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Sample records for adult burn patients

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

    PubMed

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

    2014-12-01

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

  2. Adherence to pressure garment therapy in adult burn patients.

    PubMed

    Ripper, S; Renneberg, B; Landmann, C; Weigel, G; Germann, G

    2009-08-01

    Pressure garment therapy (PGT) is a generally accepted procedure to prevent hypertrophic scarring after severe burns. Wearing pressure garments is uncomfortable and challenging for the patient and, consequently adherence is low. In order to improve adherence, precise knowledge about the advantages and disadvantages of PGT is necessary. In this study we investigated specific aspects which inhibit or reinforce the application of PGT on the patients' part. Twenty-one patients participated in a semi-structured interview concerning their experiences with PGT. The complaints most frequently mentioned were 'physical and functional limitations' caused by the garments, 'additional effort' created by the need to care for garments and 'perceived deficiencies' of the treatment. At the same time, most of the patients reported coping strategies used to persevere with the therapy. Coping can be categorised into 'behavioural' and 'cognitive coping strategies'. Besides the 'expectation of success', 'emotional' as well as 'practical support' and experiencing 'good outcome' were motivating factors for the patients. Based on the analyses of limitations and resources, recommendations for future interventions enhancing adherence are outlined.

  3. Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

    DTIC Science & Technology

    2013-01-11

    hyponatre- mia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had Received: July 14...A multiple logistic regression analysis was performed to ana - lyze the relationship between independent variables of age, gen- der, %TBSA, %FT...15] . Of the 194 patients with hypernatre- mia , only 6 had concurrent head trauma for which an elevated sodium level was recommended by neurosur

  4. Aztreonam pharmacokinetics in burn patients.

    PubMed Central

    Friedrich, L V; White, R L; Kays, M B; Brundage, D M; Yarbrough, D

    1991-01-01

    The pharmacokinetics of aztreonam in eight adult patients with severe burn injuries (total body surface area burn, 49% +/- 21% [mean +/- standard deviation]) were studied. The time of initiation of study following burn injury was 7.0 +/- 1.4 days. Four patients at first dose and at steady state were studied. Aztreonam concentrations were measured by high-performance liquid chromatography, and a two-compartment model was used to fit the data. No significant differences in any pharmacokinetic parameters between first dose and steady state were observed. Volume of distribution of the central compartment after first dose (0.14 liters/kg) and volume of distribution at steady state (0.31 liters/kg) were approximately 30% higher than those reported for other patient populations. Total drug clearance and renal drug clearance when normalized to creatinine clearance (CLCR) were similar to those previously reported for other critically ill patients. CLCR was strongly correlated with renal drug clearance (r = 0.94) and total drug clearance (r = 0.95). The extent and degree of burn (percent second or third degree burn) were poorly correlated with all pharmacokinetic parameters with the exception of the volume of distribution at steady state, which was correlated with both total body surface area burn (r = 0.95) and percent second degree burn (r = 0.83). Aztreonam pharmacokinetics are altered as a result of thermal injury; however, CLCR can be used to assess the clearance of aztreonam in burn patients. PMID:2014982

  5. Pain in burn patients.

    PubMed

    Latarjet, J; Choinère, M

    1995-08-01

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

  6. Outcomes After Cardiac Arrest in an Adult Burn Center

    DTIC Science & Technology

    2013-12-07

    Cardiopulmonary resuscitation Burn patients Thermal injury a b s t r a c t Objective: Adult burn patients who experience in-hospital cardiac arrest (CA) and...undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the...Support; BICU, burn intensive care unit; BOR, burn operating room; CA, cardiac arrest; CPR, cardiopulmonary resuscitation; DNR, do not resuscitate; EG

  7. Fluconazole Pharmacokinetics in Burn Patients

    PubMed Central

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

    1998-01-01

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

  8. Prone Positioning Improves Oxygenation in Adult Burn Patients with Severe Acute Respiratory Distress Syndrome

    DTIC Science & Technology

    2012-01-01

    Burn Inten- sive Care Unit ( ICU ) is a 16-bed unit within a tertiary academic military teaching hospital and Level I trauma center. It serves active-duty...position on a standard ICU bed. All pron- ing procedures were performed under the direct supervision of an intensivist with prior PP experience. Wound care...PP initiation; and at 6, 12, 24, 36, and 48 hours after PP initiation. Compli- cations related to PP and to the patient’s ICU course were identified

  9. Epidemiology of hospitalized burns patients in Taiwan.

    PubMed

    Chien, Wu-Chien; Pai, Lu; Lin, Chao-Cheng; Chen, Heng-Chang

    2003-09-01

    Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00 h and 16:00 to 18:00 h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.

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

    PubMed Central

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

    2014-01-01

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

  11. Rehabilitation of the burn patient

    PubMed Central

    Procter, Fiona

    2010-01-01

    Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

  12. Repeated Use of Immersive Virtual Reality Therapy to Control Pain during Wound Dressing Changes in Pediatric and Adult Burn Patients

    PubMed Central

    Faber, Albertus W.; Patterson, David R.; Bremer, Marco

    2012-01-01

    Objective The current study explored whether immersive virtual reality continues to reduce pain (via distraction) during more than one wound care session per patient. Patients: Thirty six patients aged 8 to 57 years (mean age of 27.7 years), with an average of 8.4% total body surface area burned (range .25 to 25.5 TBSA) received bandage changes, and wound cleaning. Methods Each patient received one baseline wound cleaning/debridement session with no-VR (control condition) followed by one or more (up to seven) subsequent wound care sessions during VR. After each wound care session (one session per day), worst pain intensity was measured using a Visual Analogue Thermometer (VAT), the dependent variable. Using a within subjects design, worst pain intensity VAT during wound care with no-VR (baseline, Day 0) was compared to pain during wound care while using immersive virtual reality (up to seven days of wound care during VR). Results Compared to pain during no-VR Baseline (Day 0), pain ratings during wound debridement were statistically lower when patients were in virtual reality on Days 1, 2 and 3, and although not significant beyond day 3, the pattern of results from Days 4, 5, and 6 are consistent with the notion that VR continues to reduce pain when used repeatedly. Conclusions Results from the present study suggest that VR continues to be effective when used for three (or possibly more) treatments during severe burn wound debridement. PMID:23970314

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

    DTIC Science & Technology

    2014-10-01

    in Nutritional Care for Burned Patients PRINCIPAL INVESTIGATOR: Steven E. Wolf, MD CONTRACTING ORGANIZATION: REPORT DATE... Nutritional Care for Burned Patients 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Steven E Wolf, MD Betty Diamond...Study/Product Aim(s) were as follows: 1) To determine under what conditions compliance with nutritional goals are not met in severely burned adults, 2

  14. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect solution...of the degradation-resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings...Identified membrane stiffness as a critical parameter for a successful cornea -protective membrane and quantitatively assessed this parameter

  15. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2011-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect... cornea as is done in amniotic membrane transplantation . However we proposed and, have now tested, an alternative method for securing the... cornea of burn patients that were produced in Year 1. Major findings: Established that 2 and 3 layer crosslinked amniotic membrane composites are more

  16. Assessment and management of patients with burns.

    PubMed

    Butcher, Martyn; Swales, Beverley

    Burns are a common injury in the UK. Most burns are limited in size and depth and are therefore suitable for management in the community. Primary care and non-specialist clinicians need to understand initial assessment of the burn and when referral to a specialist burns unit is indicated. Successful treatment of minor burns and ongoing care of severe burns in the community requires careful selection of dressings to support wound healing and achieve optimal outcomes for patients.

  17. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings: Identified

  18. Antibiotics and the burn patient.

    PubMed

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

    2011-02-01

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

  19. Zinc supplementation in burn patients.

    PubMed

    Caldis-Coutris, Nancy; Gawaziuk, Justin P; Logsetty, Sarvesh

    2012-01-01

    Micronutrient supplementation is a common practice throughout many burn centers across North America; however, uncertainty pertaining to dose, duration, and side effects of such supplements persists. The authors prospectively collected data from 23 hospitalized patients with burn sizes ranging from 10 to 93% TBSA. Each patient received a daily multivitamin and mineral supplement, 50 mg zinc (Zn) daily, and 500 mg vitamin C twice daily. Supplements were administered orally or enterally. Albumin, prealbumin, C-reactive protein, serum Zn, and serum copper were measured weekly during hospital admission until levels were within normal reference range. Our study concluded that 50 mg daily dose of Zn resulted in normal serum levels in 19 of 23 patients at discharge; 50 mg Zn supplementation did not interfere with serum copper levels; and Zn supplements, regardless of administration route, did not result in gastrointestinal side effects.

  20. The elderly patient with burns: treatment considerations.

    PubMed

    Staley, M; Richard, R

    1993-01-01

    When therapists treat elderly patients with burns, they should ask themselves several questions: Am I treating elderly patients with burns "just like other patients with burns?" Am I assessing the patient's joint mobility and strength as critically as I should? Am I ensuring that further tissue trauma is avoided by instructing the nursing staff in turning/transfer techniques? Am I routinely monitoring heart rate and blood pressure? Am I requiring repetition and practice of exercises before the patient's discharge? Is my patient safe to function in the environment to which he or she is being discharged? Most physical changes in the elderly population are attributed to the aging process but often are due to diminished movement disorders arising from poor physical fitness and disuse. The "slowdown" in the older adult may result from a lack of appropriate movement practice and failure to receive reinforcement for activity. Regardless of age, physiological challenges result in enhanced functional status. Training for a specific skill increases performance in that skill just as strength training increases strength. Practice or repetition of a task improves movement and response time for that task. Appropriate physical training programs for the elderly can (1) counterbalance age-associated declines in work capacity and physical performance; (2) maintain and improve range of motion, strength, flexibility, balance, and endurance; and (3) reduce the disability of the cardiovascular, respiratory, and musculoskeletal systems that may result in decreased risk of falls and accidents. Practice of a task and maintenance of physical fitness helps ensure a high level of motor performance and speed as a person grows older. One is never too old to exercise!

  1. Vitamin E Supplementation in Burn Patients

    DTIC Science & Technology

    2014-10-01

    SUBJECT TERMS Vitamin E deficiency in burn patients and supplementation 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES...AD_________________ Award Number: W81XWH-12-1-0429 TITLE: Vitamin E Supplementation in Burn Patients PRINCIPAL INVESTIGATOR: Perenlei...to 26 Sep 2014 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Vitamin E Supplementation in Burn Patients 5b. GRANT NUMBER W81XWH-12-1-0429 5c. PROGRAM

  2. Aeromonas hydrophila in a burn patient.

    PubMed

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

    2009-01-01

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

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

    PubMed Central

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

    2014-01-01

    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 due to residential fires, and to compare this to 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 1,557 residential fire-related deaths province-wide and 1,139 patients were admitted to our provincial burn center due to 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. PMID:25412056

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

    PubMed

    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.

  5. Vitamin E Supplementation in Burn Patients

    DTIC Science & Technology

    2013-10-01

    and we have completed 9 subjects out of proposed 42 subjects for 3 years. 15. SUBJECT TERMS Vitamin E deficiency in burn patients and...AD_________________ Award Number: W81XWH-12-1-0429 TITLE: Vitamin E Supplementation in Burn...NUMBER Vitamin E Supplementation in Burn Patients 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Enkhbaatar P, Sousse Linda

  6. Vitamin E Supplementation in Burn Patients

    DTIC Science & Technology

    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

  7. Lipidomic analysis enables prediction of clinical outcomes in burn patients

    PubMed Central

    Qi, Peter; Abdullahi, Abdikarim; Stanojcic, Mile; Patsouris, David; Jeschke, Marc G.

