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Sample records for thermal burn patients

  1. Emergency department management of patients with thermal burns [digest].

    Science.gov (United States)

    Tolles, Juliana; Gupta, Nachi; Nusbaum, Jeffrey

    2018-02-01

    Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care. Special populations, including children and pregnant women, require additional treatment considerations. Referral to specialized burn care for select patients is necessary to improve long-term outcomes. This article reviews thermal burn classification and evidence-based treatment strategies. [Points & Pearls is a digest of Emergency Medicine Practice.].

  2. Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital.

    Science.gov (United States)

    Kilyewala, C; Alenyo, R; Ssentongo, R

    2017-07-06

    Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count 12,000/μL (p = 0.05). Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

  3. Management of a patient with thermal burns and para-chloronitrobenzene poisoning

    Directory of Open Access Journals (Sweden)

    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.

  4. Transient Diabetes Insipidus Following Thermal Burn; A Case Report and Literature Review.

    Science.gov (United States)

    Dash, Suvashis; Ghosh, Shibajyoti

    2017-10-01

    Diabetes insipidus is a disease charaterised by increased urine production and thrist. Neurogenic diabetes insipidus following head trauma,autoimmune disease and infection is quite common but diabetes insipidus following thermal burn injury is a rare complication.We should know about this complication as its management need a comprehensive approach for satisfactory outcome. Thermal burn can cause different complications in early post burn period like electrolyte imbalance, dehydration, acute renal failure, but diabetes insipidus is a very rare and unusual complication that may come across in thermal burn. We should be aware about this condition to prevent and treat mortality and morbidity in burn patients. We have reported a case of transient diabetes insipidus in a patient of thermal burn in early post burn period. Patient was treated accordingly, leading to complete recovery.

  5. Burn Depth Estimation Using Thermal Excitation and Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Dickey, F.M.; Holswade, S.C.; Yee, M.L.

    1998-12-17

    Accurate estimation of the depth of partial-thickness burns and the early prediction of a need for surgical intervention are difficult. A non-invasive technique utilizing the difference in thermal relaxation time between burned and normal skin may be useful in this regard. In practice, a thermal camera would record the skin's response to heating or cooling by a small amount-roughly 5{degrees} Celsius for a short duration. The thermal stimulus would be provided by a heat lamp, hot or cold air, or other means. Processing of the thermal transients would reveal areas that returned to equilibrium at different rates, which should correspond to different burn depths. In deeper thickness burns, the outside layer of skin is further removed from the constant-temperature region maintained through blood flow. Deeper thickness areas should thus return to equilibrium more slowly than other areas. Since the technique only records changes in the skin's temperature, it is not sensitive to room temperature, the burn's location, or the state of the patient. Preliminary results are presented for analysis of a simulated burn, formed by applying a patch of biosynthetic wound dressing on top of normal skin tissue.

  6. [Prevention of gastrointestinal bleeding in patients with advanced burns].

    Science.gov (United States)

    Vagner, D O; Krylov, K M; Verbitsky, V G; Shlyk, I V

    2018-01-01

    To reduce the incidence of gastrointestinal bleeding in patients with advanced burns by developing a prophylactic algorithm. The study consisted of retrospective group of 488 patients with thermal burns grade II-III over 20% of body surface area and prospective group of 135 patients with a similar thermal trauma. Standard clinical and laboratory examination was applied. Instrumental survey included fibrogastroduodenoscopy, endoscopic pH-metry and invasive volumetric monitoring (PICCO plus). Statistical processing was carried out with Microsoft Office Excel 2007 and IBM SPSS 20.0. New algorithm significantly decreased incidence of gastrointestinal bleeding (p<0.001) and mortality rate (p=0.006) in patients with advanced burns.

  7. Burn Depth Estimation Based on Infrared Imaging of Thermally Excited Tissue

    Energy Technology Data Exchange (ETDEWEB)

    Dickey, F.M.; Hoswade, S.C.; Yee, M.L.

    1999-03-05

    Accurate estimation of the depth of partial-thickness burns and the early prediction of a need for surgical intervention are difficult. A non-invasive technique utilizing the difference in thermal relaxation time between burned and normal skin may be useful in this regard. In practice, a thermal camera would record the skin's response to heating or cooling by a small amount-roughly 5 C for a short duration. The thermal stimulus would be provided by a heat lamp, hot or cold air, or other means. Processing of the thermal transients would reveal areas that returned to equilibrium at different rates, which should correspond to different burn depths. In deeper thickness burns, the outside layer of skin is further removed from the constant-temperature region maintained through blood flow. Deeper thickness areas should thus return to equilibrium more slowly than other areas. Since the technique only records changes in the skin's temperature, it is not sensitive to room temperature, the burn's location, or the state of the patient. Preliminary results are presented for analysis of a simulated burn, formed by applying a patch of biosynthetic wound dressing on top of normal skin tissue.

  8. Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets

    Directory of Open Access Journals (Sweden)

    Samira Sharma

    2014-01-01

    Full Text Available 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 and non-vegetarian diets. The patients were divided into two groups depending upon their pre-injury food habits. Total calories were calculated by Curreri formula. Both groups were compared by various biochemical parameters, microbiological investigations, weight , status of wound healing, graft take, and hospital stay and they were followed for at least 60 days postburn. Results: The results were comparable in both groups. Vegetarian diet was found to be more palatable and cost-effective. Conclusion: Vegetarian diet is a safe and viable option for the patients suffering from burn injury. The common belief that non-vegetarian diet is superior to vegetarian diet is a myth.

  9. Increased chromium uptake in polymorphonuclear leukocytes from burned patients

    International Nuclear Information System (INIS)

    Davis, J.M.; Illner, H.; Dineen, P.

    1984-01-01

    Following thermal injury neutrophil function is severely impaired and thought to be hypometabolic; however, the host is considered to be hypermetabolic. To further investigate the metabolism and the function of neutrophils following thermal injury, neutrophil migration and chromium uptake were studied using radio-labelled neutrophils. Random and directed migration were found to be significantly reduced compared to control values. Neutrophil lysozyme content was also reduced in these burn cells while serum lysozyme from the same patients was significantly elevated over control values. These data suggest lysozyme is released by the neutrophil into the circulatory system. The influx of chromium in cells from burned patients was much greater than the influx in normal cells used in studies for chemotaxis. Influx of chromium over time and over varying concentrations of chromium was linear in cells from burned patients and normals. Cells from burned patients, however, took up more chromium than normals. Influx velocity of chromium was also determined and found to be greater in burn cells than normal cells. Since it has been shown that chromium influx is an energy-dependent reaction it is suggested that cellular energy stores are being depleted by the influx of chromium. Whether this is a response to an intracellular deficit or uncoupling of metabolic pathways is not known at this time

  10. Minor Actinide Burn in Thermal Spectrum with Enhanced Moderation

    International Nuclear Information System (INIS)

    Petrovic, B.; Huang, L. M.

    2010-01-01

    Resolving the issue of spent nuclear fuel and nuclear waste management is the necessary condition for long-term sustainability of nuclear power, and requires addressing plutonium, minor actinides (MA) and fission products. Various strategies from once-through homogeneous burn to partitioning and transmutation, and from thermal to fast systems, are being considered. The optimum system-level performance will likely require advanced critical or subcritical systems with a range of neutron spectra. Thermal systems, while not optimum, may be deployed sooner, and may provide mid-term amelioration of the issue. This paper examines burn of MA in thermal systems. One specific concern in this case is deterioration of safety parameters due to a high thermal absorption cross section of MA. Enhanced moderation has potential to at least partly remedy this concern. Therefore, we have evaluated adopting the IRIS neutronic design to MA burn. The IRIS reactor design offers enhanced safety margin, due to its fully passive safety systems and safety-by-design approach. Also, in addition to the standard UO 2 fuel (reference IRIS design), an alternative core with enhanced moderation fuel was considered. These two features (safety margin, enhanced moderation) provide a good starting point for MA burn in a thermal system. Further modifications to accommodate MA-bearing rods will be discussed. The paper will examine the benefit of the enhanced moderation in comparison to homogeneous MA burn in a typical PWR reactor.(author).

  11. Initial evaluation and management of the critical burn patient.

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    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  12. High-tension electrical-arc-induced thermal burns caused by railway overhead cables.

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    Koller, J

    1991-10-01

    Eleven patients with high-tension electrical-arc-induced thermal burns due to railway overhead cables were treated at the Bratislava Burn Department during a relatively short period of 18 months. All the injuries occurred by the same mechanism, that is persons climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. All the burns were the result of an electrical arc passing externally to the body, with subsequent ignition of the victim's clothes. The cutaneous burns, ranging from 24 to 79 per cent of the BSA, were mostly deep partial to full skin thickness injuries. One patient died on day 5 postburn, the other survived. In spite of high-tension aetiology, no true electrical injuries appear to have occurred and no amputations were necessary. The pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed object approaching, but not touching, a cable carrying a high voltage.

  13. Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013.

    Science.gov (United States)

    Strassle, Paula D; Williams, Felicia N; Napravnik, Sonia; van Duin, David; Weber, David J; Charles, Anthony; Cairns, Bruce A; Jones, Samuel W

    Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.

  14. Thermal burn and electrical injuries among electric utility workers, 1995-2004.

    Science.gov (United States)

    Fordyce, Tiffani A; Kelsh, Michael; Lu, Elizabeth T; Sahl, Jack D; Yager, Janice W

    2007-03-01

    This study describes the occurrence of work-related injuries from thermal-, electrical- and chemical-burns among electric utility workers. We describe injury trends by occupation, body part injured, age, sex, and circumstances surrounding the injury. This analysis includes all thermal, electric, and chemical injuries included in the Electric Power Research Institute (EPRI) Occupational Health and Safety Database (OHSD). There were a total of 872 thermal burn and electric shock injuries representing 3.7% of all injuries, but accounting for nearly 13% of all medical claim costs, second only to the medical costs associated with sprain- and strain-related injuries (38% of all injuries). The majority of burns involved less than 1 day off of work. The head, hands, and other upper extremities were the body parts most frequently injured by burns or electric shocks. For this industry, electric-related burns accounted for the largest percentage of burn injuries, 399 injuries (45.8%), followed by thermal/heat burns, 345 injuries (39.6%), and chemical burns, 51 injuries (5.8%). These injuries also represented a disproportionate number of fatalities; of the 24 deaths recorded in the database, contact with electric current or with temperature extremes was the source of seven of the fatalities. High-risk occupations included welders, line workers, electricians, meter readers, mechanics, maintenance workers, and plant and equipment operators.

  15. Forty-Year Follow-up of Full-Thickness Skin Graft After Thermal Burn Injury to the Volar Hand.

    Science.gov (United States)

    Weeks, Dexter; Kasdan, Morton L; Wilhelmi, Bradon J

    2016-01-01

    The hands are commonly affected in severe thermal burn injuries. Resulting contractures lead to significant loss of function. Burn contracture release and skin grafting are necessary to restore hand function. We report a case in which surgical reconstruction of a volar hand burn was performed with full-thickness skin grafting. The patient had a 40-year follow-up to assess the function and cosmesis of the repaired hand. We report a case in which a 15-month-old boy presented after receiving third-degree burns to the left volar hand, including the flexural aspects of the index, long, and ring fingers by placing it on a hot kitchen stove burner. The patient subsequently underwent scar contracture release and full-thickness skin grafting. Eleven years after reconstruction, further contractures developed associated with the patient's growth, which were reconstructed with repeat full-thickness skin graft from the inguinal region. No recurrence was witnessed afterward and 40 years after initial injury, the patient maintains full activities of daily living and use of his hand in his occupation. There is debate regarding the superiority of split-thickness versus full-thickness grafts during reconstruction. Our case strengthens the argument for durability of a full-thickness skin graft following thermal burn injury.

  16. Burn propagation in a PBX 9501 thermal explosion

    International Nuclear Information System (INIS)

    Henson, B. F.; Smilowitz, L.; Romero, J. J.; Sandstrom, M. M.; Asay, B. W.; Schwartz, C.; Saunders, A.; Merrill, F.; Morris, C.; Murray, M. M.; McNeil, W. V.; Marr-Lyon, M.; Rightley, P. M.

    2007-01-01

    We have applied proton radiography to study the conversion of solid density to gaseous combustion products subsequent to ignition of a thermal explosion in PBX 9501. We apply a thermal boundary condition to the cylindrical walls of the case, ending with an induction period at 205 C. We then introduce a laser pulse that accelerates the thermal ignition and synchronizes the explosion with the proton accelerator. We then obtain fast, synchronized images of the evolution of density loss with few microsecond resolution during the approximately 100 microsecond duration of the explosion. We present images of the solid explosive during the explosion and discuss measured rates and assumed mechanisms of burning the role of pressure in this internal burning

  17. The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns.

    Science.gov (United States)

    Hundeshagen, Gabriel; Wurzer, Paul; Forbes, Abigail A; Voigt, Charles D; Collins, Vanessa N; Cambiaso-Daniel, Janos; Finnerty, Celeste C; Herndon, David N; Branski, Ludwik K

    2017-05-01

    Multiple organ failure (MOF) is a major contributor to morbidity and mortality in burned children. While various complications induced by electrical injuries have been described, the incidence and severity of single organ failure (SOF) and MOF associated with this type of injury are unknown. The study was undertaken to compare the incidence and severity of SOF and MOF as well as other complications between electrically and thermally burned children. Between 2001 and 2016, 288 pediatric patients with electrical burns (EB; n = 96) or thermal burns (CTR; n = 192) were analyzed in this study. Demographic data; length of hospitalization; and number and type of operations, amputations, and complications were statistically analyzed. Incidence of SOF and MOF was assessed using the DENVER2 classification in an additive mixed model over time. Compound scores and organ-specific scores for lung, heart, kidney, and liver were analyzed. Serum cytokine expression profiles of both groups were also compared over time. Significance was accepted at p in age (CTR, 11 ± 5 years, vs EB, 11 ± 5 years), percent total body surface area burned (CTR, 33% ± 25%, vs EB, 32 ± 25%), and length of hospitalization (CTR, 18 ± 26 days, vs EB, 18 ± 21 days). The percentage of high-voltage injury in the EB group was 64%. The incidence of MOF was lower in the EB group (2 of 96 [2.1%]) than the CTR group (20 of 192 [10.4%]; p The incidence of single organ failure was comparable between groups. Incidence of pulmonary failure was comparable in both groups, but incidence of inhalation injury was significantly higher in the CTR group (p in the EB group had more amputations (p the groups. Serum cytokine expression profiles were also comparable between the groups. In pediatric patients, electrical injury is associated with a lower incidence of MOF than other thermal burns. Early and radical debridement of nonviable tissue is crucial to improve outcomes in the electrical burn patient population

  18. Thermal Decomposition Behaviors and Burning Characteristics of AN/Nitramine-Based Composite Propellant

    Science.gov (United States)

    Naya, Tomoki; Kohga, Makoto

    2015-04-01

    Ammonium nitrate (AN) has attracted much attention due to its clean burning nature as an oxidizer. However, an AN-based composite propellant has the disadvantages of low burning rate and poor ignitability. In this study, we added nitramine of cyclotrimethylene trinitramine (RDX) or cyclotetramethylene tetranitramine (HMX) as a high-energy material to AN propellants to overcome these disadvantages. The thermal decomposition and burning rate characteristics of the prepared propellants were examined as the ratio of AN and nitramine was varied. In the thermal decomposition process, AN/RDX propellants showed unique mass loss peaks in the lower temperature range that were not observed for AN or RDX propellants alone. AN and RDX decomposed continuously as an almost single oxidizer in the AN/RDX propellant. In contrast, AN/HMX propellants exhibited thermal decomposition characteristics similar to those of AN and HMX, which decomposed almost separately in the thermal decomposition of the AN/HMX propellant. The ignitability was improved and the burning rate increased by the addition of nitramine for both AN/RDX and AN/HMX propellants. The increased burning rates of AN/RDX propellants were greater than those of AN/HMX. The difference in the thermal decomposition and burning characteristics was caused by the interaction between AN and RDX.

  19. The FLIR ONE thermal imager for the assessment of burn wounds: Reliability and validity study.

    Science.gov (United States)

    Jaspers, M E H; Carrière, M E; Meij-de Vries, A; Klaessens, J H G M; van Zuijlen, P P M

    2017-11-01

    Objective measurement tools may be of great value to provide early and reliable burn wound assessment. Thermal imaging is an easy, accessible and objective technique, which measures skin temperature as an indicator of tissue perfusion. These thermal images might be helpful in the assessment of burn wounds. However, before implementation of a novel measurement tool into clinical practice is considered, it is appropriate to test its clinimetric properties (i.e. reliability and validity). The objective of this study was to assess the reliability and validity of the recently introduced FLIR ONE thermal imager. Two observers obtained thermal images of burn wounds in adult patients at day 1-3, 4-7 and 8-10 after burn. Subsequently, temperature differences between the burn wound and healthy skin (ΔT) were calculated on an iPad mini containing the FLIR Tools app. To assess reliability, ΔT values of both observers were compared by calculating the intraclass correlation coefficient (ICC) and measurement error parameters. To assess validity, the ΔT values of the first observer were compared to the registered healing time of the burn wounds, which was specified into three categories: (I) ≤14 days, (II) 15-21 days and (III) >21 days. The ability of the FLIR ONE to discriminate between healing ≤21 days and >21 days was evaluated by means of a receiver operating characteristic curve and an optimal ΔT cut-off value. Reliability: ICCs were 0.99 for each time point, indicating excellent reliability up to 10 days after burn. The standard error of measurement varied between 0.17-0.22°C. the area under the curve was calculated at 0.69 (95% CI 0.54-0.84). A cut-off value of -1.15°C shows a moderate discrimination between burn wound healing ≤21 days and >21 days (46% sensitivity; 82% specificity). Our results show that the FLIR ONE thermal imager is highly reliable, but the moderate validity calls for additional research. However, the FLIR ONE is pre-eminently feasible

  20. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

    Directory of Open Access Journals (Sweden)

    Elton Mathias

    2017-12-01

    Full Text Available Burn injuries are a devastating critical care problem. In children, burns continue to be a major epidemiologic problem around the globe resulting in significant morbidity and death. Apparently, treating these burn injuries in children and adults remains similar, but there are significant physiological and psychological differences. The dermal layer of the skin is generally thinner in neonates, infants, and children than in adults. Enhanced evaporative loss and need for isotonic fluids increases the risk of hypothermia in the pediatric population. The pain management of the children with major burns challenges the skills of the personnel of every unit. Managing these wounds requires intensive therapeutic treatment for multi-organ dysfunction, and surgical treatment to prevent sepsis and other complications that further delay wound closure. Alternatives to the practice of donor site harvest and autografting for the treatment of severe burns and other complex skin defects are urgently needed for both adult and pediatric populations. This review article focuses on thermal burn pathophysiology and pain management and provides an overview of currently approved products used for the treatment of pediatric burn wounds. A new promising approach has been presented as a first-line therapy in the treatment of burns to reduce surgical autografting in pediatric patients.

  1. MRI induced second-degree burn in a patient with extremely large uterine leiomyomas: A case report

    International Nuclear Information System (INIS)

    Lee, Chul Min; Kang, Bo Kyeong; Song, Soon Young; Koh, Byung Hee; Choi, Joong Sub; Lee, Won Moo

    2015-01-01

    Burns and thermal injuries related with magnetic resonance imaging (MRI) are rare. Previous literature indicates that medical devices with cable, cosmetics or tattoo are known as risk factors for burns and thermal injuries. However, there is no report of MRI-related burns in Korea. Herein, we reported a case of deep second degree burn after MRI in a 38-year-old female patient with multiple uterine leiomyomas including some that were large and degenerated. The large uterine leiomyoma-induced protruded anterior abdominal wall in direct contact with the body coil during MRI was suspected as the cause of injury, by retrospective analysis. Therefore, awareness of MRI related thermal injury is necessary to prevent this hazard, together with extreme care during MRI

  2. MRI induced second-degree burn in a patient with extremely large uterine leiomyomas: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Min; Kang, Bo Kyeong; Song, Soon Young; Koh, Byung Hee; Choi, Joong Sub; Lee, Won Moo [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    Burns and thermal injuries related with magnetic resonance imaging (MRI) are rare. Previous literature indicates that medical devices with cable, cosmetics or tattoo are known as risk factors for burns and thermal injuries. However, there is no report of MRI-related burns in Korea. Herein, we reported a case of deep second degree burn after MRI in a 38-year-old female patient with multiple uterine leiomyomas including some that were large and degenerated. The large uterine leiomyoma-induced protruded anterior abdominal wall in direct contact with the body coil during MRI was suspected as the cause of injury, by retrospective analysis. Therefore, awareness of MRI related thermal injury is necessary to prevent this hazard, together with extreme care during MRI.

  3. Problems of thermal IR-imaging in evaluation of burn wounds

    International Nuclear Information System (INIS)

    Nowakowski, A.

    2009-01-01

    Results of the research devoted to application of thermal IR-imaging in diagnostics of burn wounds are discussed. The main aim of the work was to develop an effective method for quantitative evaluation of the depth of a burn wound and for classification of regions for surgical treatment. The criterion of determination the area of the wound to be treated surgically is the time, which should not exceed three weeks for natural healing of a burn wound. Prediction that the healing process may last longer is concluded by immediate surgical intervention. We concentrate on using for this purpose QIRT - NDT TI methods (Quantitative Infra-Red Thermography - Non-Destructive Testing Thermal Imaging); especially - active dynamic thermography - ADT. In this work both, classical thermography using a high quality thermal camera as well as ADT are applied and the results of analysis are joined, allowing multimodality diagnostic approach and improved classification of burns requiring surgical treatment. Now our work in application of thermal imaging in determination of burns is continued for around 10 years, as the first publication showing our methodology was presented in 1999. In 2001, during the Thermosense conference, we have been awarded the Andronicos Kantsios Award for the work on Medical applications of model based dynamic thermography. Important reports of our experience in classical as well as ADT thermography are already published. Now we concentrate on practical aspects of the problem, trying to construct a measuring set to be operative even by not experienced staff and meeting all of necessary requirements for clinical applications. (author)

  4. 40 CFR 265.383 - Interim status thermal treatment devices burning particular hazardous waste.

    Science.gov (United States)

    2010-07-01

    ... status thermal treatment devices burning particular hazardous waste. (a) Owners or operators of thermal treatment devices subject to this subpart may burn EPA Hazardous Wastes FO20, FO21, FO22, FO23, FO26, or... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Interim status thermal treatment...

  5. Bacterial infections in burn patients at a burn hospital in Iran.

    Science.gov (United States)

    Ekrami, Alireza; Kalantar, Enayat

    2007-12-01

    The major challenge for a burn team is nosocomial infection in burn patients, which is known to cause over 50% of burn deaths. Most studies on infection in burn patients focus on burn wound infection, whereas other nosocomial infections in these patients are not well described. We undertook this study to determine three types of nosocomial infections viz., burn wound infection, urinary tract infection, and blood stream infection in burn patients in a burn hospital in Iran. During the one year period (May 2003 to April 2004), 182 patients were included in this study. Blood, urine and wound biopsy samples were taken 7 and 14 days after admission to Taleghani Burn hospital. Isolation and identification of microorganisms was done using the standard procedure. Disk diffusion test were performed for all the isolates for antimicrobial susceptibility. Of the 182 patients, 140 (76.9%) acquired at least one type of infection of the 140, 116 patients (82.8%) were culture positive on day 7 while 24 (17.2%) on 14 days after admission. Primary wound infection was most common (72.5%), followed by blood stream (18.6%) and urinary tract infections (8.9 %). The microorganisms causing infections were Pseudomonas aeruginosa (37.5%), Staphylococcus aureus (20.2%), and Acinetobacter baumanni (10.4%). Among these isolates P. aeruginosa was found to be 100 per cent resistant to amikacin, gentamicin , carbenicillin, ciprofloxacin, tobramycin and ceftazidime; 58 per cent of S. aureus and 60 per cent of coagulase negative Staphylococcus were methicillin resistant. High prevalence of nosocomial infections and the presence of multidrug resistant bacteria, and methicillin resistant S. aureus in patients at Taleghani Burn Hospital suggest continuous surveillance of burn infections and develop strategies for antimicrobial resistance control and treatment of infectious complications.

  6. Improving burn care and preventing burns by establishing a burn database in Ukraine.

    Science.gov (United States)

    Fuzaylov, Gennadiy; Murthy, Sushila; Dunaev, Alexander; Savchyn, Vasyl; Knittel, Justin; Zabolotina, Olga; Dylewski, Maggie L; Driscoll, Daniel N

    2014-08-01

    Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country. Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository. This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%). We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  7. Galactorrhea and amenorrhea in burn patients.

    Science.gov (United States)

    Goyal, Navin; Gore, Madhuri A; Shankar, Ravi

    2008-09-01

    Galactorrhea and/or amenorrhea, although uncommonly reported in post-burn patients, is a complex problem to treat. Patient is reluctant to volunteer history of these symptoms, unless asked specifically. To study profile of adult female patients with galactorrhea and/or amenorrhea in post burn period. A prospective study of all adult female patients presenting with or detected to have galactorrhea and/or amenorrhea in post burn period was conducted over 6 month's period. Detailed clinical examination, estimation of LH, FSH, Prolactin levels and X-ray of skull was done in all patients. The data collected was analyzed. Patients with hyperprolactinemia and galactorrhea were treated with Bromocriptine for 3 weeks to 3 months. In all patients with amenorrhea, pregnancy was ruled out by gynecological examination and urine pregnancy test. During this period, 30 patients (15.15%) were detected to have galactorrhea and/or amenorrhoea. The extent of burn in these patients was 20-65%of body surface area. Out of 30 patients, 5 had galactorrhea and amenorrhea, 1 galactorrhea alone and 24 had amenorrhea alone. Analysis of voluntary disclosures and detection on interrogation was done. Till the end of study, 4 patients with galactorrhea had complete relief, 2 patients reported reduction in discharge. Galactorrhea was distressing for all and was always associated with high prolactine levels .The reverse was not true. All the patients had chest burns besides other body areas. Association was noted between menstrual aberration and ovulatory phase at the time of burn. Galactorrhea and menstrual disturbances do exist in female patients in reproductive age group in post burn period and patients should be especially interrogated for these symptoms by the burn care providers.

  8. In vitro burn model illustrating heat conduction patterns using compressed thermal papers.

    Science.gov (United States)

    Lee, Jun Yong; Jung, Sung-No; Kwon, Ho

    2015-01-01

    To date, heat conduction from heat sources to tissue has been estimated by complex mathematical modeling. In the present study, we developed an intuitive in vitro skin burn model that illustrates heat conduction patterns inside the skin. This was composed of tightly compressed thermal papers with compression frames. Heat flow through the model left a trace by changing the color of thermal papers. These were digitized and three-dimensionally reconstituted to reproduce the heat conduction patterns in the skin. For standardization, we validated K91HG-CE thermal paper using a printout test and bivariate correlation analysis. We measured the papers' physical properties and calculated the estimated depth of heat conduction using Fourier's equation. Through contact burns of 5, 10, 15, 20, and 30 seconds on porcine skin and our burn model using a heated brass comb, and comparing the burn wound and heat conduction trace, we validated our model. The heat conduction pattern correlation analysis (intraclass correlation coefficient: 0.846, p < 0.001) and the heat conduction depth correlation analysis (intraclass correlation coefficient: 0.93, p < 0.001) showed statistically significant high correlations between the porcine burn wound and our model. Our model showed good correlation with porcine skin burn injury and replicated its heat conduction patterns. © 2014 by the Wound Healing Society.

  9. [Enteral nutrition in burn patients].

    Science.gov (United States)

    Pereira, J L; Garrido, M; Gómez-Cía, T; Serrera, J L; Franco, A; Pumar, A; Relimpio, F; Astorga, R; García-Luna, P P

    1992-01-01

    Nutritional support plays an important role in the treatment of patients with burns. Due to the severe hypercatabolism that develops in these patients, oral support is insufficient in most cases, and this makes it essential to initiate artificial nutritional support (either enteral or parenteral). Enteral nutrition is more physiological than parenteral, and data exist which show that in patients with burns, enteral nutrition exercises a protective effect on the intestine and may even reduce the hypermetabolic response in these patients. The purpose of the study was to evaluate the effectiveness and tolerance of enteral nutritional support with a hypercaloric, hyperproteic diet with a high content of branched amino acids in the nutritional support of patients suffering from burns. The study included 12 patients (8 males and 4 females), admitted to the Burns Unit. Average age was 35 +/- 17 years (range: 21-85 years). The percentage of body surface affected by the burns was 10% in two cases, between 10-30% in three cases, between 30-50% in five cases and over 50% in two cases. Initiation of the enteral nutrition was between twenty-four hours and seven days after the burn. The patients were kept in the unit until they were discharged, and the average time spent in the unit was 31.5 days (range: 17-63 days). Total energetic requirements were calculated based on Harris-Benedict, with a variable aggression factor depending on the body surface burned, which varied from 2,000 and 4,000 cal day. Nitrogenous balance was determined on a daily basis, and plasmatic levels of total proteins, albumin and prealbumin on a weekly basis. There was a significant difference between the prealbumin values at the initiation and finalization of the enteral nutrition (9.6 +/- 2.24 mg/dl compared with 19.75 +/- 5.48 mg/dl; p diet was very good, and only mild complications such as diarrhoea developed in two patients. Enteral nutrition is a suitable nutritional support method for patients with

  10. 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. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  11. 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...... 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...

  12. Quality of life and mediating role of patient scar assessment in burn patients.

    Science.gov (United States)

    Oh, Hyunjin; Boo, Sunjoo

    2017-09-01

    In this study, we examined the plausibility of the mediating effect of the levels of patient scar assessment on the relationship between burn severity measured with total body surface area and burn-specific health-related quality of life (HRQL) among patients with burns in South Korea. In this cross sectional descriptive study, we collected data from 100 burn patients in three burn centers specializing in burn care in South Korea. Patient scar assessment, burn specific HRQL, and burn-related characteristics were self-reported with anonymous, paper-based surveys. The findings showed a positive correlation between burn severity, patient scar assessment, and HRQL in burn patients. The evidence of this paper is that quality of life after burns more determined by scar characteristics than burn severity. In the light of the poor HRQL in burn patients, the results of this study support that improving scar status could improve patients' HRQL. Health care providers should keep in mind that patients' perspectives of their scars would be a great indicator of their HRQL, so the providers' focus should be on intensive scar management intervention in their care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  13. Accuracy of burn size estimation in patients transferred to adult Burn Units in Sydney, Australia: an audit of 698 patients.

    Science.gov (United States)

    Harish, Varun; Raymond, Andrew P; Issler, Andrea C; Lajevardi, Sepehr S; Chang, Ling-Yun; Maitz, Peter K M; Kennedy, Peter

    2015-02-01

    The purpose of this study was to compare burn size estimation between referring centres and Burn Units in adult patients transferred to Burn Units in Sydney, Australia. A review of all adults transferred to Burn Units in Sydney, Australia between January 2009 and August 2013 was performed. The TBSA estimated by the referring institution was compared with the TBSA measured at the Burns Unit. There were 698 adults transferred to a Burns Unit. Equivalent TBSA estimation between the referring hospital and Burns Unit occurred in 30% of patients. Overestimation occurred at a ratio exceeding 3:1 with respect to underestimation, with the difference between the referring institutions and Burns Unit estimation being statistically significant (Pburn-injured patients as well as in patients transferred more than 48h after the burn (Pburn (Pburns (≥20% TBSA) were found to have more satisfactory burn size estimations compared with less severe injuries (burn size assessment by referring centres. The systemic tendency for overestimation occurs throughout the entire TBSA spectrum, and persists with increasing time after the burn. Underestimation occurs less frequently but rises with increasing time after the burn and with increasing TBSA. Severe burns (≥20% TBSA) are more accurately estimated by the referring hospital. The inaccuracies in burn size assessment have the potential to result in suboptimal treatment and inappropriate referral to specialised Burn Units. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  14. Thermal instability of helium-burning shell in stars evolving toward carbon-detonation supernovae

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, D; Nomoto, K [Tokyo Univ. (Japan). Coll. of General Education

    1975-07-01

    Artificially suppressing the occurrence of thermal pulses, evolution in the phase of a growing carbon-oxygen core was computed through the ignition of carbon burning. From this computation we chose two models with the core masses of 1.074 and 1.393 Msub(solar mass). Starting from these models, we followed by numerical computation the occurrence of thermal pulses in the helium-burning shell. We have found the following. More than 4000 thermal pulses take place through the evolutionary phase. The peak energy generation rate is 10/sup 7/Lsub(solar) at most, a rate too small to induce any major dynamical effect. After each pulse the convective envelope penetrates into the helium zone, and the products of helium burning, which contain carbon and s-process elements, are mixed into the convective envelope, which thereby develops composition characteristics of carbon stars.

  15. Microbiological Monitoring and Proteolytic Study of Clinical Samples From Burned and Burned Wounded Patients

    International Nuclear Information System (INIS)

    Toema, M.A.; El-Bazza, Z.E.; El-Hifnawi, H.N.; Abd-El-Hakim, E.E.

    2013-01-01

    In this study, clinical samples were collected from 100 patients admitted to Burn and Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt, over a period of 12 months. The proteolytic activity of 110 clinical samples taken from surfaces swabs which taken from burned and burned wounded patients with different ages and gender was examined. Screening for the proteolytic activity produced by pathogenic bacteria isolated from burned and burned wounded patients was evaluated as gram positive Bacilli and gram negative bacilli showed high proteolytic activity (46.4%) while 17.9% showed no activity. The isolated bacteria proved to have proteolytic activity were classified into high, moderate and weak. The pathogenic bacteria isolated from burned and burned wounded patients and showing proteolytic activity were identified as Pseudomonas aeruginosa, Proteus mirabilis, Proteus vulgaris, Bacillus megaterium, Bacillus cereus, Staphylococcus aureus, Escherichia coli, Klebsiella ozaeanae, Klebsiella oxytoca, Klebsiella pneumoniae and Pseudomonas fluoresces.

  16. Assessment of burn-specific health-related quality of life and patient scar status following burn.

    Science.gov (United States)

    Oh, Hyunjin; Boo, Sunjoo

    2017-11-01

    This study assessed patient-perceived levels of scar assessment and burn-specific quality of life (QOL) in Korean burn patients admitted to burn care centers and identified differences in scar assessment and QOL based on various patient characteristics. A cross-sectional descriptive study using anonymous paper-based survey methods was conducted with 100 burn patients from three burn centers specializing in burn care in South Korea. Mean subject age was 44.5 years old, and 69% of the subjects were men. The overall mean QOL was 2.91 out of 5. QOL was lowest for the work subdomain (2.25±1.45) followed by the treatment regimen subdomain (2.32±1.16). The subjects' mean total scar assessment score was 35.51 out of 60, and subjects were most unsatisfied with scar color. Subjects with low income, flame-source burns, severe burns, visible scars, and scars on face or hand reported significantly lower QOL. Subjects with severe burn degree and burn range perceived their burn scar condition to be worse than that of others. The results show that burn subjects experience the most difficulties with their work and the treatment regimen. Subjects with severe burn and visible scarring have a reduced QOL and a poor scar status. Scar management intervention may improve QOL of burn patients especially those with severe burn and visible scars. Further studies are warranted to evaluate the relationship between scar assessment and QOL. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  17. Emergency service admissions of patients with burn injury

    Directory of Open Access Journals (Sweden)

    Sadiye Yolcu

    2013-09-01

    Full Text Available Objective: In this study, we aimed to investigate the propertiesof burn injured patients who admitted to our hospitalemergency service.Methods: Patients were detected from the hospital recordsof emergency service during six months period andwere divided into five groups according to their ages (60 years. Age, gender totalbody surface area (TBSA, mechanism of injury and theoutcome of emergency evaluation were recorded.Results: Totally 111619 patients admitted to our emergencyservice between 01.07.2011 and 31.12.2011. Duringsix months, 2349 males and 1960 females totally4309 patients were burn injured patients. 1773 patientswere between 0-10 years, 1083 patients were 11-20years, 735 patients were between 21 and 40, 361 patientswere between 41 and 60 and 357 patients were over 60years. Most of the patients were treated in the emergencyservice (90.1%. 0-10% TBSA patients constituted 94.2%.This ratio for burn area >40% was 0.6%. Hot liquid burn(vapored water, milk etc. was 60.2%. There was a significantrelation between mechanism of burn injury andage groups (p<0.05. No corrosive and sunburn injuriesdetermined in females. Age groups were related with hospitalization(p<0.05. The highest intensive care unit admissionwas found in the 0-10 age group (1.3%.Conclusion: Emergency service is the first admission departmentof burn injury patients. Knowing the propertiesof burn injury patients, would help hard-working emergencydoctors in triage of these patients. Also, reportingthe data of emergency service burn injury patients wouldbe helpful for further studies. J Clin Exp Invest 2013; 4(3: 285-288Key words: Burn injury, emergency service, total body surface area

  18. Vitamin E Supplementation in Burn Patients

    Science.gov (United States)

    2015-10-01

    AWARD NUMBER: W81XWH-12-1-0429 TITLE: Vitamin E Supplementation in Burn Patients PRINCIPAL INVESTIGATOR: Perenlei Enkhbaatar, MD., PhD...NOTES 14. ABSTRACT Our recent findings demonstrate that burn injury significantly depleted stores of vitamin E in adipose tissue of children by nearly...oxidative stress. The objectives of our proposal were to a) attenuate alpha-tocopherol depletion in burn patients by vitamin E supplementation, b) to

  19. Crusted Scabies in the Burned Patient

    DEFF Research Database (Denmark)

    Berg, Jais Oliver; Alsbjørn, Bjarne

    2011-01-01

    ; 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...... healing and autograft healing were impaired because of the condition. Successful treatment of the burns was only accomplished secondarily to scabicide treatment. An outbreak of scabies among staff members indirectly led to diagnosis. CS is ubiquitous, and diagnosis may be difficult. This is the first...... 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...

  20. Burn-related factors affecting anxiety, depression and self-esteem in burn patients: an exploratory study.

    Science.gov (United States)

    Jain, M; Khadilkar, N; De Sousa, A

    2017-03-31

    Burns are physically, psychologically and economically challenging injuries, and the factors leading to them are many and under-studied. The aim of the current study was to assess level of anxiety, depression and self-esteem in burn patients, and look at various burn-related variables that affect them. This cross-sectional study included 100 patients with burn injuries admitted to a tertiary care private hospital in an urban metropolis in India. The patients were assessed for anxiety, depression and self-esteem using the Hamilton anxiety rating scale, Hamilton depression rating scale and Rosenberg self-esteem scale respectively. Assessment was carried out within 2-8 weeks of injury following medical stabilization. The data was tabulated and statistically analyzed. The study sample was predominantly male (54%), married (69%), with a mean age of 34.1 ± 10.8 years. Accidental burns (94%) were the most common modality of injury. The majority (46%) suffered burns involving 20-59% total body surface area (TBSA), and facial burns were present (57%). No significant association was found between TBSA and anxiety, depression or self-esteem, and the same was true for facial burns. Deep burns, however, were significantly associated with anxiety (p=0.03) and depression (p=0.0002). High rates of anxiety and depression are associated with burn injuries and related to burn depth. Adjustment and recovery in these patients depends on various other factors like the patient's psychological status, nature/extent of the injury and ensuing medical care. Further research is warranted to reveal the magnitude and predictors of psychological problems in burn patients.

  1. Burn-related peripheral neuropathy: A systematic review.

    Science.gov (United States)

    Tu, Yiji; Lineaweaver, William C; Zheng, Xianyou; Chen, Zenggan; Mullins, Fred; Zhang, Feng

    2017-06-01

    Peripheral neuropathy is the most frequent disabling neuromuscular complication of burns. However, the insidious and progressive onset of burn neuropathy makes it often undiagnosed or overlooked. In our study, we reviewed the current studies on the burn-related peripheral neuropathy to summarize the morbidity, mechanism, detecting method and management of peripheral neuropathy in burn patients. Of the 1533 burn patients included in our study, 98 cases (6.39%) were presented with peripheral neuropathy. Thermal and electrical burns were the most common etiologies. Surgical procedures, especially nerve decompression, showed good effect on functional recovery of both acute and delayed peripheral neuropathy in burn patients. It is noteworthy that, for early detection and prevention of peripheral neuropathy, electrodiagnostic examinations should be performed on burn patients independent of symptoms. Still, the underlying mechanisms of burn-related peripheral neuropathy remain to be clarified. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  2. On the thermal conductivity of UO2 nuclear fuel at a high burn-up of around 100 MWd/kgHM

    International Nuclear Information System (INIS)

    Walker, C.T.; Staicu, D.; Sheindlin, M.; Papaioannou, D.; Goll, W.; Sontheimer, F.

    2006-01-01

    A study of the thermal conductivity of a commercial PWR fuel with an average pellet burn-up of 102 MWd/kgHM is described. The thermal conductivity data reported were derived from the thermal diffusivity measured by the laser flash method. The factors determining the fuel thermal conductivity at high burn-up were elucidated by investigating the recovery that occurred during thermal annealing. It was found that the thermal conductivity in the outer region of the fuel was much higher than it would have been if the high burn-up structure were not present. The increase in thermal conductivity is a consequence of the removal of fission products and radiation defects from the fuel lattice during recrystallisation of the fuel grains (an integral part of the formation process of the high burn-up structure). The gas porosity in the high burn-up structure lowers the increase in thermal conductivity caused by recrystallisation

  3. Thermal burns on lower limb resulting from laptop use: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Nebu C Jacob

    2014-01-01

    Full Text Available We report a case of a 29-year-old man with a background history of incomplete quadriplegia, who sustained a second degree thermal burn of the lower limb from prolonged proximity to the extractor fan of his laptop. We have also reviewed all other reported cases of thermal burns associated with laptop use. This literature review highlights the variability in the extent of injury and the subsequent management of laptop induced burns.

  4. Epidemiology, etiology and outcomes of burn patients in a Referral Burn Hospital, Tehran

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Soltan Dallal

    2016-08-01

    Full Text Available Background: Burns and its complications are regarded as a major problem in the society. Skin injuries resulted from ultraviolet radiation, radioactivity, electricity or chemicals as well as respiratory damage from smoke inhalation are considered burns. This study aimed to determine the epidemiology and outcome of burn patients admitted to Motahari Hospital, Tehran, Iran. Methods: Two hundred patients with second-degree burns admitted to Motahari Referral Center of Burn in Tehran, Iran. They were studied during a period of 12 months from May 2012 to May 2013. During the first week of treatment swabs were collected from the burn wounds after cleaning the site with sterile normal saline. Samples were inoculated in blood agar and McConkey agar, then incubation at 37 C for 48 hours. Identification was carried out according to standard conventional biochemical tests. Treatment continued up to epithelial formation and wound healing. Results of microbial culture for each patient was recorded. Healing time of the burn wounds in patients was recorded in log books. Chi-square test and SPSS Software v.19 (IBM, NY, USA were used for data analysis. Results: Our findings indicate that the most causes of burns are hot liquids in 57% of cases and flammable liquid in 21% of cases. The most cases of burns were found to be in the range of 21 to 30 percent with 17.5% and 7% in male and female respectively. Gram-negative bacteria were dominated in 85.7% and among them pseudomonas spp. with 37.5% were the most common cause of infected burns, followed by Enterobacter, Escherichia coli, Staphylococcus aureus, Acinetobacter and Klebsiella spp. Conclusion: The results of this study showed that the most cause of burns in both sex is hot liquid. Men were more expose to burn than women and this might be due to the fact that men are involved in more dangerous jobs than female. Pseudomonas aeruginosa was the most common organism encountered in burn infection.

  5. Nursing care of the thermally injured patient.

    Science.gov (United States)

    Elfving, U

    1980-01-01

    Team work is required in the treatment of the thermally injured patient--nursing staff being part of the team. The nurses are with the patient for 24 hours a day and they have to understand the objectives of all other members of the team involved in the treatment as well as thoroughly mastering their own work. For the nursing staff the care of the thermally injured patient is a challenge. The work demands strong motivation and interest--it includes at times painful treatment, isolation and also constant alertness. It is important that the nursing staff is given continuous training so that they are able to give the required care efficiently and to keep up active interest. Practical work is the best way of getting aquainted with the complex forms of treatment of the thermally injured patient. It also lessens the fear of a badly burned patient. Nursing care of the thermally injured patient consists of good basic care, local attention and active observation. The basic care consists of basic hygiene, diet, observation of the patient's psychological condition, giving emotional support, encouraging initiative physiotherapy and postural treatment.

  6. Characteristics of Polybrominated Diphenyl Ethers Released from Thermal Treatment and Open Burning of E-Waste.

    Science.gov (United States)

    Li, Ting-Yu; Zhou, Jun-Feng; Wu, Chen-Chou; Bao, Lian-Jun; Shi, Lei; Zeng, Eddy Y

    2018-04-17

    Primitive processing of e-waste potentially releases abundant organic contaminants to the environment, but the magnitudes and mechanisms remain to be adequately addressed. We conducted thermal treatment and open burning of typical e-wastes, that is, plastics and printed circuit boards. Emission factors of the sum of 39 polybrominated diphenyl ethers (∑ 39 PBDE) were 817-1.60 × 10 5 ng g -1 in thermal treatment and nondetected-9.14 × 10 4 ng g -1 , in open burning. Airborne particles (87%) were the main carriers of PBDEs, followed by residual ashes (13%) and gaseous constituents (0.3%), in thermal treatment, while they were 30%, 43% and 27% in open burning. The output-input mass ratios of ∑ 39 PBDE were 0.12-3.76 in thermal treatment and 0-0.16 in open burning. All PBDEs were largely affiliated with fine particles, with geometric mean diameters at 0.61-0.83 μm in thermal degradation and 0.57-1.16 μm in open burning from plastic casings, and 0.44-0.56 and nondetected- 0.55 μm, from printed circuit boards. Evaporation and reabsorption may be the main emission mechanisms for lightly brominated BDEs, but heavily brominated BDEs tend to affiliate with particles from heating or combustion. The different size distributions of particulate PBDEs in emission sources and adjacent air implicated a noteworthy redisposition process during atmospheric dispersal.

  7. Imipenem in burn patients: pharmacokinetic profile and PK/PD target attainment.

    Science.gov (United States)

    Gomez, David S; Sanches-Giraud, Cristina; Silva, Carlindo V; Oliveira, Amanda M Ribas Rosa; da Silva, Joao Manoel; Gemperli, Rolf; Santos, Silvia R C J

    2015-03-01

    Unpredictable pharmacokinetics (PK) in burn patients may result in plasma concentrations below concentrations that are effective against common pathogens. The present study evaluated the imipenem PK profile and pharmacokinetic/pharmacodynamics (PK/PD) correlation in burn patients. Fifty-one burn patients, 38.7 years of age (mean), 68.0 kg, 36.3% total burn surface area (TBSA), of whom 84% (43/51) exhibited thermal injury, 63% inhalation injury and 16% electrical injury (8/51), all of whom were receiving imipenem treatment were investigated. Drug plasma monitoring, PK study (120 sets of plasma levels) and PK/PD correlation were performed in a series of blood samples. Only 250 μl of plasma samples were required for drug plasma measurements using the ultra filtration technique for the purification of biological matrix and quantification using liquid chromatography. Probability of target attainment (PTA) was calculated using a PD target of 40% free drug concentrations above the minimum inhibitory concentration (40%fT>MIC). Significant differences in PK parameters (medians), such as biological half-life (2.2 vs 5.5 h), plasma clearance (16.2 vs 1.4 l h(-1)) and volume of distribution (0.86 vs 0.19 l kg(-1)), were registered in burn patients via comparisons of set periods with normal renal function against periods of renal failure. Correlations between creatinine clearance and total body plasma clearance were also obtained. In addition, the PK profile did not change according to TBSA during sets when renal function was preserved. PTA was >89% for MIC values up to 4 mg l(-1). In conclusion, imipenem efficacy for the control of hospital infection on the basis of PK/PD correlation was guaranteed for burn in patients at the recommended dose regimens for normal renal function (31.1±9.7 mg kg(-1) daily), but the daily dose must be reduced to 17.2±9.7 mg kg(-1) during renal failure to avoid neurotoxicity.

  8. Resorption of radionuclides through the surface of thermal burns and problems of decontamination

    International Nuclear Information System (INIS)

    Il'in, L.A.; Ivannikov, A.T.; Popov, B.A.; Parfenova, I.M.

    1981-01-01

    Resorption of sup(137)Cs, sup(89)Sr, sup(131)I, sup(241)Am during thermal burns of 1-3 degrees and choice of a decontamination method used simultaneously for decontamination and disinfection of burn wounds were studied. It is shown that a degree of burns effects in a certain form on skin penetrability: through burns of 1-2 degrees the resorption increases 1 5-3 times, through burns of the thir degree the resorption decreases slightly as compared to the resorption through intact skin. High efficiency of 3% soap solution for removing radionuclides from burn csurfae of skin has been established. For burns accompanied with the disturbance of epidermis integrality, when considerable absorption of radionuclides is possible, decontamination must be accomplished as soon and complete as possible [ru

  9. Clinical outcome of patients with self-inflicted burns.

    Science.gov (United States)

    Cornet, P A; Niemeijer, A S; Figaroa, G D; van Daalen, M A; Broersma, T W; van Baar, M E; Beerthuizen, G I J M; Nieuwenhuis, M K

    2017-06-01

    Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  10. Factors Influencing Resilience of Burn Patients in South Korea.

    Science.gov (United States)

    Jang, Mi Heui; Park, Jongui; Chong, Mi Kyong; Sok, Sohyune R

    2017-09-01

    To examine and identify the factors influencing the degree of resilience among Korean burn patients. A cross-sectional descriptive design was employed. The study sample consisted of 138 burn patients recovering from the acute phase in H hospital, Seoul. The male patient participants numbered 93 (67.4%) and the female participants numbered 45 (32.6%). The average age of the participants was 46.79 years. Measures used were the Beck Depression Inventory, State Trait Anxiety Inventory, self-esteem scale, family support scale, and resilience scale. The analyses showed that the prediction model for resilience among burn patients was significant (F = 33.94, p resilience among burn patients was self-esteem (β = .35), followed by family support (β = .29). This study provides preliminary evidence that self-esteem is a major and primary predictor of resilience among burn patients, next followed by family support. In the nursing practice, nurses need to pay attention to the burn patient's self-esteem and family support. Concrete interventions and strategies to improve the resilience of burn patients are needed. © 2017 Sigma Theta Tau International.

  11. Analysis of anaerobic blood cultures in burned patients.

    Science.gov (United States)

    Regules, Jason A; Carlson, Misty D; Wolf, Steven E; Murray, Clinton K

    2007-08-01

    The utility of anaerobic blood culturing is often debated in the general population, but there is limited data on the modern incidence, microbiology, and utility of obtaining routine anaerobic blood cultures for burned patients. We performed a retrospective review of the burned patients electronic medical records database for all blood cultures drawn between January 1997 and September 2005. We assessed blood cultures for positivity, organisms identified, and growth in aerobic or anaerobic media. 85,103 blood culture sets were drawn, with 4059 sets from burned patients. Three hundred and forty-five single species events (619 total blood culture isolates) were noted in 240 burned patients. For burned patients, four isolates were obligate anaerobic bacteria (all Propionibacterium acnes). Anaerobic versus aerobic culture growth was recorded in 310 of 619 (50.1%) burned patient blood culture sets. 46 (13.5%) of the identified organisms, most of which were not obligate anaerobic bacteria, were identified from solely anaerobic media. The results of our study suggest that the detection of significant anaerobic bacteremia in burned patients is very rare and that anaerobic bottles are not needed in this population for that indication. However anaerobic blood cultures systems are also able to detect facultative and obligate aerobic bacteria; therefore, the deletion of the anaerobic culture medium may have deleterious clinical impact.

  12. Burn mortality in patients with preexisting cardiovascular disease.

    Science.gov (United States)

    Knowlin, Laquanda; Reid, Trista; Williams, Felicia; Cairns, Bruce; Charles, Anthony

    2017-08-01

    Burn shock, a complex process, which develops following burn leads to severe and unique derangement of cardiovascular function. Patients with preexisting comorbidities such as cardiovascular diseases may be more susceptible. We therefore sought to examine the impact of preexisting cardiovascular disease on burn outcomes. A retrospective analysis of patients admitted to a regional burn center from 2002 to 2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, and length of ICU/hospital stay. Bivariate analysis was performed and Poisson regression modeling was utilized to estimate the incidence of being in the ICU and mortality. There were a total of 5332 adult patients admitted over the study period. 6% (n=428) had a preexisting cardiovascular disease. Cardiovascular disease patients had a higher mortality rate (16%) compared to those without cardiovascular disease (3%, pwill likely be a greater number of individuals at risk for worse outcomes following burn. This knowledge can help with burn prognostication. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

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

    Science.gov (United States)

    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 (pburn patients. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  14. Coagulopathy and its management in patients with severe burns

    NARCIS (Netherlands)

    Glas, G. J.; Levi, M. [=Marcel M.; Schultz, M. J.

    2016-01-01

    Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic

  15. Outcomes of patients who commit suicide by burning.

    Science.gov (United States)

    Castana, O; Kourakos, P; Moutafidis, M; Stampolidis, N; Triantafyllou, V; Pallantzas, Ath; Filippa, E; Alexandropoulos, C

    2013-03-31

    Cases in which people use fire when attempting or committing suicide are not common but nevertheless constitute a cause of admission to burns units worldwide. Usually these people are suffering from stress and have been diagnosed as mentally ill. Schizophrenia, depression, and personality disorders are the most frequently diagnosed conditions. The psychological problems appear to have been overlooked by the family or not to have been presented to them. The aim of this study is to present the clinical features, characteristics, and outcomes of patients burned during a suicide attempt. The role of the psychiatrist is important, starting in the emergency room. The incidence of patients committing self-injury by burning appears to be higher in women burn patients. Deceased patients usually have a larger extent of burns and a higher incidence of other injuries and require more surgical procedures and longer hospitalization times. The problems for burn unit staff and qualified psychiatric care are discussed.

  16. Outcomes of patients who commit suicide by burning

    Science.gov (United States)

    Castana, O.; Kourakos, P.; Moutafidis, M.; Stampolidis, N.; Triantafyllou, V.; Pallantzas, Ath.; Filippa, E.; Alexandropoulos, C.

    2013-01-01

    Summary Cases in which people use fire when attempting or committing suicide are not common but nevertheless constitute a cause of admission to burns units worldwide. Usually these people are suffering from stress and have been diagnosed as mentally ill. Schizophrenia, depression, and personality disorders are the most frequently diagnosed conditions. The psychological problems appear to have been overlooked by the family or not to have been presented to them. The aim of this study is to present the clinical features, characteristics, and outcomes of patients burned during a suicide attempt. The role of the psychiatrist is important, starting in the emergency room. The incidence of patients committing self-injury by burning appears to be higher in women burn patients. Deceased patients usually have a larger extent of burns and a higher incidence of other injuries and require more surgical procedures and longer hospitalization times. The problems for burn unit staff and qualified psychiatric care are discussed. PMID:23966897

  17. Psychiatric Assessment and Rehabilitation of Burn Patients

    Directory of Open Access Journals (Sweden)

    Süleyman Akarsu

    2017-03-01

    Full Text Available Objective: Psychiatric rehabilitation has gained significance owing to improved healthcare facilities for burn injuries and decreased mortality/ morbidity rates. Burn traumas may result in psychiatric signs such as denial, anger, guilt, confusion, disgrace, anxiety, distress, and nervousness. Psychiatric disorders such as delirium, depression, anxiety, post-traumatic stress disorder, and sexual problems can also be encountered. Therefore, it is necessary to look for these signs and disorders through regular sessions with burn patients and appropriate psychometric tests. This study aims at examining the process of psychological rehabilitation for burn patients in light of the current literature. Material and Methods: This study has been carried out in the light of the main and current literature review. The study intends to put forth the data observed in the course of the psychological diagnosis, treatment and rehabilitation of burn patients. The study has been conducted in accordance with the Helsinki Declaration Guidelines. Results: Treatment and rehabilitation process requires a multidisciplinary teamwork that consists of physicians, dieticians, psychologists, social service specialists, and other healthcare workers who can meet the needs of burn patients and their families. It is necessary for the team to contribute both to the hospitalization process and the social environment of the patients and their families. Conclusion: It is observed that the quality of life of these patients can be considerably improved with the effective assessment of psychiatric signs that occur during or after the injury and with appropriate treatment methods.

  18. Oil mixes omega 9, 6 and 3, enriched with seaweed, promoted reduction of thermal burned modulating NF-kB and Ki-67

    OpenAIRE

    Campelo, Ana Paula Bomfim Soares; Campelo, Márcio Wilker Soares; Brito, Gerly Anne de Castro; Jamacaru, Francisco Vagnaldo Fechine; Leitão, Renata Ferreira de Carvalho; Vasconcelos, Paulo Roberto Leitão de

    2015-01-01

    PURPOSE: To examine the effects of the oil mixes (ω-9, ω-6 and ω-3) in rats subjected to thermal burn. It was also aimed to assess whether the sources of ω3 would interfere with the effect of such mixes on the thermal injury.METHODS:Thirty-six rats distributed into five groups: burned + water, burned + isolipid mix, burned + oil mix 1 (ALA), burned + oil mix 2 (ALA + EPA + DHA of fish) and burned + oil mix 3 (ALA + DHA from seaweed). The thermal injury was involving total ...

  19. [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.

  20. [Qualitative research on pain experiences of adult burn patients].

    Science.gov (United States)

    Li, L; Pan, Q; Xu, L; Lin, R Q; Dai, J X; Chen, Z H

    2018-03-20

    Objective: To explore the pain experiences of adult burn patients so as to lay foundation for practical analgesic measures. Methods: Using phenomenological method in qualitative research, semi-structured interviews were conducted on 12 adult burn patients hospitalized in our burn units from May to November 2015, aiming at pain experiences from immediately after burns to 3 to 7 months after being discharged from hospital. Then the Colaizzi's analysis method was applied to analyze, induce, and refine themes of interview data. Results: After analysis, pain experiences of adult burn patients were generalized into 6 themes: deep pain experiences, heavy psychological burden, limited daily life, poor assessment and treatment of pain, different attributions of pain, and different ways of coping of pain. Conclusions: Burn pain brings harm to the patients' physiology, mentality, and daily life. Nevertheless, pain processing modes of medical staff and patients themselves are the key factors affecting patients' pain experiences. Therefore, according to the deficiency of current situation of pain management, the targeted analgesic intervention measures should be carried out from the perspectives of medical staff and patients.

  1. [Reconstruction of the ear in the burns patient].

    Science.gov (United States)

    Carrillo-Córdova, Jorge Raúl; Jiménez Murat, Yusef; Apellaniz-Campo, Armando; Bracho-Olvera, Hazel; Carrillo Esper, Raúl

    Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  2. 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.

  3. Update on metabolism and nutrition therapy in critically ill burn patients.

    Science.gov (United States)

    Moreira, E; Burghi, G; Manzanares, W

    Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  4. Emissions, energy return and economics from utilizing forest residues for thermal energy compared to onsite pile burning

    Science.gov (United States)

    Greg Jones; Dan Loeffler; Edward Butler; Woodam Chung; Susan Hummel

    2010-01-01

    The emissions from delivering and burning forest treatment residue biomass in a boiler for thermal energy were compared with onsite disposal by pile-burning and using fossil fuels for the equivalent energy. Using biomass for thermal energy reduced carbon dioxide emissions on average by 39 percent and particulate matter emissions by 89 percent for boilers with emission...

  5. Effectiveness of Aloe Vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns.

    Science.gov (United States)

    Shahzad, Muhammad Naveed; Ahmed, Naheed

    2013-02-01

    To assess the efficacy of Aloe Vera gel compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns. This Interventional Comparative study was carried out at the Burn unit and Plastic surgery department, Nishtar Hospital Multan, Pakistan from July 2008 to December 2010. A total of 50 patients with superficial and partial thickness burns were divided into two equal groups randomly by consecutive sampling method, one group was dressed with Aloe Vera gel while the other was treated with 1% silversulphadiazine cream, and the results regarding duration of wound epithelialization, pain relief and cost of treatment were compared. In patients treated with Aloe Vera gel, healing of burn wounds were remarkably early than those patients treated with 1% silver sulfadiazine. All the patients of Aloe Vera group were relieved of pain earlier than those patients who were treated with SSD. Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with SSD regarding early wound epithelialization, earlier pain relief and cost-effectiveness.

  6. The impact of the types of microorganisms isolated from blood and wounds on the results of treatment in burn patients with sepsis.

    Science.gov (United States)

    Glik, Justyna; Kawecki, Marek; Gaździk, Tadeusz; Nowak, Mariusz

    2012-01-01

    Despite development of combustiology, infections continue to be the most important cause of death among patients with burns. Sepsis is the most severe clinical presentation of infection in patients after thermal injuries who require immediate treatment. Early diagnosis and proper treatment of sepsis are important in the clinical management that is often hampered for multiple reasons, e.g. impaired patient immunity, problems with microorganisms with multi-antibacterial drug resistance. The aim of the study was to assess effect of type of a microorganism isolated from blood and wound on results of treatment of sepsis in patients with burns. Effect of type of microorganisms isolated from blood and wound on the result of treatment of sepsis was studied in 338 patients hospitalized immediately after an injury in Centre for Burn Treatment in Siemianowice Śląskie in years 2003 - 2004 (at the age of 18 - 96 years, 66 women and 272 men). Clinical symptoms of generalized infection were found in all study subjects. The study group was divided into two subgroups: cured patients and patients who died of sepsis. The following parameters were assessed in both subgroups: type of microorganism isolated from blood, type of microorganism isolated from wound as well as occurrence of the same and different infections of blood and burn wound. positive blood cultures were found in 165 patients (48.8%), 106 (64.2%) were cured, 59 (35.8%) died. The most commonly isolated microorganisms in cured patients were Gram(+) Staphylococcus epidermidis MRSE (19.81%) and Staphylococcus aureus MRSA (18.87%). Gram(-) intestinal rods were least commonly isolated from this group. The most commonly isolated microorganisms from blood of patients who were to die, included non-fermenting Gram(-) rods Acinetobacter baumannii (35.59%) and Pseudomonas aeruginosa (22.03%). Mixed bacterial flora was found in the blood of 22.03% patients. Among patients who were to die, the same microorganisms were found in the

  7. [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.

