, Ali Mohammad; Abedi, Daryoush; Fazeli, Hossein; Javadi, Abbasali; Jalali, Mohammad; Maracy, Mohammad Reza; Soltani, Rasool; Karamyafti, Mohammad Javad

    2012-01-01

    Objective: About 73% of death cases in the first 5 days after burning are due to infection complications. The aim of this study was to identify the causing agents of infections in burn patients and the sensitivity pattern of them to the commonly used antimicrobials in an Iranian Burn center University Hospital. Methods: In this cross-sectional study, patients who were admitted to one of the Iranian Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, whom r...

  15. tcpC as a prospective new virulence marker in blood Escherichia coli isolates from sepsis patients admitted to the intensive care unit

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    D. Nagarjuna

    2015-09-01

    Full Text Available The prevalence of the tcpC in the blood Escherichia coli isolates collected from the sepsis patients admitted to the intensive care unit was investigated for the first time. The blood and faecal samples were collected from sepsis and nonsepsis patients, respectively. The prevalence of the tcpC and phylogroups was confirmed by gene-specific PCR. The occurrence of the tcpC in the blood E. coli isolates from sepsis patients was significantly higher than the faecal isolates. The higher prevalence of blood E. coli isolates among the pathogenic groups (B2, D compared to the commensal groups (A, B1 suggests tcpC as a prospective new virulence marker for sepsis.

  16. L-asparaginase-induced abnormality in plasma glucose level in patients of acute lymphoblastic leukemia admitted to a tertiary care hospital of Odisha

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    Mousumee Panigrahi

    2016-01-01

    Full Text Available Objectives: The objective of this study was to evaluate any abnormal change in plasma glucose levels in patients treated with L-asparaginase (L-Asp-based chemotherapy regimen in patients of acute lymphoblastic leukemia (ALL. Materials and Methods: This retrospective, hospital-based study was conducted in patients of ALL, admitted to the Clinical Haematology Department of a tertiary care hospital of Odisha from August 2014 to July 2015. Indoor records of 146 patients on multi-centered protocol-841 were evaluated for any alteration in plasma glucose level, time of onset of hypo/hyperglycemia, and persistence of plasma glucose alteration. Results: Twenty-one percent of patients showed abnormal plasma glucose level. Most of these patients developed hypoglycemia and were of lower age group. Most of these patients developed hypoglycemia and were of lower age group, whereas a majority of higher age group patients developed hyperglycemia. In majority of the cases, abnormal glucose developed after three doses of L-Asp. Hypoglycemia subsided whereas hyperglycemia persisted till the end of our observation period. Conclusions: L-Asp produces more incidences of hypoglycemia than hyperglycemia in a good number of ALL patients towards which clinicians should be more vigilant. However, hyperglycemia persists for a longer duration than hypoglycemia.

  17. Optimal blood glucose control in severely burned patients: a long way to go, but one step closer

    OpenAIRE

    Kamolz, Lars-Peter; Pieber, Thomas; Smolle-Jüttner, Freyja M; Lumenta, David B

    2013-01-01

    Over the past years there has been a significant decrease in mortality and morbidity in patients suffering from severe burns due to improved burn wound management and approaches in critical care. Survival is no longer the exception, but unfortunately death still occurs. One of the key elements concerning state-of-the-art burn care is blood glucose control and insulin therapy; it is well known that burn-induced hyperglycaemia is associated with adverse clinical outcomes. However, controversy f...

  18. Establishment and assessment of new formulas for energy consumption estimation in adult burn patients.

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    Peng Xi

    Full Text Available An accurate knowledge of energy consumption in burn patients is a prerequisite for rational nutrition therapy. This study sought to create a formula that accounts for the metabolic characteristics of adult burn patients to accurately estimate energy consumption of patients with different areas and extents of burn and at different times after injury.Resting energy expenditure (REE data on 66 burn patients, with total body surface area (TBSA of burns ranging from 4% to 96%, were evaluated at different times after injury. REE values were determined in patients using indirect calorimetry at days 1, 2, 3, 7, 14, 21, and 28 after injury. We then constructed a mathematical model of REE changes post-burn. Next, established two new formulas (one non-linear and the other linear for energy consumption estimation using model-based analytical solution and regression analysis. The new formulas were compared with measured REE and commonly used formulas including those of Carlson, Xie, Curreri, and Milner to determine accuracy and reliability.Comparative analysis showed that the new formulas offered significantly higher accuracy and reliability than the Milner formula, which is considered the most accurate of commonly used burn energy consumption estimate formulas. The accuracy of the new nonlinear formula (94.29% and that of the linear formula (91.43% were significantly higher than that of Milner formula (72.86% when compared to measured REE (χ2  =  11.706, P  =  0.001; χ2  =  8.230, P  =  0.004, respectively. The reliabilities of the new estimation formulas were both 100% and that of Milner formula was 74.24% (χ2  =  19.513, P  =  0.000.The new formulas constructed in this study provide reliable simulation of the impact of the degree of burn and post-burn days on energy consumption and offer notably higher accuracy and reliability than other formulas. These formulas will help determine nutritional needs of burn patients.The study

  19. Serum IL-18 Is Increased at Early Postburn Period in Moderately Burned Patients

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available A severe systemic inflammatory response is usually seen after burn injury. IL-18 enhances the Th1 immune responses in bacterial andviral infections. In order to evaluate the IL-18 serum levels as well as IL-6 and TNF-α at the 48th hour postburn, serial serum samples of 8 burned patients were analyzed. 8 moderately burned patients were included into the study. Serum samples were taken at admission at the 48th hour of postburn. IL-6, IL-18, and TNF-α serum levels were analyzed. Total mean burned surface area (TBSA was 24.6±5.7% and mean BMI (body mass index was 24.5±3.4. The patients' age ranged from 17 to 38 (mean 26.3±7.4 years. An increase in sera IL-6, IL-18, and TNF-α was detected at the 48th hour postburn (.0001$"> P<.0001. All patients survived. A marked increase in serum levels of IL-18 as well as the other cytokines evaluated was observed in the moderately burned patients. These three parameters were highly correlated with each other (r>0.9 and .001$">P<.001. This is the first study that shows an increase in serum IL-18 levels at the early postburn period.

  20. Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure. An ACAP-HF data analysis

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    Marrick L. Kukin

    2011-06-01

    Full Text Available Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI at hospital admission are associated with increased length of hospital stay (LOS in patients admitted with acute decompensated heart failure (ADHF. Serum albumin levels and lymphocyte counts were retrospectively determined at hospital admission in 1740 consecutive patients admitted with primary and secondary diagnosis of ADHF. The Nutrition Risk Score (NRI developed originally in AIDS and cancer populations was derived from the serum albumin concentration and the ratio of actual to usual weight, as follows: NRI = (1.519 × serum albumin, g/dL + {41.7 × present weight (kg/ideal body weight(kg}. Patients were classified into four groups as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between nutritional risk category and LOS. 381 Patients (34% were at moderate or severe nutritional risk by NRI score. This cohort had lower BMI (24 ± 5.6 kg/m2, albumin (2.8±0.5 g/dL, mean NRI (73.5±9 and Lower eGFR (50±33 mL/min per 1.73 m2. NRI for this cohort, adjusted for age, was associated with LOS of 10.1 days. Using the Multiple Logistic regression module, NRI was the strongest predictor for LOS (OR 1.7, 95% CI: 1.58-1.9; P=0.005, followed by TIMI Risk Score [TRS] (OR 1.33, 95% CI: 1.03-1.71; P=0.02 and the presence of coronary artery disease (OR 2.29, 95%CI: 1.03-5.1; P=0.04. Moderate and severe NRI score was associated with higher readmission and death rates as compared to the other two groups. Nutritional depletion as assessed by Nutritional Risk Index is associated with worse outcome in patients admitted with ADHF. Therefore; we recommend adding NRI to further risk stratify these patients.

  1. Fluid management in burn patients: results from a European survey-more questions than answers.

    Science.gov (United States)

    Boldt, Joachim; Papsdorf, Michael

    2008-05-01

    Many strategies were proposed for fluid management in burn patients with different composition containing saline solution, colloids, or plasma. The actual clinical use of volume replacement regimen in burn patients in Europe was analysed by an international survey. A total of 187 questionnaires consisting of 20 multiple-choice questions were sent to 187 burn units listed by the European Burn Association. The response rate was 43%. The answers came from a total of 20 European countries. Volume replacement is mostly exclusively with crystalloids (always: 58%; often: 28%). The majority still use fixed formulae: 12% always use the traditional Baxter formula, in 50% modifications of this formula are used. The most often used colloid is albumin (always: 17%, often: 38%), followed by HES (always: 4%, often: 34%). Gelatins, dextrans, and hypertonic saline are used only very rarely. Fresh frozen plasma (FFP) is given in 12% of the units as the colloid of choice. Albumin was named most often to be able to improve patients' outcome (64%), followed by HES (53%), and the exclusive use of crystalloids (45%). Central venous pressure (CVP) is most often used to monitor volume therapy (35%), followed by the PiCCO-system (23%), and mixed-venous saturation (ScVO2; 10%). It is concluded that the kind of volume therapy differs widely among European burn units. This survey supported that no generally accepted volume replacement strategy in burn patients exists. New results, e.g. importance of goal-directed therapy or data concerning use of albumin in the critically ill, have not yet influenced strategies of volume replacement in the burn patient.

  2. A drug utilization study of analgesics for management of postoperative pain in patients admitted at a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Jignesh S. Chaudhari

    2013-12-01

    Conclusions: 112 patients from diclofenac only received group and 13 patients from diclofenac + tramadol received group complain of post operative pain. Post-operative pain control at 12 hours is sufficient but high post-operative pain scores at 18 hour of post-operative time interval suggesting needs of additional pain control. Majority of study patients received single analgesic (Diclofenac sodium. [Int J Basic Clin Pharmacol 2013; 2(6.000: 757-762

  3. Depression as a Predictor of Length of Hospital Stay in Elderly Patients Admitted to Ain Shams University Hospitals

    OpenAIRE

    Sherine M. Elbanouby, Sarah A.Hamza,Samia A. Abdel Rahman and Ahmed Kamel Mortagy

    2013-01-01

    Background: Depression among the physically ill is common and frequently under-diagnosed. Elderly patients with depressive symptoms are at higher risk of hospital admission for non psychiatric conditions and are more likely to have longer hospital stays and worse hospital outcomes, compared with non depressed patients. Objectives: The aim of this study was to find out if depression can be considered a predictor of prolonged hospital stay in elderly patients. Design: A prospective cohor...

  4. ACCIDENTAL SUBCUTANEOUS INJECTION OF VECURONIUM BROMIDE IN A PATIENT WITH BURNS

    Directory of Open Access Journals (Sweden)

    Usha Dev

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: In patients with burn injury drug pharmacology will be altered and this poses special anaesthetic challenge when an subcutaneous injection of a non- depolarizing muscle relaxant occurs in such a patient. Small studies remain an important source of knowledge and hence this study aims to provide information on the anaesthetic management in a case of accidental subcutaneous injection of vecuronium bromide in a burns patient. PRESENTATION, DIAGNOSIS & MANAGEMENT: A 22 year young male with 4 days old hot water induced grade 1 burns involving 45% of body surface area was posted for burns dressing. Anaesthesia was induced with propofol and vecuronium bromide through an external jugular vein to aid tracheal intubation. As the patient was not anaesthetized even after 10 minutes routine check lead to the discovery of fullness at the tip of the intravenous catheter indicating an extravasation of the drugs. Hence the other external jugular vein was cannulated and the patient induced and intubated using propofol, sevoflurane, nitrous oxide and oxygen. The action of vecuronium outlasted the duration of surgery. So the patient continued to receive support of mechanical ventilation with nitrous oxide and oxygen. It took 130 minutes for the clinical signs of recovery from the muscle relaxant to manifest. He was then reversed & extubated with subsequent good recovery. CONCLUSION: Subcutaneous injection of these drugs poses problems of delayed onset of action and prolonged duration of action. In an inadvertent accidental subcutaneous 0.1 mg/kg vecuronium bromide injection in a patient with 4 day old 45% burns showed delayed onset action and prolonged neuromuscular blockade due to subcutaneous deposition of the drug which was managed with mechanical ventilation .The reported resistance to the action of NDMR drugs in patient with burns was not noticed here probably because of the age of the thermal injury.

  5. Feasibility of telecare solution for patients admitted with COPD exacerbation: screening data from a pulmonary ward in a university hospital

    DEFF Research Database (Denmark)

    Gottlieb, Magnus; Marså, Kristoffer; Andreassen, Helle;

    2014-01-01

    to assess the reasons for the exclusion of patients, and the reasons for patients not consenting to participate, as well as to identify the predictors for consenting or not consenting among the subgroup of eligible patients. Methods: In this study, all data in the screening log were collected over a...... help patients manage their disease at home and thereby possibly reduce the risk of readmission. Purpose: The primary aim of this study is to assess the feasibility of a telehealth care solution when offered in connection with discharges from a pulmonary ward at a university hospital. Secondary aims are...

  6. Factors associated with poor prognosis among patients admitted with heart failure in a Nigerian tertiary medical centre: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sani Mahmoud U

    2008-07-01

    Full Text Available Abstract Background Heart failure is a major and growing public health problem worldwide. The prognosis of Heart Failure (HF is uniformly poor despite advances in treatment. The aims of the present study were to determine the causes of HF among patients admitted to a Nigerian tertiary medical centre, to determine the prevalence of factors known to be associated with poor prognosis among these patients, and to compare the factors and causes between males and females. Methods The study was cross-sectional in design, carried out on eligible patients who were consecutively admitted with HF, in Aminu Kano Teaching Hospital, Kano, Nigeria. The following established factors associated with poor prognosis of HF were assessed: low Left Ventricular Ejection Fraction (LVEF of ≤ 40%, anaemia, renal impairment, cardiac rhythm disturbances on the electrocardiogram, prolonged corrected QT interval (QTc, complete Left Bundle Branch Block (LBBB and advanced age. Results A total of 79 patients were studied over a six-month period. Forty four (55.7% of these patients were males while the remaining 35 (44.3% were females. The most prevalent prognostic factor was low LVEF found in a total of 35 patients (44.3%, while the least prevalent was complete LBBB found in two male patients only (2.53%. The commonest cause of heart failure in all patients and males was hypertensive heart disease, found in a total of 45 patients (57.0%, comprising of 33 male (73.3% and 12 female patients (26.7% (p = 0.0003. Cardiomyopathies were the commonest causes in females, the predominant type being peripartum cardiomyopathy found in 11 (31.4% female patients. Acute myocardial infarction has emerged to be an important cause of HF in males (13.6% with a high in-hospital mortality of 66.7%. Conclusion The most prevalent factor associated with poor prognosis was low LVEF. Hypertensive heart disease and cardiomyopathies were the most common causes of HF in males and females respectively

  7. Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention

    NARCIS (Netherlands)

    van den Heuvel, ETP; de Witte, LP; Schure, LM; Sanderman, R; Meyboom-de Jong, B

    2001-01-01

    Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered. Design and setting: Caregi

  8. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit

    NARCIS (Netherlands)

    de Rooij, S. E.; Govers, A.; Korevaar, J C; Abu-Hanna, A; Levi, M; de Jonge, E

    2006-01-01

    OBJECTIVE: To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality DESIGN AND SETTING: Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital. PATIENTS: 578 c

  9. A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

    NARCIS (Netherlands)

    Nijboer, Johanna M. M.; Wullschleger, Martin E.; Nielsen, Susan E.; McNamee, Anitia M.; Lefering, Rolf; ten Duis, Hendrik-Jan; Schuetz, Michael A.

    2010-01-01

    Background: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million i

  10. [Supervision of junior doctors and allocation of work tasks regarding admissions and further treatment of acute admitted patients.

    DEFF Research Database (Denmark)

    Folkestad, Lars; Brabrand, Mikkel; Hallas, Peter

    2010-01-01

    -up of patients with clinical deterioration at the wards. RESULTS: A total of 88 interns with an average of 2.8 months of experience were included in the survey. Sixty percent of the interns answered that they initially dealt with acute admissions. During the day, patients with clinical deterioration......INTRODUCTION: It is being debated whether medical staff working at the emergency departments with acute admission services dealing with medical patients have the required professional competence level. It has not previously been documented which doctors see the acute admissions initially...... are the responsibility of the physicians doing their rounds at the ward. During evening and night hours, 80% of interns say that patients with clinical deterioration are their responsibility. Fifty four percent of participants care for medical patients as they initially arrive at the emergency room. The interns consult...

  11. Pain and anxiety experiences of South African adult burn injury patients during physiotherapy management

    Directory of Open Access Journals (Sweden)

    L.D. Morris

    2010-02-01

    Full Text Available A dequate management of procedural pain during physiotherapy management plays an important role in building a trusting relationship betweenthe burn victim and the physiotherapist, and in ensuring desirable functional outcomes. However, the burn pain management regimens currently utilized inburn units, primarily consist of traditional pharmacologic analgesics which areassociated with numerous side-effects and alone are often reported as inadequateto alleviate procedural pain, warranting safer and effective adjunct therapies.Prior to the introduction and implementation of adjunct therapies into a developing world, it is imperative that the current situation in a burn unit, in terms of whether or not the pain management regimens in place are adequate, is first assessed, due to cost concerns. The following short report exemplifies the pain and anxiety experiences of a small number of burn injury patients during physiotherapy at the Tygerberg Hospital adult burn unit, South A frica.  It was hypothesized that the results of this study would underpin whether adult burn injury patients in a developing countryrequire adjunct therapies during physiotherapy management to supplement traditional pharmacologic analgesics inmanaging their procedural pain and subsequent anxiety.