    2016-01-01

    Recent discoveries have highlighted the novel metabolic functions of adipose tissue in enhancing hypermetabolism after trauma. As the exact function and expression profiles of serum lipids and free fatty acids (FFA) are essentially unknown, we determined the lipidomic expression profile after burn in correlation to clinical outcomes to identify important lipid mediators affecting post-burn outcomes. We conducted a prospective cohort study with 46 adult burn patients and 5 healthy controls at the Ross Tilley Burn Center in Toronto, Canada. Patients were stratified based on major demographic and clinical variables, including age, burn severity, mortality, and sepsis. Serum FFAs and inflammatory markers were measured during acute hospital stay. We found that FFAs were acutely elevated post-burn and returned to baseline over time. Greater burn severity and age were associated with an impaired acute response in unsaturated FFAs and pro-inflammatory cytokines. Elevations in saturated and mono-unsaturated FFAs correlated significantly to increased mortality. In summary, persistent elevation of unsaturated lipids was associated with a functionally altered inflammatory-immunological milieu and worse clinical outcomes. The present lipidomic analysis indicates profound alterations in the lipid profile after burn by characterizing key lipids as potential diagnostic and outcome indicators in critically injured patients. PMID:27982130

  8. Renal failure in burn patients: a review

    PubMed Central

    Emara, S.S.; Alzaylai, A.A.

    2013-01-01

    Summary Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management. PMID:23966893

  9. Renal failure in burn patients: a review.

    PubMed

    Emara, S S; Alzaylai, A A

    2013-03-31

    Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management.

  10. Memories of pain after burn injury--the patient's experience.

    PubMed

    Tengvall, Oili; Wickman, Marie; Wengström, Yvonne

    2010-01-01

    Pain after burns is a major clinical problem and researchers continue to report that burn pain remains undertreated. Adequate pain management could contribute to the prevention of posttraumatic stress disorder and can give a growing sense of patients' self-confidence and strength. Freedom from pain might be unrealistic, but the objective should be to reduce pain as much as possible. The purpose of this study was to describe burn patients' experiences and memories of pain during burn care and to acquire a deeper understanding of how patients cope with the experience. The study method was qualitative and interviews were conducted with 12 adult burn patients (eight men and four women) 6 to 12 months postburn (mean = 7 months). The mean burn size for the group was 10.6% mean of TBSA and the mean stay in hospital was 16 days. The interviews were analyzed using Kvales' method for structuring analysis. The patients' experiences and memories of pain during the trajectory of care were clearly described by the informants during the interviews. Four themes were identified for pain: becoming aware of pain, allowing oneself to feel pain, different pain experiences, and fragile body surface. Four themes were identified for coping: pragmatic coping, allowing someone to care for you, carrying the pain, and perspectives on the trauma. Both good and bad memories were recorded during the care trajectory, and it is evident that the patient has to carry the pain experience by themselves to a large extent.

  11. Infections in critically ill burn patients.

    PubMed

    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.

  12. Burning mouth syndrome: a challenge for dental practitioners and patients.

    PubMed

    Klasser, Gary D; Epstein, Joel B; Villines, Dana; Utsman, Robert

    2011-01-01

    A retrospective study was conducted on patients with burning mouth syndrome (BMS) to assess demographics, onset characteristics, temporal behavior (frequency), duration, and progression of oral burning symptoms. Additionally, treatments provided by health practitioners prior to a definitive diagnosis of BMS were analyzed with an overview of current management strategies. The records of 49 adult patients diagnosed with BMS were reviewed. Descriptive statistics and a Pearson correlation with a statistical significance at p < 0.05 were utilized to analyze the data. The majority of patients were mid-life white women who reported a sudden onset of constant oral burning symptoms that increased in intensity. On average, patients reported oral burning symptoms for 41 months (standard deviation = 73.5, range = 2-360 months, median = 20 months), and 38 of the patients received/trialed 71 various interventions (mean = 1.9) prior to receiving a definitive diagnosis for their oral burning symptoms. This study sample shared many characteristics with those reported previously in the literature. The authors found that patients frequently reported delays in receiving a definitive diagnosis with an array of various trialed interventions. For this reason, the authors provide this overview of current management strategies in order to assist dental practitioners in providing appropriate interventions for patients with BMS.

  13. Quantifying Risk Factors for Long-Term Sleep Problems After Burn Injury in Young Adults.

    PubMed

    Lee, Austin F; Ryan, Colleen M; Schneider, Jeffrey C; Kazis, Lewis E; Li, Nien Chen; Rose, Mary; Liang, Matthew H; Wang, Chao; Palmieri, Tina; Meyer, Walter J; Pidcock, Frank S; Reilly, Debra; Sheridan, Robert L; Tompkins, Ronald G

    Restorative sleep is an important component of quality of life. Disturbances in sleep after burn injury were reported but all based on uncontrolled or nonstandardized data. The occurrence and the effect of long-term sleep problems in young adult burn survivors have not been well defined. This 5-year (2003-2008) prospective multicenter longitudinal study included adults with burn injuries ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire (YABOQ) up to 36 months after injury. The items measured 15 patient-reported outcomes including physical, psychological, and social statuses and symptoms such as itch and pain. Scores of these 15 YABOQ outcome domains were standardized to a mean of 50 and a SD of 10 based on an age-matched nonburned reference group of young adults. Sleep quality was assessed using the item 'How satisfied are you now with your sleep,' rated by a 5-point Likert scale. Patients responding with very and somewhat dissatisfied were classified as having sleep dissatisfaction and the remaining as less or not dissatisfied. The associations between sleep dissatisfaction (yes/no) and YABOQ outcome domains were analyzed longitudinally using mixed-effect generalized linear models, adjusted for %TBSA burned, age, gender, and race. Generalized estimating equations were used to take into account correlated error resulting from repeated surveys on each patient over time. One hundred and fifty-two burn survivors participated in the YABOQ survey at baseline and during the follow-up who had at least one survey with a response to the sleep item. Among them, sleep dissatisfaction was twice as prevalent (76/152, 50%) when compared with the nonburned reference group (29/112, 26%). The likelihood of a burn survivor being dissatisfied with sleep was reduced over time after the burn injury. Sleep dissatisfaction following burns was significantly associated, in a dose-dependent manner, with increasing burn size (P = .001). Better sleep was associated

  14. Burn care professionals' attitudes and practices regarding discussions of sexuality and intimacy with adult burn survivors.

    PubMed

    Rimmer, Ruth Brubaker; Rutter, Cindy E; Lessard, Collette R; Pressman, Melissa Singer; Jost, Janet Cusick; Bosch, James; Foster, Kevin N; Caruso, Daniel M

    2010-01-01

    Burn injury survival means coping with more than just the physical changes and disabilities often encountered after burn injury. Overall quality of life is important, and issues such as sexuality and intimacy are significant facets of quality of life. A literature review revealed limited research regarding current burn center practices related to sexuality and intimacy concerns of burn survivors and their partners. A 28-item survey, designed by seasoned burn care professionals and survivors, was distributed to burn care practitioners attending general sessions at several burn conferences in the United States. Seventy-one (86%) of the invited respondents completed the survey, with nursing representing the majority (63%). Mean tenure working in burn care was 10 years. Mean age of respondents was 40.5 years, with 75% being female and 25% male. Nearly half (47%) reported that specific staff was not designated to discuss sexuality and intimacy with survivors in their center. Sixty-two percent reported that special training regarding sexuality and intimacy was not available at their burn center. Only 14% of respondents indicated that they were "very comfortable" initiating conversation regarding these topics. Fifty-five percent said they were only likely to discuss sexuality and intimacy if the patient/partner initiated the discussion; however, 95% agreed that the patient should not have this responsibility. Although results represent findings from only 37 burn centers, the issues of sexuality and intimacy are not being effectively addressed in the participating centers. Designated staff to provide education is lacking, and there is limited comfort on the part of health care providers in initiating such conversations. These factors seem to often prevent burn care professionals from adequately addressing burn survivor's sexuality and intimacy needs and establish the need for further development of training and educational materials specific to sexuality, intimacy, and

  15. Hot bitumen burns: 92 hospitalized patients.

    PubMed

    Baruchin, A M; Schraf, S; Rosenberg, L; Sagi, A A

    1997-08-01

    Bitumen burns while comprising a small percentage of all types of burns are troublesome. They affect persons engaged in gainful employment which the burns then curtail, as well as requiring special attention because the substance adheres to the skin and is therefore difficult to remove. Ninety-two consecutive patients with such burns who were admitted as in-patients over a 10-year period (1985-1995) have been reviewed. Most of the burns occurred on a worksite and involved active young persons (mean age 29.6 years) the mean size of the burn was 3.87 per cent TBSA, mainly affecting the upper extremities and hands. Mean hospitalization time was 10.6 days. Bitumen burns are fully predictable and can easily be prevented by avoiding unsafe practice and/or equipment. Bitumen is a general term for petroleum-derived substances ranging from true petroleum through so-called mineral tars, to asphalt. Asphalt (Asphaltum) is a semi-solid mixture of several hydrocarbons probably formed by the evaporation of the lighter or more volatile constituents. It is amorphous of low specific gravity, 1-2, with a black or brownish black colour and pitchy lustre. At room temperature it is solid becoming molten and spreadable when heated to 93 degrees C and over. Roofing tars and asphalts are usually heated to temperatures of 232 degrees C to achieve desirable viscosities (e.g. for spraying), whereas lower temperatures are required for the manageable form to pave roads. Notable localities for asphaltum are the island of Trinidad and the Dead Sea region where lake asphaltums were long known to the ancient. Ironically, none of the 92 patients who were treated for bitumen injuries in the 'Soroka' (Beer-Sheba, Israel) and 'Barzilai' (Ashkelon, Israel) Medical Centres (80 and 150 km from the lake respectively) had anything to do with the Dead Sea area.

  16. Outcomes of Older Adults with Burn Injury: University Clinical Center of Kosovo

    PubMed Central

    B. Duci, Shkelzen; M. Arifi, Hysni; R. Ahmeti, Hasan; K. Zatriqi, Violeta; A. Buja, Zejn; T. Hoxha, Enver; Y. Mekaj, Agon

    2015-01-01

    BACKGROUND Advances in burn care over the past 50 years have brought about remarkable improvement in mortality rates such that survival has become an expected outcome even in patients with extensive injuries. Although these improvements have occurred in all age groups, survival in older adults still lags far behind that in younger cohorts. This study determines the outcomes of older adults with burn injury in University Clinical Center of Kosovo. METHODS This is a retrospective study that includes 56 burn patients, older than 60 years who were admitted at the Department of Plastic Surgery, between 1 January 2004 and 31 December 2013. Data processing was done with the statistical package of Stat 3. From the statistical parameters the structural index, arithmetic median, and standard deviation were calculated. RESULTS Fifty six burned patient older than 60 years were included during a 10-year period. Of the 56 elderly patients 29 were women and 27 were men with a mean age of 66.7 years (range, 60-85 years). The differences were not statistically significant for both genders regarding the causes of burn injury. CONCLUSION Considering the gradual increase of the elderly population in our country based on the data of the Ministry of Public Services, an increase is expected to the incidence of burn injuries in the population of this category of our country. PMID:26284184

  17. [Myocardial depression in the burn patient].