  8. Oil mixes omega 9, 6 and 3, enriched with seaweed, promoted reduction of thermal burned modulating NF-kB and Ki-67.

    Science.gov (United States)

    Campelo, Ana Paula Bomfim Soares; Campelo, Márcio Wilker Soares; Brito, Gerly Anne de Castro; Jamacaru, Francisco Vagnaldo Fechine; Leitão, Renata Ferreira de Carvalho; Vasconcelos, Paulo Roberto Leitão de

    2015-06-01

    To examine the effects of the oil mixes (ω-9, ω-6 and ω-3) in rats subjected to thermal burn. It was also aimed to assess whether the sources of ω3 would interfere with the effect of such mixes on the thermal injury. Thirty-six rats distributed into five groups: burned + water, burned + isolipid mix, burned + oil mix 1 (ALA), burned + oil mix 2 (ALA + EPA + DHA of fish) and burned + oil mix 3 (ALA + DHA from seaweed). The thermal injury was involving total thickness of skin. After the burns animals received the oil mixes for seven days. The lesions were evaluated by immunohistochemistry. Animals receiving mix 3 showed a smaller extension of the thermal injury as compared to those that were supplemented with other oils mixes. Expression of Ki-67 in the receiving Mix 3 increased as compared to all the other groups. Animals supplemented with mix 3 were able to inhibit NF-κB in injured tissue. Rats received oil mix in which the source of ω3 (ALA+DHA of seaweed) showed inhibition of NF-κB, increase in cell proliferation, and reduction the extension of thermal lesion.

  9. Effect of burn-up on the thermal conductivity of uranium dioxide up to 100.000 MWd t-1

    International Nuclear Information System (INIS)

    Ronchi, C.; Sheindlin, M.; Staicu, D.; Kinoshita, M.

    2004-01-01

    The thermal diffusivity and specific heat of reactor-irradiated UO 2 fuel have been measured. Starting from end-of-life conditions at various burn-ups, measurements under thermal annealing cycles were performed in order to investigate the recovery of the thermal conductivity as a function of temperature. The separate effects of soluble fission products, of fission gas frozen in dynamical solution and of radiation damage were determined. In this context, particular emphasis was given to the behaviour of samples displaying the high burn-up rim structure. Recovery stages could be thoroughly investigated in samples that were irradiated at low burn-ups and/or at high irradiation temperatures. Other samples, in particular those exhibiting the characteristic rim structure, disintegrated at temperatures slightly higher than the irradiation temperature. Finally, from a database of several thousand measurements, an accurate formula for the in-pile thermal conductivity of UO 2 up to 100 GWd t -1 was developed, taking into account all the relevant effects and structural changes induced by reactor burn-up

  10. Etiology of Burn Injuries Among 0-6 Aged Children in One University Hospital Burn Unit, Bursa, Turkey

    Directory of Open Access Journals (Sweden)

    Neriman Akansel

    2013-01-01

    Full Text Available Background; Children whose verbal communications are not fully developed are the ones at risk for burn injuries. Causes of burn injuries vary among different age groups and scald injuries are the common cause of burn injuries among children. The majority of burns result from contact with thermal agents such as flame, hot surfaces, or hot liquids.Aim: The aim of this study was to determine etiologic factors of the burn injured children Methods: Data were collected for burn injured children treated in Uludag University Medical Hospital Burn Unit between January 2001 – December 2008. Patients’ demographic variables, etiology of burn injury, TBSA(total body surface area, degree of the burn injury, duration of hospitalization was detected from medical records of the hospitalized patients.Results: The mean age of the children was 2.5±1.5 (median=2. Although 4.6 % of burned patients were under one year of age, most of the children (67.8% were between 1-3 years. All of the patients were burned as a result of accident and house environment was the place where the burn incident occurred. Burn injuries occurredmostly during summer (29.9% and spring (28.7%. Scald injuries (75.3% were mostly seen burn injury types all among other burn injuries.Conclusions: Lack of supervision and observation are usually the most common causes of burn injuries in children. Statistical differences were found among age groups according to their burn etiology (p<0.05. An effect of TBSA on patient survival was statistically significant (p<0.000 and also statistically significant results were seen among age groups according to their TBSA’s (p<0.005.

  11. Burns From Hot Wheat Bags: A Public Safety Issue

    Science.gov (United States)

    Collins, Anna; Amprayil, Mathew; Solanki, Nicholas S.; Greenwood, John Edward

    2011-01-01

    Introduction: Wheat bags are therapeutic devices that are heated in microwaves and commonly used to provide relief from muscle and joint pain. The Royal Adelaide Hospital Burns Unit has observed a number of patients with significant burn injuries resulting from their use. Despite their dangers, the products come with limited safety information. Methods: Data were collected from the Burns Unit database for all patients admitted with burns due to hot wheat bags from 2004 to 2009. This was analyzed to determine the severity of the burn injury and identify any predisposing factors. An experimental study was performed to measure the temperature of wheat bags when heated to determine their potential for causing thermal injury. Results: 11 patients were admitted with burns due to hot wheat bags. The median age was 52 years and the mean total body surface area was 1.1%. All burns were either deep dermal (45.5%) or full thickness (54.5%). Ten patients required operative management. Predisposing factors (eg, neuropathy) to thermal injury were identified in 7 patients. The experimental study showed that hot wheat bags reached temperatures of 57.3°C (135.1°F) when heated according to instructions, 63.3°C (145.9°F) in a 1000 W microwave and 69.6°C (157.3°F) on reheating. Conclusions: Hot wheat bags cause serious burn injury. When heated improperly, they can reach temperatures high enough to cause epidermal necrosis in a short period of time. Patients with impaired temperature sensation are particularly at risk. There should be greater public awareness of the dangers of wheat bag use and more specific safety warnings on the products. PMID:21915357

  12. Burn-up determination of irradiated thoria samples by isotope dilution-thermal ionisation mass spectrometry

    International Nuclear Information System (INIS)

    Aggarwal, S.K.; Jaison, P.G.; Telmore, V.M.; Shah, R.V.; Sant, V.L.; Sasibhushan, K.; Parab, A.R.; Alamelu, D.

    2010-03-01

    Burn-up was determined experimentally using thermal ionization mass spectrometry for two samples from ThO 2 bundles irradiated in KAPS-2. This involved quantitative dissolution of the irradiated fuel samples followed by separation and determination of Th, U and a stable fission product burn-up monitor in the dissolved fuel solution. Stable fission product 148 Nd was used as a burn-up monitor for determining the number of fissions. Isotope Dilution-Thermal Ionisation Mass Spectrometry (ID-TIMS) using natural U, 229 Th and enriched 142 Nd as spikes was employed for the determination of U, Th and Nd, respectively. Atom % fission values of 1.25 ± 0.03 were obtained for both the samples. 232 U content in 233 U determined by alpha spectrometry was about 500 ppm and this was higher by a factor of 5 compared to the theoretically predicted value by ORIGEN-2 code. (author)

  13. Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war.

    Science.gov (United States)

    Yuce, Yucel; Acar, Hakan A; Erkal, Kutlu H; Arditi, Nur B

    2017-01-01

    To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns greater than 15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.

  14. Retrospective analysis of patients with burn injury treated in a burn center in Turkey during the Syrian civil war

    Directory of Open Access Journals (Sweden)

    Yucel Yuce

    2017-01-01

    Full Text Available Objectives: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43 and most of them had burns >15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients.

  15. Healthcare costs of burn patients from homes without fire sprinklers.

    Science.gov (United States)

    Banfield, Joanne; Rehou, Sarah; Gomez, Manuel; Redelmeier, Donald A; Jeschke, Marc G

    2015-01-01

    The treatment of burn injuries requires high-cost services for healthcare and society. Automatic fire sprinklers are a preventive measure that can decrease fire injuries, deaths, property damage, and environmental toxins. This study's aim was to conduct a cost analysis of patients with burn or inhalation injuries caused by residential fires and to compare this with the cost of implementing residential automatic fire sprinklers. We conducted a cohort analysis of adult burn patients admitted to our provincial burn center (1995-2012). Patient demographics and injury characteristics were collected from medical records and clinical and coroner databases. Resource costs included average cost per day at our intensive care and rehabilitation program, transportation, and property loss. During the study period, there were 1557 residential fire-related deaths province-wide and 1139 patients were admitted to our provincial burn center as a result of a flame injury occurring at home. At our burn center, the average cost was CAN$84,678 per patient with a total cost of CAN$96,448,194. All resources totaled CAN$3,605,775,200. This study shows the considerable healthcare costs of burn patients from homes without fire sprinklers.

  16. Pediatric Burns: A Single Institution Retrospective Review of Incidence, Etiology, and Outcomes in 2273 Burn Patients (1995-2013).

    Science.gov (United States)

    Lee, Christina J; Mahendraraj, Krishnaraj; Houng, Abraham; Marano, Michael; Petrone, Sylvia; Lee, Robin; Chamberlain, Ronald S

    Unintentional burn injury is the third most common cause of death in the U.S. for children age 5 to 9, and accounts for major morbidity in the pediatric population. Pediatric burn admission data from U.S. institutions has not been reported recently. This study assesses all pediatric burn admissions to a State wide Certified Burn Treatment Center to evaluate trends in demographics, burn incidence, and cause across different age groups. Demographic and clinical data were collected on 2273 pediatric burn patients during an 18-year period (1995-2013). Pediatric patients were stratified by age into "age 0 to 6," "age 7 to 12," and "age 13 to 18." Data were obtained from National Trauma Registry of the American College of Surgeons and analyzed using standard statistical methodology. A total of 2273 burn patients under age 18 were treated between 1995 and 2013. A total of 1663 (73.2%) patients were ages 0 to 6, 294 (12.9%) were 7 to 12, and 316 (13.9%) were age 13 to 18. A total of 1400 (61.6%) were male and 873 (38.4%) were female (male:female ratio of 1.6:1). Caucasians had the highest burn incidence across all age groups (40.9%), followed by African-Americans (33.6%), P burns occurred at home, P burned was 8.9%, with lower extremity being the most common site (38.5%). Scald burns constituted the majority of cases (71.1%, n = 1617), with 53% attributable to hot liquids related to cooking, including coffee or tea, P burns were the dominant cause (53.8%). Overall mean length of stay was 10.5 ± 10.8 days for all patients, and15.5 ± 12 for those admitted to the intensive care unit, P burn injuries are scald burns that occur at home and primarily affect the lower extremities in Caucasian and African-American males. Among Caucasian teenagers flame burns predominate. Mean length of stay was 10 days, 23% of patients required skin grafting surgery, and mortality was 0.9%. The results of this study highlight the need for primary prevention programs focusing on avoiding

  17. Suicide by burning: epidemiological and clinical profiles.

    Science.gov (United States)

    Theodorou, Panagiotis; Phan, Vu T Q; Weinand, Christian; Maegele, Marc; Maurer, Christoph A; Perbix, Walter; Leitsch, Sebastian; Lefering, Rolf; Spilker, Gerald

    2011-04-01

    Self-immolation constitutes a rare form of suicide in developed countries, though it accounts for unique injury characteristics in the burn intensive care unit. The aim of this study was to present the epidemiological and clinical features of patients burned during a suicidal attempt seen in a North Rhine-Westphalia burn intensive care unit (BICU). To address this aim, we undertook a 21-year retrospective study involving patients with thermal injuries admitted to the largest burn unit in Germany. A total of 125 suicide-related burn victims were identified in the study period (9.4%). Comparing the self-immolation group with the rest burn patient cohort, suicide victims were more likely to be single and to act under the influence of alcohol. The suicidal group had a larger extent of burns, higher incidence of inhalation injury, required more surgical procedures, catecholamines, blood transfusions, and a longer BICU stay. Their clinical course was complicated by prolonged intubation period, higher rate of multiple drug-resistant bacteria acquisition and sepsis, leading to a higher mortality rate. Although the proportion of self-immolation victims among all burned patients is not high, the markedly higher severity of their burns and their poorer quality of outcomes makes them an important clinical subgroup for further study.

  18. Methamphetamine-related burns in the cornbelt.

    Science.gov (United States)

    Burke, Bridget A; Lewis, Robert W; Latenser, Barbara A; Chung, Joseph Y; Willoughby, Clark; Kealey, G Patrick; Wibbenmeyer, Lucy A

    2008-01-01

    Methamphetamine (MA) is a highly addictive drug that is easily manufactured from everyday household products and chemicals found at local farm stores. The proliferation of small MA labs has led to a dramatic increase in patients sustaining thermal injury while making and/or using MA. We hypothesized that these patients have larger injuries with longer hospital stays, and larger, nonreimbursed hospital bills compared with burn patients not manufacturing or using MA. In a retrospective case-control study, all burn patients >or=16 years of age admitted to our burn center from January 2002 to December 2005 were stratified into two groups based on urine MA status. Of the 660 burn patients >or=16 years of age admitted during this 4 year period, urine drug screens were obtained at admission on 410 patients (62%); 10% of urine drug screens were MA (+). MA (+) patients have larger burns compared with MA (-) patients (9.3 vs 8.6% body surface area burns), have higher rates of inhalation injuries (20.4 vs 9.3%, P = .015), and more nonthermal trauma (13.0 vs 3.1%, P = .001). When compared with MA (-) patients, MA (+) patients require longer hospital stays (median 9.5 vs 7.0 days, P = .036), accrue greater hospital bills per day (dollars 4292 vs dollars 2797, P = .01), and lack medical insurance (66.7 vs 17.7%, P manufacture mandates that burn centers monitor patients for MA use and develop and institute protocols to ensure proper care of this increasingly costly population.

  19. Improved survival with an innovative approach to the treatment of severely burned patients: development of a burn treatment manual.

    Science.gov (United States)

    Morisada, S; Nosaka, N; Tsukahara, K; Ugawa, T; Sato, K; Ujike, Y

    2015-09-30

    The management of severely burned patients remains a major issue worldwide as indicated by the high incidence of permanent debilitating complications and poor survival rates. In April 2012, the Advanced Emergency & Critical Care Medical Center of the Okayama University Hospital began implementing guidelines for severely burned patients, distributed as a standard burn treatment manual. The protocol, developed in-house, was validated by comparing the outcomes of patients with severe extensive burns (SEB) treated before and after implementation of these new guidelines at this institution. The patients included in this study had a burn index (BI) ≥30 or a prognostic burn index (PBI = BI + patient's age) ≥100. The survival rate of the patients with BI ≥30 was 65.2% with the traditional treatment and 100% with the new guidelines. Likewise, the survival rate of the patients with PBI ≥100 was 61.1% with the traditional treatment compared to 100% with the new guidelines. Together, these data demonstrate that the new treatment guidelines dramatically improved the treatment outcome and survival of SEB patients.

  20. Myroides Species in a Paediatric Burn Patient

    Directory of Open Access Journals (Sweden)

    Sevda Soydan

    2017-11-01

    Full Text Available Members of the genus Myroides are non-motile, Gram negative bacteria that are mostly found in environmental sources such as soil and water. They are not a part of human flora. For a long time they were evaluated as low grade opportunistic pathogens causing infections in immunocompromised patients whereas a few life-threatening infections were reported in immunocompetent individuals due to Myroides species. The child having a 64% of total body surface area burn was admitted to the burn unit. Myroides spp. was isolated first in urine culture then in blood culture. This is the first time Myroides spp. is reported in a paediatric patient with serious burn.

  1. Management of Mass Casualty Burn Disasters

    National Research Council Canada - National Science Library

    Cancio, Leopoldo C; Pruitt, Basil A

    2005-01-01

    Mass casualty burn disasters are potentially challenging, in part because the majority of health care providers are inexperienced in the care of thermally injured patients and in part because of the...

  2. Osteomyelitis in burn patients requiring skeletal fixation

    NARCIS (Netherlands)

    Barret, JP; Desai, MH; Herndon, DN

    Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

  3. Infection in burn patients in a referral center in Colombia.

    Science.gov (United States)

    Ramirez-Blanco, Carlos Enrique; Ramirez-Rivero, Carlos Enrique; Diaz-Martinez, Luis Alfonso; Sosa-Avila, Luis Miguel

    2017-05-01

    Worldwide, burns are responsible for more than 300,000 deaths annually; infection is a major cause of morbidity and mortality in these patients. Early identification and treatment of infection improves outcome. Toward this end it's necessary to identify the institutions flora and organisms that most frequently produces infection. To characterize infections developed by burn patients hospitalized at the University Hospital of Santander (HUS). Burn patients hospitalized in the HUS from January 1 to December 2014 were followed. Medical information regarding infections, laboratory and pathology reports were obtained. Statistical analysis with measures of central tendency, proportions, global and specific incidence density plus overall and specific incidence was obtained. For the microbiological profile proportions were established. 402 burn patients were included, 234 (58.2%) men and 168 (41.8%) women, aged between 6 days and 83 years, median 12.5 years. The burn agents include scald (52.5%), fire (10.0%), gasoline (9.2%), electricity (7.5%), among others. Burn area ranged from 1% to 80% TBS. Cumulative mortality was 1.5%. 27.8% of burned patients had one or more infections. Identified infections include folliculitis (27.0%), urinary tract infection (19.0%), infection of the burn wound (10.4%), pneumonia (8.6%), Central venous catheter (7.4%), bloodstream infection (7.4%) and skin grafts infection (4.3%) among others. Bacteria were responsible for 88.5% of the cases and fungi 11.5%. The most frequently isolated germs were P. aeruginosa, A. baumannii, E. coli, S. aureus and K. pneumoniae. Most gram-negative bacteria were sensitive to Amikacin, gram positive bacteria were sensitive to multiple antibiotics. Burns is a severe trauma that occurs in adult and pediatric patients, has several causative agents and can compromise the patient's life. The burned patient is at risk for a variety of infections. According to the type of infection it is possible to infer the most

  4. Terminal Maturation of Orthochromatic Erythroblasts Is Impaired in Burn Patients.

    Science.gov (United States)

    Hasan, Shirin; Mosier, Michael J; Conrad, Peggie; Szilagyi, Andrea; Gamelli, Richard L; Muthumalaiappan, Kuzhali

    2018-02-20

    Mechanisms of erythropoietin (Epo)-resistant anemia in burn patients are poorly understood. We have recently found that administering a nonselective beta 1,2-adrenergic blocker propranolol (PR) was effective in reversing myelo-erythroid commitment through MafB regulation and increase megakaryocyte erythrocyte progenitors in burn patients' peripheral blood mononuclear cell (PBMC)-derived ex vivo culture system. Having known that Epo-dependent proliferation of early erythroblasts is intact after burn injury, here we inquired whether or not Epo-independent maturation stage of erythropoiesis is affected by burn injury and the relative role of PR on late-stage erythropoiesis. While majority of erythropoiesis occurs in the bone marrow, maturation into reticulocytes is crucial for their release into sinusoids to occupy the peripheral circulation for which enucleation is vital. peripheral blood mononuclear cells (PBMCs) from burn patients were extended beyond commitment and proliferation stages to late maturation stage in ex vivo culture to understand the role of PR in burn patients. Burn impedes late maturation of orthochromatic erythroblasts into reticulocytes by restricting the enucleation step. Late-stage erythropoiesis is impaired in burn patients irrespective of PR treatment. Further, substituting the microenvironment with control plasma (homologous) in place of autologous plasma rescues the conversion of orthochromatic erythroblasts to reticulocytes. Results show promise in formulating interventions to regulate late-stage erythropoiesis, which can be used in combination with PR to reduce the number of transfusions.

  5. Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection

    DEFF Research Database (Denmark)

    Calum, H.; Moser, C.; Jensen, P. O.

    2009-01-01

    Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn...... injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group...... of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization...

  6. Experience of Milled Peat Burning at Thermal Electric Power Plant

    Directory of Open Access Journals (Sweden)

    G. I. Zhikhar

    2013-01-01

    Full Text Available The paper presents extensive knowledge and practical experience on burning of milled peat in the boilers of thermal electric power plants in Belarus and Russia. The accumulated experience can be used for solution of problems pertaining to substitution of some types of fuel imported to Belarus by milled peat which is extracted at many fuel effective peat enterprises of the Republic.

  7. General theory for thermal pulses of finite amplitude in nuclear shell-burnings

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, D [Tokyo Univ. (Japan). Coll. of General Education; Fujimoto, M Y

    1978-09-01

    Theory for thermal pulses of nuclear shell-burning is advanced to include the case of finite amplitude. The aims are to predict the progress of thermal pulse quantitatively and to obtain the peak values of the temperature and nuclear energy generation rate without making detailed numerical computation of stellar structure. In order to attain them the physical processes involved in the progress of the pulse are clarified using the concepts of the flatness of the shell source, which destabilizes nuclear burning, and the effect of radiation pressure, which stabilizes it. It is shown that the progress of the pulse can be predicted quantitatively when the pressure and the gravitational potential of the burning shell are specified for the onset stage of the pulse. The pulse height is determined mainly by the initial pressure; the higher initial pressure results in the higher pulse. Mass dependence is also obtained by approximating the gravitational potential by that of white dwarfs. The initial pressure is the quantity which is determined in the course of evolution preceding the pulse. The theory is shown to give a satisfactory agreement with numerical computations for a wide variety of the preceding evolutions, i.e., both for the case of the core in red giant stars and of the accreting white dwarfs.

  8. Sunflower oil in the treatment of hot tar burns.

    Science.gov (United States)

    Türegün, M; Oztürk, S; Selmanpakoğlu, N

    1997-08-01

    Hot tar burns compose a unique class of thermal injury, because removal of this highly sticky compound may be very difficult without inflicting additional tissue damage. Early removal of tar facilitates assessment of the burn and improves patient comfort. Although the use of many substances for the painless removal of tar has been described, we used sunflower oil effectively in the treatment of four tar burn patients. This first report describes the practical and successful use of sunflower oil which was easily obtained from the hospital kitchen.

  9. Thermal distillation system utilizing biomass energy burned in stove by means of heat pipe

    Directory of Open Access Journals (Sweden)

    Hiroshi Tanaka

    2016-09-01

    Full Text Available A thermal distillation system utilizing a part of the thermal energy of biomass burned in a stove during cooking is proposed. The thermal energy is transported from the stove to the distiller by means of a heat pipe. The distiller is a vertical multiple-effect diffusion distiller, in which a number of parallel partitions in contact with saline-soaked wicks are set vertically with narrow gaps of air. A pilot experimental apparatus was constructed and tested with a single-effect and multiple-effect distillers to investigate primarily whether a heat pipe can transport thermal energy adequately from the stove to the distiller. It was found that the temperatures of the heated plate and the first partition of the distiller reached to about 100 °C and 90 °C, respectively, at steady state, showing that the heat pipe works sufficiently. The distilled water obtained was about 0.75 and 1.35 kg during the first 2 h of burning from a single-effect and multiple-effect distillers, respectively.

  10. 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.

  11. Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures.

    Science.gov (United States)

    Jones, Laura L; Calvert, Melanie; Moiemen, Naiem; Deeks, Jonathan J; Bishop, Jonathan; Kinghorn, Philip; Mathers, Jonathan

    2017-12-01

    Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial

  12. Fractional Nonablative 1540 nm Laser Resurfacing for Thermal Burn Scars: A Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Haedersdal, M.; Moreau, K.E.R.; Beyer, D.M.

    2009-01-01

    Background and Objective: Burn scars cause permanent and disfiguring problems for many patients and limited treatments are available. Nonablative fractional lasers induce a wound healing response, which may lead to remodeling of burn sear texture. This randomized trial evaluates efficacy and adve......Background and Objective: Burn scars cause permanent and disfiguring problems for many patients and limited treatments are available. Nonablative fractional lasers induce a wound healing response, which may lead to remodeling of burn sear texture. This randomized trial evaluates efficacy...

  13. Study on the thermal-hydraulic stability of high burn up STEP III fuel in Japan

    International Nuclear Information System (INIS)

    Ishikawa, M.; Kitamura, H.; Toba, A.; Omoto, A.

    2004-01-01

    Japanese BWR utilities have performed a joint study of the Thermal Hydraulic Stability of High Burn up STEP III Fuel. In this study, the parametric dependency of thermal hydraulic stability threshold was obtained. It was confirmed through experiments that the STEP III Fuel has sufficient stability characteristics. (author)

  14. Unplanned readmission after hospital discharge in burn patients in Iran.

    Science.gov (United States)

    Jafaryparvar, Zakiyeh; Adib, Masoomeh; Ghanbari, Atefeh; Leyli, Ehsan Kazemnezhad

    2018-02-21

    Burns are considered as one of the most serious health problems throughout the world. They may lead to adverse consequences and outcomes. One of these outcomes is unplanned readmission. Unplanned readmission has been commonly used as a quality indicator by hospitals and governments. This study aimed to determine the predictors of unplanned readmission in patients with burns hospitalized in a burn center in the North of Iran (Guilan province, Rasht). This retrospective analytic study has been done on the medical records of hospitalized patients with burns in Velayat Sub-Specialty Burn and Plastic Surgery Center, Rasht, Iran during 2008-2013. In general, 703 medical records have been reviewed but statistical analysis was performed on 626 medical records. All data were entered in SPSS (version 16) and analyzed by descriptive and inferential statistics. Among 626 patients with burns, the overall readmission rate was 5.1%. Predictors of readmission included total body surface area (OR 1.030, CI 1.011-1.049), hypertension (OR 2.923, CI 1.089-7.845) and skin graft (OR 7.045, CI 2.718-18.258). Considering the outcome, predictors following burn have a crucial role in the allocation of treatment cost for patients with burns and they can be used as one of the quality indicators for health care providers and governments.

  15. Thermal and mechanical quantitative sensory testing in Chinese patients with burning mouth syndrome--a probable neuropathic pain condition?

    Science.gov (United States)

    Mo, Xueyin; Zhang, Jinglu; Fan, Yuan; Svensson, Peter; Wang, Kelun

    2015-01-01

    To explore the hypothesis that burning mouth syndrome (BMS) probably is a neuropathic pain condition, thermal and mechanical sensory and pain thresholds were tested and compared with age- and gender-matched control participants using a standardized battery of psychophysical techniques. Twenty-five BMS patients (men: 8, women: 17, age: 49.5 ± 11.4 years) and 19 age- and gender-matched healthy control participants were included. The cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT) and mechanical pain threshold (MPT), in accordance with the German Network of Neuropathic Pain guidelines, were measured at the following four sites: the dorsum of the left hand (hand), the skin at the mental foramen (chin), on the tip of the tongue (tongue), and the mucosa of the lower lip (lip). Statistical analysis was performed using ANOVA with repeated measures to compare the means within and between groups. Furthermore, Z-score profiles were generated, and exploratory correlation analyses between QST and clinical variables were performed. Two-tailed tests with a significance level of 5 % were used throughout. CDTs (P < 0.02) were significantly lower (less sensitivity) and HPTs (P < 0.001) were significantly higher (less sensitivity) at the tongue and lip in BMS patients compared to control participants. WDT (P = 0.007) was also significantly higher at the tongue in BMS patients compared to control subjects . There were no significant differences in MDT and MPT between the BMS patients and healthy subjects at any of the four test sites. Z-scores showed that significant loss of function can be identified for CDT (Z-scores = -0.9±1.1) and HPT (Z-scores = 1.5±0.4). There were no significant correlations between QST and clinical variables (pain intensity, duration, depressions scores). BMS patients had a significant loss of thermal function but not

  16. A population-based study of the epidemiology of acute adult burns in Ecuador from 2005 to 2014.

    Science.gov (United States)

    Ortiz-Prado, Esteban; Armijos, Luciana; Iturralde, Ana Lucia

    2015-05-01

    To describe the demographic, risk factor, occupational, and morbidity and mortality characteristics of burns in adults in Ecuador using national data. These data are from the only specialized public hospital in Ecuador that has a 12-bed burn unit. The National Institute of Statistics and Census provided data from the burn unit of the Hospital Eugenio Espejo, in Quito. Three different datasets pertaining to burn deaths, burn unit inpatient admissions, and hospital discharge were analyzed. Patients who died or were discharged before entering the burn unit were not included in this analysis. During the 10-year period, 1106 patients were admitted to the burn unit, men represent 69.37% with 768 cases and women represent 30.62% with 337 patients; the number of patients per year was on average 123 cases; the average age was 33-34 years old, with a range between 16 and 96 years old. Heat (thermal) burns represent 65.78% followed by electrical with 30.53%, friction burns with 2.06%, and chemical burns with 1.62%. Domestic methane gas was the most frequent agent causing thermal burns and the most affected occupational groups are construction workers and people who stay at home. The overall mortality is 10.2% and the average length of stay was 23 days. Thermal burns are more frequent than any other cause of burns. Electrical burns are more frequent in Ecuador than anywhere else according to our research, meaning that control and prevention of workplace safety, urban planning, and home safety are scarce. The most affected groups are those dedicated to labor work. Finally, mortality in hospitalized patient is higher when compared with developed countries. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  17. Burn mouse models

    DEFF Research Database (Denmark)

    Calum, Henrik; Høiby, Niels; Moser, Claus

    2014-01-01

    Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6 % third-degree b......Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6 % third...... with infected burn wound compared with the burn wound only group. The burn mouse model resembles the clinical situation and provides an opportunity to examine or develop new strategies like new antibiotics and immune therapy, in handling burn wound victims much....

  18. Pre-existing psychiatric disorder in the burn patient is associated with worse outcomes.

    Science.gov (United States)

    Hudson, Alexandra; Al Youha, Sarah; Samargandi, Osama A; Paletz, Justin

    2017-08-01

    To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n=25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p=0.001), and were more likely to have an inhalation injury (pBurn Unit (p=0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13-9.10; p-value 0.03). Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  19. Novel burn device for rapid, reproducible burn wound generation.

    Science.gov (United States)

    Kim, J Y; Dunham, D M; Supp, D M; Sen, C K; Powell, H M

    2016-03-01

    Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal

  20. Epidemiology and Outcomes of Hospitalized Burn Patients in Gaza ...

    African Journals Online (AJOL)

    BACKGROUNG: Burns are serious health problems and leading causes of mortality and morbidity in the Eastern Mediterranean Region. This study aimed to overview the epidemiological profile and to present outcomes among hospitalized burn patients in AL Alamy burn center in Gaza. METHODS: This was a ...

  1. 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 (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.

  2. Improved survival with an innovative approach to the treatment of severely burned patients: development of a burn treatment manual

    OpenAIRE

    Morisada, S.; Nosaka, N.; Tsukahara, K.; Ugawa, T.; Sato, K.; Ujike, Y.

    2015-01-01

    The management of severely burned patients remains a major issue worldwide as indicated by the high incidence of permanent debilitating complications and poor survival rates. In April 2012, the Advanced Emergency & Critical Care Medical Center of the Okayama University Hospital began implementing guidelines for severely burned patients, distributed as a standard burn treatment manual. The protocol, developed in-house, was validated by comparing the outcomes of patients with severe extensive b...

  3. Thermal behavior of aerosol particles from biomass burning during the BBOP campaign using transmission electron microscopy

    Science.gov (United States)

    Adachi, K.; Ishimoto, H.; Sedlacek, A. J., III; Kleinman, L. I.; Chand, D.; Hubbe, J. M.; Buseck, P. R.

    2017-12-01

    Aerosol samples were collected from wildland and agricultural biomass fires in North America during the 2013 Biomass Burning Observation Project (BBOP). We show in-situ shape and size changes and variations in the compositions of individual particles before and after heating using a transmission electron microscope (TEM). The responses of aerosol particles to heating are important for measurements of their chemical, physical, and optical properties, classification, and determination of origin. However, the thermal behavior of organic aerosol particles is largely unknown. We provide a method to analyze such thermal behavior through heating from room temperature to >600°C by using a heating holder within TEM. The results indicate that individual tar balls (TB; spherical organic material) from biomass burning retained, on average, up to 30% of their volume when heated to 600°C. Chemical analysis reveals that K and Na remained in the residues, whereas S and O were lost. In contrast to bulk sample measurements of carbonaceous particles using thermal/optical carbon analyzers, our single-particle results imply that many individual organic particles consist of multiple types of organic matter having different thermal stabilities. Our results also suggest that because of their thermal stability, some organic particles may not be detectable by using aerosol mass spectrometry or thermal/optical carbon analyzers. This result can lead to an underestimate of the abundance of TBs and other organic particles, and therefore biomass burning may have a greater influence than is currently recognized in regional and global climate models.

  4. The impact of patient demographics and comorbidities upon burns admitted to Tygerberg Hospital Burns Unit, Western Cape, South Africa.

    Science.gov (United States)

    Cloake, T; Haigh, T; Cheshire, J; Walker, D

    2017-03-01

    In South Africa, burns are a major public health problem responsible for significant morbidity and long-term physical disability. This is, in part, due to a significant proportion of the urban population living in poorly constructed, combustible accommodation. The presence of co-morbid diseases such as diabetes and malignancy in patients with burns has been associated with a poorer outcome. The impact of other diseases such as HIV has yet to be defined. A retrospective data collection study analysed the 221 patients admitted to Tygerberg Hospital Burns Unit in 2011 and the first six months of 2013. Using hospital records, patient demographic data was collected alongside burn agent, ICU admission, complications, and patient outcome in terms of length of stay and mortality. The most common burn agent was hot liquid (45.7%). A significant proportion of patients were subject to intentional attacks (34.3%). Shack fires and flame accounted cumulatively for 85% of total inhalational burns, the highest rates of admission to ICU (85.5%), the highest rate of complications, as well as 92.3% of all total fatalities. HIV+ patients had a higher mortality (13.3% vs 5%, p=0.22) and a higher complication rate (46.7% vs 30%, p=0.21). There was no difference in length of stay between the HIV+ and HIV- cohort (12days vs. 15.5 days, p=0.916). Burns are a significant yet preventable cause of mortality and morbidity. The rising number of shack fires, responsible for extensive burns and resultant mortality is concerning and indicates urgent attention and action. HIV complicates the recovery from burn and is responsible for an increased rate of in hospital mortality. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  5. Thermal properties and burning efficiency of crude oils and refined fuel oil

    DEFF Research Database (Denmark)

    van Gelderen, Laurens; Alva, Wilson Ulises Rojas; Mindykowski, Pierrick Anthony

    2017-01-01

    The thermal properties and burning efficiencies of fresh and weathered crude oils and a refined fuel oil were studied in order to improve the available input data for field ignition systems for the in-situ burning of crude oil on water. The time to ignition, surface temperature upon ignition, heat......-cooled holder for a cone calorimeter under incident heat fluxes of 0, 5, 10, 20, 30, 40 and 50 kW/m2. The results clearly showed that the weathered oils were the hardest to ignite, with increased ignition times and critical heat fluxes of 5-10 kW/m2. Evaporation and emulsification were shown...

  6. 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. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  7. 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.

  8. [Burns care following a nuclear incident].

    Science.gov (United States)

    Bargues, L; Donat, N; Jault, P; Leclerc, T

    2010-09-30

    Radiation injuries are usually caused by radioactive isotopes in industry. Detonations of nuclear reactors, the use of military nuclear weapons, and terrorist attacks represent a risk of mass burn casualties. Ionizing radiation creates thermal burns, acute radiation syndrome with pancytopenia, and a delayed cutaneous syndrome. After a latency period, skin symptoms appear and the depth of tissue damages increase with dose exposure. The usual burn resuscitation protocols have to be applied. Care of these victims also requires assessment of the level of radiation, plus decontamination by an experienced team. In nuclear disasters, the priority is to optimize the available resources and reserve treatment to patients with the highest probability of survival. After localized nuclear injury, assessment of burn depth and surgical techniques of skin coverage are the main difficulties in a burn centre. Training in medical facilities and burn centres is necessary in the preparation for management of the different types of burn injuries.

  9. 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.

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

    International Nuclear Information System (INIS)

    Ibran, E.; Adil, S.E.R.; Rao, M.H.

    2013-01-01

    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)

  11. [Nosocomial infection due to Trichosporon asahii in a critical burned patient].

    Science.gov (United States)

    Tamayo Lomas, Luis; Domínguez-Gil González, Marta; Martín Luengo, Ana Isabel; Eiros Bouza, José María; Piqueras Pérez, José María

    2015-01-01

    Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection. Copyright © 2014 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  12. Graphical Calculation of Estimated Energy Expenditure in Burn Patients.

    Science.gov (United States)

    Egro, Francesco M; Manders, Ernest C; Manders, Ernest K

    2018-03-01

    Historically, estimated energy expenditure (EEE) has been related to the percent of body surface area burned. Subsequent evaluations of these estimates have indicated that the earlier formulas may overestimate the amount of caloric support necessary for burn-injured patients. Ireton-Jones et al derived 2 equations for determining the EEE required to support burn patients, 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Evidence has proved their reliability, but they remain challenging to apply in a clinical setting given the difficult and cumbersome mathematics involved. This study aims to introduce a graphical calculation of EEE in burn patients that can be easily used in the clinical setting. The multivariant linear regression analysis from Ireton-Jones et al yielded equations that were rearranged into the form of a simple linear equation of the type y = mx + b. By choosing an energy expenditure and the age of the subject, the weight was calculated. The endpoints were then calculated, and a graph was mapped by means of Adobe FrameMaker. A graphical representation of Ireton-Jones et al's equations was obtained by plotting the weight (kg) on the y axis, the age (years) on the x axis, and a series of parallel lines representing the EEE in burn patients. The EEE has been displayed graphically on a grid to allow rapid determination of the EEE needed for a given patient of a designated weight and age. Two graphs were plotted: 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Correction factors for sex, the presence of additional trauma, and obesity are indicated on the graphical calculators. We propose a graphical tool to calculate caloric requirements in a fast, easy, and portable manner.

  13. Mouse Model of Burn Wound and Infection

    DEFF Research Database (Denmark)

    Calum, Henrik; Høiby, Niels; Moser, Claus

    2017-01-01

    The immunosuppression induced by thermal injury renders the burned victim susceptible to infection. A mouse model was developed to examine the immunosuppression, which was possible to induce even at a minor thermal insult of 6% total body surface area. After induction of the burn (48 hr) a depres......The immunosuppression induced by thermal injury renders the burned victim susceptible to infection. A mouse model was developed to examine the immunosuppression, which was possible to induce even at a minor thermal insult of 6% total body surface area. After induction of the burn (48 hr...

  14. Evaluation of culture and antibiogram results in burned patients

    OpenAIRE

    Polat, Yusuf; Karabulut, Aysun; Balcı, Yasemin I.; Çilengir, Mehmet; Övet, Gültekin; Cebelli, Sami

    2010-01-01

    Infections are most common cause of morbidity and mortality in burned patients due to destruction of skin barrier. In this study, we aimed to determine most common microorganisms and their antibiotic susceptibility detected in wound cultures of these patients. Sixty six positive wound cultures were detected in patients admitted to burn clinic of Denizli State hospital between November, 2008 and November, 2009 and were evaluated in the study. Antibiotic susceptibility tests were performed by d...

  15. Burns in sub-Saharan Africa: A review.

    Science.gov (United States)

    Nthumba, Peter M

    2016-03-01

    Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region. An online search of publications on burns from sub-Saharan countries was performed. A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims. These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  16. Burn patient care lost in good manufacturing practices?

    Science.gov (United States)

    Dimitropoulos, G.; Jafari, P.; de Buys Roessingh, A.; Hirt-Burri, N.; Raffoul, W.; Applegate, L.A.

    2016-01-01

    Summary Application of cell therapies in burn care started in the early 80s in specialized hospital centers world-wide. Since 2007, cell therapies have been considered as “Advanced Therapy Medicinal Products” (ATMP), so classified by European Directives along with associated Regulations by the European Parliament. Consequently, regulatory changes have transformed the standard linear clinical care pathway into a more complex one. It is important to ensure the safety of cellular therapies used for burn patients and to standardize as much as possible the cell sources and products developed using cell culture procedures. However, we can definitely affirm that concentrating the bulk of energy and resources on the implementation of Good Manufacturing Practice (GMP) alone will have a major negative impact on the care of severely burned patients world-wide. Developing fully accredited infrastructures and training personnel (required by the new directives), along with obtaining approval for clinical trials to go ahead, can be a lengthy process.We discuss whether or not these patients could benefit from cell therapies provided by standard in-hospital laboratories, thus avoiding having to meet rigid regulations concerning the use of industrial pharmaceutical products. “Hospital Exemption” could be a preferred means to offer burn patients a customized and safe product, as many adaptations may be required throughout their treatment pathway. Patients who are in need of rapid treatment will be the ones to suffer the most from regulations intended to help them. PMID:28149232

  17. Compliance with nutrition support guidelines in acutely burned patients.

    Science.gov (United States)

    Holt, Brennen; Graves, Caran; Faraklas, Iris; Cochran, Amalia

    2012-08-01

    Adequate and timely provision of nutritional support is a crucial component of care of the critically ill burn patient. The goal of this study was to assess a single center's consistency with Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition (SCCM/ASPEN) guidelines for nutritional support in critically ill patients. Acutely burned patients >45kg in weight admitted to a regional burn center during a two-year period and who required 5 or more days of full enteral nutritional support were eligible for inclusion in this retrospective review. Specific outcomes evaluated include time from admission to feeding tube placement and enteral feeding initiation and percent of nutritional goal received within the first week of hospital stay. Descriptive statistics were used for all analyses. IRB approval was obtained. Thirty-seven patients were included in this retrospective review. Median age of patients was 44.9 years (IQR: 24.2-55.1), and median burn injury size was 30% (IQR: 19-47). Median time to feeding tube placement was 31.1h post admission (IQR: 23.6-50.2h), while median time to initiation of EN was 47.9h post admission (IQR: 32.4-59.9h). The median time required for patients to reach 60% of caloric goal was 3 days post-admission (IQR: 3-4.5). The median time for initiation of enteral nutrition was within the SCCM/ASPEN guidelines for initial nutrition in the critically ill patient. This project identified a 16h time lag between placement of enteral access and initiation of enteral nutrition. Development of a protocol for feeding tube placement and enteral nutrition management may optimize early nutritional support in the acutely injured burn patient. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  18. Unique Presentation of Orf Virus Infection in a Thermal-Burn Patient After Receiving an Autologous Skin Graft.

    Science.gov (United States)

    Hsu, Christopher H; Rokni, Ghasem Rahmatpour; Aghazadeh, Nessa; Brinster, Nooshin; Li, Yu; Muehlenbachs, Atis; Goldsmith, Cynthia S; Zhao, Hui; Petersen, Brett; McCollum, Andrea M; Reynolds, Mary G

    2016-10-15

    We describe a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemical analysis, pathologic analysis, and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Although no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft recipients with exposures to animals may be at risk for this viral infection. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  19. Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis of Major Burn Patients in a Mass Burn Casualty.

    Science.gov (United States)

    Chiao, Hao-Yu; Chou, Chang-Yi; Tzeng, Yuan-Sheng; Wang, Chih-Hsin; Chen, Shyi-Gen; Dai, Niann-Tzyy

    2018-02-01

    Adequate fluid titration during the initial resuscitation period of major burn patients is crucial. This study aimed to evaluate the feasibility and efficacy of a goal-directed fluid resuscitation protocol that used hourly urine output plus the arterial waveform analysis FloTrac (Edwards LifeSciences, Irvine, Calif) system for major burns to avoid fluid overload. We conducted a retrospective cohort study of 43 major burn patients at the Tri-Service General Hospital after the Formosa Fun Coast Dust Explosion on June 27, 2015. Because of the limited capacity of intensive care units (ICUs), 23 intubated patients were transferred from the burn wards or emergency department to the ICU within 24 hours. Fluid administration was adjusted to achieve a urine output of 30 to 50 mL/h, cardiac index greater than 2.5 L/min/m, and stroke volume variation (SVV) less than 12%. The hourly crystalloid fluid infusion rate was titrated based on SVV and hourly urine output. Of the 23 critically burned patients admitted to the ICU, 13 patients who followed the goal-directed fluid resuscitation protocol within 12 hours postburn were included in the analysis. The mean age (years) was 21.8, and the mean total body surface area (TBSA) burned (%) was 68.0. The mean Revised Baux score was 106.8. All patients sustained inhalation injury. The fluid volumes administered to patients in the first 24 hours and the second 24 hours (mL/kg/% total body surface area) were 3.62 ± 1.23 and 2.89 ± 0.79, respectively. The urine outputs in the first 24 hours and the second 24 hours (mL/kg/h) were 1.13 ± 0.66 and 1.53 ± 0.87, respectively. All patients achieved the established goals within 32 hours postburn. In-hospital mortality rate was 0%. The SVV-based goal-directed fluid resuscitation protocol leads to less unnecessary fluid administration during the early resuscitation phase. Clinicians can efficaciously manage the dynamic body fluid changes in major burn patients under the guidance of the protocol.

  20. Elevated thrombopoietin in plasma of burned patients without and with sepsis enhances platelet activation.

    Science.gov (United States)

    Lupia, E; Bosco, O; Mariano, F; Dondi, A E; Goffi, A; Spatola, T; Cuccurullo, A; Tizzani, P; Brondino, G; Stella, M; Montrucchio, G

    2009-06-01

    Thrombopoietin (TPO) is a humoral growth factor that does not induce platelet aggregation per se, but enhances platelet activation in response to several agonists. Circulating levels of TPO are increased in patients with sepsis and are mainly related to sepsis severity. To investigate the potential contribution of elevated TPO levels in platelet activation during burn injury complicated or not by sepsis. We studied 22 burned patients, 10 without and 12 with sepsis, and 10 healthy subjects. We measured plasma levels of TPO, as well as leukocyte-platelet binding and P-selectin expression. The priming activity of plasma from burned patients or healthy subjects on platelet aggregation and leukocyte-platelet binding, and the role of TPO in these effects were also studied in vitro. Burned patients without and with sepsis showed higher circulating TPO levels and increased monocyte-platelet binding compared with healthy subjects. Moreover, TPO levels, monocyte-platelet binding and P-selectin expression were significantly higher in burned patients with sepsis than in burned patients without sepsis. In vitro, plasma from burned patients without and with sepsis, but not from healthy subjects, primed platelet aggregation, monocyte-platelet binding and platelet P-selectin expression. The effect of plasma from burned patients with sepsis was significantly higher than that of plasma from burned patients without sepsis. An inhibitor of TPO prevented the priming effect of plasma from burned patients. Increased TPO levels may enhance platelet activation during burn injury and sepsis, potentially participating in the pathogenesis of multi-organ failure in these diseases.

  1. Can we make an early 'do not resuscitate' decision in severe burn patients?

    Science.gov (United States)

    Yüce, Yücel; Acar, Hakan Ahmet; Erkal, Kutlu Hakan; Tuncay, Erhan

    2017-03-01

    The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort

  2. Thermal responses of tokamak reactor first walls during cyclic plasma burns

    International Nuclear Information System (INIS)

    Smith, D.L.; Charak, I.

    1978-01-01

    The CINDA-3G computer code has been adapted to analyze the thermal responses and operating limitations of two fusion reactor first-wall concepts under normal cyclic operation. A component of an LMFBR computer code has been modified and adapted to analyze the ablative behavior of first-walls after a plasma disruption. The first-wall design concepts considered are a forced-circulation water-cooled stainless steel panel with and without a monolithic graphite liner. The thermal gradients in the metal wall and liner have been determined for several burn-cycle scenarios and the extent of surface ablation that results from a plasma disruption has been determined for stainless steel and graphite first surfaces

  3. Thermal responses of tokamak reactor first walls during cyclic plasma burns

    International Nuclear Information System (INIS)

    Smith, D.L.; Charak, I.

    1977-01-01

    The CINDA-3G computer code has been adapted to analyze the thermal responses and operating limitations of two fusion reactor first-wall concepts under normal cyclic operation. A component of an LMFBR computer has been modified and adapted to analyze the ablative behavior of first-walls after a plasma disruption. The first-wall design concepts considered are a forced-circulation water-cooled stainless steel panel with and without a monolithic graphite liner. The thermal gradients in the metal wall and liner have been determined for several burn-cycle scenarios and the extent of surface ablation that results from a plasma disruption has been determined for stainless steel and graphite first surfaces

  4. Life expectancy in elderly patients following burns injury.

    Science.gov (United States)

    Sepehripour, Sarvnaz; Duggineni, Sirisha; Shahsavari, Somaya; Dheansa, Baljit

    2018-05-18

    Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors. The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109). Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. [Surgical treatment of burns : Special aspects of pediatric burns].

    Science.gov (United States)

    Bührer, G; Beier, J P; Horch, R E; Arkudas, A

    2017-05-01

    Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. Analysis of current literature, discussion of reviews, incorporation of current guidelines. Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.

  6. 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.

  7. Bony ankylosis following thermal and electrical injury

    Energy Technology Data Exchange (ETDEWEB)

    Balen, P.F.; Helms, C.A. [Dept. of Radiology, Duke University Medical Center, Durham, NC (United States)

    2001-07-01

    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  8. Risk factors for multidrug-resistant Gram-negative infection in burn patients.

    Science.gov (United States)

    Vickers, Mark L; Dulhunty, Joel M; Ballard, Emma; Chapman, Paul; Muller, Michael; Roberts, Jason A; Cotta, Menino O

    2018-05-01

    Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia. A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values negative infection included superficial partial thickness burn size (OR: 1.08; 95% confidence interval (CI): 1.01-1.16; P-value: 0.034), prior meropenem exposure (OR: 10.39; 95% CI: 0.96-112.00; P-value: 0.054), Gram-negative colonization on admission (OR: 9.23; 95% CI: 0.65-130.15; P-value: 0.10) and escharotomy (OR: 2.66; 95% CI: 0.52-13.65; P-value: 0.24). For cases, mean age was 41 (SD: 13) years, mean total body surface area burned was 47% (SD: 18) and mean days in ICU until MDR specimen collection was 17 (SD: 10) days. Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient. © 2017 Royal Australasian College of Surgeons.

  9. Patients' perspectives on quality of life after burn.

    Science.gov (United States)

    Kool, Marianne B; Geenen, Rinie; Egberts, Marthe R; Wanders, Hendriët; Van Loey, Nancy E

    2017-06-01

    The concept quality of life (QOL) refers to both health-related outcomes and one's skills to reach these outcomes, which is not yet incorporated in the burn-related QOL conceptualisation. The aim of this study was to obtain a comprehensive overview of relevant burn-specific domains of QOL from the patient's perspective and to determine its hierarchical structure. Concept mapping was used comprising a focus group (n=6), interviews (n=25), and a card-sorting task (n=24) in burn survivors. Participants sorted aspects of QOL based on content similarity after which hierarchical cluster analysis was used to determine the hierarchical structure of burn-related QOL. Ninety-nine aspects of burn-related QOL were selected from the interviews, written on cards, and sorted. The hierarchical structure of burn-related QOL showed a core distinction between resilience and vulnerability. Resilience comprised the domains positive coping and social sharing. Vulnerability included 5 domains subdivided in 13 subdomains: the psychological domain included trauma-related symptoms, cognitive symptoms, negative emotions, body perception and depressive mood; the economical domain comprised finance and work; the social domain included stigmatisation/invalidation; the physical domain comprised somatic symptoms, scars, and functional limitations; and the intimate/sexual domain comprised the relationship with partner, and anxiety/avoidance in sexual life. From the patient's perspective, QOL following burns includes a variety of vulnerability and resilience factors, which forms a fresh basis for the development of a screening instrument. Whereas some factors are well known, this study also revealed overlooked problem and resilience areas that could be considered in client-centred clinical practice in order to customize self-management support. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  10. A systematic review of quantitative burn wound microbiology in the management of burns patients.

    Science.gov (United States)

    Halstead, Fenella D; Lee, Kwang Chear; Kwei, Johnny; Dretzke, Janine; Oppenheim, Beryl A; Moiemen, Naiem S

    2018-02-01

    The early diagnosis of infection or sepsis in burns are important for patient care. Globally, a large number of burn centres advocate quantitative cultures of wound biopsies for patient management, since there is assumed to be a direct link between the bioburden of a burn wound and the risk of microbial invasion. Given the conflicting study findings in this area, a systematic review was warranted. Bibliographic databases were searched with no language restrictions to August 2015. Study selection, data extraction and risk of bias assessment were performed in duplicate using pre-defined criteria. Substantial heterogeneity precluded quantitative synthesis, and findings were described narratively, sub-grouped by clinical question. Twenty six laboratory and/or clinical studies were included. Substantial heterogeneity hampered comparisons across studies and interpretation of findings. Limited evidence suggests that (i) more than one quantitative microbiology sample is required to obtain reliable estimates of bacterial load; (ii) biopsies are more sensitive than swabs in diagnosing or predicting sepsis; (iii) high bacterial loads may predict worse clinical outcomes, and (iv) both quantitative and semi-quantitative culture reports need to be interpreted with caution and in the context of other clinical risk factors. The evidence base for the utility and reliability of quantitative microbiology for diagnosing or predicting clinical outcomes in burns patients is limited and often poorly reported. Consequently future research is warranted. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  11. 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.

  12. 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.

  13. A retrospective evaluation of 56 patients with oral burning and limited clinical findings.

    Science.gov (United States)

    Brown, Ronald S; Farquharson, Andre A; Sam, Frances E; Reid, Errol

    2006-01-01

    This study retrospectively evaluated the charts of 56 patients who had been referred to an oral medicine clinic between 1995 and 2004 with oral burning and limited clinical findings. Of the 56 patients, 35 had a final diagnosis of essential burning mouth disorder (EBMD). Five patients with EBMD had a family history of diabetes and two had been diagnosed with late-onset diabetes. Other oral burning diagnoses included sialoadenitis (burning lips syndrome), irritation or allergic reactions to triclosan, diabetic neuropathy, subclinical oral candidiasis, nutritional deficiency/neuropathy, and a drug reaction to an ACE inhibitor (scalded mouth syndrome) that resulted in oral burning.

  14. Safety and potential anticoagulant effects of nebulised heparin in burns patients with inhalational injury at Singapore General Hospital Burns Centre.

    Science.gov (United States)

    Yip, Lian Yee; Lim, Yen Fang; Chan, Hong Ngee

    2011-11-01

    Nebulised heparin, N-acetylcysteine (NAC) and salbutamol were shown to decrease reintubation rates, incidence of atelectasis and mortality in paediatric patients and reduce lung injury scores in adult burns patients with inhalational lung injury (ILI). Nebulised heparin, NAC and salbutamol treatment protocol was introduced in Singapore General Hospital (SGH) Burns Centre in 2006. However, safety data on the use of nebulised heparin and NAC for burns patients with ILI is not well established. In this study, we investigated the safety and potential anticoagulant effects of nebulised heparin in burns patients with ILI. A retrospective study with historical control was conducted. The treatment group consisted of 52 mechanically ventilated adult patients, with a diagnosis of ILI as confirmed by bronchoscopy, admitted to burn intensive care unit (BICU) from the year 2006 to 2009. The group was treated with nebulised heparin, NAC and salbutamol. The control group consists of 11 mechanically ventilated BICU ILI patients treated from year 2001 to 2005 before protocol initiation. Blood coagulation indices (prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count) were monitored and bleeding incidences were assessed. Blood coagulation indices did not suggest an increase risk of bleeding with nebulised heparin. The APTT, PT and platelet count followed a similar trend for both groups over 7 days. No clinically significant increase in bleeding risk was found to be associated with nebulised heparin. Nebulised heparin was not found to potentiate the risk of bleeding in burns patients with ILI. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  15. Obesity and outcomes following burns in the pediatric population.

    Science.gov (United States)

    Ross, Evan; Burris, Agnes; Murphy, Joseph T

    2014-03-01

    While obesity is associated with increased mortality and decreased functional outcomes in adult burn patients, the ramifications of larger than average body size in the pediatric burn population are less well understood. The present study examines whether obesity was associated with poor outcomes following pediatric burn injuries. Thermal injury data for patients ≤ 18 years of age admitted to a Level III burn center over ten years (n=536) was analyzed. Obesity was defined as ≥ 95 th percentile of weight for height according to the WHO growth charts (obese (n=154) and non-obese (n=382) children. All data was collected in accordance with IRB regulations. Obese and non-obese thermally-injured children did not differ in TBSA, percentage of full thickness burn, or overall mortality. However, these groups were significantly different with respect to age (obese=7.16 ± 0.46 years, non-obese=9.38 ± 0.32 years, pobese=4.89 ± 1.3 days, non-obese=2.67 ± 0.49 days, pobese (n=46) and non-obese (n=129) did not differ significantly with respect to age, TBSA, percentage of full thickness burn or other outcome measures. However, significant differences between these groups were noted for ICU LOS (obese=18.59 ± 5.18 days, non-obese=9.51 ± 1.82 days, pobese=11.65 ± 3.91 days, non-obese=3.92 ± 0.85 days, pobese pediatric patients required longer and more intensive medical support in the form of BICU care and respiratory intervention. Counter to findings in adult populations, differences in mortality were not observed. Collectively, these findings suggest obesity as a risk factor for increased morbidity in the pediatric burn population. © 2014 Elsevier Inc. All rights reserved.

  16. 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.

  17. 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.

  18. The impact of major trauma network triage systems on patients with major burns.

    Science.gov (United States)

    Nizamoglu, Metin; O'Connor, Edmund Fitzgerald; Bache, Sarah; Theodorakopoulou, Evgenia; Sen, Sankhya; Sherren, Peter; Barnes, David; Dziewulski, Peter

    2016-12-01

    Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have improved the management of patients with major burns. A retrospective study was performed over a four-year period reviewing all major burns in adults and children received at a regional burns centre in the UK before and after the implementation of the regional trauma systems and major trauma centres (MTC). Comparisons were drawn between three areas: (1) Patients presenting before the introduction of MTC and after the introduction of MTC. (2) Patients referred from MTC and non-MTC within the region, following the introduction of MTC. (3) Patients referred using the urban trauma protocol and the rural trauma protocol. Following the introduction of regional trauma systems and major trauma centres (MTC), isolated burn patients seen at our regional burns centre did not show any significant improvement in transfer times, admission resuscitation parameters, organ dysfunction or survival when referred from a MTC compared to a non-MTC emergency department. There was also no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network. No significant outcome benefit was demonstrated for burns patients referred via MTCs compared to non-MTCs. We suggest further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  19. Smartphone applications in burns.

    Science.gov (United States)

    Wurzer, Paul; Parvizi, Daryousch; Lumenta, David B; Giretzlehner, Michael; Branski, Ludwik K; Finnerty, Celeste C; Herndon, David N; Tuca, Alexandru; Rappl, Thomas; Smolle, Christian; Kamolz, Lars P

    2015-08-01

    Since the introduction of applications (apps) for smartphones, the popularity of medical apps has been rising. The aim of this review was to demonstrate the current availability of apps related to burns on Google's Android and Apple's iOS store as well as to include a review of their developers, features, and costs. A systematic online review of Google Play Store and Apple's App Store was performed by using the following search terms: "burn," "burns," "thermal," and the German word "Verbrennung." All apps that were programmed for use as medical apps for burns were included. The review was performed from 25 February until 1 March 2014. A closer look at the free and paid calculation apps including a standardized patient was performed. Four types of apps were identified: calculators, information apps, book/journal apps, and games. In Google Play Store, 31 apps were related to burns, of which 20 were calculation apps (eight for estimating the total body surface area (TBSA) and nine for total fluid requirement (TFR)). In Apple's App Store, under the category of medicine, 39 apps were related to burns, of which 21 were calculation apps (19 for estimating the TBSA and 17 for calculating the TFR). In 19 out of 32 available calculation apps, our study showed a correlation of the calculated TFR compared to our standardized patient. The review demonstrated that many apps for medical burns are available in both common app stores. Even free available calculation apps may provide a more objective and reproducible procedure compared to manual/subjective estimations, although there is still a lack of data security especially in personal data entered in calculation apps. Further clinical studies including smartphone apps for burns should be performed. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  20. Thermal remote sensing of active vegetation fires and biomass burning events [Chapter 18

    Science.gov (United States)

    Martin J. Wooster; Gareth Roberts; Alistair M.S. Smith; Joshua Johnston; Patrick Freeborn; Stefania Amici; Andrew T. Hudak

    2013-01-01

    Thermal remote sensing is widely used in the detection, study, and management of biomass burning occurring in open vegetation fires. Such fires may be planned for land management purposes, may occur as a result of a malicious or accidental ignition by humans, or may result from lightning or other natural phenomena. Under suitable conditions, fires may spread rapidly...