  12. [Controlling infection and spread of carbapenems-resistant Klebsiella pneumoniae among burn patients].

    Science.gov (United States)

    Huan, Jingning

    2015-02-01

    The emergence and spread of carbapenems-resistant Klebsiella pneumoniae (CRKP) in burn ward is an important threat to burn management. CRKP isolates are resistant to almost all available antibiotics and are susceptible only to polymyxins and tigecycline. The mechanism of the drug resistance of CRKP is associated with the plasmid-encoded carbapenemase Klebsiella pneumoniae carbapenemase (KPC), a carbapenem-hydrolyzing β-lactamase. Antibiotics which can currently be used to treat CRKP infection include polymyxins, tigecycline, and some aminoglycosides. The efficacy of using antibiotics in combination is better than that of single-agent therapy for the treatment of CRKP infection in bloodstream. In order to control CRKP infection in burn patients, strategies for preventing CRKP dissemination in burn ward are strongly advocated.

  13. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N.; Williams, Felicia N.; Al-Mousawi, Ahmed M; Finnerty, Celeste C.; Jeschke, Marc G

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on body mass index percentiles. Results Patients stratified below (normal) and ≥ 85th percentile had similar age, gender distribution, and total burn size. No significant differences were detected in the incidence of sepsis (11% for obese vs. 10% for normal), the incidence of multiple organ failure (21% for obese and 16% for normal), or mortality (11% for obese vs. 8% for normal). Compared to the normal group, the ≥ 85th percentile group had low levels of constitutive proteins (α2macroglobulin and Apolipoprotein A-1) (p < 0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (p < 0.05 for both) up to 60 days after injury. Patients ≥ 85th percentile showed a significant higher loss of bone mineral density and lipolysis compared to normal individuals. Stepwise logistic regression analysis revealed that body mass index had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (p < 0.001). Conclusions BMI ≥ 85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, multiple organ failure, or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered inflammatory response occurs already in patients starting at the 85th percentile BMI. PMID:22143622

  14. Burn Rehabilitation

    Directory of Open Access Journals (Sweden)

    Koray Aydemir

    2011-07-01

    Full Text Available Burn injuries are important in terms of causing serious disability and threatening life. With the establishment of modern burn treatment units and advances in acute care management contributed to a reduced mortality rate over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive burn rehabilitation program. Burn rehabilitation is a process that starts from day of admission and continues for months or sometimes years after the initial event. The term ‘burn rehabilitation’ incorporates the physical, physiological and social aspects of care. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Burn rehabilitation aims to prevent the possible complications, minimalize joint contractures and deformities, increase range of motion, control hypertrophic scarring, achieve the best possible functional capacity and to regain the patients vocational and recreational activities. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 70-7

  15. Profile and mortality outcome of patients admitted with cryptococcal meningitis to an urban district hospital in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Benjamin Adeyemi

    2014-11-01

    Full Text Available Introduction: Cryptococcal meningitis (CCM is one of the leading causes of early mortality among HIV-infected patients. This study was a part of clinical audit (1 aimed at improving care for patients with CCM at an urban district hospital in South Africa. Methods: Clinical records of all patients (age>13 years admitted to the hospital with a diagnosis of CCM (based on a positive India ink, positive cryptococcal latex agglutination test (CLAT or a positive culture of Cryptococcus neoformans between June 2011 and December 2012 were retrospectively reviewed. Descriptive statistics and Chi-square analysis were generated with Epi Info 7.1.2.0. 95% confidence intervals were reported where appropriate. Results: Of the 127 patients admitted with CCM, only 97 (76.4% knew their HIV status. Only 44.8% (43/96 of those who knew they were HIV positive were on antiretroviral therapy (ART. Seventeen out of 25 patients (68% previously treated for CCM had defaulted fluconazole and only 60% (15/25 were on ART. Acute mortality (death within 14 days of CCM diagnosis was 55.9% (71/127. The median time to death from diagnosis was four days (IQR 2–9. The association between CSF WBC count<20cells/mL and increased risk of death within 14 days was statistically significant (OR 2.2; 95% CI 1.1–4.6, p=0.03. Patients with heavy cryptococcal burden (reported as numerous yeasts seen on microscopy at diagnosis were three times more likely to die within 14 days of diagnosis of CCM (OR 3.2; 95% CI 0.9–10.7, p=0.06. Even though a CD4 count<100cells/mm3 was associated with a 1.6 times increased acute mortality risk, the association was not statistically significant (OR 1.6; 95% CI 0.6–4.6, p=0.3. The role of elevated CSF opening pressure at diagnosis was not assessed because only two (1.6% patients had their baseline opening pressure measured. Conclusions: Acute CCM-related mortality remains high. The number of patients who do not know their HIV status, the number of HIV

  16. Inhalation injury in burn patients: establishing the link between diagnosis and prognosis.

    Science.gov (United States)

    You, Kicheol; Yang, Hyeong-Tae; Kym, Dohern; Yoon, Jaechul; HaejunYim; Cho, Yong-Suk; Hur, Jun; Chun, Wook; Kim, Jong-Hyun

    2014-12-01

    This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1±13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (pburns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.

  17. [Review and prospect of parenteral nutrition support for burn patients in China].

    Science.gov (United States)

    Deng, Shi-lin

    2008-10-01

    Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standardized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immuno nutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immuno nutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly, the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parenteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition. PMID:19103029

  18. Is the Target of 1 Day of Stay per 1% Total Body Surface Area Burned Achieved in Chemical Burns?

    Science.gov (United States)

    Tan, Teresa; Wong, David S Y

    2016-02-01

    The length of hospital stay (LOS) is a standard parameter used to reflect quality and evaluate outcomes in acute burn care. This study aims to assess whether the target of 1 day of stay per 1% total body surface area (TBSA) burned was achieved in acute chemical burns management and factors affecting the LOS. A retrospective analysis of the records of patients who suffered from chemical burn injuries admitted to a university burn center over a continuous 14-year period was performed.A total of 118 patients were admitted over the period for chemical burns. Only 14% of cases achieved the target stated. Factors associated with lengthening of the hospital stay included TBSA, ocular involvement, the cause of injury, and the need for surgery during the same admission.The LOS in chemical burns frequently exceeds 1 day of stay per 1% TBSA burned. Many factors can contribute to a patient's LOS and are worth exploring in order to see if the impact of these factors could be minimized. Early surgical intervention should help to reduce the LOS if reliable methods of burn wound depth assessment are available.

  19. Randomized-controlled trial of esomeprazole in functional dyspepsia patients with epigastric pain or burning

    DEFF Research Database (Denmark)

    Talley, N J; Vakil, N; Lauritsen, K;

    2007-01-01

    BACKGROUND: Early identification of true responders to acid suppression in functional dyspepsia patients with symptoms of epigastric pain or burning may enable clinicians to optimally tailor treatment. AIM: To evaluate whether a 1-w acid suppression trial is useful for identifying true responders...... in this population. METHODS: Patients (18-70 years) were randomized to either esomeprazole 40 mg q.d.s., b.d. or placebo for 1w, and then esomeprazole 40 mg q.d.s. or placebo for 7w. Epigastric pain and/or burning were recorded on a 4-point scale (0 = none, 3 = severe). Trial-week response was defined as symptom...... is of limited use for predicting symptom response at 8w in patients with unexplained epigastric pain or burning....

  20. 'The time it takes…' How doctors spend their time admitting a patient during the acute medical take.

    Science.gov (United States)

    Sabin, Jodie; Khan, Waleed; Subbe, Christian P; Franklin, Marc; Abulela, Iman; Khan, Anwar; Mohammed, Hassan

    2016-08-01

    Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. History taking and examination by a core medical trainee took 22 minutes for a patient referred from the ED and 21 minutes for a patient referred from primary care. A complete admission clerking with prescription and ordering of investigations ranged from a mean of 15 minutes for a consultant in acute medicine to a mean of 55 minutes for a foundation year 1 trainee. The duration of post-take ward rounds also showed significant variability.Our data can be used to model staffing patterns if combined with information about admission numbers and local set up. PMID:27481373

  1. Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Rafiei

    2013-01-01

    Conclusions: There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension.

  2. A Study on Clinical Features and Cost Incurred by Dengue Syndrome Patients Admitted to a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Sathish Chandra MR, Ashwath Narayana DH, Manjunath M

    2014-01-01

    Conclusion: Professionals and public should be made aware of common clinical manifestations of dengue syndrome for early reporting and seeking prompt treatment there by reducing the case fatality rate and the economic loss to the patients and country at large.

  3. Proposed protocol for realization of abdominal CT in patients admitted to the emergency room for trauma in HSJD

    International Nuclear Information System (INIS)

    A protocol is established for computed tomography in trauma patients treated in emergency of Hospital San Juan de Dios. A literature review is conducted on abdominal CT protocols in specialized databases. The criteria, scanning, parameters and delay time are established for realization of abdominal CT in patients with traumatic emergencies in HSJD. Taking the thickness of the sections, the thickness of the sections in reconstruction, the quantities of contrast and the speed of injection in patients, have been standardized for the realization of abdominal CT in HSJD. Computed tomography should be preferably performed of routine in portal phase and the late from 5 minutes in patients with abdominal trauma, contributing in this phase as much information regarding the extent of abdominal injury

  4. Transfer of patients with severe burn injury%严重烧伤伤员的转运

    Institute of Scientific and Technical Information of China (English)

    彭毅志

    2015-01-01

    Transfer of patients with severe burn injury is an important issue during the rescue of mass casualties,as it may give rise to great influence on the prognosis of patients.Timing of transfer,preparation before transfer,and details for attention are elaborated in this article,aiming to further specify the procedures of transfer of patients with burn injury.

  5. Inappropriate prescribing to older patients admitted to hospital: A comparison of different tools of misprescribing and underprescribing

    OpenAIRE

    San-José, Antonio; Agustí, Antonia; Vidal, Xavier; Formiga Pérez, Francesc; López-Soto, Alfonso; Fernández Moyano, Antonio; García, Juana; Ramírez Duque, Nieves; Torres, Olga H.; Barbé, José

    2014-01-01

    Purpose: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and t...

  6. Clinical profile of dengue fever infection in patients admitted in tertiary care centre Agroha, Hisar, Haryana, India

    OpenAIRE

    Mohd Younus Shah; Mohd Mubarak Naqash; Goel, R.K.; Deepak Galhan; Sunil Kumar; Vivek Chhabra; Abhishek Saini; K. L. Jaggal

    2016-01-01

    Background: Dengue infections can result in a wide spectrum of disease severity ranging from an influenza-like illness (dengue fever; DF) to the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The study was aimed to compare the clinical profile of all patients diagnosed with dengue viral infection at MAMC. Methods: This retrospective study included 188 patients infected with dengue virus, age 6 years to 70 years. Laboratory and haematological data were include...

  7. Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the Intensive Care Unit

    Science.gov (United States)

    Rafinazari, Niloofar; Abbasi, Saeed; Farsaei, Shadi; Mansourian, Marjan; Adibi, Peyman

    2016-01-01

    Objective: Concern about adverse effects of the inconsistent use of stress-related mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this study was designed to prospectively evaluate the rate of inappropriate stress ulcer prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine the adherence to American Society of Health-System Pharmacists (ASHP) guideline during ICU stay. Methods: In this study, 200 patients were randomly selected from all ICU admissions during 9 months. Risk factors of stress ulcer were recorded daily during ICU stay and appropriateness of SUP administration was assessed according to the ASHP criteria. Findings: Of all 160 (80%) patients who received SUP, 44.4% did not have indication; and among 95 patients with an indication for SUP administration, 6.3% did not receive it upon ICU admission. Consequently, 77 (38.5%) of 200 patients received inappropriate prophylaxis on ICU admission. In addition, 53.5% of patients had appropriate adherence to ASHP guideline during all days of ICU stay (44% and 2.5% of patients received SUP more than 120% and administration included both overutilization and underutilization in this ICU, but high prevalence of SUP overutilization caused unnecessary hospital costs, personal monetary burden, and may increase adverse drug reactions. Therefore, educating physicians and cooperation of clinical pharmacists regarding implementing standard protocols could improve patterns of SUP administration.

  8. Herpes simplex virus infection in burned patients: epidemiology of 11 cases.

    Science.gov (United States)

    Bourdarias, B; Perro, G; Cutillas, M; Castede, J C; Lafon, M E; Sanchez, R

    1996-06-01

    Burned patients suffer significant immunosuppression during the first 3 or 4 weeks after hospitalization. Herpes simplex virus (HSV) infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We studied retrospectively 11 patients with severe burn injury who became infected with HSV. We determined the prevalence of viral infection in this group of patients. Serological testing and viral culture was used to diagnose HSV infection. No general complications appeared in these 11 patients in association with HSV but two patients died of multiorgan failure. Locally, areas of active epidermal regeneration were most commonly affected. Acyclovir therapy was not used and the duration of hospitalization was normal in these 11 patients. PMID:8781721

  9. CLINICAL AND DEMOGRAPHIC STUDY OF JAPANESE ENCEPHALITIS PATIENTS ADMITTED IN GAUHATI MEDICAL COLLEGE AND HOSPITAL, GUWAHATI, ASSAM, INDIA DURING 2014 EPIDEMIC

    Directory of Open Access Journals (Sweden)

    Bhaskar

    2015-11-01

    Full Text Available BACKGROUND Japanese Encephalitis is one of the most common causes of Acute Encephalitic Syndrome in Asia. During the period of June to August in 2014 an epidemic occurred in Assam, a northestern state of India. METHODS Patients admitted in the Medicine Department in Gauhati Medical College and Hospital (GMCH, Guwahati, Assam, India, with clinical features of Acute Encephalitic Syndrome (AES i.e. acute onset fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk and/or new onset seizures (excluding simple febrile seizures from June to August 2014 underwent ELISA for Japanese Encephalitis Immunoglobulin M in cerebrospinal fluid (CSF at the time of admission. Clinical features, demographic profile and laboratory investigations were recorded in positive patients. RESULTS 226 AES patients were admitted in 6 different units of Medicine ward in GMCH, out of which 76 patients were diagnosed to be JE positive with CSF IgM ESLIA, coming from 17 districts of Assam. Out of 76 patients, 69 patients were from rural area, only 7 patients were from urban area. 59 (77.63% patients were farmers or daily labourers by occupation and 23 (30.26% patients were illiterate. Mean age of patients was 47.7 years and male to female ratio was 1.7:1. Mean duration of fever was 6.5 days, convulsion was found in 13.15% patients, out of which most common was generalised seizure (9.2%. 55.2% patients had meningeal signs, 23.68% patients had focal neurological deficits in the form of hemiparesis and monoparesis and mean GCS score was 9.28. Extra pyramidal features present in patients were rigidity (23.68%, abnormal posturing (15.78% and abnormal movements (23.68%. 23.68% patients had Leukocytosis and Thrombocytopenia was found in 21 (27.6% patients. Mean CSF cell count was 34.34 cells/mm3 with mean 29.67% polymorphs, mean CSF protein and sugar was 56.15 mg/dl and 66.92 mg/dl respectively. Serum bilirubin level was

  10. The Effect of Foot Massage on Physiological Indicators of Female Patients with CVA Admitted in the ICU

    Directory of Open Access Journals (Sweden)

    Z Moshtaqeshgh

    2009-07-01

    Full Text Available Introduction: Intensive care unit is one of stressful wards for patients and stress creates some alterations in physiologic indicators of patients. So it is necessary to use a low expense and comforting method to stabilize physiologic indicators. The purpose of the present research is to determine the effect of foot massage on physiologic indicators including pulse, respiration, mean arterial pressure, temperature and arterial blood oxygen saturation. Methods: This research was a quasi experimental study and a clinical trial with repeated measures in which 46 patients with brain stroke hospitalized in intensive care unit of Tajrish Shohada Hospital in Tehran were studied. Information was collected 10 minutes before and 10 and 30 minute intervals after foot stroke massage on the second, third and fourth days of ICU admission. Data was analyzed with repeated measures ANOVA statistical method. Results: Findings showed that after 5-minute foot massage, pulse rate, respiratory rate and mean arterial blood pressure significantly decreased (P<0.001 and spo2 increased (P<0.001. Decreasing temperature was significant but alterations were little and clinically it can be said that body temperature had no alteration and approximately remained constant. Conclusion: Findings showed that parasympathetic activity after foot massage results in alteration of various body physiologic responses, relaxes patients and decreases their anxiety. Therefore anxiety of patients can decreased with using a simple, low expense and non invasive method and can stabilize physiologic indicators and decrease effects of vital signs instability.

  11. [Fatal hyperpyrexia in an adolescent patient with severe burns after a traffic accident].