    PubMed

    Carrillo-Esper, Raúl; Sánchez-Zúñiga, Martín de Jesús

    2006-01-01

    Myocardial depression and heart failure are frequent complications in critically ill burn patients. The physiopathology is complex and involves the activation of inflammatory pathways, ischemia-reperfusion, oxidative stress and endothelial lesion. Diagnosis should be made early by means of hemodynamic monitoring. Treatment is accomplished by inotropics that act on different pathways of the contractile function and immune response associated with antioxidants and allopurinol.

  18. Analysis of antibiotic consumption in burn patients

    PubMed Central

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

    2015-01-01

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

  19. Adult burn survivors' personal experiences of rehabilitation: an integrative review.

    PubMed

    Kornhaber, R; Wilson, A; Abu-Qamar, M Z; McLean, L

    2014-02-01

    Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey.

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

    PubMed

    Mashreky, S R; Bari, S; Sen, S L; Rahman, A; Khan, T F; Rahman, F

    2010-09-01

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

  1. Burns in Morbidly Obese Patients,

    DTIC Science & Technology

    1992-12-01

    tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary

  2. Thermoregulation in burn patients during exercise.

    PubMed

    Austin, K G; Hansbrough, J F; Dore, C; Noordenbos, J; Buono, M J

    2003-01-01

    The purpose of this study was to assess the ability of patients with burns on 30 to 40% and 60% or greater of their BSA to thermoregulate their core temperature during exercise in the heat. Two groups (n = 3 in each) of subjects with healed third-degree burns (34.0 +/- 1.4% and 77.7 +/- 12.4%, respectively) and a group of unburned subjects (n = 2) exercised for 1 hour on a cycle ergometer at 75 Watts in an environmental chamber set at 35 degrees C and 60% relative humidity. Subjects were monitored for rectal and skin temperatures, heart rate, whole body sweat rate, skin blood flow, and active sweat gland density (number per cm ) in unburned, burned, and harvested skin. The results demonstrated that patients with burns on 60% or greater BSA did not show an intolerance to moderate exercise in the heat, as evidenced by only a moderate rise in rectal temperature and heart rate. Furthermore, the responses were similar to those of the unburned subjects.

  3. Characteristics of burn patients injured in methamphetamine laboratory explosions.

    PubMed

    Spann, Matthew D; McGwin, Gerald; Kerby, Jeffrey D; George, Richard L; Dunn, Shane; Rue, Loring W; Cross, James M

    2006-01-01

    The use of methamphetamine (MA) as a recreational drug has increased exponentially in recent years, resulting in an emergence of clandestine laboratories. Consequently, the frequency with which burn centers across the country are admitting patients injured as a consequence of the volatile manufacturing process of MA is increasing. This study focused on comparing outcomes between burn patients injured secondary to MA laboratory explosions and patients sustaining burns from other mechanisms. All patients identified to have suffered burns secondary to MA laboratory explosions between 1998 and 2004 were included in this study. These patients were compared with those who did not experience such burns during this same time period. In total, 19 patients were identified as having been burned in MA laboratory explosions. These patients had a larger component of third-degree burns (24.8% vs 13.5%; P < .05) as well as TBSA burned (28.4% vs 20.7%; P < .05). In addition, patients using MA had an increased incidence of inhalation injury (31.2% vs 6.1%; P < .05). They also exhibited a significantly increased frequency of complications, such as nosocomial pneumonia, respiratory failure, and sepsis. Overall, the rate of mortality was significantly increased in patients using MA (26.3% vs 8.5%; P < .05); however, no significant difference was observed after adjustment for age, burn size, and inhalation injury. MA burn patients have larger burn size, incidence of inhalation injury, and increased morbidity when compared with non-MA burn patients.

  4. Oral Rehydration Therapy in Burn Patients

    ClinicalTrials.gov

    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

  5. High risk for accidental death in previously burn-injured adults.

    PubMed

    Onarheim, Henning; Vindenes, Hallvard A

    2005-05-01

    This study investigated the long-term mortality in 1182 burn patients admitted at a single burn centre in 1984-2003. One thousand and forty-nine patients were discharged alive, of which 999 (95.2% of all discharged) were available for follow-up (mean observation time: 9.6+/-5.5 (S.D.) years). One hundred and twenty-two patients had died after discharge but before follow-up. For 111 patients, the official information recorded from their death certificates revealed that 83 patients (mainly in the higher age groups) had died due to a variety of natural causes. Twenty-three patients (M:F=18:5) (age: 37.7+/-11.3 years), previously hospitalised for burns, had later suffered accidental or violent deaths, including suicide (5), assault (2), and deaths related to substance and/or alcohol abuse (12). Additionally, five other deaths were recorded as sudden death, with no additional specific information as to the cause of death. This study shows that the rates of accidental or violent death in previously burned adult patients (around 40 deaths per 1000 years at risk) may be an order of magnitude higher than that in the average Norwegian population.

  6. Acute and Perioperative Care of the Burn-Injured Patient

    PubMed Central

    Bittner, Edward A.; Shank, Erik; Woodson, Lee; Martyn, J.A. Jeevendra

    2016-01-01

    Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury are characterized by a reduction in cardiac output, increased systemic and pulmonary vascular resistance. Approximately 2–5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic end points. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia and altered pharmacology. PMID:25485468

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

    PubMed

    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.

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

    PubMed

    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.

  9. Plasma copper, zinc and iron in burn patients

    SciTech Connect

    Olson, A.K.; Tamura, T.; Sauberlich, H.E.; Dimick, A.R. )

    1989-02-09

    Plasma copper, zinc and iron levels were measured using atomic absorption spectrometry in 25 patients admitted to the Burn Care Center from December 1986 to May 1988. The plasma samples were obtained within 48 hours of admission while the patients were beginning aggressive oral nutrition support therapy. The percentage of total body-surface area (TBSA) burn ranged from 11 to 65 (mean 29.2%) and involved 2nd and 3rd degree burns. The mean plasma zinc and iron levels were 0.77 ({plus minus} 0.23; SD) and 0.58 ({plus minus} 0.22) {mu}g/ml, respectively, in 11 patients with < 25% TBSA burns. These levels were higher than the means of 14 patients with {ge} 25% TBSA burns (0.67 {plus minus} 0.23 and 0.50 {plus minus} 0.13 {mu}g/ml, respectively). Plasma copper levels were significantly decreased in patients with {ge} 25% TBSA burns (0.56 {plus minus} 0.27 {mu}l/ml) compared to patients with < 25% TBSA burns. A significant correlation between TBSA burn and plasma copper levels was also found among all patients. The data indicate that the plasma copper levels are lower as the percentage of body surface area burn increases. Although the mechanisms of this rapid decline of plasma levels are not known, careful attention should be given to monitor the nutrient status of these minerals during the treatment and recovery of burn patients.

  10. Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA)

    PubMed Central

    Moghazy, A.M.; Adly, O.A.; Elbadawy, M.A.; Hashem, R.E.

    2016-01-01

    Summary Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen’s formula. The control group was given IV fluids according to the Parkland formula. Patients’ vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson’s formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters. PMID:27857652

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

    PubMed

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

    2012-03-01

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

  12. Risk Factors for Hypotension in Urgently Intubated Burn Patients

    DTIC Science & Technology

    2012-01-01

    fold increase in the odds of death. The use of propofol for the induction of anesthesia for endotracheal intubation in critically ill burned patients...did not increase the odds of hypotension or death. In burn patients requiring emergent endotracheal intubation in the BICU, the care team should...01 DEC 2012 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Risk factors for hypotension in urgently intubated burn patients 5a

  13. Identification of novel prognostic indicators in burned patients.

    PubMed

    Peterson, V M; Murphy, J R; Haddix, T; Ford, P; Anderson, S J; Bartle, E J

    1988-05-01

    The size and depth of burn and patient age are useful early prognostic indicators in burned patients, but have limited value in predicting which patients in a given cohort are likely to die. The objective of this study was to identify additional variables in the first 10 days of burn injury which could better predict patient outcome. Variables consisting of demographic information, routine laboratory data, and clinical observations on 89 burned patients (63 survivors and 26 nonsurvivors) were analyzed. Compared to survivors, nonsurvivors had significantly larger burns (58 +/- 23% vs. 37 +/- 17%; p less than 0.0002) and a higher incidence of Gram-negative septicemia (20 of 26 [77%] vs. 24 of 63 [38%]; p less than 0.001). Potential prognostic variables were subjected to multivariate logistic regression analysis for each of the first 10 days following burn injury in order to identify a combination of parameters which predicted patient outcome. The regression analyses revealed that, as previously demonstrated, patient age and burn size were significant predictors of mortality on admission and throughout the first 10 days postburn. In addition, absolute monocyte count (AMC), absolute lymphocyte count (ALC), maximum daily temperature (Tmax), and BUN were also significant predictors (p less than 0.05). These data indicate that logistic regression models can identify simple prognostic variables in burned patients which may improve clinicians' ability to identify high-risk patients early in the course of their burn injuries.

  14. Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis.

    PubMed

    Silva, L; Garcia, L; Oliveira, B; Tanita, M; Festti, J; Cardoso, L; Lavado, L; Grion, C

    2016-09-30

    After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury due to inhaled smoke and fumes or mediated by the inflammatory response associated with the burn or its infectious complications. The aim of the present study is to assess the epidemiologic profile of ARDS in adult burn patients admitted to intensive care in a burn unit at a university hospital. A prospective cohort study was performed from January to December 2012. Demographic and diagnostic data, prognostic scores, etiology and data on the extent and depth of burns were collected. Data related to risk factors for ARDS and death were also recorded. A total of 85 patients were included in the study. Patients were aged 41.7 (SD = 15.7) years old; 71.8% were male and the mean total body surface area burned was 28.3% (SD = 19.1%); 35.3% presented inhalation injuries. Invasive ventilatory support was required in 44 ICU inpatients (51.8%). ARDS was diagnosed in 38.6% of patients under invasive mechanical ventilation. In multivariate analysis, the presence of inhalation injuries was a risk factor for ARDS (OR = 9.75; CI 95% 2.79 - 33.95; P < 0.001). ARDS is a common complication in burn patients admitted to specialized intensive care units. Inhalation injuries were an independent risk factor for ARDS. Mortality rate observed in the study patients was high and associated with ARDS diagnosis.

  15. Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis

    PubMed Central

    Silva, L.; Garcia, L.; Oliveira, B.; Tanita, M.; Festti, J.; Cardoso, L.; Lavado, L.; Grion, C.