  1. Perceived social support among patients with burn injuries: A perspective from the developing world.

    Science.gov (United States)

    Waqas, Ahmed; Turk, Marvee; Naveed, Sadiq; Amin, Atif; Kiwanuka, Harriet; Shafique, Neha; Chaudhry, Muhammad Ashraf

    2018-02-01

    Social support is among the most well-established predictors of post-burn psychopathology after burn. Despite a disproportionately large burden of burns in the developing world, the nature of social support among burn patients in this context remains elusive. We, therefore, seek to investigate social support and its biopsychosocial determinants among patients with burn injuries in Pakistan. A cross-sectional study of 343 patients presenting with burn injuries at four teaching hospitals in the Punjab province of Pakistan was conducted. Patient evaluation consisted of a multi-part survey of demographic status, clinical features, and social support as measured by the validated Urdu translation of the Multidimensional Scale of Perceived Social Support (MSPSS). Multiple regression analysis was performed to evaluate associations between patient characteristics and MSPSS score. Mean overall MSPSS score was 57.64 (std dev 13.57). Notable positive predictors of social support include male gender, Punjabi ethnicity, burn surface area, and ego resiliency. Our study reveals a troubling pattern of inadequate social support among certain subgroups of Pakistani burn patients. Addressing these inequities in the provision of social support must be prioritized as part of the global burn care agenda. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  2. Burns caused by electronic vaping devices (e-cigarettes): A new classification proposal based on mechanisms.

    Science.gov (United States)

    Serror, K; Chaouat, M; Legrand, Matthieu M; Depret, F; Haddad, J; Malca, N; Mimoun, M; Boccara, D

    2018-05-01

    Introduction With more than 10 million of daily users, e-cigarettes encountered a great success. But in the past few years, the number of medical reports of injuries caused by the explosion of e-cigarettes has significantly increased. This article aims at reporting our series and reviewing the literature to propose a new classification based on the mechanisms of injuries related to e-cigarettes that can guide non-specialists and specialists in the management of these patients. Method We performed a retrospective review of our institutional burn database from June 2016 to July 2017 for injuries caused by or in the context of using an e-cigarette. The patients' demographics (age, gender), burn injury mechanisms, depth, localization, surface and interventions were described. Results Ten patients suffered from burns related to the use of e-cigarettes. The burns were located at the thigh (80%) and the hand (50%) with a mean surface of 3% of TBSA. Four different mechanisms could be described: Type A: thermal burns with flames due to the phenomenon of "thermal runaway", Type B: blasts lesions secondary to the explosion, Type C: chemical alkali burns caused by spreading of the electrolyte solution and Type D: thermal burns without flames due to overheating. These different mechanisms suggest specific surgical and non-surgical management. Conclusion Management of injuries sustained from e-cigarettes' explosions should be approached from the standpoint of mechanisms. Different mechanisms could be associated and should be considered in specific management. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  3. Gut microbiota trajectory in patients with severe burn: A time series study.

    Science.gov (United States)

    Wang, Xinying; Yang, Jianbo; Tian, Feng; Zhang, Li; Lei, Qiucheng; Jiang, Tingting; Zhou, Jihong; Yuan, Siming; Wang, Jun; Feng, Zhijian; Li, Jieshou

    2017-12-01

    This time series experiments aimed to investigate the dynamic change of gut microbiomes after severe burn and its association with enteral nutrition (EN). Seven severely burned patients who suffered from a severe metal dust explosion injury were recruited in this study. The dynamic changes of gut microbiome of fecal samples at six time points (1-3days, 2, 3, 4, 5 and 6weeks after severe burn) were detected using 16S ribosomal RNA pyrosequencing technology. Following the post-burn temporal order, gut microbiota dysbiosis was detected in the gut microbiome after severe burn, then it was gradually resolved. The bio-diversity of gut bacteria was initially decreased, and then returned to normal level. In addition, at the early stage (from 2 to 4weeks), the majority of those patients' gut microbiome were opportunistic pathogen genus, Enterococcus and Escherichia; while at the end of this study, the majority was a beneficial genus, Bacteroides. EN can promote the recovery of gut microbiota, especially in EN well-tolerated patients. Severe burn injury can cause a dramatic dysbiosis of gut microbiota. A trend of enriched beneficial bacteria and diminished opportunistic pathogen bacteria may serve as prognosis microbiome biomarkers of severe burn patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Auricular burns associated with operating microscope use during otologic surgery.

    Science.gov (United States)

    Latuska, Richard F; Carlson, Matthew L; Neff, Brian A; Driscoll, Colin L; Wanna, George B; Haynes, David S

    2014-02-01

    To raise awareness of the potential hazard of auricular burns associated with operating microscope use during otologic surgery. Retrospective case series and summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse event reports pertaining to microscope related auricular thermal injuries. All patients who sustained auricular burns while using the operating microscope during otologic surgery at 2 tertiary academic referral centers. Surgical procedure, microscope model, intensity of illumination, length of procedure, focal length, location and severity of burn, and patient outcome. A total of 4 microscope-related auricular thermal injuries were identified from the authors' institutions. Additionally, 82 unique cases of soft tissue burns associated with the use of an operative microscope have been voluntarily reported to the FDA since 2004. A disproportionately large percent (∼ 30%) of these occurred within the field of otology, the majority of which were during tympanoplasty or tympanomastoidectomy procedures at focal length distances of 300 mm or less with xenon light source microscopes. Simultaneous advancements in light delivery technologies and lens optics have continued to improve the efficiency of the operating microscope; however, these improvements also increase the potential for thermal injuries. Although rare, a review of the FDA MAUDE database suggests that microscope-related soft tissue burns occur more frequently in otology than any other surgical specialty. A variety of factors may help explain this finding, including the unique anatomy of the external ear with thin skin and limited underlying adipose tissue. Preventative measures should be taken to decrease the risk of thermal injuries including use of the lowest comfortable light intensity, adjusting the aperture width to match the operative field, frequent wound irrigation, and covering exposed portions of the pinna

  5. Asymptotic strength of thermal pulses in the helium shell burning

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, M Y [Niigata Univ. (Japan); Sugimoto, D

    1979-03-01

    Secular growth in the strength of the recurrent thermal pulses of helium shell burning is discussed for the purpose of determining its asymptotic strength. It is shown that the pulse grows stronger if the helium zone has been cooled more before the initiation of the pulse. The secular growth of the pulse is related with the increasing degree of cooling. Thermal pulses are computed for an initial model corresponding to the maximum possible cooling, i.e., for a model in which the steady-state entropy distribution was realized in the helium zone. Such thermal pulses are shown to give an upper bound to the asymptotic strength, which is close enough to the asymptotic strength itself for relatively large core masses. Numerical results are given for the core mass of 1.07 M sub(sun), for which the asymptotic strength is found to be 9 x 10/sup 6/ L sub(sun). Thermal pulses are also computed for an initial model which has been cooled artificially more than the steady-state model. The first pulse results in a much greater strength than in the normal model, but a later pulse approaches the normal asymptotic value. Such models are also discussed in relation to the shell flashes on accreting white dwarfs.

  6. Radioactive contamination and health risk assessment due to burning of coal in thermal energy generation

    International Nuclear Information System (INIS)

    Kant, K.

    2008-01-01

    Full text: Radon being a ubiquitous air pollutant has global impact and its monitoring in the environment at work places is essential from health and hygiene point of view. In thermal power plants, a lot of coal is burnt which contains radionuclides which are released into the environment and are hazardous. Radon is the main culprit in the local radioactive contamination of the environment due to burning of coal in thermal energy generation. It has been reported by several researchers (Nikl and Vegvari 1992, Bodizs et al. 1992) that the concentrations of the isotopes U 238 and Ra 226 become 3-5 times more than those in the coal itself in the coal slag and fly ash obtained by burning the coal in coal fired power plants. Several researchers have reported radon levels in thermal power plants (Bodizs et al. 1992, Rawat et al. 1991, Nikl and Vevgari 1992, Papastefanou and Charalanbous 1979, Kant et al. 2001). Keeping in view the environmental pollution caused due to the burning of coal in thermal power stations, there is an upsurge in the establishment of nuclear and gas turbine power stations in recent times. An increased share of gas and nuclear in power generation could lead to lower emissions. Also, considerable emphasis is being laid on developing non-polluting and renewable energy sources like water, air, solar energy and others. In this study, measurement of radon and its progeny levels was carried out over long integrated times in thermal power plant in Haryana by using LR-115, Type- II (Kodak Pathe, France), plastic track detectors commonly known as solid state nuclear track detectors (SS NTDs). Alpha particles emitted from radon cause radiation damage tracks, which were subsequently revealed by chemical etching in NaOH. These alpha tracks registered were counted by optical microscope at suitable magnification and converted into radon concentration. The findings indicate that it is very important to carry out these studies and the results of the full study will

  7. [Nitrogen balance assessment in burn patients].

    Science.gov (United States)

    Beça, Andreia; Egipto, Paula; Carvalho, Davide; Correia, Flora; Oliveira, Bruno; Rodrigues, Acácio; Amarante, José; Medina, J Luís

    2010-01-01

    The burn injury probably represents the largest stimulus for muscle protein catabolism. This state is characterized by an accelerated catabolism of the lean or skeletal mass that results in a clinical negative balance of nitrogen and muscle wasting. The determination of an appropriate value for protein intake is essential, since it is positively related to the nitrogen balance (NB) and accordingly several authors argue that a positive NB is the key parameter associated with nutritional improvement of a burn patient. Evaluation of the degree of protein catabolism by assessment of the Nitrogen Balance; Defining of nutritional support (protein needs) to implement in patients with burned surface area (BSA) = 10%. We prospectively evaluated the clinical files and scrutinized the clinical variables of interest. The NB was estimated according to three formulae. Each gram of nitrogen calculated by the NB was then converted into grams of protein, subtracted or added to protein intake (or administered enteric or parenterically) and divided by kg of reference Weight (kg Rweight), in an attempt to estimate the daily protein needs. The cohort consisted of 10 patients, 6 females, with average age of 58(23) years old, a mean of BSA of 21.4(8.4)%, ranging from a minimum of 10.0% and máximum of 35.0%. On average, patients were 58 (23) years old. The average number of days of hospitalization in the burn unit was 64.8(36.5) days. We observed significant differences between the 3 methods used for calculating the NB (p = 0.004), on average the NB was positive. When the formula A was used the average value of NB was higher. Regarding the attempt to estimate the needs of g prot/kg Rweight/day most of the values did not exceed, on average, 2.6 g Prot/kg Rweight/day and no significant differences between patients with a BSA% of 10-20% and with BSA% > 20% were found. Despite being able to estimate the protein catabolism through these formulas and verifying that most values were above zero

  8. Matrix metalloproteinase-2 and its correlation with basal membrane components laminin-5 and collagen type IV in paediatric burn patients measured with Surface Plasmon Resonance Imaging (SPRI) biosensors.

    Science.gov (United States)

    Weremijewicz, Artur; Matuszczak, Ewa; Sankiewicz, Anna; Tylicka, Marzena; Komarowska, Marta; Tokarzewicz, Anna; Debek, Wojciech; Gorodkiewicz, Ewa; Hermanowicz, Adam

    2018-01-30

    The purpose of this study was the determination of matrix metalloproteinase-2 and its correlation with basal membrane components laminin-5 and collagen type IV in the blood plasma of burn patients measured with Surface Plasmon Resonance Imaging (SPRI) biosensors. 31 children scalded by hot water who were managed at the Department of Paediatric Surgery between 2014-2015, after primarily presenting with burns in 4-20% TBSA were included into the study (age 9 months up to 14 years, mean age 2,5+1 years). There were 10 girls and 21 boys. Venous blood samples were drawn 2-6h, and 12-16h after the thermal injury, and on the subsequent days 3, 5 and 7. The matrix metalloproteinase-2, collagen type IV and laminin-5 concentrations were assessed using Surface Plasmon Resonance Imaging by the investigators blinded to the other data. The MMP-2, laminin-5 and collagen type IV concentrations in the blood plasma of patients with burns, were highest 12-16h after thermal injury, the difference was statistically significant. The MMP-2, laminin-5 and collagen type IV concentrations measured 3 days, 5 days and 7 days after the thermal injury, slowly decreased over time, and on the 7th day reached the normal range, when compared with the concentration measured in controls. Current work is the first follow-up study regarding MMP-2 in burns. MMP-2, laminin-5 and collagen type IV levels were elevated early after burn injury in the plasma of studied patients, and were highest 12-16h after the injury. MMP-2, laminin-5 and collagen type IV levels were not proportional to the severity of the burn. We believe in the possibility that the gradual decrease of MMP-2, collagen type IV and laminin-5 concentrations could be connected with the process of healing, but to prove it, more investigation is needed in this area. The SPR imaging biosensor is a good diagnostic tool for determination of MMP-2, laminin-5 and collagen type IV in blood plasma of patients with burns. Copyright © 2017 Elsevier Ltd

  9. Managing burn wounds with SMARTPORE Technology polyurethane foam: two case reports.

    Science.gov (United States)

    Imran, Farrah-Hani; Karim, Rahamah; Maat, Noor Hidayah

    2016-05-12

    Successful wound healing depends on various factors, including exudate control, prevention of microbial contaminants, and moisture balance. We report two cases of managing burn wounds with SMARTPORE Technology polyurethane foam dressing. In Case 1, a 2-year-old Asian girl presented with a delayed (11 days) wound on her right leg. She sustained a thermal injury from a hot iron that was left idle on the floor. Clinical inspection revealed an infected wound with overlying eschar that traversed her knee joint. As her parents refused surgical debridement under general anesthesia, hydrotherapy and wound dressing using SMARTPORE Technology Polyurethane foam were used. Despite the delay in presentation of this linear thermal pediatric burn injury that crossed the knee joint, the patient's response to treatment and its outcome were highly encouraging. She was cooperative and tolerated each dressing change without the need of supplemental analgesia. Her wound was healed by 24 days post-admission. In Case 2, a 25-year-old Asian man presented with a mixed thickness thermal flame burn on his left leg. On examination, the injury was a mix of deep and superficial partial thickness burn, comprising approximately 3% of his total body surface area. SMARTPORE Technology polyurethane foam was used on his wound; his response to the treatment was very encouraging as the dressing facilitated physiotherapy and mobility. The patient rated the pain during dressing change as 2 on a scale of 10 and his pain score remained the same in every subsequent change. His wound showed evidence of epithelialization by day 7 post-burn. There were no adverse events reported. Managing burn wounds with SMARTPORE Technology polyurethane foam resulted in reduced pain during dressing changes and the successful healing of partial and mixed thickness wounds. The use of SMARTPORE Technology polyurethane foam dressings showed encouraging results and requires further research as a desirable management option in

  10. A ten-year experience with hemodialysis in burn patients at Los Angeles County + USC Medical Center.

    Science.gov (United States)

    Soltani, Ali; Karsidag, Semra; Garner, Warren

    2009-01-01

    Acute renal failure (ARF) is a rare, but serious, complication after burn injury that is commonly thought to be fatal. Before the modern era, there were few survivors of burn injuries who required dialysis. We report our 10-year experience with ARF and dialysis at the Los Angeles County + USC burn unit. During the period of August 1994 to February 2004, 3356 patients were admitted. Furthermore, 1143 patients were admitted to the intensive care unit and 1125 had burns >10% TBSA. Thirty-three patients developed ARF necessitating dialysis, equaling 0.98% of all admitted patients, and 2.7% of patients with TBSA >10% burns, which is at the low end of published burn unit data. The average age of these patients requiring dialysis was 49 years, 91% were men, 24% were diabetic, and 39% were positive for substances of abuse at admission, and the average TBSA burned was 36%. This is compared with an average age of 31 years, 70% men, 7.3% diabetic, and 14.7% intoxicated in the general burned population at our burn unit. Furthermore, our overall mortality in the burn unit was 5% overall and 14% in patients with >10% TBSA burns during the study period. In patients requiring hemodialysis, the mortality rate was 69.7%. The average time to hemodialysis was 14 days in our series, and patients, on average, required 10.3 days of dialysis support. These mortality data are the lowest recorded for burned patients requiring dialysis and suggest that ARF is a survivable complication in some of these patients.

  11. Quantification of thermal damage in skin tissue

    Institute of Scientific and Technical Information of China (English)

    Xu Feng; Wen Ting; Lu Tianjian; Seffen Keith

    2008-01-01

    Skin thermal damage or skin burns are the most commonly encountered type of trauma in civilian and military communities. Besides, advances in laser, microwave and similar technologies have led to recent developments of thermal treatments for disease and damage involving skin tissue, where the objective is to induce thermal damage precisely within targeted tissue structures but without affecting the surrounding, healthy tissue. Further, extended pain sensation induced by thermal damage has also brought great problem for burn patients. Thus, it is of great importance to quantify the thermal damage in skin tissue. In this paper, the available models and experimental methods for quantification of thermal damage in skin tissue are discussed.

  12. 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.

  13. clinical outcome of burns in hiv positive patients at the university

    African Journals Online (AJOL)

    Esem

    Hospital (UTH), Lusaka, Zambia, Male and Female. Surgical Admission Wards and all General Surgical. Wards with burns patients from November 2009 to. November 2010. Study Design. This study was a Prospective Observational Cohort. Study. Case Definition. In this study, a case referred to a patient with recent burns,.

  14. Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns.

    Science.gov (United States)

    Klein, Matthew B; Engrav, Loren H; Holmes, James H; Friedrich, Jeffrey B; Costa, Beth A; Honari, Shari; Gibran, Nicole S

    2005-05-01

    Management of deep facial burns remains one of the greatest challenges in burn care. We have developed a protocol over the past 20 years for management of facial burns that includes excision and coverage with thick autograft. However, the results were not perfect. Deformities of the eyelids, nose and mouth as well as the prominence of skin graft junctures demonstrated the need to explore novel approaches. Integra has been used with success in the management of burns of the trunk and extremities. The purpose of this study was to prospectively evaluate the aesthetic outcome of the use of Integra for deep facial burns. Twelve consecutive patients underwent excision of large, deep facial burns and placement of Integra. Integra provides excellent color and minimally visible skin graft junctures. The texture is good but not as supple as thick autograft. Integra is not well suited for use in the coverage of eyelid burns due to the need to wait 2 weeks for adequate vascularization. In summary, thick autograft remains the gold standard for deep facial burns. However, for patients with extensive burns and limited donor sites, Integra provides an acceptable alternative.

  15. [Burns, new challenges to take on].

    Science.gov (United States)

    Galí-Llàcer, Rosa; Sena-Fernández, Beatriz; Leyva-Moral, Juan Manuel

    2009-04-01

    This article concerns a transversal descriptive study which shows the characteristics of burns treated in a Primary Health Care Center in an urban environment in Barcelona from 19 July 2005 unti 11 August 2007 (N=93). Patients younger than 15 were excluded from this study. 88% (82; CI of 95% 81,47-94,59) of the burns treated were caused by a thermal agent. Kitchen cooking oil ranks first as the cause of burns (24; 27%, CI of 95% 17,99-36,01). 70% of the burns studied had signs of superficial skin damage (65, CI of 95% 60,70-79,30). 61% (57; CI of 95% 51,70-70,30) of these burns were located on upper extremities The average recorded body surface burned was 0.0076% (median = 0,005%, range = 0,0001-0,5000%). The greatest number of wounds were observed among men aged 31 to 45 (17%; 16; CI of 95% 9,38-24,62). Educational health programs which focus on prevention of, and first aid care for, burns are needed. Studies like this one may prove useful when starting preventive or educational strategies.

  16. Fluid resuscitation for major burn patients with the TMMU protocol.

    Science.gov (United States)

    Luo, Gaoxing; Peng, Yizhi; Yuan, Zhiqiang; Cheng, Wenguang; Wu, Jun; Tang, Jin; Huang, Yuesheng; Fitzgerald, Mark

    2009-12-01

    Fluid resuscitation is one of the critical treatments for the major burn patient in the early phases after injury. We evaluated the practice of fluid resuscitation for severely burned patients with the Third Military Medical University (TMMU) protocol, which is most widely used in many regions of China. Patients with major burns (>30% total body surface area (TBSA)) presenting to Southwest Hospital, Third Military Medical University, between January 2005 and October 2007, were included in this study. Fluid resuscitation was initiated by the TMMU protocol. A total of 71 patients were (46 adults and 25 children) included in this study. All patients survived the first 48 h after injury smoothly and none developed abdominal compartment syndrome or other recognised complications associated with fluid resuscitation. The average quantity of fluid infused was 3.3-61.33% more than that calculated based on the TMMU protocol in both adult and paediatric groups. The average urine output during the first 24h after injury was about 1.2 ml per kg body weight per hour in the two groups, but reached 1.2 ml and 1.7 ml during the second 24h in adult and pediatric groups, respectively. This study indicates that the TMMU protocol for fluid resuscitation is a feasible option for burn patients. Individualised resuscitation - guided by the physiological response to fluid administration - is still important as in other protocols.

  17. Lethal Area 50 in Patients with Burn Injuries in North West, Iran

    Directory of Open Access Journals (Sweden)

    Ahmad Mirza Aghazadeh

    2018-03-01

    Full Text Available Introduction: In view of their considerably high rates of mortality and morbidity, burns are still viewed as one of the most important health-threatening environmental hazards imposing a significant burden on the health care system in low and middle-income countries. This study seeks to determine the lethal area fifty percent (LA50 in all burn patients admitted over a period of five years and the factors influencing mortality in burn injuries. Methods: This study was a cross-sectional carried out from 2010 to 2014 in Sina Hospital of Tabriz, 1226 participant including 319 women, 346 men, 272 girls, and 289 boys were selected through stratified sampling. The demographic and clinical data of patients ( their age, gender, burn type, TBSA, the season and consequences of burning were all extracted and then analyzed, using descriptive statistics (measures of central tendency and variability and inferential statistics(chi-square and linear regressionat a significance level of 0.05. The LA50 was calculated through determining the relationship between the total body surface area and mortality rate (The extent of the body burns measured and recorded based on Lando Chart in hospitals. Results: The highest (47.6% and the lowest (3.8% rates of burns were observed among those aged below 16 and above 65, respectively. The majority of the participants were residents of cities (55.4%, married (34.6%, illiterate (56.6%, and housewives (14.8%. Most burns were caused by accidents (98.4% at home (90.6%. Most patients had suffered first- and second-degree burns (68.4%, with no inhalation damages (99.5%. Hot liquids were the main culprit in most of the burns (58.7% and the upper extremities were the most frequently affected areas (34.8%. There was .99 rise in mortality for every percent increase in TBSA, and there seemed to be a significant relationship between the age level and the eventual outcome- the higher the age, the more likely for the incident to end in death

  18. Noninvasive measurement of burn wound depth applying infrared thermal imaging (Conference Presentation)

    Science.gov (United States)

    Jaspers, Mariëlle E.; Maltha, Ilse M.; Klaessens, John H.; Vet, Henrica C.; Verdaasdonk, Rudolf M.; Zuijlen, Paul P.

    2016-02-01

    In burn wounds early discrimination between the different depths plays an important role in the treatment strategy. The remaining vasculature in the wound determines its healing potential. Non-invasive measurement tools that can identify the vascularization are therefore considered to be of high diagnostic importance. Thermography is a non-invasive technique that can accurately measure the temperature distribution over a large skin or tissue area, the temperature is a measure of the perfusion of that area. The aim of this study was to investigate the clinimetric properties (i.e. reliability and validity) of thermography for measuring burn wound depth. In a cross-sectional study with 50 burn wounds of 35 patients, the inter-observer reliability and the validity between thermography and Laser Doppler Imaging were studied. With ROC curve analyses the ΔT cut-off point for different burn wound depths were determined. The inter-observer reliability, expressed by an intra-class correlation coefficient of 0.99, was found to be excellent. In terms of validity, a ΔT cut-off point of 0.96°C (sensitivity 71%; specificity 79%) differentiates between a superficial partial-thickness and deep partial-thickness burn. A ΔT cut-off point of -0.80°C (sensitivity 70%; specificity 74%) could differentiate between a deep partial-thickness and a full-thickness burn wound. This study demonstrates that thermography is a reliable method in the assessment of burn wound depths. In addition, thermography was reasonably able to discriminate among different burn wound depths, indicating its potential use as a diagnostic tool in clinical burn practice.

  19. Burn injury reduces neutrophil directional migration speed in microfluidic devices.

    Directory of Open Access Journals (Sweden)

    Kathryn L Butler

    2010-07-01

    Full Text Available Thermal injury triggers a fulminant inflammatory cascade that heralds shock, end-organ failure, and ultimately sepsis and death. Emerging evidence points to a critical role for the innate immune system, and several studies had documented concurrent impairment in neutrophil chemotaxis with these post-burn inflammatory changes. While a few studies suggest that a link between neutrophil motility and patient mortality might exist, so far, cumbersome assays have prohibited exploration of the prognostic and diagnostic significance of chemotaxis after burn injury. To address this need, we developed a microfluidic device that is simple to operate and allows for precise and robust measurements of chemotaxis speed and persistence characteristics at single-cell resolution. Using this assay, we established a reference set of migration speed values for neutrophils from healthy subjects. Comparisons with samples from burn patients revealed impaired directional migration speed starting as early as 24 hours after burn injury, reaching a minimum at 72-120 hours, correlated to the size of the burn injury and potentially serving as an early indicator for concurrent infections. Further characterization of neutrophil chemotaxis using this new assay may have important diagnostic implications not only for burn patients but also for patients afflicted by other diseases that compromise neutrophil functions.

  20. Does inhalation injury predict mortality in burns patients or require redefinition?

    Directory of Open Access Journals (Sweden)

    Youngmin Kim

    Full Text Available Inhalation injury is known to be an important factor in predicting mortality in burns patients. However, the diagnosis is complicated by the heterogeneous presentation and inability to determine the severity of inhalation injury. The purpose of this study was to identify clinical features of inhalation injury that affect mortality and the values that could predict the outcome more precisely in burns patients with inhalation injury. This retrospective observational study included 676 burns patients who were over 18 years of age and hospitalized in the Burns Intensive Care Unit between January 2012 and December 2015. We analyzed variables that are already known to be prognostic factors (age, percentage of total body surface area (%TBSA burned, and inhalation injury and factors associated with inhalation injury (carboxyhemoglobin and PaO2/FiO2 [PF] ratio by univariate and multivariate logistic regression. Age group (odds ratio [OR] 1.069, p<0.001, %TBSA burned (OR 1.100, p<0.001, and mechanical ventilation (OR 3.774, p<0.001 were identified to be significant predictive factors. The findings for presence of inhalation injury, PF ratio, and carboxyhemoglobin were not statistically significant in multivariate logistic regression. Being in the upper inhalation group, the lower inhalation group, and having a PF ratio <100 were identified to be significant predictors only in univariate logistic regression analysis (OR 4.438, p<0.001; OR 2.379, p<0.001; and OR 2.765, p<0.001, respectively. History and physical findings are not appropriate for diagnosis of inhalation injury and do not predict mortality. Mechanical ventilation should be recognized as a risk factor for mortality in burns patients with inhalation injury.

  1. The Predictive Value of Scores Used in Intensive Care Unit for Burn Patients Prognostic.

    Science.gov (United States)

    Novac, M; Dragoescu, Alice; Stanculescu, Andreea; Duca, Lucica; Cernea, Daniela

    2014-01-01

    Statistical evaluation of the prognosis of burned patients based on the analysis of prognostic scores as quickly and easily obtainable that track the evolution of burned patient in ICU. Material / Methods: The prospective study included 92 patients were performed with severe burns on 35-67% body surface large area, aiming to establish a cut-off score for each studied and statistically significant prognostic parameter for assessing the risk of mortality. The control group was represented by 20 patients with burns on the body surface of 0.05) sex (male / female), but we had p cut-off. Quantification of variables by calculating the area under the ROC curve (AUC), sensitivity and sensitivity, positive predictive value (PPV) and negative predictive value (NPV), allowed a better appreciation of these prognostic scores. These systems applicable to the burned patient scores, making a cut-off of each index / mortality probability score, he can manifest usefulness in medical decision making process and strategy to reduce the risk of death in patients with severe burns.

  2. Duration of antibiotic therapy for ventilator-associated pneumonia in burn patients.

    Science.gov (United States)

    Wahl, Wendy L; Taddonio, Michael A; Arbabi, Saman; Hemmila, Mark R

    2009-01-01

    Shorter compared with longer courses of antibiotic therapy for ventilator-associated pneumonia (VAP) in mixed medical-surgical intensive care units (ICUs) have been reported to produce equivalent outcomes. There have been few studies on the duration of antibiotic therapy for VAP in the burn population. We hypothesized that a shorter duration of antibiotic therapy for VAP would produce similar outcomes in our burn ICU. All burn patients from July 2001 to December 2006 admitted to the burn ICU requiring mechanical ventilation were studied. VAP was diagnosed prospectively by our Infection Control Liaison using bronchoalveolar lavage for cultures. Patients were cohorted into two groups: before July 1, 2004, antibiotic therapy duration was directed by the discretion of the attending physician (preprotocol), and after, the goal was 8 days of appropriate therapy or longer based on physician discretion (postprotocol). There were 98 patients treated for VAP with similar rates of inhalation injury, %TBSA burn size, age, and need for mechanical ventilation between the groups. The incidence of recurrent VAP was the same: 17% for the preprotocol and 15% for the postprotocol periods. The overall duration of antibiotic therapy did not change from 11 +/- 4 to 12 +/- 6 days. For patients treated longer than the target of 8 days, 66% had positive respiratory cultures at 4 days after initiation of antibiotic therapy. For the majority of patients with aspiration-type organisms or nonvirulent strains, there were fewer antibiotic days overall at 10 +/- 5 days (P VAP with the same bacteria. Despite a focused effort to decrease antibiotic usage for VAP in burn patients, the overall duration of therapy did not change. The majority of patients with virulent organisms such as methicillin-resistant Staphylococcus aureus or nonfermenting Gram-negative rods still had clinical signs of pneumonia and positive cultures, leading clinicians to continue antibiotics. In patients without virulent

  3. Major Transcriptome Changes Accompany the Growth of Pseudomonas aeruginosa in Blood from Patients with Severe Thermal Injuries.

    Directory of Open Access Journals (Sweden)

    Cassandra Kruczek

    Full Text Available Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes serious infections in immunocompromised hosts including severely burned patients. After multiplying within the burn wound, P. aeruginosa translocate into the bloodstream causing bacterial sepsis frequently leading to organ dysfunction and septic shock. Although the pathogenesis of P. aeruginosa infection of thermally-injured wounds has been extensively analyzed, little is known regarding the ability of P. aeruginosa to adapt and survive within the blood of severely burned patients during systemic infection. To identify such adaptations, transcriptome analyses (RNA-seq were conducted on P. aeruginosa strain PA14 that was grown in whole blood from a healthy volunteer or three severely burned patients. Compared with growth in blood from healthy volunteers, growth of PA14 in the blood from severely burned patients significantly altered the expression of 2596 genes, with expression of 1060 genes enhanced, while that of 1536 genes was reduced. Genes whose expression was significantly reduced included genes related to quorum sensing, quorum sensing-controlled virulence factors and transport of heme, phosphate, and phosphonate. Genes whose expression was significantly enhanced were related to the type III secretion system, the pyochelin iron-acquisition system, flagellum synthesis, and pyocyanin production. We confirmed changes in expression of many of these genes using qRT-PCR. Although severe burns altered the levels of different blood components in each patient, the growth of PA14 in their blood produced similar changes in the expression of each gene. These results suggest that, in response to changes in the blood of severely burned patients and as part of its survival strategy, P. aeruginosa enhances the expression of certain virulence genes and reduces the expression of others.

  4. Effect of perceived social support and dispositional optimism on the depression of burn patients.

    Science.gov (United States)

    He, Fei; Zhou, Qin; Zhao, Zhijing; Zhang, Yuan; Guan, Hao

    2016-06-01

    Burn wounds have a significant impact on the mental health of patients. This study aimed to investigate the impact of perceived social support and dispositional optimism on depression of burn patients. A total of 246 burn patients accomplished the Multidimensional Scale of Perceived Social Support, the Revised Life Orientation Test, and Depression Scale. The results revealed that both perceived social support and optimism were significantly correlated with depression. Structural equation modeling indicated that optimism partially mediated the relationship between perceived social support and depression. Implications for prevention of depression in burn patients were discussed. © The Author(s) 2014.

  5. 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

  6. Increased serum concentrations of soluble ST2 predict mortality after burn injury.

    Science.gov (United States)

    Hacker, Stefan; Dieplinger, Benjamin; Werba, Gregor; Nickl, Stefanie; Roth, Georg A; Krenn, Claus G; Mueller, Thomas; Ankersmit, Hendrik J; Haider, Thomas

    2018-06-27

    Large burn injuries induce a systemic response in affected patients. Soluble ST2 (sST2) acts as a decoy receptor for interleukin-33 (IL-33) and has immunosuppressive effects. sST2 has been described previously as a prognostic serum marker. Our aim was to evaluate serum concentrations of sST2 and IL-33 after thermal injury and elucidate whether sST2 is associated with mortality in these patients. We included 32 burn patients (total body surface area [TBSA] >10%) admitted to our burn intensive care unit and compared them to eight healthy probands. Serum concentrations of sST2 and IL-33 were measured serially using an enzyme-linked immunosorbent assay (ELISA) technique. The mean TBSA was 32.5%±19.6%. Six patients (18.8%) died during the hospital stay. Serum analyses showed significantly increased concentrations of sST2 and reduced concentrations of IL-33 in burn patients compared to healthy controls. In our study cohort, higher serum concentrations of sST2 were a strong independent predictor of mortality. Burn injuries cause an increment of sST2 serum concentrations with a concomitant reduction of IL-33. Higher concentrations of sST2 are associated with increased in-hospital mortality in burn patients.

  7. Pseudomonas aeruginosa, an emerging pathogen among burn patients in Kurdistan Province, Iran.

    Science.gov (United States)

    Kalantar, Enayat; Taherzadeh, Shadi; Ghadimi, Tayeb; Soheili, Fariborz; Salimizand, Heiman; Hedayatnejad, Alireza

    2012-05-01

    This study was conducted to determine the incidence of Pseudomonas aeruginosa infections among burn patients at Tohid Hospital, Iran. A total of 176 clinical specimens were obtained from 145 burn patients admitted to the burn unit of Tohid Hospital to detect the presence of P. aeruginosa. Antimicrobial susceptibility testing was conducted to detect extended spectrum beta-lactamase (ESBL) producing P. aeruginiosa using Clinical and Laboratory Standards Institute guidelines with the double disc synergy test (DDST). A polymerase chain reaction was used to detect PER-1 and OXA-10 among the isolates. The mean age, total body surface area and length of hospital stay among patients were 29 years, 37.7%, and 10 days, respectively. Kerosene was the commonest cause of burn (60%), followed by gas (30%). During the study, P. aeruginosa was detected in 100 isolates. The antibiotics they were most commonly resistant to were cefotaxime, ceftriaxone and ciprofloxacin. Of the 100 P. aeroginusa isolates, 28% were positive for ESBL production with the DDST, 48% and 52% were PER-1 and OXA-10 producers, respectively. The high frequency of PER-1 and OXA-10 producers at this hospital is of concern considering their potential spread among burn patients.

  8. Efficacy of glutathione mesotherapy in burns: an experimental study.

    Science.gov (United States)

    Buz, A; Görgülü, T; Olgun, A; Kargi, E

    2016-12-01

    Thermal burns are the leading cause of trauma worldwide. Currently, no consensus on optimal treatment of deep partial-thickness (second-degree) burns has emerged, as reflected by the wide variability in available wound-care materials. The relative efficacies of products used for treatment of partial-thickness thermal burns remain unclear. Mesotherapy features intradermal administration of various agents, depending on burn location. In the present experimental study, we explored the efficacy of mesotherapy used to treat partial-thickness thermal burns in 50 male Wistar rats divided into five groups of equal number. No procedure was performed after infliction of thermal burns in control group (Group 1). Mesotherapy was applied with physiological saline in sham group (Group 2), glutathione, taurine, and L-carnitine were separately applied in Group 3, Group 4, and Group 5, respectively. Mesotherapeutic agents were injected intradermally into the reticular layer of the dermis using the point technique. The first course of mesotherapy was given within the first 2 h after infliction of thermal burns, and therapy was continued to day 10. On day 22, unhealed thermal burn areas were measured prior to sacrifice, and biopsies covering the total areas of burns were performed to allow of pathological evaluation. Group 3 (the glutathione group) showed the best extent of healing, followed by Group 4 (the taurine group) and Group 5 (the L-carnitine group). The healed thermal burn areas in these groups were significantly greater than those in the control and sham groups (P = 0.001). All of healing, acute and chronic inflammation, the amount of granulation tissue, the level of fibroblast maturation, the amount of collagen, the extent of re-epithelization and neovascularization, and ulcer depth were scored upon pathological examination of tissue cross-sections. The best outcomes were evident in the glutathione group, with statistical significance. Although wound healing in the L

  9. Licking as an out-of-hospital burns treatment-An isolated cultural phenomenon?

    LENUS (Irish Health Repository)

    Seoighe, Deirdre M

    2012-02-01

    Wound management in burns is a potentially complex issue. Salivary constituents have been shown experimentally to be of benefit in the treatment of thermal injuries. In our clinical experience we have encountered patients who have saliva directly applied to the burn wound prior to presenting to the national burns service. The practice is known as "Licking". We report two cases to illustrate the presentations we have encountered. We believe that these illustrate an isolated phenomenon unique to the Republic of Ireland.

  10. Introduction to burning plasma physics

    International Nuclear Information System (INIS)

    Momota, Hiromu

    1982-01-01

    The free energy of fusion-produced charged particles, the critical plasma Q-value for the thermal instability, and the Cherenkov's emission are discussed. The free energy of fusion-produced charged particles is large even in DT burning plasma. The primary role of fusion-produced energetic charged particles is the heating of fuel plasma. If the charged particle heating is large, burning may be thermally unstable. A zero dimensional analysis shows that the critical plasma Q-values for this thermal instability are nearly 5 for DT burning plasma of 14 keV and 1.6 for D-He 3 burning plasma of 60 keV. These critical plasma Q-values are small as compared to that required for commercial reactors. Then, some methods of burning-control should be introduced to fusion plasma. Another feature of energetic charged particles may be Cherenkov's emission of various waves in fusion plasma. The relationship between this micro-instability and transport phenomena may be the important problem to be clarified. The fusion-produced energetic charged particles have large Larmor radii, and they may have effects on balooning mode instability. (Kato, T.)

  11. Properties and Types of Significant Thermal Skin Burn Injuries

    Science.gov (United States)

    2018-02-01

    The deep burn category includes deep second, deep third and deep fourth-degree burns. Table 2: Burn Classification and Injury Outcome ( Rice ...Subcutaneous tissue  Entire dermis destroyed  No to low pain due to nerve destruction  Waxy white to leathery gray to charred black skin  Dry...Richard R.L. (2009) Rehabilitation of the Burned Hand. Hand Clinics, 25, 529- 541 Rice P.L. & Orgill, D.P. (2015).Classification of burns. (Ed

  12. Is superficial burn caused by ultraviolet radiation (sunburn) comparable to superficial burn caused by heat--a histomorphological comparison by in vivo Reflectance-Mode-Confocal Microscopy.

    Science.gov (United States)

    Altintas, M A; Altintas, A A; Guggenheim, M; Busch, K H; Niederbichler, A D; Aust, M C; Vogt, P M

    2009-12-01

    Regardless of the underlying cause, both sunburn and superficial thermal injuries are classified as first-degree burns, since data on morphological differences are scarce. Reflectance-Mode-Confocal Microscopy (RMCM) enables high-resolution non-invasive investigation of the human skin. We studied in vivo histomorphological alterations in both sunburn and superficial thermal injuries using RMCM. Ten patients (6 female, 4 male; aged 28.4 +/- 10.6 years) with first-degree thermal-contact Injuries (TI group), and 9 sunburned patients (SB group; 7 female, 2 male; aged 30.2 +/- 16.4 years), to a maximum extent of 10% of the body surface were evaluated 24 h after burn injury using RMCM. The following parameters were obtained using RMCM: stratum corneum thickness, epidermal thickness, basal layer thickness, granular cell size. Compared to the controls (12.8 +/- 2.5 microm), stratum corneum thickness decreased significantly to 10.6 +/- 2.1 microm in the TI group, whereas it increased significantly to 16.4 +/- 3.1 microm in the SB group. The epidermal thickness did not differ significantly in the TI group (47.9 +/- 2.3 microm) and SB group (49.1 +/- 3.5 microm); however, both increased significantly compared to their respective controls (41.8 +/- 1.4 microm). The basal layer thickness increased more in the SB group compared to the TI group (17.9 +/- 1.4 microm vs. 15.6 +/- 1.1 microm). Both differed also significantly compared to their controls (13.8 +/- 0.9 microm). The granular cell size increased significantly in both groups compared to the controls (731 +/- 42 microm); however, a significantly higher increase was observed in the TI group (852 +/- 58 microm) compared to the SB group (784 +/- 61 microm). Ultraviolet radiation seems to influence predominantly deeper epidermal layers, whereas heat-induced burns affect more superficial epidermal layers. The term 'First-degree burn' should not be used synonymously for sunburn and superficial thermal burn injuries. Conflicts of

  13. Effects of magnesium-based hydrogen storage materials on the thermal decomposition, burning rate, and explosive heat of ammonium perchlorate-based composite solid propellant.

    Science.gov (United States)

    Liu, Leili; Li, Jie; Zhang, Lingyao; Tian, Siyu

    2018-01-15

    MgH 2 , Mg 2 NiH 4 , and Mg 2 CuH 3 were prepared, and their structure and hydrogen storage properties were determined through X-ray photoelectron spectroscopy and thermal analyzer. The effects of MgH 2 , Mg 2 NiH 4 , and Mg 2 CuH 3 on the thermal decomposition, burning rate, and explosive heat of ammonium perchlorate-based composite solid propellant were subsequently studied. Results indicated that MgH 2 , Mg 2 NiH 4 , and Mg 2 CuH 3 can decrease the thermal decomposition peak temperature and increase the total released heat of decomposition. These compounds can improve the effect of thermal decomposition of the propellant. The burning rates of the propellant increased using Mg-based hydrogen storage materials as promoter. The burning rates of the propellant also increased using MgH 2 instead of Al in the propellant, but its explosive heat was not enlarged. Nonetheless, the combustion heat of MgH 2 was higher than that of Al. A possible mechanism was thus proposed. Copyright © 2017. Published by Elsevier B.V.

  14. 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.

  15. Blood transfusion in burn patients: Triggers of transfusion in a referral burn center in Iran.

    Science.gov (United States)

    Tavousi, S H; Ahmadabadi, A; Sedaghat, A; Khadem-Rezaiyan, M; Yaghoubi Moghaddam, Z; Behrouzian, M J; Nemati, S; Saghafi, H

    2018-02-01

    Blood and its derivatives are one of the most lifesaving products in the modern medicine practice. However, it is not an absolutely safe prescription. Many adverse effects such as infection, transfusion-related acute lung injury, immunosuppression, multi-organ dysfunction, acute respiratory syndrome, transfusion errors, transmission of infectious agents such as HIV, HBV, HCV are attributable to blood transfusion. The aim of this study was to describe how and when blood products were transfused in a referral burn center. This cross-sectional study was performed on medical records of all admitted patients in the Department of Burns and Reconstructive Surgery of Imam Reza Hospital, Mashhad, Iran during September 2014 up to August 2015. Transfusion measures such as Hb, Hct and demographic data were extracted from patient records. SPSS version 11.5 was used for data analysis. During the study period, 701 acute burnt patients were admitted with the mean age of 25.5±20.5 years. Sixty-four percent were male and burnt percentage of total body surface area (TBSA) was 30.9±24.3%. About one third (240) of patients received at least one blood product. Mean of the transfused packed red blood cell was 274.1±674.6mL per patient and 8.85mL per 1% of burnt TBSA. Anemia was the most common transfusion trigger. Mortality in burnt patients who received blood products was two folds more than patients who did not receive any blood products. We prescribed less blood products compared with other reviewed burn centers. However, following a written blood transfusion protocol by all clinicians may reduce blood transfusion in unnecessary situations even more significantly. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Burn-up dependent steady-state thermal hydraulic analysis of Pakistan research reactor-1

    Directory of Open Access Journals (Sweden)

    Muhammad Atta

    2011-01-01

    Full Text Available The burn-up dependent steady-state thermal hydraulic analysis of Pakistan research reactor-1, reference operating core, has been carried out utilizing standard computer codes WIMS/D4, CITATION, and RELAP5/MOD3.4. Reactor codes WIMS/D4 and CITATION have been used for the calculations of neutronic parameters including peaking factors and power profiles at different burn-up considering a xenon free core and also the equilibrium xenon values. RELAP5/MOD3.4 code was utilized for the determination of peak fuel centerline, clad and coolant temperatures to ensure the safety of the reactor throughout the cycle. The calculations reveal that the reactor is safe and no nucleate boiling will commence at any part of the core throughout the cycle and that the safety margin increases with burnup as peaking factors decrease.

  17. Rationalization of thermal injury quantification methods: application to skin burns.

    Science.gov (United States)

    Viglianti, Benjamin L; Dewhirst, Mark W; Abraham, John P; Gorman, John M; Sparrow, Eph M

    2014-08-01

    Classification of thermal injury is typically accomplished either through the use of an equivalent dosimetry method (equivalent minutes at 43 °C, CEM43 °C) or through a thermal-injury-damage metric (the Arrhenius method). For lower-temperature levels, the equivalent dosimetry approach is typically employed while higher-temperature applications are most often categorized by injury-damage calculations. The two methods derive from common thermodynamic/physical chemistry origins. To facilitate the development of the interrelationships between the two metrics, application is made to the case of skin burns. This thermal insult has been quantified by numerical simulation, and the extracted time-temperature results served for the evaluation of the respective characterizations. The simulations were performed for skin-surface exposure temperatures ranging from 60 to 90 °C, where each surface temperature was held constant for durations extending from 10 to 110 s. It was demonstrated that values of CEM43 at the basal layer of the skin were highly correlated with the depth of injury calculated from a thermal injury integral. Local values of CEM43 were connected to the local cell survival rate, and a correlating equation was developed relating CEM43 with the decrease in cell survival from 90% to 10%. Finally, it was shown that the cell survival/CEM43 relationship for the cases investigated here most closely aligns with isothermal exposure of tissue to temperatures of ~50 °C. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  18. Implications for would healing of patient age and time elapsed since burn injury.

    Science.gov (United States)

    Mountford, E M; Blight, A; Cheshire, I M

    1995-01-01

    To determine the relationship between growth potential in culture and the age of the patient, skin biopsies were obtained from over 60 patients of varying ages. The relationship between the length of time elapsed since burn injury and growth potential was also examined, using biopsies obtained from patients with burns during their treatment. Keratinocytes were extracted from biopsies and assessed for colony-forming ability by standard methods. Repeated subculture of cells was undertaken to determine the reproductive capacity of cells in vitro. Age had no effect on the colony-forming ability of keratinocytes in primary culture; however age did affect the total number of generations achieved by these cells. The growth potential of keratinocytes from patients with severe burns showed considerable variation according to the amount of time which had elapsed since the injury. This was most apparent around one week post-burn. These results need to be investigated further to understand their clinical implications. The study provides an insight into the influence of age and physiological response on the wound healing process in burn injuries.

  19. [Clinical study on the postburn change in the hypothalamus-pituitary-adrenal hormones in severely burned patients].

    Science.gov (United States)

    Li, Hong-mian; Liang, Zi-qian; Luo, Zuo-jie

    2003-06-01

    To investigate the postburn dynamic changes in the hypothalamus-pituitary-adrenal hormones in severely burned patients. Fifty burn patients were enrolled in the study. The plasma contents of total GC (cortisol), ACTH and aldosterone (ALDO) and urinary contents of 17-OHO and 17-KS were determined with radio-immunological assay (RIA) method after burn injury to compare with the normal values which were well established clinically. The postburn plasma and urinary contents of the above indices were increased evidently with two peak values in shock and infectious stages, whilst the majority of he indices were lower than the normal values after 6 postburn weeks (PBWs). The values of these hormones were the lowest in dying patients. On the other hand, the values approached normal levels in those patients whose burn wounds were healing. Increases of the plasma and urinary levels of hypothalamus-pituitary -adrenal hormones in severely burned patients were constantly seen. Burn shock and infection seemed to be the two major factors in inducing postburn stress reaction in burn victims. Abrupt decrease of the hormone levels in plasma and or urine indicated adrenal failure predicting a poor prognosis of the burn patients.

  20. Health-related quality of life 6 months after burns among hospitalized patients: Predictive importance of mental disorders and burn severity.

    Science.gov (United States)

    Palmu, Raimo; Partonen, Timo; Suominen, Kirsi; Saarni, Samuli I; Vuola, Jyrki; Isometsä, Erkki

    2015-06-01

    Major burns are likely to have a strong impact on health-related quality of life (HRQoL). We investigated the level of and predictors for quality of life at 6 months after acute burn. Consecutive acute adult burn patients (n=107) admitted to the Helsinki Burn Centre were examined with a structured diagnostic interview (SCID) at baseline, and 92 patients (86%) were re-examined at 6 months after injury. During follow-up 55% (51/92) suffered from at least one mental disorder. The mean %TBSA was 9. TBSA of men did not differ from that of women. Three validated instruments (RAND-36, EQ-5, 15D) were used to evaluate the quality of life at 6 months. All the measures (RAND-36, EQ-5, 15D) consistently indicated mostly normal HRQoL at 6 months after burn. In the multivariate linear regression model, %TBSA predicted HRQoL in one dimension (role limitations caused by physical health problems, p=0.039) of RAND-36. In contrast, mental disorders overall and particularly major depressive disorder (MDD) during follow-up (p-values of 0.001-0.002) predicted poor HRQoL in all dimensions of RAND-36. HRQoL of women was worse than that of men. Self-perceived HRQoL among acute burn patients at 6 months after injury seems to be mostly as good as in general population studies in Finland. The high standard of acute treatment and the inclusion of small burns (%TBSAburn itself on HRQoL. Mental disorders strongly predicted HRQoL at 6 months. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  1. Frequency of burning mouth and subjective xerostomia in patients with diabetes mellitus type 2

    Directory of Open Access Journals (Sweden)

    M. Salehi

    2017-12-01

    Full Text Available Background: Diabetes mellitus is a common chronic metabolic disease which have numerous physical effects for patients. Objective: The aim of this study was to determine the prevalence of subjective xerostomia and burning mouth of patients with type 2 diabetes mellitus in cities of Sari and Qaemshahr. Methods: In this descriptive-analytic study, totally 1455 patients with type 2 diabetes mellitus with complain of xerostomia and/or burning mouth which had referred to diabetes clinic in Sari and Qaemshahr were examined in 2016. For every patient asked about chronic xerostomia and burning mouth and if the answer was positive, the oral examination was done to ensure the absence of mucosal lesions and find signs of xerostomia. Then, xerostomia questionnaire was completed by patients suffering from dry mouth. Finally, the information was statistically analyzed by T test and chi square test. Findings: Prevalence of burning mouth was found 111 (7.6% in diabetic patients that in the women were significantly higher than in men (P<0.0001. Prevalence of xerstomia patients was found 239 (16.4% that was not significant between the male and female. There was a significant correlation between burning mouth and xerostomia with FBS and HbA1c in diabetic patients (P<0.0001. Conclusion: Possibility of burning mouth, and xerostomia will increase in the diabetic patients with low metabolic control which can cause more severe side effects related to oral health.

  2. A clinician's guide to the treatment of foot burns occurring in diabetic patients.

    Science.gov (United States)

    Jones, Larry M; Coffey, Rebecca; Khandelwal, Sorabh; Atway, Said; Gordillo, Gayle; Murphy, Claire; Fries, Jody A; Dungan, Kathleen

    2014-12-01

    Diabetes mellitus affects 25.8 million Americans and is predicted to almost double by 2050. The presence of diabetes complicates hospital courses because of the microvascular complications associated with disease progression. Patients with diabetes represent 18.3% of annual burn admissions to our unit and 27% have burns to the feet. The purpose of this project was to develop an evidence-based guideline for care of the patient with diabetes and foot burns A multidisciplinary group was charged with developing an evidence-based guideline for the treatment of foot burns in patients with diabetes. Evidence was evaluated in the areas of diabetes, burn care, hyperbaric medicine, care of diabetic foot wounds and physical therapy. After guideline development and approval, key aspects were incorporated into order sets. Key aspects of this guideline are the ability to identify patients with undiagnosed diabetes, assess diabetic control, optimize glycemic and metabolic control, optimize burn wound management, treat microvascular disease, and provide education and a discharge plan. Evaluated outcomes are glycemic control, length of stay, complication rates, amputation rates, infection rates and the use of hyperbaric oxygen. Best outcomes for this high risk population will be attainable with an evidence based guideline. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  3. 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

  4. Impact of a Newly Implemented Burn Protocol on Surgically Managed Partial Thickness Burns at a Specialized Burns Center in Singapore.

    Science.gov (United States)

    Tay, Khwee-Soon Vincent; Chong, Si-Jack; Tan, Bien-Keem

    2016-03-01

    This study evaluated the impact of a newly implemented protocol for superficial to mid-dermal partial thickness burns which involves early surgery and rapid coverage with biosynthetic dressing in a specialized national burns center in Singapore. Consecutive patients with 5% or greater total body surface area (TBSA) superficial to mid-dermal partial thickness burns injury admitted to the Burns Centre at the Singapore General Hospital between August and December 2014 for surgery within 48 hours of injury were prospectively recruited into the study to form the protocol group. Comparable historical cases from the year 2013 retrieved from the burns center audit database were used to form the historical control group. Demographics (age, sex), type and depth of burns, %TBSA burnt, number of operative sessions, and length of stay were recorded for each patient of both cohorts. Thirty-nine burns patients managed under the new protocol were compared with historical control (n = 39) comparable in age and extensiveness of burns. A significantly shorter length of stay (P burns was observed in the new protocol group (0.74 day/%TBSA) versus historical control (1.55 day/%TBSA). Fewer operative sessions were needed under the new protocol for burns 10% or greater TBSA burns (P protocol for surgically managed burns patients which involves early surgery and appropriate use of biosynthetic dressing on superficial to mid-dermal partial thickness burns. Clinically, shorter lengths of stay, fewer operative sessions, and decreased need for skin grafting of burns patient were observed.

  5. Reduction on high level radioactive waste volume and geological repository footprint with high burn-up and high thermal efficiency of HTGR

    Energy Technology Data Exchange (ETDEWEB)

    Fukaya, Yuji, E-mail: fukaya.yuji@jaea.go.jp; Nishihara, Tetsuo

    2016-10-15

    Highlights: • We evaluate the number of canisters and its footprint for HTGR. • We proposed new waste loading method for direct disposal of HTGR. • HTGR can significantly reduce HLW volume compared with LWR. - Abstract: Reduction on volume of High Level radioactive Waste (HLW) and footprint in a geological repository due to high burn-up and high thermal efficiency of High Temperature Gas-cooled Reactor (HTGR) has been investigated. A helium-cooled and graphite-moderated commercial HTGR was designed as a Gas Turbine High Temperature Reactor (GTHTR300), and that has particular features such as significantly high burn-up of approximately 120 GWd/t, high thermal efficiency around 50%, and pin-in-block type fuel. The pin-in-block type fuel was employed to reduce processed graphite volume in reprocessing. By applying the feature, effective waste loading method for direct disposal is proposed in this study. By taking into account these feature, the number of HLW canister generations and its repository footprint are evaluated by burn-up fuel composition, thermal calculation and criticality calculation in repository. As a result, it is found that the number of canisters and its repository footprint per electricity generation can be reduced by 60% compared with Light Water Reactor (LWR) representative case for direct disposal because of the higher burn-up, higher thermal efficiency, less TRU generation, and effective waste loading proposed in this study for HTGR. But, the reduced ratios change to 20% and 50% if the long term durability of LWR canister is guaranteed. For disposal with reprocessing, the number of canisters and its repository footprint per electricity generation can be reduced by 30% compared with LWR because of the 30% higher thermal efficiency of HTGR.

  6. Coverage of extensive tibial bone exposure in burn patients with ...

    African Journals Online (AJOL)

    Covering tibial bone exposure from third degree burns to the lower limbs is a challenging task for the plastic surgeon. We present our experience of covering tibial exposure from burns in three different patients, where four limbs were involved and three muscular flaps were used in conjunction with one another; i.e. the ...

  7. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

    Science.gov (United States)

    Azzopardi, Ernest A; Azzopardi, Elayne; Camilleri, Liberato; Villapalos, Jorge; Boyce, Dean E; Dziewulski, Peter; Dickson, William A; Whitaker, Iain S

    2014-01-01

    Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

  8. Management of patients in a dedicated burns intensive care unit (BICU) in a developing country.

    Science.gov (United States)

    Hashmi, Madiha; Kamal, Rehana

    2013-05-01

    In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU). This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented. A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR =32-7). 32% victims were children 50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36-33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%. Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death. Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality. Burn hazard awareness, prevention and educational programmes targeted at the

  9. Propofol clearance and volume of distribution are increased in patients with major burns.

    Science.gov (United States)

    Han, Tae-Hyung; Greenblatt, David J; Martyn, J A Jeevendra

    2009-07-01

    Propofol pharmacokinetics were examined in 17 adults with major burns during the hyperdynamic convalescent phase. Eighteen nonburned surgical patients served as controls. After a 2-mg/kg intravenous dose of propofol, blood samples were collected at multiple time points. Noncompartmental methods were used to calculate the pharmacokinetic parameters. The following indices were higher in burns than controls: propofol clearance (64+/-17 vs 29+/-4 mL/kg/min, Pclearance of propofol in burned patients may imply that these patients require higher doses or infusion rates of propofol to attain a target plasma concentration or pharmacodynamic effect.

  10. Thermal Neutron Capture and Thermal Neutron Burn-up of K isomeric state of 177mLu: a way to the Neutron Super-Elastic Scattering cross section

    International Nuclear Information System (INIS)

    Roig, O.; Belier, G.; Meot, V.; Daugas, J.-M.; Romain, P.; Aupiais, J.; Jutier, Ch.; Le Petit, G.; Letourneau, A.; Marie, F.; Veyssiere, Ch.

    2006-01-01

    Thermal neutron radiative capture and burn-up measurements of the K isomeric state in 177Lu form part of an original method to indirectly obtain the neutron super-elastic scattering cross section at thermal energy. Neutron super-elastic scattering, also called neutron inelastic acceleration, occurs during the neutron collisions with an excited nuclear level. In this reaction, the nucleus could partly transfer its excitation energy to the scattered neutron

  11. Nursing research on a first aid model of double personnel for major burn patients.

    Science.gov (United States)

    Wu, Weiwei; Shi, Kai; Jin, Zhenghua; Liu, Shuang; Cai, Duo; Zhao, Jingchun; Chi, Cheng; Yu, Jiaao

    2015-03-01

    This study explored the effect of a first aid model employing two nurses on the efficient rescue operation time and the efficient resuscitation time for major burn patients. A two-nurse model of first aid was designed for major burn patients. The model includes a division of labor between the first aid nurses and the re-organization of emergency carts. The clinical effectiveness of the process was examined in a retrospective chart review of 156 cases of major burn patients, experiencing shock and low blood volume, who were admitted to the intensive care unit of the department of burn surgery between November 2009 and June 2013. Of the 156 major burn cases, 87 patients who received first aid using the double personnel model were assigned to the test group and the 69 patients who received first aid using the standard first aid model were assigned to the control group. The efficient rescue operation time and the efficient resuscitation time for the patients were compared between the two groups. Student's t tests were used to the compare the mean difference between the groups. Statistically significant differences between the two groups were found on both measures (P's first aid model based on scientifically validated procedures and a reasonable division of labor can shorten the efficient rescue operation time and the efficient resuscitation time for major burn patients. Given these findings, the model appears to be worthy of clinical application.

  12. Catastrophizing in Patients with Burning Mouth Syndrome

    Directory of Open Access Journals (Sweden)

    Ana ANDABAK ROGULJ

    2014-01-01

    Full Text Available Background: Burning mouth syndrome (BMS is an idiopathic painful condition which manifests with burning sensations in the oral cavity in patients with clinically normal oral mucosa and without any local and/or systemic causative factor. Catastrophizing is defined as an exaggerated negative orientation toward pain stimuli and pain experience. The aim of this study was to examine the association between catastrophizing and clinical parameters of BMS, and to examine the association between catastrophizing and the quality of life in patients with BMS. Materials and methods: Anonymous questionnaire consisting of 3 parts (demographic and clinical data with 100 mm visual analogue scale (VAS, Croatian version of the Oral Health Impact Profile (OHIP-14 scale and Croatian version of the Pain Catastrophizing scale (PC, was distributed to 30 patients diagnosed with BMS. Results: A higher level of catastrophizing was clinically significant in 30% of the patients. Total catastrophizing score and all three subcomponents of catastrophizing significantly correlated with the intensity of symptoms, but did not correlate with the duration of symptoms. Gender and previous treatment did not affect the catastrophizing. Conclusion: Obtaining the information about catastrophizing could help a clinician to identify patients with negative behavioural patterns. Additional psychological intervention in these individuals could reduce/eliminate negative cognitive factors and improve coping with chronic painful condition such as BMS.

  13. Glutamine granule-supplemented enteral nutrition maintains immunological function in severely burned patients.

    Science.gov (United States)

    Peng, Xi; Yan, Hong; You, Zhongyi; Wang, Pei; Wang, Shiliang

    2006-08-01

    Glutamine is an important energy source for immune cells. It is a necessary nutrient for cell proliferation, and serves as specific fuel for lymphocytes, macrophages, and enterocytes when it is present in appropriate concentrations. The purpose of this clinical study was to observe the effects of enteral nutrition supplemented with glutamine granules on immunologic function in severely burned patients. Forty-eight severely burned patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trail. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, Gln and B group patents were given glutamine granules or placebo (glycine) at 0.5 g/kgd for 14 days with oral feeding or tube feeding, respectively. The plasma level of glutamine and several indices of immunologic function including lymphocyte transformation ratio, neutrophil phagocytosis index (NPI), CD4/CD8 ratio, the content of immunoglobulin, complement C3, C4 and IL-2 levels were determined. Moreover, wound healing rate of burn area was observed and then hospital stay was recorded. The results showed significantly reduced plasma glutamine and damaged immunological function after severe burn Indices of cellular immunity function were remarkably decreased from normal controls. After taking glutamine granules for 14 days, plasma glutamine concentration was significantly higher in Gln group than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P0.05). In addition, wound healing was better and hospital stay days were reduced in Gln group (46.59+/-12.98 days versus 55.68+/-17.36 days, Pburn; supplemented glutamine granules with oral feeding or tube feeding abate the degree of immunosuppression, improve immunological function

  14. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-.