    Science.gov (United States)

    Jaehn, T; Sievers, R; Junger, A; Graunke, F; Blings, A; Reichert, B

    2016-07-01

    After a motorcycle accident a 16-year-old patient suffered severe burns to 40.5 % of the total body surface area (TBSA) of which 37 % were deep subdermal burns. After tangential and partly epifascial necrosectomy, Integra® was used as a temporary dermis replacement material for the lower extremities, combined with extensive negative pressure wound therapy (NPWT). In the further course of the treatment the patient developed uncontrollable hyperpyrexia with a fatal outcome. Possible influencing factors, such as the dermis replacement material combined with NPWT over large areas as well as the differential diagnoses propofol infusion syndrome, heatstroke and malignant hyperthermia are discussed. PMID:26767381

  12. Dysrhythmias Induced by Streptokinase Infusion in Patients with Acute Myocardial Infarction Admitted to Cardiac Care Units in the Northwest of Iran

    Directory of Open Access Journals (Sweden)

    Parizad Razieh

    2014-01-01

    Full Text Available Objective: Currently, the most common cause of death in the world is cardiovascular disease, particularly myocardial infarction. Myocardial infarction is caused by reducing or cutting off the blood supply to the heart muscle due to obstruction caused by the presence of plaque or thrombus. The first step for the treatment of acute myocardial infarction is using thrombolytic drugs. By the analysis of plaque and removing the blockage, the blood flows to the affected area again. The most important thrombolytic agent is streptokinase; however, in addition to its therapeutic effect it also has some complications and by identifying them mortality and disability can be prevented. The present study aimed to investigate the most common arrhythmia after infusion of streptokinase in patients with acute myocardial infarction (AMI. Materials and Methods: This research was a descriptive study. The study population included patients admitted to the cardiac care unit of Shahid Madani Hospital, Tabriz, Iran, with a diagnosis of AMI from September 2012 until March 2014. Data were collected by using a checklist and the findings of the study were analyzed by SPSS software. Results: Of the 116 hospitalized patients, 78 (67.5% were male and 37 (32.5% were female, and the largest percentage of infected patients was in the age group of 60-70 years [n = 38 (33%]. Regarding cardiac risk factors, 57 (49% of patients were hyperlipidemic, 36 (31% were diabetic, 34 (30% had high blood pressure, 25 (21% were smokers, and 21 (18% had a positive family history of cardiac problems. Patients who were admitted with a diagnosis of AMI, in 53 (46% cases had streptokinase injection, and in 86 (74% complications had occurred during drug injection; 87 (75% patients had dysrhythmia and 29 (25% had bleeding. Common dysrhythmia was premature ventricular contraction (PVC with 90 (78.2% cases. Moreover, 53 (46% patients had slow ventricular tachycardia (VT, 18 (16% had premature atrial

  13. Outcome and prognostic indicators of patients with hematopoietic stem cell transplants admitted to the intensive care unit.

    Science.gov (United States)

    Huynh, Thanh N; Weigt, S Sam; Belperio, John A; Territo, Mary; Keane, Michael P

    2009-01-01

    The prognosis of patients with hematopoietic stem cell transplants (HSCTs) who require admission to the intensive care unit (ICU) has been regarded as extremely poor. We sought to re-evaluate recent outcomes and predictive factors in a retrospective cohort study. Among the 605 adult patients that received an HSCT between 2001 and 2006, 154 required admission to the ICU. Of these, 47% were discharged from the ICU, 36% were discharged from the hospital, and 19% survived 6 months. Allogeneic transplant, mechanical ventilation, vasopressor-use, and neutropenia were each associated with increased mortality, and the mortality of patients with all four characteristics was 100%. Hemodialysis was also associated with increased mortality in a Kaplan-Meier analysis but did not appear important in a multivariate tree analysis. A final Cox model confirmed that allogeneic transplant, mechanical ventilation, and vasopressor-use were each independent risk factors for mortality in the 6 months following ICU admission. PMID:20130763

  14. Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation.

    Science.gov (United States)

    Klein, H J; Schanz, U; Hivelin, M; Waldner, M; Koljonen, V; Guggenheim, M; Giovanoli, P; Gorantla, V S; Fehr, T; Plock, J A

    2016-03-01

    Sensitization describes the acquired ability of the immune system to react to foreign human leukocyte antigens (HLA) by producing antibodies and developing memory cells. In the field of transplantation, recipient preformed HLA antibodies due to previous sensitization have been identified - beneath ABO incompatibility - as a major factor for acute graft rejection. Several reasons for sensitization have largely been studied, such as previous blood transfusions, pregnancies or former transplants. Recent studies indicate that the use of assist devices (e.g. ECMO) or cadaveric skin allotransplantation providing temporary coverage in burn patients may lead to additional sensitization. As vascularized composite allotransplantation (VCA) has become a rapidly advancing therapeutic option for reconstruction of complex tissue defects in burns, it seems even more important to become familiar with immunological principles and to be cautiously aware of both sources of sensitization and therapeutic concepts in burns avoiding sensitization. This may also include emergency VCAs in burn patients as potential strategy for early definitive reconstruction avoiding procedures triggering HLA antibody formation. We hereby provide an overview on current evidence in the field of pre- and peritransplant sensitization, followed by posttransplant strategies of desensitization and their potential impact on future treatments of burn patients. PMID:26392022

  15. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature.

    Science.gov (United States)

    Mann, Elizabeth A; Wood, Geri L; Wade, Charles E

    2011-06-01

    The purpose of this systematic review was to assess the evidence for use of routine procalcitonin testing to diagnose the presence of sepsis in the burn patient. The electronic databases MEDLINE, Cochrane, CINAHL, ProQuest, and SCOPUS were searched for relevant studies using the MeSH terms burn, infection, procalcitonin, and meta-analysis. The focus of the review was the adult burn population, but other relevant studies of critically ill patients were included as data specific to the patient with burns are limited. Studies were compiled in tabular form and critically appraised for quality and level of evidence. Four meta-analyses, one review of the literature, one randomized controlled trial, nine prospective observational, and three retrospective studies were retrieved. Six of these studies were specific to the burn population, with one specific to burned children. Only one meta-analysis, one adult burn and one pediatric burn study reported no benefit of procalcitonin testing to improve diagnosis of sepsis or differentiate sepsis from non-infectious systemic inflammatory response. The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination. Evaluation of the burn specific studies is limited by the use of guidelines to define sepsis and inconsistent results from the burn studies. Utility of the procalcitonin assay is limited due to the lack of availability of rapid, inexpensive tests. However, it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit.

  16. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-01-01

    Full Text Available Objective. To examine whether cognitive behavioral therapy (CBT alleviates dysfunctional eating (DE patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females patients with a mean (SD age of 43 (10 years and BMI 43.5 (4.9 kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education. The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, g=-.92, P≤.001; DE-uncontrolled eating, g=-.90, P≤.001, moderate (HADS-depression, g=-.73, P≤.001; DE-emotional eating, g=-.67, P≤.001; HADS-anxiety, g=-.62, P=.003, and low (BMI, g=-.24, P=.004. Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558.

  17. Study of patterns of prescribing antibiotics in geriatric patients admitted to the medical wards in a tertiary care hospital

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    Ankita Bist

    2016-02-01

    Conclusions: Polypharmacy is commonly observed practice in geriatric patients. Apart from increasing the cost of treatment it also promotes irrational prescription of drugs. Most of the prescriptions were in adherence with the WHO's Essential Medicine List but antibiotics were mainly prescribed empirically. [Int J Basic Clin Pharmacol 2016; 5(1.000: 155-158

  18. Antimicrobial resistance in Salmonella spp. recovered from patients admitted to six different hospitals in Tehran, Iran from 2007 to 2008

    DEFF Research Database (Denmark)

    Tajbakhsh, Mercedeh; Hendriksen, Rene S.; Nochi, Zahra;

    2012-01-01

    The objective of this study was to assess the genotypic diversity associated with antimicrobial susceptibility of Salmonella serovars isolated from patients arriving with diarrhoea to six hospitals of Tehran, Iran. During 2007–2008, a cross-sectional convenience study was performed. Stool samples...

  19. INCIDENCE OF FLUOROQUINOLONES INDUCED PSYCHOTIC DISORDERS IN PATIENTS ADMITTED TO DEPARTMENT OF MEDICINE IN A GENERAL HOSPITAL SETUP

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    Dnyanda V

    2015-10-01

    Full Text Available Toxic psychosis in adults although it is relatively uncommon side-effect in proportion to the large worldwide consumption of the drugs, there has been a number of case reports of Fluoroquinolone-associated psychosis. Our study was first of its kind as no other prospective cohort study on the use of fluoroquinolones and its relation to development of psychosis has yet been carried out. 2007 patients who were prescribed fluoroquinolones were followed for one month for development of any signs of psychosis out of which 22 patients that is 1.11% was found to have fluoroquinolones induced psychosis. We also discuss the possible neurophysiological mechanisms behind fluoroquinolones induced psychosis.

  20. Application of Silver Sulfadiazine Cream With Early Surgical Intervention in Patients Suffering From Combined Burn-Blast Injury Facial Tattoos

    OpenAIRE

    Ebrahimi, Ali; Kalantar Motamedi, Mohammad Hosein

    2012-01-01

    Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied...

  1. INCIDENCE OF FLUOROQUINOLONES INDUCED PSYCHOTIC DISORDERS IN PATIENTS ADMITTED TO DEPARTMENT OF MEDICINE IN A GENERAL HOSPITAL SETUP

    OpenAIRE

    Dnyanda V; Vidyut A; Shrikant B.; Ashish V

    2015-01-01

    Toxic psychosis in adults although it is relatively uncommon side-effect in proportion to the large worldwide consumption of the drugs, there has been a number of case reports of Fluoroquinolone-associated psychosis. Our study was first of its kind as no other prospective cohort study on the use of fluoroquinolones and its relation to development of psychosis has yet been carried out. 2007 patients who were prescribed fluoroquinolones were followed for one month for develo...

  2. Comparison of Plasma BNP and ET-1 Levels With Hemodynamics in Patients Admitted for Decompensated Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Hu Yongmei; Zhao Siqin; Li Qiu; Nie Xiaoli; Wu Tao; Liu Xiaorong; Wang Mian

    2005-01-01

    Objectives This study addressed to compare plasma B-type natriuretic peptide (BNP) and endothelin-1 (ET-l) levels with hemodynamics in heart failure (HF) patients. Methods Plasma BNP and ET-1 levels were obtained from 75patients with HF by rapid immunofluorescence assay and radio-immunity method, respectively, and left ventricular end-diastolic diameter (LVEDD) were observed by echocardiogram. Hemodynamic data of 53HF patients were determined by Swan-Ganz catheterization. Results Hemodynamics (PCWP,MPAP and RAP) and plasma BNP, ET-1 levels were proportional to New York Heart Association (NYHA)class (P< 0.001-0.05). Both BNP and ET-1 had positive linear relations with PCWP, MPAP, RAP (P< 0.05-001). Moreover, plasma ET-1 was an independent and significant predictor of BNP (P<0.001). Plasma levels of BNP (968.23±478.63 pg/ml)and ET-1 (129.45±88.56 pg/ml)in group with LVEDD (n=31) ≥60 mm were much higher than those in LVEDD(n = 44) < 60mm group (BNP:286.26 ±156.89 pg/mL,ET-1:87.45±43.65 pg/mL, P< 0.001). Conclusions BNP level is as a direct result of ventricular volume expansion and pressure overload. BNP is a sensitive biochemical maker of left ventricular injury and ET-1may stimulate the secretion of cardiac BNP independent of hemodynamics in patients with HF.

  3. Are AMI patients with comorbid mental illness more likely to be admitted to hospitals with lower quality of AMI care?

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    Xueya Cai

    Full Text Available OBJECTIVE: Older patients with comorbid mental illness are shown to receive less appropriate care for their medical conditions. This study analyzed Medicare patients hospitalized for acute myocardial infarction (AMI and determined whether those with comorbid mental illness were more likely to present to hospitals with lower quality of AMI care. METHODS: Retrospective analyses of Medicare claims in 2008. Hospital quality was measured using the five "Hospital Compare" process indicators (aspirin at admission/discharge, beta-blocker at admission/discharge, and angiotension-converting enzyme inhibitor or angiotension receptor blocker for left ventricular dysfunction. Multinomial logit model determined the association of mental illness with admission to low-quality hospitals (rank of the composite process score 90(th percentile, compared to admissions to other hospitals with medium quality. Multivariate analyses further determined the effects of hospital type and mental diagnosis on outcomes. RESULTS: Among all AMI admissions to 2,845 hospitals, 41,044 out of 287,881 patients were diagnosed with mental illness. Mental illness predicted a higher likelihood of admission to low-quality hospitals (unadjusted rate 2.9% vs. 2.0%; adjusted odds ratio [OR]1.25, 95% confidence interval [CI] 1.17-1.34, p<0.01, and an equal likelihood to high-quality hospitals (unadjusted rate 9.8% vs. 10.3%; adjusted OR 0.97, 95% CI 0.93-1.01, p = 0.11. Both lower hospital quality and mental diagnosis predicted higher rates of 30-day readmission, 30-day mortality, and 1-year mortality. CONCLUSIONS: Among Medicare myocardial infarction patients, comorbid mental illness was associated with an increased risk for admission to lower-quality hospitals. Both lower hospital quality and mental illness predicted worse post-AMI outcomes.

  4. A clinical observation of early short-term use of potent antibiotics in severely burned patients

    Institute of Scientific and Technical Information of China (English)

    RONG Xin-zhou; ZHANG Wen-zhen; REN Jia-liang; ZHOU Wei-ming

    2001-01-01

    Objective: To evaluate the effect of early and short-term use of potent antibiotics following extensive severe burn injury. Methods: Seventeen severely burned patients hospitalized in the same period (Nov.,1998 to Oct., 2000) wer esame treatment in Group 2 (n=8) was discontinued until day 15 postburn. The survival rate, blood bacterial culture, body temperature and white blood cell and platelet counts were compared between the 2 groups. Results: All the 17 patients survived and all blood bacterial cultures were negative. No significant difference of body temperature and white blood cell and platelet counts between the 2 groups was observed (P>0.05). Conclusion: Early use of high-potency antibiotics at short treatment course after extensive severe burn is effective to prevent infection and reduce the cost.

  5. Antibacterial susceptibility of bacteria isolated from burns and wounds of cancer patients

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    Sulaiman A. Alharbi

    2014-01-01

    Full Text Available In this study 540 burns and wound swabs were collected from cancer patients of some Egyptian hospitals. The single infection was detected from 210, and 70 cases among wounded and burned patients, while mixed infection was 30 and 45, respectively. We recovered where 60 isolates of Pseudomonas aeruginosa, 60 isolates of Staphylococcus aureus, 7 isolates of Staphylococcus epidermidis, 4 isolates of Streptococcus pyogenes, 25 isolates of Escherichia coli, 23 isolates of Klebsiella pneumoniae and 27 isolates of Proteus vulgaris from 355 burn and surgical wound infections . All bacterial isolates showed high resistance to the commonly used β-lactams (amoxycillin, cefaclor, ampicillin, vancomycin, amoxicillin/clavulonic, and low resistance to imepenim and ciprofloxacin. Plasmid analysis of six multidrug resistant and two susceptible bacterial isolates revealed the same plasmid pattern. This indicated that R-factor is not responsible for the resistance phenomenon among the isolated opportunistic bacteria. The effect of ultraviolet radiation on the isolated bacteria was studied.

  6. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study

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    Nilgün Aksoy

    2014-08-01

    Full Text Available Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female. The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%. The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046, intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047, referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001, and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001 were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035. Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from

  7. Medical and household characteristics associated with methicillin resistant Staphylococcus aureus nasal carriage among patients admitted to a rural tertiary care hospital.

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    Leah Schinasi

    Full Text Available BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA poses a threat to patient safety and public health. Understanding how MRSA is acquired is important for prevention efforts. This study investigates risk factors for MRSA nasal carriage among patients at an eastern North Carolina hospital in 2011. METHODS: Using a case-control design, hospitalized patients ages 18 - 65 years were enrolled between July 25, 2011 and December 15, 2011 at Vidant Medical Center, a tertiary care hospital that screens all admitted patients for nasal MRSA carriage. Cases, defined as MRSA nasal carriers, were age and gender matched to controls, non-MRSA carriers. In-hospital interviews were conducted, and medical records were reviewed to obtain information on medical and household exposures. Multivariable conditional logistic regression was used to derive odds ratio (OR estimates of association between MRSA carriage and medical and household exposures. RESULTS: In total, 117 cases and 119 controls were recruited to participate. Risk factors for MRSA carriage included having household members who took antibiotics or were hospitalized (OR: 3.27; 95% Confidence Interval (CI: 1.24-8.57 and prior hospitalization with a positive MRSA screen (OR: 3.21; 95% CI: 1.12-9.23. A lower proportion of cases than controls were previously hospitalized without a past positive MRSA screen (OR: 0.40; 95% CI: 0.19-0.87. CONCLUSION: These findings suggest that household exposures are important determinants of MRSA nasal carriage in hospitalized patients screened at admission.

  8. Factors Related to Postoperative Pain Trajectories following Total Knee Arthroplasty: A Longitudinal Study of Patients Admitted to a Russian Orthopaedic Clinic.