    2016-01-01

    Summary After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury due to inhaled smoke and fumes or mediated by the inflammatory response associated with the burn or its infectious complications. The aim of the present study is to assess the epidemiologic profile of ARDS in adult burn patients admitted to intensive care in a burn unit at a university hospital. A prospective cohort study was performed from January to December 2012. Demographic and diagnostic data, prognostic scores, etiology and data on the extent and depth of burns were collected. Data related to risk factors for ARDS and death were also recorded. A total of 85 patients were included in the study. Patients were aged 41.7 (SD = 15.7) years old; 71.8% were male and the mean total body surface area burned was 28.3% (SD = 19.1%); 35.3% presented inhalation injuries. Invasive ventilatory support was required in 44 ICU inpatients (51.8%). ARDS was diagnosed in 38.6% of patients under invasive mechanical ventilation. In multivariate analysis, the presence of inhalation injuries was a risk factor for ARDS (OR = 9.75; CI 95% 2.79 – 33.95; P < 0.001). ARDS is a common complication in burn patients admitted to specialized intensive care units. Inhalation injuries were an independent risk factor for ARDS. Mortality rate observed in the study patients was high and associated with ARDS diagnosis. PMID:28149245

  16. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: a systematic review of the literature.

    PubMed

    Mann, Elizabeth A; Wood, Geri L; Wade, Charles E

    2011-06-01

    The purpose of this systematic review was to assess the evidence for use of routine procalcitonin testing to diagnose the presence of sepsis in the burn patient. The electronic databases MEDLINE, Cochrane, CINAHL, ProQuest, and SCOPUS were searched for relevant studies using the MeSH terms burn, infection, procalcitonin, and meta-analysis. The focus of the review was the adult burn population, but other relevant studies of critically ill patients were included as data specific to the patient with burns are limited. Studies were compiled in tabular form and critically appraised for quality and level of evidence. Four meta-analyses, one review of the literature, one randomized controlled trial, nine prospective observational, and three retrospective studies were retrieved. Six of these studies were specific to the burn population, with one specific to burned children. Only one meta-analysis, one adult burn and one pediatric burn study reported no benefit of procalcitonin testing to improve diagnosis of sepsis or differentiate sepsis from non-infectious systemic inflammatory response. The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination. Evaluation of the burn specific studies is limited by the use of guidelines to define sepsis and inconsistent results from the burn studies. Utility of the procalcitonin assay is limited due to the lack of availability of rapid, inexpensive tests. However, it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit.

  17. Burns in patients over 90: a fifteen-year series from a regional burns centre.

    PubMed

    Shariff, Zakir; Rodrigues, Jeremy N; Anwar, Umair; Austin, Orla; Phipps, Alan

    2015-03-01

    The elderly constitute an expanding subgroup within society, and may have differences in health needs compared to younger patients. The specific needs and outcomes of elderly patients with burns have been widely studied. However, the definition of elderly often used in previous studies is a cut off of 65 years old. Within this broadly defined group, the very elderly may have distinct health care needs and issues. This study investigated aetiology, management and outcome of burns in those over 90 years treated at a single UK burns service over a period of 15 years between 1998 and 2013, and compares these data to published data describing 'younger' elderly burns patients. Twenty two patients were included, with a 2:1 female:male ration, and a mean 9%TBSA burn. Six of the 22 died during their admission, and those who survived averaged 8 days inpatient stay per %TBSA. The very elderly with burns may fare worse than younger elderly patients. Although burns in the very elderly are relatively infrequent events, they require significant resource. Further work to optimise their outcome is required.

  18. Nontuberculous Mycobacterium Infection in a Burn ICU Patient

    DTIC Science & Technology

    2010-01-01

    care of burn patients at our institution includes early burn wound excision and grafting, early bronchoscopy for suspected inhalation injury and...ISS) was 4 (range 0 75). The majority of the patients were male (2051, 84%). Inhalational injury was seen in 287 patients (11.8%). From this cohort...24.8% (range 4.5 72.5%) with a median age of 50 years (range 18 79). Inhalational injury was diagnosed in 3 patients and only 2 patients sustained

  19. First resuscitation of critical burn patients: progresses and problems.

    PubMed

    Sánchez-Sánchez, M; García-de-Lorenzo, A; Asensio, M J

    2016-03-01

    Currently, the aim of the resuscitation of burn patients is to maintain end-organ perfusion with fluid intake as minimal as possible. To avoid excess intake, we can improve the estimation using computer methods. Parkland and Brooke are the commonly used formulas, and recently, a new, an easy formula is been used, i.e. the 'Rule of TEN'. Fluid resuscitation should be titrated to maintain the urine output of approximately 30-35 mL/h for an average-sized adult. The most commonly used fluids are crystalloid, but the phenomenon of creep flow has renewed interest in albumin. In severely burn patients, monitoring with transpulmonary thermodilution together with lactate, ScvO2 and intraabdominal pressures is a good option. Nurse-driven protocols or computer-based resuscitation algorithms reduce the dependence on clinical decision making and decrease fluid resuscitation intake. High-dose vitamin C, propranolol, the avoidance of excessive use of morphine and mechanical ventilation are other useful resources.

  20. Description of Streptococcus pneumoniae Infections in Burn Patients

    DTIC Science & Technology

    2010-01-01

    Description of Streptococcus pneumoniae infections in burn patients§ Jessie S. Glasser a, Michael L. Landruma,b,c, Kevin K. Chung a,d, Duane R...history: Accepted 10 July 2009 Keywords: Burn Streptococcus pneumoniae Pneumococcus Pneumococcal a b s t r a c t Background: Longer survival in burn...Staphylococcus aureus. Although Streptococcus pneumoniae infections are common in the community and can cause nosocomial infections, the incidence and

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

    PubMed

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

    2017-03-06

    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.

  2. Management of cyanide toxicity in patients with burns.

    PubMed

    MacLennan, Louise; Moiemen, Naiem

    2015-02-01

    The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present.

  3. Chemical burns

    PubMed Central

    Cartotto, Robert C.; Peters, Walter J.; Neligan, Peter C.; Douglas, Leith G.; Beeston, Jeff

    1996-01-01

    Objectives To report a burn unit’s experience with chemical burns and to discuss the fundamental principles in managing chemical burns. Design A chart review. Setting A burn centre at a major university-affiliated hospital. Patients Twenty-four patients with chemical burns, representing 2.6% of all burn admissions over an 8-year period at the Ross Tilley Regional Adult Burn Centre. Seventy-five percent of the burn injuries were work-related accidents. Chemicals involved included hydrofluoric acid, sulfuric acid, black liquor, various lyes, potassium permanganate and phenol. Results Fourteen patients required excision and skin grafting. Complications were frequent and included ocular chemical contacts, wound infections, tendon exposures, toe amputation and systemic reactions from absorption of chemical. One patient died from a chemical scald burn to 98% of the body surface area. Conclusions The key principles in the management of chemical burns include removal of the chemical, copious irrigation, limited use of antidotes, correct estimation of the extent of injury, identification of systemic toxicity, treatment of ocular contacts and management of chemical inhalation injury. Individualized treatment is emphasized. PMID:8640619

  4. Impact of obesity on body image dissatisfaction and social integration difficulty in adolescent and young adult burn injury survivors.

    PubMed

    Chondronikola, Maria; Sidossis, Labros S; Richardson, Lisa M; Temple, Jeff R; van den Berg, Patricia A; Herndon, David N; Meyer, Walter J

    2013-01-01

    Burn injury deformities and obesity have been associated with social integration difficulty and body image dissatisfaction. However, the combined effects of obesity and burn injury on social integration difficulty and body image dissatisfaction are unknown. Adolescent and young adult burn injury survivors were categorized as normal weight (n = 47) or overweight and obese (n = 21). Burn-related and anthropometric information were obtained from patients' medical records, and validated questionnaires were used to assess the main outcomes and possible confounders. Analysis of covariance and multiple linear regressions were performed to evaluate the objectives of this study. Obese and overweight burn injury survivors did not experience increased body image dissatisfaction (12 ± 4.3 vs 13.1 ± 4.4; P = .57) or social integration difficulty (17.5 ± 6.9 vs 15.5 ± 5.7; P = .16) compared with normal weight burn injury survivors. Weight status was not a significant predictor of social integration difficulty or body image dissatisfaction (P = .19 and P = .24, respectively). However, mobility limitations predicted greater social integration difficulty (P = .005) and body image dissatisfaction (P < .001), whereas higher weight status at burn was a borderline significant predictor of body image dissatisfaction (P = .05). Obese and overweight adolescents and young adults, who sustained major burn injury as children, do not experience greater social integration difficulty and body image dissatisfaction compared with normal weight burn injury survivors. Mobility limitations and higher weight status at burn are likely more important factors affecting the long-term social integration difficulty and body image dissatisfaction of these young people.

  5. Pathophysiology of nerve regeneration and nerve reconstruction in burned patients.

    PubMed

    Coert, J Henk

    2010-08-01

    In extensive burns peripheral nerves can be involved. The injury to the nerve can be direct by thermal or electrical burns, but nerves can also be indirectly affected by the systemic reaction that follows the burn. Mediators will be released causing a neuropathy to nerves remote from the involved area. Involved mediators and possible therapeutic options will be discussed. In burned patients nerves can be reconstructed using autologous nerve grafts or nerve conduits. A key factor is an adequate wound debridement and a well-vascularized bed to optimize the outgrowth of the axons. Early free tissue transfers have shown promising results.

  6. A qualitative analysis of family member needs and concerns in the population of patients with burns.

    PubMed

    Thompson, R; Boyle, D; Teel, C; Wambach, K; Cramer, A

    1999-01-01

    The importance of family support to ameliorate the recovery of a patient with burns has been documented in the literature. However, there is a dearth of research that identifies family members' needs and concerns during the hospitalization of patients with burns. Study aims were as follows: (1) identify support needs and concerns of family members of adult and pediatric patients currently in a burn center and (2) explore the relationship between family needs and the patient's severity of injury. An observational design was used that incorporated semistructured interviews with family members 1 to 3 days after the burn. A convenience sample of family members of burn center patients (n = 97) was recruited over 9 months. Content analysis was used to establish themes from interview data. Interrater reliability on coding of thematic units from 15% of the interviews was 86%; discrepancies were corrected to 100%. The average family member was 42.3 years old, female, white, and at least a high school graduate. Family members' concerns included general patient concerns, physical concerns about the patient, satisfaction of personal needs, and psychologic concerns about the patient. Major sources of support were family and friends, burn center staff, and spirituality. Family members of pediatric patients identified pain and skin graft surgery as priority worries. Satisfaction of personal needs, financial support, and information needs were greater among family members of intensive care unit patients in comparison with step-down patients. These findings underscore the importance of communication and reassurance between the burn team and the family members. Alterations to the support provided to families can be made on the basis of study subjects' responses.

  7. The treatment of extensively burned patients and {beta} irradiational injury skin burn patients with irradiated pigskin

    SciTech Connect

    Tang Zhong Yi; Lu Xing An; Jing Ling; Qi Qiang

    1994-12-31

    Obvious therapeutic effects achieved by the covering of irradiation sterilized pigskin on burn wounds, escarectomized 3rd degree burn wounds and {beta} injured burns are introduced. The article introduces also the manufacture processes of irradiated pigskins and the selection of surgical treatments of various burns.

  8. Burns

    MedlinePlus

    ... if signs of infection develop. These signs include: Drainage or pus from the burned skin Fever Increased pain Red streaks spreading from the burn Swollen lymph nodes Also call a provider right away if ...