    Directory of Open Access Journals (Sweden)

    Ernest A Azzopardi

    Full Text Available BACKGROUND: Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS: Studies investigating adult hospitalised patients (2000-2010 were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS: Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20 = 1.1, p = 0.3797; r2 = 9.84. INTERPRETATION: Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.

  15. A Retrospective Analysis of Clinical Laboratory Interferences Caused by Frequently Administered Medications in Burn Patients.

    Science.gov (United States)

    Godwin, Zachary; Lima, Kelly; Greenhalgh, David; Palmieri, Tina; Sen, Soman; Tran, Nam K

    2016-01-01

    The goal of this study is to quantify the number of medications administered to burn patients and identify potential drugs interfering with laboratory testing. The authors reviewed the medical records of 12 adult (age ≥ 18 years) burn patients with more than 20% TBSA burns from an existing glucose control database at our institution. Dose, interval, and route of medications administered from admission to discontinuation of intensive insulin therapy were recorded. Interfering drugs were identified based on established clinical chemistry literature. The retrospective cohort of adult burn patients exhibited a mean (SD) age of 37.9 (3.0) years. Mean TBSA burn was 51.3 (9.3)%. Disease severity determined by the average multiple organ dysfunction score was 5.4 (0.2). Mean and median medications administered per day were 42.1 (9.5) and 49 (with a daily range of 0-65), respectively. A total of 666 potential laboratory test interferences caused by medications were identified. There were 261 different effects (eg, increased glucose, decreased potassium). Multiple interferences, 71.0% (475/666), were caused by more than one medication. Investigation of the number of medications administered to a burn patient and delineation of potential laboratory test interferences has not been conducted in burn patients. Given the substantial number of medications administered to burn patients, physicians and laboratory personnel should work together to identify potential interferences and define appropriate countermeasures while enhancing the laboratorians understanding of this unique population. This synergistic partnership can lead to intelligent support tools and potentially autocorrecting instruments.

  16. Evaluation of TCOM/HBOT practice guideline for the treatment of foot burns occurring in diabetic patients.

    Science.gov (United States)

    Jones, Larry M; Rubadue, Christopher; Brown, Nicole V; Khandelwal, Sorabh; Coffey, Rebecca A

    2015-05-01

    A multidisciplinary team developed an evidence-based guideline for the management of foot burns occurring in diabetic patients that included transcutaneous oxygen measurements (TCOM) and application of hyperbaric oxygen therapy (HBOT) to selected patients. This report represents an evaluation of preliminary TCOM/HBOT data. This is a retrospective review of patients with diabetes mellitus (DM) who were admitted to a single American Burn Association (ABA) verified burn center for the treatment of foot burns. Patients were treated via the guideline if they were over the age of 16, admitted for the initial care of burns involving the feet between 4/01/2012 and 7/22/2013, and had a known or new diagnosis of DM. Eighteen patients were treated according to the guideline, 14 men and 4 women. Average age was 54 years+14.78. Average BMI was 30.63+6.34. Median burn size was 0.88% TBSA (median partial thickness of 1% and median full thickness of 0.5%). The average HbA1c was 9.08+2.42. Seven patients received pre-operative HBOT, two received post-operative HBOT and three patients healed their wounds with HBOT alone. Average hospital length of stay was 13.39 days+9.94 and was significantly longer for the group receiving HBOT. Admission HbA1c was not a predictor of the need for HBOT. While TCOM/HBOT therapy has not been widely applied to the management of diabetic foot burns, the use of an evidence-based guideline incorporating TCOM/HBOT can provide a systematic way to evaluate the patients' microcirculation and ability to heal burns of the foot. The incorporation of TCOM determination and application of HBOT in selected patients with DM and burns of the feet warrant continued study. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  17. Evaluation of salivary function in patients with burning mouth syndrome.

    Science.gov (United States)

    Lee, Y C; Hong, I K; Na, S Y; Eun, Y G

    2015-04-01

    To investigate salivary function in patients with primary burning mouth syndrome (BMS) compared with control and to evaluate salivary hypofunction using salivary gland scintigraphy (SGS). A total of 33 patients with primary BMS and 30 control subjects were enrolled in our study. The severity of the pain and the burning sensation on a 10-cm visual analog scale (VAS) and the Oral Health Impact Profile-14 (OHIP-14) were assessed. Unstimulated and stimulated salivary flow rates (SFRs) were measured. (99m) Tc pertechnetate SGS was used to evaluate salivary gland function. Unstimulated SFR in patients with BMS was significantly lower than that in the control group (0.11 ± 0.15 vs 0.21 ± 0.16 ml min(-1) , P = 0.014). There was no significant difference in stimulated SFR between the two groups. The VAS scores for oral pain and burning sensation, the total OHIP-14 score, and salivary gland function by salivary scintigraphy were not significantly different between BMS patients with normal flow rate and hyposalivation. Patients with primary BMS exhibited a significant decrease in unstimulated SFR compared with control group. In addition, we could not find any difference in salivary gland function between BMS patients with or without hyposalivation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Adjunctive hyperbaric oxygen therapy in severe burns: Experience in Taiwan Formosa Water Park dust explosion disaster.

    Science.gov (United States)

    Chiang, I-Han; Chen, Shyi-Gen; Huang, Kun-Lun; Chou, Yu-Ching; Dai, Niann-Tzyy; Peng, Chung-Kan

    2017-06-01

    Despite major advances in therapeutic strategies for the management of patients with severe burns, significant morbidity and mortality is observed. Hyperbaric oxygen therapy (HBOT) increases the supply of oxygen to burn areas. The aim of this study was to determine whether HBOT is effective in the treatment of major thermal burns. On June 27, 2015 in New Taipei, Taiwan, a mass casualty disaster occurred as fire erupted over a large crowd, injuring 499 people. Fifty-three victims (20 women and 33 men) were admitted to Tri-Service General Hospital. Thirty-eight patients underwent adjunctive HBOT (HBOT group), and 15 patients received routine burn therapy (control group). Serum procalcitonin (PCT) level, a sepsis biomarker, was measured until it reached normal levels (burn care combined with adjunctive HBOT improves sepsis control compared with standard treatment without HBOT. Prospective studies are required to define the role of HBOT in extensive burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  19. Acute kidney injury in critically burned patients resuscitated with a protocol that includes low doses of Hydroxyethyl Starch

    OpenAIRE

    Sánchez-Sánchez, M.; Garcia-de-Lorenzo, A.; Cachafeiro, L.; Herrero, E.; Asensio, MJ.; Agrifoglio, A.; Flores, E.; Estebanez, B.; Extremera, P.; Iglesias, C.; Martinez, J.R..

    2016-01-01

    Acute kidney injury (AKI) is an important complication in burn patients. Recently, it has been recommended that hydroxyethyl starch (HES) be avoided in burn patients because it increases the incidence of AKI. Our purpose was to study incidence of AKI in critically ill burn patients resuscitated with Ringer’s solution and supplements of HES. We conducted an observational study of 165 patients admitted to the critical care burn unit (with 30 ± 15% TBSA burned). The main outcome measures were in...

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

    Science.gov (United States)

    2015-03-06

    ceruloplasmin; ferroxidase; iron status; oxidant stress; burn; trauma 1. Introduction Iron is an essential element for life that facilitates...899–906. 45. Shakespeare , P.G. Studies on the serum levels of iron, copper and zinc and the urinary excretion of zinc after burn injury. Burns Incl

  1. VENOUS THROMBOSIS COMPLICATIONS IN THERMAL TRAUMA. A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    V. S. Borisov

    2016-01-01

    Full Text Available The article analyzes the currently existing data concerning incidence and timing of venous thrombosis development in burn patients. There is no consensus not only on the incidence of this disease amongst burn patients, but also on methods of diagnosis and prevention. For the first time, we raised an issue of the need for formation of risk groups using the scale of prof. Joseph Caprini (USA applied to patients with thermal injury.

  2. Global Burned Area and Biomass Burning Emissions from Small Fires

    Science.gov (United States)

    Randerson, J. T.; Chen, Y.; vanderWerf, G. R.; Rogers, B. M.; Morton, D. C.

    2012-01-01

    In several biomes, including croplands, wooded savannas, and tropical forests, many small fires occur each year that are well below the detection limit of the current generation of global burned area products derived from moderate resolution surface reflectance imagery. Although these fires often generate thermal anomalies that can be detected by satellites, their contributions to burned area and carbon fluxes have not been systematically quantified across different regions and continents. Here we developed a preliminary method for combining 1-km thermal anomalies (active fires) and 500 m burned area observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) to estimate the influence of these fires. In our approach, we calculated the number of active fires inside and outside of 500 m burn scars derived from reflectance data. We estimated small fire burned area by computing the difference normalized burn ratio (dNBR) for these two sets of active fires and then combining these observations with other information. In a final step, we used the Global Fire Emissions Database version 3 (GFED3) biogeochemical model to estimate the impact of these fires on biomass burning emissions. We found that the spatial distribution of active fires and 500 m burned areas were in close agreement in ecosystems that experience large fires, including savannas across southern Africa and Australia and boreal forests in North America and Eurasia. In other areas, however, we observed many active fires outside of burned area perimeters. Fire radiative power was lower for this class of active fires. Small fires substantially increased burned area in several continental-scale regions, including Equatorial Asia (157%), Central America (143%), and Southeast Asia (90%) during 2001-2010. Globally, accounting for small fires increased total burned area by approximately by 35%, from 345 Mha/yr to 464 Mha/yr. A formal quantification of uncertainties was not possible, but sensitivity

  3. Dissemination of carbapenem-resistant Acinetobacter baumannii in patients with burn injuries.

    Science.gov (United States)

    Shoja, Saeed; Moosavian, Mojtaba; Rostami, Soodabeh; Farahani, Abbas; Peymani, Amir; Ahmadi, Khadijeh; Ebrahimifard, Nasim

    2017-04-01

    Carbapenem-resistant Acinetobacter baumannii has emerged as an important cause of infection in burn patients. This study aimed to characterize the antimicrobial susceptibility pattern, determine the prevalence of oxacillinase and metallo-beta-lactamase (MBL) genes, and type the A. baumannii isolates obtained from burn patients. During a 1-year period, a total of 40 nonduplicated isolates of A. baumannii were obtained from burn patients who were hospitalized in the Taleghani Burn Hospital in Ahvaz, in the southwest of Iran. Testing for antimicrobial susceptibility was carried out by disk diffusion and E-test. To screen MBL production, a double disk synergy and MBL E-test were performed. The presence of bla OXA-23-like , bla OXA-24-like , bla OXA-51-like and bla OXA-58-like , bla VIM , bla IMP and bla SPM , and bla NDM was sought by polymerase chain reaction (PCR). Repetitive extragenic palindromic sequence-based PCR was carried out for determination of isolates clonality. Overall, 92.5% of isolates were carbapenem-resistant. Polymyxin B, colistin, and ampicillin-sulbactam were the most effective agents in vitro, with a susceptibility rate of 100%, 97.5%, and 72.5%, respectively. According to the double disk synergy and E-test, 55.6% and 97.3% of isolates were MBL producers, respectively. Furthermore, 70% of isolates harbored bla OXA-23-like and 20% were positive for bla OXA-24-like. However, no encoding genes were detected for bla VIM , bla IMP and bla SPM , bla NDM , and bla OXA-58-like . Repetitive extragenic palindromic sequence-based PCR revealed that carbapenem-resistant isolates belonged to four clones, including A, B, C, and D; the predominant clones were B and C. The rate of carbapenem resistance was high, and it appeared that bla OXA-23-like and bla OXA-24-like contributed to the carbapenem resistance of A. baumannii isolates. This result suggests that the two predominant clones of A. baumannii were spread among burn patients. In order to prevent future

  4. Child Supervision and Burn Outcome among Admitted Patients at Major Trauma Hospitals in the Gambia

    Directory of Open Access Journals (Sweden)

    Edrisa Sanyang

    2017-07-01

    Full Text Available Burn-related injuries are a significant burden in children, particularly in low- and middle-income countries (LMICs, where more than 90% of burn-related pediatric deaths occur. Lack of adult supervision of children is a major risk for pediatric burn injuries. The goal of this paper was to examine the general characteristics of burns and identify burn injury outcomes among adult-supervised children compared to those who were not supervised. The study examined burn injury and clinical characteristics among all burn patients admitted to two trauma hospitals in The Gambia, West Africa. At intake in the emergency room, the treating physician or nurse determined the need for admission based on body surface area burned (BSAB, depth of burn, and other clinical considerations such as co-occurring injuries and co-morbidities. During the study period of 1 April 2014 through 31 October 2016, 105 burn patients were admitted and data were collected by the treating physician for all of them. Information about supervision was only asked for children aged five years or less. More than half (51% of the burn patients were children under 18 years, and 22% were under 5 years. Among children under five, most (86.4% were supervised by an adult at the time of burn event. Of the 19 supervised children, 16 (84.2% had body area surface burned (BSAB of less than 20%. Two of the three children without adult supervision at the time of burn event had BSAB ≥ 20%. Overall, 59% of the patients had 20% + BSAB. Females (aOR = 1.25; 95% CI = 0.43–3.62, those burned in rural towns and villages (aOR = 2.29; 95% CI = 0.69–7.57, or burned by fire or flames (aOR = 1.47; 95% CI = 0.51–4.23 had increased odds of having a BSAB ≥ 20%, although these differences were not statistically significant. Children 0–5 years or 5–18 years (aOR = 0.04, 95% CI = 0.01–0.17; aOR = 0.07, 95% CI = 0.02–0.23, respectively were less likely to have BSAB ≥ 20% than adults. Those burned in a

  5. Checklist and Decision Support in Nutritional Care for Burned Patients

    Science.gov (United States)

    2016-10-01

    able to construct a checklist of a clinical and physiologic model and then a computerised decision support system that will perform two functions: the...the provision of nutritional therapy, and assessment of use by nursing and physician staff KEYWORDS Nutrition, severe burn, decision support... clinical testing. Checklist and Decision Support in Nutritional Care for Burned Patients Proposal Number: 12340011 W81XWH-12-2-0074 PI: Steven E

  6. Photoacoustic discrimination of viable and thermally coagulated blood using a two-wavelength method for burn injury monitoring

    International Nuclear Information System (INIS)

    Talbert, Robert J; Holan, Scott H; Viator, John A

    2007-01-01

    Discriminating viable from thermally coagulated blood in a burn wound can be used to profile burn depth, thus aiding the removal of necrotic tissue. In this study, we used a two-wavelength photoacoustic imaging method to discriminate coagulated and non-coagulated blood in a dermal burn phantom. Differences in the optical absorption spectra of coagulated and non-coagulated blood produce different values of the ratio of peak photoacoustic amplitude at 543 and 633 nm. The absorption values obtained from spectroscopic measurements indicate that the ratio of photoacoustic pressure for 543 and 633 nm for non-coagulated blood was 15.7:1 and 1.6:1 for coagulated blood. Using planar blood layers, we found the photoacoustic ratios to be 13.5:1 and 1.6:1, respectively. Using the differences in the ratios of coagulated and non-coagulated blood, we propose a scheme using statistical classification analysis to identify the different blood samples. Based upon these distinctly different ratios, we identified the planar blood samples with an error rate of 0%. Using a burn phantom with cylindrical vessels containing coagulated and non-coagulated blood, we achieved an error rate of 11.4%. These results have shown that photoacoustic imaging could prove to be a valuable tool in the diagnosis of burns

  7. 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.

  8. Persistent candidemia in major burn patients: radiologic findings of the thorax

    International Nuclear Information System (INIS)

    Lee, Eil Seong; Lee, Kwan Seop; Kang, Ik Won

    1997-01-01

    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

  9. Predictors of serious bacterial infections in pediatric burn patients with fever.

    Science.gov (United States)

    Vyles, David; Sinha, Madhumita; Rosenberg, David I; Foster, Kevin N; Tran, Melissa; Drachman, David

    2014-01-01

    To determine predictors of serious bacterial infections in pediatric burn patients with fever (core temp ≥38.5°C), the authors conducted a retrospective review of medical records of pediatric (0-18 years) patients admitted to the Arizona Burn Center between 2008 and 2011 with greater than 5% TBSA and inpatient hospitalization for ≥72 hours. The study group comprised patients with a febrile episode during their inpatient stay. Serious bacterial infection (the primary outcome variable) was defined as: bacteremia, urinary tract infection, meningitis (blood, urine, or cerebrospinal fluid culture positive for a pathogen respectively), pneumonia, line, and wound infection. A generalized estimating equation analysis was done to predict the presence or absence of serious bacterial infection. Of 1082 pediatric burn patients hospitalized during the study period, 353 met the study eligibility criteria. A total of 108 patients (30.6%) had at least one fever episode (fever group). No difference in demographic characteristics was noted between the fever and no-fever groups; significant differences were observed for: third-degree TBSA, second-degree TBSA, total operating room visits, length of stay, Injury Severity Score, and death. A total of 47.2% of the patients had one or more episodes of fever with serious bacterial infection. In a generalized estimating equation predictive model, presence of a central line, second-, and third-degree TBSA were predictive of serious bacterial infection in burn patients with fever. In this study, individual clinical variables such as tachypnea and tachycardia were not predictive of serious bacterial infections, but the presence of a central line, and larger TBSA were significant predictors of serious bacterial infections. Younger age (P =.08) and ventilator support (P =.057) also approached significance as predictors of serious bacterial infections.

  10. Trauma mechanisms and injury patterns in pediatric burn patients.

    Science.gov (United States)

    Moehrlen, Theres; Szucs, Thomas; Landolt, Markus A; Meuli, Martin; Schiestl, Clemens; Moehrlen, Ueli

    2018-03-01

    The objective of this study was to evaluate the frequency, severity, exact patterns and mechanisms of burn injuries in children. The patient records of children with acute burns admitted to the University Children's Hospital of Zurich were retrospectively reviewed over an 11year period. The age group with the highest risk, were children under the age of five (69%). Boys were overrepresented in all age groups, but the gender imbalance increased with age. Infants and toddlers were mainly injured by scalds and contact burns. Conversely, almost three quarters of injuries over the age of 9 were caused by flame. The majority of scald injuries was a result of pulling down hot liquids. The typical distribution of this accident scenario involved mainly the face, trunk and arms. More than half of all flame injuries occurred due to fire accelerants. 55% of children were passively involved while other children throwing flammable substances into a fire. Most of these injuries involved the face and arms. This study shows that burn etiology is age dependent. Additionally, our results demonstrate the diversity of burn accidents and their resulting injuries. These findings may help better specify target groups and subjects for prevention. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  11. Protocol for a systematic review of quantitative burn wound microbiology in the management of burns patients.

    Science.gov (United States)

    Kwei, Johnny; Halstead, Fenella D; Dretzke, Janine; Oppenheim, Beryl A; Moiemen, Naiem S

    2015-11-06

    Sepsis from burn injuries can result from colonisation of burn wounds, especially in large surface area burns. Reducing bacterial infection will reduce morbidity and mortality, and mortality for severe burns can be as high as 15 %. There are various quantitative and semi-quantitative techniques to monitor bacterial load on wounds. In the UK, burn wounds are typically monitored for the presence or absence of bacteria through the collection and culture of swabs, but no absolute count is obtained. Quantitative burn wound culture provides a measure of bacterial count and is gaining increased popularity in some countries. It is however more resource intensive, and evidence for its utility appears to be inconsistent. This systematic review therefore aims to assess the evidence on the utility and reliability of different quantitative microbiology techniques in terms of diagnosing or predicting clinical outcomes. Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Bibliographic databases and ongoing trial registers will be searched and conference abstracts screened. Studies will be eligible if they are prospective studies or systematic reviews of burn patients (any age) for whom quantitative microbiology has been performed, whether it is compared to another method. Quality assessment will be based on quality assessment tools for diagnostic and prognostic studies and tailored to the review as necessary. Synthesis is likely to be primarily narrative, but meta-analysis may be considered where clinical and methodological homogeneity exists. Given the increasing use of quantitative methods, this is a timely systematic review, which will attempt to clarify the evidence base. As far as the authors are aware, it will be the first to address this topic. PROSPERO, CRD42015023903.

  12. Gap analysis of pharmacokinetics and pharmacodynamics in burn patients: a review.

    Science.gov (United States)

    Steele, Amanda N; Grimsrud, Kristin N; Sen, Soman; Palmieri, Tina L; Greenhalgh, David G; Tran, Nam K

    2015-01-01

    Severe burn injury results in a multifaceted physiological response that significantly alters drug pharmacokinetics and pharmacodynamics (PK/PD). This response includes hypovolemia, increased vascular permeability, increased interstitial hydrostatic pressure, vasodilation, and hypermetabolism. These physiologic alterations impact drug distribution and excretion-thus varying the drug therapeutic effect on the body or microorganism. To this end, in order to optimize critical care for the burn population it is essential to understand how burn injury alters PK/PD parameters. The purpose of this article is to describe the relationship between burn injury and drug PK/PD. We conducted a literature review via PubMed and Google to identify burn-related PK/PD studies. Search parameters included "pharmacokinetics," "pharmacodynamics," and "burns." Based on our search parameters, we located 38 articles that studied PK/PD parameters specifically in burns. Twenty-seven articles investigated PK/PD of antibiotics, 10 assessed analgesics and sedatives, and one article researched an antacid. Out of the 37 articles, there were 19 different software programs used and eight different control groups. The mechanisms behind alterations in PK/PD in burns remain poorly understood. Dosing techniques must be adapted based on burn injury-related changes in PK/PD parameters in order to ensure drug efficacy. Although several PK/PD studies have been undertaken in the burn population, there is wide variation in the analytical techniques, software, and study sample sizes used. In order to refine dosing techniques in burns and consequently improve patient outcomes, there must be harmonization among PK/PD analyses.

  13. Perioperative fasting in burn patients: Are we doing it right?

    African Journals Online (AJOL)

    alimentation are vital in burn patients if we hope to decrease the stress response, prevent bacterial ... time increases the risk of aspiration and there are a number of reviews that show ... Stress factors was calculated. For paediatric patients, an ...

  14. Epidemiology of pediatric burns and future prevention strategies-a study of 475 patients from a high-volume burn center in North India.

    Science.gov (United States)

    Dhopte, Amol; Tiwari, V K; Patel, Pankaj; Bamal, Rahul

    2017-01-01

    Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

  15. [Advances in the research of zinc deficiency and zinc supplementation treatment in patients with severe burns].

    Science.gov (United States)

    Wang, X X; Zhang, M J; Li, X B

    2018-01-20

    Zinc is one of the essential trace elements in human body, which plays an important role in regulating acute inflammatory response, glucose metabolism, anti-oxidation, immune and gastrointestinal function of patients with severe burns. Patients with severe burns may suffer from zinc deficiency because of insufficient amount of zinc intake from the diet and a large amount of zinc lose through wounds and urine. Zinc deficiency may affect their wound healing process and prognosis. This article reviews the characteristics of zinc metabolism in patients with severe burns through dynamic monitoring the plasma and urinary concentration of zinc. An adequate dosage of zinc supplemented to patients with severe burns by an appropriate method can increase the level of zinc in plasma and skin tissue and improve wound healing, as well as reduce the infection rates and mortality. At the same time, it is important to observe the symptoms and signs of nausea, dizziness, leukopenia and arrhythmia in patients with severe burns after supplementing excessive zinc.

  16. Thermal injuries associated with MRI

    International Nuclear Information System (INIS)

    Dempsey, Mary F.; Condon, Barrie

    2001-01-01

    Most physicians are aware of the absolute contraindications to magnetic resonance imaging (MRI). However, less familiar is the potential for an MRI-induced thermal or electrical burn associated with electrical monitoring devices. Although detailed studies concerning the burn hazard in MRI have not been reported, it is widely believed that direct electromagnetic induction in looped cables associated with the patient is responsible for the excessive heating and it is on this theory that present guidelines are based. Recent reports have however indicated that other mechanisms may cause the heating of metal, either in or on the patient. This document reviews numerous reported burn injuries sustained during MRI and addresses the underlying heating mechanisms possibly causing these events. Dempsey, M.F. and Condon, B. (2001)

  17. Satisfaction with life after burn: A Burn Model System National Database Study.

    Science.gov (United States)

    Goverman, J; Mathews, K; Nadler, D; Henderson, E; McMullen, K; Herndon, D; Meyer, W; Fauerbach, J A; Wiechman, S; Carrougher, G; Ryan, C M; Schneider, J C

    2016-08-01

    While mortality rates after burn are low, physical and psychosocial impairments are common. Clinical research is focusing on reducing morbidity and optimizing quality of life. This study examines self-reported Satisfaction With Life Scale scores in a longitudinal, multicenter cohort of survivors of major burns. Risk factors associated with Satisfaction With Life Scale scores are identified. Data from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Model System (BMS) database for burn survivors greater than 9 years of age, from 1994 to 2014, were analyzed. Demographic and medical data were collected on each subject. The primary outcome measures were the individual items and total Satisfaction With Life Scale (SWLS) scores at time of hospital discharge (pre-burn recall period) and 6, 12, and 24 months after burn. The SWLS is a validated 5-item instrument with items rated on a 1-7 Likert scale. The differences in scores over time were determined and scores for burn survivors were also compared to a non-burn, healthy population. Step-wise regression analysis was performed to determine predictors of SWLS scores at different time intervals. The SWLS was completed at time of discharge (1129 patients), 6 months after burn (1231 patients), 12 months after burn (1123 patients), and 24 months after burn (959 patients). There were no statistically significant differences between these groups in terms of medical or injury demographics. The majority of the population was Caucasian (62.9%) and male (72.6%), with a mean TBSA burned of 22.3%. Mean total SWLS scores for burn survivors were unchanged and significantly below that of a non-burn population at all examined time points after burn. Although the mean SWLS score was unchanged over time, a large number of subjects demonstrated improvement or decrement of at least one SWLS category. Gender, TBSA burned, LOS, and school status were associated with SWLS scores at 6 months

  18. Prevalence and Predictors of Sjögren's Syndrome in Patients with Burning Mouth Symptoms.

    Science.gov (United States)

    Lee, Young Chan; Song, Ran; Yang, You-Jung; Eun, Young-Gyu

    To investigate the prevalence and predictive factors of Sjögren's syndrome (SS) in a cohort of patients with burning mouth symptoms. A total of 125 patients with burning mouth symptoms were enrolled in a prospective study and assessed for the presence of SS. The severity of oral symptoms was evaluated by using questionnaires. Salivary flow rates and salivary scintigraphy were used to evaluate salivary function. Patient laboratory work-ups were reviewed, and SS was diagnosed by a rheumatologist based on the American-European Consensus Group criteria. The differences between the SS patient group and the non-SS patient group were analyzed with chi-square test or t test. A total of 12 of the 125 enrolled patients (9.5%) had a positive autoimmune antibody test, and 6 (4.8% of the entire cohort) had SS (4 [3.2%] primary and 2 [1.6%] secondary). Patients with SS exhibited significantly decreased hemoglobin levels, an increased erythrocyte sedimentation rate, and an increased prevalence of autoantibody positive results compared to non-SS patients. Salivary scintigraphy showed that the uptake ratio of the submandibular gland in SS patients was decreased significantly. The prevalence of SS in patients with burning mouth symptoms was 4.8%. Therefore, clinicians who treat patients with burning mouth symptoms should evaluate laboratory findings and salivary functions to identify patients with SS.

  19. Burn-up calculation of different thorium-based fuel matrixes in a thermal research reactor using MCNPX 2.6 code

    Directory of Open Access Journals (Sweden)

    Gholamzadeh Zohreh

    2014-12-01

    Full Text Available Decrease of the economically accessible uranium resources and the inherent proliferation resistance of thorium fuel motivate its application in nuclear power systems. Estimation of the nuclear reactor’s neutronic parameters during different operational situations is of key importance for the safe operation of nuclear reactors. In the present research, thorium oxide fuel burn-up calculations for a demonstrative model of a heavy water- -cooled reactor have been performed using MCNPX 2.6 code. Neutronic parameters for three different thorium fuel matrices loaded separately in the modelled thermal core have been investigated. 233U, 235U and 239Pu isotopes have been used as fissile element in the thorium oxide fuel, separately. Burn-up of three different fuels has been calculated at 1 MW constant power. 135X and 149Sm concentration variations have been studied in the modelled core during 165 days burn-up. Burn-up of thorium oxide enriched with 233U resulted in the least 149Sm and 135Xe productions and net fissile production of 233U after 165 days. The negative fuel, coolant and void reactivity of the used fuel assures safe operation of the modelled thermal core containing (233U-Th O2 matrix. Furthermore, utilisation of thorium breeder fuel demonstrates several advantages, such as good neutronic economy, 233U production and less production of long-lived α emitter high radiotoxic wastes in biological internal exposure point of view

  20. Wound healing trajectories in burn patients and their impact on mortality.

    Science.gov (United States)

    Nitzschke, Stephanie L; Aden, James K; Serio-Melvin, Maria L; Shingleton, Sarah K; Chung, Kevin K; Waters, J A; King, Booker T; Burns, Christopher J; Lundy, Jonathan B; Salinas, José; Wolf, Steven E; Cancio, Leopoldo C

    2014-01-01

    The rate of wound healing and its effect on mortality has not been well described. The objective of this article is to report wound healing trajectories in burn patients and analyze their effects on in-hospital mortality. The authors used software (WoundFlow) to depict burn wounds, surgical results, and healing progression at multiple time points throughout admission. Data for all patients admitted to the intensive care unit with ≥ 20% TBSA burned were collected retrospectively. The open wound size (OWS), which includes both unhealed burns and unhealed donor sites, was measured. We calculated the rate of wound closure (healing rate), which we defined as the change in OWS/time. We also determined the time delay (DAYS) from day of burn until day on which there was a reduction in OWS healing (H), and 13 did not (NH). H differed from NH on age (38 years [32-57] vs 63 [51-74]), body mass index (27 [21-28] vs 32 [19-52]), 24-hour fluid resuscitation (12 L [10-16] vs 18 [15-20]), pressors during first 48 hours (72% vs 100%), use of renal replacement therapy (32% vs 92%), and mortality (4% vs 100%). Repeated measures analysis of covariance showed a significant difference between survivors and nonsurvivors on OWS as a function of time (Phealing rate (+2%/day) after postburn day 20 had 100% survival whereas those with a negative healing rate (-2%/day) had 100% mortality. For H patients, median DAYS was 41 (28-54); median DAYS/TBSA was 1.3 (1.0-1.9). Survivors had a 0.62% drop in OWS/day, or 4.3%/week. In this cohort of patients with ≥ 20% TBSA, there was a difference in mortality after postburn day 20, between patients with a positive healing rate (+2%/day, 100% survival) and those with a negative healing rate (-2%/day, 100% mortality, P < .05).

  1. 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...

  2. Burns education for non-burn specialist clinicians in Western Australia.

    Science.gov (United States)

    McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

    2015-03-01

    Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  3. What should be the antibiotic prescription protocol for burn patients admitted in the department of burns, plastic and reconstructive surgery.

    Science.gov (United States)

    Mir, Mohd Altaf; Khurram, Mohammad Fahud; Khan, Arshad Hafiz

    2017-02-01

    This is a prospective study with the aim to determine specific patterns of burn wound bacterial colonisation and antimicrobial resistance profiles. There is a high incidence of infections and septicaemia in post-burn patients, which, in turn, are associated with high morbidity and mortality, a fact that compelled us to undertake this study. The study was conducted over a period 11 months, from 1 August 2014 to 30 June 2015, in 50 burn patients admitted in our burn unit. Wound cultures were taken after 72 hours of admission from all the patients, and then, empirical systemic antibiotics were administered. For wound cultures; 1 cubic cm tissue was taken and placed in aerobic and anaerobic culture vials and transported to the microbiology lab under all aseptic precautions as soon as possible. At the time of fever any time after 72 hours of admission, 16 ml of blood was drawn under all aseptic precautions. Both aerobic and anaerobic blood culture vials were filled with 8 ml of blood each and transported to the microbiology lab. The results of culture and sensitivity reports of 50 patients were recorded. The data obtained was analysed using appropriate statistical analytical tests. The most common organism responsible for bacteraemia is Pseudomonas (43%). Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital; Pseudomonas was found 100% resistant to a combination of ampicillin + sulbactum, ceftriaxone and was most often sensitive to imipenem, amikacin and vancomycin. Methicillin-resistant Staphylococcus aureus (MRSA) was also found resistant to commonly used antibiotics like ceftriaxone, ampicillin + sulbactum and ceftazidime + calvulanic acid. Linzolid and vancomycin were effective in 83% and 100% cases, respectively. We conclude that similar institution-specific studies should be conducted, and such studies will be helpful in providing useful guidelines for choosing effective empirical therapy that will have a great

  4. The Changing Epidemiology of Infection in Burn Patients,

    Science.gov (United States)

    1992-01-01

    immunosupresores sistdmicos 13. Bruck, H.M., Nash, G.. Foley, F.D., Pruitt, B.A. Jr.: Opportunis- de l leidntdrica ainfccin semanien coo l casa n~s...in burn patients. J. tablecimiento de gdrmenes resistentes recientemente introduc- Trauma 16:824, 1976 idos, en diignosticar.lawifecci6n enkforma

  5. Assessment of anxiety and depression in patients with burning mouth syndrome: A clinical trial

    Science.gov (United States)

    Malik, Rohit; Goel, Sumit; Misra, Deepankar; Panjwani, Sapna; Misra, Akansha

    2012-01-01

    Introduction: Burning mouth syndrome is a chronic pain syndrome primarily affecting elderly women with hormonal changes or psychological disorders. It is multifactorial in origin, often idiopathic and its etiopathogenesis, majorly being neuropathic, largely remains enigmatic. Aim: To determine the prevalence of burning mouth symptom, in elderly women and evaluate local and systemic causes responsible for burning sensation. Materials and Methods: 100 elderly postmenopausal women were included in the study out of which 56 had a chief complaint of burning sensation. These patients were evaluated for the levels of anxiety and depression by means of questionnaire. The severity of burning and the response to the treatment was assessed with a five point Visual Analog Scale. The results were analyzed using “Chi-square test”. Results: There was statistically significant increase in the levels of anxiety and depression in the study group. Conclusion: The present study clearly indicates that most of the patients had moderate to severe levels of depression, which suggests that anxiety and depression are constant features in postmenopausal female patients. PMID:22923978

  6. Investigating the depth of thermal burns in elephants

    Directory of Open Access Journals (Sweden)

    A. Shakespeare

    2006-06-01

    Full Text Available Histological examination of burn injuries in elephants revealed that the depth was not as severe as expected from clinical observation. Although the actual burn depth was deep, the thickness of elephant skin, especially the dermis, resulted in the lesions being classified as less severe than expected. Examination of skin samples from selected areas showed that most lesions were either superficial (1st degree or superficial partial-thickness (superficial 2nd degree burns with the occasional deep partial thickness (deep 2nd degree wound. These lesions however, resulted in severe complications that eventually led to the death of a number of the elephants.

  7. ESTIMATION OF THE EFFECTIVENESS OF DECASAN, DECAMETHOXIN AND ITS COMPOSITION USAGE IN PATIENTS WITH SEVERE THERMAL INJURY

    Directory of Open Access Journals (Sweden)

    Nazarchuk O.А.

    2015-05-01

    -positive and Gram-negative pathogens of purulentinflammatory complications in patients with severe thermal injury to antiseptics (decasan, miramistin, chlorhexidine and antimicrobial composition of decamethoxin (AMC presented advantages of antimicrobial activity of decasan, AMC against S. aureus, S. epidermidis, Enterococcus spp., P. aeruginosa, A. baumannii, Proteus spp., Enterobacter spp., K. pneumoniae, E. coli, C. аlbicans in comparison with miramistin (<0,001, chlorhexidine digluconate (<0,001. Antimicrobial qualities of antimicrobial gauze, impregnated with AMC, against S. аureus (32,4±0,5 mm, E. coli (26,4±0,3 mm, P. aeruginosa (20,8±0,34 mm were higher than in textile materials containing chlorhexidine. Clinical effectiveness of the use of materials, impregnated with AMC, for prophylaxis and treatment of purulentinflammatory complications in patients with severe thermal injury was proved. Microbial load of P. aeruginosa in wounds, where gauze with AMC was used, decreased from 7,1 x 107 CFU/ml (before treatment to 2,9 x 105 CFU/ml (7th day. In control group P. aeruginosa colonized wounds 1 x 108 CFU/ml (before treatment, and 3,2 x 107 CFU/ml (7th day. The same tendency was found for A. baumannii. Conclusions. Modern antiseptics decasan and AMC have high antimicrobial qualities against Gram-positive (S. aureus, S. epidermidis, Enterococcus spp., Gram-negative (P. aeruginosa, A. baumannii, Proteus spp., E. coli, K. pneumoniae bacteria and C. albicans which cause purulent-inflammatory complications in patients with difficult burn injury. AMC of decamethoxin demonstrate higher antimicrobial effect against S. aureus, A. baumannii, P. aeruginosa, Proteus spp., E. coli in comparison with miramistin, chlorhexidine digluconate (р<0,001. AMC using for impregnation of gauze and its use in patients with burns provide high clinical effectiveness in wound infection prophylaxis.

  8. Survival after burn in a sub-Saharan burn unit: Challenges and opportunities

    Science.gov (United States)

    Tyson, Anna F.; Boschini, Laura P.; Kiser, Michelle M.; Samuel, Jonathan C.; Mjuweni, Steven N.; Cairns, Bruce A.; Charles, Anthony G.

    2013-01-01

    Background Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. Methods This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. Results A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age—17% for 0–18 year olds, 24% for 19–60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0–18 years old, 79% in patients 19–60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Discussion Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved

  9. Survival function and protein malnutrition in burns patients at a rural hospital in Africa.

    Science.gov (United States)

    Kingu, H J; Longo-Mbenza, Benjamin; Dhaffala, A; Mazwai, E L

    2011-07-01

    The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients' demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox's proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan-Meier survival curves were generated for each arm of exposure status. In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8±12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n=42): 46.3% (n=31) at admission and 15.7% (n=11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n=11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn>40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7-63; P<0.01] and affected anterior trunk (HR 4.4, 95% CI 1.3-14.7; P=0.018). Urgent prevention strategies of burns and evidence-based practice with early nutritional supplementation are needed to reduce high rates of malnutrition and mortality.

  10. Hemodynamic responses to dexmedetomidine in critically injured intubated pediatric burned patients: a preliminary study.

    Science.gov (United States)

    Shank, Erik S; Sheridan, Robert L; Ryan, Colleen M; Keaney, Timothy J; Martyn, J A Jeevendra

    2013-01-01

    Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. After baseline measurements of mean arterial blood pressure and heart rhythm were taken, each patient received a 1.0 µg/kg bolus of Dex followed by an ascending dose infusion protocol (0.7-2.5 µg/kg/hr), with each dose administered for 15 minutes. There was significant hypotension (27±7.5%, average drop in mean arterial pressure [MAP] ± SD), and a decrease in heart rate (HR; 19% ± 7, average drop in HR ± SD). The average HR decreased from 146 beats per minute to 120. No bradycardia (HR patients, the MAP decreased to patients, three patients completed the study receiving the highest infusion dose of Dex (2.5 µg/kg/hr), whereas in 2 patients the infusion part of the study was begun, but the study was stopped due to persistent hypotension (MAP burn patients.

  11. The past 25 years of pediatric burn treatment in Graz and important lessons been learned. An overview.

    Science.gov (United States)

    Trop, Marija; Herzog, Sereina A; Pfurtscheller, Klaus; Hoebenreich, Angelika M; Schintler, Michael V; Stockenhuber, Andrea; Kamolz, Lars-Peter

    2015-06-01

    The aim of this study was to characterize the epidemiology of pediatric and adolescent burns admitted to the Children's Burns Unit at the Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria, between January 1st 1988 and December 31st 2012. This is a retrospective review over the past 25-years and describes admission rate by gender and age groups, causes of burns, anatomical sites of burns, extent and depth of injury, length of hospital stay, child abuse and in-hospital mortality. In the studied 25 year-period, 1586 pediatric burn patients were admitted. 1451 patients were "acute" admissions, 64 "secondary" admissions and 71 patients did not fulfill the inclusion criteria. Of the 1451 patients, 930 (64%) were male and 521 (36%) female. The majority of patients - 880 or 60.6% - were children from 1 to 5 years of age. Domestic burns occurring at home resulted in 1164 (80.2%) of injuries and scalds were the most common type of thermal trauma with 945 (65.1%) patients. According to the extent of injury 1106 (76.2%) patients suffered burns of burn care over a long time period, at a single center, including children and adolescents, with stable surgical and rehabilitation staff. The data is also important for the design of prevention programs and establishment of burn care capacities, since the analysis showed no change in the incidence of burn related admissions over the time period studied. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  12. Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients.

    Science.gov (United States)

    Jibeen, Tahira; Mahfooz, Musferah; Fatima, Shamem

    2017-08-30

    The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.

  13. Importance of risk factors in the development of complications of infectious and inflammatory genesis in patients with severe burns

    Directory of Open Access Journals (Sweden)

    B. V. Guzenko

    2013-06-01

    Full Text Available Introduction. Infectious and inflammatory complications , such as pneumonia and burn sepsis, often develop in patients with extensive burns, thus causing high mortality. The aim of the work was to determine the risk factors for the development of infectious and inflammatory complications in patients with burns. Materials and methods. The study involved 140 burned patients divided into two groups: Group 1 – 78 patients who underwent necrectomy within 3-7 days after the burn, Group 2 (control – 62 patients with necrectomy performed in later period. Results of the research. In the 1st group pneumonia was diagnosed in 11 (14.10 ± 3.94% patients, sepsis – in 13 (16.67 ± 4.22%. In the control group pneumonia was diagnosed in 20 (32.26 ± 5.94% patients, sepsis – in 23 (37.10 ± 6.13% (p < 0.05. In the burned patients of the main group the development of infectious and inflammatory complications was observed mainly in patients over 45 years of age (43%, that is 2.9 times more often than in the patients of younger age (p < 0.05. In patients with the severity index of burn damage exceeding 90 units complications were diagnosed in 32.14 ± 6.24% of cases, which is 7 times more than in the other subgroup (p < 0.05. In the control group patients with the severity index of destruction exceeding 90 units had complications in 56.41 ± 7.94% of cases, which is 2.6 times more than in patients with less severity index (p = 0.004. If the total area of the skin burns was over 40%, the number of sepsis and pneumonia complications significantly increased in both groups, and was 1.7 times greater than in patients with a smaller area of the burn. If the area of deep skin burns was over 25%, the number of cases of pneumonia and sepsis in patients of the main group increased in 2.4 times, and in the control group it was in 1.6 times higher. Among patients with area of deep burns exceeding 40% the incidence of sepsis and pneumonia was 78% (p = 0.03 in the main

  14. A systematic review of patient reported outcome measures (PROMs) used in child and adolescent burn research.

    Science.gov (United States)

    Griffiths, C; Armstrong-James, L; White, P; Rumsey, N; Pleat, J; Harcourt, D

    2015-03-01

    Patient reported outcome measures (PROMs) can identify important information about patient needs and therapeutic progress. The aim of this review was to identify the PROMs that are being used in child and adolescent burn care and to determine the quality of such scales. Computerised and manual bibliographic searches of Medline, Social Sciences Index, Cinahl, Psychinfo, Psycharticles, AMED, and HAPI, were used to identify English-language articles using English-language PROMs from January 2001 to March 2013. The psychometric quality of the PROMs was assessed. 23 studies met the entry criteria and identified 32 different PROMs (31 generic, 1 burns-specific). Overall, the psychometric quality of the PROMs was low; only two generic scales (the Perceived Stigmatisation Questionnaire and the Social Comfort Scale) and only one burns-specific scale (the Children Burn Outcomes Questionnaire for children aged 5-18) had psychometric evidence relevant to this population. The majority of PROMs did not have psychometric evidence for their use with child or adolescent burn patients. To appropriately identify the needs and treatment progress of child and adolescent burn patients, new burns-specific PROMs need to be developed and validated to reflect issues that are of importance to this population. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  15. [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.

  16. All-Russia Thermal Engineering Institute experience in using difficult to burn fuels in the power industry

    Science.gov (United States)

    Tugov, A. N.; Ryabov, G. A.; Shtegman, A. V.; Ryzhii, I. A.; Litun, D. S.

    2016-07-01

    This article presents the results of the research carried out at the All-Russia Thermal Engineering Institute (VTI) aimed at using saline coal, municipal solid waste and bark waste, sunflower husk, and nesting/ manure materials from poultry farms. The results of saline coal burning experience in Troitsk and Verkhny Tagil thermal power plants (TPP) show that when switching the boiler to this coal, it is necessary to take into account its operating reliability and environmental safety. Due to increased chlorine content in saline coal, the concentration of hydrogen chloride can make over 500 mg/m3. That this very fact causes the sharp increase of acidity in sludge and the resulting damage of hydraulic ash removal system equipment at these power stations has been proven. High concentration of HCl can trigger damage of the steam superheater due to high-temperature corrosion and result in a danger of low-temperature corrosion of air heating surfaces. Besides, increased HCl emissions worsen the environmental characteristics of the boiler operation on the whole. The data on waste-to-energy research for municipal solid waste (MSW) has been generalized. Based on the results of mastering various technologies of MSW thermal processing at special plants nos. 2 and 4 in Moscow, as well as laboratory, bench, and industrial studies, the principal technical solutions to be implemented in the modern domestic thermal power plant with the installed capacity of 24 MW and MSW as the primary fuel type has been developed. The experience of the VTI in burning various kinds of organic waste—bark waste, sunflower husk, and nesting/manure materials from poultry farms—has been analyzed.

  17. Air-Freshener Burns: A New Paradigm in Burns Etiology?

    OpenAIRE

    Sarwar, Umran; Nicolaou, M.; Khan, M. S.; Tiernan, E.

    2011-01-01

    Objectives: We report a rare case of burns following the use of automated air-fresheners. Methods: We present a case report with a brief overview of the literature relating to burns associated with air-fresheners. The mechanism and treatment of these types of injuries are also described. Results: A 44 year-old female was admitted under the care of the burns team following burns secondary to an exploding air-freshener canister. The patient sustained burns to the face, thorax and arms re...

  18. Pediatric burns: Kids' Inpatient Database vs the National Burn Repository.

    Science.gov (United States)

    Soleimani, Tahereh; Evans, Tyler A; Sood, Rajiv; Hartman, Brett C; Hadad, Ivan; Tholpady, Sunil S

    2016-04-01

    Burn injuries are one of the leading causes of morbidity and mortality in young children. The Kids' Inpatient Database (KID) and National Burn Repository (NBR) are two large national databases that can be used to evaluate outcomes and help quality improvement in burn care. Differences in the design of the KID and NBR could lead to differing results affecting resultant conclusions and quality improvement programs. This study was designed to validate the use of KID for burn epidemiologic studies, as an adjunct to the NBR. Using the KID (2003, 2006, and 2009), a total of 17,300 nonelective burn patients younger than 20 y old were identified. Data from 13,828 similar patients were collected from the NBR. Outcome variables were compared between the two databases. Comparisons revealed similar patient distribution by gender, race, and burn size. Inhalation injury was more common among the NBR patients and was associated with increased mortality. The rates of respiratory failure, wound infection, cellulitis, sepsis, and urinary tract infection were higher in the KID. Multiple regression analysis adjusting for potential confounders demonstrated similar mortality rate but significantly longer length of stay for patients in the NBR. Despite differences in the design and sampling of the KID and NBR, the overall demographic and mortality results are similar. The differences in complication rate and length of stay should be explored by further studies to clarify underlying causes. Investigations into these differences should also better inform strategies to improve burn prevention and treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Extensive colonization with carbapenemase-producing microorganisms in Romanian burn patients : infectious consequences from the Colectiv fire disaster

    NARCIS (Netherlands)

    Pirii, L E; Friedrich, A W; Rossen, J W A; Vogels, W; Beerthuizen, G I J M; Nieuwenhuis, M K; Kooistra-Smid, A M D; Bathoorn, E

    Health care of severe burn patients is highly specialized and may require international patient transfer. Burn patients have an increased risk of developing infections. Patients that have been hospitalized in countries where carbapenemase-producing microorganisms (CPMO) are endemic may develop

  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

    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. Contribution of Bacterial and Viral infections to Attributable Mortality in Patients with Severe Burns: An Autopsy Series

    Science.gov (United States)

    2010-01-01

    and related mortality following severe burns. Burns 2008;3(4):1108 12. [5] Nash G , Foley FD. Herpetic infection of the middle and lower respiratory...Albrecht M, Griffith M, Murray C, Chung K, Horvath E, Ward J, et al. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll... Mason AD. Survival benefit conferred by topical antimicrobial preparations in burn patients: a historical perspective. J Trauma 2004;56:863 6. [27

  2. Efficacy of topical honey therapy against silver sulphadiazine treatment in burns: A biochemical study

    OpenAIRE

    Nagane, N. S.; Ganu, J. V.; Bhagwat, V. R.; Subramanium, M.

    2004-01-01

    Thermal injury is associated with biochemical changes. The present study was undertaken to investigate relation of oxidative free radical generation and related biochemical parameters in burn trauma. The specific aim was to compare the levels of serum lipid peroxide, Ceruloplasmin and Uric Acid in burn patients during treatment with Silver Sulfadiazine Cream and honey therapy. It is a single blind prospective controlled study involving comparison of biochemical changes after treatment with si...

  3. Surgical treatment and management of the severely burn patient: Review and update.

    Science.gov (United States)

    Gacto-Sanchez, P

    Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed by initial aggressive surgical debridement. Many surgical options for covering the wound bed have been described, although split-thickness skin grafts remain the standard for the rapid and permanent closure of full-thickness burns. Significant advances made in the past decades have greatly improved burns patient care, as such that major future improvements in survival rates seem to be more difficult. Research into stem cells, grafting, biomarkers, inflammation control, and rehabilitation will continue to improve individualized care and create new treatment options for these patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  4. Aquacel(®) Ag dressing versus Acticoat™ dressing in partial thickness burns: a prospective, randomized, controlled study in 100 patients. Part 1: burn wound healing.

    Science.gov (United States)

    Verbelen, Jozef; Hoeksema, Henk; Heyneman, Alexander; Pirayesh, Ali; Monstrey, Stan

    2014-05-01

    Studies comparing contemporary silver dressings in burns are scarce. In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel(®) Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience. Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel(®) Ag dressing was found for average ease of use (p<0.001), average ease of application (p=0.001), patient pain (p<0.001), patient comfort with the dressing (p=0.017), silver staining (p<0.001), and cost effectiveness (p<0.001). Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  5. Acute kidney injury in critically burned patients resuscitated with a protocol that includes low doses of Hydroxyethyl Starch.

    Science.gov (United States)

    Sánchez-Sánchez, M; Garcia-de-Lorenzo, A; Cachafeiro, L; Herrero, E; Asensio, M J; Agrifoglio, A; Flores, E; Estebanez, B; Extremera, P; Iglesias, C; Martinez, J R

    2016-09-30

    Acute kidney injury (AKI) is an important complication in burn patients. Recently, it has been recommended that hydroxyethyl starch (HES) be avoided in burn patients because it increases the incidence of AKI. Our purpose was to study incidence of AKI in critically ill burn patients resuscitated with Ringer's solution and supplements of HES. We conducted an observational study of 165 patients admitted to the critical care burn unit (with 30 ± 15% TBSA burned). The main outcome measures were incidence of AKI, contributions of colloids and crystalloids, various severity scores, comorbidities, complications and mortality. According to the RIFLE criteria, 10 (6.1%) patients presented with Risk, 11 (6.7%) presented with Injury and 11 (6.7%) presented with Failure. According to the AKIN criteria, 9.7% presented stage I, 3% stage II and 10.3% stage III. Replacement therapy (RRT) was performed in 15 patients (9.1%), but in 6 of them RRT was employed in the final stages of multi-organ failure. The incidence of AKI in severe burn patients is high according to the RIFLE or AKIN criteria and these patients experience more complications and higher mortality. Our study suggests that the use of HES in low doses in the burn resuscitation phase does not cause more AKI than resuscitation without HES, but further evaluation is required. Further studies should be conducted.

  6. Evaluation of Amniotic Membrane Effectiveness in Skin Graft Donor Site Dressing in Burn Patients.

    Science.gov (United States)

    Salehi, Seyed Hamid; As'adi, Kamran; Mousavi, Seyed Jaber; Shoar, Saeed

    2015-12-01

    Although the recipient site in burn wounds is dressed with universally accepted materials, the ideal management of split-thickness skin donor sites remains controversial. The aim of our study is to compare two methods of wound dressing in donor sites of split-thickness skin graft in patients undergoing burn wound reconstructive surgery. Forty-two consecutive patients with second- and third-degree burns with a total body surface area between 20 and 40 % were enrolled in this randomized clinical trial conducted in Motahari Burn Hospital in Tehran, Iran. In each patient, two anatomic areas with similar features were randomly selected as intervention and control donor sites. The intervention site was dressed with amniotic membrane, whereas the control site was treated with Vaseline-impregnated gauze. Wounds were examined daily by expert surgeons to measure the clinical outcomes including duration of healing, severity of pain, and infection rate. The mean ± SD age of patients was 31.17 ± 13.72 years; furthermore, burn percentage had a mean ± SD of 31.19 ± 10.56. The mean ± SD of patients' cooperation score was 1.6 ± 0.79 in the intervention group compared with 2.93 ± 0.71 in the control group, revealing a statistically significant difference (P  0.05). Amniotic membrane as an alternative for dressing of skin graft donor sites provides significant benefits by increasing patients' comfort via diminishing the number of dressing changes and facilitating the process of wound healing.

  7. The effect of ethyl pyruvate on oxidative stress in intestine and bacterial translocation after thermal injury.

    Science.gov (United States)

    Karabeyoğlu, Melih; Unal, Bülent; Bozkurt, Betül; Dolapçi, Iştar; Bilgihan, Ayşe; Karabeyoğlu, Işil; Cengiz, Omer

    2008-01-01

    Thermal injury causes a breakdown in the intestinal mucosal barrier due to ischemia reperfusion injury, which can induce bacterial translocation (BT), sepsis, and multiple organ failure in burn patients. The aim of this study was to investigate the effect of ethyl pyruvate (EP) on intestinal oxidant damage and BT in burn injury. Thirty-two rats were randomly divided into four groups. The sham group was exposed to 21 degrees C water and injected intraperitoneal with saline (1 mL/100 g). The sham + EP group received EP (40 mg/kg) intraperitoneally 6 h after the sham procedure. The burn group was exposed to thermal injury and given intraperitoneal saline injection (1 mL/100 g). The burn + EP group received EP (40 mg/kg) intraperitoneally 6 h after thermal injury. Twenty-four hours later, tissue samples were obtained from mesenteric lymph nodes, spleen, and liver for microbiological analysis and ileum samples were harvested for biochemical analysis. Thermal injury caused severe BT in burn group. EP supplementation decreased BT in mesenteric lymph nodes and spleen in the burn + EP group compared with the burn group (P < 0.05). Also, burn caused BT in liver, but this finding was not statistically significant among all groups. Thermal injury caused a statistically significant increase in malondialdehyde and myeloperoxidase levels, and EP prevented this effects in the burn + EP group compared with the burn group (P < 0.05). Our data suggested that EP can inhibit the BT and myeloperoxidase and malondialdehyde production in intestine following thermal injury, suggesting anti-inflammatory and anti-oxidant properties of EP.

  8. Moderate glycemic control safe in critically ill adult burn patients: A 15 year cohort study.

    Science.gov (United States)

    Stoecklin, Patricia; Delodder, Frederik; Pantet, Olivier; Berger, Mette M

    2016-02-01

    Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment. 15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre. death or length of stay burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, carbohydrate and insulin delivery/24h, arterial blood glucose and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven. 229 patients, aged 45 ± 20 years (mean ± SD), burned 32 ± 20% TBSA were analyzed. SAPSII was 35 ± 13. TBSA, Ryan and ABSI remained stable. Inhalation injury increased. A total of 28,690 blood glucose samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme hypoglycemia in period 4). Severe hyperglycemia persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and glucose deliveries decreased in periods 3 and 4 (pprotocol improved the glycemic control in adult burn patients, reducing glucose variability. Moderate glycemic control in burns was safe specifically related to hypoglycemia, reducing the incidence of hypoglycaemic events compared to the period before. Hyperglycemia persisted at a lower level. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  9. Hair bleaching and skin burning

    OpenAIRE

    Forster, K.; Lingitz, R.; Prattes, G.; Schneider, G.; Sutter, S.; Schintler, M.; Trop, M.

    2012-01-01

    Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.

  10. Patients with burning mouth sensations. A clinical investigation of causative factors in a group of "compete denture wearers" Jordanian population.

    Science.gov (United States)

    Mukatash-Nimri, Gadeer Elea; Al-Nimri, Marwan A; Al-Jadeed, Omar G; Al-Zobe, Zaid R; Aburumman, Khuzama K; Masarwa, Nader A

    2017-01-01

    To find out the prevalence of "true" burning mouth syndrome and study the association between patients' spontaneous complaints of burning mouth and systemic conditions in a group of middle age and elderly "denture wearers" patients in Jordan. A group of 129 patients (112 female and 17 male) of "complete denture wearers" subjects aged 40 years and over attended prosthetic clinic at King Hussein Medical Hospital complaining from oral burning, with no oral lesion possibly responsible for the burning sensations were selected. Assessment of oral and general status was done based on questioners, detailed history taking, medical records and extra and intraoral examination. The existed complete dentures retention, stability, jaw relationship and the free way space were evaluated. The current blood test and instrumental protocol for examination of patients with burning mouth complains were performed for each patient. Then those studied patients with burning mouth sensations including "true" burning mouth syndrome have been compared to the controls with regard to the presence of local problem, undermined local, systemic or psychological disease. The diagnosis of "true" burning mouth syndrome was established in (2.3%) of the studied population two females and one male. In most patients (58%) more than one site was affected. Significant positive associations were found between local factors (i.e., wearing complete dentures with unsatisfactory retention or jaw relationship, dry mouth or candidasis) and patients suffering from burning mouth sensation. The results also show that some systemic or psychological disorders were significantly more present among patients with burning mouth symptoms when compared to the control group ( p  burning mouth without mucosal signs should be considered as a manifestation of undermind pathology and/or distress, and the multi-factorial causes of burning mouth syndrome and sensation need to be referred to the suitable specialist for better

  11. Upper gastrointestinal bleeding in severely burned patients: a case-control study to assess risk factors, causes, and outcome.

    Science.gov (United States)

    Kim, Young Jin; Koh, Dong Hee; Park, Se Woo; Park, Sun Man; Choi, Min Ho; Jang, Hyun Joo; Kae, Sea Hyub; Lee, Jin; Byun, Hyun Woo

    2014-01-01

    To determine the risk factors, causes, and outcome of clinically important upper gastrointestinal bleeding that occurs in severely burned patients. The charts of all patients admitted to the burn intensive care unit were analyzed retrospectively over a 4-year period (from January 2006 to December 2009). Cases consisted of burned patients who developed upper gastrointestinal bleeding more than 24 hours after admission to the burn intensive care unit. Controls were a set of patients, in the burn intensive care unit, without upper gastrointestinal bleeding matched with cases for age and gender. Cases and controls were compared with respect to the risk factors of upper gastrointestinal bleeding and outcomes. During the study period, clinically important upper gastrointestinal bleeding occurred in 20 patients out of all 964 patients. The most common cause of upper gastrointestinal bleeding was duodenal ulcer (11 of 20 cases, 55%). In the multivariate analysis, mechanical ventilation (p = 0.044) and coagulopathy (p = 0.035) were found to be the independent predictors of upper gastrointestinal bleeding in severely burned patients. Upper gastrointestinal hemorrhage tends to occur more frequently after having prolonged mechanical ventilation and coagulopathy.

  12. Comparing the reported burn conditions for different severity burns in porcine models: a systematic review.

    Science.gov (United States)

    Andrews, Christine J; Cuttle, Leila

    2017-12-01

    There are many porcine burn models that create burns using different materials (e.g. metal, water) and different burn conditions (e.g. temperature and duration of exposure). This review aims to determine whether a pooled analysis of these studies can provide insight into the burn materials and conditions required to create burns of a specific severity. A systematic review of 42 porcine burn studies describing the depth of burn injury with histological evaluation is presented. Inclusion criteria included thermal burns, burns created with a novel method or material, histological evaluation within 7 days post-burn and method for depth of injury assessment specified. Conditions causing deep dermal scald burns compared to contact burns of equivalent severity were disparate, with lower temperatures and shorter durations reported for scald burns (83°C for 14 seconds) compared to contact burns (111°C for 23 seconds). A valuable archive of the different mechanisms and materials used for porcine burn models is presented to aid design and optimisation of future models. Significantly, this review demonstrates the effect of the mechanism of injury on burn severity and that caution is recommended when burn conditions established by porcine contact burn models are used by regulators to guide scald burn prevention strategies. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns

    OpenAIRE

    Nilsson, Andreas; Kalman, Sigga; Arvidsson, Anders; Sjöberg, Folke

    2011-01-01

    The aim of this study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no pain and 10 = unbearable pain), patients were asked to estimate their acceptable and worst experienced pain by specifying a number on a scale and at what point they would like addi...