    Science.gov (United States)

    Kornilov, Nikolai; Lindberg, Maren Falch; Gay, Caryl; Saraev, Alexander; Kuliaba, Taras; Rosseland, Leiv Arne; Muniz, Konstantin; Lerdal, Anners

    2016-01-01

    This study explores sociodemographic, clinical, and surgical factors in relation to pain trajectories during the first 3 days following total knee arthroplasty (TKA). 100 patients (mean age 63.5 ± 7.8 years and 93% female) consecutively admitted for uncomplicated primary TKA were prospectively included. Postoperative pain was assessed using pain diaries. Measures of preoperative pain, symptoms, daily functioning, quality of life, comorbidities, knee function, perioperative characteristics, and physical/biochemical parameters were also evaluated. All pain ratings decreased in the three days following surgery (p cohabitation, or any patient clinical and biochemical characteristics but were significantly related to preoperative anxiety (p = .029). Patients reporting moderate/severe pain prior to surgery also reported more hours in moderate/severe pain on days 0-3 postoperatively (p = .029). Patients with surgeries longer than 90 min reported more hours of moderate/severe pain compared with patients who had shorter surgeries (p = .008), and similar results were observed for ratings of pain with activity (p = .012). In this sample, only female gender, higher levels of preoperative pain and anxiety, and longer surgical duration were associated with increased pain after TKA. PMID:26885390

  9. Nosocomial Infections in Iranian Pediatric Patients With Burn Injuries: A Review

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    Mohammad Sadegh Rezai

    2015-07-01

    Full Text Available Context: Nosocomial infections (NIs are the most common life-threatening complications and leading cause of morbidity and mortality in pediatric patients with burn injuries. It is estimated that annually two million infections, 90000 deaths, and 4.5 billion USD in excess healthcare costs are imposed by NIs. Herein, we reviewed the articles related to NIs in Iranian pediatric patients with burn injuries. Evidence Acquisition: A review of epidemiologic studies on NI in pediatric patients with burn injuries in Iran was performed by searching studies indexed in PubMed, Google scholar, Iranmedex, Magiran, SID databases, published in English language in 2014. Keywords for searching included “Nosocomial Infections”, “Hospital- acquired infection”, “Healthcare- associated infections”, “burn”, “children”, “pediatric”, and “Iran”. All articles related to NIs in pediatric patients with burn injuries or about general population with burn injuries, which included pediatric population up to the age 18 years in Iran, were included. Articles out of the definition for age group or lack of significant data, outpatients, and patients selected for reconstructive surgeries were excluded. Results: Of 43 reviewed articles, nine eligible articles were selected. The male to female ratio was 1.6:1. The age ranged from birth to 18 years with the mean of 3.4 years. Overall incidence of NIs was 20.94%. Pseudomonas aeruginosa (30.39%, Klebsiella pneumonia (17.54%, Acinetobacter (17.47%, and Staphylococcus aureus (14.98% were the most common prominent isolates with high antibiotic resistance isolated from the cultures of different sites of infections including burn wound. Vancomycin was highly specific antibiotic against Gram-positive bacteria isolates. All spices of Acinetobacter were multidrug resistant. The mean of mortality rate was 8.75%. Conclusions: In spite of higher incidence of NIs in children with burn injuries, there are no well

  10. The role of resilience in the recovery of the burn-injured patient: an integrative review

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    Kornhaber R

    2016-05-01

    component influencing the recovery from burns trauma, it still remains a broad construct within the burns framework. Regular assessment of resilience in burn-injured patients is recommended in clinical practice in addition to longitudinal and intervention studies to best inform patient care. Keywords: resilience, burn injury, rehabilitation, optimism, tenacity, review

  11. Pattern and risk factors of stroke in the young among stroke patients admitted in medical college hospital, Thiruvananthapuram

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    Praveen Prasannakumar Subha

    2015-01-01

    Full Text Available Background: Stroke in the young is particularly tragic because of its potential to create a long-term burden on the victims, their families, and the community. There had been relatively few studies on young stroke in Kerala′s socio-economic setup, that too encapsulating the mentioned apparently relevant dimensions of stroke in the young . Objective: To study the prevalence, patterns and risk factors of young stroke. Settings and Design: A cross-sectional study with case control comparison at Government Medical College Hospital, Thiruvananthapuram, Kerala, India. Materials and and Methods: Total 100 stroke patients were identified over a period of 2 months, and data were collected on the basis of questionnaire developed for the purpose. Results: Of 100 stroke patients, 15 had stroke in the young, among which 9 (60% had ishaemic stroke. Hypertension was the most common risk factor. Smoking, alcohol, atrial fibrillation, and hyperlipidemia were found to be more common in cases (young stroke when compared with controls. Alcohol use and atrial fibrillation were significantly higher among young stroke patients. Physical inactivity was significantly lesser in those with stroke in the young than elderly. Atrial fibrillation emerged as an independent risk factor of stroke in the young with adjusted odds ratio of 6.18 (1.31-29.21. Conclusion: In all, 15% of total stroke occurred in young adults <50 years. The proportion of hemorrhagic stroke in young adults is higher than in elderly. Atrial fibrillation is identified as an independent risk factor of stroke in the young. Compared with stroke in elderly alcohol use, smoking, hyperlipidemia, and cardiac diseases, which are known risk factors, are higher in young stroke.

  12. Analysis of biofilm formation and antibiotic susceptibility pattern of uropathogens in patients admitted in a tertiary care hospital in India

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    Ruchi A Tayal

    2015-01-01

    Full Text Available Background: Microorganisms attach to surfaces and produce polysaccharides resulting in the formation of biofilms and providing an ideal niche for the exchange of genetic material leading to the emergence of drug-resistant pathogens. Biofilms can develop on anatomical surfaces and implants producing chronic and intractable infections. Aims: Detection of biofilm formation and comparison of antibiotic resistance between biofilm producers and nonproducers. Study Design: Prospective study in which urine specimens from adult patients with urinary tract infection (UTI during the period of the study were analyzed (1 year. Materials and Methods: Mid-stream clean catch urine from noncatheterized and urine aspirated from in-dwelling urinary catheter in catheterized patients were taken for microbiological processing. Wet mounts, Gram-staining, and urine culture were done. Biofilm formation was detected by tissue culture plate method (TCPM. Statistical Analysis: Chi-square test and mid "P" test were used to analyze the data. A value ofP<0.05 was taken as significant. Results: Gram-negative organisms predominated (89%. Biofilm production was detected in 27% isolates. Maximum biofilm production was seen in Enterococcus spp. (71%, followed by Escherichia coli (26%. Biofilm-producing isolates demonstrated higher antibiotic resistance. All the biofilm-producing Enterococcus spp. showed high-level aminoglycoside resistance. The biofilm-producing isolates of Pseudomonas aeruginosa and Klebsiella pneumoniae demonstrated multi-drug resistance. Conclusions: TCPM is an economical phenotypic method which can be used routinely to detect biofilm formation. Biofilms contribute to an increased resistance to antibiotics used for the treatment of UTIs. Therefore, detection of biofilms is recommended for all patients presenting with chronic or recurrent disease.

  13. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    Science.gov (United States)

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.

  14. The interaction between burn injury and vitamin D metabolism and consequences for the patient.

    Science.gov (United States)

    Klein, Gordon L

    2008-09-01

    The stress and inflammatory responses to burn injury are associated with bone loss. The stress response entails production of large amounts of endogenous glucocorticoids that decrease osteoblasts on the mineralization surface of bone and decreases differentiation of marrow stromal cells into osteoblasts, thereby decreasing the amount of bone formation. Deficiency of osteoblasts also blocks osteoclastogenesis thus leading to low bone turnover and bone loss. The inflammatory response generates cytokines such as interleukin 1-beta and interleukin-6, which normally increase osteoclastogenic bone resorption via stimulation of osteoblast production of RANK ligand. However, in the absence of osteoblasts as a target we postulate that they attack the parathyroid gland chief cells and up-regulate the calcium-sensing receptor. The consequence of this upregulation is the lowering of the circulating calcium necessary to suppress parathyroid hormone production and the development of hypocalcemia and urinary calcium wasting. It is the parathyroid hormone suppression that causes us to postulate acute deficiency of 1,25-dihydroxyvitamin D and the consequence of this for post-burn metabolism could include derepression of the gene that controls renin production, leading to elevated levels of angiotensin II, which can contribute to insulin resistance, as can vitamin D deficiency itself. Moreover, the skin from burned patients cannot synthesize vitamin D normally. Thus vitamin D supplementation is the only means by which to ensure vitamin D sufficiency for burn victims. The proper requirement for vitamin D in acutely burned patients remains unknown.

  15. Etiological study of fever of unknown origin in patients admitted to medicine ward of a teaching hospital of Eastern India

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    Dipanjan Bandyopadhyay

    2011-01-01

    Full Text Available Background: In a developing country, infectious disease remains the most important cause of fever, but the noncommunicable diseases, like malignancy, are fast becoming important differential diagnoses. An important clinical problem is the cases labeled as fever of unknown origin (FUO, which often evade diagnosis. Objective: The present study was undertaken to find the cause of FUO in a tertiary care hospital of eastern India. Materials and Methods: This is a prospective study of inpatients, with regard to both clinical signs and investigations. Results: The main diagnosis in the end was tuberculosis, closely followed by hematological malignancy. A substantial number of cases remained undiagnosed despite all investigations. The provisional diagnosis matched with the final in around two thirds of the cases. While for younger patients leukemia was a significant diagnosis, for older ones, extra-pulmonary tuberculosis was a main concern. Interpretation: In India, infectious disease still remains the most important cause of fever. Thus the initial investigations should always include tests for that purpose in a case of FUO. Conclusion: Geographic variations and local infection profiles should always be considered when investigating a case of FUO. However, some of the cases always elude diagnosis, although the patients may respond to empirical therapy.

  16. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007

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    Lantes-Louzao Sara

    2011-03-01

    Full Text Available Abstract Background Suicide and suicide attempts represent a severe problem for public health services. The aim of this study is to determine the socio-demographic and psychopathological variables associated with suicide attempts in the population admitted to a General Hospital. Methods An observational-descriptive study of patients admitted to the A Coruña University Hospital (Spain during the period 1997-2007, assessed by the Consultation and Liaison Psychiatric Unit. We include n = 5,234 admissions from 4,509 patients. Among these admissions, n = 361 (6.9% were subsequent to a suicide attempt. Admissions arising from a suicide attempt were compared with admissions occurring due to other reasons. Multivariate generalised estimating equation logistic regression models were used to examine factors associated with suicide attempts. Results Adjusting by age, gender, educational level, cohabitation status, being employed or unemployed, the psychiatric diagnosis at the time of the interview and the information on previous suicide attempts, we found that the variables associated with the risk of a suicide attempt were: age, psychiatric diagnosis and previous suicide attempts. The risk of suicide attempts decreases with age (OR = 0.969. Psychiatric diagnosis was associated with a higher risk of suicide attempts, with the highest risk being found for Mood or Affective Disorders (OR = 7.49, followed by Personality Disorders (OR = 7.31, and Schizophrenia and Other Psychotic Disorders (OR = 5.03. The strongest single predictive factor for suicide attempts was a prior history of attempts (OR = 23.63. Conclusions Age, psychopathological diagnosis and previous suicide attempts are determinants of suicide attempts.

  17. Effect of Foot Massage on Physiologic Indicators in Critically Ill Patients Admitted in the I.C.U

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    H Alavi- Majd

    2006-10-01

    Full Text Available Introduction: Intensive care unit is one of the most stressful wards for patients and it is estimated that 30 to70 percent of patients experience severe physiologic stress during admission. Some of the physiologic responses to stress include increase in metabolic rate with consequent increase in body temperature, increase in cardiac output and contraction power and subsequently increase in blood pressure, heart rate and sodium accumulation, bronchodilation and increase in respiration rate. Control of homodynamic condition and vital signs is an essential and important practice in intensive care units for stabilizing physiologic indicators. Massage is one of the methods that can be used for this purpose. The purpose of this research was to determine the effect of foot massage on physiologic indicators including pulse, respiration rate, mean arterial pressure, temperature and arterial blood oxygen saturation. Methods: 46 patients with brain stroke who were hospitalized in the intensive care unit of Tajrish Shohada hospital were studied.The validity of information record form was determined with content validity and the validity of instruments was established using valid marks. The reliability of instruments was assessed with test-re-test after calibration. Information was collected on second, third and fourth days after ICU admission at 4 to 6 pm. For this purpose, the physiologic indicators were controlled and after 10 minute, the patients underwent 5-minute foot stroke massage and then at 10 and 30-minute intervals, physiologic indicators were controlled again. Data was analyzed by ANOVA statistical method. Results: Findings showed that pulse rate, respiratory rate and mean arterial blood pressure significantly decreased after 5 minute foot massage (p< 0.001 and the value of these indicators 10 minutes after foot massage was less than the values 10 minute before massage. Also, arterial oxygen conc. 10 minute after foot massage was more than the

  18. Prevalence and associated factors of viral hepatitis and transferrin elevations in 5036 patients admitted to the emergency room of a Swiss university hospital: cross-sectional study

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    Printzen Gert

    2007-02-01

    Full Text Available Abstract Background The epidemiology of liver disease in patients admitted to emergency rooms is largely unknown. The current study aimed to measure the prevalence of viral hepatitis B and C infection and pathological laboratory values of liver disease in such a population, and to study factors associated with these measurements. Methods Cross-sectional study in patients admitted to the emergency room of a university hospital. No formal exclusion criteria. Determination of anti-HBs, anti-HCV, transferrin saturation, alanine aminotransferase, and obtaining answers from a study-specific questionnaire. Results The study included 5'036 patients, representing a 14.9% sample of the target population during the study period. Prevalence of anti-HBc and anti-HCV was 6.7% (95%CI 6.0% to 7.4% and 2.7% (2.3% to 3.2%, respectively. Factors independently associated with positive anti-HBc were intravenous drug abuse (OR 18.3; 11.3 to 29.7, foreign country of birth (3.4; 2.6 to 4.4, non-white ethnicity (2.7; 1.9 to 3.8 and age ≥60 (2.0; 1.5 to 2.8. Positive anti-HCV was associated with intravenous drug abuse (78.9; 43.4 to 143.6, blood transfusion (1.7; 1.1 to 2.8 and abdominal pain (2.7; 1.5 to 4.8. 75% of all participants were not vaccinated against hepatitis B or did not know their vaccination status. Among anti-HCV positive patients only 49% knew about their infection and 51% reported regular alcohol consumption. Transferrin saturation was elevated in 3.3% and was associated with fatigue (prevalence ratio 1.9; 1.2 to 2.8. Conclusion Emergency rooms should be considered as targets for public health programs that encourage vaccination, patient education and screening of high-risk patients for liver disease with subsequent referral for treatment if indicated.

  19. Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

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    Benedetta De Berardinis

    2014-01-01

    Full Text Available Introduction. Acute heart failure (AHF is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3 is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED. Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P<0.005. Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.

  20. HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study

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    Henry Namme Luma

    2013-01-01

    Full Text Available Background. Studies on HIV-associated central nervous system (CNS diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years HIV-1 patients, and 44.6% (300/672 of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was years, and median CD4 count was 49 cells/mm3 (interquartile range (QR: 17–90. The most common clinical presentations were headache (83%, focal signs (40.6%, and fever (37.7%. Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%. Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2. Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

  1. Effects of early physiotherapy with respect to severity of pneumonia of elderly patients admitted to an intensive care unit: a single center study in Japan.

    Science.gov (United States)

    Chigira, Yusuke; Takai, Tomoko; Igusa, Hironobu; Dobashi, Kunio

    2015-07-01

    [Purpose] We performed early physiotherapy for elderly patients with pneumonia admitted to an intensive care unit (ICU), and examined the effects of this early physiotherapy on the severity of pneumonia. [Subjects and Methods] Patients for whom physiotherapy was started the day after admission to the ICU (acute phase) were assigned to the early intervention group and compared with patients in the standard intervention group. All patients were divided into three groups (Groups I, II, and III) based on the severity of pneumonia. We evaluated the ICU admission period, hospitalization period, and activities of daily living (ADL) before and after admission. [Results] With respect to the severity of pneumonia, Group II showed significant differences in the ICU admission period and rates of change in the operating range, cognitive domain, and Functional Independence Measure (FIM). Group III showed significant differences in the ICU admission period and rate of change in the cognitive domain (FIM item). The results were more favorable in the early intervention group than in the standard intervention group. [Conclusion] The ICU admission period was shorter and a reduction in the ADL level was prevented in Groups II, and III compared to Group I. This may have occurred because of the early rehabilitation. PMID:26311924

  2. Rapid detection of Vancomycin-Resistant Enterococci (VRE in rectal samples from patients admitted to intensive care units

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    Pedro Alves d'Azevedo

    2009-08-01

    Full Text Available The reduction in time required to identify vancomycin-resistant enterococci (VRE has gained increased importance during hospital outbreaks. In the present study, we implemented a laboratory protocol to speed up the VRE screening from rectal samples. The protocol combines a medium for selective VRE isolation (VREBAC®, Probac, São Paulo and a multiplex PCR for detection and identification of vanA and vanB resistance genes. The screening performance was analyzed in 114 specimens collected from four intensive care units. The swabs were collected at two periods: (1 during a VRE outbreak (February 2006, n=83 patients and (2 at the post-outbreak period, after adoption of infection control measures (June 2006, n=31 patients. Forty-one/83 VRE (49.4% and 3/31(9.7% VRE were found at the first and second period, respectively. All isolates harbored the vanA gene. In both periods, detection of the gene vanA parallels to the minimum inhibitory concentration values of >256 µg/mL and >48 µg/mL for vancomycin and teicoplanin, respectively. Multiplex PCR and conventional methods agreed in 90.2% for enterococci identification. Besides this accuracy, we also found a remarkable reduction in time to obtain results. Detection of enterococcal species and identification of vancomycin resistance genes were ready in 29.5 hours, in comparison to 72 hours needed by the conventional methods. In conclusion, our protocol identified properly and rapidly enterococci species and vancomycin-resistance genes. The results strongly encourage its adoption by microbiology laboratories for VRE screenning in rectal samples.