  9. Stress Ulcer Disease in the Burned Patient

    DTIC Science & Technology

    1981-03-01

    association of acute upper gastrointestinal tract disease with burn injury was noted as early as 1823 by both Cumin |l| and Swan [2|. but was largely...recommend intragastric irrigation with warm saline [42] and/or selective arterial injec- tion of vasoactive agents such as posterior pituitary extract [43... Cumin , W.: Cases of severe burn, with dissections and remarks. Edinburgh Medical Journal 7^:337, 1823 2. Swan. J.: Practical observations: case of a

  10. Analysis of 1089 burn patients in province of Kurdistan, Iran.

    PubMed

    Groohi, Bahram; Alaghehbandan, Reza; Lari, Abdolaziz Rastegar

    2002-09-01

    Burn injuries still produce a significant morbidity and mortality in Iran. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of 1089 burn patients in the province of Kurdistan in the west of Iran during the 6 years from 21 March 1994 to 20 March 2000. There were two burn centers in Kurdistan, serving 1.4 million people in an area of 28,000 km(2). The incidence rate of burn hospitalization was 13.5 per 100,000 person-years. The median age was 18 years with 58% of the patients under 20 years. The median Body Surface Area (BSA) burned was 40%. Incidence rate of burns for females was 18 per 100,000 person-years and 9.1 per 100,000 person-years for males (P((2))<0.000001). Also there was a statistically significant association between mortality rate and age groups/gender/BBS (P((2))<0.000001). Flame was the most common type of burn (694/1089, 63.7%). There was also a significant correlation between the age groups and types of burn (P((2))<0.000001). Ninety-one percent (991/1089) of the burns were unintentional (12.3 per 100,000 person-years), while suicide attempts by burning for the population aged 13 and older accounted for 12.7% (98/771) (2 per 100,000 person-years). The mortality rate was 4.5 per 100,000 person-years. The study results provide a valuable baseline by which to assess future efforts directed toward the prevention of burn injuries in Kurdistan.

  11. Percutaneous dilational and surgical tracheostomy in burn patients: incidence of complications and dysphagia.

    PubMed

    Smailes, S T; Ives, M; Richardson, P; Martin, R V; Dziewulski, P

    2014-05-01

    The aim of this study is to evaluate the incidence of complications and dysphagia in relation to the timing of tracheostomy and tracheostomy technique in 49 consecutive adult burn patients. We analysed prospectively collected data. Bronchoscopy was used to diagnose tracheal stenosis and a modified Evans blue dye test was used to diagnose dysphagia. Eighteen patients received a percutaneous dilatational tracheostomy (PDT) and thirty-one patients received an open surgical tracheostomy (OST). Eight patients developed significant complications (16%) following tracheostomy, there is no difference in the incidence of complications; post op infection, stoma infection or tracheal stenosis between PDT and OST groups. Patients with full thickness neck burn who developed complications had a tracheostomy significantly earlier following autografting (p=0.05). Failed extubation is associated with dysphagia (p=0.02) whereas prolonged intubation and ventilation prior to tracheostomy independently predicts dysphagia (p=0.03). We conclude that there is no difference in the complication rates for PDT and OST in our burn patients. We recommend early closure of neck burns and tracheostomy through fully adherent autograft or at least 10 days after grafting to reduce stomal infections. For patients with no neck burn, we support early tracheostomy to reduce the likelihood of dysphagia.

  12. Characterization of Candida isolates from pediatric burn patients.

    PubMed Central

    Neely, A N; Odds, F C; Basatia, B K; Holder, I A

    1988-01-01

    To provide more detailed information about Candida epidemiology and pathogenesis in pediatric burn patients, Candida isolates from 113 patients collected over 3 years were identified at the species level and the serotypes and biotypes of the C. albicans isolates were determined. A total of 85% of the patients were colonized or infected by C. albicans, 18% by C. tropicalis, and 11% by C. parapsilosis. Although colonization or infection often was found at multiple sites and times, 87% of the patients were colonized or infected by only one Candida species or strain; the other 13% showed multiple colonizations or infections, some of which occurred simultaneously at the same site. C. albicans biotyping determined the tolerance of the isolates to pH (pH 1.4) and salt; flucytosine, borate, and safranine resistance; and ability to produce proteinase and assimilate urea, sorbose, and citrate; results are expressed as three-digit numbers. For isolates from three different anatomical sites, the distribution of the nine biotype characteristics was similar in all cases but one. Significantly more fecal than wound or throat isolates were resistant to safranine. Sixty-four different serotype-biotype combinations were found in the 96 patients with C. albicans infections or colonizations. Twenty-nine percent of all C. albicans isolates had the partial biotype -57, while 20 of the 96 patients had specifically serotype B, biotype 557 colonizations or infections. Eleven patients had the B557 infection when admitted; nine patients acquired the yeast in-house. Thirty percent of the C. albicans isolated from 23 adult patients at a nearby hospital also showed the -57 biotype pattern, suggesting that C. albicans isolates expressing this biotype are either extremely prevalent in nature or are more virulent than other C. albicans isolates. PMID:3053771

  13. Exercise behaviors and barriers to exercise in adult burn survivors: A questionnaire survey.

    PubMed

    Baldwin, Jennifer; Li, Frank

    2013-01-01

    Exercise is a key component of burn rehabilitation across all phases of care. Supervised outpatient exercise programs have been shown to improve outcomes following burn injury. However, little is known about the exercise behaviors of burn survivors who do not undertake such programs. This study aimed to investigate self-reported exercise behaviors and barriers to exercise in adult burn survivors. A short questionnaire survey was conducted on adult burn survivors attending the ambulatory burns clinic of a tertiary hospital over a 6-week period. The collected data were subjected to paired t-tests and Pearson's correlation test. A total of 63 adult burn survivors (mean age 36.5 years) completed the questionnaire. Participants reported exercising less frequently and engaged in fewer different types of exercise compared with pre-burn (P < 0.05). Poor physical conditions and low motivation and enthusiasm were the major barriers to exercise. Participation in supervised exercise programs can be limited by a range of factors including the availability of resources and access to facilities. This preliminary study suggests that there is a need to improve compliance with outpatient exercise programs. Burn survivors appear to exercise less frequently after burn injury. Barriers to exercise following burn injury include poor physical condition and reduced motivation. Further investigation into overall physical activity following burn injury and potential physical and psychological limitations is warranted. Burn clinicians should highly encourage injury survivors to participate in supervised exercise programs when available or to do exercises at home to maximize post-burn injury recovery.

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

    PubMed Central

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

    2017-01-01

    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. PMID:28042637

  15. Improvement of survival in patients with extensive burns involving the perineum with use of a faecal management system.

    PubMed

    Farroha, A; Frew, Q; Philp, B; Dziewulski, P

    2014-03-31

    The purpose of this study is to assess the effectiveness of faecal management systems in improving survival of patients with extensive burns involving the perineum. All adults with burns of more than 30% total body surface area (TBSA) who were actively treated in our regional burn service between December 2008 and July 2012 were reviewed and compared to an historical cohort of 18 adult patients with similar injury involving the perineum, treated in our regional burn service between 1999 and 2001. For the last five years, faecal management systems (FMS) have been in use for patients with extensive burns involving the perineum. Sixteen patients with burns greater than 30% TBSA involving the perineal region were admitted during this period and all were managed with FMS. Four of the 16 patients (25%) managed with FMS died compared to 11 of the 18 patients (61%) in the historical cohort. The survival of patients with extensive burns involving the perineal region was improved using FMS. No significant complications were reported in relation to the use of FMS. FMS allows faecal diversion, reduced perineal soiling and improved personal hygiene. We believe this allows easier management of these difficult injuries, may reduce the incidence of sepsis and improves survival.

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

    PubMed

    Lavrentieva, Athina; Kontakiotis, Theodore; Bitzani, Militsa

    2014-01-01

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

  17. Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients

    PubMed Central

    Puckett, Yana

    2016-01-01

    Purpose Our objective was to determine the risk factors for inpatient admission of pediatric burn patients. Materials & methods This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included. Results A total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse.  Conclusions Pediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July. PMID:27335714

  18. Initial dosage regimens of gentamicin in patients with burns.

    PubMed

    Zaske, D E; Chin, T; Kohls, P R; Solem, L D; Strate, R G

    1991-01-01

    For 95 patients with burns the gentamicin dosage regimen necessary to achieve optimal serum concentrations was determined. Individual elimination rates and distribution volumes for gentamicin were determined and correlated with renal function parameters and age. In patients with burns who had normal serum creatinine levels (less than 1.5 mg/dl), gentamicin clearance and thus dosage regimens can be stratified by age. Gentamicin's clearance decreased inversely with age. Initial dosage guidelines were calculated for different age groups of patients with normal levels of serum creatinine. The guidelines were developed to assist the clinician in attaining therapeutic concentrations with initial doses of gentamicin. Therapeutic serum concentrations were reached in most patients with burns dosed by these guidelines. Serum gentamicin concentrations should always be monitored during therapy, and dosages should be adjusted to ensure optimal concentrations during the course of therapy.

  19. Burns

    MedlinePlus

    ... cause swelling, blistering, scarring and, in serious cases, shock, and even death. They also can lead to infections because they damage your skin's protective barrier. Treatment for burns depends on the cause of the ...

  20. Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients.

    PubMed

    Ali, Zizi M Ibrahim; El-Refay, Basant H; Ali, Rania Reffat

    2015-03-01

    [Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20-40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20-40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for 60 min and participated in a traditional physical therapy program, and group B (n=15), which only participated in a traditional exercise program 3 days/week. Maximal aerobic capacity, treadmill time, and Berg balance scale were measured before and after the study. [Results] In both groups, the results revealed significant improvements after treatment in all measurements; however, the improvement in group A was superior to that in group B. [Conclusion] The results provide evidence that aerobic exercises for adults with healed burn injuries improve aerobic physical fitness and balance.

  1. Update in the management of critically ill burned patients.

    PubMed

    Lorente, J A; Amaya-Villar, R

    2016-01-01

    The management of critically ill burn patients is challenging. These patients have to be managed in specialized centers, where the expertise of physicians and nursing personnel guarantees the best treatment. Mortality of burn patients has improved over the past decades due to a better understanding of burn shock pathophysiology, optimal surgical management, infection control and nutritional support. Indeed, a more aggressive resuscitation, early excision and grafting, the judicious use of topical antibiotics, and the provision of an adequate calorie and protein intake are key to attain best survival results. General advances in critical care have also to be implemented, including protective ventilation, glycemic control, selective decontamination of the digestive tract, and implementation of sedation protocols.