  14. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries.

    Science.gov (United States)

    Hill, David M; Sinclair, Scott E; Hickerson, William L

    2017-07-01

    Caring for patients with burn injuries is challenging secondary to the acute disease process, chronic comorbidities, and underrepresentation in evidence-based literature. Much current practice relies on extrapolation of guidance from different patient populations and wide variations in universal practices. Identifying infections or sepsis in this hypermetabolic population is imperfect and often leads to overprescribing of antimicrobials, suboptimal dosing, and multidrug resistance. An understanding of pharmacokinetics and pharmacodynamics may aid optimization of dosing regimens to better attain treatment targets. This article provides an overview of the current status of burn infection and attempts recommendations for consideration to improve universally accepted care. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. 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), Denmar...

  16. Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre.

    Science.gov (United States)

    Wearn, Christopher; Hardwicke, Joseph; Kitsios, Andreas; Siddons, Victoria; Nightingale, Peter; Moiemen, Naiem

    2015-09-01

    Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  17. Mortality pattern of burn patients admitted in S. G. M. Hospital Rewa: A teaching institute of central India

    Directory of Open Access Journals (Sweden)

    S Lal

    2012-01-01

    Full Text Available Background: Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate. In previous studies, incidence, severity and deaths due to burn were found higher in young married women in India. Study to find out mortality pattern in burn patient was not carried out in this part of country. Objective: To identify demographic and sociocultural factors, type, modes, causes and risk factors for burn injuries and their gender-wise association. Materials and Methods: It was a retrospective study. Data were collected from all burn patients who admitted and died while on the treatment from 2004 to 2009. A total of 586 patients were included in this study. Data were gathered from hospital records and entered in the excel sheet. Analysis of data was done by using SPSS version 17 statistical software. Results: The mean age of patients was 22.66 years (range 1 m to 80 years. Episodes of burn were 4.63 times common in female (82.25% than in male (17.75%. It was statistically significant in females of age group 21-30 years (93.93% vs. 15.33% P < 0.0001. Married females (86.80% burned more commonly than married males (13.19% P < 0.0001. Flame burn was the major cause of death (95.56%. Kerosene was the most common (69% source of flame burn. Clothes caught fire while working on Chullha were 25% cases ( P < 0.0001. Accidental (86.44% burn was the most common intention of injury. The majority of burn deaths (68% occurred within one week of the incident due to septicemia (57%. Conclusion: Factors associated with an increase in mortality were accidental burns, burn size, young age, married women, and flame burns. For planning and implementing prevention programs, the approach has to be multidisciplinary and coordinated.

  18. Hypertonic lactated saline resuscitation reduces the risk of abdominal compartment syndrome in severely burned patients.

    Science.gov (United States)

    Oda, Jun; Ueyama, Masashi; Yamashita, Katsuyuki; Inoue, Takuya; Noborio, Mitsuhiro; Ode, Yasumasa; Aoki, Yoshiki; Sugimoto, Hisashi

    2006-01-01

    Secondary abdominal compartment syndrome is a lethal complication after resuscitation from burn shock. Hypertonic lactated saline (HLS) infusion reduces early fluid requirements in burn shock, but the effects of HLS on intraabdominal pressure have not been clarified. Patients admitted to our burn unit between 2002 and 2004 with burns > or =40% of the total body surface area without severe inhalation injury were entered into a fluid resuscitation protocol using HLS (n = 14) or lactated Ringer's solution (n = 22). Urine output was monitored hourly with a goal of 0.5 to 1.0 mL/kg per hour. Hemodynamic parameters, blood gas analysis, intrabladder pressure as an indicator of intraabdominal pressure (IAP), and the peak inspiratory pressure were recorded. Pulmonary compliance and the abdominal perfusion pressure were also calculated. In the HLS group, the amount of intravenous fluid volume needed to maintain adequate urine output was less at 3.1 +/- 0.9 versus 5.2 +/- 1.2 mL/24 h per kg per percentage of total body surface area, and the peak IAP and peak inspiratory pressure at 24 hours after injury were significantly lower than those in the lactated Ringer's group. Two of 14 patients (14%) in the HLS group and 11 of 22 patients (50%) developed IAH within 20.8 +/- 7.2 hours after injury. In patients with severe burn injury, a large intravenous fluid volume decreases abdominal perfusion during the resuscitative period because of increased IAP. Our data suggest that HLS resuscitation could reduce the risk of secondary abdominal compartment syndrome with lower fluid load in burn shock patients.

  19. Occupational therapy and physiotherapy for the patient with burns: principles and management guidelines.

    Science.gov (United States)

    Simons, M; King, S; Edgar, D

    2003-01-01

    Clinical practice guidelines are a tool to assist with clinical decision making. They provide information about the care for a condition and make recommendations based on research evidence, which can be adapted locally. A focus group within the Allied Health Interest Group of the Australian and New Zealand Burn Association has compiled the "Occupational Therapy and Physiotherapy for the Patient with Burns--Principles and Management Guidelines." These guidelines are designed as a practical guide to the relevant clinical knowledge and therapy intervention techniques required for effective patient management. Content areas include respiratory management, edema management, splinting and positioning, physical function (mobility, function, exercise), scar management, and psychosocial and mutual elements. The document has undergone extensive review by members of the Australian and New Zealand Burn Association to ensure clarity, internal consistency, and acceptability. The guidelines have been endorsed by the Australian and New Zealand Burn Association. An abridged version of the guidelines is included in this article, with the full document available from www.anzba.org.au.

  20. Review of the use of povidone-iodine (PVP-I) in the treatment of burns.

    Science.gov (United States)

    Steen, M

    1993-01-01

    Local infection and burn wound sepsis are one of the most severe problems in the treatment of thermally injured patients. Early surgical treatment and the use of topical antiseptics led to a decrease in the infection rate and significantly improved the survival rate of burns patients within the last twenty-five years. Many antiseptics are used in the treatment of burns. Silver nitrate, silver sulphadiazine, sulfamylon and povidone-iodine (PVP-I) are the most common substances used worldwide in burn care facilities. Clinical studies demonstrate that treatment with PVP-I is the most effective against bacterial and fungal infection. Several methodological problems however arise from direct comparison between these antiseptics, and local and systemic adverse effects can make the right choice difficult. Some case reports documented possible side effects in the treatment of patients with PVP-I, leading to general concerns about this treatment. Absorption of iodine and possible changes in thyroid hormones are well known, but evaluation of the clinical consequences is controversial. Reports of severe metabolic acidosis and renal insufficiency with lethal results have condemned the use of PVP-I in the treatment of extensive burns. The case reports, however, dealt with patients suffering from general morbidity and sepsis and therefore these single reports may not be generally valid. Local treatment of burns may cause further problems. The beneficial effect of a decrease of bacterial counts in deeper tissue may be confounded by other effects delaying wound healing, as shown in some experimental studies. Controlled clinical investigations on burn patients however are still missing. The paper will discuss these topics in detail referring to the treatment of burns with PVP-I. It is based on a critical review of the literature and the author's own experience in burns therapy.

  1. Pain and anxiety experiences of South African adult burn injury patients during physiotherapy management

    Directory of Open Access Journals (Sweden)

    L.D. Morris

    2010-01-01

    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.

  2. A Study on the Correlation between Pain and Pain Anxiety during Wound Care in Burn Patients

    Directory of Open Access Journals (Sweden)

    Seyed Reza Mazlom

    2017-05-01

    Full Text Available Background and Objectives: Wound care in burn patients is associated with severe anxiety that is characterized by feeling of fear and prediction of burn dressing pain. The purpose of this study was to determine the correlation between pain and pain anxiety in burn patients. Methods: In this descriptive-analytical study, 60 eligible patients hospitalized in men’s and women’s burn wards of Mashhad Imam Reza Hospital, were selected using available sampling. Pain anxiety and pain severity were measured using self-report pain anxiety questionnaire and visual analog scale, respectively, before and after burn dressing during three weeks (once a week. Data were analyzed by descriptive statistics and Pearson correlation test. Results: In this study, there was a significant linear correlation between pain and pain anxiety in the first week (r=0.512, p<0.001, but there was no significant linear correlation between these variables in the second (r=0.079, p=0.547 and third (r=0.167, p=0.203 weeks. Conclusion: According to the results of this study, assessment and treatment of pain anxiety are essential elements of pain care and management in burn patients.            

  3. Hyperosmolar metabolic acidosis in burn patients exposed to glycol based topical antimicrobials-A systematic review.

    Science.gov (United States)

    Leibson, Tom; Davies, Paige; Nickel, Cheri; Koren, Gideon

    2018-06-01

    The well documented susceptibility of burn patients to acquired infections via damaged skin mandates application of antimicrobial agents. These agents are dissolved in various vehicles that augment skin absorption thus allowing greater efficacy. Polyethylene glycol (PEG) and Propylene glycol (PropG) are among the most commonly used vehicles, and both have been used in numerous medications and cosmetic products over the past few decades. Rarely, burn patients treated with agents containing these glycols present with a life threatening systemic toxidrome of hyperosmolar metabolic acidosis. We present a systematic review of outcomes in burn patients treated with similar agents. Relevant studies were identified through systematic searches conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Thomson Reuters), from database inception to August 4th, 2016. All publications of clinical burn patient studies included at least one arm receiving a glycol based topical therapy. A total of 61 studies involving 10,282 patients and 4 different antimicrobial medications fulfilled the inclusion criteria. Nine burn patients (0.09%) were documented to present with hyperosmolar metabolic acidosis during topical silver sulfadiazine treatment. Propylene glycol isolated from their blood accounted for the high osmole gap. This first systematic review found very few cases of documented hyperosmolar metabolic acidosis, all within one study that had set to specifically explore this toxidrome. High index of suspicion with frequent osmolar gap monitoring may help identify future toxicities in a timely manner. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  4. Lawn mower-related burns.

    Science.gov (United States)

    Still, J; Orlet, H; Law, E; Gertler, C

    2000-01-01

    Lawn mower-related injuries are fairly common and are usually caused by the mower blades. Burns may also be associated with the use of power lawn mowers. We describe 27 lawn mower-related burn injuries of 24 male patients and 3 female patients. Three of the patients with burn injuries were children. Burn sizes ranged from 1% to 99% of the total body surface area (mean, 18.1%). Two of the patients died. The hospital stay ranged from 1 day to 45 days. Twenty-six injuries involved gasoline, which is frequently associated with refueling accidents. Safety measures should involve keeping children away from lawn mowers that are being used. The proper use and storage of gasoline is stressed.

  5. The clinical and microbiological characteristics of infections in burn patients from the Formosa Fun Coast Dust Explosion

    Directory of Open Access Journals (Sweden)

    Tzu-Chao Lin

    2018-04-01

    Full Text Available Background/Purpose: Bloodstream infection is a leading cause of mortality among burn patients. This study aimed to evaluate the risk factors, causative pathogens, and the relationship between bloodstream infections and other infections among burn patients from the Formosa Fun Coast Dust Explosion. Methods: This retrospective study evaluated the demographic and clinical characteristics, infection types, causative pathogen(s, and isolates' antibiotic susceptibilities from patients who were hospitalized between June 27 and September 31, 2015. Results: Fifty-eight patients were admitted during the study period (36 males, mean age: 22.6 years. The mean burned total body surface area (TBSA was 40% for all patients. Eighteen (31% patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2% episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%, Ralstonia pickettii (17, 18.5%, and Chryseobacterium meningosepticum (13, 14.1% were the most common pathogens causing bloodstream infections. A high concordance rate of wound cultures with blood cultures was seen in Staphylococcus aureus (3, 75% and C. meningosepticum (8, 61.5% infections. However, no Ralstonia isolate was found in burn wounds of patients with Ralstonia bacteremia. A high concordance rate of central venous catheter cultures with blood cultures was noted in Ralstonia mannitolilytica (5, 62.5% and Chryseobacterium indologenes (3, 60% infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. All S. aureus isolates were susceptible to methicillin. Conclusions: Waterborne bacteria should be considered in patients of burns with possible water contact. Empirical broad-spectrum antibiotics should be considered for patients who were hospitalized for severe sepsis, or septic shock with a large burn. Antibiotic treatment should be administered based on the specific pathogens and their detection

  6. The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study.

    Science.gov (United States)

    Christiaens, Wendy; Van de Walle, Elke; Devresse, Sophie; Van Halewyck, Dries; Benahmed, Nadia; Paulus, Dominique; Van den Heede, Koen

    2015-08-01

    In most Western countries burn centres have been developed to provide acute and critical care for patients with severe burn injuries. Nowadays, those patients have a realistic chance of survival. However severe burn injuries do have a devastating effect on all aspects of a person's life. Therefore a well-organized and specialized aftercare system is needed to enable burn patients to live with a major bodily change. The aim of this study is to identify the problems and unmet care needs of patients with severe burn injuries throughout the aftercare process, both from patient and health care professional perspectives in Belgium. By means of face-to-face interviews (n = 40) with individual patients, responsible physicians and patient organizations, current experiences with the aftercare process were explored. Additionally, allied healthcare professionals (n = 17) were interviewed in focus groups. Belgian burn patients indicate they would benefit from a more integrated aftercare process. Quality of care is often not structurally embedded, but depends on the good intentions of local health professionals. Most burn centres do not have a written discharge protocol including an individual patient-centred care plan, accessible to all caregivers involved. Patients reported discontinuity of care: nurses working at general wards or rehabilitation units are not specifically trained for burn injuries, which sometimes leads to mistakes or contradictory information transmission. Also professionals providing home care are often not trained for the care of burn injuries. Some have to be instructed by the patient, others go to the burn centre to learn the right skills. Finally, patients themselves underestimate the chronic character of burn injuries, especially at the beginning of the care process. The variability in aftercare processes and structures, as well as the failure to implement locally developed best-practices on a wider scale emphasize the need for a comprehensive network

  7. Hot soup! Correlating the severity of liquid scald burns to fluid and biomedical properties.

    Science.gov (United States)

    Loller, Cameron; Buxton, Gavin A; Kerzmann, Tony L

    2016-05-01

    Burns caused by hot drinks and soups can be both debilitating and costly, especially to pediatric and geriatric patients. This research is aimed at better understanding the fluid properties that can influence the severity of skin burns. We use a standard model which combines heat transfer and biomedical equations to predict burn severity. In particular, experimental data from a physical model serves as the input to our numerical model to determine the severity of scald burns as a consequence of actual fluid flows. This technique enables us to numerically predict the heat transfer from the hot soup into the skin, without the need to numerically estimate the complex fluid mechanics and thermodynamics of the potentially highly viscous and heterogeneous soup. While the temperature of the soup is obviously is the most important fact in determining the degree of burn, we also find that more viscous fluids result in more severe burns, as the slower flowing thicker fluids remain in contact with the skin for longer. Furthermore, other factors can also increase the severity of burn such as a higher initial fluid temperature, a greater fluid thermal conductivity, or a higher thermal capacity of the fluid. Our combined experimental and numerical investigation finds that for average skin properties a very viscous fluid at 100°C, the fluid must be in contact with the skin for around 15-20s to cause second degree burns, and more than 80s to cause a third degree burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  8. Accumulation and transport of microbial-size particles in a pressure protected model burn unit: CFD simulations and experimental evidence

    Directory of Open Access Journals (Sweden)

    Mimoun Maurice

    2011-03-01

    Full Text Available Abstract Background Controlling airborne contamination is of major importance in burn units because of the high susceptibility of burned patients to infections and the unique environmental conditions that can accentuate the infection risk. In particular the required elevated temperatures in the patient room can create thermal convection flows which can transport airborne contaminates throughout the unit. In order to estimate this risk and optimize the design of an intensive care room intended to host severely burned patients, we have relied on a computational fluid dynamic methodology (CFD. Methods The study was carried out in 4 steps: i patient room design, ii CFD simulations of patient room design to model air flows throughout the patient room, adjacent anterooms and the corridor, iii construction of a prototype room and subsequent experimental studies to characterize its performance iv qualitative comparison of the tendencies between CFD prediction and experimental results. The Electricité De France (EDF open-source software Code_Saturne® (http://www.code-saturne.org was used and CFD simulations were conducted with an hexahedral mesh containing about 300 000 computational cells. The computational domain included the treatment room and two anterooms including equipment, staff and patient. Experiments with inert aerosol particles followed by time-resolved particle counting were conducted in the prototype room for comparison with the CFD observations. Results We found that thermal convection can create contaminated zones near the ceiling of the room, which can subsequently lead to contaminate transfer in adjacent rooms. Experimental confirmation of these phenomena agreed well with CFD predictions and showed that particles greater than one micron (i.e. bacterial or fungal spore sizes can be influenced by these thermally induced flows. When the temperature difference between rooms was 7°C, a significant contamination transfer was observed to

  9. [Investigation and analysis of the cognition degree of parents of 150 pediatric burn patients on scar rehabilitation].

    Science.gov (United States)

    Han, Da-wei; Fu, Jin-feng; Yan, Gang; Jiang, He; Liu, Wen-jun

    2013-02-01

    To analyze the cognition degree of parents of pediatric burn patients on hyperplasia of scar and its prevention and rehabilitation, so as to provide a guidance for preventing deformity and dysfunction caused by scar hyperplasia. Questionnaire survey was carried out among parents of 150 pediatric burn patients hospitalized from October 2010 to November 2011 to analyze the cognition degree of patients on the formation of scar after burns, the demand degree for scar treatment between parents of different genders of patients and among parents of patients with burn injury occurred in different body sites, the relationship between the literacy level of parents and their degree of willingness of undergoing scar treatment, and the degree of comprehension and acceptance on the part of parents regarding the methods of prevention and treatment of scar. Data were processed with chi-square test or Fisher's exact test. (1) Only the parents of 19 pediatric burn patients (accounting for 12.7%) realized the possibility of scar formation before admission. After admission, more than half of the parents were told that their children would bear scar and need regular follow-up, while only parents of 52 patients (34.7%) were instructed the methods of preventing and treating scar. (2) One hundred and forty parents (93.3%) considered their children need prevention and treatment of scar after burns. There was no statistically significant difference between parents of male patients and female patients in the demand for scar treatment (χ(2) = 0.825, P > 0.05). The demand degree of parents for rehabilitation treatment for the upper limbs after burns surpassed those of the other sites of body, and altogether there were 85 parents accounting for 97.7% of all. (3) The difference among parents with different levels of literacy was not obvious in the willingness of receiving treatment for scar hyperplasia (P > 0.05). (4) Eight methods were chosen by parents to prevent and treat scars of patients

  10. Use of sugammadex on burn patients: descriptive study

    Directory of Open Access Journals (Sweden)

    Eduardo Rodríguez Sánchez M.

    2015-07-01

    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. Resumo: Objetivos: O paciente queimado representa um desafio para o anestesiologista, pois submete-se a várias intervenções cirúrgicas durante sua hospitalização, necessitando de anestesia geral e relaxamento muscular na maior parte delas. Apresenta sistema respiratório comprometido e uma resposta aos relaxantes musculares que difere do paciente sadio; portanto, um monitoramento correto e reversão tornam-se imprescindíveis. Avaliamos a eficácia e segurança do sugamadex nesta população. Material e métodos: Estudo descritivo com caráter prospectivo que inclui quatro pacientes, todos eles considerados grandes queimados, submetidos a escarectomia com anestesia geral e relaxamento neuromuscular. Como variável principal tomou-se o tempo de recuperação de TOF superior a 0,9 após a administra

  11. Subgroup analysis of continuous renal replacement therapy in severely burned patients.

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    Jaechul Yoon

    Full Text Available Continuous renal replacement therapy (CRRT is administered to critically ill patients with renal injuries as renal replacement or renal support. We aimed to identify predictors of mortality among burn patients receiving CRRT, and to investigate clinical differences according to acute kidney injury (AKI status. This retrospective observational study evaluated 216 Korean burn patients who received CRRT at a burn intensive care unit. Patients were categorized by AKI status. Data were collected regarding arterial pH, laboratory results, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF ratio, and urine production. Among surviving patients, CRRT duration and the sequential organ failure assessment score were 6.5 days and 4.7 in the non-AKI group and 23.4 days and 7.4 in the AKI group, respectively (p = 0.003 and p = 0.008. On logistic regression analyses, mortality was significantly associated with a pH of 5.0 mEg/L (p = 0.045, creatinine levels of >2.0 mg/dL (p = 0.011, lactate levels of >2 mmol/L (p2 mmol/L, and a platelet count of 2 mg/dL. In the non-AKI group, poor outcomes were associated with lactate levels of >1.5 mmol/L, a PF ratio of 1.2 mg/dL. Duration of the CRRT application and the requirement for either renal replacement or renal support at the initiation of CRRT application are important considerations depending on its application.

  12. Airborne bacterial dispersal during and after dressing and bed changes on burns patients.

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    Bache, Sarah E; Maclean, Michelle; Gettinby, George; Anderson, John G; MacGregor, Scott J; Taggart, Ian

    2015-02-01

    It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas. Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team. In order to assess the contribution of airborne spread of bacteria, air samples were taken repeatedly throughout and following these events, to quantify levels of airborne bacteria. Air samples were taken at 3-min intervals before, during and after a dressing and bed change on a burns patient using a sieve impaction method. Following incubation, bacterial colonies were enumerated to calculate bacterial colony forming units per m(3) (cfu/m(3)) at each time point. Statistical analysis was performed, whereby the period before the high-risk event took place acted as a control period. The periods during and after the dressing and bed sheet changes were examined for significant differences in airborne bacterial levels relative to the control period. The study was carried out four times, on three patients with burns between 35% total burn surface area (TBSA) and 51% TBSA. There were significant increases in airborne bacteria levels, regardless of whether the dressing change or bed sheet change took place first. Of particular note, is the finding that significantly high levels (up to 2614cfu/m(3)) of airborne bacteria were shown to persist for up to approximately 1h after these activities ended. This is the most accurate picture to date of the rapidly changing levels of airborne bacteria within the room of a burns patient undergoing a dressing change and bed change. The novel demonstration of a significant increase in the airborne bacterial load during these events has implications for infection control on burns units. Furthermore, as these increased levels remained for approximately 1h afterwards

  13. Wound management and outcome of 595 electrical burns in a major burn center.

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    Li, Haisheng; Tan, Jianglin; Zhou, Junyi; Yuan, Zhiqiang; Zhang, Jiaping; Peng, Yizhi; Wu, Jun; Luo, Gaoxing

    2017-06-15

    Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review.

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    Morris, Linzette Deidré; Louw, Quinette Abegail; Grimmer-Somers, Karen

    2009-01-01

    To systematically review the current evidence for the effectiveness of Virtual Reality (VR), in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. A comprehensive search was conducted between December 2007 and January 2008, and updated in January 2009, before publication. Computerized bibliographic databases were individually searched using specifically developed search strategies to identify eligible studies. Nine studies were deemed eligible for inclusion in this review. Wound dressing changes was the most common procedure during which VR was trialed. Pain was the primary outcome measure in all of the studies included. Anxiety was a secondary outcome measure in 3 of the 9 included studies. VR, in conjunction with pharmacologic analgesics, significantly reduced pain experienced by burn injury patients during wound dressing changes and physiotherapy. There is equivocal evidence for the effect of VR in conjunction with pharmacologic analgesics on reducing anxiety in burn injury patients during wound dressing changes and physiotherapy. This is the first known systematic review to report on the effectiveness of VR, in conjunction with pharmacologic analgesia on reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy management compared with pharmacologic analgesia alone or other forms of distraction. Used as an adjunct to the current burn pain management regimens, VR could possibly assist health professionals in making the rehabilitation process for burn patients less excruciating, thereby improving functional outcomes. Further research investigating the effect of VR on anxiety in burn injury patients is warranted.

  15. Development of a Vascularized Skin Construct Using Adipose-Derived Stem Cells from Debrided Burned Skin

    Science.gov (United States)

    2012-01-01

    2010. [4] D. Mellus and R. K. Chan, “Reconstructive surgery in the thermally injured patient,” Perioperative Nursing Clinics, vol. 7, no. 1, pp. 107–113...survival probability in paediatric patients in modern burn care: a prospective observational cohort study,” The Lancet, vol. 379, no. 9820, pp. 1013–1021

  16. Evaluation of the effect of patient-selected music on sleep quality and pain intensity in burn patients

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    Mohaddes Ardabili Fatemeh

    2016-08-01

    Full Text Available Background and Objective: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Materials and Method: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001  and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention

  17. Patient-reported outcome measures in burning mouth syndrome - a review of the literature.

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    Ni Riordain, R; McCreary, C

    2013-04-01

    Oral Diseases (2013) 19, 230-235 This review aims to investigate the patient-reported outcomes currently used in the burning mouth syndrome literature and to explore whether any standardisation of such measures has taken place. Electronic databases were searched for all types of burning mouth syndrome studies using patient-reported outcome measures. Studies were selected by predefined inclusion criteria. Copies of the papers obtained were thoroughly reviewed. A study-specific data extraction form was used, allowing papers to be reviewed in a standardised manner. The initial literature search yielded a total of 173 citations, 43 of which were deemed suitable for inclusion in this study. Symptom severity and symptomatic relief were reported as a patient-reported outcome measure in 40 of the studies and quantified most commonly using a visual analogue scale. Quality of life was reported in 13 studies included in this review. Depression and/or anxiety was reported in 14 of the studies. As is evident from the variety of questionnaires and instruments used in the evaluation of the impact of burning mouth syndrome on patients' lives, no standardisation of patient outcomes has yet been achieved. © 2012 John Wiley & Sons A/S.

  18. Using Coupled Mesoscale Experiments and Simulations to Investigate High Burn-Up Oxide Fuel Thermal Conductivity

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    Teague, Melissa C.; Fromm, Bradley S.; Tonks, Michael R.; Field, David P.

    2014-12-01

    Nuclear energy is a mature technology with a small carbon footprint. However, work is needed to make current reactor technology more accident tolerant and to allow reactor fuel to be burned in a reactor for longer periods of time. Optimizing the reactor fuel performance is essentially a materials science problem. The current understanding of fuel microstructure have been limited by the difficulty in studying the structure and chemistry of irradiated fuel samples at the mesoscale. Here, we take advantage of recent advances in experimental capabilities to characterize the microstructure in 3D of irradiated mixed oxide (MOX) fuel taken from two radial positions in the fuel pellet. We also reconstruct these microstructures using Idaho National Laboratory's MARMOT code and calculate the impact of microstructure heterogeneities on the effective thermal conductivity using mesoscale heat conduction simulations. The thermal conductivities of both samples are higher than the bulk MOX thermal conductivity because of the formation of metallic precipitates and because we do not currently consider phonon scattering due to defects smaller than the experimental resolution. We also used the results to investigate the accuracy of simple thermal conductivity approximations and equations to convert 2D thermal conductivities to 3D. It was found that these approximations struggle to predict the complex thermal transport interactions between metal precipitates and voids.

  19. Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study.

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    Caleman, Gilson; Morais, José Fausto de; Puga, Maria Eduarda Dos Santos; Riera, Rachel; Atallah, Alvaro Nagib

    2010-01-01

    among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. the use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

  20. Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study

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    Gilson Caleman

    Full Text Available CONTEXT AND OBJECTIVE: Among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: Non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: Burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54 for moderate burns and 6.24 (CI 5.22-7.45 for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30 and 7.35 for major burns (CI 5.99-9.01. The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: The use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

  1. Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State.

    Science.gov (United States)

    Wibbenmeyer, Lucy; Kluesner, Karen; Wu, Hongqian; Eid, Anas; Heard, Jason; Mann, Benjamin; Pauley, Alison; Peek-Asa, Corrine

    The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with

  2. Comparison of the Berlin definition with the American European consensus definition for acute respiratory distress syndrome in burn patients.

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    Bordes, Julien; Lacroix, Guillaume; Esnault, Pierre; Goutorbe, Philippe; Cotte, Jean; Dantzer, Eric; Meaudre, Eric

    2014-06-01

    Acute respiratory distress syndrome (ARDS) is a leading cause of mortality in burn patients. Smoke inhalation, pneumonia and inflammation process are the major causes of ARDS in burn patients. The American European Consensus Conference (AECC) definition proposed in 1994 has recently been revised by the Berlin definition. Our objective was to describe the epidemiology of ARDS comparing the Berlin definition with the AECC definition in a retrospective cohort of burn patients. We reviewed admitted burn adult patients for a two year period, and investigated patient who received mechanical ventilation for more than 48 h and in whom pneumonia was diagnosed. 40 patients were analyzed. According to the AECC definition, 11 patients met criteria for ALI (27.5%), and 29 patients for ARDS (72.5%). According to the Berlin definition, all patients met criteria for ARDS: 4 (10%) for a severe ARDS, 25 (62.5%) for a moderate ARDS, 11 (27.5%) for a mild ARDS. Inhalation injury was diagnosed in 10 patients (25%). Categorizing patients with the Berlin definition showed statistically significative difference of mortality within the three groups, but not with the AECC definition. The Berlin definition seems to be more accurate than the AECC definition to assess the severity of ARDS in term of outcome in burn patients. This definition may facilitate prompt recognition of ARDS in burn patients, and promote protective ventilation strategy to a larger number of patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  3. 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

  4. Air-freshener burns: a new paradigm in burns etiology?

    Science.gov (United States)

    Sarwar, Umran; Nicolaou, M; Khan, M S; Tiernan, E

    2011-10-01

    We report a rare case of burns following the use of automated air-fresheners. We present a case report with a brief overview of the literature relating to burns associated with air-fresheners. The mechanism and treatment of these types of injuries are also described. A 44 year-old female was admitted under the care of the burns team following burns secondary to an exploding air-freshener canister. The patient sustained burns to the face, thorax and arms resulting in a seven-day hospital admission. The burns were treated conservatively. To our knowledge this is one of the few documented cases of burns as a result of air-fresheners. As they become more ubiquitous, we anticipate the incidence of such cases to increase. As such, they pose a potential public health concern on a massive scale.

  5. Outcome predictors and quality of life of severe burn patients admitted to intensive care unit

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    Buoninsegni Laura

    2010-04-01

    Full Text Available Abstract Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40% treated in a polyvalent intensive care unit (ICU and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D questionnaire. Methods A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health. Results During a period of five years, 50 patients participated in the study. Their mean age was 53.8 ± 19.8; they had a mean of %TBSA burned of 54.5 ± 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%, self-care (moderate 21%; extreme 36.9%, usual activities (moderate 68.5%; extreme 21%, pain/discomfort (moderate 68.5%; extreme 10.5%, anxiety/depression (moderate 36.9%; extreme 42.1%. Conclusions In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.

  6. Vegetation management with fire modifies peatland soil thermal regime.

    Science.gov (United States)

    Brown, Lee E; Palmer, Sheila M; Johnston, Kerrylyn; Holden, Joseph

    2015-05-01

    Vegetation removal with fire can alter the thermal regime of the land surface, leading to significant changes in biogeochemistry (e.g. carbon cycling) and soil hydrology. In the UK, large expanses of carbon-rich upland environments are managed to encourage increased abundance of red grouse (Lagopus lagopus scotica) by rotational burning of shrub vegetation. To date, though, there has not been any consideration of whether prescribed vegetation burning on peatlands modifies the thermal regime of the soil mass in the years after fire. In this study thermal regime was monitored across 12 burned peatland soil plots over an 18-month period, with the aim of (i) quantifying thermal dynamics between burned plots of different ages (from post burning), and (ii) developing statistical models to determine the magnitude of thermal change caused by vegetation management. Compared to plots burned 15 + years previously, plots recently burned (management effects. Temperatures measured in soil plots burned vegetation regrows. Our findings that prescribed peatland vegetation burning alters soil thermal regime should provide an impetus for further research to understand the consequences of thermal regime change for carbon processing and release, and hydrological processes, in these peatlands. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Comparison of mortality prediction models and validation of SAPS II in critically ill burns patients.

    Science.gov (United States)

    Pantet, O; Faouzi, M; Brusselaers, N; Vernay, A; Berger, M M

    2016-06-30

    Specific burn outcome prediction scores such as the Abbreviated Burn Severity Index (ABSI), Ryan, Belgian Outcome of Burn Injury (BOBI) and revised Baux scores have been extensively studied. Validation studies of the critical care score SAPS II (Simplified Acute Physiology Score) have included burns patients but not addressed them as a cohort. The study aimed at comparing their performance in a Swiss burns intensive care unit (ICU) and to observe whether they were affected by a standardized definition of inhalation injury. We conducted a retrospective cohort study, including all consecutive ICU burn admissions (n=492) between 1996 and 2013: 5 epochs were defined by protocol changes. As required for SAPS II calculation, stays burned (TBSA) and inhalation injury (systematic standardized diagnosis since 2006). Study epochs were compared (χ2 test, ANOVA). Score performance was assessed by receiver operating characteristic curve analysis. SAPS II performed well (AUC 0.89), particularly in burns burns <40% TBSA. Ryan and BOBI scores were least accurate, as they heavily weight inhalation injury.

  8. 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.

  9. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn.

    Science.gov (United States)

    Finlay, V; Phillips, M; Allison, G T; Wood, F M; Ching, D; Wicaksono, D; Plowman, S; Hendrie, D; Edgar, D W

    2015-11-01

    As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (pburns were excluded due to loss to follow up. For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  10. Assessing burn depth in tattooed burn lesions with LASCA Imaging

    Science.gov (United States)

    Krezdorn, N.; Limbourg, A.; Paprottka, F.J.; Könneker; Ipaktchi, R.; Vogt, P.M

    2016-01-01

    Summary Tattoos are on the rise, and so are patients with tattooed burn lesions. A proper assessment with regard to burn depth is often impeded by the tattoo dye. Laser speckle contrast analysis (LASCA) is a technique that evaluates burn lesions via relative perfusion analysis. We assessed the effect of tattoo skin pigmentation on LASCA perfusion imaging in a multicolour tattooed patient. Depth of burn lesions in multi-coloured tattooed and untattooed skin was assessed using LASCA. Relative perfusion was measured in perfusion units (PU) and compared to various pigment colours, then correlated with the clinical evaluation of the lesion. Superficial partial thickness burn (SPTB) lesions showed significantly elevated perfusion units (PU) compared to normal skin; deep partial thickness burns showed decreased PU levels. PU of various tattoo pigments to normal skin showed either significantly lower values (blue, red, pink) or significantly increased values (black) whereas orange and yellow pigment showed values comparable to normal skin. In SPTB, black and blue pigment showed reduced perfusion; yellow pigment was similar to normal SPTB burn. Deep partial thickness burn (DPTB) lesions in tattoos did not show significant differences to normal DPTB lesions for black, green and red. Tattoo pigments alter the results of perfusion patterns assessed with LASCA both in normal and burned skin. Yellow pigments do not seem to interfere with LASCA assessment. However proper determination of burn depth both in SPTB and DPTB by LASCA is limited by the heterogenic alterations of the various pigment colours. PMID:28149254

  11. Is there a threshold age and burn size associated with poor outcomes in the elderly after burn injury?

    Science.gov (United States)

    Jeschke, Marc G; Pinto, Ruxandra; Costford, Sheila R.; Amini-Nik, Saeid

    2016-01-01

    Elderly burn care represents a vast challenge. The elderly are one of the most susceptible populations to burn injuries, but also one of the fastest growing demographics, indicating a substantial increase in patient numbers in the near future. Despite the need and importance of elderly burn care, survival of elderly burn patients is poor. Additionally, little is known about the responses of elderly patients after burn. One central question that has not been answered is what age defines an elderly patient. The current study was conducted to determine whether there is a cut-off age for elderly burn patients that is correlated with an increased risk for mortality and to determine the burn size in modern burn care that is associated with increased mortality. To answer these questions, we applied appropriate statistical analyses to the Ross Tilley Burn Centre and the Inflammatory and Host Response to Injury databases. We could not find a clear cut-off age that differentiates or predicts between survival and death. Risk of death increased linearly with increasing age. Additionally, we found that the LD50 decreases from 45% total body surface area (TBSA) to 25% TBSA from the age of 55 years to the age of 70 years, indicating that even small burns lead to poor outcome in the elderly. We therefore concluded that age is not an ideal to predictor of burn outcome, but we strongly suggest that burn care providers be aware that if an elderly patient sustains even a 25% TBSA burn, the risk of mortality is 50% despite the implementation of modern protocolized burn care. PMID:26803373

  12. A rare case of failed healing in previously burned skin after a secondary burns.

    Science.gov (United States)

    Goldie, Stephen J; Parsons, Shaun; Menezes, Hana; Ives, Andrew; Cleland, Heather

    2017-01-01

    Patients presenting with large surface area burns are common in our practice; however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings; however, they failed to heal and became infected requiring surgical management. Burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

  13. Concept on coupled spectrum B/T (burning and/or transmutation) reactor for treatment of minor actinides by thermal and fast neutrons

    International Nuclear Information System (INIS)

    Aziz, Ferhat; Kitamoto, Asashi

    1996-01-01

    A conceptual design of B/T (burning and/or transmutation) reactor based on a modified conventional 1150 MWe-PWR system, with core consisted of two concentric regions for thermal and fast neutrons, was proposed herein for B/T treatment of MA (minor actinides). The B/T fuel considered was supposed such that MA discharged from 1 GWe-LWR was blended homogeneously with the composition of LWR fuel. In the outer region 23- Np, 241 Am and 243 Am were loaded and burned by thermal neutron, while in the inner region 244 Cm was loaded and burned mainly by fast neutron. The geometry of B/T fuel and the fuel assembly in the outer region was left in the same condition to those of standard PWR while in the inner region the B/T fuel was arranged in the hexagonal geometry, allowed high fuel to coolant volume ratio (V m /V f ), to keep the harder neutron spectrum. Two cases of the Coupled Spectrum B/T Reactor (CSR) with different (V m 1 f ) ratio in the inner region were studied, and the results for the tight lattice with (V m /V f ) = 0.5 showed that those isotopes approached the equilibrium composition after about 5 recycle period, when the CSR was operated under the reactivity swing of 2.8 % dk/k. The evaluations on the void coefficient of reactivity, the Doppler effect and the reactivity swing showed that the CSR concept has the inherent safety and can burn and/or transmute all kind of MA in a single reactor. This CSR can burn about 808 kg of MA in one recycle period of 3 years, which is equivalent to the discharged fuel from about 12 units of LWR in a year. (author)

  14. Early assessment and identification of posttraumatic stress disorder, satisfaction with appearance and coping in patients with burns.

    Science.gov (United States)

    Dahl, Oili; Wickman, Marie; Björnhagen, Viveca; Friberg, Mona; Wengström, Yvonne

    2016-12-01

    The first year after severe burn is a psychologically challenging period for the patient. Patients may still struggle with burn-related physical and psychological problems such as posttraumatic stress disorder (PTSD) and body image dissatisfaction (BID). This study investigates the presence of PTSD, BID and coping, at three, six and twelve months after discharge for early identification of patients in need of focused support during rehabilitation. Fifty-two adult patients with different degrees of burns were followed at three, six and twelve months after discharge and 36 patients completed all assessment points. A standardized clinical protocol was used for systematic assessment of PTSD (IES-R), BID (SWAP-Swe) and Coping (CBQ). The follow-up included an intervention with a burn nurse as a complement to the existing program. Approximately half of the patients had a risk of developing PTSD three months after discharge from hospital, and body image dissatisfaction was found to potentially predict risk of PTSD during follow-up. The findings suggest that it is important to include patients with less extensive burns in follow-up as this group is at risk of development of PTSD. Using standardized questionnaires in early follow-up along with assessment of body image dissatisfaction may facilitate detection of psychological problems. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  15. Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients.

    Science.gov (United States)

    Freitas, Noélle de Oliveira; Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W; Rossi, Lidia A

    2018-01-01

    Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p self-esteem (-0.57; p

  16. Soluble Suppression of Tumorigenicity-2 Predicts Hospital Mortality in Burn Patients: An Observational Prospective Cohort Pilot Study.

    Science.gov (United States)

    Ruiz-Castilla, Mireia; Bosacoma, Pau; Dos Santos, Bruce; Baena, Jacinto; Guilabert, Patricia; Marin-Corral, Judith; Masclans, Joan R; Roca, Oriol; Barret, Juan P

    2018-04-10

    The IL33/ST2 pathway has been implicated in the pathogenesis of different inflammatory diseases. Our aim was to analyze whether plasma levels of biomarkers involved in the IL33/ST2 axis might help to predict mortality in burn patients. Single-center prospective observational cohort pilot study performed at the Burns Unit of the Plastic and Reconstructive Surgery Department of the Vall d'Hebron University Hospital (Barcelona). All patients aged ≥18 years old with second or third-degree burns requiring admission to the Burns Unit were considered for inclusion. Blood samples were taken to measure levels of interleukins (IL)6, IL8, IL33, and soluble suppression of tumorigenicity-2 (sST2) within 24 h of admission to the Burns Unit and at day 3. Results are expressed as medians and interquartile ranges or as frequencies and percentages. Sixty-nine patients (58 [84.1%] male, mean age 52 [35-63] years, total body surface area burned 21% [13%-30%], Abbreviated Burn Severity Index 6 [4-8]) were included. Thirteen (18.8%) finally died in the Burns Unit. Plasma levels of sST2 measured at day 3 after admission demonstrated the best prediction accuracy for survival (area under the ROC curve 0.85 [0.71-0.99]; P < 0.001). The best cutoff point for the AUROC index was estimated to be 2,561. In the Cox proportional hazards model, after adjusting for potential confounding, a plasma sST2 level ≥2,561 measured at day 3 was significantly associated with mortality (HR 6.94 [1.73-27.74]; P = 0.006). Plasma sST2 at day 3 predicts hospital mortality in burn patients.

  17. Temporomandibular disorders in burning mouth syndrome patients: an observational study.

    Science.gov (United States)

    Corsalini, Massimo; Di Venere, Daniela; Pettini, Francesco; Lauritano, Dorina; Petruzzi, Massimo

    2013-01-01

    Burning Mouth Syndrome (BMS) is a chronic disease characterized by absence of any lesions and burning of the oral mucosa associated to a sensation of dry mouth and/or taste alterations. The purpose of our study is to estimate signs and symptoms of Temporomandibular Disorders (TMD) in patients with BMS and to investigate for the existence of an association between BMS and TMD. Forty-four BMS patients were enrolled; BMS subtype was established according to the classification of Lamey. After a gnathological evaluation, according to the protocol of the European Academy of Craniomandibular Disorders, patients were classified by RDC/TMD criteria. The data were compared and analyzed using a chi-square test to describe the existence of an association between BMS and TMD. 65.9% the BMS patients showed disorders classified as primary signs and symptoms of TMD according to RDC / TMD criteria, and 72.7% showed parafunctional habits. The chi-square test revealed a statistically significant association (p = 0.035) between BMS and TMD. The data suggest that there is a possible relationship not yet well understood between BMS and TMD, may be for neurophatic alterations assumed for BMS that could be also engaged in TMD pathogenesis.

  18. The clinical and microbiological characteristics of infections in burn patients from the Formosa Fun Coast Dust Explosion.

    Science.gov (United States)

    Lin, Tzu-Chao; Wu, Rui-Xin; Chiu, Chih-Chien; Yang, Ya-Sung; Lee, Yi; Lin, Jung-Chung; Chang, Feng-Yee

    2018-04-01

    Bloodstream infection is a leading cause of mortality among burn patients. This study aimed to evaluate the risk factors, causative pathogens, and the relationship between bloodstream infections and other infections among burn patients from the Formosa Fun Coast Dust Explosion. This retrospective study evaluated the demographic and clinical characteristics, infection types, causative pathogen(s), and isolates' antibiotic susceptibilities from patients who were hospitalized between June 27 and September 31, 2015. Fifty-eight patients were admitted during the study period (36 males, mean age: 22.6 years). The mean burned total body surface area (TBSA) was 40% for all patients. Eighteen (31%) patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2%) episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%), Ralstonia pickettii (17, 18.5%), and Chryseobacterium meningosepticum (13, 14.1%) were the most common pathogens causing bloodstream infections. A high concordance rate of wound cultures with blood cultures was seen in Staphylococcus aureus (3, 75%) and C. meningosepticum (8, 61.5%) infections. However, no Ralstonia isolate was found in burn wounds of patients with Ralstonia bacteremia. A high concordance rate of central venous catheter cultures with blood cultures was noted in Ralstonia mannitolilytica (5, 62.5%) and Chryseobacterium indologenes (3, 60%) infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. All S. aureus isolates were susceptible to methicillin. Waterborne bacteria should be considered in patients of burns with possible water contact. Empirical broad-spectrum antibiotics should be considered for patients who were hospitalized for severe sepsis, or septic shock with a large burn. Antibiotic treatment should be administered based on the specific pathogens and their detection points. Copyright © 2017. Published by Elsevier B.V.

  19. CLINICAL STUDY OF ELECTRICAL BURNS AMONG ALL BURNS CASES- 3 YEARS’ EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Nagabathula Durga Prasad

    2017-08-01

    Full Text Available BACKGROUND With the advances in technology, electrical injuries are becoming more common and are the leading cause of work-related traumatic death. One third of all electrical traumas and most high-voltage injuries are job related and more than 50% of these injuries result from power line contact. The management of the major burn injury represents a significant challenge to every member of the burns team. Most of electrical burns present with gangrene of toes and limbs with eschar over body parts. Their presentation is mostly due to contact with high-voltage electricity at their work places. MATERIALS AND METHODS A retrospective study was made to study the clinico-social profile of patients suffering electric burns admitted into Department of General Surgery. RESULTS 92 cases were evaluated and studied. Majority of patients developed gangrene of limbs and toes. Amputations and skin grafting was done. Most patients who suffered electric burns were males of age group 21 to 40 years. All cases are accidental and mostly occurred at work places. Most electric burns are high-voltage based and caused deep burns. Major complications like acute renal failure and septicaemia were encountered. Most of them suffered 16 to 30% burns. Most commonly isolated organism from wounds is pseudomonas. Most of them suffered a hospital stay of 1 to 2 months. CONCLUSION Electric burns are a burden to the society. Prevention is the best way to deal with them. Electricity-based employees have to be trained properly regarding safety measures to be taken. General education of public regarding safety measures can prevent electrical burn injuries.

  20. Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?

    Science.gov (United States)

    Hranjec, Tjasa; Turrentine, Florence E; Stukenborg, George; Young, Jeffrey S; Sawyer, Robert G; Calland, James F

    2012-05-01

    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 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.

  1. Long-term impacts of prescribed burns on soil thermal conductivity and soil heating at a Colorado Rocky Mountain site: a data/model fusion study

    Science.gov (United States)

    W. J. Massman; J. M. Frank; N. B. Reisch

    2008-01-01

    Heating any soil during a sufficiently intense wild fire or prescribed burn can alter that soil irreversibly, resulting in many significant, and well studied, long-term biological, chemical, and hydrological effects. On the other hand, much less is known about how fire affects the thermal properties and the long-term thermal regime of soils. Such knowledge is important...

  2. The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.

    Science.gov (United States)

    Cleland, Heather; Greenwood, John E; Wood, Fiona M; Read, David J; Wong She, Richard; Maitz, Peter; Castley, Andrew; Vandervord, John G; Simcock, Jeremy; Adams, Christopher D; Gabbe, Belinda J

    2016-03-21

    Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation. BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles. Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients. Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units. Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified. Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

  3. Clinical and protein metabolic efficacy of glutamine granules-supplemented enteral nutrition in severely burned patients.

    Science.gov (United States)

    Peng, Xi; Yan, Hong; You, Zhongyi; Wang, Pei; Wang, Shiliang

    2005-05-01

    As an abundant amino acid in the human body, glutamine has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system. A relative deficiency of glutamine in such patients could compromise recovery and result in prolonged illness and an increase in late mortality. The purpose of this clinical study is to observe the effects of enteral supplement with glutamine granules on protein metabolism in severely burned patients. Forty-eight severe burn patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trial. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, glutamine and B group patents were supplemented with glutamine granules or placebo (glycine) at 0.5 g/kg per day for 14 days with oral feeding or tube feeding, respectively. The level of plasma glutamine, plasma protein content, urine nitrogen and urine 3-methylhistidine (3-MTH) excretion were determined, wound healing rate of the burned area and hospital stay were recorded. The results showed that there were significant reductions in plasma glutamine level and abnormal protein metabolism. After supplement with glutamine granules for 14 days, the plasma glutamine concentration was significantly higher than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P0.05). On the other hand, the amount of urine nitrogen and 3-MTH excreted in Gln group were significantly lower than that in B group. In addition, wound healing was faster and hospital stay days were shorter in Gln group than B group (46.59+/-12.98 days versus 55.68+/-17.36 days, P<0.05). These indicated that supplement glutamine granules with oral feeding or tube feeding could abate the degree of glutamine depletion

  4. 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.

  5. From Cholera to Burns: A Role for Oral Rehydration Therapy

    Science.gov (United States)

    Green, W.B.; Asuku, M.E.; Feldman, M.; Makam, R.; Noppenberger, D.; Price, L.A.; Prosciak, M.; van Loon, I.N.

    2011-01-01

    According to the practice guidelines of the American Burn Association on burn shock resuscitation, intravenous (IV) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of ≥20% of the total body surface area. However, in mass burn casualties, IV fluid resuscitation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte®90 could replace fluid losses requiring IV fluid therapy in thermal injury. The requirement of the continuing IV fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to IV fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where IV fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification. PMID:22283039

  6. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    Science.gov (United States)

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p burned (p  0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively. © 2012 by the Wound Healing Society.

  7. Clostridium difficile infections in patients with severe burns

    Science.gov (United States)

    2011-01-01

    placards indicating that hand hygiene should involve soap and water. Periodic hand hygiene compliance surveys have indicated relatively consistent...care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007;28:123–30. [6] Marcon AP, Gamba MA, Vianna LA. Nosocomial ...Clostridium difficile infections in patients with severe burns§ Scott J. Crabtree a, Janelle L. Robertson a,b, Kevin K. Chung c, Evan M. Renz b,c

  8. Methylated spirit burns: an ongoing problem.

    Science.gov (United States)

    Jansbeken, J R H; Vloemans, A F P M; Tempelman, F R H; Breederveld, R S

    2012-09-01

    Despite many educational campaigns we still see burns caused by methylated spirit every year. We undertook a retrospective study to analyse the impact of this problem. We retrospectively collected data of all patients with burns caused by methylated spirit over twelve years from 1996 to 2008. Our main endpoints were: incidence, age, mechanism of injury, total body surface area (TBSA) burned, burn depth, need for surgery and length of hospital stay. Ninety-seven patients with methylated spirit burns were included. During the study period there was no decrease in the number of patients annually admitted to the burn unit with methylated spirit burns. 28% of the patients (n=27) were younger than eighteen years old, 15% (n=15) were ten years old or younger. The most common cause of burns was carelessness in activities involving barbecues, campfires and fondues. Mean TBSA burned was 16% (SD 12.4). 70% (n=68) had full thickness burns. 66% (n=64) needed grafting. Mean length of hospital stay was 23 days (SD 24.7). The use of methylated spirit is an ongoing problem, which continues to cause severe burns in adults and children. Therefore methylated spirit should be banned in households. We suggest sale only in specialised shops, clear labelling and mandatory warnings. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  9. Burn encephalopathy and syndrome of hypermetabolism-hypercatabolism: is there an interrelation?

    Directory of Open Access Journals (Sweden)

    Олена Юріївна Сорокіна

    2015-11-01

    Full Text Available Aim: To define an influence of hypermetabolism-hypercatabolism syndrome on the burn encephalopathy development on the base of study of metabolic changes on the background of an acute period of burn disease.  Materials and methods: there were examined 104 patients separated in 2 groups depending on heaviness of injury. There were defined the levels of cortisol, neurospecific enolase (NSE, glucose and blood protein. There were assessed memory, thinking and psychological state of patients.Results: At admission to hospital the cortisol level in patients of 1 and 2 groups was 270,5±29,2 ng/ml and 330,3±17,4 ng/ml, glucose level - 6,0±0,4 mmol/l and 7,7±0,5 mmol/l in 1 and 2 groups respectively. The protein level of blood maximally decreased at 3 day and was 53,6±1,1 g/l in patients of the 1 group and 48,9±1,1 g/l in patients of the 2 group. An increase of cortisol level depended on heaviness of thermal trauma.  There was defined correlation between the levels of cortisol and neuron specific enolase in patients of the 1 group at 3 day (R=0.638, p=0.006, in patients of the 2 group at 7 day (R=0.488, p=0.002. In patients of the 1 group sleep disorder and delirium development did not depended on the level of metabolic changes. At the 7 day there was defined correlative connection between cortisol level and memory (R=-0,681, p=0,071 and thinking (R=-0,520, p=0,038. In patients of the 2 group cortisol level at 1 day determined the memory and thinking disorders to the septic-toxemia stage.  Sleep disorder correlated with expressed hypoproteinomia at 3 day (R=-0,483, p=0,001. The delirium development was caused with an increase of blood serum cortisol at 1 day after thermal trauma (R=0,467, p=0,058.Conclusion: The one of mechanisms of nerve tissue injury was the development of metabolic changes caused by stress on the background of heavy thermal trauma. The dynamics of cortisol level to the burn shock stage corresponded with the changes of

  10. Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers.

    Science.gov (United States)

    Penny, Rachel; Coffey, Rebecca; Jones, Larry; Bailey, J Kevin

    It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.

  11. Reliability and Validity of the Turkish Version of Patient and Observer Scar Assessment Scale in Patients with Burns

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    Ayşe Kabuk

    2017-12-01

    Full Text Available Objective: To evaluation reliability and validity of the Turkish version of Patient and Observer Scar Assessment Scale (POSAS in patients with burns. Methods: This is a methodologically study. Data were collected using POSAS, survey form and plexiglas. Patient Scar Assessment Scale (PSAS was completed by patients (n=53 and Observer Scar Assessment Scale (OSAS was completed by two observers separately. The test-retest was measured applying the scales in 25 patients after two weeks. Data were analyzed by Kruskal-Wallis and Mann-Whitney U test. Content validity was determined using Kaiser-Meyer-Olkin, Barlett’s test and structure validity was performed by explanatory factor analysis (EFA and confirmatory factor analysis (CFA; reliability was evaluated using internal consistency, Cronbach’s alpha and intraclass correlation coefficient (ICC. Results: Factor weights were in appropriate range according to EFA, 6 items single factor structure of the original scale was valid and had high consistency index according to CFA, ICC between the 7th item and the total points was proportional, inner consistency was highly reliable (PSAS a=0.992, OSAS a=0.993, consistency between the observers was high (a=0.952, r=0.909. It was determined OSAS scores increased as the burn degree increased (p<0.05. Conclusion: POSAS was determined to be a valid and reliable scale in patients with burns in the Turkish society.

  12. The effect of a rehabilitation nursing intervention model on improving the comprehensive health status of patients with hand burns.

    Science.gov (United States)

    Li, Lin; Dai, Jia-Xi; Xu, Le; Huang, Zhen-Xia; Pan, Qiong; Zhang, Xi; Jiang, Mei-Yun; Chen, Zhao-Hong

    2017-06-01

    To observe the effect of a rehabilitation intervention on the comprehensive health status of patients with hand burns. Most studies of hand-burn patients have focused on functional recovery. There have been no studies involving a biological-psychological-social rehabilitation model of hand-burn patients. A randomized controlled design was used. Patients with hand burns were recruited to the study, and sixty patients participated. Participants were separated into two groups: (1) The rehabilitation intervention model group (n=30) completed the rehabilitation intervention model, which included the following measures: enhanced social support, intensive health education, comprehensive psychological intervention, and graded exercise. (2) The control group (n=30) completed routine treatment. Intervention lasted 5 weeks. Analysis of variance (ANOVA) and Student's t test were conducted. The rehabilitation intervention group had significantly better scores than the control group for comprehensive health, physical function, psychological function, social function, and general health. The differences between the index scores of the two groups were statistically significant. The rehabilitation intervention improved the comprehensive health status of patients with hand burns and has favorable clinical application. The comprehensive rehabilitation intervention model used here provides scientific guidance for medical staff aiming to improve the integrated health status of hand-burn patients and accelerate their recovery. What does this paper contribute to the wider global clinical community? Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Covering techniques for severe burn treatment: lessons for radiological burn accidents

    International Nuclear Information System (INIS)

    Carsin, H.; Stephanazzi, J.; Lambert, F.; Curet, P.M.; Gourmelon, P.

    2002-01-01

    Covering techniques for severe burn treatment: lessons for radiological burn accidents. After a severe burn, the injured person is weakened by a risk of infection and a general inflammation. The necrotic tissues have to be removed because they are toxic for the organism. The injured person also needs to be covered by a cutaneous envelope, which has to be done by a treatment centre for burned people. The different techniques are the following: - auto grafts on limited burned areas; - cutaneous substitutes to cover temporary extended burned areas. Among them: natural substitutes like xenografts (pork skin, sheep skin,..) or allografts (human skin), - treated natural substitutes which only maintain the extracellular matrix. Artificial skins belong to this category and allow the development of high quality scars, - cell cultures in the laboratory: multiplying the individual cells and grafting them onto the patient. This technique is not common but allows one to heal severely injured patients. X-ray burns are still a problem. Their characteristics are analysed: intensive, permanent, antalgic resistant pain. They are difficult to compare with heat burns. In spite of a small number of known cases, we can give some comments and guidance on radio necrosis cures: the importance of the patients comfort, of ending the pain, of preventing infection, and nutritional balance. At the level of epidermic inflammation and phlyctena (skin blisters), the treatment may be completed by the use of growth factors. At the level of necrosis, after a temporary cover, an auto graft can be considered only if a healthy basis is guaranteed. The use of cellular cultures in order to obtain harmonious growth factors can be argued. (author)

  14. Sedation and Analgesia in Burn

    Directory of Open Access Journals (Sweden)

    Özkan Akıncı

    2011-07-01

    Full Text Available Burn injury is one of the most serious injuries that mankind may face. In addition to serious inflammation, excessive fluid loss, presence of hemodynamic instability due to intercurrent factors such as debridements, infections and organ failure, very different levels and intensities of pain, psychological problems such as traumatic stress disorder, depression, delirium at different levels that occur in patient with severe burn are the factors which make it difficult to provide the patient comfort. In addition to a mild to moderate level of baseline permanent pain in burn patients, which is due to tissue damage, there is procedural pain as well, which occurs by treatments such as grafting and dressings, that are severe, short-term burst style 'breakthrough' pain. Movement and tactile stimuli are also seen in burn injury as an effect to sensitize the peripheral and central nervous system. Even though many burn centers have established protocols to struggle with the pain, studies show that pain relief still inadequate in burn patients. Therefore, the treatment of burn pain and the prevention of possible emergence of future psychiatric problems suc as post-traumatic stress disorder, the sedative and anxiolytic agents should be used as a recommendation according to the needs and hemodynamic status of individual patient. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 26-30

  15. Car radiator burns: a prevention issue.

    Science.gov (United States)

    Rabbitts, Angela; Alden, Nicole E; Conlin, Tara; Yurt, Roger W

    2004-01-01

    Scald burns continue to be the major cause of injury to patients admitted to the burn center. Scald burns occurring from car radiator fluid comprise a significant subgroup. Although manufacturer warning labels have been placed on car radiators, these burns continue to occur. This retrospective review looks at all patients admitted to our burn center who suffered scald burns from car radiator fluid to assess the extent of this problem. During the study period, 86 patients were identified as having suffered scald burns as a result of contact with car radiator fluid. Seventy-one percent of the burn injuries occurred in the summer months. The areas most commonly burned were the head and upper extremities. Burn prevention efforts have improved greatly over the years; however, this study demonstrates that scald burns from car radiator fluid continue to cause physical, emotional, and financial devastation. The current radiator warning labels alone are not effective. The National Highway Traffic Safety Administration has proposed a new federal motor vehicle safety standard to aid in decreasing the number of scald burns from car radiators. The results of this study were submitted to the United States Department of Transportation for inclusion in a docket for federal legislation supporting these safety measures.

  16. Assault by burning in Jordan

    Science.gov (United States)

    Haddadin, W.

    2012-01-01

    Summary Criminal attacks by burns on women in Jordan are highlighted in this retrospective study carried out of all proved cases of criminal burns in female patients treated at the burn unit of the Royal Rehabilitation Center in Jordan between January 2005 and June 2012. Thirteen patients were included in our study, out of a total of 550 patients admitted, all in the age range of 16-45 yr. Of these 13 women, six were burned by acid throwing, five by hot water, and two by direct flames from fuel thrown over them. Burn percentage ranged from 15 to 75% of the total body surface area, with involvement in most cases of the face and upper trunk. The mean hospital stay was 33 days and the mortality rate was 3/13, i.e. 23%. Violence against women exists in Jordanian society, yet burning assaults are rare. Of these, burning by throwing acid is the most common and most disfiguring act, with a higher mortality rate in domestic environments. PMID:23766757

  17. Use of methylnaltrexone to induce laxation in acutely injured patients with burns and necrotizing soft-tissue infections.