  3. Sensitivity and specificity of bronchoalveolar lavage and protected bronchial brush in the diagnosis of pneumonia in pediatric burn patients

    NARCIS (Netherlands)

    Barret, JP; Ramzy, PI; Wolf, SE; Herndon, DN

    1999-01-01

    Background: Infection is still one of the leading causes of death in burn patients. The diagnosis of respiratory tract infection in critically ill burn patients is still difficult. The diagnostic technique of choice remains uncertain, especially because of the lack of a criterion standard by which o

  4. Divergent and dynamic activity of endogenous retroviruses in burn patients and their inflammatory potential.

    Science.gov (United States)

    Lee, Kang-Hoon; Rah, HyungChul; Green, Tajia; Lee, Young-Kwan; Lim, Debora; Nemzek, Jean; Wahl, Wendy; Greenhalgh, David; Cho, Kiho

    2014-04-01

    Genes constitute ~3% of the human genome, whereas human endogenous retroviruses (HERVs) represent ~8%. We examined post-burn HERV expression in patients' blood cells, and the inflammatory potentials of the burn-associated HERVs were evaluated. Buffy coat cells, collected at various time points from 11 patients, were screened for the expression of eight HERV families, and we identified their divergent expression profiles depending on patient, HERV, and time point. The population of expressed HERV sequences was patient-specific, suggesting HERVs' inherent genomic polymorphisms and/or differential expression potentials depending on characteristics of patients and courses of injury response. Some HERVs were shared among the patients, while the others were divergent. Interestingly, one burn-associated HERV gag gene from a patient's genome induced IL-6, IL-1β, Ptgs-2, and iNOS. These findings demonstrate that injury stressors initiate divergent HERV responses depending on patient, HERV, and disease course and implicate HERVs as genetic elements contributing to polymorphic injury pathophysiology.

  5. α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients123

    OpenAIRE

    Traber, Maret G.; Leonard, Scott W.; Traber, Daniel L; Traber, Lillian D; Gallagher, James; Bobe, Gerd; Jeschke, Marc G.; Finnerty, Celeste C.; Herndon, David

    2010-01-01

    Background: We previously showed that thermal injury depletes plasma vitamin E in pediatric burn patients; however, plasma changes may reflect immediate alterations in vitamin E nutriture. Adipose tissue α-tocopherol concentrations are generally accepted to reflect long-term vitamin E status.

  6. A new approach: role of data mining in prediction of survival of burn patients.

    Science.gov (United States)

    Patil, Bankat Madhavrao; Joshi, Ramesh C; Toshniwal, Durga; Biradar, Siddeshwar

    2011-12-01

    The prediction of burn patient survivability is a difficult problem to investigate till present times. In present study a prediction Model for patients with burns was built, and its capability to accurately predict the survivability was assessed. We have compared different data mining techniques to asses the performance of various algorithms based on the different measures used in the analysis of information pertaining to medical domain. Obtained results were evaluated for correctness with the help of registered medical practitioners. The dataset was collected from SRT (Swami Ramanand Tirth) Hospital in India, which is one of the Asia's largest rural hospitals. Dataset contains records of 180 patients mainly suffering from burn injuries collected during period from the year 2002 to 2006. Features contain patients' age, sex and percentage of burn received for eight different parts of the body. Prediction models have been developed through rigorous comparative study of important and relevant data mining classification techniques namely, navie bayes, decision tree, support vector machine and back propagation. Performance comparison was also carried out for measuring unbiased estimate of the prediction models using 10-fold cross-validation method. Using the analysis of obtained results, we show that Navie bayes is the best predictor with an accuracy of 97.78% on the holdout samples, further, both the decision tree and support vector machine (SVM) techniques demonstrated an accuracy of 96.12%, and back propagation technique resulted in achieving accuracy of 95%. PMID:20703764

  7. Microfluidics for T- lymphocyte cell separation and inflammation monitoring in burn patients.

    Science.gov (United States)

    Rosenbach, Alan E; Koria, Piyush; Goverman, Jeremy; Kotz, Kenneth T; Gupta, Amit; Yu, Ming; Fagan, Shawn P; Irimia, Daniel; Tompkins, Ronald G

    2011-02-01

    Severe burns result in T lymphocyte specific immunologic changes. In addition to decreased levels of circulating lymphocytes, changes in cytokine secretion and receptor expression also take place. Our finer understanding of the inflammatory response has led to the development of immune-targeted therapeutics, requiring specialized gene-expression monitoring. The emerging field of bio-micro-electromechanical systems can be used to isolate highly pure T lymphocytes in a clinically relevant and timely manner for downstream genomic analysis. Blood samples from healthy volunteers and burn-injured patients were introduced into microfluidic devices developed in our laboratory. Utilizing cell-affinity chromatography for positive selection of T lymphocytes, the devices served as a platform for RNA extraction and downstream cytokine analysis via quantitative real-time polymerase chain reaction (PCR). From a 0.5-mL whole blood sample, the microfluidic devices captured highly pure T lymphocytes from healthy volunteers and burn-injured patients. Cell capture was of sufficient quantity, and extracted RNA was of sufficient quality, for evaluating the gene expression of cytokines: interferon-gamma, interleukin-2, interleukin-4, and interleukin-10. Microfluidics is a useful tool in processing blood from burn-injured patients. Though in its very early stages of development, cell-specific information obtained by this platform/technology will likely be an important component of near-patient molecular diagnostics and personalized medicine.

  8. A retrospective study of drug prescribing pattern in burns patients in a tertiary care rural hospital

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    Palak Agrawal

    2015-06-01

    Conclusions: Females are more vulnerable to burn injuries. Polypharmacy was observed in prescriptions. Systemic antibiotic should be used with caution to prevent emergence of resistant microorganisms. Results of the present study indicate that some aspects of drug treatment need to be rationalized in order to achieve better patient care. [Int J Res Med Sci 2015; 3(6.000: 1446-1452

  9. Visual analogue thermometer: a valid and useful instrument for measuring pain in burned patients.

    Science.gov (United States)

    Choinière, M; Auger, F A; Latarjet, J

    1994-06-01

    This study assessed the psychometric qualities of a new pain rating instrument--the visual analogue thermometer (VAT)--which was developed to measure pain in burned patients. The validity and utility of the VAT was assessed and compared with a conventional numeric (NUM) and adjective pain scale (ADJ) with a group of 103 burned patients and 51 nurses. Analyses of the results support the concurrent and construct validity of the VAT as a pain measure. Furthermore, the VAT gave more sensitive and precise pain measures than the ADJ and/or NUM scales. No major difference between the three scales emerged in the patients' preference. The same was true for the nurses' evaluation except for those who had more clinical experience with the VAT and who tended to prefer this scale for its accuracy and ease of utilization. The VAT appears to be a valid, sensitive and clinically useful tool to measure pain in burned patients. A systematic pain assessment procedure which can be easily implemented in burn care facilities is presented.

  10. [Use of a neutral paraffin dressing (Jelonet) at the Burn Care Center at the Saint Luc Hospital in Lyon].

    Science.gov (United States)

    Foyatier, J L; Hezez, G; Masson, C L; Latarjet, J

    1990-01-01

    Several thousand dressings are performed each year to treat the patients admitted to the St Luc Hospital Burn Care Unit. The use of paraffin gauze dressing (Jelonet) allowed standardization and rationalization of the four different types of dressings used in burns. Positive features of this product include ease of use, good tolerance, and low cost.

  11. Do burns increase the severity of terror injuries?

    Science.gov (United States)

    Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

    2008-01-01

    The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score

  12. Medical Treatment for Burn Patients with Eating Disorders: A Case Report

    OpenAIRE

    Minekatsu Akimoto; Akira Takeda; Kazutaka Nagashima; Rie Uehara; Mitsuru Nemoto; Eiju Uchinuma

    2011-01-01

    There have been many cases of burn patients who also suffer from psychiatric problems, including eating disorders. We present a case of a 38-year-old female with an eating disorder and depression who became light-headed and fell, spilling boiling water from a kettle on herself at home sustaining partial thickness and full thickness burns over 5% of her total body surface area: left buttock and right thigh and calf. Eating disorders (in the present case, anorexia nervosa) cause emaciation and ...

  13. Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia

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    Joelle W Boeve

    2011-03-01

    Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

  14. Bacterial Respiratory Tract Infections are Promoted by Systemic Hyperglycemia after Severe Burn Injury in Pediatric Patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Mlcak, Ronald P; Finnerty, Celeste C; Cox, Robert A; Williams, Felicia N; Jeschke, Marc G

    2014-01-01

    Background Burn injuries are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complication. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients. Methods One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS mechanical ventilation (L: 21% H: 32%) and off mechanical ventilation (L: 5% H: 15%), as well as ARDS were significantly higher in the high group (L: 3% H: 19%), p<0.05, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients (p<0.05). Furthermore, incidence of infection and sepsis were significantly higher in the high group, p<0.05. Conclusion Our results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia confirming the previous studies in critically ill patients. PMID:24074819

  15. Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Shin Hye; You, Je Sung; Choi, Jin-Young; Kim, Myeong-Jin; Chung, Yong Eun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Seodaemun-gu, Seoul (Korea, Republic of); Song, Mi Kyong [Yonsei University, Biostatistics Collaboration Unit, College of Medicine, Seoul (Korea, Republic of)

    2015-04-01

    To evaluate feasibility of radiation dose reduction by optimal phase selection of computed tomography (CT) in patients who visited the emergency department (ED) for abdominal pain. We included 253 patients who visited the ED for abdominal pain. They underwent multiphasic CT including precontrast, late arterial phase (LAP), and hepatic venous phase (HVP). Three image sets (HVP, precontrast + HVP, and precontrast + LAP + HVP) were reviewed. Two reviewers determined the most appropriate diagnosis with five-point confidence scale. Diagnostic performances were compared among image sets by weighted-least-squares method or DeLong's method. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. There was no difference in diagnostic performance among three image sets, although diagnostic confidence level was significantly improved after review of triphasic images compared with both HVP images only or HVP with precontrast images (confidence scale, 4.64 ± 0.05, 4.66 ± 0.05, and 4.76 ± 0.04 in the order of the sets; overall P = 0.0008). Similar trends were observed in the subgroup analysis for diagnosis of pelvic inflammatory disease and cholecystitis. There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. (orig.)

  16. Management of a patient with thermal burns and para-chloronitrobenzene poisoning

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    Yuanhai Zhang

    2014-10-01

    Full Text Available Para-chloronitrobenzene (p-CNB, a hazardous and toxic substance, is widely used as an intermediary in chemical industries. p-CNB can cause methaemoglobinaemia due to electron-withdrawing properties of the nitro and chlorine groups. We present a case of a 23-year-old man suffering from thermal burns and p-CNB poisoning. In this case, severe methaemoglobinaemia was caused by the absorption of p-CNB through the burn wounds. Despite active treatment, such as the antidote of methylene blue, the patient’s methaemoglobinaemia progressed, with slowly increasing methaemoglobin (MetHb level. This case highlights the complexity and difficulty of managing this type of injury. To our knowledge, this case can be the first case report describing methaemoglobinaemia induced by p-CNB in a patient with thermal burns.

  17. Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume

    Energy Technology Data Exchange (ETDEWEB)

    Balbo, B.E.P. [Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Sapienza, M.T.; Ono, C.R. [Divisão de Medicina Nuclear, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Jayanthi, S.K. [Divisão de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Dettoni, J.B. [Divisão de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Castro, I.; Onuchic, L.F. [Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-06-13

    Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.

  18. Epidemiology of elderly patients' burns in the South West of France.

    Science.gov (United States)

    Cutillas, M; Sesay, M; Perro, G; Bourdarias, B; Castede, J C; Sanchez, R

    1998-03-01

    A retrospective study of 716 patients aged 60 years and above (324 men, 392 women) was undertaken in order to determine quality control in burns management in the South West of France. The following epidemiological data was obtained: high hospitalization rate (7 per cent of the general admissions); monthly and seasonal periodicity; predominance of indoor accidents (86 per cent) with domestic accidents being more frequent in women (63 vs. 37 per cent). Outdoor accidents were mainly recreational and were five times more frequent in men than in women. The overall mortality was 39 per cent and was influenced by the burns extent, depth, predisposing factors and early management. More burns occurred in urban areas (53 per cent) but mortality was higher in patients from rural areas (62 vs. 38 per cent). It was observed that delay in management, especially fluid resuscitation of patients from the rural areas, was partly responsible for this outcome. Propositions were made to diffuse more information on the importance of early management of burns in rural areas. PMID:9625238

  19. Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure.

    Science.gov (United States)

    Valbusa, Filippo; Bonapace, Stefano; Grillo, Cristina; Scala, Luca; Chiampan, Andrea; Rossi, Andrea; Zoppini, Giacomo; Lonardo, Amedeo; Arcaro, Guido; Byrne, Christopher D; Targher, Giovanni

    2016-02-01

    Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF. We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate. Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P < 0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46-12.1, P < 0.001) after adjustment for multiple HF risk factors and potential confounders. In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF. PMID:26886619

  20. Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change

    Directory of Open Access Journals (Sweden)

    Arthur Halley Barbosa do Vale

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2 was associated via mask, with a flow of 10 L/min (N2O group and on the other day only O2 under the same flow (control group. RESULTS: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS: The association of N2O was not effective in reducing opioid consumption during dressing changes.

  1. The epidemiology of geriatric burns in Iran: A national burn registry-based study.

    Science.gov (United States)

    Emami, Seyed-Abolhassan; Motevalian, Seyed Abbas; Momeni, Mahnoush; Karimi, Hamid

    2016-08-01

    Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs. We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3-59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (pBurn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (ppatients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about $7450.

  2. Antimicrobial Resistance Patterns of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus Isolated From Patients With Nosocomial Infections Admitted to Tehran Hospitals

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    Fallah

    1970-01-01

    Full Text Available Background Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The choice of antimicrobial treatment for nosocomial infections is often empirical and based on the knowledge of local antimicrobial activity patterns of the most common bacteria causing such infections. Objectives The aim of this study was to determine the 3 most prevalent bacterial pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus causing nosocomial infections and their antimicrobial resistant profiles in patients admitted to three hospitals in Tehran city, Iran. Materials and Methods In this cross-sectional study, the A. baumannii, P. aeruginosa and S. aureus isolates were obtained from different samples of patients with nosocomial infections admitted to different wards of three hospitals including Milad, Motahary and Loghman from November 2014 to April 2015. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48 hours after admission. Antimicrobial susceptibility testing was performed using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI guidelines. Results In total, 539 samples were collected during the study period from patients with nosocomial infections. Overall, 198, 75 and 98 A. baumannii, P. aeruginosa and S. aureus isolates were obtained, respectively. Cefepim and meropenem were found to be the most effective antibiotics for nosocomial infections caused by S. aureus with only 1 resistant isolate. Resistance to gentamicin and amikacin and susceptibility to cefepim was the highest compared to other antibiotics amongst P. aeruginosa isolates which is in consistent with the fact that cephalosporins remain useful agents for the management of nosocomial infections caused by P. aeruginosa. Acinetobacter baumannii isolates showed lower susceptibility rates to imipenem and ciprofloxacin than other

  3. Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil

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    Alfredo Pereira Leite de Albuquerque Filho

    2011-12-01

    Full Text Available INTRODUCTION: Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. METHODS: Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture. Test properties were determined for each cutoff number of the criteria from the case definition. RESULTS: Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (p<0.0001. Best sensitivity (85.3% and specificity (68.2% combination was found with a cutoff of 7 or more criteria, reaching positive and negative predictive values of 90.1% and 57.7%, respectively; accuracy was 81.4%. CONCLUSIONS: The case definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

  4. Retrospective cohort analysis of chest injury characteristics and concurrent injuries in patients admitted to hospital in the Wenchuan and Lushan earthquakes in Sichuan, China.

    Directory of Open Access Journals (Sweden)

    Xi Zheng

    Full Text Available BACKGROUND: The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. METHODS: We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. RESULTS: The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. CONCLUSIONS: Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake

  5. A cross-sectional study on occurrence of type 2 diabetes among patients admitted with chronic liver diseases in a medical college in Kolkata

    Directory of Open Access Journals (Sweden)

    Shuvankar Mukherjee

    2013-01-01

    Full Text Available Objectives: To study the magnitude of the problem of type 2 diabetes mellitus and impaired glucose intolerance among the patients with various types of chronic liver diseases and to find out the association of diabetes mellitus and impaired glucose tolerance with the demographic and clinical characteristics of the patients. Materials and Methods: This observational study, which was cross-sectional in design, was undertaken in the Department of General Medicine at a medical College in Kolkata during October 2010 to July 2011. Altogether 161 patients diagnosed with chronic liver disease (CLD were admitted in the General Medicine ward during the study period, out of which 9 patients got themselves discharged against medical advice. From the remaining 152 patients, a total of 136 patients aged 20 years and above were selected for the study according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Results : Among the study subjects, 58.1% had impaired glucose tolerance (IGT, while 14.0% had overt diabetes mellitus. IGT and diabetes were significantly higher among the CLD patients aged 45 years or more (P < 0.05. However, similar association was not observed with regard to sex of the patients. No association was found between the occurrence of IGT and/or overt diabetes with either severity (as per Child-Pugh score or with the duration of CLD. More than half of the study subjects having alcoholic liver disease or chronic hepatitis B or C or autoimmune hepatitis and one third of those having Wilson's disease had IGT, while one third of those with either chronic hepatitis C or Wilson's disease and one fourth of those having autoimmune hepatitis had overt diabetes. Twenty-one percent of those with chronic hepatitis B also found to have overt diabetes, which was least in those with alcoholic liver

  6. Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics.