  2. Population Pharmacokinetic Analysis of Piperacillin in Burn Patients

    PubMed Central

    Jeon, Sangil; Han, Seunghoon; Lee, Jongtae; Hong, Taegon; Paek, Jeongki

    2014-01-01

    Piperacillin in combination with tazobactam, a β-lactamase inhibitor, is a commonly used intravenous antibiotic for the empirical treatment of infection in intensive care patients, including burn patients. The purpose of this study was to develop a population pharmacokinetic (PK) model for piperacillin in burn patients and to predict the probability of target attainment (PTA) using MICs and concentrations simulated from the PK model. Fifty burn patients treated with piperacillin-tazobactam were enrolled. Piperacillin-tazobactam was administered via infusion for approximately 30 min at a dose of 4.5 g (4 g piperacillin and 0.5 g tazobactam) every 8 h. Blood samples were collected just prior to and at 1, 2, 3, 4, and 6 h after the end of the infusion at steady state. The population PK model of piperacillin was developed using NONMEM. A two-compartment first-order elimination PK model was finally chosen. The covariates included were creatinine clearance (CLCR), day after burn injury (DAI), and sepsis. The final PK parameters were clearance (liters/h) (equal to 16.6 × [CLCR/132] + DAI × [−0.0874]), central volume (liters) (equal to 25.3 + 14.8 × sepsis [0 for the absence or 1 for the presence of sepsis]), peripheral volume (liters) (equal to 16.1), and intercompartmental clearance (liters/h) (equal to 0.636). The clearance and volume of piperacillin were higher than those reported in patients without burns, and the terminal half-life and PTA decreased with the increased CLCR. Our PK model suggests that higher daily doses or longer durations of infusion of piperacillin should be considered, especially for burn patients with a CLCR of ≥160 ml/min. PMID:24752260

  3. Adult burn survivors' views of peer support: a qualitative study.

    PubMed

    Badger, Karen; Royse, David

    2010-01-01

    This qualitative study examined 30 burn survivors' perceptions of the value of peer support in their own psychosocial rehabilitation. Little research is available that investigates the role of peer support in post-burn recovery in terms of perceived benefits and costs. Findings revealed strong positive views regarding the helpfulness of peer support. Burn survivors reported that peer supporters provided a sense of belonging and affiliation and gave hope and confidence. Two-thirds of the sample had served as peer supporters themselves after receiving their injuries, suggesting that mutual aid does involve reaching out to others. At the same time, survivors spoke of possible costs in helping others. Involving peer supporters in the psychological rehabilitation of burn survivors may be an important complement to the medical team.

  4. Growth curve trajectories of distress in burn patients.

    PubMed

    Mason, Shawn T; Corry, Nida; Gould, Neda F; Amoyal, Nicole; Gabriel, Vincent; Wiechman-Askay, Shelly; Holavanahalli, Radha; Banks, Sean; Arceneaux, Lisa; Fauerbach, James A

    2010-01-01

    Psychological adjustment after a major burn injury is a significant concern to providers and patients alike. Although efforts have been made to identify associated risk factors, little is known about heterogeneity in the levels or trajectories of adjustment in this population. This study used a novel application of Growth Mixture Modeling to identify subgroups of patients based on their longitudinal self-reported distress using the Brief Symptom Inventory (BSI). Data were drawn from the database of the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The BSI was used to assess symptoms in-hospital and at 6, 12, and 24 months postburn. Participants' T scores on the BSIs Global Severity Index provided a continuous measure of psychological distress. Analyses were conducted using participants' Global Severity Index T scores to discern distinct classes of respondents with similar trajectories across the 2-year follow-up. Results from the Growth Mixture Modeling analysis produced an ordered four-class model of psychological recovery from a major burn. Groups represented the equivalent of high, subthreshold, mild, and minimal symptom severity. Covariates significantly affected the intercept and slope of each class, as well as prediction of group assignment. These analyses demonstrate differences between individual recoveries after a major burn. Psychological distress symptoms remain largely stable over time and highlight the psychological vulnerability of this patient population.

  5. Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2011-10-01

    Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes (ACT) Mr. Reginald Richard American Burn...and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT representing Acuity, Contractures and Time, is...wound leading to scar contracture begins almost immediately after the burning process stops. Rehabilitation treatment delivered prior to beginning

  6. Elevated circulating leukemia inhibitory factor in patients with extensive burns.

    PubMed

    Akita, Sadanori; Akino, Kozo; Ren, Song Guang; Melmed, Shlomo; Imaizumi, Toshifumi; Hirano, Akiyoshi

    2006-01-01

    To investigate circulating cytokine responsiveness in major burns in association with the systemic stress response system, we tested hypothalamic-pituitary-adrenal (HPA) axis markers in extensive burn cases treated in the Department of Plastic and Reconstructive Surgery at Nagasaki University. The HPA axis is a major stress response system, and the leukemia inhibitory factor (LIF) may be a potent mediator of the HPA axis; therefore, circulating LIF levels in burn patients were studied. Twenty extensively burned patients (burn surface area, >20%), ie, 10 women and 10 men, 37 to 77 years of age (average: 59.1 +/- 12.10 years), were assessed. Circulating LIF, adrenocorticotropic hormone (ACTH), other inflammatory markers, and 24-hour urinary free cortisol excretion levels were investigated. LIF levels were greater in patients who died than in those who survived (186.1 +/- 80.41, 83.5 +/- 64.49 pg/ml, respectively, P < .001) at 36 hours after injury. ACTH levels were more significantly elevated in fatal cases than in those who survived. (41.3 +/- 8.28, 25.2 +/- 7.84 pg/ml, respectively, P < .0001). Twenty-four hour (24 to 48 hours after injury) pooled urinary free cortisol excretion levels also were significantly greater in fatal cases than in the surviving patient group (235.0 +/- 36.49 microg/day, 69.0 +/- 18.04 microg/day, respectively, P < .0001). The correlation between serum LIF and urine free cortisol was significant (r = .30; P < .01) as was the correlation of serum LIF with plasma ACTH (r = .24; P < .01). Serum LIF as well as HPA axis activity markers is a good marker of disease severity and prognosis in patients with extensive burns.

  7. Anti-Inflammatory Effect of Taurine in Burned Patients

    PubMed Central

    Lak, Sima; Ostadrahimi, Alireza; Nagili, Behrooz; Asghari-Jafarabadi, Mohammad; Beigzali, Sanaz; Salehi, Feridoon; Djafarzadeh, Roxana

    2015-01-01

    Purpose: Burn induced inflammatory response can be mediated by reactive oxygen metabolites and accompanied by multiple organ dysfunction. Taurine has protective effects against various inflammatory conditions. The aim of this study was to determine the effect of Taurine supplement in thermal burn victims. Methods: Thirty patients with severe thermal burns were enrolled in this randomized double-blinded clinical trial. These patients were randomly divided into two equal groups (namely Control and Taurine groups), where both received isocaloric and isonitrogenous formula. One group was supplemented with 50 mg/kg of Taurine per day for a duration of 10 days. Blood samples were obtained to measure Interleukin-10 (IL-10), high-sensitivity C-reactive protein (hs-CRP), and Tumor Necrosis Factor alpha (TNF-α) levels at the beginning and the end of the study. Results: Change in serum level of IL-10 in Taurine group was more than Control group [-13.60(-31.40, -10.40) compared to -4.00(-20.00, -0.20) respectively; P = 0.030]. This change was significant in patients with more than 30% TBSA of burn [-14.20(-31.40, -10.40) compared to -2.40(-9.60, 0.40) respectively; P = 0.013]. As for the hs-CRP and TNF-α levels, the difference between the two groups were not significant. Conclusion: Based on the results obtained, Taurine supplement showed a positive outcome on anti-inflammatory cytokine IL-10 in all burn patients. This effect was even more significant in patients with higher percentage of burn area. Taurine had no significant effect on the inflammatory marker hs-CRP and the pro-inflammatory cytokine TNF-α level. For a more thorough verification, measurement of a wider range of inflammatory cytokines in more frequent time intervals are suggested. PMID:26819926

  8. What do we know about one-to-one peer support for adults with a burn injury? A scoping review.

    PubMed

    Tolley, Janelle S; Foroushani, Pooria Sarrami

    2014-01-01

    The purpose of this study was to conduct a broad examination of the central themes and concepts associated with one-to-one peer support for adult patients with a burn injury. The aim of the synthesis was to examine 1) what is reported in the literature regarding the impact of peer support for patients or peers and 2) what methods or elements were considered important with regard to the program design and structure. The synthesis undertaken for this study followed scoping review methodology. A systematic search of the literature was undertaken to identify articles of relevance. Four databases were searched: MEDLINE (medicine), Embase (medicine), PsychINFO (psychology), and SWAbstracts (social work). Information pertaining to program design and structure, recruitment and screening requirements, and perceived benefits and risks associated with peer support were extracted from the included articles. Nine key themes pertaining to program design and structure, and 10 key themes relating to the impact of peer support for patients or peers were identified and discussed. One-to-one peer support for adults with burns trauma has the potential to be a unique support option with earnest attributes. The preliminary data representing the effects of peer support for adults with a burn injury as presented in this literature review shows an emerging pattern of benefit for givers and receivers of peer support. Further work is needed in this field and recommendations are made for future studies.

  9. The importance of family environment for young adults burned during childhood.

    PubMed

    Rosenberg, Laura; Blakeney, Patricia; Thomas, Christopher R; Holzer, Charles E; Robert, Rhonda S; Meyer, Walter J

    2007-08-01

    This study examined the role of family environment for young adult burn survivors making the transition from adolescence to adulthood. Ninety-three young adults who sustained large burns as children were asked to describe their families using the Family Environment Scale (FES). When examining the difference between burn survivors and the normative sample of the FES, burn survivors did not perceive their current family environment different than the normative group. However, burn survivors endorsed more items in the areas of achievement orientation and moral-religious emphasis, and less involvement in intellectual-cultural activities. We also examined the relationship between family characteristics on the FES and psychological adjustment of burn survivors as measured by the Young Adult Self-Report (YASR). Increased conflict on the FES was positively associated with YASR total problem score, internalizing behaviors, and externalizing behaviors. In addition, participation in recreational and social activities and organization both inversely correlated with YASR total problem score. In conclusion, increased family conflict was associated with decreased psychological adjustment of burn survivors as measured by the YASR total problem score.

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

    PubMed Central

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

    2017-01-01

    BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION Massage was shown not to have any effect on anticipatory anxiety and procedural pain. PMID:28289612

  11. Microbiology of wildfire victims differs significantly from routine burns patients: data from an Australian wildfire disaster.

    PubMed

    Sherry, Norelle L; Padiglione, Alexander A; Spelman, Denis W; Cleland, Heather

    2013-03-01

    The catastrophic wildfires of February 2009 in Victoria, Australia killed 173 people and hospitalised 18 adults with burns. We conducted a case-control study of wildfire victims (WFVs) compared to routine burns patients to assess early differences in bacteriology. Demographic, outcome and bacteriology data (for the first 72 h) were prospectively collected on all 18 WFVs, and compared to those of 36 RBPs matched 2:1 for age, gender, burns severity (total body surface area ≥20%) and ICU admission. We found that WFVs had more positive cultures overall (10/18 [56%] vs 7/36 [19%], p=0.04), and we cultured more Gram negative bacteria from wounds (11/13 [85%] vs 3/12 [25%], p=0.005). Although WFVs were more likely to culture Enterobacteriaceae (5/18 vs 2/36) and Aeromonas spp. (3/18 vs 1/36), and less likely to culture Staphylococcus aureus (2/18 vs 6/36), these differences were not statistically significant. Given the predominance of Gram negative organisms cultured from WFVs, our routine burn wound prophylaxis (intravenous cephazolin) would have been inadequate in the WFV group. We suggest that an alternative regimen of oxacillin/nafcillin/flucloxacillin plus gentamicin (or a fluoroquinolone if renal impairment present) may be more appropriate for burn wound prophylaxis in this complex group of patients.