    Science.gov (United States)

    Hewitt, Kelly; Lin, Hsin; Faraklas, Iris; Morris, Stephen; Cochran, Amalia; Saffle, Jeffrey

    2014-01-01

    The routine use of high-dose opioids for analgesia in patients with acute burns and soft-tissue injuries often leads to the development of opioid-induced constipation. The opioid antagonist methylnaltrexone (MLTX) reverses narcotic-related ileus without affecting systemic pain treatment. The authors' burn center developed a bowel protocol that included administration of MLTX for relief of opioid-induced constipation after other methods failed. The authors performed a retrospective review of patients with acute burns or necrotizing soft-tissue infections, who had been given subcutaneous MLTX to induce laxation. All patients who received MLTX were included and all administrations of the drug were included in the analysis. The primary outcome examined was time to laxation from drug administration. Forty-eight patients received MLTX a total of 112 times. Six patients were admitted with soft-tissue injuries and the rest suffered burns with an average TBSA of 17%. The median patient age was 41 years and the majority (75%) were men. Administration of a single dose of MLTX resulted in laxation within 4 hours in 38% of cases, and within 24 hours in 68%. Patients given MLTX received an average of 174 mg morphine equivalents daily for pain control. MLTX was given after an average of 52 hours since the last bowel movement. As this experience has evolved, it has been incorporated into an organized bowel protocol, which includes MLTX administration after other laxatives have failed. MLTX is an effective laxation agent in patients with burn and soft-tissue injuries, who have failed conventional agents.

  18. Genital burns in the national burn repository: incidence, etiology, and impact on morbidity and mortality.

    Science.gov (United States)

    Harpole, Bethany G; Wibbenmeyer, Lucy A; Erickson, Bradley A

    2014-02-01

    To better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. The National Burn Repository, a large North American registry of hospitalized burn patients, was queried for patients with GB. Burn characteristics and mechanism, demographics, mortality, and surgical interventions were retrieved. Outcomes of interest were mortality, hospital-acquired infection (HAI), and surgical intervention on the genitalia. Adjusted odds ratios (aOR) for outcomes were determined with binomial logistic regression controlling for age, total burn surface area, race, length of stay, gender, and inhalation injury presence. GBs were present in 1245 cases of 71,895 burns (1.7%). Patients with GB had significantly greater average total burn surface area, length of stay, and mortality. In patients with GB, surgery of the genitalia was infrequent (10.4%), with the aOR of receiving surgery higher among men (aOR 2.7, P burns (aOR 3.1, P <.002). Presence of a GB increased the odds of HAI (aOR 3.0, P <.0001) and urinary tract infections (aOR 3.4, P <.0001). GB was also an independent predictor of mortality (aOR 1.54) even after adjusting for the increased HAI risk. GBs are rare but associated with higher HAI rates and higher mortality after adjusting for well-established mortality risk factors. Although a cause and effect relationship cannot be established using these registry data, we believe this study suggests the need for special management considerations in GB cases to improve overall outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  20. Reliable scar scoring system to assess photographs of burn patients.

    Science.gov (United States)

    Mecott, Gabriel A; Finnerty, Celeste C; Herndon, David N; Al-Mousawi, Ahmed M; Branski, Ludwik K; Hegde, Sachin; Kraft, Robert; Williams, Felicia N; Maldonado, Susana A; Rivero, Haidy G; Rodriguez-Escobar, Noe; Jeschke, Marc G

    2015-12-01

    Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose. We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3-12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. The intraclass correlation coefficient, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Subanalysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Characterisation of SCCmec elements in methicillin-resistant Staphylococcus aureus isolated from burn patients.

    Science.gov (United States)

    Namvar, Amirmorteza Ebrahimzadeh; Afshar, Mastaneh; Asghari, Babak; Rastegar Lari, Abdolaziz

    2014-06-01

    Staphylococcus aureus is an important pathogen, especially in burn units all around the world. Because of the emergence of the β-lactam antibiotic-resistant strains since 1961, concern about the prevalence of methicillin-resistant S. aureus (MRSA) has increased in these units. Resistance to methicillin is mediated by penicillin-binding proteins (PBPs) that have enough affinity for binding to the β-lactam ring, but another kind of protein (PBP2α), which is encoded by the mecA gene, has a lower affinity for binding to these antibiotics. The mecA gene is transferred by SCCmec (staphylococcal cassette chromosome mec) as a mobile genetic element, exclusively found in the Staphylococcus genus. Identification of the frequency of the mecA gene, different SCCmec types and also its incidence may have benefit in surveillance prevention and control of MRSA strains in burn units. In this study, 40 S. aureus isolates were collected from patients hospitalised in Motahari burn center of Tehran, during 2012-2013. Conventional microbiological methods were applied and the confirmed isolates were stored at -20°C for molecular polymerase chain reaction (PCR) tests. The antibiotic resistance pattern was performed by disc diffusion method and finally the different SCCmec types were determined by specific primers. During this research, 40 isolates of S. aureus were collected from burn patients, of which (37.5%) of the specimens belonged to female patients and 62.5% to male patients. The aetiology of the burn was classified as follows: open flame (35%), liquid (32.5%), chemical (5%) and other (27.5%). By a disc diffusion method, no resistance pattern was observed to vancomycin and fosfomycin. Based on a multiplex PCR assay, the five different SCCmec types were detected as: 47.5% type III, 25% type IV, 10% type V, 10% type II and 7.5% type I. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  2. Relationship between oxidative stress and "burning mouth syndrome" in female patients: a scientific hypothesis.

    Science.gov (United States)

    Tatullo, M; Marrelli, M; Scacco, S; Lorusso, M; Doria, S; Sabatini, R; Auteri, P; Cagiano, R; Inchingolo, F

    2012-09-01

    Burning Mouth Syndrome (BMS) is characterized by burning sensation and pain in the mouth with or without inflammatory signs and specific lesions. Aim of the present study was to investigate about a possible correlation between the Burning Mouth Syndrome and oxidative stress. We recruited 18 healthy female patients between 54 and 68 years of age with a diagnosis of Burning Mouth Syndrome. Oxidative stress assessment was performed by means of an integrated analytical system composed of a photometer and a mini-centrifuge (FRAS4, H and D s.r.l., Parma, Italy). Samples of whole capillary blood were taken by a finger puncture in a heparinized tube and immediately centrifuged; a small amount of samples plasma (10 microL) were thereafter tested for total oxidant capacity (d-ROMs test) and biological antioxidant potential as iron-reducing activity (BAP test) (Diacron International s.r.l., Grosseto, Italy). Our results indicate that female patients affected by Burning Mouth Syndrome show significantly different d-ROMs and BAP levels, similar to those present in oxidative stress condition with respect to the general population. It was also emphasized that, after the most painful phase, the levels representing the present oxidative stress, progressively return to normal, even if still significantly higher 7 days after, with respect to the normal population. No similar study was performed up to now. This study confirms the effectiveness of antioxidant treatments in the patients affected by BMS, in order to prevent or decrease the onset of oxidative stress and the consequent increased risk of oxidative-related systemic diseases.

  3. 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

    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......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...

  4. The treatment of extensively burned patents and β irradiational injury skin burn patients with irradiated pigskin

    International Nuclear Information System (INIS)

    Tang Zhongyi; Lu Xingan; Jing Ling; Qi Qiang

    1994-01-01

    Obvious therapeutic effects achieved by the covering of irradiation sterilized pigskin on burn wounds, escarectomized 3rd degree burn wounds β injured burns are discussed. The article also describes the manufacture processes of irradiated pigskins and the selection of surgical treatments of various burns. 5 refs., 1 tab., 4 figs

  5. Comparing the Workload Perceptions of Identifying Patient Condition and Priorities of Care Among Burn Providers in Three Burn ICUs.

    Science.gov (United States)

    McInnis, Ian; Murray, Sarah J; Serio-Melvin, Maria; Aden, James K; Mann-Salinas, Elizabeth; Chung, Kevin K; Huzar, Todd; Wolf, Steven; Nemeth, Christopher; Pamplin, Jeremy C

    Multidisciplinary rounds (MDRs) in the burn intensive care unit serve as an efficient means for clinicians to assess patient status and establish patient care priorities. Both tasks require significant cognitive work, the magnitude of which is relevant because increased cognitive work of task completion has been associated with increased error rates. We sought to quantify this workload during MDR using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Research staff at three academic regional referral burn centers administered the NASA-TLX to clinicians during MDR. Clinicians assessed their workload associated with 1) "Identify(ing) if the patient is better, same, or worse than yesterday" and 2) "Identify(ing) the most important objectives of care for the patient today." Data were collected on clinician type, years of experience, and hours of direct patient care. Surveys were administered to 116 total clinicians, 41 physicians, 25 nurses, 13 medical students, and 37 clinicians in other roles. Clinicians with less experience reported more cognitive work when completing both tasks (P NASA-TLX was an effective tool for collecting perceptions of cognitive workload associated with MDR. Perceived cognitive work varied by clinician type and experience level when completing two key tasks. Less experience was associated with increased perceived work, potentially increasing mental error rates, and increasing risk to patients. Creating tools or work processes to reduce cognitive work may improve clinician performance.

  6. Pediatric Burns in the Bedouin Population in Southern Israel

    Directory of Open Access Journals (Sweden)

    Arnon D. Cohen

    2007-01-01

    Full Text Available Burn trauma is an important public health concern, with increased risk for burns in children. A cross-sectional study was performed to describe the epidemiological characteristics and risk factors for burns in hospitalized Bedouin children in Soroka University Medical Center during the years 2001–2002. In a population of 558 hospitalized burn-injured patients, 282 Bedouin children were identified. Two hundred and sixty five patients (94.0% had burns involving less than 20% of the body surface area. Cause of the burns was scald in 190 patients (67.4%, fire in 80 patients (28.4%, chemical in 8 patients (2.8%, and explosion in 2 patients (0.7%. Two female patients (0.7% aged 11 and 17 years died of their burns that were caused by fire. The mean length of hospitalization was 9.8 days. Pediatric burn injury has become a significant public health problem in the Bedouin population of the Negev. To reduce the burden of burn injury, it is necessary to increase current efforts in prevention of burns.

  7. Evaluation of the effects of patient-selected music therapy on the sleep quality and pain intensity of burn patients

    Directory of Open Access Journals (Sweden)

    Fatemeh Muhaddith Ardabili

    2016-02-01

    Full Text Available Background: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Methods: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001 and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention approach be applied by

  8. Predictors of Discharge Disposition in Older Adults With Burns: A Study of the Burn Model Systems.

    Science.gov (United States)

    Pham, Tam N; Carrougher, Gretchen J; Martinez, Erin; Lezotte, Dennis; Rietschel, Carly; Holavanahalli, Radha; Kowalske, Karen; Esselman, Peter C

    2015-01-01

    Older patients with burn injury have a greater likelihood for discharge to nursing facilities. Recent research indicates that older patients discharged to nursing facilities are two to three times as likely to die within a 3-year period relative to those discharged to home. In light of these poor long-term outcomes, we conducted this study to identify predictors for discharge to independent vs nonindependent living status in older patients hospitalized for burns. We retrospectively reviewed all older adults (age ≥ 55 years) who were prospectively enrolled in a longitudinal multicenter study of outcomes from 1993 to 2011. Patient, injury, and treatment outcomes data were analyzed. Recognizing that transfer to inpatient rehabilitation may have impacted final hospital discharge disposition: we assessed the likelihood of inpatient rehabilitation stay, based on identified predictors of inpatient rehabilitation. We subsequently performed a logistic regression analysis on the clustered, propensity-matched cohort to assess associations of burn and injury characteristics on the primary outcome of final discharge status. A total of 591 patients aged ≥55 years were treated and discharged alive from three participating U.S. burn centers during the study period. Mean burn size was 14.8% (SD 11.2%) and mean age was 66.7 years (SD 9.3 years). Ninety-three patients had an inpatient rehabilitation stay before discharge (15.7%). Significant factors predictive of inpatient rehabilitation included a burn >20% TBSA, mechanical ventilation, older age, range of motion deficits at acute care discharge, and study site. These factors were included in the propensity model. Four hundred seventy-one patients (80%) were discharged to independent living status. By matched propensity analysis, older age was significantly associated with a higher likelihood of discharge to nonindependent living (P burn centers need to be elucidated to better understand discharge disposition status in older

  9. [Clinical effect of three dimensional human body scanning system BurnCalc in the evaluation of burn wound area].

    Science.gov (United States)

    Lu, J; Wang, L; Zhang, Y C; Tang, H T; Xia, Z F

    2017-10-20

    Objective: To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods: A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results: (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm(2,) respectively, and there was no statistically significant difference among them ( F =1.55, P >0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm(2,) respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc ( P >0.05). The wound area of limbs of patients

  10. Altered structure and function in the hippocampus and medial prefrontal cortex in patients with burning mouth syndrome.

    Science.gov (United States)

    Khan, Shariq A; Keaser, Michael L; Meiller, Timothy F; Seminowicz, David A

    2014-08-01

    Burning mouth syndrome (BMS) is a debilitating, idiopathic chronic pain condition. For many BMS patients, burning oral pain begins in late morning and becomes more intense throughout the day, peaking by late afternoon or evening. We investigated brain gray matter volume (GMV) with voxel-based morphometry (VBM), white matter fractional anisotropy (FA) with diffusion tensor imaging (DTI), and functional connectivity in resting state functional MRI (rsfMRI) in a tightly screened, homogeneous sample of 9 female, postmenopausal/perimenopausal BMS patients and 9 matched healthy control subjects. Patients underwent 2 scanning sessions in the same day: in the morning, when ongoing pain/burning was low, and in the afternoon, when pain/burning was significantly higher. Patients had increased GMV and lower FA in the hippocampus (Hc), and decreased GMV in the medial prefrontal cortex (mPFC). rsfMRI revealed altered connectivity patterns in different states of pain/burning, with increased connectivity between mPFC (a node in the default mode network) and anterior cingulate cortex, occipital cortex, ventromedial PFC, and bilateral Hc/amygdala in the afternoon compared with the morning session. Furthermore, mPFC-Hc connectivity was higher in BMS patients than control subjects for the afternoon but not the morning session. mPFC-Hc connectivity was related to Beck depression inventory scores both between groups and between burning states within patients, suggesting that depression and anxiety partially explain pain-related brain dysfunction in BMS. Overall, we provide multiple lines of evidence supporting aberrant structure and function in the mPFC and Hc, and implicate a circuit involving the mPFC and Hc in regulating mood and depressive symptoms in BMS. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  11. Pressure necrosis masquerading as a burn injury in a patient with a cervical epidural abscess producing acute quadriplegia.

    Science.gov (United States)

    Thorpe, Eric J; McCallin, John P; Miller, Sidney F

    2008-01-01

    A case of a patient with acute onset of quadriplegia from a cervical epidural abscess referred to our tertiary burn center is presented. The pattern of the patient's 'burns' suggested pressure necrosis. A literature review was undertaken of this unusual condition, its evaluation and management. Cervical epidural abscesses are rare and present in a variety of ways. Acute onset of quadriplegia without a history of trauma should trigger a workup to make the diagnosis. The management of complicating skin lesions or burns and the patient outcome will primarily be determined by the management of the epidural abscess.

  12. [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.

  13. The application of neuropathic pain questionnaires in burning mouth syndrome patients.

    Science.gov (United States)

    Heo, Jun-Young; Ok, Soo-Min; Ahn, Yong-Woo; Ko, Myung-Yun; Jeong, Sung-Hee

    2015-01-01

    To evaluate and compare the validity of the PainDETECT, DN4, and abbreviated DN4 (DN4i) neuropathic pain questionnaires for primary burning mouth syndrome (BMS), which is a burning sensation in the oral mucosa in the absence of any identifiable organic etiology. Eighty-one patients (42 with primary BMS and 39 with nociceptive pain) complaining of a burning sensation and pain in their oral mucosa were enrolled in this study. All of the patients completed the neuropathic pain questionnaires. The sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve were estimated. Then the relationship between pain intensity and total neuropathic pain score was investigated. Data were analyzed with the chi-square test and independent t test for subjects' baseline characteristic differences, and with Pearson correlation coefficients for the relationship of variables. The mean area under the ROC curves (AUCs) for PainDETECT, DN4, and DN4i were 0.81, 0.79, and 0.81, respectively. There was no statistically significant difference in the AUCs among the questionnaires. PainDETECT, DN4, and DN4i had a lower sensitivity and specificity for BMS compared to previous validation studies. The total scores for PainDETECT, DN4, and DN4i in the primary BMS group were significantly associated with pain intensity. Although the results of this study suggest that neuropathic pain questionnaires, such as PainDETECT and DN4, are not ideal principal screening tools for BMS patients, a substantial proportion of neuropathic symptoms in primary BMS patients were identified.

  14. Use of the low air loss bed system in treatment of burns patients.

    Science.gov (United States)

    Leeder, C J

    1979-01-01

    When a person is confined to bed, whatever the reason, small areas of soft tissues are compressed between the skeleton and the supporting surfaces. Transient circulatory disturbances resulting in epidermis to dermis damage or finally deep penetrating necrosis involving subcutaneous tissues, fascia muscle and bone may result. In the case of the severely burned patient who has already sustained gross trauma, any further destruction of tissues is to be avoided at all costs. The Low Air Loss Bed System offers many advantages in the care and management of the burns patient. There is a definite saving of nursing time by rendering unnecessary constant attention to the patient for preventative skin care, positioning, bed pan etc. The nurse is then able to devote her time positively to the more involved needs of the patient and family. It will also provide for periods of rest that are so often lacking, especially in the initial stages of treatment. The patient does not have to be kept on a rigid regime of Q2H turning. He is turned only for wound care, physio- and general body cleansing. His position may be contoured without having to touch him circumferentially. Any lifting and positioning necessary is easier for staff members due to the design of the unit, and more comfortable for the patient. Over a period of two years, eighteen patients with varying extent and degree of burn injuries were treated on the bed. This paper will describe the mechanical operation of the bed and experiences with nursing management and monitoring of the system.

  15. The role of resilience in the recovery of the burn-injured patient: an integrative review

    Directory of Open Access Journals (Sweden)

    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

  16. Studies of thermal-hydraulics and plant systems for actinide burning fast reactor concept

    International Nuclear Information System (INIS)

    Yamazaki, Seiichiro; Misumi, Masahiro; Izaki, Makoto; Koike, Hiroyuki; Tanaka, Ryokichi

    1984-01-01

    As one of the methods to dispose long life actinide nuclides, the actinide burning fast reactor using only actinide wastes as the fuel has been proposed. Kawasaki Heavy Industries Ltd. carried out the conceptual examination on the ABFR cooled with helium gas, cooperating with Japan Atomic Energy Research Institute, and its feasibility and problems were clarified. In this report, the setting-up of various fundamental dimensions by the parameter survey of the thermal and flowing performance of the core, the examination of the thermal and flowing characteristics of the core based on the detailed power distribution, and the examination of the plant system centering around the main cooling system are outlined. The fuel is composed of actinide oxide and diluent MgO. The diluent is used for obtaining proper excess reactivity, and MgO has been taken up also in foreign countries, considering the compatibility with actinide oxide, the easiness of reprocessing and manufacture. The fuel element is of pin type, and actinide oxide and MgO pellets are in a SUS 316 cladding tube. This ABFR can treat the wastes from ten 1000 MWe power reactors, and has the power output of about 1000 MWt. (Kako, I.)

  17. Small high temperature gas-cooled reactors with innovative nuclear burning

    International Nuclear Information System (INIS)

    Liem, Peng Hong; Ismail; Sekimoto, Hiroshi

    2008-01-01

    Since the innovative concept of CANDLE (Constant Axial shape of Neutron Flux, nuclide densities and power shape During Life of Energy producing reactor) burning strategy was proposed, intensive research works have been continuously conducted to evaluate the feasibility and the performance of the burning strategy on both fast and thermal reactors. We learned that one potential application of the burning strategy for thermal reactors is for the High Temperature Gas-Cooled Reactors (HTGR) with prismatic/block-type fuel elements. Several characteristics of CANDLE burning strategy such as constant reactor characteristics during burn-up, no need for burn-up reactivity control mechanism, proportionality of core height with core lifetime, sub-criticality of fresh fuel elements, etc. enable us to design small sized HTGR with a high degree of safety easiness of operation and maintenance, and long core lifetime which are required for introducing the reactors into remote areas or developing countries with limited infrastructures and resources. In the present work, we report our evaluation results on small sized block-type HTGR designs with CANDLE burning strategy and compared with other existing small HTGR designs including the ones with pebble fuel elements, under both uranium and thorium fuel cycles. (author)

  18. Hematogenous candida pneumonia in major burn patients: plain chest radiograph and thin-section CT findings

    International Nuclear Information System (INIS)

    Kim, Hyo Heon; Lee, Eil Seong; Shim, Ya Seong; Kim, Ji Hun; Suh, Hong Kil; Cho, Sin Young; Kim, Dae Sun; Lee, Kil Woo; Kang, Ik Won

    1995-01-01

    To describe plain radiographic and thin-section CT findings of hematogenous candida pneumonia in major burn patients. We reviewed nine cases of hematogenous candida pneumonia in major burn patients who had positive blood culture for candida and findings of pneumonia on plain chest radiograph. On five of nine cases, thin-section CT was done. We evaluated retrospectively nine cases for onset, the pattern, distribution, and size of lesions on plain chest radiograph and thin-section CT. On plain chest radiograph, randomly distributed 2-10 mm nodules were seen in six cases(66%) and randomly distributed 10-15 mm consolidations in remaining three cases(33%). Lesion occurred in 11th to 75th post-burn day(average, 34th post-burn day). Other findings were cardiomegaly in three cases, atelectasis in three cases, and pulmonary edema in one case. Thin-section CT showed variable shaped subpleural nodules in all five cases. The size of nodules were 1-5 mm in two cases(40%) and 5-10 mm(60%) in three cases. Feeding vessel signs were seen in two cases. Other findings were atelectasis in three cases, cardiomegaly in three cases, ground-glass opacity and interlobular septal thickenings by pulmonary edema in two cases. Plain chest radiographic findings of hematogenous candida pneumonia in major burn patients are randomly distributed nodules or consolidations of variable size. Thin-section CT findings are variable shaped subpleural nodules less than 1 cm

  19. The Effect of Massage on Anticipatory Anxiety and Procedural Pain in Patients with Burn Injury.

    Science.gov (United States)

    Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Manafi, Farzad

    2017-01-01

    Pain related to burn injuries is one of the most troublesome pain intensity. This study aimed to investigate the effect of massage on anticipatory anxiety, procedural pain intensity, vital signs and relaxation level of patients with burn injury. In this quasi-experimental study, through convenience sampling, 60 hospitalized adult burn patients were selected from a specialized burn and reconstructive hospital. Subjects were assigned to massage and control groups through simple randomization. Massage was offered by using non aromatic oil about 10-15 minutes before wound care on intact part of the body once a day for 20 minutes on patients' bedside for 3 consecutive days. In the 3 days, the control group did not received any massage and were asked to stay at bed. Demographic and clinical characteristics and vital signs, Visual Analogue Scale and the Persian version of Burn Specific Pain Anxiety Scale were used to determine baseline and procedural pain, anxiety and relaxation levels and anticipatory anxiety. No significant difference was noted between mean score of pain intensity, anxiety and relaxation level, and vital signs in massage and control groups after intervention following wound care. In massage and control groups, there was no significant differences between mean scores of anticipatory anxiety before and after intervention. There was no significant difference between the mean scores of anticipatory anxiety in massage and control groups after intervention prior wound care. Massage was shown not to have any effect on anticipatory anxiety and procedural pain.

  20. Thermal equilibrium, stability and burn control

    International Nuclear Information System (INIS)

    Cohn, D.

    1982-01-01

    A number of aspects of the thermal stability and equilibrium control of ignited tokamak plasma have been investigated. Examined approaches were passive control (the effect of radial motion, the effect of radial motion and small additional transport loss), active control (the compression and decompression of plasma, subignited operation with small amount of variable external heating, and density control), and thermal equilibrium control (additional power loss from impurity radiation and enhanced transport from increased ripple). One-D calculation has been made on thermal instability eigen-modes. It was found that for electron thermal induction loss given by Alcator scaling and for neoclassical ion transport, there was at most one unstable mode with a temperature profile which maintains the temperature profile at thermal equilibrium. The effect of the coupling of temperature fluctuation and the fluctuation in major radius was investigated. Temperature driven radial motion combined with a small amount of ripple transport loss was found to be a very effective mechanism for passive thermal stability control. (Kato, T.)

  1. Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

    Energy Technology Data Exchange (ETDEWEB)

    Vigil-Holterman, Luciana R. [Los Alamos National Laboratory

    2012-05-07

    This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of the open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.

  2. Accelerant-related burns and drug abuse: Challenging combination.

    Science.gov (United States)

    Leung, Leslie T F; Papp, Anthony

    2018-05-01

    Accelerants are flammable substances that may cause explosion when added to existing fires. The relationships between drug abuse and accelerant-related burns are not well elucidated in the literature. Of these burns, a portion is related to drug manufacturing, which have been shown to be associated with increased burn complications. 1) To evaluate the demographics and clinical outcomes of accelerant-related burns in a Provincial Burn Centre. 2) To compare the clinical outcomes with a control group of non-accelerant related burns. 3) To analyze a subgroup of patients with history of drug abuse and drug manufacturing. Retrospective case control study. Patient data associated with accelerant-related burns from 2009 to 2014 were obtained from the British Columbia Burn Registry. These patients were compared with a control group of non-accelerant related burns. Clinical outcomes that were evaluated include inhalational injury, ICU length of stay, ventilator support, surgeries needed, and burn complications. Chi-square test was used to evaluate categorical data and Student's t-test was used to evaluate mean quantitative data with the p value set at 0.05. A logistic regression model was used to evaluate factors affecting burn complications. Accelerant-related burns represented 28.2% of all burn admissions (N=532) from 2009 to 2014. The accelerant group had higher percentage of patients with history of drug abuse and was associated with higher TBSA burns, ventilator support, ICU stay and pneumonia rates compared to the non-accelerant group. Within the accelerant group, there was no difference in clinical outcomes amongst people with or without history of drug abuse. Four cases were associated with methamphetamine manufacturing, all of which underwent ICU stay and ventilator support. Accelerant-related burns cause significant burden to the burn center. A significant proportion of these patients have history of drug abuse. Copyright © 2017 Elsevier Ltd and ISBI. All rights

  3. Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial.

    Science.gov (United States)

    Burns-Nader, Sherwood; Joe, Lindsay; Pinion, Kelly

    2017-09-01

    Distraction is often used in conjunction with analgesics to minimize pain in pediatric burn patients during treatment procedures. Computer tablets provide many options for distraction items in one tool and are often used during medical procedures. Few studies have examined the effectiveness of tablet distraction in improving the care of pediatric burn patients. This study examines the effectiveness of tablet distraction provided by a child life specialist to minimize pain and anxiety in pediatric burn patients undergoing hydrotherapy. Thirty pediatric patients (4-12) undergoing hydrotherapy for the treatment of burns participated in this randomized clinical trial. The tablet distraction group received tablet distraction provided by a child life specialist while those in the control group received standard care. Pain was assessed through self-reports and observation reports. Anxiety was assessed through behavioral observations. Length of procedure was also recorded. Nurses reported significantly less pain for the tablet distraction group compared to the control group. There was no significant difference between groups on self-reported pain. The tablet distraction group displayed significantly less anxiety during the procedure compared to the control group. Also, the tablet distraction group returned to baseline after the procedure while those in the control group displayed higher anxiety post-procedure. There was no difference in the length of the procedure between groups. These findings suggest tablet distraction provided by a child life specialist may be an effective method for improving pain and anxiety in children undergoing hydrotherapy treatment for burns. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  4. Establishment of THERPRO Database and Estimation of the Effect of Fuel Burn-up on the Thermal Conductivity of Uranium Dioxide

    International Nuclear Information System (INIS)

    Lee, Hyun Seon

    2005-02-01

    Materials property data are an essential part of major disciplines in many engineering fields. To nuclear engineering, fundamental understanding of thermo-physical chemical mechanical properties of nuclear materials is very important. THERPRO data base that is re-designed and re-constructed through this study is a web-based on-line nuclear materials properties data base. For the future upgrade of the data base contemporary information technologies have been incorporated during the construction. Basically THERPRO data base has a hierarchical structure consisting of several levels: home page, element, compound, property, author, report, and bibliography level. All of data sets in each level are interconnected using network structure and thus every data can be easily retrieved including the bibliographical information by an appropriate query action. As a part of THERPRO DB utilization, the effect of fuel burn-up on the thermal conductivity of irradiated uranium dioxide is analyzed with the data contained in the data base as well as recent data published in the relevant journals. Their data are comparatively studied and the effect is estimated using FRAPCON-3 code with two in-pile data sets, BR-3 111i5 and Oconee rod 15309. The results show that the fuel center line temperature can differ 200 .deg. C∼400 .deg. C from thermal conductivity models depending on burn-up, which can significantly influence high burn-up fuel performance. In conclusion, it is demonstrated through this study that THERPRO data base can be a great utility for nuclear engineers and researchers, if appropriately utilized

  5. Which factors influence the development of post-traumatic stress disorder in patients with burn injuries? A systematic review of the literature.

    Science.gov (United States)

    Hobbs, Katherine

    2015-05-01

    This article aims to discover which variables influence the development of post-traumatic stress disorder in patients with burn injuries. It will also consider whether it is possible to predict which burns patients will develop PTSD. Post-traumatic stress disorder is an important psychopathology for burned patients as it can affect both physical outcomes and quality of life for those affected. Research states that PTSD may be identified in up to 30% of burns patients, making it relatively common. A systematic review of the literature was carried out using four databases. Eleven articles were identified from these searches, and were then analysed thematically to draw out common ideas. Gender, extraversion and neuroticism, attribution of blame, capacity for forgiveness, the event as a disaster or non-disaster, alcohol consumption and peri-traumatic emotional response were all found to influence burns patients' risk of developing PTSD. While it is possible to identify the factors that put burns patients are greater risk of developing PTSD, it is not possible to accurately predict who will go on to develop PTSD due to the interplay between variables and individual differences. Focus should instead be on screening for PTSD and timely recognition of intrusive symptoms. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  6. Firefighter burn injuries: predictable patterns influenced by turnout gear.

    Science.gov (United States)

    Kahn, Steven A; Patel, Jignesh H; Lentz, Christopher W; Bell, Derek E

    2012-01-01

    Approximately 100 firefighters suffer fatal injuries annually and tens of thousands receive nonfatal injuries. Many of these injuries require medical attention and restricted activity but may be preventable. This study was designed to elucidate etiology, circumstances, and patterns of firefighter burn injury so that further prevention strategies can be designed. In particular, modification of protective equipment, or turnout gear, is one potential strategy to prevent burn injury. An Institutional Review Board-approved retrospective review was conducted with records of firefighters treated for burn injury from 2005 to 2009. Data collected included age, gender, TBSA, burn depth, anatomic location, total hospital days per patient, etiology, and circumstances of injury. Circumstances of injury were stratified into the following categories: removal/dislodging of equipment, failure of equipment to protect, training errors, and when excessive external temperatures caused patient sweat to boil under the gear. Over the 4-year period, 20 firefighters were treated for burn injury. Mean age was 38.9 ± 8.9 years and 19 of 20 patients were male. Mean burn size was 1.1 ± 2.7% TBSA. Eighteen patients suffered second-degree burns, while two patients suffered first-degree burns. Mean length of hospitalization was 2.45 days. Scald burns were responsible for injury to 13 firefighters (65%). Flame burns caused injury to four patients (20%). Only three patients received contact burns (15%). The face was the site most commonly burned, representing 29% of injuries. The hand/wrist and ears were the next largest groups, with 23 and 16% of the injuries, respectively. Other areas burned included the neck (10%), arm (6.5%), leg (6.5%), knees (3%), shoulders (3%), and head (3%). Finally, the circumstance of injury was evaluated for each patient. Misuse and noncontiguous areas of protective equipment accounted for 14 of the 20 injuries (70%). These burns were caused when hot steam

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

    Directory of Open Access Journals (Sweden)

    Lai-Ping Wang

    2016-09-01

    Full Text Available 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.

  8. Burning characteristics of chemically isolated biomass ingredients

    International Nuclear Information System (INIS)

    Haykiri-Acma, H.; Yaman, S.; Kucukbayrak, S.

    2011-01-01

    This study was performed to investigate the burning characteristics of isolated fractions of a biomass species. So, woody shells of hazelnut were chemically treated to obtain the fractions of extractives-free bulk, lignin, and holocellulose. Physical characterization of these fractions were determined by SEM technique, and the burning runs were carried out from ambient to 900 o C applying thermal analysis techniques of TGA, DTG, DTA, and DSC. The non-isothermal model of Borchardt-Daniels was used to DSC data to find the kinetic parameters. Burning properties of each fraction were compared to those of the raw material to describe their effects on burning, and to interpret the synergistic interactions between the fractions in the raw material. It was found that each of the fractions has its own characteristic physical and thermal features. Some of the characteristic points on the thermograms of the fractions could be followed definitely on those of the raw material, while some of them seriously shifted to other temperatures or disappeared as a result of the co-existence of the ingredients. Also, it is concluded that the presence of hemicellulosics and celluloses makes the burning of lignin easier in the raw material compared to the isolated lignin. The activation energies can be arranged in the order of holocellulose < extractives-free biomass < raw material < lignin.

  9. Results of a protocol of transfusion threshold and surgical technique on transfusion requirements in burn patients.

    Science.gov (United States)

    O'Mara, Michael S; Hayetian, Fernando; Slater, Harvey; Goldfarb, I William; Tolchin, Eric; Caushaj, Philip F

    2005-08-01

    Blood loss and high rates of transfusion in burn centers remains an area of ongoing concern. Blood use brings the risk of infection, adverse reaction, and immunosuppression. A protocol to reduce blood loss and blood use was implemented. Analysis included 3-year periods before and after institution of the protocol. All patients were transfused for a hemoglobin below 8.0 gm/dL. Operations per admission did not change during the two time periods (0.78 in each). Overall units transfused per operation decreased from 1.56+/-0.06 to 1.25+/-0.14 units after instituting the protocol (pburns of less than 20% surface area, declining from 386 to 46 units after protocol institution, from 0.37 to 0.04 units per admission, and from 0.79 to 0.08 units per operation in this group of smallest burns. There was no change noted in the larger burns. This study suggests that a defined protocol of hemostasis, technique, and transfusion trigger should be implemented in the process of burn excision and grafting. This will help especially those patients with the smallest burns, essentially eliminating transfusion need in that group.

  10. Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

    Science.gov (United States)

    Boucher, Bradley A; Hudson, Joanna Q; Hill, David M; Swanson, Joseph M; Wood, G Christopher; Laizure, S Casey; Arnold-Ross, Angela; Hu, Zhe-Yi; Hickerson, William L

    2016-12-01

    High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. Prospective clinical pharmacokinetic study. Ten adult patients with burns receiving I/C for a documented infection and requiring high-dose CVVH were studied. Blood and effluent samples for analysis of I/C concentrations were collected for up to 6 hours after the I/C infusion for calculation of I/C total CL (CL T otal ), CL by CVVH (CL HF ), half-life during CVVH, volume of distribution at steady state (Vd ss ), and the percentage of drug eliminated by CVVH. In this patient sample, the mean age was 50 ± 17 years, total body surface area burns was 23 ± 27%, and 80% were male. Nine patients were treated with high-dose CVVH for acute kidney injury and one patient for sepsis. The mean delivered CVVH dose was 52 ± 14 ml/kg/hour (range 32-74 ml/kg/hr). The imipenem CL HF was 3.27 ± 0.48 L/hour, which accounted for 23 ± 4% of the CL T otal (14.74 ± 4.75 L/hr). Cilastatin CL HF was 1.98 ± 0.56 L/hour, which accounted for 45 ± 19% of the CL T otal (5.16 + 2.44 L/hr). The imipenem and cilastatin half-lives were 1.77 ± 0.38 hours and 4.21 ± 2.31 hours, respectively. Imipenem and cilastatin Vd ss were 35.1 ± 10.3 and 32.8 ± 13.8 L, respectively. Efficient removal of I/C by high-dose CVVH, a high overall clearance, and a high volume of distribution in burn intensive care unit patients undergoing this CRRT method warrant aggressive dosing to treat serious infections effectively depending on the infection site and/or pathogen. © 2016 Pharmacotherapy Publications, Inc.

  11. A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients

    OpenAIRE

    Baghel, P. S.; Shukla, S.; Mathur, R. K.; Randa, R.

    2009-01-01

    To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: ?honey group? and ?SSD group?. Time elapsed since burn was recorded. After washing wi...

  12. Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting.

    Science.gov (United States)

    Carlsson, Anders H; Rose, Lloyd F; Fletcher, John L; Wu, Jesse C; Leung, Kai P; Chan, Rodney K

    2017-02-01

    Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (pskin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete excision. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  13. Telemedicine and burns: an overview.

    Science.gov (United States)

    Atiyeh, B; Dibo, S A; Janom, H H

    2014-06-30

    Access to specialized burn care is becoming more difficult and is being restricted by the decreasing number of specialized burn centers. It is also limited by distance and resources for many patients, particularly those living in poverty or in rural medically underserved communities. Telemedicine is a rapidly evolving technology related to the practice of medicine at a distance through rapid access to remote medical expertise by telecommunication and information technologies. Feasibility of telemedicine in burn care has been demonstrated by various centers. Its use facilitates the delivery of care to patients with burn injuries of all sizes. It allows delivery of acute care and can be appropriately used for a substantial portion of the long-term management of patients after a burn by guiding less-experienced surgeons to treat and follow-up patients more appropriately. Most importantly, it allows better effective triage which reduces unnecessary time and resource demanding referrals that might overwhelm system capacities. However, there are still numerous barriers to the implementation of telemedicine, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and an inadequate evidence base of its value and efficiency.

  14. Comparison between topical honey and mafenide acetate in treatment of auricular burn.

    Science.gov (United States)

    Hashemi, Basir; Bayat, Akbar; Kazemei, Tayebe; Azarpira, Negar

    2011-01-01

    The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons. Mafenide acetate is a topical agent used routinely for these patients, but it has some disadvantages including painful application and allergic rash. Some authors have reported the healing effect and antibacterial activity of honey. The study reported here was undertaken to compare the effect of honey and mafenide acetate on auricular burn in rabbit. In our study, although the pathologic score of the honey group was better than that of the mafenide group both on 14 and 21 days after burning, it was not statistically significant. In the mafenide acetate group, deep complication of burn (chondritis) was significantly lower than that of the honey group. In conclusion, in contrast to healing and antibiotic activity reported for honey, it may have failure in preventing deep bacterial complications of wound (like chondritis). So in deep wounds, the use of honey as dressing is not recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Cardiovascular risk profile in burn survivors.

    Science.gov (United States)

    Leung, Becky; Younger, John F; Stockton, Kellie; Muller, Michael; Paratz, Jennifer

    2017-11-01

    Burn patients have prolonged derangements in metabolic, endocrine, cardiac and psychosocial systems, potentially impacting on their cardiovascular health. There are no studies on the risk of cardiovascular disease (CVD) after-burn. The aim of our study was to record lipid values and evaluate CVD risk in adult burn survivors. In a cross-sectional study patients ≥18 years with burn injury between 18-80% total burn surface area (TBSA) from 1998 to 2012 had total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides measured via finger prick. Means were compared to optimal ranges. Multivariate regression models were performed to assess the association of lipids with age, years after-burn and total body surface area % (TBSA). A p value Risk Score (FGCRS) was calculated. Fifty patients were included in the study. Compared to optimal values, patients had low HDL and high triglycerides. Greater %TBSA was associated with statistically significant elevation of triglycerides (p=0.007) and total cholesterol/HDL ratio (p=0.027). The median FGCRS was 3.9% (low) 10-year risk of CVD with 82% of patients in the low-risk category. Patients involved in medium/high level of physical activity had optimal values of HDL, TC/HDL and triglycerides despite the magnitude of TBSA%. Adult burn survivors had alterations in lipid profile proportional to TBSA, which could be modified by exercise, and no increase in overall formally predicted CVD risk in this cross sectional study. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  16. Explanatory Model of Resilience in Pediatric Burn Survivors.

    Science.gov (United States)

    Quezada, Lucía; González, Mónica T; Mecott, Gabriel A

    2016-01-01

    Identifying factors of adjustment in pediatric burn patients may facilitate appropriate mental health interventions postinjury. The aim of this is study was to explore the roles of both the patient's and caregivers' resilience and posttraumatic stress in pediatric burn survivor adjustment. For the purposes of the study, "51 patient-parent/guardian" dyads participated. Patients answered the Resilience Questionnaire for Children and Adolescents, and caregivers answered the Mexican Resilience Scale and the Davidson Trauma Scale. The roles of patient age, time since the burn, and size of burn injury were also considered. Statistical analyses included Spearman's ρ for correlations and structural equation modeling. P less than .05 was considered significant. Patients and caregivers reported high levels of resilience, and the majority of caregivers reported low severity of posttraumatic stress disorder symptoms. Pediatric burn survivors' resilience was associated with being younger at the time of the burn and less severity of intrusive and avoidance symptoms in caregivers; it was also associated with a higher resilience in caregivers. It can be concluded that psychological responses of caregivers of pediatric burn survivors affect the well being and positive adjustment of patients; thus psychological services for caregivers would likely have a double benefit for both caregivers and patients.

  17. Comparison between burning mouth syndrome patients with and without psychological problems.

    Science.gov (United States)

    Kim, M-J; Kim, J; Kho, H-S

    2018-07-01

    The purpose of this study was to compare clinical and socio-demographic characteristics between burning mouth syndrome (BMS) patients with and without psychological problems. Of 644 patients with symptoms of oral burning, 224 with primary BMS were selected on the basis of laboratory testing, medical history, and psychometric tests: 39 with psychological problems (age 62.5±11.5years) and 185 without psychological problems (age 58.4±11.4years). Comprehensive clinical and socio-demographic characteristics, including psychological profiles and salivary flow rates, were compared between the two groups. No significant difference in sex ratio, duration and diurnal pattern of symptoms, unstimulated whole saliva flow rate, or marital status was found between the groups. The patients with psychological problems had a significantly higher mean age, reduced stimulated whole saliva flow rate, and lower level of education than those without psychological problems. The patients with psychological problems also displayed higher rates and greater severity of various types of BMS-related symptom in most parts of the oral mucosa, higher rates of stress-related symptoms, and greater difficulties in daily activities. The severity of taste disturbance was the factor most significantly correlated with the level of psychometry. In conclusion, psychological problems in BMS patients are associated with an aggravation of BMS symptoms. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Pattern of burn injury at north of Jordan.

    Science.gov (United States)

    Bataineh, Ziad A; Al Quran, Thekraiat M; Al Balas, Hamzeh; Khammash, Muhmammad R

    2018-01-01

    To the best of our knowledge, pattern of burn injury was not reported yet at our region, our hospital considered the only tertiary referral center with the only burn unit at the region since 2001 till date, a retrospective analysis of our computerized filing system recorded 527 burn patients between 2001-2016, mean age was 26 years; 1.27:1 was the male to female ratio, 79 patients were found to have major burns, 46% of admissions were below 20 years' age, 92% was at domestic site of affection and 65% due to flame burn followed by scald burn in about 23%. The limbs were the most affected body site, majority of patients were below 15% TBSA and partial thickness, 77 patients found to have inhalational injury. Our mean hospital stay was 16 days and mortality was 8.2%. Mortality was associated with high TBSA affection, depth and flame type. This study shows the pattern of burn at north of Jordan, preventive measures by education and observation will reduce the incidence of burn and its sequel, non-flammable cook plates and stoves will probably help in decrease burn morbidity and mortality.

  19. Thromboembolic Complications in Thermally Injured Patients,

    Science.gov (United States)

    1992-12-01

    profilaxis con brdld vanec entre 0.4% et 7%. La signification cliniquc de ces heparina, militan en contra de su uso rutinario, excepto en Ev~nements est...centros adopten rutinariamente la profilaxis 8. Purdue, G.F., Hunt, J.L.: Pulmonary emboli in burned patients. J. con heparina de baja dosificaci6n. Se

  20. Acute pavement burns: a unique subset of burn injuries: a five-year review of resource use and cost impact.

    Science.gov (United States)

    Silver, Andrew G; Dunford, Gerrit M; Zamboni, William A; Baynosa, Richard C

    2015-01-01

    This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient's stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries.

  1. A retrospective study to determine the incidence of pressure ulcers in burn patients using an alternating pressure mattress.

    Science.gov (United States)

    Still, Joseph M; Wilson, Joan; Rinker, Connie; Law, Edward; Craft-Coffman, Beretta

    2003-08-01

    In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

  2. Paediatric post-burn scar management in the UK: a national survey.

    Science.gov (United States)

    Liuzzi, Francesca; Chadwick, Sarah; Shah, Mamta

    2015-03-01

    Thermal injuries affect 250,000 people annually in the United Kingdom. As burn survival improves, good scar management is paramount to help individuals living with the resultant scars lead a life without restrictions. Post-burn hypertrophic scars can limit growth in children, interfere with function and cause psychological problems. In the current literature there is great variation in post-burn scar management across the world and in the evidence available for the efficacy of these management modalities. The aim of this study was to investigate the variances if any, in the management of post-burn scarring in children across the UK. A telephone survey of UK paediatric burn services was conducted to obtain information on post-burn scar management and advice given to patients/carers. Of the 19 burn services that participated, all advised moisturising of scars but with variable emphasis on massaging. Silicones and pressure therapy were used by 18 services but commencement of use varied from soon after healing to onset of hypertrophic scarring. Laser therapy, ultrasound therapy and steroid therapy were used sporadically. This study highlights the common modalities of post-burn scar management in children across the UK. However, there is marked variation in timing and selection of the commonly used modalities. Although this study did not investigate the outcomes of scar management, it clearly identifies the need for a well-designed multi-centred study to establish evidence-based best practice in the management of post-burn scarring in children as these modalities are time consuming and not without potential complications. Evidence based practice could potentially lead to significant financial savings to the health service. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  3. 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.

  4. Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice.

    Science.gov (United States)

    Cambiaso-Daniel, Janos; Parry, Ingrid; Rivas, Eric; Kemp-Offenberg, Jennifer; Sen, Soman; Rizzo, Julie A; Serghiou, Michael A; Kowalske, Karen; Wolf, Steven E; Herndon, David N; Suman, Oscar E

    2018-03-22

    Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with >30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivor's ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor.

  5. Simulation of thermal effectiveness under coal dust burning

    International Nuclear Information System (INIS)

    Korabejnikova, V.K.

    2001-01-01

    The simulation equation of polydisperse fuel (coal dust) torch combustion in the definite zones of burning cameras of stream generator and taking into account reactions in kinetic and diffusion areas at distinguishing temperatures of particles and gas are considered. (author)

  6. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    Science.gov (United States)

    2015-10-01

    movement.  Due to this  biomechanical  difference, the validity of current standard GM methods related to patient  function with burn scars is questioned...as a source of tissue recruitment or  restriction when evaluating ROM.  Standard GM methods do not account for the cutaneous  biomechanical ...complete. Each  column is labelled according to the categories on the CRFs and data should be entered  horizontally in the top available  row . The excel

  7. 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. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  8. Posttraumatic Stress and Cognitive Processes in Patients with Burns

    OpenAIRE

    Sveen, Josefin

    2011-01-01

    A severe burn is one of the most traumatic injuries a person can experience. Posttraumatic stress disorder (PTSD) is relatively common after burns, and can be devastating for the individual’s possibilities for recovery. The principal aims were to gain knowledge regarding posttraumatic stress symptoms and cognitive processes after burn and to evaluate methods for assessing symptoms of PTSD up to one year after burn. The psychometric properties of a Swedish version of the Impact of Event Scale-...

  9. Non-linear analysis of solid propellant burning rate behavior

    Energy Technology Data Exchange (ETDEWEB)

    Junye Wang [Zhejiang Univ. of Technology, College of Mechanical and Electrical Engineering, Hanzhou (China)

    2000-07-01

    The parametric analysis of the thermal wave model of the non-steady combustion of solid propellants is carried out under a sudden compression. First, to observe non-linear effects, solutions are obtained using a computer under prescribed pressure variations. Then, the effects of rearranging the spatial mesh, additional points, and the time step on numerical solutions are evaluated. Finally, the behaviour of the thermal wave combustion model is examined under large heat releases (H) and a dynamic factor ({beta}). The numerical predictions show that (1) the effect of a dynamic factor ({beta}), related to the magnitude of dp/dt, on the peak burning rate increases as the value of beta increases. However, unsteady burning rate 'runaway' does not appear and will return asymptotically to ap{sup n}, when {beta}{>=}10.0. The burning rate 'runaway' is a numerical difficulty, not a solution to the models. (2) At constant beta and m, the amplitude of the burning rate increases with increasing H. However, the increase in the burning rate amplitude is stepwise, and there is no apparent intrinsic instability limit. A damped oscillation of burning rate occurs when the value of H is less. However, when H>1.0, the state of an intrinsically unstable model is composed of repeated, amplitude spikes, i.e. an undamped oscillation occurs. (3) The effect of the time step on the peak burning rate increases as H increases. (Author)

  10. Burning mouth syndrome

    Directory of Open Access Journals (Sweden)

    K A Kamala

    2016-01-01

    Full Text Available Burning mouth syndrome (BMS is multifactorial in origin which is typically characterized by burning and painful sensation in an oral cavity demonstrating clinically normal mucosa. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS. An interdisciplinary and systematic approach is required for better patient management. The purpose of this study was to provide the practitioner with an understanding of the local, systemic, and psychosocial factors which may be responsible for oral burning associated with BMS, and review of treatment modalities, therefore providing a foundation for diagnosis and treatment of BMS.

  11. Bacteriological profile of burn wound isolates in a burns center of a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Amankwa Richcane

    2017-01-01

    Full Text Available Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity.Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3% and females 35 (40.7%. Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%, followed by Pseudomonas spp. 21(24.4%, Escherichia coli 17(19.8%, Klebsiella spp. 12(14.0%. Coagulase negative Staphylococcus accounted for 2(2.3%. Overall prevalence of infection in the study was 90.7%.Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.

  12. Long term mortality in critically ill burn survivors.

    Science.gov (United States)

    Nitzschke, Stephanie; Offodile, Anaeze C; Cauley, Ryan P; Frankel, Jason E; Beam, Andrew; Elias, Kevin M; Gibbons, Fiona K; Salim, Ali; Christopher, Kenneth B

    2017-09-01

    Little is known about long term survival risk factors in critically ill burn patients who survive hospitalization. We hypothesized that patients with major burns who survive hospitalization would have favorable long term outcomes. We performed a two center observational cohort study in 365 critically ill adult burn patients who survived to hospital discharge. The exposure of interest was major burn defined a priori as >20% total body surface area burned [TBSA]. The modified Baux score was determined by age + %TBSA+ 17(inhalational injury). The primary outcome was all-cause 5year mortality based on the US Social Security Administration Death Master File. Adjusted associations were estimated through fitting of multivariable logistic regression models. Our final model included adjustment for inhalational injury, presence of 3rd degree burn, gender and the acute organ failure score, a validated ICU risk-prediction score derived from age, ethnicity, surgery vs. medical patient type, comorbidity, sepsis and acute organ failure covariates. Time-to-event analysis was performed using Cox proportional hazard regression. Of the cohort patients studied, 76% were male, 29% were non white, 14% were over 65, 32% had TBSA >20%, and 45% had inhalational injury. The mean age was 45, 92% had 2nd degree burns, 60% had 3rd degree burns, 21% received vasopressors, and 26% had sepsis. The mean TBSA was 20.1%. The mean modified Baux score was 72.8. Post hospital discharge 5year mortality rate was 9.0%. The 30day hospital readmission rate was 4%. Patients with major burns were significantly younger (41 vs. 47 years) had a significantly higher modified Baux score (89 vs. 62), and had significantly higher comorbidity, acute organ failure, inhalational injury and sepsis (all Pburns. In the multivariable logistic regression model, major burn was associated with a 3 fold decreased odds of 5year post-discharge mortality compared to patients with TBSAburn, gender and the acute organ failure score

  13. Analgesic and antisympathetic effects of clonidine in burn patients, a randomized, double-blind, placebo-controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Ostadalipour Abbas

    2007-01-01

    Full Text Available Objectives: Unlike most other Analgesic drugs, α2 adrenoceptor agonists are capable of producing analgesia. The aim of this study was to evaluate the Analgesic and antisympathetic effects of clonidine, an α2 adrenoceptor agonist in burn patients. Materials and Methods: This randomized, double-blind, placebo-controlled clinical trial performed on one hundred burn patients in Zarea Hospital, Mazandaran, Iran from august 2004 to July 2005. All patients divided in two groups. Case group (n=50 received oral clonidine, 3.3μg/kg TDS and controls (n=50 received placebo. Heart rate and systolic blood pressure and pain severity Visual analogue score (VAS, were recorded after clonidine administration. Statistical analysis was done by means of Mann Witney U test. Results: 50 patients (mean age 28.96±10 years in case group, and 50 patients (mean age 27.60±11.4 years in control group were studied. VAS pain scores and heart rate in the clonidine group were significantly lower than the control group (P< 0.0001, P< 0.02.there were no significant difference in systolic blood pressure between the two groups on the first and second day but on third day the systolic blood pressure in clonidine group, was lower than controls significantly (P=0.002. Conclusion: This study demonstrates that the use of oral clonidine affects the hemodynamic response to pain in burn patients. Our study demonstrated that clonidine can produce good analgesia and decreased in sympathetic over activity in burn patients, and also reduce opioid dose requirements.

  14. Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

    Directory of Open Access Journals (Sweden)

    Çiğdem Aliosmanoğlu

    2011-06-01

    Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.

  15. OPTIONS FOR USE OF APPROPRIATE ANTICOAGULANT THERAPY IN PATIENTS WITH THERMAL INJURY WITH A HIGH RISK OF THROMBOEMBOLIC COMPLICATIONS DEVELOPMENT ASSOCIATED WITH RECURRENT INTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    V. S. Borisov

    2015-01-01

    Full Text Available ABSTRACT. Patients with major thermal injury require anticoagulant therapy during almost the whole period of the burn disease, forcing the physician to balance constantly between the risk of possible bleeding associated with surgical treatment and the risk of thrombosis development in patients demonstrating a number of factors predisposing to the development of VTС. We report a clinical case of appropriate anticoagulant therapy using the new oral anticoagulants in a patient with a high risk of VTС development and recurrent bleeding from the tumor of the ascending colon. 

  16. Adult survivors' lived experience of burns and post-burn health: A qualitative analysis.

    Science.gov (United States)

    Abrams, Thereasa E; Ogletree, Roberta J; Ratnapradipa, Dhitinut; Neumeister, Michael W

    2016-02-01

    The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study explores the experiences and perceptions early (ages 18-35) and midlife (ages 36-64) adults providing insight for how participants perceived their burns in relationship to their post-burn health. Participants were interviewed using semi-structured interview questions framed around seven domains of health. Interview recordings were transcribed verbatim then coded line by line, identifying dominant categories related to health. Categories were analyzed identifying shared themes among the study sample. Participants were Caucasian, seven males and one female. Mean age at time of interviews was 54.38 and 42.38 at time of burns. Mean time since burns occurred was 9.38 years with a minimum of (20%) total body surface area (TBSA) burns. Qualitative content analysis rendered three emergent health-related categories and associated themes that represented shared meanings within the participant sample. The category of "Physical Health" reflected the theme physical limitations, pain and sensitivity to temperature. Within the category of "Intellectual Health" were themes of insight, goal setting and self-efficacy, optimism and humor and within "Emotional Health" were the themes empathy and gratitude. By exploring subjective experiences and perceptions of health shared through dialog with experienced burned persons, there are opportunities to develop a more complete picture of how holistic health may be affected by major burns that in turn could support future long-term rehabilitative trajectories of early and midlife adult burn patients. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  17. Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

    Science.gov (United States)

    Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

    2015-01-01

    Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

  18. The Western Australia Population-based Burn Injury Project: Using record linkage to examine long-term effects of burn injury

    Directory of Open Access Journals (Sweden)

    Janine Duke

    2017-04-01

    Both minor and severe burns were associated with increased long-term cardiovascular and musculoskeletal morbidity and mortality. These results identify treatment needs for burn patients for a prolonged time after discharge. Further research that links primary care and pharmaceutical data is required to facilitate identification of at-risk patients and appropriate treatment pathways to reduce post-burn morbidity.

  19. Microbiological and quantitative analysis of burn wounds in the burn unit at a tertiary care hospital in Kashmir

    Directory of Open Access Journals (Sweden)

    Tahir Saleem Khan

    2016-01-01

    Full Text Available Background: The burn wound represents a susceptible site for opportunistic colonization by organisms of endogenous and exogenous origin. The present study was undertaken to analyze the microflora of burn wounds of the burn patients from a tertiary care hospital in Kashmir, India. Materials sand Methods: The study included all patients with acute burns admitted from January 2010 to December 2011 (2 years. The standard techniques, as practiced during collection of microbiological specimens, were used during wound swab/biopsy collection. Results: 74.19% of swab cultures yielded single isolates. On swab culture, Pseudomonas aeruginosa was the commonly isolated organism (46.86%. Staphylococcus aureus was the most common isolate isolated during 1st postburn week (30.86%. 258/288 (89.58% blood cultures were sterile. 8/58 (13.79% blood cultures were positive during the second postburn week. S. aureus was the most common organism grown on blood culture (44.44%. P. aeruginosa was mostly sensitive to polymyxin B (86.0%, amikacin (40.0%, and ciprofloxacin (37.3%, respectively. S. aureus was most commonly sensitive to linezolid (85.0% and vancomycin (78.8%% whereas Acinetobacter spp. was sensitive to polymyxin B (65.3%, piperacillin/tazobactam (44.9%, and amikacin (38.8%. Patients (27.27% who showed local signs of burn wound infection and positive blood culture were subjected to burn wound biopsy. 93.33% of patients who had counts >105 colony-forming unit/g of tissue showed significant association with local signs of burn wound infection and positive blood culture for any organism. Conclusion: The microbiological surveillance of burn wounds needs to be continued for a rational antibiotic policy and prevention of emergence of resistant organisms. Burn wound biopsy culture is an effective tool for quantitative analysis of burn wounds; however, subjecting this biopsy to histological examination is more predictable of burn wound infection and its correlation

  20. SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS - A RETROSPECTIVE ANALYSIS

    NARCIS (Netherlands)

    MANSON, WL; KLASEN, HJ; SAUER, EW; OLIEMAN, A

    In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral

  1. [Fat grafting in facial burns sequelae].

    Science.gov (United States)

    Viard, R; Bouguila, J; Voulliaume, D; Comparin, J-P; Dionyssopoulos, A; Foyatier, J-L

    2012-06-01

    Fat graft is now part of the armamentarium in face plastic surgery. It is successfully used in burn scars. The aim of our study is the discussion of the value of this technique in optimizing cosmetic result of burns face sequelae. Fifteen adult patients (10 females and five males) with scars resulting from severe burns 2 to 9 years previously were selected. The patients were treated by injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman's technique. Two to three injections were administered at the dermohypodermal junction. Ages, sexes, aetiology of burn, facial burn sequelae, recipient sites, quantity of fat injected, aesthetic results are discussed. Patient age ranged from 21 to 55 years (average: 38). The mean follow-up of the study was 66 months (23-118). Patients received 7.5 (5-11) facial restorative surgeries before fat graft. Patients underwent two sessions of fat transfer, 33cc average per session. We did not report any complications. The clinical appearance, discussed by three surgeons and subjective patient feelings, after a 6-month follow-up period, suggests considerable improvement in the mimic features, skin texture, and thickness. The result is good in 86% of cases and acceptable in the other cases. Burns sequelae offer local conditions which justify special cannula can cross fibrosis and explaining the value of multiplying the sessions. Indications for lipostructure include four distinct nosological situations, sometimes combined. Lipostructure can restore a missing relief, filling a localized depression, reshape a lack of face volume or smooth a scarring skin. Fat graft seems to complete and improve the results of the standard surgical approach in burned face. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  2. Evaluation of burn injuries related to liquefied petroleum gas.

    Science.gov (United States)

    Tarim, Mehmet Akin

    2014-01-01

    Liquefied petroleum gas (LPG) is a fuel that is widely used for domestic, agricultural, and industrial purposes. LPG is also commonly used in restaurants, industries, and cars; however, the home continues to be the main site for accidents. In Turkey, the increased usage of LPG as a cooking or heating fuel has resulted in many burn injuries from LPG mishaps. Between January 2000 and June 2011, 56 LPG-burned patients were compared with 112 flame-burned patients. There were no significant differences with respect to the mean age, sex, hospitalization time, and mortality in both groups. In the LPG-caused burn cases, 41 burns (73.2%) occurred at home, seven (12.5) were work-related mishaps, and eight (14.3) were associated with car accidents. The majority of the LPG burns (82%, 46 patients) resulted from a gas leak, and 18% of them were related to the failure to close LPG tubes in the patients' kitchens (10 patients). Burns to the face and neck (82 vs 67%, P = .039) and upper (62 vs 23%, P = .000) and lower (70 vs 45%, P = .002) extremities were significantly higher in LPG-caused burn cases than flame-burned cases. General awareness regarding the risk of LPG and first aid for burns appears to be lacking. The LPG delivery system should be standardized throughout countries that widely use LPG.

  3. Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes.

    Science.gov (United States)

    Konstantatos, A H; Angliss, M; Costello, V; Cleland, H; Stafrace, S

    2009-06-01

    Pain arising in burns sufferers is often severe and protracted. The prospect of a dressing change can heighten existing pain by impacting both physically and psychologically. In this trial we examined whether pre-procedural virtual reality guided relaxation added to patient controlled analgesia with morphine reduced pain severity during awake dressings changes in burns patients. We conducted a prospective randomized clinical trial in all patients with burns necessitating admission to a tertiary burns referral centre. Eligible patients requiring awake dressings changes were randomly allocated to single use virtual reality relaxation plus intravenous morphine patient controlled analgesia (PCA) infusion or to intravenous morphine patient controlled analgesia infusion alone. Patients rated their worst pain intensity during the dressing change using a visual analogue scale. The primary outcome measure was presence of 30% or greater difference in pain intensity ratings between the groups in estimation of worst pain during the dressing change. Of 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone. The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher pain intensities during the dressing change (mean=7.3) compared with patients receiving morphine PCA alone (mean=5.3) (p=0.003) (95% CI 0.6-2.8). The addition of virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes. In the absence of a validated predictor for responsiveness to virtual reality relaxation such a therapy cannot be recommended for general use in burns patients having awake dressings changes.