    Science.gov (United States)

    Sveen, J; Sjöberg, F; Öster, C

    2014-08-01

    Although many children with burns recover well and have a satisfying quality of life after the burn, some children do not adjust as well. Health-related quality of life (HRQoL) focuses on the impact health status has on quality of life. The aim of this study was to assess HRQoL with the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) in a nationwide Swedish sample of children with burns 0.3-9.0 years after injury. Participants were parents (n=109) of children aged up to 18 years at the time of investigation who were treated at the Linköping or Uppsala Burn Center between 2000 and 2008. The majority of children did not have limitations in physical function and they did not seem to experience much pain. However, there were indications of psychosocial problems. Parents of preschool children reported most problems with the children's behavior and family disruption, whereas parents of children aged 5-18 years reported most problems with appearance and emotional health. There were mainly burn-related variables associated with suboptimal HRQoL in children aged 5-18 years, while family-related variables did not contribute as much.

  7. Mortality according to age and burned body surface in the Virgen del Rocio University Hospital.

    Science.gov (United States)

    Gómez-Cía, T; Mallén, J; Márquez, T; Portela, C; Lopez, I

    1999-06-01

    The application of updated clinical protocols for the treatment of burned patients is showing very good results. The mortality curves according to age and the percentage of burned body surface could be of great use for the comparison of clinical results between different burns units. The probability of survival in 1000 consecutive patients admitted to the Burns Unit of the Virgen del Rocio University Hospital between July, 1993 and August, 1997, is compared, by graphic analysis, with the mortality curves of other centers, obtaining similar results. We conclude that the results of medical attendance in our unit are in line with those considered as a reference.

  8. Use of negative pressure wound therapy in burn patients.

    Science.gov (United States)

    Teng, Shou-Cheng

    2016-09-01

    According to previous research, adjunctive negative pressure wound therapy (NPWT) can help manage infected wounds when applied along with appropriate debridement and antibiotic therapy as deemed clinically relevant. NPWT not only removes fluid, and reduces oedema, but also promotes perfusion around the wounds. In addition, NPWT may lead to improved graft fixation when used as a bolster, especially in patients who are less compliant or have poor graft fixation that result from using traditional methods. NPWT is a good choice to bolster skin grafts in young, active and less-compliant patients. We propose an enhanced segmental compartment-covered technique, which uses NPWT adjunctively as first-line wound treatment to help manage postoperative infection. Moreover, NPWT promotes granulation tissue formation to prepare the wound bed for subsequent skin graft and may be used as a bolster over the graft, which helps to attain skin graft viability. PMID:27547959

  9. The practical evaluation and management of patients with symptoms of a sore burning mouth.

    Science.gov (United States)

    Steele, John C

    2016-01-01

    There are many etiologic factors to consider in a patient who presents with symptoms or sensations of a sore burning mouth. These range from local causes within the oral cavity to underlying systemic disease, including psychologic factors. This paper aims to describe the different clinical presentations and to outline a systematic approach to the evaluation and management of such patients. The clinician will be directed to the relevant diagnosis by following the traditional medical model of taking a focused history, performing a thorough clinical examination, considering the potential differential diagnoses, and requesting pertinent and appropriate investigations. The various differential diagnoses and broad treatment options will also be discussed and outlined. This paper will not, however, discuss burning mouth syndrome (oral dysesthesia), which is a diagnosis of exclusion, whereby the oral mucosa is clinically normal and there are no identifiable medical or dental causes to account for the patient's symptoms. PMID:27343959

  10. Severe burns as a consequence of seizures in patients with epilepsy.

    Science.gov (United States)

    Spitz, M C

    1992-01-01

    We report 10 seizure-related thermal injuries severe enough to require hospitalization in patients with epilepsy. Eight of the ten incidents were with patients who had had seizures with impaired consciousness two or more times a month. This suggests that seizure frequency is a risk factor and implies the importance of striving for optimal seizure control. Two burns each occurred from an electric iron, a hand-held hair dryer, and stove-top cooking. Minimizing these activities, especially in patients with frequent consciousness-altering seizures, may be useful. Three burns occurred while showering; these resulted in the most severe injuries, with hospital stays of 29, 30, and 41 days. Simple plumbing devices may have prevented these injuries.

  11. Persistent candidemia in major burn patients: radiologic findings of the thorax

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eil Seong; Lee, Kwan Seop; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-04-01

    To describe radiologic findings of burn-associated persistent candidemia of the thorax. This study included 42 patients with major burns in whom blood culture had shown the presence for more than 24 hours of persistent candidemia. The duration of positive culture for candidiasis ranged from two to 67 days(mean, 15 days). Radiographic(n=42) and thin-section CT findings(n=13) were retrospectively analyzed. The onset, pattern, size, distribution and persistence of parenchymal abnormalities as well as the presence or absence of pleural effusions, mediastinal lymphadenopathy and cardiomegaly were assessed. On chest radiographs, positive findings were noticed in 61.9%(26/42) and on thin-section CT, in 76.9%(10/13). The most frequent radiographic finding was pulmonary nodule(s), observed in 14 patients(33.3%); in 13, these were bilateral. Bronchovascular bundle thickening(n=6, 14.3%), consolidation(n=4, 9.5%), cardiomegaly(n=6, 14.3%) and pleural effusion(n=4, 9.5%) were also observed. Those lesions appeared eight to 129 days(mean, 33 days) after the burn. Radiographic abnormalities persisted for seven to 115(mean, 35) days, regardless of the treatment. Thin-section CT showed parenchymal abnormalities in 10/13 patients(76.9%) and subpleural nodules of less than 1cm in diameter and without halo in all patients. Cardiomegaly, pleural effusion and mediastinal adenopathy were observed on CT in 5(38.5%), 4(30.8%) and 2(15.4%) of the 13 patients, respectively. In a high proportion of patients with burn-associated candidemia, chest radiograph and thin-section CT findings were positive. The most frequent radiographic parenchymal abnormality was multiple bilateral nodules.

  12. Persistent candidemia in major burn patients: radiologic findings of the thorax

    International Nuclear Information System (INIS)

    To describe radiologic findings of burn-associated persistent candidemia of the thorax. This study included 42 patients with major burns in whom blood culture had shown the presence for more than 24 hours of persistent candidemia. The duration of positive culture for candidiasis ranged from two to 67 days(mean, 15 days). Radiographic(n=42) and thin-section CT findings(n=13) were retrospectively analyzed. The onset, pattern, size, distribution and persistence of parenchymal abnormalities as well as the presence or absence of pleural effusions, mediastinal lymphadenopathy and cardiomegaly were assessed. On chest radiographs, positive findings were noticed in 61.9%(26/42) and on thin-section CT, in 76.9%(10/13). The most frequent radiographic finding was pulmonary nodule(s), observed in 14 patients(33.3%); in 13, these were bilateral. Bronchovascular bundle thickening(n=6, 14.3%), consolidation(n=4, 9.5%), cardiomegaly(n=6, 14.3%) and pleural effusion(n=4, 9.5%) were also observed. Those lesions appeared eight to 129 days(mean, 33 days) after the burn. Radiographic abnormalities persisted for seven to 115(mean, 35) days, regardless of the treatment. Thin-section CT showed parenchymal abnormalities in 10/13 patients(76.9%) and subpleural nodules of less than 1cm in diameter and without halo in all patients. Cardiomegaly, pleural effusion and mediastinal adenopathy were observed on CT in 5(38.5%), 4(30.8%) and 2(15.4%) of the 13 patients, respectively. In a high proportion of patients with burn-associated candidemia, chest radiograph and thin-section CT findings were positive. The most frequent radiographic parenchymal abnormality was multiple bilateral nodules

  13. Pharmacokinetic-pharmacodynamic correlation of imipenem in pediatric burn patients using a bioanalytical liquid chromatographic method

    Directory of Open Access Journals (Sweden)

    Silvia Regina Cavani Jorge Santos

    2015-06-01

    Full Text Available A bioanalytical method was developed and applied to quantify the free imipenem concentrations for pharmacokinetics and PK/PD correlation studies of the dose adjustments required to maintain antimicrobial effectiveness in pediatric burn patients. A reverse-phase Supelcosil LC18 column (250 x 4.6 mm 5 micra, binary mobile phase consisting of 0.01 M, pH 7.0 phosphate buffer and acetonitrile (99:1, v/v, flow rate of 0.8 mL/min, was applied. The method showed good absolute recovery (above 90%, good linearity (0.25-100.0 µg/mL, r2=0.999, good sensitivity (LLOQ: 0.25 µg/mL; LLOD: 0.12 µg/mL and acceptable stability. Inter/intraday precision values were 7.3/5.9%, and mean accuracy was 92.9%. A bioanalytical method was applied to quantify free drug concentrations in children with burns. Six pediatric burn patients (median 7.0 years old, 27.5 kg, normal renal function, and 33% total burn surface area were prospectively investigated; inhalation injuries were present in 4/6 (67% of the patients. Plasma monitoring and PK assessments were performed using a serial blood sample collection for each set, totaling 10 sets. The PK/PD target attained (40%T>MIC for each minimum inhibitory concentration (MIC: 0.5, 1.0, 2.0, 4.0 mg/L occurred at a percentage higher than 80% of the sets investigated and 100% after dose adjustment. In conclusion, the purification of plasma samples using an ultrafiltration technique followed by quantification of imipenem plasma measurements using the LC method is quite simple, useful, and requires small volumes for blood sampling. In addition, a small amount of plasma (0.25 mL is needed to guarantee drug effectiveness in pediatric burn patients. There is also a low risk of neurotoxicity, which is important because pharmacokinetics are unpredictable in these critical patients with severe hospital infection. Finally, the PK/PD target was attained for imipenem in the control of sepsis in pediatric patients with burns.

  14. Live sibling skin allografts for severe burns in a paediatric patient: A viable option in developing countries

    Directory of Open Access Journals (Sweden)

    Basil Leodoro

    2014-11-01

    Full Text Available Severe burns in the paediatric population are associated with high mortality and morbidity in any developing countries. Children with more than 40% total body surface area burns in Fiji will succumb from complications and as a direct result of inadequate treatment and lack of resources. The surgical treatment of any severely burnt patient is not only laborious but very costly to the Fiji health system and depletes existing resources with few options for skin coverage. This is the first case report of live sibling skin allograft for severe paediatric burns and one of only few patients to have survived more than 50% burns in Fiji. We describe the technique and the role of using live sibling skin allograft as an option to improve survival in patients with severe burns in a developing country.

  15. Bacterial Respiratory Tract Infections are Promoted by Systemic Hyperglycemia after Severe Burn Injury in Pediatric Patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N; Mlcak, Ronald P; Finnerty, Celeste C; Cox, Robert A; Williams, Felicia N; Jeschke, Marc G

    2014-01-01

    Background Burn injuries are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complication. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients. Methods One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS <150 mg/dl). Incidences of pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student’s t-test and chi-square test. Significance was set at p<0.05. Results Patient groups were similar in demographics and injury characteristics. Pneumonia in patients on the mechanical ventilation (L: 21% H: 32%) and off mechanical ventilation (L: 5% H: 15%), as well as ARDS were significantly higher in the high group (L: 3% H: 19%), p<0.05, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients (p<0.05). Furthermore, incidence of infection and sepsis were significantly higher in the high group, p<0.05. Conclusion Our results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia confirming the previous studies in critically ill patients. PMID:24074819

  16. Urban-Rural Dichotomy of Burn Patients in Georgia and South Carolina: A Geographic Information System Study.

    Science.gov (United States)

    Mian, Mohammad Anwarul Huq; Haque, Akhlaque; Mullins, Robert Fred; Fiebiger, Barbara; Hassan, Zaheed

    2015-01-01

    This study uses a 4-year (2006-2009) cross-section of epidemiological burn injury data from Georgia and South Carolina. The results from the study show that the burn patients from rural areas differ from their urban counterparts in terms of relative burn injury incidence. Younger population groups that live in lower socioeconomic status communities especially in the urban areas are at a higher risk than other population groups. The differences in the types of burns in the urban-rural communities can give us further insights to the patients' association with injury sites. The presence of fewer burn injury treatment and care facilities in rural areas and the high incidence of burn in low-income communities in the urban areas should carry important policy implications for health planners. This study will enable researchers to understand the epidemiology of burn injuries at the local and national levels in the United States. It also carries important implications for using Geographic Information Systems for studying spatial distribution of burn injuries for disaster planning and mitigation of burn injuries.

  17. The feasibility of computer-based prism adaptation to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center.

    Directory of Open Access Journals (Sweden)

    Miranda eSmit

    2013-07-01

    Full Text Available AbstractIntroduction: There is wide interest in transferring paper-and-pencil tests to a computer-based setting, resulting in more precise recording of performance. Here, we investigated the feasibility of computer-based testing and computer-based prism adaptation (PA to ameliorate neglect in sub-acute stroke patients admitted to a rehabilitation center. Methods: 33 neglect patients were included. PA was performed with a pair of goggles with wide-field point-to-point prismatic lenses inducing an ipsilesional optical shift of 10 degrees. A variety of digitalized neuropsychological tests were performed using an interactive tablet immediately before and after PA.Results: All 33 patients (mean age 60.36 (SD 13.30, (mean days post-stroke 63.73 (SD 37.74 were able to work with the tablet and to understand, perform and complete the digitalized tests within the proposed time-frame, indicating that there is feasibility of computer-based assessment in this stage post-stroke. Analyses of the efficacy of PA indicated no significant change on any of the outcome measures, except time.Discussion: In conclusion, there is feasibility of computer-based testing in such an early stage, which makes the computer-based setting a promising technique for evaluating more ecologically valid tasks. Secondly, the computer-based PA can be considered as a reliable procedure. We can conclude from our analysis, addressing the efficacy of PA, that the effectiveness of single session PA may not be sufficient to produce short term effects on our static tasks. Further studies, however, need to be done to evaluate the computer-based efficacy with more ecologically valid assessments in an intensive double-blind, sham-controlled multiple PA treatment design.

  18. Epidemiology and screening of intentional burns in children in a Dutch burn centre.

    Science.gov (United States)

    Bousema, Sara; Stas, Helene G; van de Merwe, Marjolijn H; Oen, Irma M M H; Baartmans, Martin G A; van Baar, Margriet E

    2016-09-01

    International estimates of the incidence of non-accidental burns (NAB) in children admitted to burn centres vary from 1% to 25%. Hardly any data about Dutch figures exist. The aim of this study was to evaluate the incidence, treatment and outcome of burns due to suspected child abuse in paediatric burns. We described the process of care and outcome, including the accuracy of the SPUTOVAMO screening tool and examined child, burn and treatment characteristics related to suspicions of child abuse or neglect. A retrospective study was conducted in children aged 0-17 years with a primary admission after burn injuries to the burn centre Rotterdam in the period 2009-2013. Data on patient, injury and treatment characteristics were collected, using the Dutch Burn Repository R3. In addition, medical records were reviewed. In 498 paediatric admissions, suspected child abuse or neglect was present in 43 children (9%). 442 screening questionnaires (89%) were completed. In 52 out of 442 questionnaires (12%) the completed SPUTOVAMO had one or more positive signs. Significant independent predictors for suspected child abuse were burns in the genital area or buttocks (OR=3.29; CI: 143-7.55) and a low socio-economic status (OR=2.52; 95%CI: 1.30-4.90). The incidence of suspected child abuse indicating generation of additional support in our population is comparable to studies with a similar design in other countries. PMID:27211360

  19. Epidemiology and screening of intentional burns in children in a Dutch burn centre.

    Science.gov (United States)

    Bousema, Sara; Stas, Helene G; van de Merwe, Marjolijn H; Oen, Irma M M H; Baartmans, Martin G A; van Baar, Margriet E

    2016-09-01

    International estimates of the incidence of non-accidental burns (NAB) in children admitted to burn centres vary from 1% to 25%. Hardly any data about Dutch figures exist. The aim of this study was to evaluate the incidence, treatment and outcome of burns due to suspected child abuse in paediatric burns. We described the process of care and outcome, including the accuracy of the SPUTOVAMO screening tool and examined child, burn and treatment characteristics related to suspicions of child abuse or neglect. A retrospective study was conducted in children aged 0-17 years with a primary admission after burn injuries to the burn centre Rotterdam in the period 2009-2013. Data on patient, injury and treatment characteristics were collected, using the Dutch Burn Repository R3. In addition, medical records were reviewed. In 498 paediatric admissions, suspected child abuse or neglect was present in 43 children (9%). 442 screening questionnaires (89%) were completed. In 52 out of 442 questionnaires (12%) the completed SPUTOVAMO had one or more positive signs. Significant independent predictors for suspected child abuse were burns in the genital area or buttocks (OR=3.29; CI: 143-7.55) and a low socio-economic status (OR=2.52; 95%CI: 1.30-4.90). The incidence of suspected child abuse indicating generation of additional support in our population is comparable to studies with a similar design in other countries.

  20. Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

    Directory of Open Access Journals (Sweden)

    Cláudio Penido Campos Júnior

    2010-04-01

    Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.