  12. A Goniometry Paradigm Shift to Measure Burn Scar Contracture in Burn Patients

    DTIC Science & Technology

    2015-10-01

    ABSTRACT Objective: To test more extensively a recently designed Revised Goniometry (RG)method and compare it to Standard Goniometry (SG)used to...Unclassified c. THIS PAGE Unclassified Unclassified 19b. TELEPHONE NUMBER (include area code) Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std...recruitment. While standard GM has been described as reliable in burns, scarring can affect GM results based on patient positioning thereby leading to

  13. Burn patient care lost in good manufacturing practices?

    PubMed Central

    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

  14. Burn patient care lost in good manufacturing practices?

    PubMed

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

    2016-06-30

    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.

  15. Early glycemic control in critically ill patients with burn injury.

    PubMed

    Murphy, Claire V; Coffey, Rebecca; Cook, Charles H; Gerlach, Anthony T; Miller, Sidney F

    2011-01-01

    Glucose management in patients with burn injury is often difficult because of their hypermetabolic state with associated hyperglycemia, hyperinsulinemia, and insulin resistance. Recent studies suggest that time to glycemic control is associated with improved outcomes. The authors sought to determine the influence of early glycemic control on the outcomes of critically ill patients with burn injury. A retrospective analysis was performed at the Ohio State University Medical Center. Patients hospitalized with burn injury were enrolled if they were admitted to the intensive care unit between March 1, 2006, and February 28, 2009. Early glycemic control was defined as the achievement of a mean daily blood glucose of ≤150 mg/dl for at least two consecutive days by postburn day 3. Forty-six patients made up the study cohort with 26 achieving early glycemic control and 20 who did not. The two groups were similar at baseline with regard to age, pre-existing diabetes, APACHE II score and burn size and depth. There were no differences in number of surgical interventions, infectious complications, or length of stay between patients who achieved or failed early glycemic control. Failure of early glycemic control was, however, associated with significantly higher mortality both by univariate (35.0 vs 7.7%, P = .03) and multivariate analyses (hazard ratio 6.754 [1.16-39.24], P = .03) adjusting for age, TBSA, and inhalation injury. Failure to achieve early glycemic control in patients with burn injury is associated with an increased risk of mortality. However, further prospective controlled trials are needed to establish causality of this association.

  16. The Changing Epidemiology of Infection in Burn Patients,

    DTIC Science & Technology

    1992-01-01

    Ann. Surg. 176: 108, 1972 por organismos oportunisticos no bacterianos en Una etapa en 12. Pruitt, B.A., Jr,: The burn patient: 11. Later care and...S.H., Hubbard, G.B., McManus, W.F., Mason, A.D._ Pruitt, paciente han variado en concierto con los cambios en Ia flora de B.A. Jr.: Frozen section

  17. Patient Experience of Wearing Compression Garments Post Burn Injury: A Review of the Literature.

    PubMed

    Coghlan, Nicole; Copley, Jodie; Aplin, Tammy; Strong, Jenny

    2017-02-16

    This review was conducted to critically appraise the literature regarding the patient's lived experience of, and adherence to, wearing compression garments post burn injury. Scholarly articles were identified from searches of the following databases: Pubmed, Cochrane Central, CINAHL, PsycINFO, and OT Seeker. Combinations of key words including compression therapy/garment, pressure therapy/garment, burn(s), adherence, and patient experience were utilized. Retrieved studies were included in the review if they were written in English, reported on adult burn populations, and the patient's lived experience of wearing compression garments. Included studies were critically appraised and content analysis was completed on the results sections of the two qualitative studies. Nine studies investigating patient's lived experiences were retained: one systematic review, one randomized controlled trial, five cross-sectional surveys, and two qualitative studies. An adherence framework provided a conceptual basis to categorize reported patient's lived experiences. Results identified a strong focus on patient and treatment-related experiences with limited investigation of condition, patient-provider and health care system experiences. Minimal investigation has been completed regarding the impact of these patient's lived experiences on the adherence to wearing compression garments. Additional research using qualitative methods is required to gain a deep understanding of patient's experiences and perspectives of wearing compression garments and how these experiences influence on their adherence to wearing them. Identification of key experiences that lead to patients removing their compression garments may lead to modification of treatment and system approaches to better align with patients' needs and development of potential interventions that promote adherence.

  18. A Medical Mystery: Unexplained Renal Failure in Burn Patients.

    PubMed

    Lands, Harrison M; Drake, David B

    2017-01-31

    The objective of this study was to review the investigation that uncovered the medical mystery of burn patients developing unexpected renal failure. The authors examined published and unpublished manuscripts and case reports, as well as conducted personal interviews with primary sources. In the late 1970s, emergence of resistant bacterial strains to the topical antimicrobial silver sulfadiazine occurred at the University of Virginia Medical Center. In the search for an alternative topical antimicrobial with known coverage of Pseudomonas aeruginosa, Furacin Soluble Dressing was substituted. However, Furacin Soluble Dressing produced an unexpected toxicity syndrome of hyperosmolality, metabolic gap acidosis, hypercalcemia, and ultimately renal failure. In a search for an antimicrobial with an improved spectrum against Pseudomonas, a Federal Drug Administration-approved product was used to treat large surface area burns. An unexpected toxicity syndrome developed which was traced to the polyethylene glycol base of Furacin Soluble Dressing. This substance was absorbed through the burn wounds, metabolized, and resulted in a toxicity syndrome leading to renal failure. The burn community should be cautious when using products that may be approved as nontoxic for small surface area application, as they may have unexpected medical side effects when used with large surface area burns.

  19. [Acute respiratory insufficiency in burn patients from smoke inhalation].

    PubMed

    Gartner, R; Griffe, O; Captier, G; Selloumi, D; Otman, S; Brabet, M; Baro, B

    2002-03-01

    Respiratory injuries by smoke inhalation are one of the most frequent reasons for acute respiratory failure in burn victims. They are most often of chemical origin and are responsible of a 20 to 70% increase of the mortality compared to the mortality of patients with similar burn injuries, but without inhalation lesions. They are often associated to a certain degree to other factors of acute respiratory failure: superior air way obstruction by oedema in face and neck burns, thoracic expansion hindrance due to thoracic burns, lung trauma lesions by blast injury. The generalized inflammatory reaction due to the extent of burns and an initial inadequate resuscitation are worsening factors. The inflammatory process may be responsible of lung injuries similar to those induced by smoke inhalation, even when there is no inhalation. The treatment remains symptomatic and based on the oxygen therapy, mechanical ventilation, prevention of infections and maintain of homeostasis by hydroelectrolytic adequate resuscitation. The nitric oxyde associated to the almitrin allows in a certain number of cases to minimize intra pulmonary shunting and to normalize the VA/O ratio. The development of treatments allowing to modulate inflammatory mediators may lead to news therapies in the future.

  20. A major burn injury in a liver transplant patient

    PubMed Central

    Delikonstantinou, I.; Philp, B.; Kamel, D.; Barnes, D.; Dziewulski, P.

    2016-01-01

    Summary Immunosuppressive therapy may aggravate the clinical course of a burned patient, primarily affecting wound healing and thus complicating permanent wound coverage. We hereby present the successful management of a 48-year-old female liver transplant recipient with a major burn injury, aiming to elucidate the effects of the patient’s immunosuppression on surgical treatment. After admission to the Burns ITU, the patient underwent serial debridement of the burn and coverage with cryopreserved allografts. Despite immunosuppression, no prolonged survival of the allo-epidermis was documented. Nevertheless, a variable degree of vascularized allo-dermis was clinically identified. She subsequently underwent skin autografting and was discharged home with most of the wounds healed. Although there are isolated reports of survival of skin allografts in immunocompromised patients, in our case the allografted skin did not provide permanent wound coverage. However, it permitted a staged surgical management, allowing the immunosuppressive regime to change, the skin donor sites to heal and it also provided a dermal scaffold for successful skin autografting. PMID:28149251

  1. [Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid in burned patients].

    PubMed

    Carrillo-Esper, Raúl; Contreras-Domínguez, Vladimir

    2004-01-01

    The EDTA-dependent pseudothrombocytopenia is a false decrease in the number of platelets below the normal value when analyzed with automated devices. There is an incidence of 0.09 to 0.21% in hospitalized patients. Pseudothrombocytopenia is secondary to platelet clumping induced by antibodies in the presence of EDTA and has been associated with sepsis, cancer, cardiac surgery and drugs. We report the first case of pseudothrombocytopenia induced by EDTA in a burn patient.

  2. Caring for burn patients at the United States Institute of Surgical Research: the nurses' multifaceted roles.

    PubMed

    Serio-Melvin, Maria; Yoder, Linda H; Gaylord, Kathryn M

    2010-06-01

    Nursing plays a critical role in the comprehensive burn care delivered at the US Army Institute of Surgical Research, otherwise known as the US Army's Burn Center serving the Department of Defense. This center serves as a model for burn units nationally and internationally. It also provides a challenging and innovative work environment for military and civilian nurses. Nurses in the Burn Center contribute to innovations in acute, rehabilitative, and psychological care for patients with burns. This article provides an overview of the complex nursing care provided to burn patients treated at the Burn Center.

  3. Detection of integrons and Staphylococcal Cassette Chromosome (SCCmec) types in Staphylococcus aureus isolated from burn and non-burn patients

    PubMed Central

    Namvar, Amirmorteza Ebrahimzadeh; Khodaei, Farzaneh; Bijari, Aslan; Lari, Abdolaziz Rastegar

    2015-01-01

    Background Methicillin Resistant Staphylococcus aureus (MRSA) strains have been recognized as an important reason of infections in health care units. Integrons role in antibiotic resistance box gene transfer has been well recognized which are found in Gram positive bacteria. Objective The aim of this study was analyzed of SCCmec typing and determine of integron classes in burn and non-burn specimens. Methodology A total of 110 S. aureus strains were isolated from burn and non-burn patients. Antimicrobial susceptibility testing, detection of mecA gene, various SCCmec types and integrons classes were analyzed. Results In antimicrobial susceptibility test in burn patients, resistant to both gentamicin and oxacilin and in non-burn patients resistance to oxacilin and cefepime showed the highest ratio In PCR molecular test (80%) and (52.7%) of strains harbored the mecA gene. Therefore five different SCCmec types were recognized among our studied strains. Subsequently, integron class I was evaluated as (94.5%) in burn and (12.7%) in non-burn isolates by the multiplex PCR method. Conclusion Albeit MRSA strains have the hospital reservoir so may cause serious treats for hospitalized and non-hospitalized patients, hence clinical decision for prevention and treatment may develop due to, mecA gene, SCCmec elements and integrons detection in health care units. PMID:26715924

  4. Opsonic activity of blister fluid from burn patients.

    PubMed Central

    Deitch, E A

    1983-01-01

    The combination of skin loss and immune depression after thermal injury predisposes burn patients to an increased risk of infection. Since the commonest site of infection in the burn patient is the burn wound itself, we elected to study the opsonic activity of locally produced blister fluid, from 18 thermally injured patients, for the two most common organisms colonizing the burn wound (Pseudomonas aeruginosa and Staphylococcus aureus). Blister fluid was as good an opsonin source for staphylococcus as normal serum. In contrast, the blister fluid did not support either the phagocytosis of the intracellular killing of P. aeruginosa. The poor opsonic activity of blister fluid for P. aeruginosa did not appear to be due to the presence of an inhibitory factor(s) since the addition of normal serum restored the opsonic activity of the blister fluid to normal. The concentrations of immunoglobulins and the complement components C3 and C4 in the blister fluid samples were less than half the level of those in normal serum. The opsonic activity of the blister fluid could not be restored to normal by the addition of either immunoglobulin or heat-inactivated serum (56 degrees C for 30 min). Thus, the opsonic factor(s) missing from the blister fluid was heat labile and thus probably represents complement components. That blister fluid had impaired opsonic activity for P. aeruginosa but not for S. aureus indicated that a local humoral defect may be responsible, at least in part, for the high incidence of gram-negative organisms, especially pseudomonads, colonizing the burn wound after thermal injury. PMID:6411619