  4. Difficulties in controlling mobilization pain using a standardized patient-controlled analgesia protocol in burns.

    Science.gov (United States)

    Nilsson, Andreas; Kalman, Sigga; Sonesson, Lena Karin; Arvidsson, Anders; Sjöberg, Folke

    2011-01-01

    The aim of this study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no pain and 10 = unbearable pain), patients were asked to estimate their acceptable and worst experienced pain by specifying a number on a scale and at what point they would like additional analgesics. Patients were allowed free access to morphine with a PCA pump device. Bolus doses were set according to age, (100 - age)/24 = bolus dose (mg), and 6 minutes lockout time. Degrees of pain, morphine requirements, doses delivered and demanded, oral intake of food, and antiemetics given were used as endpoints. Acceptable pain (mean [SD]) was estimated to be 3.8 (1.3) on the NRS, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean morphine per day was 81 (15) mg, and the number of doses requested increased during the first 6 days after the burn. The authors found no correlation between dose of morphine required and any other variables. Background pain can be controlled adequately with a standard PCA protocol. During mobilization, the pain experienced was too intense, despite having the already high doses of morphine increased. The present protocol must be refined further to provide analgesia adequate to cover mobilization as well.

  5. A review of campfire burns in children: The QLD experience.

    Science.gov (United States)

    Okon, O; Zhu, L; Kimble, R M; Stockton, K A

    2018-03-27

    Campfire burns in children are a significant health issue. It is imperative that the extent of the problem is examined and strategies discussed to inform future prevention campaigns. A retrospective review of data from the Queensland Paediatric Burns Registry for all children presenting with campfire burns between January 2013 and December 2014 (inclusive). Information collected included patient demographics, detail regarding mechanism of injury, first aid, Total Body Surface Area (TBSA), burn depth, and treatment. Seventy-five children with campfire burns were seen in our paediatric burns centre during this 2-year period. The median age of patients was 3 years (range 10 days-14 years). The hands and feet were the areas most commonly affected. Eleven percent of patients suffered flame burns, whilst 89% suffered contact burns from the hot coals or ashes. Of the latter group, approximately half experienced burns from campfires that had been extinguished for at least one night. Thirteen percent of patients underwent split thickness skin grafting. The incidence of burns was increased during school holiday months. We have previously demonstrated the effectiveness of targeted campaigns in reducing the incidence of campfire burns. A significant portion of patients sustained burns from incorrectly extinguished campfires. These injuries are likely to be preventable with ongoing public awareness campaigns. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

  6. Prior stress exposure increases pain behaviors in a rat model of full thickness thermal injury.

    Science.gov (United States)

    Nyland, Jennifer E; McLean, Samuel A; Averitt, Dayna L

    2015-12-01

    Thermal burns among individuals working in highly stressful environments, such as firefighters and military Service Members, are common. Evidence suggests that pre-injury stress may exaggerate pain following thermal injury; however current animal models of burn have not evaluated the potential influence of pre-burn stress. This sham-controlled study evaluated the influence of prior stress exposure on post-burn thermal and mechanical sensitivity in male Sprague-Dawley rats. Rats were exposed to 20 min of inescapable swim stress or sham stress once per day for three days. Exposure to inescapable swim stress (1) increased the intensity and duration of thermal hyperalgesia after subsequent burn and (2) accelerated the onset of thermal hyperalgesia and mechanical allodynia after subsequent burn. This stress-induced exacerbation of pain sensitivity was reversed by pretreatment and concurrent treatment with the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine. These data suggest a better understanding of mechanisms by which prior stress augments pain after thermal burn may lead to improved pain treatments for burn survivors. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  7. Procalcitonin as a diagnostic biomarker for septic shock and bloodstream infection in burn patients from the Formosa Fun Coast dust explosion

    Directory of Open Access Journals (Sweden)

    Rui-Xin Wu

    2017-12-01

    Full Text Available Background/Purpose: Infection is the most common cause of death following burn injury. The study was conducted to compare the diagnostic value of serum procalcitonin (PCT with the other current benchmarks as early predictors of septic shock and bloodstream infection in burn patients. Methods: We included 24 patients admitted to the Burn Unit of a medical center from June 2015 to December 2015 from the Formosa Fun Coast dust explosion. We categorized all patients at initial admission into either sepsis or septic shock groups. Laboratory tests including the worst PCT and C-reactive protein (CRP levels, platelet (PLT, and white blood cell (WBC count were performed at <48 h after admission. Patients were also classified in two groups with subsequent bacteremia and non-bacteremia groups during hospitalization. Results: Significantly higher PCT levels were observed among participants with septic shock compared to those with sepsis (47.19 vs. 1.18 ng/mL, respectively; p < 0.001. Patients with bacteremia had significantly elevated PCT levels compared to patients without bacteremia (29.54 versus 1.81 ng/mL, respectively, p < 0.05. No significant differences were found in CRP levels, PLT, and WBC count between the two groups. PCT levels showed reasonable discriminative power (cut-off: 5.12 ng/mL; p = 0.01 in predicting of bloodstream infection in burn patients and the area under receiver operating curves was 0.92. Conclusions: PCT levels can be helpful in determining the septic shock and bloodstream infection in burn patients but CRP levels, PLT, and WBC count were of little diagnostic value. Keywords: Procalcitonin, Septic shock, Bloodstream infection, Burn patient, Formosa fun coast dust explosion

  8. Treatment of secondary burn wound progression in contact burns-a systematic review of experimental approaches.

    Science.gov (United States)

    Schmauss, Daniel; Rezaeian, Farid; Finck, Tom; Machens, Hans-Guenther; Wettstein, Reto; Harder, Yves

    2015-01-01

    After a burn injury, superficial partial-thickness burn wounds may progress to deep partial-thickness or full-thickness burn wounds, if kept untreated. This phenomenon is called secondary burn wound progression or conversion. Burn wound depth is an important determinant of patient morbidity and mortality. Therefore, reduction or even the prevention of secondary burn wound progression is one goal of the acute care of burned patients. The objective of this study was to review preclinical approaches evaluating therapies to reduce burn wound progression. A systematic review of experimental approaches in animals that aim at reducing or preventing secondary burn wound progression was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. The selected references consist of all the peer-reviewed studies performed in vivo in animals and review articles published in English, German, Italian, Spanish, or French language relevant to the topic of secondary burn wound progression. We searched MEDLINE, Cochrane Library, and Google Scholar including all the articles published from the beginning of notations to the present. The search was conducted between May 3, 2012 and December 26, 2013. We included 29 experimental studies in this review, investigating agents that maintain or increase local perfusion conditions, as well as agents that exhibit an anti-coagulatory, an anti-inflammatory, or an anti-apoptotic property. Warm water, simvastatin, EPO, or cerium nitrate may represent particularly promising approaches for the translation into clinical use in the near future. This review demonstrates promising experimental approaches that might reduce secondary burn wound progression. Nevertheless, a translation into clinical application needs to confirm the results compiled in experimental animal studies.

  9. Feasibility of monomodal analgesia with IV alfentanil during burn dressing changes at bedside (in spontaneously breathing non-intubated patients).

    Science.gov (United States)

    Fontaine, Mathieu; Latarjet, Jacques; Payre, Jacqueline; Poupelin, Jean-Charles; Ravat, François

    2017-03-01

    The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. Cohort study began after favorable opinion from local ethic committee has been collected. Patient's informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable). 100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000μg for a median duration of 35min. Pain scores during the procedure were low or moderate (VRS mean=2.0 and maximal VRS=5). Median satisfaction collected 2h after the dressing was 10 on a ten step scale. Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated

  10. Management of acid burns: experience from Bangladesh.

    Science.gov (United States)

    Das, Kishore Kumar; Olga, Loren; Peck, Michael; Morselli, Paolo G; Salek, A J M

    2015-05-01

    Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients' clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  11. [Influence of WeChat platform on the compliance of continuous treatment of scar in adult burn patients].

    Science.gov (United States)

    Wang, F; Zhang, H L

    2018-03-20

    Objective: To explore influence of the WeChat platform on the compliance of continuous treatment of scar in adult burn patients. Methods: A total of 124 adult burn patients, conforming to the study criteria, admitted in the Department of Burns of our hospital from January 2015 to January 2016 were divided into WeChat group ( n =63) and control group ( n =61) according to the random number table. Patients in control group only received regular discharging rehabilitation guide, while patients in WeChat group received regular discharging rehabilitation guide and joined WeChat platform after being discharged from hospital. Through pushing rehabilitation plan and rehabilitation related knowledge, organizing support discussion of burn patients, answering the patients' questions, members of WeChat platform intervention group conducted continuous treatment for 6 months on patients of WeChat group. The compliance of functional exercise of patients in two groups in one week before discharge and 3 and 6 months after discharge was evaluated by using the self-made functional exercise compliance log sheet. The compliance of using anti-scar drug and appliance of patients in two groups in 3 and 6 months after discharge was evaluated by using self-made anti-scar drug and appliance usage log sheets. Data were processed with chi-square test, independent sample t test, non-parametric rank sum test of independent sample, and Wilcoxon rank sum test. Results: (1) The compliance ratio of functional exercise of patients in WeChat group (95.24%, 60/63) was close to 93.44% (57/61) in control group in one week before discharge ( χ (2)=0.188, P >0.05). The compliance ratios of functional exercise of patients in WeChat group were respectively 93.65% (59/63) and 87.30% (55/63) in 3 and 6 months after discharge, which were higher than 68.85% (42/61) and 65.57% (40/61) in control group ( χ (2)=12.615, 8.166, P WeChat group was significantly better than that in control group in 3 and 6 months

  12. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.

    Science.gov (United States)

    Cho, Yoon Soo; Jeon, Jong Hyun; Hong, Aram; Yang, Hyeong Tae; Yim, Haejun; Cho, Yong Suk; Kim, Do-Hern; Hur, Jun; Kim, Jong Hyun; Chun, Wook; Lee, Boung Chul; Seo, Cheong Hoon

    2014-12-01

    To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  13. Burning of MOX fuels in LWRs; fuel history effects on thermal properties of hull and end piece wastes and the repository performance

    International Nuclear Information System (INIS)

    Hirano, Fumio; Sato, Seichi; Kozaki, Tamotsu

    2012-01-01

    The thermal impacts of hull and end piece wastes from the reprocessing of MOX spent fuels burned in LWRs on repository performance were investigated. The heat generation rates in MOX spent fuels and the resulting heat generation rates in hull and end piece wastes change depending on the history of MOX fuels. This history includes the burn-up of UO 2 spent fuels from which the Pu is obtained, the cooling period before reprocessing, the storage period of fresh MOX fuels before being loaded into an LWR, as well as the burn-up of the MOX fuels. The heat generation rates in hull and end piece wastes from the reprocessing of MOX spent fuels with any of those histories are significantly larger than those from UO 2 spent fuels with burn-ups of 45 GWd/THM. If a temperature below 80degC is specified for cement-based materials used in waste packages after disposal, the allowable number of canisters containing compacted hull and end pieces in a package for 45 and 70 GWd-MOX needs to be limited to a value of 0.4-1.6, which is significantly lower than 4.0 for 45 GWd-UO 2 . (author)

  14. Validity of the Braden Scale in grading pressure ulcers in trauma and burn patients.

    Science.gov (United States)

    Griswold, Lauren H; Griffin, Russell L; Swain, Thomas; Kerby, Jeffrey D

    2017-11-01

    Pressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of ≤18 is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and nontrauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients. We collected data from medical records regarding documented Braden scores and presence of pressure ulcers regardless of staging. Patients with ulcers present on admission were excluded from analysis. For each patient, the lowest Braden score documented before the occurrence of the pressure ulcer was determined. A logistic regression was used to estimate odds ratios and associated 95% confidence intervals for the association between pressure ulcer likelihood and lowest Braden Scale measurement. To determine the discriminatory ability of the Braden Scale on pressure ulcer risk, four measures of performance (i.e., sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) were calculated for four nonmutually exclusive groups: a Braden Scale measurement ≤18, ≤14, ≤12, and ≤9. From 2011 through 2014, a total of 2660 patients were admitted to the trauma/burn intensive care unit. Of these patients, 63 (2.3%) subsequently developed a pressure ulcer. A Braden Scale of ≤18 as the threshold for being at-risk of pressure ulcer had a sensitivity of 100% and specificity of 6%, whereas a Braden Scale of ≤9 had a sensitivity of 28.6% and a specificity of 90%. For all Braden Scale measurements, the positive likelihood ratio never reached the value of 10 that suggests high likelihood of an ulcer. The Braden scale has mediocre discriminatory ability among

  15. Five-year epidemiology of liquefied petroleum gas-related burns.

    Science.gov (United States)

    Jin, Ronghua; Wu, Pan; Ho, Jon Kee; Wang, Xingang; Han, Chunmao

    2018-02-01

    The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32±25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90±19.47days (range

  16. [Effects of group psychological counseling on self-confidence and social adaptation of burn patients].

    Science.gov (United States)

    Dang, Rui; Wang, Yishen; Li, Na; He, Ting; Shi, Mengna; Liang, Yanyan; Zhu, Chan; Zhou, Yongbo; Qi, Zongshi; Hu, Dahai

    2014-12-01

    To explore the effects of group psychological counseling on the self-confidence and social adaptation of burn patients during the course of rehabilitation. Sixty-four burn patients conforming to the inclusion criteria and hospitalized from January 2012 to January 2014 in Xijing Hospital were divided into trial group and control group according to the method of rehabilitation, with 32 cases in each group. Patients in the two groups were given ordinary rehabilitation training for 8 weeks, and the patients in trial group were given a course of group psychological counseling in addition. The Rosenberg's Self-Esteem Scale was used to evaluate the changes in self-confidence levels, and the number of patients with inferiority complex, normal feeling, self-confidence, and over self-confidence were counted before and after treatment. The Abbreviated Burn-Specific Health Scale was used to evaluate physical function, psychological function, social relationship, health condition, and general condition before and after treatment to evaluate the social adaptation of patients. Data were processed with t test, chi-square test, Mann-Whitney U test, and Wilcoxon test. (1) After treatment, the self-confidence levels of patients in trial group were significantly higher than those in control group (Z = -2.573, P 0.05). (2) After treatment, the scores of psychological function, social relationship, health condition, and general condition were (87 ± 3), (47.8 ± 3.6), (49 ± 3), and (239 ± 10) points in trial group, which were significantly higher than those in control group [(79 ± 4), (38.3 ± 5.6), (46 ± 4), and (231 ± 9) points, with t values respectively -8.635, -8.125, -3.352, -3.609, P values below 0.01]. After treatment, the scores of physical function, psychological function, social relationship, health condition, and general condition in trial group were significantly higher than those before treatment (with t values from -33.282 to -19.515, P values below 0.05). The scores

  17. Epidemiology of burns undergoing hospitalization to the National Burns Unit in the Sultanate of Oman: a 25-year review.

    Science.gov (United States)

    Al-Shaqsi, Sultan; Al-Kashmiri, Ammar; Al-Bulushi, Taimoor

    2013-12-01

    The aim of this study was to describe the epidemiology of burns admitted to the National Burns Unit (NBU) in the Sultanate of Oman between 1987 and 2011. This is a retrospective review of burn patients admitted to Oman's National Burns Unit (NBU) between 1987 and 2011. The data extracted from the national burn registry. The study describes the admission rate by gender and age groups, occupation, causes of burns, time-to-admission, length of stay and in-hospital mortality of burns between 1987 and 2011. During a 25-year from 1987 to 2011, there were 3531 burn patients admitted to the National Burns Unit in Oman. The average admission rate to NBU is 7.02 per 100,000 persons per year. On average, males were more likely to be admitted to the NBU than females during the study period (P value Oman. Children are disproportionately over-represented in this study. Prevention programmes are urgently needed to address this "silent and costly epidemic." Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  18. Burning mouth disorder

    Directory of Open Access Journals (Sweden)

    Anand Bala

    2012-01-01

    Full Text Available Burning mouth disorder (BMD is a burning or stinging sensation affecting the oral mucosa, lips and/or tongue, in the absence of clinically visible mucosal lesions. There is a strong female predilection, with the age of onset being approximately 50 years. Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. The causes of BMD are multifactorial and remain poorly understood. Recently, there has been a resurgence of interest in this disorder with the discovery that the pain of burning mouth syndrome (BMS may be neuropathic in origin and originate both centrally and peripherally. The most common sites of burning are the anterior tongue, anterior hard palate and lower lip, but the distribution of oral sites affected does not appear to affect the natural history of the disorder or the response to treatment BMS may persist for many years. This article provides updated information on BMS and presents a new model, based on taste dysfunction, for its pathogenesis.

  19. Importance of proper initial treatment of moderate and major burns

    Directory of Open Access Journals (Sweden)

    Vulović Dejan

    2008-01-01

    Full Text Available Background/Aim. Burns are common injuries with frequency depending on human factors, development of protection, industry and traffic, eventual wars. Organized treatment of major burn injuries has tremendous medical, social and economic importance. The aim of this study was to analyze initial treatment of major and moderate burns, to compare it with the current recommendations and to signify the importance of organized management of burns. Methods. In a prospective study 547 adult patients with major burns were analyzed, covering a period of eight years, with the emphasis on the initial hospital admission and emergency care for burns greater than 10% of total body surface area (TBSA. Results. In the different groups of major burns, the percentage of hospital admission was: 81.5 in burns greater than 10% TBSA, 37.7 in burns of the functional areas, 54.5 in the III degree burns, 81.6 in electrical burns, 55.9 in chemical burns, 61.9 in inhalation injury, 41.0 in burns in patients with the greater risk and 100 in burns with a concomitant trauma. In the group of 145 patients with burns greater than 10% TBSA, intravenous fluids were given in 87 patients, analgesics in 45, corticosteroids in 29, antibiotics in 23 and oxygen administration in 14. In the same group, wound irrigation was done in 14.4%, removing of the clothing and shoes in 29.6%, elevation of the legs in 8.9% and prevention of hypothermia in 7.6% of the victims. There were no initial estimations of burn extent (percentage of a burn, notes about the patient and injury and tetanus immunizations. Conclusion. Based on these findings, it is concluded that there should be much more initial hospital admissions of major burns, and also, necessary steps in the emergency care of burns greater than 10% TBSA should be taken more frequently. On the other side, unnecessary or wrong steps should be avoided in the initial burn treatment.

  20. D-T plasma of self-sustained burning under high performance

    International Nuclear Information System (INIS)

    Gong Xueyu

    2003-01-01

    By adopting a Bohm-type thermal diffusion coefficient related to the energy confinement enhancement factor H within the conventional magnetic shear regime, and a mixed Bohm-gyro-Bohm thermal diffusion coefficient related to the shear within the negative central magnetic shear regime, considering the effect of the α particle anomalous diffusion and the dynamic feedback heating, and starting from energy transport of electrons and ions, we have studied the high performance self-sustaining burning deuterium-tritium plasma under a given plasma density profile for the two different kinds of magnetic shear regimes. Some conclusions are obtained: under the conventional shear, only when H≥3, the D-T burning can produce a large power output, and when H is larger than a certain value (H≅4), D-T plasma self-sustained burning can be maintained without the dynamic feedback heating; under the negative central shear, the plasmas have a higher plasma performance and a larger power output than that under conventional shear, and D-T plasma self-sustained burning can be maintained without the dynamic feedback heating power, the suitable alpha particle diffusion is advantage ous to D-T plasma burning under the conventional shear, and D-T self-sustained burning cannot be maintained under a large α particle anomalous diffusion for the negative central shear. The dynamic feedback heating power is important for sustaining D-T plasma burning under the conventional shear

  1. Predictors of muscle protein synthesis after severe pediatric burns.

    Science.gov (United States)

    Diaz, Eva C; Herndon, David N; Lee, Jinhyung; Porter, Craig; Cotter, Matthew; Suman, Oscar E; Sidossis, Labros S; Børsheim, Elisabet

    2015-04-01

    Following a major burn, skeletal muscle protein synthesis rate increases but is often insufficient to compensate for massively elevated muscle protein breakdown rates. Given the long-term nature of the pathophysiologic response to burn injury, we hypothesized that muscle protein synthesis rate would be chronically elevated in severely burned children. The objectives of this study were to characterize muscle protein synthesis rate of burned children over a period of 24 months after injury and to identify predictors that influence this response. A total of 87 children with 40% or greater total body surface area (TBSA) burned were included. Patients participated in stable isotope infusion studies at 1, 2, and approximately 4 weeks after burn and at 6, 12, and 24 months after injury to determine skeletal muscle protein fractional synthesis rate. Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics. Patients (8 ± 6 years) had large (62, 51-72% TBSA) and deep (47% ± 21% TBSA third degree) burns. Muscle protein fractional synthesis rate was elevated throughout the first 12 months after burn compared with established values from healthy young adults. Muscle protein fractional synthesis rate was lower in boys, in children older than 3 years, and when burns were greater than 80% TBSA. Muscle protein synthesis is elevated for at least 1 year after injury, suggesting that greater muscle protein turnover is a component of the long-term pathophysiologic response to burn trauma. Muscle protein synthesis is highly affected by sex, age, and burn size in severely burned children. These findings may explain the divergence in net protein balance and lean body mass in different populations of burn patients. Prognostic study, level III.

  2. Bacteriological cultures on admission of the burn patient: To do or not to do, that's the question.

    Science.gov (United States)

    Dokter, J; Brusselaers, N; Hendriks, W D H; Boxma, H

    2016-03-01

    In many burn centers, routine bacteriological swabs are taken from the nose, throat, perineum, and the burn wound on admission, to check for the presence of microorganisms that require specific measures in terms of isolation or initial treatment. According to the Dutch policy of "search and destroy," for example, patients infected by multiresistant bacteria have to be strictly isolated, and patients colonized with β-hemolytic Streptococcus pyogenes must receive antibiotic therapy to prevent failed primary closure or loss of skin grafts. In this respect, the role of bacteria cultured on admission in later infectious complications is investigated. The aim of this study is to assess systematic initial bacteriological surveillance, based on an extensive Dutch data collection. A total of 3271 patients primarily admitted to the Rotterdam Burn Centre between January 1987 and August 2010 with complete bacteriological swabs from nose, throat, perineum, and the burn wounds were included. For this study, microbiological surveillance was aimed at identifying resistant microorganisms such as methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Acinetobacter, and multiresistant Pseudomonas, as well as Lancefield A β-hemolytic streptococci (HSA), in any surveillance culture. The cultures were labeled as "normal flora or non-suspicious" in the case of no growth or a typical low level of bacterial colonization in the nose, throat, and perineum and no overgrowth of one type of microorganism. Further, the blood cultures of 195 patients (6.0%) who became septic in a later phase were compared with cultures taken on admission to identify the role of the initially present microorganisms. Statistical analysis was performed using SPSS 20.0. Almost 61% of the wound cultures are "non-suspicious" on admission. MRSA was cultured in 0.4% (14/3271) on admission; 12 out of these 14 patients (85.7%) were repatriated. Overall, 9.3% (12/129) of the repatriated patients were colonized

  3. 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

    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...

  4. The effects of massage and music on pain, anxiety and relaxation in burn patients: Randomized controlled clinical trial.

    Science.gov (United States)

    Najafi Ghezeljeh, T; Mohades Ardebili, F; Rafii, F

    2017-08-01

    The aim of this study was to evaluate the effects of massage and music on pain intensity, anxiety intensity and relaxation level in burn patients. Pain and anxiety are common among burn patients, but there are many physical and psychological consequences. This randomized controlled clinical trial with factorial design 2×2 included 240 burn patients admitted at Shahid Motahari Burns Hospital, Tehran, Iran, between September 2013 and May 2015. The patients were allocated into the following groups: (i) control (n=60) receiving the conventional primary care, (ii) music group (n=60) receiving their favorite songs, (iii) massage group (n=60) receiving Swedish massage, and (iv) music-plus-massage group (n=60) receiving a combination of their favorite songs and Swedish massage, for 20min once a day for 3 consecutive days, using random permuted blocks of sizes 4 with a 1:1 ratio. To collect the data before and after the intervention, a specific Visual Analogue Scale (VAS) was applied for pain intensity, anxiety intensity, and relaxation level. The data were analyzed using SPSS, version 21. Our findings showed a decrease in pain and anxiety intensity and an increase in relaxation level in all three intervention groups as compared to the control group, indicating there was no significant difference among the interventions applied. Furthermore, following application of each intervention, pain and anxiety intensity decreased and relaxation level increased in the intervention groups as compared to before intervention. Our results revealed that music, massage and a combination of both interventions were effective on reducing pain and anxiety intensity and increasing relaxation level. Due to easy, low-cost and availability of the interventions applied, these complementary therapies are suggested for the burn patients. Although application of a single complementary therapy is cost-effective, further studies are required to determine the most effective and cost-effective method to

  5. Epidemiology of burns in teaching hospital of Northern India

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    Mumtazudin Wani

    2016-01-01

    Full Text Available Background: There is no information on the pattern of outcomes among burn patients in relation to clinical aspects in India. Hence, the present study was undertaken in a burn unit to determine selected epidemiological variables, assess the clinical aspects (etiology, extent and anatomical location and finally to analyze the outcomes in cases of burn injury. Materials and Methods: This prospective study was undertaken to analyze the patients admitted to the Burn Unit of Government Medical college Srinagar. The study was carried over a period 2 years from January 2013 to December 2014. Various variables including age and sex distribution, nature of burn injuries, Anatomical location, percentage of total body surface area burnt, depth of burns, Survival of expired patients and mortality were recorded and analyzed. Results: Highest incidence of burns was in the age group between 21 and 40 years; 61% patients were females and 39% were males; majority of our patients had burns in the range of 20 to 40% TBSA (total body surface area; mortality rate in our study was 36.82%; most common site of the burn injury was upper limb(30.19%;among patients who died those with TBSA burn of >60%, 41 to 60% and 31 to 40% succumbed within three, six and nine days respectively. Age ranged from 6 months to 93 years. Mean age of the patients was 31 years. Eighty percent patients belonged to rural areas and 20% belonged to Urban locality. Conclusion: People with low educational qualification should be taught about the proper and safe usage of modern appliances based on electricity, LPG or kerosene. People with psychiatric problems or low intelligence quotient (I.Q should be helped by their care takers in avoiding the burn injuries and also devices with alarms should be used in their households. Fuel or electric devices should be checked by a trained person regularly (e.g once in month to avoid usage of faulty devices.

  6. High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injury.

    Science.gov (United States)

    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P

    2015-04-01

    Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of this study was to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and ARDS in pediatric burned patients with inhalation injury within 1 year post burn injury. From 1986 to 2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n = 932). Patients were divided into 3 groups: unventilated (n = 241), high tidal volume (HTV, 15 ± 3 mL/kg, n = 190), and low tidal volume (LTV, 9 ± 3 mL/kg, n = 501). High tidal volume was associated with significantly decreased ventilator days (p tidal volume significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with low tidal volume in pediatric burned patients with inhalation injury. Therefore, the use of HTV may interrupt sequences leading to lung injury in our patient population. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Ash and burn control through fishbones

    Energy Technology Data Exchange (ETDEWEB)

    Varadarajan, V.; Miley, G.H.

    1989-01-01

    The thermal alphas will accumulate in the center of the ignited thermonuclear plasma in the long pulse experiments. This accumulation increases the Z{sub eff} leading to increased synchrotron losses and decreases the effective fuel density which reduces the power output. Also the ignited plasma is burn-unstable and its temperature is expected to increase above the design point until a stable equilibrium is reached at a higher temperature. This higher operating temperature is not expected to be beneficial. Thus we are faced with the dual problem of ash accumulation and thermonuclear burn instability in the steadily burning tokamak plasma. So some means of controlling them is desirable. Several control schemes for both problems have been proposed. But it is felt that we need alternatives with more desirable characteristics. In this paper, we explore the use of fishbones' as possible scheme that will achieve the dual purpose of ash and burn control. 3 refs.

  8. Characteristic changes of saliva and taste in burning mouth syndrome patients.

    Science.gov (United States)

    Imura, Hiroko; Shimada, Masahiko; Yamazaki, Yoko; Sugimoto, Kumiko

    2016-03-01

    Burning mouth syndrome (BMS) is characterized by chronic pain with a burning sensation of the tongue and oral mucosa and reported to be often accompanied by subjective xerostomia and dysgeusia. Since the etiology of BMS has not been elucidated, to understand the characteristics of BMS, we measured some components of saliva and taste sensitivity and compared the measured values between BMS and healthy subjects. Unstimulated saliva was collected from 15 female BMS patients and 30 healthy women. The flow rate, viscosity (spinnability) and concentration of secretory IgA (SIgA) of saliva and serum antioxidant capacity were measured. The recognition thresholds for sweet, salty, sour, bitter, and umami tastes were measured by whole-mouth method. The statistical analyses were performed using Student's t-test, and P < 0.05 was considered to be significant. In BMS group, the flow rate of saliva was significantly lower and the spinnability was significantly higher compared with healthy group. The secreted amount of SIgA per min and serum antioxidant capacity was significantly lower in the patients. The threshold for sourness in patients was significantly higher, while those for other tastes did not differ from healthy group. BMS patients showed lower salivary flow and higher salivary spinnability. These results together with decreased SIgA amount, suggest that BMS may be relevant to the deterioration of salivary condition, which could in turn affect taste function. Furthermore, the lower antioxidant capacity in patient's serum suggests that it can serve as a diagnostic tool for BMS. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Tourniquet associated chemical burn

    Directory of Open Access Journals (Sweden)

    Jae-Hyuk Yang

    2012-01-01

    Full Text Available Chemical burn under pneumatic tourniquet is an iatrogenic preventable injury and is rarely reported in the literature. The two important mechanisms are maceration (friction and wetness underneath the tourniquent. In this report, our experience with two illustrative patients who presented with iatrogenic tourniquet associated burn is described.

  10. Nosocomial infections in hospitalized patients in the burn unit of Hospital Universitario San José, Popayán - Colombia

    Directory of Open Access Journals (Sweden)

    Yeni Arroyave

    2014-08-01

    Full Text Available Objective. To determine the prevalence and microbiological behavior of the infections in hospitalized patients in the burn unit of the University Hospital San José ( HUSJ at Popayan, Colombia, 2010-2011. Methods: A retrospective cross-sectional study was conducted in patients admitted to the burn unit of HUSJ between the years 2010–2011. Patients were characterized sociodemographic and clinically. The prevalence of nosocomial infections was estimated. Frequency and antibiotic resistance of microorganisms isolated was described. Data were analyzed using SPSS version 15. Results. 113 patients was enrolled, the average age was 17.7 years and male gender predominated (55.8%. Hot liquids (64.6% were the principal cause, the average of body surface area burned was 11.3% and the average hospital stay was 19.8 days. 13.3% of the patients had some nosocomial infection. The most frequently diagnosed infections were sepsis (24%, urinary tract infection (20% and pneumonia (20%. Staphylococcus aureus was the most frequent bacteria (41.7% followed by Staphylococcus epidermidis, mostly meticilino-resistant. The mean length of hospital stay and burned surface area (BSA in patients with diagnosis of infection was 36.6 days and 17.3% respectively. Conclusions. The prevalence of infection is similar to that reported in Colombia. The resistance of the isolates was high. The meticilinoresistance of Staphylococcus was associated with clindamicina resistance.

  11. Burns first aid treatment in remote Northern Australia.

    Science.gov (United States)

    Read, David J; Tan, Swee Chin; Ward, Linda; McDermott, Kathleen

    2018-03-01

    It is well demonstrated that adequate burns first aid treatment (BFAT) improves clinical outcomes for the injured but adequacy remains low in many studies. This study presents a twelve month assessment of the adequacy of burns first aid treatment for patients managed by the Burns Service, Royal Darwin Hospital (RDH). Prospective study design of all patients managed by the Burns Service, Royal Darwin Hospital. Data were collated from two sources; RDH Burns Registry, and the Burns Registry of Australia and New Zealand (BRANZ). Inclusion criterion was all patients managed by the Burns Service, Royal Darwin Hospital for the period 1 January 2014-31 December 2014. Variables collected and analysed include: demographics, burn mechanism, burn wound depth and adequacy of and circumstances around first aid. Overall 310 cases were analysed. Most injuries involved adults (68%), 19% Indigenous persons and 70% of all patients had their burn injury occur in the urban region. Adequate BFAT occurred in 41% of cases. Adults, contact burns and those where the burn injury occurred in the remote regions were less likely to receive adequate BFAT. Indigenous persons were less likely to attempt any BFAT at all and when they did receive BFAT it was more likely applied by an emergency responder or health professional. Overall adequacy of BFAT is low in the Top End of the Northern Territory. Remote dwellers and Indigenous persons are at increased risk of not applying or receiving adequate BFAT. The poor level of adequate BFAT demonstrated in this study suggests that the Top End community particularly remote and Indigenous persons would benefit from targeted BFAT education programs that are delivered in a culturally and linguistically appropriate fashion. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  12. Preliminary study of rabbit model with corneal neovascularization after thermal burn under the constant temperature

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    Yong Jia

    2014-07-01

    Full Text Available AIM:To explore the suitable conditions in rapid model of corneal neovascularization(CNVafter thermal burn under different constant temperature in rabbit. METHODS: Total 45 New Zealand white rabbits were divided randomly into five groups(A, B, C, D, E. A groups: 100℃(n=10, B groups: 200℃(n=10, C groups: 300℃(n=10, D groups: 400℃(n=10, and E groups: control group(n=5. All left eyes of rabbits in A,B,C,D groups were induced corneal neovascularization by constant temperature burning device. The growth of CNV was observed by slit lamp microscope and the area of CNV were recorded on 4 th, 7 th, 14th, 30th days postoperatively. SPSS 19.0 statistical package was used for data analysis, and the data was recorded by mean±standard deviation. Comparison by analysis of variance was made by repeated measures in the area of neovascularization at each time point in groups. Statistical tests were considered significantly when P values were less than 0.05. RESULTS: On postoperative 4th, 7th, 14th, 30th days: no neovascularization was found after corneal thermal burn in A group, but only a few nebula left(n=2; the area of CNV were(9.16±1.45mm2,(37.73±5.49mm2,(62.44±7.54mm2,(40.28±7.39mm2 in B group respectively; and(11.45±1.04mm2,(44.51±4.64mm2,(66.13±4.13mm2,(43.04±2.33mm2 in C group respectively; and(13.23±0.86mm2,(47.26±4.59mm2,(67.57±4.56mm2,(45.59±4.44mm2 in D group respectively, and part corneal carbide(n=4was observed as well as corneal perforation(n=6were found on 3d in D group. No neovascularization was found in normal control group. Comparison of the areas of CNV at each time point between groups was statistically different, PPCOCLUSION: In 4 to 7d, the higher the temperature is, the more the neovascularization area of CNV are. It has no significant difference in 14 to 30d. But corneal carbide and corneal perforation are often found in 400℃ group, so its modeling failure rate is high. It is between 200℃ and 300℃ that

  13. Clinical analysis of amniotic membrane patches and grafts for acute ocular surface burn

    Directory of Open Access Journals (Sweden)

    Lin Li

    2015-01-01

    Full Text Available AIM: To investigate the effect and value of amniotic membrane patches and grafts for acute ocular surface burn at different degrees.METHODS: A retrospective analysis of 28 cases(28 eyesaffected by ocular chemical or thermal burn with different degree were included in our hospital from March 2007 to March 2012. Amniotic membrane patched was undergone in 13 eyes with fresh amnion that the patients corneal burns degree Ⅱ or Ⅲ with partial limbal buns at degree Ⅳ. Amniotic membrane grafts was performed in 15 eyes with fresh amnion that the patients all corneal burns at degree Ⅲ with the whole limbal necrosis without severe eyelid defect. The follow-up time ranged 6~24mo. The postoperative visual acuity, the condition of amniotic membrane transplant, renovation of cornea and complications were observed. RESULTS: Postoperative corrected visual acuity was improved in 20 eyes(71%, it was not changed in 5 eyes(18%, the visual acuity declined in 3 eyes(11%. The amniotic membrane survived in 23 eyes and the survival rate was up to 82%. The cornea of 4 eyes recovered to transparent, nebula emceed in 8 eyes eventually, corneal macula emerged in 10 eyes, 4 eyes ended up with leukoma, 2 eyes developed corneal melting after therapy, then received lamellar keratoplasty. Corneal surface become epithelization after amnion patches or grafts, but any of them have recurrent epithelial erosion, and become stable epithalization after repeat operation.CONCLUSION: Amniotic membrane patches and grafts is an effective method to deal with acute ocular surface burn.

  14. [Bibliometric analysis of scientific articles on rehabilitation nursing for adult burn patients in China].

    Science.gov (United States)

    Ying, Sun; Jie, Cao; Ping, Feng; Lingjuan, Zhang

    2015-06-01

    To analyze the current research status of rehabilitation nursing for adult burn patients in China, and to disuss the related strategies. Chinese scientific articles on adult burn patients' rehabilitation nursing published from January 2003 to December 2013 were retrieved from 3 databases namely China Biology Medicine disc, Chinese Journals Full-text Database , and Chinese Science and Technology Journals Database . From the results retrieved, data with regard to publication year, journal distribution, research type, region of affiliation of the first author, and the main research content were collected. Data were processed with Microsoft Excel software. A total of 417 articles conforming with the criteria were retrieved. During the 11 years, the number of the relevant articles per year was on the rise, and the increasing rates in 2005, 2008, 2009, and 2013 were all above 30% . Regarding the distribution among journals, these 417 articles were published in 151 journals, with 188 articles in Source Journal for Chinese Scientific and Technical Papers , accounting for 45.08%. Regarding the research type, 173 out of the 417 articles were dealing with clinical experiences, accounting for 41.49% ; 172 out of the 417 articles were dealing with experimental studies, accounting for 41.25% . The regions of affiliation of the first author were mainly situated in Guangdong province, Shandong province, Hunan province, and Jiangsu province, with Guangdong province contributing 58 articles, accounting for 13.91%. The research content of these articles was mainly focused on psychological nursing, nursing model, and health education, respectively 188,101, and 85 articles, accounting for 45.08%, 24.22%, and 20.38%. The research on rehabilitation nursing for adult burn patients in China has been carried out nationwide. Although the number of relevant papers is on the rise, the quality of these papers needs to be further improved. There is an urgent need for the guideline on

  15. Fusarium spp infections in a pediatric burn unit: nine years of experience.

    Science.gov (United States)

    Rosanova, María Teresa; Brizuela, Martín; Villasboas, Mabel; Guarracino, Fabian; Alvarez, Veronica; Santos, Patricia; Finquelievich, Jorge

    2016-01-01

    Fusarium spp are ubiquitous fungi recognized as opportunistic agents of human infections, and can produce severe infections in burn patients. The literature on Fusarium spp infections in pediatric burn patients is scarce. To describe the clinical and epidemiological features as well as outcome of Fusarium spp infections in pediatric burn patients. Retrospective, descriptive study of Fusarium spp infections in a specialized intensive care burn unit. In 15 patients Fusarium spp infections were diagnosed. Median age was 48 months. Direct fire injury was observed in ten patients. The median affected burn surface area was 45%. Twelve patients had a full thickness burn. Fourteen patients had a Garces Index ≥3. Fungal infection developed at a median of 11 days after burn injury. Fungi were isolated from burn wound in 14 patients and from the bone in one patient. Amphotericin B was the drug of choice for treatment followed by voriconazole. Median time of treatment completion was 23 days. One patient (7%) died of fungal infection-related causes. In our series Fusarium spp was an uncommon pathogen in severely burnt patients. The burn wound was the most common site of infection and mortality was low. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

  16. Pediatric burn wound impetigo after grafting.

    Science.gov (United States)

    Aikins, Kimberly; Prasad, Narayan; Menon, Seema; Harvey, John G; Holland, Andrew J A

    2015-01-01

    Modern burn care techniques have reduced the risk of infection of the acute burn wound, resulting in more rapid healing and a lower incidence of graft loss. Secondary breakdown may still occur. The loss of epithelium in association with multifocal superficial abscesses and ulceration has been termed burns impetigo. This may result in considerable morbidity and require prolonged treatment. The events preceding development, the impact on the patient, and the ideal treatment appear unclear and poorly reported. In 5 years, between 2006 and 2011, 406 pediatric burns were treated with skin grafts, with 7% developing burns impetigo. Time to resolution ranged from 5 to 241 days: the mean time to complete healing was greatest with conservative management (96 days), followed by antibacterial dressings (37 days), oral antibiotics (36 days), topical steroids (16 days), and oral antibiotics in combination with topical steroids (13.5 days). Burns impetigo resulted in significant morbidity, requiring multiple visits to the treatment center and prolonged symptoms. Delay in diagnosis and treatment resulted in worse outcomes. Prompt consideration of burns impetigo should occur when postgraft patients present with suggestive clinical signs and treatment with oral antibiotics plus topical steroids should be considered.

  17. Burns at KCMC: epidemiology, presentation, management and treatment outcome.

    Science.gov (United States)

    Ringo, Y; Chilonga, K

    2014-08-01

    About 90% of the global burden of burns occurs in the low and middle income countries. In Africa it is estimated that between 17,000 and 30,000 children under five die each year due to burns. In Tanzania there are no specialized burn centers. Burn patients are often managed in the general surgical wards in most hospitals. Kilimanjaro Christian Medical Centre is one of the four tertiary referral hospitals in Tanzania. This study aimed to review the epidemiology presentation management and outcome of burn patients in this challenging environment. A cross-sectional prospective study involving 41 patients was undertaken from October 2011 to April 2012. 65.9% were males. The largest age group was below 5 years (36.6%). 19.5% were epileptic. More than half of the burns were due to open flame. 80.5% had second degree burns. 56.1% had a BSA of 15% or less and 56.1% had an APACHE score of 10 or less. It was found that 73.2% of burns occurred at home. The commonest prehospital first aid applied was honey. Only 41.5% arrived in hospital within the first 24h after burn. Among the 14.6% who had skin grafting, none had early excision of burn wound. 53.7% developed wound sepsis while 24.4% developed contractures. The mortality rate was 26.8%. Children under five are the worst affected by burns. Most patients had second degree burn wounds. Inappropriate management of the burn wound started just after injury and continued even in hospital. Mortality and complication rates are high. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

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

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    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.

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

    Science.gov (United States)

    Chen, Qianming; Xia, Juan; Lin, Mei; Zhou, Hongmei; Li, Bingqi

    2007-01-01

    Objective. To examine alteration of serum interleukin-6 and its clinical significance in burning mouth syndrome (BMS) patients. Methods. 48 BMS patients and 31 healthy controls participated in the study. Serum interleukin-6 was measured by means of ELISA. Hamilton rating scale of depression (HRSD) and visual analogue scale (VAS) were used to quantitiate depressive status and pain levels of subjects, respectively. Results. 15 (31%) patients displayed substantial depressive symptoms (HRSD ≧ 16). HRSD scores of patients were significantly higher than controls and positively correlated to their VAS values (P = .002). Serum interleukin-6 in patients was much lower than controls and negatively correlated to their VAS values (P = .011). However, no significant relations were found between interleukin-6 and HRSD scores (P = .317). 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. PMID:17641729

  20. Calculation of isotope burn-up and change in efficiency of absorbing elements of WWER-1000 control and protection system during burn-up

    International Nuclear Information System (INIS)

    Timofeeva, O.A.; Kurakin, K.U.

    2006-01-01

    The report deals with fast and thermal neutron flows distribution in structural elements of WWER-1000 fuel assembly and absorbing rods, determination of absorbing isotope burn-up and worth variation in WWER reactor control and protection system rods. Simulation of absorber rod burn-up is provided using code package SAPPHIRE 9 5 end RC W WER allowing detailed description of the core segment spatial model. Maximum burn-up of absorbing rods and respective worth variation of control and protection system rods is determined on the basis of a number of calculations considering known characteristics of fuel cycles (Authors)

  1. How important is hydrotherapy? Effects of dynamic action of hot spring water as a rehabilitative treatment for burn patients in Switzerland.

    Science.gov (United States)

    Moufarrij, S; Deghayli, L; Raffoul, W; Hirt-Burri, N; Michetti, M; de Buys Roessingh, A; Norberg, M; Applegate, L A

    2014-12-31

    Burn rehabilitation using hydrotherapy can have multiple benefits for the burn patient. The therapy uses specific mineral enriched hot spring water and water jets with varied hydro-pressure to combat hypertrophy, inflammatory reaction signs, abnormal pigmentation, and, more specifically, redness and scarring. Standard operating procedures for burn rehabilitation have been developed and integrated into the Standard of Care at the CHUV hospital using localized hydro-mechanical stimulation of burn sites (20 minutes of alternating anatomical sites) followed by constant pressure large-bore and filiform showers targeting specific scarred areas. These therapeutic regimens are repeated daily for 2 to 3 weeks. Patients showed lasting effects from this regimen (up to 3-6 months), the results becoming permanent with more uniform skin structure, color and visco-elasticity in addition to a decrease in pruritus. The specifications of clinical protocols are described herein along with the virtues of hot spring hydro-pressure therapy for burn rehabilitation. The use of hydrotherapy, which has been a controversial topic among burn units across the world, is also discussed. In North America, hydrotherapy is defined only within the scope of in-patient wound cleansing and is thought to lead to microbial auto-contamination and bacterial resistance. In Switzerland and France the emphasis of hydrotherapy is on rehabilitation after the wound has closed.

  2. Colloid normalizes resuscitation ratio in pediatric burns.

    Science.gov (United States)

    Faraklas, Iris; Lam, Uyen; Cochran, Amalia; Stoddard, Gregory; Saffle, Jeffrey

    2011-01-01

    Fluid resuscitation of burned children is challenging because of their small size and intolerance to over- or underresuscitation. Our American Burn Association-verified regional burn center has used colloid "rescue" as part of our pediatric resuscitation protocol. With Institutional Review Board approval, the authors reviewed children with ≥15% TBSA burns admitted from January 1, 2004, to May 1, 2009. Resuscitation was based on the Parkland formula, which was adjusted to maintain urine output. Patients requiring progressive increases in crystalloid were placed on a colloid protocol. Results were expressed as an hourly resuscitation ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). We reviewed 53 patients; 29 completed resuscitation using crystalloid alone (lactated Ringer's solution [LR]), and 24 received colloid supplementation albumin (ALB). Groups were comparable in age, gender, weight, and time from injury to admission. ALB patients had more inhalation injuries and larger total and full-thickness burns. LR patients maintained a median I/O of 0.17 (range, 0.08-0.31), whereas ALB patients demonstrated escalating ratios until the institution of albumin produced a precipitous return of I/O comparable with that of the LR group. Hospital stay was lower for LR patients than ALB patients (0.59 vs 1.06 days/%TBSA, P = .033). Twelve patients required extremity or torso escharotomy, but this did not differ between groups. There were no decompressive laparotomies. The median resuscitation volume for ALB group was greater than LR group (9.7 vs 6.2 ml/kg/%TBSA, P = .004). Measuring hourly I/O is a helpful means of evaluating fluid demands during burn shock resuscitation. The addition of colloid restores normal I/O in pediatric patients.

  3. Patient controlled sedation using a standard protocol for dressing changes in burns: patients' preference, procedural details and a preliminary safety evaluation.

    Science.gov (United States)

    Nilsson, Andreas; Steinvall, Ingrid; Bak, Zoltan; Sjöberg, Folke

    2008-11-01

    Patient controlled sedation (PCS) enables patients to titrate doses of drugs by themselves during different procedures involving pain or discomfort. We studied it in a prospective crossover design using a fixed protocol without lockout time to examine it as an alternative method of sedation for changing dressings in burned patients. Eleven patients with >10% total burn surface area (TBSA) had their dressings changed, starting with sedation by an anaesthetist (ACS). The second dressing change was done with PCS (propofol/alfentanil) and the third time the patients had to choose ACS or PCS. During the procedures, data on cardiopulmonary variables, sedation (bispectral index), pain intensity (VAS), procedural details, doses of drugs, and patients' preferences were collected to compare the two sedation techniques. The study data indicated that wound care in burned patients is feasible with a standardized PCS protocol. The patients preferred PCS to ACS on the basis of self-control, and because they had less discomfort during the recovery period. Wound care was also considered adequate by the staff during PCS. No respiratory (respiratory rate/transcutaneous PCO(2)) or cardiovascular (heart rate/blood pressure) adverse events were recorded at any time during any of the PCS procedures. The doses of propofol and alfentanil and BIS index decrease were less during PCS than ACS. Procedural pain was higher during PCS but lower after the procedure. We suggest that PCS using a standard protocol is an interesting alternative to anaesthetist-provided sedation during dressing changes. It seems effective, saves resources, is safe, and at same time is preferred by the patients. The strength of these conclusions is, however, hampered by the small size of this investigation and therefore further studies are warranted.

  4. Burning mouth syndrome: an enigmatic disorder.

    Science.gov (United States)

    Javali, M A

    2013-01-01

    Burning mouth syndrome (BMS) is a chronic oral pain or burning sensation affecting the oral mucosa, often unaccompanied by mucosal lesions or other evident clinical signs. It is observed principally in middle-aged patients and postmenopausal women and may be accompanied by xerostomia and altered taste. Burning mouth syndrome is characterized by an intense burning or stinging sensation, preferably on the tongue or in other areas of mouth. This disorder is one of the most common, encountered in the clinical practice. This condition is probably of multifactorial origin; however the exact underlying etiology remains uncertain. This article discusses several aspects of BMS, updates current knowledge about the etiopathogenesis and describes the clinical features as well as the diagnosis and management of BMS patients.

  5. Skin substitutes for management of thermal burns in the event of a nuclear detonation

    International Nuclear Information System (INIS)

    Singh, Rita

    2014-01-01

    Skin substitutes can play a potential role in the treatment of burn injuries in a nuclear scenario. Defence Laboratory, Jodhpur is involved in the development of various types of skin substitutes for use in burn injuries. Amniotic membranes collected from placentae are processed as biological dressings and sterilized by gamma radiation. Multi-centric clinical trials have demonstrated the functional and clinical efficacy of radiation sterilized biological dressings in burn wound care. Chitin-nanosilver membranes and hydrogels have also been developed and characterized for use as burn wound dressing

  6. Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos.

    Science.gov (United States)

    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 to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

  7. 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.

  8. [Burns in adolescents].

    Science.gov (United States)

    Ortiz Rodríguez, R; Domínguez Amillo, E; Soto Beauregard, C; Díaz González, M; López Gutiérrez, J C; Ros Mar, Z; Tovar Larrucea, J A

    2012-04-01

    The aim of this study was to know the epidemiology of burns in teenagers. Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fireworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +/- 1.4 interventions and 21.3% had long-term sequelaes that required at least one surgical intervention. Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents.

  9. The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit.

    Science.gov (United States)

    Grudziak, Joanna; Snock, Carolyn; Mjuweni, Stephen; Gallaher, Jared; Cairns, Bruce; Charles, Anthony

    2017-11-01

    Nutritional status predicts burn outcomes in the developed world, but its effect on burn mortality in the developing world has not been widely studied. In sub Saharan Africa, burn is primarily a disease of children, and the majority of children in sub-Saharan Africa are malnourished. We therefore sought to determine the prevalence and effect of malnutrition on burn mortality at our institution. This is a retrospective review of children aged 0-5, with anthropomorphic measurements available, who were admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we used logistic regression to construct a fully adjusted model of predictors of mortality. Of the 1357 admitted patients, 839 (61.2%) were aged 0-5. Of those, 512 (62.9%) had one or more anthropomorphic measurements available, and were included in the analysis. 54% were male, and the median age was 28 months. The median TBSA was 15%, with a majority of burns caused by scalds (77%). Mortality was 16%. Average Z-score for any of the indicators of malnutrition was -1.45±1.66. TBSA (OR: 1.08, 95% CI: 1.06, 1.11), decreasing Z-score (OR: 1.19, 95% CI: 1.00, 1.41), and flame burn (OR: 2.51, 95% CI: 1.40, 4.49) were associated with an increase in mortality. Preexisting malnutrition in burn patients in sub-Saharan Africa increases odds of mortality after controlling for significant covariates. Survival of burn patients in this region will not reach that of the developed world until a strategy of aggressive nutritional support is implemented in this population. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  10. Development of a numerical experimentation method for thermal hydraulics design and evaluation of high burn-up and innovative fuel pins

    International Nuclear Information System (INIS)

    Ninokata, Hisashi; Misawa, Takeharu; Baglietto, Emilio; Sorokin, A.P.; Maekawa, Isamu; Ohshima, Hiroyuki; Yamaguchi, Akira

    2003-03-01

    A method of large scale direct numerical simulation of turbulent flows in a high burn-up fuel pin bundle is proposed to evaluate wall shear stress and temperature distributions on the pin surfaces as well as detailed coolant velocity and temperature distributions inside subchannels under various thermal hydraulic conditions. This simulation is aimed at providing a tool to confirm margins to thermal hydraulics design limits of the nuclear fuels and at the same time to be used in design-by-analysis approaches. The method will facilitate thermal hydraulic design of high performance LMFR core fuels characterized by high burn-up, ultra long life, high reliable and safe performances, easiness of operation and maintenance, minimization of radio active wastes, without much relying on such empirical approach as hot spot factor and sub-factors, and above all the high cost mock up experiments. A pseudo direct numerical simulation of turbulence (DNS) code is developed, first on the Cartesian coordinates and then on the curvilinear boundary fit coordinates that enables us to reproduce thermal hydraulics phenomena in such a complicated flow channel as subchannels in a nuclear fuel pin assembly. The coordinate transformation is evaluated and demonstrated to yield correct physical quantities by carrying out computations and comparisons with experimental data with respect to the distributions of various physical quantities and turbulence statistics for fluid flow and heat transfers in various kinds of simple flow channel geometry. Then the boundary fitted pseudo DNS for flows inside an infinite pin array configuration is carried out and compared with available detailed experimental data. In parallel similar calculations are carried out using a commercial code STAR-CD to cross-check the DNS performances. As a results, the pseudo DNS showed reasonable comparisons with experiments as well as the STAR-CD results. Importance of the secondary flow influences is emphasized on the momentum

  11. Arrhenius Rate: constant volume burn

    Energy Technology Data Exchange (ETDEWEB)

    Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-12-06

    A constant volume burn occurs for an idealized initial state in which a large volume of reactants at rest is suddenly raised to a high temperature and begins to burn. Due to the uniform spatial state, there is no fluid motion and no heat conduction. This reduces the time evolu tion to an ODE for the reaction progress variable. With an Arrhenius reaction rate, two characteristics of thermal ignition are illustrated: induction time and thermal runaway. The Frank-Kamenetskii approximation then leads to a simple expression for the adiabatic induction time. For a first order reaction, the analytic solution is derived and used to illustrate the effect of varying the activation temperature; in particular, on the induction time. In general, the ODE can be solved numerically. This is used to illustrate the effect of varying the reaction order. We note that for a first order reaction, the time evolution of the reaction progress variable has an exponential tail. In contrast, for a reaction order less than one, the reaction completes in a nite time. The reaction order also affects the induction time.

  12. Study of Alterations in Lipid Profile After Burn Injury.

    Directory of Open Access Journals (Sweden)

    Dr.Asha Khubchandani

    2017-06-01

    Full Text Available Introduction: After burn injury, changes in lipid profile occur in body. Dyslipidemia after burn injury is one of the important alterations. Objective: To check alterations in lipid profile after burn injury. Materials and Method: It was cross sectional study which was carried out on 250 burns patients of both sex, with an age group of 18-45 years, and varying burns percentage of 20-80% of total body surface area (TBSA. Serum cholesterol, serum LDL, serum HDL and serum triglyceride level were measured on XL-640 fully-auto biochemical analyser. Serum LDL and HDL were measured by Accelerator Selective Detergent Method. Serum cholesterol and triglyceride were measured by Trindor’s method. Results: Results showed decrease in serum cholesterol, serum LDL and serum HDL, while increase in serum triglyceride level in burns patients compared to normal subjects. Conclusion: This study clearly showed the importance of measuring serum cholesterol, TG, LDL and HDL in burn patients and targeting changes that occur in their levels along the burns course, which may have beneficial effect in protection from organ damage, increasing survival rates and improving burn outcome.

  13. Self-Burns in Fars Province, Southern Iran

    Science.gov (United States)

    Mohammadi, Ali Akbar; Tohidinik, Hamid Reza; Zardosht, Mitra; Seyed Jafari, Seyed Morteza

    2016-01-01

    BACKGROUND The alarming incidence of self- burning provoked to set up a multidisciplinary preventive program to decrease the incidence and complications of this harmful issue. This study investigated the incidence and the preventive measures in self-burn in Fars Province, southern Iran. METHODS This study was a longitudinal prospective design on trend of self-inflicted burn injuries in Fars province after setting up a regional multidisciplinary preventive plan (2009-2012). RESULTS From 18862 admitted patients, 388 (2%) committed self-burning. While the incidence showed a constant decrease in proportion of suicidal cases among all admitted patients (2.5% to 1.6%). The mean age of self-burning victims ranged from 28.3±10.8 to 30.3±11.7 years. The female victims comprised 67.4% of all suicidal burn patients (Female to male ratio: 2.18). The leading causes of suicide commitment were familial conflicts (75.6%) and psychological problems (16.7%) CONCLUSION It is crucial to continue the regional preventive programs and pave the way to set up national, and even international collaborations to alleviate relevant financial, social, cultural and infrastructural difficulties in order to have lower incidence for this dramatic issue. PMID:27308238

  14. Simulation study of burning control with internal transport barrier

    Energy Technology Data Exchange (ETDEWEB)

    Tateishi, Gonta [Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Fukuoka (Japan); Yagi, Masatoshi; Itoh, S.I. [Kyushu Univ., Fukuoka (Japan). Research Inst. for Applied Mechanics

    2000-02-01

    Dynamics of burning plasma with internal transport barrier is studied by use of a one dimensional transport simulation code. Two possible mechanisms are modeled for internal transport barrier collapse. One is the collapse, which occurs above the critical pressure gradient, the impact of which is modeled by the enhancement of thermal conductivity. The other is the collapse, which occurs due to the sawtooth trigger. The extended Kadomtsev type reconnection model with multiple resonant surfaces is introduced. Both models are examined for the analysis of long time sustainment of burning. A test of profile control to mitigate the collapse is investigated. The additional circulating power to suppress thermal quench (collapse) is evaluated. (author)

  15. Burning mouth syndrome: Present perspective

    OpenAIRE

    Ramesh Parajuli

    2015-01-01

    Introduction: Burning mouth syndrome is characterized by chronic oral pain or burning sensation affecting the oral mucosa in the absence of obvious visible mucosal lesions. Patient presenting with the burning mouth sensation or pain is frequently encountered in clinical practice which poses a challenge to the treating clinician. Its exact etiology remains unknown which probably has multifactorial origin. It often affects middle or old age women and it may be accompanied by xerostomia and alte...

  16. Barriers to return to work after burn injuries.

    Science.gov (United States)

    Esselman, Peter C; Askay, Shelley Wiechman; Carrougher, Gretchen J; Lezotte, Dennis C; Holavanahalli, Radha K; Magyar-Russell, Gina; Fauerbach, James A; Engrav, Loren H

    2007-12-01

    To identify barriers to return to work after burn injury as identified by the patient. A cohort study with telephone interview up to 1 year. Hospital-based burn centers at 3 national sites. Hospitalized patients (N=154) meeting the American Burn Association criteria for major burn injury, employed at least 20 hours a week at the time of injury, and with access to a telephone after discharge. Patients were contacted via telephone every 2 weeks up to 4 months, then monthly up to 1 year after discharge. A return to work survey was used to identify barriers that prevented patients from returning to work. A graphic rating scale determined the impact of each barrier. By 1 year, 79.7% of patients returned to work. Physical and wound issues were barriers early after discharge. Although physical abilities continued to be a significant barrier up to 1 year, working conditions (temperature, humidity, safety) and psychosocial factors (nightmares, flashbacks, appearance concerns) became important issues in those with long-term disability. The majority of patients return to work after a burn injury. Although physical and work conditions are important barriers, psychosocial issues need to be evaluated and treated to optimize return to work.

  17. Epidemiology and mortality of 162 major burns in Kuwait.

    Science.gov (United States)

    Bang, R L; Ghoneim, I E

    1996-09-01

    The burns intensive care unit at IBN Sina Hospital reopened in July 1991, following the Iraqi occupation of Kuwait and the Gulf War. Epidemiology and mortality of 162 burn patients with 30 per cent and over total body surface area (TBSA) burns, treated from July 1991 to December 1994, is presented. There were 91 males and 71 females with a ratio of 1.3 to 1. The median age was 30 years (range 4 months to 93 years) and 44 per cent of the patients were 15-40 years of age. 124 (76.5 per cent) accidents occurred at home and the flame burn was the commonest involving 131 (80.9 per cent) patients. The median burn surface area was 45.5 per cent and the majority of them sustained deep burns. The hospital stay of the surviving patients ranged from 11 to 174 days (median 38 days), while the day of the death was from 1 to 134 days. Forty-six deaths represent an overall mortality rate of 28.4 per cent amongst our patients. All the patients whose Baux score was 130 and above died. Burn shock was responsible for 10 deaths, and out of them eight were not actively resuscitated due to high Baux score. Sixteen deaths occurred within 48 h postburn. Septicaemia and its related effects were responsible for the majority of the deaths.