  1. Evaluation of the response to treatment and clinical evolution in patients with burning mouth syndrome

    OpenAIRE

    M.E. Rodríguez de Rivera Campillo; López López, José

    2013-01-01

    Objective: the aim of this study is to investigate the clinical evolution, the spontaneous remission of the symptomatology and the response to different treatments in a group of burning mouth syndrome patients. Study Design: the sample was formed by a group of patients that were visited in the Unit of Oral Medicine of the Dentistry Clinic of the University of Barcelona, from the year 2000 to 2011. After revising the clinical records of all the patients that had been under control for a period...

  2. Response to topical clonazepam in patients with burning mouth syndrome: a clinical study

    OpenAIRE

    Rodríguez de Rivera Campillo, Ma Eugenia; López López, José; Chimenos Küstner, Eduardo

    2010-01-01

    Burning Mouth Syndrome (BMS) is a difficult disease for patients and clinicians. Moreover, there is not a general consensus on how to treat the disease. The main objective of this paper is to evaluate BMS patients' response to topical clonazepam treatment. A double blind study was performed. Among a total of 66 patients, 33 were treated with tablets of clonazepam and another 33 were treated with a placebo. Symptoms were evaluated after 1 month and 6 months of treatment and scored on an analog...

  3. Fungiform papillae density in patients with burning mouth syndrome and xerostomia

    OpenAIRE

    Camacho-Alonso, Fabio; López-Jornet, Pía; Molino-Pagán, Diana

    2011-01-01

    Objective: The aim of this study was to analyze fungiform papillae density in patients with burning mouth syndrome (BMS) and xerostomia. Study design: In this cross-sectional clinical study, sixty patients were included (20 with BMS, 20 with xerostomia and 20 healthy controls). The fungiform papillae density was analyzed over a small region on the anterior tip of the tongue with the aid of a digital camera. The number of papillae was measured in an area of 19 mm2. Results: The patients with B...

  4. Management of a Patient With Faciocervical Burns and Inhalational Injury Due to Hydrofluoric Acid Exposure.

    Science.gov (United States)

    Yuanhai, Zhang; Xingang, Wang; Liangfang, Ni; Chunmao, Han

    2014-05-01

    Hydrofluoric acid, a highly dangerous substance, can cause tissue damage and systemic toxicity by its unique mechanisms. Many cases of severe faciocervical burns due to hydrofluoric acid exposure are lethal. Herein, we present a case of 37-year-old man who suffered from hydrofluoric acid burns to his face, anterior neck, lips, and nasal cavity. On admission, this patient coughed with much sputum, and the chest auscultation detected rough breath sounds, wheezes, and very weak heart sounds, indicating possible inhalation injury. This case highlights the extreme complexity of managing this kind of injury. Timely and accurate wound treatment and respiratory tract care, as well as active systematic support treatment, played vital roles in the management of this patient.

  5. The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department

    DEFF Research Database (Denmark)

    Plesner, Louis Lind; Iversen, Anne Kristine Servais; Langkjær, Sandra;

    2015-01-01

    (3.6 %) died within 30 days. A higher triage acuity level was associated with numerous events, including acute surgery, endovascular intervention, i.v. treatment, cardiac arrest, stroke, admission to intensive care, hospital transfer, and mortality within 30 days (p ... that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database. RESULTS: Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were...... categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46-76), 49.8 % were male and median length of stay was 1 day (IQR 0-4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219...

  6. Nutritional status of adults and elderly patients admitted in an university hospital Perfil nutricional de pacientes adultos e idosos admitidos em um hospital universitário

    Directory of Open Access Journals (Sweden)

    Nathálie Crestani

    2011-12-01

    Full Text Available Objective: To identify the nutritional status of adults and elderly patients admitted in an university hospital. Materials and Methods: This is a cross-sectional, retrospective and descriptive study. The nutritional assessment was conducted by using the body mass index (BMI and the subjective global assessment (SGA, which classifies patients into three categories: well nourished (A, moderately or suspected of being malnourished (B or severely malnourished (C. All data (SGA, BMI and primary condition were collected from information present in the evaluation forms filled in the nutritional routine, which are performed within seventy-two hours after admission. The study was approved by the Scientific and Ethics Committee for Research of PUCRS. Results: The study included 32 adults and 36 elderly (n=68. In relation to the SGA, 46,9% of adults were classified as well nourished (A and 53,1% as moderately (or suspected of being malnourished (B. Among elderly patients, 25% were classified as well nourished (A and 75% as moderately (or suspected of being malnourished (B. The BMI showed 37,5% of adults as eutrophic and 62,5% as overweight or obesity; the elderly were classified as 50% eutrophic, 36,1% overweight and 13,9% underweight. Conclusion: The nutritional status of the studied patients was characterized by the high prevalence of nutritional risk and overweight/obesity in both groups. This reality seems to translate, at the hospital level, the situation of nutritional transition experienced in our country today. In addition, the results point the importance of using more than one method of nutrition screening in patients admitted in hospitals, in order to obtain greater precision in the assessment.Objetivo: Identificar o perfil nutricional de pacientes adultos e idosos admitidos em um hospital universitário. Materiais e Métodos: Trata-se de um estudo transversal, retrospectivo e descritivo. Foram utilizados para avaliação nutricional o

  7. 烧伤患者真菌感染分析%A clinical study of fungal infection in burn patients

    Institute of Scientific and Technical Information of China (English)

    罗高兴; 吴军; 张家平; 罗奇志; 黄跃生; 彭毅志; 聂志宏; 张晓兵; 庄颖; 袁志强; 张立辉; 周秘; 程文广

    2009-01-01

    Objective To address the features of the fungal infection after burn injury in clinic.Methods Three thousand nine hundred and nine bum patients admitted to our institute from Jan. 2003 to Dec. 2006 were involved in this study. Two thousand two hundred and seventy-one samples were harvested for fungal detection by culture from 467 patients suspected to be infected by fungi based on their clinic mani-festations. The collected samples included wound tissue, blood, urine, stool, sputum, catheters and others.The antibiotic sensitivity of the identified fungi were determined by routine method. When same kind of fun-gus was found from different samples taken from one patient, it was recorded as one positive sample. The samples were ranked in an ascending order as wound secretion, stool, urine, sputum and bronchia alveolar lavage fluid, arteriovenous catheter or urinary catheter, blood. Only the positive sample of the highest rank source was recorded as the positive strain of fungus from this particular patient. Results It was found 61 fungal positive samples from the 2271 samples collected. Out of 467 patients, 38 strains of fungi were detec-ted from 36 bum patients during the investigated period, the incidence was O. 92% (36/3909). The most three commonest types among the identified 38 strains of fungi were Candida tropicalis (42.1%), Candida albicans (31.6%) and Candida famata (T. Famata, 10.5% ). The drug sensitivity tests demonstrated that most of the strains detected in this investigation, with the exception of candida galbrata, were sensitive to most of the routine antimyeotics agents such as Amphotericin B, Fluconazol, and ltraconazole etc. Among the 36 fungus positive patients, in 18 patients the burn area exceeded 80% TBSA, 12 patients with 50%-79% TBSA, 4 patients with 30% -49% TBSA, and in 2 patients the burn area was smaller than 30% TBSA. It was found most of the fungal infections(77.78% ) occurred 2 weeks after burn injury, and 8 of the 36 fun

  8. Closed-loop and decision-assist resuscitation of burn patients.

    Science.gov (United States)

    Salinas, Jose; Drew, Guy; Gallagher, James; Cancio, Leopoldo C; Wolf, Steven E; Wade, Charles E; Holcomb, John B; Herndon, David N; Kramer, George C

    2008-04-01

    Effective resuscitation is critical in reducing mortality and morbidity rates of patients with acute burns. To this end, guidelines and formulas have been developed to define infusion rates and volume requirements during the first 48 hours postburn. Even with these standardized resuscitation guidelines, however, over- and under-resuscitation are not uncommon. Two approaches to adjust infusion rate are decision-assist and closed-loop algorithms based on levels of urinary output. Specific decision assist guidelines or a closed-loop system using computer-controlled feedback technology that supplies automatic control of infusion rates can potentially achieve better control of urinary output. In a properly designed system, closed-loop control has the potential to provide more accurate titration rates, while lowering the incidence of over- and under-resuscitation. Because the system can self-adjust based on monitoring inputs, the technology can be pushed to environments such as combat zones where burn resuscitation expertise is limited. A closed-loop system can also assist in the management of mass casualties, another scenario in which medical expertise is often in short supply. This article reviews the record of fluid balance of contemporary burn resuscitation and approaches, as well as the engineering efforts, animal studies, and algorithm development of our most recent autonomous systems for burn resuscitation. PMID:18385584

  9. Burning Mouth Syndrome and "Burning Mouth Syndrome".

    Science.gov (United States)

    Rifkind, Jacob Bernard

    2016-03-01

    Burning mouth syndrome is distressing to both the patient and practitioner unable to determine the cause of the patient's symptoms. Burning mouth syndrome is a diagnosis of exclusion, which is used only after nutritional deficiencies, mucosal disease, fungal infections, hormonal disturbances and contact stomatitis have been ruled out. This article will explore the many causes and treatment of patients who present with a chief complaint of "my mouth burns," including symptomatic treatment for those with burning mouth syndrome. PMID:27209717

  10. Treatment of acute deep burns in lower extremities of the elderly

    Institute of Scientific and Technical Information of China (English)

    Babur M. Shakirov

    2015-01-01

    Objective: To study the different surgical treatments in 154 elderly patients with acute deep burns of lower extremities admitted in Burn Department of RSCUMA.Methods:Skin grafts in extensive burns were performed in 32 patients for the purpose of achieving early closure of the burn area. In 116 patients with burn surface area of 6-25 %, skin grafting was performed on the granulating wound when the wound was ready for accepting skin graft. In these 19 cases, a stamp graft procedure was used in 12 patients and Mowlen-Jackson method of skin grafting in 7 cases.Results:Analysis of the nearest results showed that 28 out of 154 patients came back to the hospital for new surgery due to loss of ability of normal movement of their extremities.Conclusions:Careful patient selection and timing of surgery will help to avoid any adverse effect on patient outcome.

  11. Optimization of burn referrals

    DEFF Research Database (Denmark)

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne;

    2014-01-01

    INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmark....... METHODS: We included burn patients referred to the NBC in a three-months period. Patient records were systematically analyzed and compared with the national guidelines for referral of burn injured patients. RESULTS: A total of 97 burn injured patients were transferred for treatment at the NBC and the most...... common reason for referral was partial thickness burn exceeding 3% estimated area of burn (55% of the patients) while facial burns (32%) and inhalational injury (25%) were other common reasons. We found that 29 (30%) of the referrals were considered potentially unnecessary according to the guidelines...

  12. Faecal Escherichia coli isolates show potential to cause endogenous infection in patients admitted to the ICU in a tertiary care hospital.

    Science.gov (United States)

    Nagarjuna, D; Mittal, G; Dhanda, R S; Verma, P K; Gaind, R; Yadav, M

    2015-09-01

    Nosocomial infections are acquired during hospital treatment or in a hospital environment. One such infecting agent, Escherichia coli, harbours many virulence genes that enable it to become pathogenic, causing damage to the host. The mechanism of the E. coli virulence factors provenance to cause infection in host environments is not clearly elucidated. We investigated the virulence and pathogenicity of E. coli affected by the host environment. For this, blood (n = 78) and faecal (n = 83) E. coli isolates were collected from patients with and without sepsis, respectively, who had been admitted to the intensive care unit. The E. coli genomic DNA was isolated; the phylogenetic grouping was conducted by triplex PCR. The occurrence of nine virulence genes among the all the isolates was confirmed by gene-specific PCR. The prevalence of E. coli in blood isolates was more in phylogenetic groups B2 and D compared to groups A and B1. However, in faecal isolates, there was no significant difference. The prevalence of adhesin and toxin (papG, sfa, afa, cnf1, hlyA) genes was higher in blood compared to faecal E. coli isolates. However, the prevalence of aer, traT and PAI was similar as well as higher among both of these groups. These observations indicate a role of external environment (hospital setting) on host susceptibility (development of infection) in the faecal E. coli isolates, thereby making the patient prone to a sepsis condition. PMID:26257914

  13. Parasuicide and drug self-poisoning: analysis of the epidemiological and clinical variables of the patients admitted to the Poisoning Treatment Centre (CAV, Niguarda General Hospital, Milan

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    Manfré Sergio

    2005-04-01

    Full Text Available Abstract Epidemiological knowledge of parasuicides and drug self-poisoning is still limited by a lack of data. A number of preliminary studies, which require further analysis, evidenced that parasuicidal acts occur more often among females, that the peak rate is generally recorded between the ages of 15 and 34 years and psychotropic medications seems to be the most frequently used. The aim of this study was to describe the demographic and clinical variables of a sample of subjects admitted to the Posisoning Treatment Centre (CAV, Niguarda General Hospital, Milan, following drug self-poisoning. Furthermore, this study is aimed to identify the risk factors associated to parasuicidal gestures, with special care for the used drugs, the presence of psychiatric or organic disorders, alcoholism and drug addiction. The study included the 201 patients attending the CAV in 1999 and 2000 who satisfied the criteria of self-poisoning attempts: 106 cases in 1999 and 95 in 2000. The sample had a prevalence of females (64%. The peak rates of parasuicides from drug self-poisoning were reached between 21 and 30 years among the females, and 31 and 40 years among the males. 81.6% of the patients used one or more psychoactive drugs, the most frequent being the benzodiazepines (58.7%, classic neuroleptics (16.9% and new-generation antidepressants (SSRIs, SNRIs, NARIs (12.9%. The prevalence of mood disorders was higher among females (64% vs 42%, whereas schizophrenia was more frequently diagnosed in males (22% vs 10%. 61% (33% had a history of previous attempted suicides. The presence of clinically relevant organic diseases was observed in 24.9% of the sample.

  14. Faecal Escherichia coli isolates show potential to cause endogenous infection in patients admitted to the ICU in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    D. Nagarjuna

    2015-09-01

    Full Text Available Nosocomial infections are acquired during hospital treatment or in a hospital environment. One such infecting agent, Escherichia coli, harbours many virulence genes that enable it to become pathogenic, causing damage to the host. The mechanism of the E. coli virulence factors provenance to cause infection in host environments is not clearly elucidated. We investigated the virulence and pathogenicity of E. coli affected by the host environment. For this, blood (n = 78 and faecal (n = 83 E. coli isolates were collected from patients with and without sepsis, respectively, who had been admitted to the intensive care unit. The E. coli genomic DNA was isolated; the phylogenetic grouping was conducted by triplex PCR. The occurrence of nine virulence genes among the all the isolates was confirmed by gene-specific PCR. The prevalence of E. coli in blood isolates was more in phylogenetic groups B2 and D compared to groups A and B1. However, in faecal isolates, there was no significant difference. The prevalence of adhesin and toxin (papG, sfa, afa, cnf1, hlyA genes was higher in blood compared to faecal E. coli isolates. However, the prevalence of aer, traT and PAI was similar as well as higher among both of these groups. These observations indicate a role of external environment (hospital setting on host susceptibility (development of infection in the faecal E. coli isolates, thereby making the patient prone to a sepsis condition.

  15. Cannabis abuse : a phenomenological study of the causative factors as perceived by patients with a history of Cannabis use, admitted at Bophelong Psychiatric Hospital in the North West Province / Boitumelo Susan Patricia Ramphomane

    OpenAIRE

    Ramphomane, Boitumelo Susan Patricia

    2005-01-01

    A phenomenological study was carried out to find out from patients with a history of cannabis use. admitted at Bophelong Psychiatric Hospital, reasons or factors that caused them to use/abuse cannabis. An original sample of 30 male patients between the ages of 16-30 years was selected from chronic (rehabilitation) wards of mentally stable patients awaiting discharge. Out of the 30 subjects, 10 protocols were selected for phenomenological explication. An unstructured type of interview was c...

  16. Time to initial antibiotic administration, and short-term mortality among patients admitted with community-acquired severe infections with and without the presence of systemic inflammatory response syndrome

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Laursen, Christian B; Hallas, Jesper;

    2015-01-01

    BACKGROUND: The prognosis for patients with severe infection is related to early treatment, including early administration of antibiotics. The study aim was to compare the short-term mortality among patients admitted with severe infection with and without systemic inflammatory response syndrome...... Medicine (ACCP/SCCM) definitions. Cases were identified by manual chart review using predefined criteria of infection. Data on vital signs, laboratory values and antibiotic treatment were obtained electronically. RESULTS: We included 1169 patients with infection and organ dysfunction, treated...

  17. 重度烧伤病人的睡眠管理%Sleep management of severe burn patients

    Institute of Scientific and Technical Information of China (English)

    刘志宣

    2013-01-01

    Based on the observation and analysis of the factors of severe burn patients sleep effect, summed up the effective management method of sleep quality of severe burn patients. To improve the sleep quality of patients with severe burn, promote early recovery of patients with severe burn, and decrease the rate of disability, and even death, has a very important significance.%本文通过对重度烧伤病人睡眠影响因素的观察与分析,总结出对重度烧伤病人睡眠质量的有效管理方法。对提高重度烧伤病人的睡眠质量,促进重度重度烧伤病人早日康复,并降低其致残率,甚至死亡率,具有非常重要的意义。

  18. Chemical burns revisited: What is the most appropriate method of decontamination?

    Science.gov (United States)

    Tan, Teresa; Wong, David S Y

    2015-06-01

    The purpose of this study is to investigate the efficacy of decontamination by immediate surgical debridement in the acute management of chemical burns as compared to conventional dilutional approaches by irrigation or wetting. A retrospective review of the medical records of patients admitted to the Burns Centre of the Prince of Wales Hospital, Hong Kong, between 2001 and 2012, was performed. The time to recovery as reflected by the hospital stay for patients who had received immediate debridement, continuous irrigation, and wet packs was calculated and compared. A total of 99 patients were admitted for chemical burns (3.3% of total admissions). There were three mortalities. Immediate surgical debridement failed to achieve a faster recovery than irrigation or wet packs. Continuous water irrigation was better than wet packs in achieving earlier recovery. Continuous water irrigation remains the most preferred method of decontamination in acute chemical burn management.

  19. A RETROSPECTIVE ANALYSIS OF CLINICAL DIAGNOSIS, PREDICTABILITY AND FETO MATERNAL OUTCOME IN A CRITICAL PATIENT S ADMITTED IN OBSTETRIC INTENSIVE CARE UNIT IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Vijayasree

    2014-01-01

    Full Text Available INTRODUCTION: Care of the critically ill parturient is a unique challenge in obstetrics particularly because of its unpredictability. Hemorrhage , toxemia , anemia and septicemia are common causes of mortality and morbidity in these patients. Obstetric critical care in developing countries continues to be ra dically different from developed countries. AIMS AND OBJECTIVES: To analyze all cases of critically ill obstetric patients admitted to an obstetric intensive care unit in relation to causes for admissions, interventions required, course during their ICU st ay and fetal maternal outcome. MATERIALS AND METHODS : A one year retrospective analysis of all obstetric admissions to the ICU at our referral hospital was conducted, observations made and results were analyzed . RESULTS AND ANALYSIS : There were 24 ICU admi ssions with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33%, n=20, P <0.05 with more patients presenting with obstetric complications (91.66%, n=22, P <0.01 as compared to medical complications (8.32%, n=2. Obstetric hemorrhage (n=15, 62.5% and hemodynamic instability (n=20, 83.33% were considered to be significant risk factors for ICU admission ( P =0.000. Inotropic support was required in 22 patients (91.66% while 17 p atients (70.83% required ventilatory support. The mean duration of ventilation (30.17±21.65 h and ICU stay (39.42±33.70 h were of significantly longer duration in survivors ( P =0.01, P =0.00 respectively versus non - survivors. The observed mortality n=10, 41.67% was significantly higher since ours is a referral tertiary center and delay in reaching the tertiary center from the place of occurrence of the mishap is a usual occurrence. CONCLUSION: Obstetric hemorrhage leading to hemodynamic instability remains the leading cause of ICU admissions and maternal mortality.

  20. Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients?

    Science.gov (United States)

    Jeschke, Marc G; Finnerty, Celeste C; Kulp, Gabriela A; Kraft, Robert; Herndon, David N

    2013-01-01

    This is a large cohort analysis in severely burned pediatric children to determine whether C-reactive protein (CRP) can be used as a predictor for severe infection or sepsis. Nine-hundred eighteen pediatric burn patients were enrolled in this study. CRP values were measured throughout acute hospitalization and for up to 6 months postburn. Demographic data, incidence of infection, surgical interventions and other relevant clinical information was compiled from medical records. We performed an extensive literature search to identify models that other groups have developed to determine the effects of CRP levels postburn to assess the value of these parameters as predictors of sepsis or severe infection. Statistical analysis was performed using ANOVA and regression analysis where appropriate. Three-hundred fifteen female and 603 male pediatric patients were enrolled in this study. Average total body surface area (TBSA) burn was 45±23%, with full thickness burn over 32±27% TBSA, and patients were 7±6 years old. CRP values significantly correlated with burn size, survival and gender. Significantly higher levels of CRP were found in large burns, in non-survivors, and in females, p<0.05. Using various described models to determine whether CRP levels change before and after an event can predict sepsis or severe infection, we found that CRP cannot predict severe infection or sepsis. Although CRP is a marker of the inflammatory response postburn, CRP fails to predict infection or sepsis in severely burn patients. PMID:23875119

  1. Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification

    Directory of Open Access Journals (Sweden)

    Goutos Ioannis

    2010-10-01

    Full Text Available To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23 are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ′gold standard′ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments.

  2. Characterization of Pseudomonas aeruginosa in Burn Patients Using PCR- Restriction Fragment Length Polymorphism and Random Amplified Polymorphic DNA Analysis

    OpenAIRE

    Abdolaziz Rastegar Lari; Bagher Yakhchali; Parviz Owlia; Hassan Salimi

    2010-01-01

    One of the major opportunistic pathogens in patients with burninjuries is Pseudomonas aeruginosa, which causes severe infectionsin burned patients. The objective of the study was to examinethe molecular epidemiology of P. aeruginosa colonization inthe burn unit of Shahid Motahari Hospital in Tehran, Iran. Restrictionfragment length polymorphism (RFLP) and random amplifiedpolymorphic DNA (RAPD) analysis were employed tostudy 127 clinical and two environmental P. aeruginosa isolatescollected fr...

  3. ASSISTANCE FOR BURNED SINK PATIENTS AT HOSPITAL BY THE PERSPECTIVE OF INFECTION CONTROL: A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Ariadna Pires Damaceno

    2002-06-01

    Full Text Available The infection in burnings is very common, involve of the main mechanism of defense: the skin. Thus,this study aimed to identify and to analyze the measures adopted for the prevention and control of the infectionsrelated to this area. The research was constituted by a case study and data were obtained from systemizeobservation and of a questionnaire applied to the teams medical and of nursing of a unit of handling of burnnings ofthe city of Goiânia. The results showed deficiencies related to the infection control and pointed to the need of thetrainmen and update in infection control as direct patient’s care as in articles processing used for this care.Therefore the adequacy of procedure to the prevention and control of the nosocomial infections becomesnecessary.

  4. Factors associated with mortality and length of stay in the Oporto burn unit (2006-2009).

    Science.gov (United States)

    Bartosch, Isabel; Bartosch, Carla; Egipto, Paula; Silva, Alvaro

    2013-05-01

    Retrospective studies are essential to evaluate and improve the efficiency of care of burned patients. This study analyses the work done in the burn unit of Hospital de S. João in the north of Portugal. A retrospective review was performed in patients admitted from 2006 to 2009. The study population was characterised regarding patient demographics, admissions profile, burn aetiology, burn site, extension and treatment. Multiple linear and logistic regression models were done in order to elucidate which of these factors influenced the mortality and length of stay. The characteristics before and after the creation of the burn unit, as well as the similarities and differences with the published data of other national and international burn units, are analysed. PMID:22981798

  5. New type of sauna-related burn: conductive contact burn.

    Science.gov (United States)

    Shin, Seung Jun; Yoo, Heon; Park, Myong Chul

    2013-01-01

    A 70-year-old woman visited a Korean-style hot dry sauna room. The patient had a medical history of hypertension and hyperlipidemia. During the sauna, the patient slept for 30 minutes. During the sleep, the right medial thigh was covered with a fully wet towel. The patient sustained a second-degree burn on the right medial thigh area with multiple bullas. On physical examination, erythema, heating sensation, and swelling around the bullas were noted. The patient was admitted and received intravenous antibiotics for 7 days. A dressing with Silmazine 1% cream (sulfadiazine) was applied twice a day for prevention of local infection. The patient was discharged on day 14 without complication. In this case, the mechanism of the burn was different. Hot air has much thermal energy but is not conducted to the skin directly. A wet towel will have a relatively higher thermal capacity or heat capacity than a dry or damp towel, and the sodden water might be a medium for the conduction of thermal energy. Owing to the global popularity of sauna bathing, it is important to recognize all sources of sauna-related burns.

  6. BACTERIOLOGICAL STUDY OF BURNS INFECTION

    Directory of Open Access Journals (Sweden)

    Shareen

    2015-10-01

    Full Text Available A burn is a wound in which there is coagulative necrosis of the tissue, majority of which are caused by heat. Burn injury is a major public health problem in many areas of the world. Burns predispose to infection by damaging the protective barrier function of the skin, thus facilitating the entry of pa thogenic microorganisms and by inducing systemic immunosuppression . (1 OBJECTIVE : The present study was therefore undertaken to isolate and identify the aerobic bacterial flora in burn patients and its antibiotic susceptibility pattern. MATERIAL & METHODS : A total of 100 patients admitted with different degree of burns were studied. Wound swabs were taken with aseptic precautions by dry sterile cotton swab sticks. These swabs were transported to the microbiology laboratory and the isolates were identified based on standard microbiological methods. Antibiotic susceptibility testing was done by Kirby Bauer’s disc diffusion method. RESULT : A total of 127 bacterial pathogens were isolated from 100 patients. Of these, 69% were monomicrobial in nature and 28% wer e polymicrobial. The most frequent cause of infection was found to be Staphylococcus aureus (39.4%, followed by Pseudomonas aeruginosa (14.2%, Klebsiella pneumonia (13.4%, E.coli (8.7% and Acinetobacter species (7.9%.Out of the total Staphylococcus au reus isolates, 19 were Methicillin sensitive and 31 were Methicillin resistant (MRSA. All the MRSA strains were 100% sensitive to Vancomycin and Linezolid. The Pseudomonas aeruginosa isolates were most sensitive to Amikacin (9 4.4%, Fluroquinolones (61.1% . CONCLUSION : Staphylococcus aureus and Pseudomonas aeruginosa were major causes of infection in burn wounds. Therefore it is necessary to implement urgent measures for restriction of nosocomial infections, sensible limitation on the use of antimicrobial agents, strict disinfection and hygiene.

  7. Admit: Alma Data Mining Toolkit

    Science.gov (United States)

    Friedel, Douglas; Looney, Leslie; Xu, Lisa; Pound, Marc W.; Teuben, Peter J.; Rauch, Kevin P.; Mundy, Lee; Kern, Jeffrey S.

    2015-06-01

    ADMIT (ALMA Data Mining Toolkit) is a toolkit for the creation and analysis of new science products from ALMA data. ADMIT is an ALMA Development Project written purely in Python. While specifically targeted for ALMA science and production use after the ALMA pipeline, it is designed to be generally applicable to radio-astronomical data. ADMIT quickly provides users with a detailed overview of their science products: line identifications, line 'cutout' cubes, moment maps, emission type analysis (e.g., feature detection), etc. Users can download the small ADMIT pipeline product (data mining between many astronomical sources and line transitions will be possible. Users will also be able to enhance the capabilities of ADMIT by creating customized ADMIT tasks satisfying any special processing needs. Future implementations of ADMIT may include EVLA and other instruments.

  8. INFARTO AGUDO DE MIOCARDIO EN PACIENTES JÓVENES INGRESADOS EN CUIDADOS INTENSIVOS / Acute myocardial infarction in young patients admitted to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ricardo Grau Ávalos

    2012-01-01

    factors, the most common topographic locations, treatment used, and to analyze mortality. Method: A descriptive, retrospective and longitudinal study was performed in patients under 45 years of age with acute myocardial infarction, admitted to the Intensive Care Units of "Celestino Hernández Robau" and "Arnaldo Milian Castro" University Hospitals in Santa Clara, Villa Clara, between January 1995 and December 2006. Results: 202 patients under 45 years of age accounted for 4,6 % of total cases, 81,2 % were male sex, smoking was the most prevalent risk factor (68,8 %, followed by hypertension (56,4 %. The inferior infarct location was found in 85 patients (42,0 %, followed by extensive anterior and antero-septal infarct location with 49 (24,2 % and 45 (22,3 % cases, respectively. 126 patients received thrombolytic therapy (62,4 %, only 1 of them (0,8 % died, the other 4 dead (5,3 % had not received such treatment. Conclusions: Male sex, smoking, myocardial infarction with ST elevation, inferior infarct location and the administration of thrombolytic therapy were predominant.

  9. Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon's experience.

    Science.gov (United States)

    Khandelwal, Anjay; Yelvington, Miranda; Tang, Xinyu; Brown, Susan

    2014-01-01

    Many patients develop hypertrophic scarring after a burn injury. Numerous treatment modalities have been described and are currently in practice. Photothermolysis or laser therapy has been recently described as an adjunct for management of hypertrophic burn scars. This study is a retrospective chart review of adult and pediatric patients undergoing fractional photothermolysis at a verified burn center examining treatment parameters as well as pre- and post-Vancouver Scar Scale scores. Forty-four patients underwent fractional photothermolysis during the study period of 8 months. Mean pretreatment score was 7.6, and mean posttreatment score was 5.4. The mean decrease in score was 2.2, which was found to be statistically significant. There were no complications. Fractional photothermolysis is a safe and efficacious adjunct therapy for hypertrophic burn scars. Prospective trials would be beneficial to determine optimal therapeutic strategies.

  10. Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hammer, J H; Krarup, Annabel Lee;

    1999-01-01

    for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age...... and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every...... died in group A and 2 in group B; all with a Bull and Fischer index between 1.0 and 2.0. Prestorage leukocyte filtration may reduce transfusion related accumulation of various bioactive substances and the requirement for blood in burn trauma patients....

  11. Decellularized human amniotic membrane: more is needed for an efficient dressing for protection of burns against antibiotic-resistant bacteria isolated from burn patients.

    Science.gov (United States)

    Gholipourmalekabadi, M; Bandehpour, M; Mozafari, M; Hashemi, A; Ghanbarian, H; Sameni, M; Salimi, M; Gholami, M; Samadikuchaksaraei, A

    2015-11-01

    Human amniotic membranes (HAMs) have attracted the attention of burn surgeons for decades due to favorable properties such as their antibacterial activity and promising support of cell proliferation. On the other hand, as a major implication in the health of burn patients, the prevalence of bacteria resistant to multiple antibiotics is increasing due to overuse of antibiotics. The aim of this study was to investigate whether HAMs (both fresh and acellular) are an effective antibacterial agent against antibiotic-resistant bacteria isolated from burn patients. Therefore, a HAM was decellularized and tested for its antibacterial activity. Decellularization of the tissue was confirmed by hematoxylin and eosin (H&E) and 4,6-diamidino-2-phenylindole (DAPI) staining. In addition, the cyto-biocompatibility of the acellular HAM was proven by the cell viability test (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide, MTT) and scanning electron microscopy (SEM). The resistant bacteria were isolated from burns, identified, and tested for their susceptibility to antibiotics using both the antibiogram and polymerase chain reaction (PCR) techniques. Among the isolated bacteria, three blaIMP gene-positive Pseudomonas aeruginosa strains were chosen for their high resistance to the tested antibiotics. The antibacterial activity of the HAM was also tested for Klebsiella pneumoniae (American Type Culture Collection (ATCC) 700603) as a resistant ATCC bacterium; Staphylococcus aureus (mecA positive); and three standard strains of ATCC bacteria including Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27833), and S. aureus (ATCC 25923). Antibacterial assay revealed that only the latter three bacteria were susceptible to the HAM. All the data obtained from this study suggest that an alternative strategy is required to complement HAM grafting in order to fully protect burns from nosocomial infections.

  12. Fatores prognósticos em pacientes idosos admitidos em unidade de terapia intensiva Prognostic factors in elderly patients admitted in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Francine de Cristo Stein

    2009-08-01

    Full Text Available OBJETIVOS: Atualmente o envelhecimento populacional é proeminente fenômeno mundial. Então, a avaliação do prognóstico em pacientes idosos é necessária, sendo assim o objetivo deste estudo foi identificar fatores de risco em população de pacientes idosos admitidos em unidade de terapia intensiva. MÉTODOS: Foi realizado estudo prospectivo, em unidade de terapia intensiva geral de um hospital terciário, durante 5 meses. Pacientes com idade maior ou igual a 65 anos que permaneceram na unidade de terapia intensiva por tempo maior ou igual a 24 horas foram incluídos, pacientes moribundos e aqueles readmitidos na unidade de terapia intensiva durante mesma internação hospitalar foram excluídos. RESULTADOS: Foram envolvidos no estudo 199 pacientes com média de idade de 75,4± 6,8 anos, 58,8% do sexo feminino. A mortalidade hospitalar foi 57,3%. A média do APACHE II, SOFA, MODS e KATZ índice (avaliação de atividades diárias foram respectivamente 20,0±5,8, 6,8±3,9, 2,4±1,9 e 5,3±1,6. A maioria dos pacientes estava no pós-operatório 59,3%, sendo que 41,6% estavam em uso de ventilação mecânica invasiva. Foi determinante independente de maior mortalidade através de análise de regressão: a idade avançada (76,9±6,7 anos óbito versus 73,3±6,5 anos alta; p=Currently, aging of the population is a widespread global phenomenon. Therefore, the assessment of prognosis in elderly patients is needed. This study aims to identify risk factors in a population of elderly patients admitted in the intensive care unit METHODS: A prospective study in the intensive care unit of a general tertiary hospital was carried out for five months. Patients with 65 years or more of age, who stayed in the intensive care unit for 24 hours or more were included and those at the-end-of-life, patients readmitted to intensive care unit during the same hospital stay were excluded. RESULTS: In this study 199 patients were involved, with a mean age of 75.4±6

  13. Effect of immune-enhancing diets on the outcomes of patients after major burns.

    Science.gov (United States)

    Mahmoud, W H; Mostafa, W; Abdel-Khalek, A H; Shalaby, H

    2014-12-31

    The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns. PMID:26336366