  18. Gold standards for primary care of burn management

    Directory of Open Access Journals (Sweden)

    Fatih Zor

    2009-01-01

    Full Text Available Every year, about 2.5 million people are affected from burns in the world. In our country there is no reliable database related to this subject. There are ongoing studies about the epidemiology of burns in Turkey. After burn injury had represent many various complications, such as myocardial infarction, cardiac deficiency, acute hypertension, endocarditis, thromboembolism, pulmonary edema, pneumonia, respiratuar failure, renal failure, gastric ulcus, ileus, sepsis, coagulopathy and anemia. Such complications can preventable or treatable. In this respect, preventive management in the first step burn treatment had very importantly in burn cases. Skin is a barrier which protects evaporative heat loss. In cases of acute burn, hypothermia occurs related to skin loss. For these cases, care must be taken to keep the patient warm. In addition fluid resuscitation is very important in these cases. Furthermore, the damaged tissues are highly susceptible to infection in burned patients. Burn care and rehabilitation includes challenging and complex procedures. Briefly, treatments of burn cases require a multidisciplinary and meticulous approach.

  19. Burning minor actinides in a HTR energy spectrum

    International Nuclear Information System (INIS)

    Pohl, Christoph; Rütten, H. Jochem

    2012-01-01

    Highlights: ► Burn-up analysis for varying plutonium/minor actinide fuel compositions. ► The influence of varying heavy metal fuel element loads is investigated. ► Significant burn-up via radiative capture and subsequently fission is observed. ► Difference observed between fuel element burn-up and total actinide burning rate. - Abstract: The generation of nuclear energy by means of the existing nuclear reactor systems is based mainly on the fission of U-235. But this comes along with the capture of neutrons by the U-238 faction and results in a build-up of plutonium isotopes and minor actinides as neptunium, americium and curium. These actinides are dominant for the long time assessment of the radiological risk of a final disposal therefore a minimization of the long living isotopes is aspired. Burning the actinides in a high temperature helium cooled graphite moderated reactor (HTR) is one of these options. The use of plutonium isotopes to sustain the criticality of the system is intended to avoid on the one hand highly enriched uranium because of international regulations and on the other hand low enriched uranium because of the build up of new actinides from neutron capture in the U-238 fraction. Because initial minor actinide isotopes are typically not fissionable by thermal neutrons the idea is to fission instead the intermediate isotopes generated by the first neutron capture. This paper comprises calculations for plutonium/minor actinides/thorium fuel compositions and their correlated final burn-up for a generic pebble bed HTR based on the reference design of the 400 MW PBMR. In particular the cross sections and the neutron balance of the different minor actinide isotopes in the higher thermal energy spectrum of a HTR will be discussed. For a fuel mixture of plutonium and minor actinides a significant burn-up of these actinides up to 20% can be achieved but at the expense of a higher residual fraction of plutonium in the burned fuel. Combining

  20. Correlation between Burning Mouth Syndrome and Psychological Symptoms in Patients Attending to Zahedan Dental School

    Directory of Open Access Journals (Sweden)

    NM Bakhshan

    2012-06-01

    Full Text Available Introduction: Burning mouth syndrome is characterized by an oral burning sensation , usually in the absence of clinical and laboratory findings. BMS is estimated to involve 1 to 5% of the adult population and is mostly reported within middle-aged women. The etiology of this disease is not thoroughly identified yet and there is a debate over the significance of Psychological factors in creating BMS. This study intended to examine the relationship between psychological factors with pain reports and psychosocial profiles of BMS patients to determine whether psychological factors are related to pain reports and burning mouth of patients. Therefore frequencies of psychological factors were analyzed. Methods: 30 patients with BMS participated in this study. They were homogenous regarding age, sex with the control group. In addition, education was possibly homogenized. The participants completed SCL-90 questionnaire for their anxiety, depression, somatic and psychotic symptoms to be scrutinized. Then, t-test was applied to analyze the research data. Results: Mean of anxiety(case20/8, control 9/53, depression(case 26/53, control 13/40, somatic(case 23/7, control 15/26 and psychotic(case 19/60, control 8/10 symptoms were higher in BMS group rather than in control groups. T-test results indicated there was no statically significant difference between BMS and control group in regard to psychological symptoms(p< 0.0001. Conclusion: The study findings indicate that psychological disorders may predispose the patients to the development of BMS.

  1. Pathophysiologic Response to Burns in the Elderly

    Directory of Open Access Journals (Sweden)

    Marc G. Jeschke

    2015-10-01

    Full Text Available Over the last decades advancements have improved survival and outcomes of severely burned patients except one population, elderly. The Lethal Dose 50 (LD50 burn size in elderly has remained the same over the past three decades, and so has morbidity and mortality, despite the increased demand for elderly burn care. The objective of this study is to gain insights on why elderly burn patients have had such a poor outcome when compared to adult burn patients. The significance of this project is that to this date, burn care providers recognize the extreme poor outcome of elderly, but the reason remains unclear. In this prospective translational trial, we have determined clinical, metabolic, inflammatory, immune, and skin healing aspects. We found that elderly have a profound increased mortality, more premorbid conditions, and stay at the hospital for longer, p  0.05, but a significant increased incidence of multi organ failure, p < 0.05. These clinical outcomes were associated with a delayed hypermetabolic response, increased hyperglycemic and hyperlipidemic responses, inversed inflammatory response, immune-compromisation and substantial delay in wound healing predominantly due to alteration in characteristics of progenitor cells, p < 0.05. In summary, elderly have substantially different responses to burns when compared to adults associated with increased morbidity and mortality. This study indicates that these responses are complex and not linear, requiring a multi-modal approach to improve the outcome of severely burned elderly.

  2. Managing a patient with burning mouth syndrome

    Science.gov (United States)

    Cheung, Danny; Trudgill, Nigel

    2015-01-01

    A 64-year-old woman presented with an increasing frequency of symptoms of heartburn and retrosternal pain over the last few months, and a constant and intense burning pain affecting her tongue tip, mouth and lips for the past 5 years. She found consuming hot drinks exacerbated the burning oral pain and chewing gum seemed to alleviate some of her symptoms. She thought these oral sensations were caused by frequently licking her finger tips to separate prints in her work in publishing. She had been previously diagnosed with gastro-oesophageal reflux disease (GORD), and her heartburn symptoms had been controlled until recently with lansoprazole 15 mg daily. Her past medical history included irritable bowel syndrome and depression, for which she had been treated with mebeverine and paroxetine for a number of years. She was a non-smoker and did not consume alcohol. Clinical examination was unremarkable with no oral lesions on examination. Her routine laboratory tests, including autoimmune serology, haematinics and thyroid function tests were all within normal limits. She underwent a gastroscopy, which revealed moderate reflux oesophagitis, and following commencing omeprazole 20 mg twice daily, her heartburn resolved. However, her oral burning symptoms were not affected and a diagnosis of burning mouth syndrome (BMS) was made. Following explanation and reassurance concerning the cause of her BMS symptoms, she chose not to receive treatment for this but to access cognitive behavioural therapy in the future if her symptoms worsened. PMID:28839812

  3. Opiorphin in burning mouth syndrome patients: a case-control study.

    Science.gov (United States)

    Salarić, Ivan; Sabalić, Maja; Alajbeg, Ivan

    2017-09-01

    Opiorphin is a pentapeptide isolated from human saliva that suppresses pain from chemically induced inflammation and acute physical pain. Burning mouth syndrome (BMS) is a chronic condition of a burning sensation in the mouth, where no underlying dental or medical cause can be identified. We aimed to measure the level of opiorphin in whole unstimulated (UWS) and stimulated (SWS) saliva of patients with BMS. Originally developed and validated LC-MS/MS method was used for opiorphin quantification. Samples were obtained from 29 BMS patients and 29 age- and sex-matched controls. The average concentration of opiorphin in UWS and SWS in the BMS group was 8.13 ± 6.45 and 5.82 ± 3.59 ng/ml, respectively. Opiorphin in BMS patients' UWS was significantly higher, compared to the control group (t = 2.5898; p = 0.0122). SWS opiorphin levels were higher, but not significantly, in BMS patients than in controls. Our results indicate that higher quantities of salivary opiorphin in BMS may be a consequence of chronic pain, but we cannot exclude that they occur as a result of emotional and behavioral imbalances possibly associated with BMS. To our knowledge, this is the first original article measuring opiorphin in a pain disorder. Opiorphin may be a measurable biomarker for chronic pain, which could help in objectifying otherwise exclusively a subjective experience. Increased opiorphin could serve as a universal objective indicator of painful conditions. Since opiorphin may also reflect emotional and socio-relational imbalances occurring with BMS, it could as well represent a biomarker for BMS. Knowledge on opiorphin's involvement in pain pathways could contribute to developing new clinical diagnostic methods for BMS.

  4. Tratamento da dor em queimados Tratamiento del dolor en quemados Pain management in burn patients

    Directory of Open Access Journals (Sweden)

    Rodrigo José Alencar de Castro

    2013-02-01

    paciente en tratamiento de quemadura es el primer paso para alcanzar el éxito en su manejo analgésico.BACKGROUND AND OBJECTIVES: Despite advances, inappropriate analgesic treatment for burn patients is still seen. The objective of this review was to collect data on pain management in burn patients. CONTENT: We reviewed the mechanisms of pain, burn patient assessment, as well as pharmacological and non-pharmacological treatment. CONCLUSION: Pain management in burn patients is still a challenge for the multidisciplinary team. Frequent and continuous evaluation of the patient's response is very important due to the various stages that the hospitalized burn patient goes through, as well as a combination therapy with analgesic and non-pharmacological measures. Understanding the complexity of the pathophysiological, psychological, and biochemical changes a burn patient presents is the first step to achieve success in analgesic management.

  5. Procalcitonin as a diagnostic biomarker for septic shock and bloodstream infection in burn patients from the Formosa Fun Coast dust explosion.

    Science.gov (United States)

    Wu, Rui-Xin; Chiu, Chih-Chien; Lin, Tzu-Chao; Yang, Ya-Sung; Lee, Yi; Lin, Jung-Chung; Chang, Feng-Yee

    2017-12-01

    Infection is the most common cause of death following burn injury. The study was conducted to compare the diagnostic value of serum procalcitonin (PCT) with the other current benchmarks as early predictors of septic shock and bloodstream infection in burn patients. We included 24 patients admitted to the Burn Unit of a medical center from June 2015 to December 2015 from the Formosa Fun Coast dust explosion. We categorized all patients at initial admission into either sepsis or septic shock groups. Laboratory tests including the worst PCT and C-reactive protein (CRP) levels, platelet (PLT), and white blood cell (WBC) count were performed at <48 h after admission. Patients were also classified in two groups with subsequent bacteremia and non-bacteremia groups during hospitalization. Significantly higher PCT levels were observed among participants with septic shock compared to those with sepsis (47.19 vs. 1.18 ng/mL, respectively; p < 0.001). Patients with bacteremia had significantly elevated PCT levels compared to patients without bacteremia (29.54 versus 1.81 ng/mL, respectively, p < 0.05). No significant differences were found in CRP levels, PLT, and WBC count between the two groups. PCT levels showed reasonable discriminative power (cut-off: 5.12 ng/mL; p = 0.01) in predicting of bloodstream infection in burn patients and the area under receiver operating curves was 0.92. PCT levels can be helpful in determining the septic shock and bloodstream infection in burn patients but CRP levels, PLT, and WBC count were of little diagnostic value. Copyright © 2017. Published by Elsevier B.V.

  6. Radioactive implications from coal burning

    International Nuclear Information System (INIS)

    Papastefanou, C.; Manolopoulou, M.; Charalambous, S.

    1989-01-01

    Lignites burning in the Greek Coal Power Plants (CPP) contain naturally occurring radionuclides mainly arising from the uranium series. Radium-226 concentrations in lignites burning in the three Coal Power Plants of the 3.02 GW energy centre, the greatest in Greece (Valley of Ptolemais, North Greece), varied from about 30 to 132 Bq kg -1 (average 65.5 Bq kg -1 . About 1.3 % of 226 Ra is discharged to the environment in particulate form - fly ash - by the stacks of thermal power stations, burning coal at a rate 14.3 Mt (GH y) -1 . The collective effective dose equivalent (EDE) commitment to the population 44400 living in the region of these plants, due to inhalation was estimated to be 0.13 man Sv y -1 , that is an order of magnitude higher than that recommended for such a population. Doses from inhaled radon and radon progeny might cause an excess of 3-7 cancer deaths this year. (author)

  7. Burn Control Mechanisms in Tokamaks

    Science.gov (United States)

    Hill, M. A.; Stacey, W. M.

    2015-11-01

    Burn control and passive safety in accident scenarios will be an important design consideration in future tokamak reactors, in particular fusion-fission hybrid reactors, e.g. the Subcritical Advanced Burner Reactor. We are developing a burning plasma dynamics code to explore various aspects of burn control, with the intent to identify feedback mechanisms that would prevent power excursions. This code solves the coupled set of global density and temperature equations, using scaling relations from experimental fits. Predictions of densities and temperatures have been benchmarked against DIII-D data. We are examining several potential feedback mechanisms to limit power excursions: i) ion-orbit loss, ii) thermal instability density limits, iii) MHD instability limits, iv) the degradation of alpha-particle confinement, v) modifications to the radial current profile, vi) ``divertor choking'' and vii) Type 1 ELMs. Work supported by the US DOE under DE-FG02-00ER54538, DE-FC02-04ER54698.

  8. Development of a test device to characterize thermal protective performance of fabrics against hot steam and thermal radiation

    International Nuclear Information System (INIS)

    Su, Yun; Li, Jun

    2016-01-01

    Steam burns severely threaten the life of firefighters in the course of their fire-ground activities. The aim of this paper was to characterize thermal protective performance of flame-retardant fabrics exposed to hot steam and low-level thermal radiation. An improved testing apparatus based on ASTM F2731-11 was developed in order to simulate the routine fire-ground conditions by controlling steam pressure, flow rate and temperature of steam box. The thermal protective performance of single-layer and multi-layer fabric system with/without an air gap was studied based on the calibrated tester. It was indicated that the new testing apparatus effectively evaluated thermal properties of fabric in hot steam and thermal radiation. Hot steam significantly exacerbated the skin burn injuries while the condensed water on the skin’s surface contributed to cool down the skin tissues during the cooling. Also, the absorbed thermal energy during the exposure and the cooling was mainly determined by the fabric’s configuration, the air gap size, the exposure time and the existence of hot steam. The research provides a effective method to characterize the thermal protection of fabric in complex conditions, which will help in optimization of thermal protection performance of clothing and reduction of steam burn. (paper)

  9. Pediatric scalds: do cooking-related burns have a higher injury burden?

    Science.gov (United States)

    Bachier, Marielena; Hammond, Sarah E; Williams, Regan; Jancelewicz, Timothy; Feliz, Alexander

    2015-11-01

    Pediatric scald burns result in frequent emergency room visits and hospitalizations. We investigated whether cooking-related burns produce greater morbidity requiring more extensive care than noncooking burns. We performed a 6-y review at our free-standing children's hospital. Children aged cooking versus noncooking burns. The Mann-Whitney U test, a chi-square test, and the negative binomial were used to compare continuous, categorical, and count data between groups. Bivariate analysis was performed to identify risk factors among patients with adverse outcomes. We identified 308 patients; 262 (85%) cooking and 46 (15%) noncooking burns. Most patients were African-American males, with public insurance, and a median age of 2 y. Cooking burns preferentially occurred over the head, neck, and upper body; noncooking burns were distributed over the lower body (P  0.11). In subgroup analysis, semisolid and grease burns resulted in increased rates of wound contractures and/or limited mobility when compared with noncooking burns (P = 0.05 and P = 0.008, respectively). Patients with complications were more likely to have third degree burns and required more consults, longer hospitalization, and more surgical debridements and clinic visits. Most accidental scald burns occurred in young children during food preparation. Greater long-term morbidity was found in patients with semisolid and grease burns. This subset of children has a higher injury burden and requires extensive care in the acute and long-term setting. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Bioactive substance accumulation and septic complications in a burn trauma patient: effect of perioperative blood transfusion?

    DEFF Research Database (Denmark)

    Nielsen, H J; Reimert, C M; Dybkjaer, E

    1997-01-01

    cationic protein (ECP), eosinophil protein X (EPX), neutrophil myeloperoxidase (MPO) and interleukin 6 (IL-6) were drawn frequently from the patient before, during and after the operations, and from all transfused red cell, platelet and fresh frozen plasma units. Urine was sampled every hour during......Evidence has emerged that suggests adverse effects to perioperative homologous blood transfusion are related to the age of the blood products. Recently, time-dependent accumulation of bioactive substances in red cell suspensions, standard platelet concentrates and fresh frozen plasma during storage...... have been shown. The potential adverse effects of these bioactive substances were analysed in a burn trauma patient. A patient with 40 per cent second and third degree burn trauma without other injuries underwent a two-step transplantation operation. Samples for analyses of histamine, eosinophil...

  11. Burning mouth syndrome: Evaluation of clinical and laboratory findings.

    Science.gov (United States)

    Halac, Gulistan; Tekturk, Pinar; Eroglu, Saliha; Cikrikcioglu, Mehmet Ali; Cimendur, Ozlem; Kilic, Elif; Asil, Talip

    2016-07-30

    Burning mouth syndrome is a chronic and persistent painful condition characterized by burning sensation in the oral mucosa. We investigated the etiological factors of patients presented with the history of burning in the mouth who admitted our outpatient clinics over the 8-years period and who had no underlying identifiable local factors. We also tried to determine their demographic and clinical characteristics. Our aim was to investigate the association between burning mouth and psychiatric disorders such as depression and anxiety, chronic diseases like diabetes mellitus (DM) and other laboratory studies in patients complaining of solely burning in the mouth. The study included patients with the history of burning in mouth who presented in our outpatient clinic between 2005 and 2012. They were evaluated by a neurologist, a psychiatrist, an internist, and a dentist. Complete blood counts, biochemical analysis and cranial magnetic resonance imaging (MRI) were performed for all patients. A total of 26 (22 (84%) females, 4 (15%) males; mean age 55.9 years) patients were enrolled in this study. Five (19.2%) of the patients had depression, 2 (7.7%) had anxiety disorder, 2 (7.7%) had diabetes mellitus, 8 (30%) had B12 vitamin deficiency, 3 (11.5%) had decreased ferritin levels in blood, and 1 (3.8%) had folic acid deficiency. Cranial MRI of all patients were normal. Nine patients (34.6%) had no etiological causes. A multidisciplinary approach in the management of burning mouth and establishment of common criteria for the diagnosis would provide insight into the underlying pathophysiological mechanism.

  12. Ethnicity and etiology in burn trauma.

    Science.gov (United States)

    Papp, Anthony; Haythornthwaite, Jordan

    2014-01-01

    The purpose of this study was to retrieve data from the British Columbia Professional Firefighters Burn Unit registry, with a focus on ethnicity and how it is involved in burn trauma. It is hypothesized that mechanism, severity, and other patient characteristics are significantly different among different ethnic groups. Furthermore, it is believed that these data can be used to augment burn prevention strategies. Data for burn patients admitted from 1979 to 2009 were reviewed from the burn registry. The main focus was with differences seen among the four main ethnicities throughout the analysis, Caucasian, Aboriginal, Asian, and Indoasian, reflecting the population distribution of the region. Age and sex were also considered when looking at burn mechanism, severity, contributing and copresenting factors. Caucasians were the largest group (79.1%) and included the largest male:female ratio (3.3:1), with high numbers of flame injury (53.9%). Caucasians presented with the highest mortality (6.6% compared with 4.1% for all other ethnicities; P workplace (28.9%) injuries with a larger proportion of scald injury (38.9%). Indoasian patients included larger numbers of women (36.4%) and household scald injuries (33.9%) whereas Aboriginals suffered the most flame injuries (60.1%) in rural areas with more frequent contributing factors such as alcohol. The study found multiple significant differences in the burn injury population when segmented by ethnicity. Though the exact reasons for these differences are difficult to say with certainty, it allows a unique opportunity to focus communication and prevention efforts to specific communities.

  13. Treatment of burn injuries with keratinocyte cultures

    International Nuclear Information System (INIS)

    Syring, C.; Maenig, H.J.; Von Versen, R.; Bruck, J.

    1999-01-01

    The German Institute for Cell and Tissue Replacement (DIZG) provides burned patients with skin and amnion for a temporary wound closure. Severely burned patients (>60% BSA for adults, >40% BSA for children) were supplied with autologous and allogenic grafts from cultured keratinocytes. The keratinocyte culture is done under GMP-conditions using the method of Rheinwald and Green. The 3T3 fibroblasts were irradiated with 60 Gy and used as feeder cells to produce keratinocyte sheets within 3 weeks. In this time up to 6.000 cm are available. The sheets were harvested by detachment with dispase (1,2 U/ml), fixed to gauze and transported to the hospital. The DIZG has a 3 years experience in the treatment of burns with keratinocyte sheets. The sheets were transplanted to patients in different hospitals, the total transplanted area is about 30.000 cm. This paper describes the experiences with ten severely burned patients treated with keratinocyte sheet

  14. The evolution of solid density within a thermal explosion II. Dynamic proton radiography of cracking and solid consumption by burning

    International Nuclear Information System (INIS)

    Smilowitz, L.; Henson, B. F.; Romero, J. J.; Asay, B. W.; Saunders, A.; Merrill, F. E.; Morris, C. L.; Kwiatkowski, K.; Grim, G.; Mariam, F.; Schwartz, C. L.; Hogan, G.; Nedrow, P.; Murray, M. M.; Thompson, T. N.; Espinoza, C.; Lewis, D.; Bainbridge, J.; McNeil, W.; Rightley, P.

    2012-01-01

    We report proton transmission images obtained subsequent to the laser assisted thermal ignition of a sample of PBX 9501 (a plastic bonded formulation of the explosive nitramine octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX)). We describe the laser assisted thermal ignition technique as a means to synchronize a non-linear thermal ignition event while preserving the subsequent post-ignition behavior. We have obtained dynamic proton transmission images at two spatial magnifications and viewed both the radial and transverse axis of a solid cylindrical sample encased in aluminum. Images have been obtained with 3 to 15 μs temporal resolution and approximately 100 μm spatial resolution at the higher magnification. We observe case expansion from very early in the experiment, until case fragmentation. We observe spatially anisotropic features in the transmission which we attribute to cracking in the solid explosive, in agreement with previous measurements conducted on two dimensional samples with optical viewing. Digital analysis of the images also reveals spatially isotropic features which we attribute to the evolution of the loss of density by burning subsequent to thermal ignition.

  15. The evolution of solid density within a thermal explosion II. Dynamic proton radiography of cracking and solid consumption by burning

    Energy Technology Data Exchange (ETDEWEB)

    Smilowitz, L.; Henson, B. F.; Romero, J. J.; Asay, B. W.; Saunders, A.; Merrill, F. E.; Morris, C. L.; Kwiatkowski, K.; Grim, G.; Mariam, F.; Schwartz, C. L.; Hogan, G.; Nedrow, P.; Murray, M. M.; Thompson, T. N.; Espinoza, C.; Lewis, D.; Bainbridge, J.; McNeil, W.; Rightley, P. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States); and others

    2012-05-15

    We report proton transmission images obtained subsequent to the laser assisted thermal ignition of a sample of PBX 9501 (a plastic bonded formulation of the explosive nitramine octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX)). We describe the laser assisted thermal ignition technique as a means to synchronize a non-linear thermal ignition event while preserving the subsequent post-ignition behavior. We have obtained dynamic proton transmission images at two spatial magnifications and viewed both the radial and transverse axis of a solid cylindrical sample encased in aluminum. Images have been obtained with 3 to 15 {mu}s temporal resolution and approximately 100 {mu}m spatial resolution at the higher magnification. We observe case expansion from very early in the experiment, until case fragmentation. We observe spatially anisotropic features in the transmission which we attribute to cracking in the solid explosive, in agreement with previous measurements conducted on two dimensional samples with optical viewing. Digital analysis of the images also reveals spatially isotropic features which we attribute to the evolution of the loss of density by burning subsequent to thermal ignition.

  16. Domestic bioethanol-fireplaces--a new source of severe burn accidents.

    Science.gov (United States)

    Neubrech, Florian; Kiefer, Jurij; Schmidt, Volker J; Bigdeli, Amir K; Hernekamp, J Frederick; Kremer, Thomas; Kneser, Ulrich; Radu, Christian Andreas

    2016-02-01

    Bioethanol-fueled fireplaces are popular interior home decoration accessories. Although their safety is promoted frequently, actual presentations of severe burn injuries in our burn intensive care unit (ICU) have focused the authors on safety problems with these devices. In this article we want to explore the mechanisms for these accidents and state our experiences with this increasingly relevant risk for severe burn injuries. The computerized medical records of all burn intensive care patients in our burn unit between 2000 and 2014 were studied. Since 2010, 12 patients with bioethanol associated burn injuries were identified. Their data was compared to the values of all patients, except the ones injured by bioethanol fireplaces that presented themselves to our burn ICU between the years 2010 and 2014. At time of admission the bioethanol patients had a mean ABSI-score of 4.8 (+/- 2.2 standard deviation (SD)). A mean of 17 percent (+/- 9.1 SD) body surface area was burned. Involvement of face and hands was very common. An operative treatment was needed in 8 cases. A median of 20 days of hospitalization (range 3-121) and a median of 4.5 days on the ICU (range 1-64) were necessary. No patient died. In most cases the injuries happened while refilling or while starting the fire, even though safety instructions were followed. In the control group, consisting of 748 patients, the mean ABSI-score was 5.6 (+/- 2.7 SD). A mean of 16.5 percent (+/- 10.1 SD) body surface area was burned. Treatment required a median of 3 days on the burn ICU (range 1-120). Regarding these parameters, the burden of disease was comparable in both groups. Bioethanol-fueled fireplaces for interior home decoration are a potential source for severe burn accidents even by intended use. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  17. The effect of adipose derived stromal vascular fraction on stasis zone in an experimental burn model.

    Science.gov (United States)

    Eyuboglu, Atilla Adnan; Uysal, Cagri A; Ozgun, Gonca; Coskun, Erhan; Markal Ertas, Nilgun; Haberal, Mehmet

    2018-03-01

    Stasis zone is the surrounding area of the coagulation zone which is an important part determining the extent of the necrosis in burn patients. In our study we aim to salvage the stasis zone by injecting adipose derived stromal vascular fraction (ADSVF). Thermal injury was applied on dorsum of Sprague-Dawley rats (n=20) by the "comb burn" model as described previously. When the burn injury was established on Sprague-Dawley rats (30min); rat dorsum was separated into 2 equal parts consisting of 4 burn zones (3 stasis zone) on each pair. ADSVF cells harvested from inguinal fat pads of Sprague-Dawley rats (n=5) were injected on the right side while same amount of phosphate buffered saline (PBS) injected on the left side of the same animal. One week later, average vital tissue on the statis zone was determined by macroscopy, angiography and microscopy. Vascular density, inflammatory cell density, gradient of fibrosis and epithelial thickness were determined via immunohistochemical assay. Macroscopic stasis zone tissue viability (32±3.28%, 57±4.28%) (p51, 1.50±0.43) (pzone on acute burn injuries. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  18. Burning mouth syndrome: An update

    OpenAIRE

    Vijay Kumar Ambaldhage; Jaishankar Homberhalli Puttabuddi; Purnachandrarao Naik Nunsavath

    2015-01-01

    Burning mouth syndrome (BMS) is characterized by an oral burning sensation in the absence of any organic disorders of the oral cavity. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. It is observed principally in middle-aged patients and postmenopausal women and is characterized by an intense burning type of pain, preferably on the tongue and in other areas of the ...

  19. Clinical characteristics and therapeutic response in patients with Burning Mouth Syndrome: accompanying 2 years

    Directory of Open Access Journals (Sweden)

    Vanessa Juliana Gomes CARVALHO

    Full Text Available Abstract Introduction Burning Mouth Syndrome (BMS is a condition characterized by burning symptom of the oral mucosa in the absence of clinical signs. Its etiology is still unknown and, and to date there is no effective treatment. Purpose The aim of this study was to evaluate patients with BMS profile and the therapies results in a retrospective study. Material and method Clinical and therapeutic data were collected from records of patients with BMS diagnosed between January 2013 to April 2015 at the Clinic of Stomatology Clinic, Faculdade de Odontologia of Universidade de São Paulo, according to the criteria established by the International Headache Society in 2013. The therapies used for BMS control were also evaluated. Result Twelve patients were diagnosed with BMS at this period. All of them were women with a mean age of 61.18 years and the apex of the tongue was the most common affected site and the duration of the burning sensation ranged from 6 months to 25 years. Many therapies were prescribed for BMS control, such as topical capsaicin, topical clonazepan, low level laser therapy and homeopathy. Among the established therapies, capsaicin has immediate effect in reducing symptoms. Conclusion The present study showed that the challenges towards an effective treatment for BMS are varied and are mainly related to the lack knowing of the pathogenesis of this disease. The demographic profile of patients studied here was similar to that described in the available literature, however, the variables represented by secondary symptoms (medical history, anxiety and depression levels may be modifying factors of therapeutic response and the pathogenesis of the disease itself.

  20. Foot burns: epidemiology and management.

    Science.gov (United States)

    Hemington-Gorse, S; Pellard, S; Wilson-Jones, N; Potokar, T

    2007-12-01

    This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

  1. A comparative study of the ignition and burning characteristics of after burning aluminum and magnesium particles

    International Nuclear Information System (INIS)

    Lim, Ji Hwan; Lee, Sang Hyup; Yoon, Woong Sup

    2014-01-01

    Ignition and the burning of air-born single aluminum and magnesium particles are experimentally investigated. Particles of 30 to 106 μm-diameters were electrodynamically levitated, ignited, and burnt in atmospheric air. The particle combustion evolution was recorded by high-speed cinematography. Instant temperature and thermal radiation intensity were measured using two-wavelength pyrometry and photomultiplier tube methods. Ignition of the magnesium particle is prompt and substantially advances the aluminum particle by 10 ms. Burning time of the aluminum particles is extended 3 to 5 times longer than the magnesium particles. Exponents of a power-law fit of the burning rates are 1.55 and 1.24 for aluminum and magnesium particles, respectively. Flame temperature is slightly lower than the oxide melting temperature. For the aluminum, dimensionless flame diameter is inert to the initial particle size, but for the magnesium inversely proportional to the initial diameter.

  2. A comparative study of the ignition and burning characteristics of after burning aluminum and magnesium particles

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Ji Hwan; Lee, Sang Hyup; Yoon, Woong Sup [Yonsei University, Seoul (Korea, Republic of)

    2014-10-15

    Ignition and the burning of air-born single aluminum and magnesium particles are experimentally investigated. Particles of 30 to 106 μm-diameters were electrodynamically levitated, ignited, and burnt in atmospheric air. The particle combustion evolution was recorded by high-speed cinematography. Instant temperature and thermal radiation intensity were measured using two-wavelength pyrometry and photomultiplier tube methods. Ignition of the magnesium particle is prompt and substantially advances the aluminum particle by 10 ms. Burning time of the aluminum particles is extended 3 to 5 times longer than the magnesium particles. Exponents of a power-law fit of the burning rates are 1.55 and 1.24 for aluminum and magnesium particles, respectively. Flame temperature is slightly lower than the oxide melting temperature. For the aluminum, dimensionless flame diameter is inert to the initial particle size, but for the magnesium inversely proportional to the initial diameter.

  3. Use of cyanide antidotes in burn patients with suspected inhalation injuries in North America: a cross-sectional survey.

    Science.gov (United States)

    Dumestre, Danielle; Nickerson, Duncan

    2014-01-01

    This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. To ascertain views on immediate administration of hydroxocobalamin before confirmation of cyanide poisoning an option was included to expand the response in written format. Twenty-nine of 90 burn directors (32%) completed the survey. For the population of interest, the majority of burn centers (59%) do not test for cyanide poisoning on admission and do not administer an antidote based solely on clinical suspicion of cyanide poisoning (58%). The most commonly available antidote is hydroxocobalamin (50%), followed by the cyanide antidote kit (29%). The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.

  4. The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition.

    Science.gov (United States)

    Cartotto, Robert; Li, Zeyu; Hanna, Steven; Spano, Stefania; Wood, Donna; Chung, Karen; Camacho, Fernando

    2016-11-01

    The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted

  5. In situ oil burning in the marshland environment : soil temperatures resulting from crude oil and diesel fuel burns

    International Nuclear Information System (INIS)

    Bryner, N.P.; Walton, W.D.; Twilley, W.H.; Roadarmel, G.; Mendelssohn, I.A.; Lin, Q.; Mullin, J.V.

    2001-01-01

    The unique challenge associated with oil spill cleanups in sensitive marsh environments was discussed. Mechanical recovery of crude or refined hydrocarbons in wetlands may cause more damage to the marsh than the oil itself. This study evaluated whether in situ burning of oiled marshlands would provide a less damaging alternative than mechanical recovery. This was done through a series of 6 crude oil and 5 diesel fuel burns conducted in a test tank to examine the impact of intentional burning of oil spilled in a wetlands environment. There are several factors which may influence how well such an environment would recover from an in situ oil burn, such as plant species, fuel type and load, water level, soil type, and burn duration. This paper focused on soil, air and water temperatures, as well as total heat fluxes that resulted when 3 plant species were exposed to full-scale in situ burns that were created by burning diesel fuel and crude oil. The soil temperatures were monitored during the test burn at three different soil/water elevations for 700 second burn exposures. A total of 184 plant sods were harvested from marshlands in southern Louisiana and were subjected to the burning fuel. They were instrumental in characterizing the thermal and chemical stress that occur during an in-situ burn. The plants were inserted into the test tanks at various water and soil depths. The results indicated that diesel fuel and crude oil burns produced similar soil temperature profiles at each of three plant sod elevations. Although in-situ burning did not appear to remediate oil that had penetrated into the soil, it did effectively remove floating oil from the water surface, thereby preventing it from potentially contaminating adjacent habitats and penetrating the soil when the water recedes. The regrowth and recovery of the plants will be described in a separate report. 25 refs., 7 tabs., 15 figs

  6. The effect of preexisting respiratory co-morbidities on burn outcomes☆

    Science.gov (United States)

    Knowlin, Laquanda T.; Stanford, Lindsay B.; Cairns, Bruce A.; Charles, Anthony G.

    2018-01-01

    Introduction Burns cause physiologic changes in multiple organ systems in the body. Burn mortality is usually attributable to pulmonary complications, which can occur in up to 41% of patients admitted to the hospital after burn. Patients with preexisting comorbidities such as chronic lung diseases may be more susceptible. We therefore sought to examine the impact of preexisting respiratory disease on burn outcomes. Methods A retrospective analysis of patients admitted to a regional burn center from 2002–2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, smoker status, length of hospital stay, and days of mechanical ventilation. Bivariate analysis was performed and Cox regression modeling using significant variables was utilized to estimate hazard of progression to mechanical ventilation and mortality. Results There were a total of 7640 patients over the study period. Overall survival rate was 96%. 8% (n=672) had a preexisting respiratory disease. Chronic lung disease patients had a higher mortality rate (7%) compared to those without lung disease (4%, pburn. Given the increasing number of Americans with chronic respiratory diseases, there will likely be a greater number of individuals at risk for worse outcomes following burn. PMID:28341260

  7. Translational systems biology: introduction of an engineering approach to the pathophysiology of the burn patient.

    Science.gov (United States)

    An, Gary; Faeder, James; Vodovotz, Yoram

    2008-01-01

    The pathophysiology of the burn patient manifests the full spectrum of the complexity of the inflammatory response. In the acute phase, inflammation may have negative effects via capillary leak, the propagation of inhalation injury, and development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later stage processes of wound healing. Despite the volume of information concerning the cellular and molecular processes involved in inflammation, there exists a significant gap between the knowledge of mechanistic pathophysiology and the development of effective clinical therapeutic regimens. Translational systems biology (TSB) is the application of dynamic mathematical modeling and certain engineering principles to biological systems to integrate mechanism with phenomenon and, importantly, to revise clinical practice. This study will review the existing applications of TSB in the areas of inflammation and wound healing, relate them to specific areas of interest to the burn community, and present an integrated framework that links TSB with traditional burn research.

  8. A method for determining the extent of thermal burns in elephants

    Directory of Open Access Journals (Sweden)

    A. Shakespeare

    2006-06-01

    Full Text Available A practical method was developed to assess the extent of burns suffered by elephants caught in bush fires. In developing this method, the surface areas of the different body parts of juvenile, subadult and adult elephants were first determined using standard equations, and then expressed as a percentage of the total body surface area. When viewed from a distance, the burnt proportion of all body segments is estimated, converted to percentages of total body surface area, and then summed to determine the extent of burns suffered.

  9. Experimental Study on the Burning Behavior of Pool Fires in Rooms with Different Wall Linings

    DEFF Research Database (Denmark)

    Poulsen, Annemarie; Jomaas, Grunde

    2011-01-01

    An experimental test series, comprising 10 experiments with varying pool sizes, lining materials and amounts of liquid burning, was conducted under free burn and room burn conditions. The thermal feedback from the enclosure (ISO 9705 Room Corner Test facility) enhanced the burning rate of the poo...... in the shortest time. Given the profound difference between the enclosure tests and the free burn tests and also between enclosure tests with different linings, it is recommended to show great caution if free burn tests are to be used in design fire scenarios....

  10. A retrospective study to determine the incidence of pressure ulcers in burn patients using a low air loss pressure relieving mattress.

    Science.gov (United States)

    Still, Joseph M; Wilson, Joan; Rinker, Connie; Law, Edward; Craft-Coffman, Beretta

    2003-06-01

    In immobilized patients, unrelieved pressure can create decubitus ulcers over bony prominences. Those burn patients who require prolonged bed rest, are prone to the development of such problems. Various methods of reducing pressure on these areas, including frequent turning and the use of air fluidized and low air loss beds, have been adopted to attempt to prevent the development of this complication. The Pegasus Renaissance alternating pressure mattress is such a device, intended to reduce the incidence of decubitus ulcers. It was introduced at our burn unit and evaluated over a 29-month period. During the study period, 186 (13.4%) of 1390 acutely burned patients, believed to be at high risk for the development of decubiti, were placed on this mattress. Other patients were treated in the standard hospital bed. Care was otherwise the same. No decubitus ulcers developed in any of the patients treated on the Pegasus Renaissance mattress.

  11. Identification of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from burn patients by multiplex PCR.

    Science.gov (United States)

    Montazeri, Effat Abbasi; Khosravi, Azar Dokht; Jolodar, Abbas; Ghaderpanah, Mozhgan; Azarpira, Samireh

    2015-05-01

    Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) as important human pathogens are causes of nosocomial infections worldwide. Burn patients are at a higher risk of local and systemic infections with these microorganisms. A screening method for MRSA by using a multiplex polymerase chain reaction (PCR) targeting the 16S ribosomal RNA (rRNA), mecA, and nuc genes was developed. The aim of the present study was to investigate the potential of this PCR assay for the detection of MRSA strains in samples from burn patients. During an 11-month period, 230 isolates (53.11%) of Staphylococcus spp. were collected from burn patients. The isolates were identified as S. aureus by using standard culture and biochemical tests. DNA was extracted from bacterial colonies and multiplex PCR was used to detect MRSA and MRCoNS strains. Of the staphylococci isolates, 149 (64.9%) were identified as S. aureus and 81 (35.21%) were described as CoNS. Among the latter, 51 (62.97%) were reported to be MRCoNS. From the total S. aureus isolates, 132 (88.6%) were detected as MRSA and 17 (11.4%) were methicillin-susceptible S. aureus (MSSA). The presence of the mecA gene in all isolates was confirmed by using multiplex PCR as a gold standard method. This study presented a high MRSA rate in the region under investigation. The 16S rRNA-mecA-nuc multiplex PCR is a good tool for the rapid characterization of MRSA strains. This paper emphasizes the need for preventive measures and choosing effective antimicrobials against MRSA and MRCoNS infections in the burn units. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  12. The potential association of later initiation of oral/enteral nutrition on euthyroid sick syndrome in burn patients.

    Science.gov (United States)

    Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I

    2013-01-01

    Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS), and shortens the length of hospital stay (LHS). Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd-5th day) and second sample collection (9th-12th day) after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: 48 h after the injury (Group 3). Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days) was, respectively, in each group, 16.77 ± 4.56, 21.98 ± 4.86, and 26.06 ± 5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61 ± 0.92 days) in Group 3, but there was no group with ESS at the second sample collection (9.89 ± 1.01 days). Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression. Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

  13. A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns.

    Science.gov (United States)

    Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith Chengetayi

    2017-10-23

    Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns

  14. A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns

    Directory of Open Access Journals (Sweden)

    Tapfuma Mudawarima

    2017-10-01

    Full Text Available Abstract Background Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves. Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement. Settings = any setting in any country. Methods/design A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Discussion Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention

  15. Modeling of WWER-440 Fuel Pin Behavior at Extended Burn-up

    International Nuclear Information System (INIS)

    El-Koliel, M.S.; Abou-Zaid, A.A.; El-Kafas, A.A.

    2004-01-01

    Currently, there is an ongoing effort to increase fuel discharge burn-up of all LWRs fuel including WWER's as much as possible in order to decrease power production cost. Therefore, burn-up is expected to be increased to 60 to 70 Mwd/kg U. The change in the fuel radial power distribution as a function of fuel burn up can affect the radial fuel temperature distribution as well as the fuel microstructure in the fuel pellet rim. In this paper, the radial burn-up and fissile products distributions of WWER-440 UO 2 fuel pin were evaluated using MCNP 4B and ORIGEN2 codes. The impact of the thermal conductivity on predicted fission gas release calculations is needed. For the analysis, a typical WWER-440 fuel pin and surrounding water moderator are considered in a hexagonal pin cell well. The thermal release and the athermal release from the pellet rim were modeled separately. The fraction of the rim structure and the excessive porosity in the rim structure in isothermal irradiation as a function of the fuel burn-up was predicted. a computer program; RIMSC-01, is developed to perform the required FGR calculations. Finally, the relevant phenomena and the corresponding models together with their validation are presented

  16. 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...

  17. Car radiator burns: a report on 72 cases.

    Science.gov (United States)

    al-Baker, A A; Attalla, M F; el-Ekiabi, S A; al Ghoul, A

    1989-08-01

    Seventy-two cases of car radiator burns (CRB) were treated in the Burns Unit, Hamad Medical Corporation, Doha, Qatar, over a 6-year period (1982-87). All the patients were males and most were between 20 and 40 years old. Chest wall, face and right upper limb were the commonest sites involved. Most of the patients suffered from relatively minor scalds. The scenario of the accidents as well as the topography of the burned areas were characteristic to this particular type of injury. The exceptionally high temperatures in the summer months were significantly related to the incidence of this type of burn.

  18. Dynamic stabilization of D—T burn in Tokamak reactors

    Institute of Scientific and Technical Information of China (English)

    ShiBing-Ren; LongYong-Xing

    1997-01-01

    A simple,engineeringly feasible dynamic method is supposed to control the deuterium-tritium burn process in Tokamak reactors operated in an advanced scenario.The thermal transport of the D-T plasma is described by an anomalous thermal conduction which is a radially increasing function and the central conduction value is proportional to the central temperature of the plasma.The dynamic external heating power is selected to be inversely proportional to certain power function of this temperature,As a result,the D-T burn can undergo in controllable way in different temperature regimes with different power output.Anomalous alpha particle transport effect is taken into account.It can affect the resultant plasma equilibrium ,the reactor efficency,the operation mode and so on.

  19. 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

    30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until......Adverse effects of perioperative blood transfusion appear to be storage-time-dependent and may be related to extracellular accumulation of bioactive substances in blood products. In this study the clinical effects of leukofiltered and non-filtered blood products in patients undergoing surgery...... 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...

  20. Treatment of radioinduced skin burns by adult stem cells

    International Nuclear Information System (INIS)

    Lataillade, J.J.; Prat, M.; Gourmelon, P.; Bey, E.

    2009-01-01

    In the area of skin injuries caused by ionizing radiations; the recent opportunity give us the the possibility to manage victims of radiation accidents with skin acute symptoms of irradiation. The approach of cell therapy developed for these patients could be in a second time, used for other types of injuries as thermal burns and the injuries linked to overexposure in radiotherapy. In spite of the diversity of approaches of allogeneic and autologous transplantation, the prognosis of deep and extended radioinduced burns is not completely satisfying because of inflammatory recurrences, origin of graft failures. The stem cells have been used in association. The stem cells were got from sampling of autologous bone marrow after an expansion in vitro from 15 to 17 days. The cultures were realised in medium with 8% of platelet lysate (clinical grade). The cells have been given by injection in complement of epidermis auto graft. A spectacular effect was noticed the day after the injection, but disappearing in some days encouraging to realize supplementary injections. An effect of the quickness and the quality of the graft success is appeared significant too. no necrosis recurrence for the patients after four years for the first one of them. We think that the stem cells participate to the local control of inflammation. (N.C.)

  1. Preoperative fasting among burns patients in an acute care setting: a best practice implementation project.

    Science.gov (United States)

    Giuliani, Sara; McArthur, Alexa; Greenwood, John

    2015-11-01

    Major burn injury patients commonly fast preoperatively before multiple surgical procedures. The Societies of Anesthesiology in Europe and the United States recommend fasting from clear fluids for two hours and solids for six to eight hours preoperatively. However, at the Royal Adelaide Hospital, patients often fast from midnight proceeding the day of surgery. This project aims to promote evidence-based practice to minimize extended preoperative fasting in major burn patients. A baseline audit was conducted measuring the percentage compliance with audit criteria, specifically on preoperative fasting documentation and appropriate instructions in line with evidence-based guidelines. Strategies were then implemented to address areas of non-compliance, which included staff education, development of documentation tools and completion of a perioperative feeding protocol for major burn patients. Following this, a post implementation audit assessed the extent of change compared with the baseline audit results. Education on evidence-based fasting guidelines was delivered to 54% of staff. This resulted in a 19% improvement in compliance with fasting documentation and a 52% increase in adherence to appropriate evidence-based instructions. There was a notable shift from the most common fasting instruction being "fast from midnight" to "fast from 03:00 hours", with an overall four-hour reduction in fasting per theater admission. These results demonstrate that education improves compliance with documentation and preoperative fasting that is more reflective of evidence-based practice. Collaboration with key stakeholders and a hospital wide fasting protocol is warranted to sustain change and further advance compliance with evidence-based practice at an organizational level.

  2. The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial.

    Science.gov (United States)

    Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

    2016-01-01

    Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

  3. Theory of hydrogen shell flashes on accreting white dwarfs. II. The stable shell burning and the recurrence period of shell flashes

    International Nuclear Information System (INIS)

    Fujimoto, M.Y.

    1982-01-01

    By means of analytical solutions of the envelope, thermal properties of hydrogen shell burning on accreting white dwarfs are studied and a general picture for their progress is presented which is described by two parameters, the accretion rate and the mass of the white dwarf. On a white dwarf, the thermal behavior of gas in the burning shell depends on the configuration of the envelope, which gives birth to two distinct types of stable configurations in thermal equilibrium, a high and a low state. In the high state, the nuclear shell burning makes up for the energy loss from the surface. There exists the lower limit to the envelope mass for this state. The nuclear burning rate lies in a narrow range of about a factor of 2.5, irrespective of the mass of the white dwarf, while the range itself varies greatly with the latter. In the low state, the nuclear burning is extinct, and yet the compressional heating by accreted gas balances with the cooling through the diffusion of heat. Therefore, the structure depends on the accretion rate. Thermal instability of nuclear burning sets the upper limit to the envelope mass of this state

  4. Radiator scald burns: a preventable hazard.

    Science.gov (United States)

    Benmeir, P; Rosenberg, L; Sagi, A; Ben-Yakar, Y

    1990-04-01

    During the last 13 years 80 patients have been admitted to our department suffering from burns caused by a vehicle's radiator. Ten of them were deeply burned and had to be treated surgically. The preventive aspect of this injury is emphasized.

  5. Fournier's gangrene in a patient after third-degree burns: a case report

    Directory of Open Access Journals (Sweden)

    Iavazzo Christos

    2009-05-01

    Full Text Available Abstract Introduction Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis. Case presentation We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed. Conclusion Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.

  6. High-burn-up fuels for fast reactors. Past experience and novel applications

    International Nuclear Information System (INIS)

    Weaver, Kevan D.; Gilleland, John; Whitmer, Charles; Zimmerman, George

    2009-01-01

    Fast reactors in the U.S. routinely achieved fuel burn-ups of 10%, with some fuel able to reach peak burn-ups of 20%, notably in the Experimental Breeder Reactor II and the Fast Flux Test Facility. Maximum burn-up has historically been constrained by chemical and mechanical interactions between the fuel and its cladding, and to some extent by radiation damage and thermal effects (e.g., radiation-induced creep, thermal creep, and radiation embrittlement) that cause the cladding to weaken. Although fast reactors have used several kinds of fuel - including oxide, metal alloy, carbide, and nitride - the vast majority of experience with fast reactors has been using oxide (including mixed oxide) and metal-alloy fuels based on uranium. Our understanding of high-burn-up operation is also limited by the fact that breeder reactor programs have historically assumed that their fuel would eventually undergo reprocessing; the programs thus have not made high burn-up a top priority. Recently a set of novel designs have emerged for fast reactors that require little initial enrichment and no reprocessing. These reactors exploit a concept known as a traveling wave (sometimes referred to as a breed-and-burn wave, fission wave, or nuclear-burning wave). By breeding and using its own fuel in place as it operates, a traveling-wave reactor can obtain burn-ups that approach 50%, well beyond the current base of knowledge and experience. Our computational work on the physics of traveling-wave reactors shows that they require metal-alloy fuel to provide the margins of reactivity necessary to sustain a breed-and-burn wave. This paper reviews operating experience with high-burn-up fuels and the technical feasibility of moving to a qualitatively new burn-up regime. We discuss our calculations on traveling-wave reactors, including those concerning the possible use of thorium. The challenges associated with high burn-up and fluence in fuels and materials are also discussed. (author)

  7. Pediatric burn rehabilitation: Philosophy and strategies

    Directory of Open Access Journals (Sweden)

    Shohei Ohgi

    2013-09-01

    Full Text Available Burn injuries are a huge public health issue for children throughout the world, with the majority occurring in developing countries. Burn injuries can leave a pediatric patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. Rehabilitation is an essential and integral part of pediatric burn treatment. The aim of this article was to review the literature on pediatric burn rehabilitation from the Medline, CINAHL, and Web of Science databases. An attempt has been made to present the basic aspects of burn rehabilitation, provide practical information, and discuss the goals and conceptualization of rehabilitation as well as the development of rehabilitation philosophy and strategies.

  8. The effect of inhalation aromatherapy with damask rose (Rosa damascena essence on the pain intensity after dressing in patients with burns: A clinical randomized trial

    Directory of Open Access Journals (Sweden)

    Ali Bikmoradi

    2016-01-01

    Conclusions: Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

  9. Partial-thickness burn wounds healing by topical treatment

    Science.gov (United States)

    Saeidinia, Amin; Keihanian, Faeze; Lashkari, Ardalan Pasdaran; Lahiji, Hossein Ghavvami; Mobayyen, Mohammadreza; Heidarzade, Abtin; Golchai, Javad

    2017-01-01

    Abstract Background: Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. Methods: Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran. The intervention group received Centiderm and control group SSD cream. Burn wounds were treated once daily at home. All of the wounds were evaluated till complete healing occurred and at the admission, days 3, 7, 14 objective signs; visual acuity score (VAS) and subjective signs were recorded. Re-epithelialization time and complete healing days were recorded. We used random fixed block for randomization. The randomization sequence was created using the computer. Patients and burning specialist physician were blinded. Results: Seventy-five patients randomized into 2 groups; (40 patients: Centiderm group; 35 patients: SSD group). The mean age of them was 30.67 ± 9.91 years and 19 of them were male (31.7%). Thirty patients in Centiderm and 30 patients in SSD group were analyzed. All of objective and subjective signs and mean of re-epithelialization and complete healing were significantly better in Centiderm group rather than SSD group (P < 0.05). There was no infection in Centiderm group. Conclusions: We showed that use of Centiderm ointment not only improved the objective and subjective signs in less than 3 days, but also the re-epithelialization and complete healing rather than SSD without any infection in the subjects. PMID:28248871

  10. Clinical Trial of Imipenem/Cilastatin in Severely Burned and Infected Patients

    Science.gov (United States)

    1987-07-01

    34"OT FILE CO.Y CLINICAL TRIAL OF IMIPENEM /CILASTATIN IN SEVERELY BURNED AND INFECTED PATIENTS Gary R. Culbertson, M.D., Albert T. McManus, PH.D., D T...NOV 1 3 1987 San Antonio, Texas b H Imipenem /cilastatin was examined for safety and effi- ,-;Opportunistic organisms causing infections in cacy in a...All of the clinical failures were in the pulmonary in ec- imipenem /cilastatin, a novel thienamycin alti- tion group. No serious toxicity or side

  11. Perineal tap water burns in the elderly: at what cost?

    Science.gov (United States)

    Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

    2017-11-01

    Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

  12. Laser Doppler imaging as a tool in the burn wound treatment protocol

    OpenAIRE

    Venclauskiene, Algirda; Basevicius, Algidas; Zacharevskij, Ernest; Vaicekauskas, Vytautas; Rimdeika, Rytis; Lukosevicius, Saulius

    2014-01-01

    Introduction The main treatment of burns is early excision of injured tissues. Aim To compare two different methods of examination of burned patients: clinical burn depth examination (CDE) and laser Doppler imaging (LDI). Material and methods A prospective randomized study of 57 burn patients treated in 2009–2011 was carried out. The burned patients were randomized into a CDE group and an LDI group. The CDE and LDI scan were performed 72 h after injury, with the second and third CDE and LDI s...

  13. Plasma NGAL predicts early acute kidney injury no earlier than s-creatinine or cystatin C in severely burned patients.

    Science.gov (United States)

    Rakkolainen, Ilmari; Vuola, Jyrki

    2016-03-01

    Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker used in acute kidney injury (AKI) diagnostics. Studies on burn patients have highlighted it as a promising biomarker for early detection of AKI. This study was designed to discover whether plasma NGAL is as a biomarker superior to serum creatinine and cystatin C in detecting AKI in severely burned patients. Nineteen subjects were enrolled from March 2013 to September 2014 in the Helsinki Burn Centre. Serum creatinine, cystatin C, and plasma NGAL were collected from the patients at admission and every 12h during the first 48h and thereafter daily until seven days following admission. AKI was defined by acute kidney injury network criteria. Nine (47%) developed AKI during their intensive care unit stay and two (11%) underwent renal replacement therapy. All biomarkers were significantly higher in the AKI group but serum creatinine- and cystatin C values reacted more rapidly to changes in kidney function than did plasma NGAL. Plasma NGAL tended to rise on average 72h±29h (95% CI) later in patients with early AKI than did serum creatinine. Area-under-the-curve values calculated for each biomarker were 0.92 for serum creatinine, 0.87 for cystatin C, and 0.62 for plasma NGAL predicting AKI by the receiver-operating-characteristic method. This study demonstrated serum creatinine and cystatin C as faster and more reliable biomarkers than plasma NGAL in detecting early AKI within one week of injury in patients with severe burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  14. Acute Kidney Injury: It's not just the 'big' burns.

    Science.gov (United States)

    Kimmel, L A; Wilson, S; Walker, R G; Singer, Y; Cleland, H

    2018-02-01

    Acute Kidney Injury (AKI) complicates the management of at least 25% of patients with severe burns and is associated with long term complications. Most research focuses on the patients with more severe burns, and whether the same factors are associated with the development of AKI in patients with burns between 10 and 19% total body surface area (TBSA) is unknown. The aims of this study were to examine the incidence of, and factors associated with, the development of AKI in patients with %TBSA≥10, as well as the relationship with hospital metrics such as length of stay (LOS). Retrospective medical record review of consecutive burns patients admitted to The Alfred Hospital, the major adult burns centre in Victoria, Australia. Demographic and injury details were recorded. Factors associated with AKI were determined using multiple logistic regression. Between 2010 and June 2014, 300 patients were admitted with burn injury and data on 267 patients was available for analysis. Median age was 54.5 years with 78% being male. Median %TBSA was 15 (IQR 12, 20). The AKI incidence, as measured by the RIFLE criteria, was 22.5%, including 15% (27/184) in patients with %TBSA 10-19. Factors associated with AKI included increasing age and %TBSA (OR 1.05 p<0.001) as well as increased surgeries (p<0.041) and a cardiac comorbidity (p<0.01). All patients with renal comorbidity developed AKI. In the %TBSA 10-19 cohort, only increasing age (OR 1.05 p<0.001) was associated with AKI. After accounting for confounding factors, the probability of discharge from hospital in Non-AKI group was greater than for the AKI patients at all time points (P<0.001). This is the first study to show an association between patients with %TBSA 10-19 and AKI. Given the association between AKI and complications, prospective research is needed to further understand AKI in burns with the aim of risk reduction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Epidemiology of burns throughout the World. Part II: intentional burns in adults.

    Science.gov (United States)

    Peck, Michael D

    2012-08-01

    A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  16. [Etiological analysis of subambient temperature burn in 351 cases of Hefei area].

    Science.gov (United States)

    Shi, Jie; Qi, Weiwei; Xu, Qinglian; Zhou, Shunying; Wang, Guobao

    2010-06-01

    To study the preventive measure of the subambient temperature burn by analysing the pathogenesis feature. The clinical data were analysed from 351 cases of subambient temperature burn between February 2004 and February 2009, including age, sex, burn season, burn factors, burn position, burn area, burn degree, treatment way, and wound healing. Subambient temperature burn occurred in every age stage. The susceptible age stages included infant, children, and the elderly. Female patients were more than male patients. The common burn reasons were hot-water bottle burn, honey warm keeper burn, and heating device burn. The peak season was winter. Lower limb was the most common site of the subambient temperature burn. The deep II degree to III degree were the most common level, and the burn area was always small, often time safety awareness should be strengthened so as to decrease the incidence rate of subambient temperature burn and the injury degree.

  17. National programme for prevention of burn injuries

    Directory of Open Access Journals (Sweden)

    Gupta J

    2010-10-01

    Full Text Available The estimated annual burn incidence in India is approximately 6-7 million per year. The high incidence is attributed to illiteracy, poverty and low level safety consciousness in the population. The situation becomes further grim due to the absence of organized burn care at primary and secondary health care level. But the silver lining is that 90% of burn injuries are preventable. An initiative at national level is need of the hour to reduce incidence so as to galvanize the available resources for more effective and standardized treatment delivery. The National Programme for Prevention of Burn Injuries is the endeavor in this line. The goal of National programme for prevention of burn injuries (NPPBI would be to ensure prevention and capacity building of infrastructure and manpower at all levels of health care delivery system in order to reduce incidence, provide timely and adequate treatment to burn patients to reduce mortality, complications and provide effective rehabilitation to the survivors. Another objective of the programme will be to establish a central burn registry. The programme will be launched in the current Five Year Plan in Medical colleges and their adjoining district hospitals in few states. Subsequently, in the next five year plan it will be rolled out in all the medical colleges and districts hospitals of the country so that burn care is provided as close to the site of accident as possible and patients need not to travel to big cities for burn care. The programme would essentially have three components i.e. Preventive programme, Burn injury management programme and Burn injury rehabilitation programme.

  18. 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.

  19. Fatalities from a Greek Burn Unit-A clinicopathological correlation of 129 cases.

    Science.gov (United States)

    Tsagkarakis, Myron; Spyropoulou, Georgia-Alexandra; Pavlidis, Leonidas; Kritikos, Othon; Karakoukis, Nikolaos; Kyriopoulos, Evgenia; Tsoutsos, Dimosthenis

    2018-02-01

    This is a retrospective study of the hospital data and autopsy reports of burn patients who died in the Burn Unit of the Department of Plastic and Reconstructive Surgery, Microsurgery and Burn Center of "G. Gennimatas" Hospital of Athens, Greece during the period 1999-2005. The records of the burn victims deceased during the period 1999-2005 were reviewed and the cause of injury, percentage of body surface area (BSA) burned, age, gender, and co-morbidities were documented. Moreover, the autopsy findings per system were recorded and compared to clinical reports to analyze any inconsistencies. Between 1999 and 2005, 368 patients were hospitalized in the Burn Unit of "G. Gennimatas" Hospital of Athens, Greece. One-hundred and twenty-nine patients died. The first three causes of death in autopsy reports were: pneumonia (30 patients), myocardial infarction (17 cases) and multiple organ failure (15 patients). Three patients had class I diagnostic discrepancies, 5 patients had class II diagnostic discrepancies and minor diagnostic errors (class III and IV) were documented in 20 patients. Although the percentage of discrepancies of premortem compared to postmortem diagnosis in this series of deceased burn patients is small (2.3%), we believe that it is sufficient to justify the performance of autopsies. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  20. Internal sub-sonic burning during an explosion viewed via dynamic X-ray radiography

    Science.gov (United States)

    Smilowitz, L.; Henson, B. F.; Oschwald, D.; Suvorova, N.; Remelius, D.

    2017-10-01

    We observe internal convective and conductive burn front propagation and solid consumption subsequent to thermal ignition for plastic bonded formulations of the solid organic secondary explosives octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine and 1,3,5-triamino-2,4,6-trinitrobenzene. This work describes x-ray radiographic diagnostics enabling the study of solid density in a fully encased explosive during internal burning subsequent to ignition. The result of this study is the ability to directly observe and measure rates of energy release during a thermal explosion.