  5. Cutaneous thermal thresholds in patients with painful burning feet.

    PubMed Central

    Smith, S J; Ali, Z; Fowler, C J

    1991-01-01

    Small nerve fibre sensory function was assessed by psychophysical estimates of cutaneous thermal thresholds in 30 patients who presented with the symptoms of painful burning feet. Thresholds were abnormal in 12 and normal in 18 patients although symptoms in the two groups were very similar. Various hypotheses for the mechanism of pain in small fibre neuropathy have been proposed previously and these are discussed, but the cause of symptoms in patients with normal thresholds, is unknown. The possibility exists that these patients have a neuropathic disorder which affects only those unmyelinated fibres involved with pain. PMID:1660531

  6. Inappropriate Vasopressin Secretion (SIADH) in Burned Patients

    DTIC Science & Technology

    1983-03-01

    after postburn day (PBD) 4 in the morning following all-night recumbency. In the 25 samples (17 patients) with hyponatremia , AVP was elevated, 1.6 to...failure or sepsis, selected also for hyponatremia and urinary Na -- 20 mEq/L, were considered separately. BUN . of 11.7 _t 1.8 mg/di and plasma glucose of...in dilutional hyponatremia . This syndrome occurs in the absence of D gross physiologic perturbations such as volume depletion or adrenal

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

    PubMed

    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.

  8. Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China

    PubMed Central

    Li, Haisheng; Yao, Zhihui; Tan, Jianglin; Zhou, Junyi; Li, Yi; Wu, Jun; Luo, Gaoxing

    2017-01-01

    Burns are a major cause of injury worldwide. We investigated the epidemiology and outcomes of burn patients in a major burn center in southwest China between 2011 and 2015 to provide guidance for burn prevention. Of the 6,325 included burn patients, 66.8% were male and 34.7% were 0 ~ 6 years old. The incidence of burns peaked in autumn. Scald was the most common cause of burns, which was predominant in patients aged 0 ~ 6 years. The mean total body surface area (TBSA) of burns was 13.4%, and patients with burns ≤10% TBSA comprised 64.1% of all cases. Patients with full-thickness burns accounted for 40.1% of all patients and 81.0% of operated patients; these burns were primarily caused by flame (34.8%), scald (21.0%), and electricity (20.4%). Fifty-six deaths occurred (mortality 0.9%), and risk factors included full-thickness burns, larger TBSA and older age. The median length of stay was 17 days, and major risk factors included more operations, better outcomes and larger TBSA. Our data showed that closer attention should be paid to children under 6 years old, males, incidents in autumn and scald burns to prevent burn injuries. Furthermore, individualized burn prevention and treatment measures based on related risk factors should be adopted. PMID:28383066

  9. Prevalence of HIV infection among burn patients: is there a relationship with patients' outcomes?

    PubMed

    Salehi, Seyed Hamid; As'adi, Kamran; Tabatabaeenezhad, Seyedeh Azam; Naderan, Mohammad; Shoar, Saeed

    2017-02-01

    The aim of the present study was to determine the prevalence of human immunodeficiency virus (HIV) infection among acute burn patients and its impacts on patient's outcomes in an Iranian burn care hospital. A cross-sectional study was conducted in a tertiary burn care hospital in Iran, retrospectively reviewing the data records of all patients admitted between February 2011 and February 2012. The HIV status of all the patients was assessed in relation to clinical outcomes and the patient's prognosis. A total of 969 patients were included in this study. Five patients (0·5%) were HIV positive, and all of them were male. Mean burn area was significantly larger in HIV-positive patients than the healthy group (P < 0·05). HIV-positive patients had a longer period of hospitalisation than HIV-negative patients (23·2 ± 16·3 versus 13·1 ± 14·6, P = 0·008). Nonetheless, the average number of procedures and the mortality rate did not significantly differ between the study groups (P > 0·05). Comparison of age, sex and burn extent between HIV-positive patients and HIV-negative cases also revealed similar results. Prevalence of HIV infection among our burn population was 0·5%; thus, HIV status may be related with more extensive injuries and longer hospital stays.

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

    PubMed

    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.

  11. Drug resistance analysis of bacterial strains isolated from burn patients.

    PubMed

    Wang, L F; Li, J L; Ma, W H; Li, J Y

    2014-01-22

    This study aimed to analyze the spectrum and drug resistance of bacteria isolated from burn patients to provide a reference for rational clinical use of antibiotics. Up to 1914 bacterial strain specimens isolated from burn patients admitted to hospital between 2001 and 2010 were subjected to resistance monitoring by using the K-B paper disk method. Retrospective analysis was performed on drug resistance analysis of burn patients. The top eight bacterium strains according to detection rate. A total of 1355 strains of Gram-negative (G(-)) bacteria and 559 strains of Gram-positive (G(+)) bacteria were detected. The top eight bacterium strains, according to detection rate, were Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Klebsiella pneumoniae, Enterobacter cloacae, and Enterococcus. Drug resistance rates were higher than 90% in A. baumannii, P. aeruginosa, S. epidermidis, and S. aureus, which accounted for 52.2, 21.7, 27.8, and 33.3%, respectively, of the entire sample. Those with drug resistance rates lower than 30% accounted for 4.3, 30.4, 16.7, and 16.7%, respectively. Multidrug-resistant S. aureus (MRSA) and methicillin-resistant S. epidermidis (MRSE) accounted for 49.2 and 76.4% of the S. epidermis and S. aureus resistance, respectively. Antibacterial drugs that had drug resistance rates to MRSE and MRSA higher than 90% accounted for 38.9 and 72.2%, respectively, whereas those with lower than 30% drug resistance rates accounted for 11.1 and 16.7%, respectively. The burn patients enrolled in the study were mainly infected with G(-) bacteria. These results strongly suggest that clinicians should practice rational use of antibiotics based on drug susceptibility test results.

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

    PubMed Central

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

    2016-01-01

    Background This study evaluated factors influencing early and late occurrence of AKI in severely burned patients and assessed the relationship between time of occurrence of AKI and mortality of AKI patients. Material/Methods Renal function was evaluated at 3 time points: at admission, at the critical point or middle point of hospitalization, and at the endpoint for which death or a discharge from the center was considered. AKI criteria were: decrease in GFR of less than 60 ml/min at admission, decrease in GFR of more than 75% compared to baseline, and decrease in the daily diuresis of less than 500 ml/24 h. Results At admission, 15.1% of the patients had eGFR <60 ml/min. AKI occurred in 38.5% of cases. The occurrence of AKI was associated with: elderly age (p<0.001), female sex (p=0.017), overweight and obesity (p=0.055); extent and depth of burns, respiratory failure, low protein concentration (for all p<0.001), low blood pressure (p=0.014), and high WBC (p=0.010). Early AKI was detected in 28% of patients. Mortality was 100% with the initial GFR ≥60, 100% with the initial GFR <60 and early deterioration of renal function, 80% with the initial GFR <60 and late worsening, and 60% with the initial GFR <60 and no worsening. Late AKI was observed in 10% of patients and mortality in this group was 79.2%. Mortality in the entire group with AKI was 88.0% versus 24.5%. Conclusions The frequent occurrence of AKI, especially early, worsens the prognosis for survival. Assessment of renal function should be included in the prognostic scales for burned patients. PMID:27746455

  13. The next generation of burns treatment: intelligent films and matrix, controlled enzymatic debridement, and adult stem cells.

    PubMed

    Drago, H; Marín, G H; Sturla, F; Roque, G; Mártire, K; Díaz Aquino, V; Lamonega, R; Gardiner, C; Ichim, T; Riordan, N; Raimondi, J C; Bossi, S; Samadikuchaksaraei, A; van Leeuwen, M; Tau, J M; Núñez, L; Larsen, G; Spretz, R; Mansilla, E

    2010-01-01

    We describe a novel technology based on nanoengineered multifunctional acellular biologic scaffolds combined with wound dressings and films of the same kind. This method allows selective delivery and release of shielded biomaterials and bioactive substances to a desired wound or damaged tissue while stimulating the selective anchoring and adhesion of endogenous circulating repairing cells, such as mesenchymal stem cells, to obtain a faster and more physiologic healing process. We also present a new controlled enzymatic debridement process for more effective burned tissue scarolysis. In light of our preliminary in vitro and in vivo data, we are convinced that these approaches can include the use of other kinds of adult stem cells, such as endometrial regenerative cells, to improve the vascularization of the constructs, with great potential in the entire tissue and organ regeneration field but especially for the treatment of severely burned patients, changing the way these lesions may be treated in the future.

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  15. Outcomes in Adult Survivors of Childhood Burn Injuries as Compared with Matched Controls.

    PubMed

    Stone, James; Gawaziuk, Justin P; Khan, Sazzadul; Chateau, Dan; Bolton, James M; Sareen, Jitender; Enns, Jessica; Doupe, Malcolm; Brownell, Marni; Logsetty, Sarvesh

    2016-01-01

    Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (<18 years old and total BSA >1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.

  16. Minor burn management: potions and lotions

    PubMed Central

    Hyland, Ela J; Connolly, Siobhan M; Fox, Jade A; Harvey, John G

    2015-01-01

    Summary The first aid for burns is to run cold water over the burn for 20 minutes. This is effective for up to three hours after the injury. Assess the affected body surface area using the rule of nines. Consult a burn unit if more than 5% of the total body surface area is burnt in a child or if more than 10% in an adult. Extensive or deep burns and burns to special areas, such as the hands, should be referred. Chemical or electrical burns should also be assessed by a burn unit. For minor burns, antimicrobial dressings are recommended, but oral antibiotics should be avoided unless there are signs of infection. As burns are tetanus prone, check the patient’s immunisation status. Burns that become infected or are slow to heal should be discussed with a burn unit. The burn unit can also provide advice if there are uncertainties about how to manage a patient. PMID:26648640

  17. Impact of Acinetobacter infection on the Mortality of Burn Patients

    DTIC Science & Technology

    2006-10-01

    Acinetobacter baumannii on a burns unit—clinical risk factors and prognosis. Burns 2002;28:349–357. 4. Sengupta S, Kumar P, Ciraj A, Shivananda P... Acinetobacter baumannii —an emerging nosocomial pathogen in the burns unit Manipal, India. Burns 2001;27:140–144. 5. Simor A, Lee M, Vearncombe M, et al. An...outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk fac- tors for acquisition and management. Infect Control Hosp Epi- demiol

  18. Serum CD14 levels in polytraumatized and severely burned patients.

    PubMed Central

    Krüger, C; Schütt, C; Obertacke, U; Joka, T; Müller, F E; Knöller, J; Köller, M; König, W; Schönfeld, W

    1991-01-01

    Recently it has been demonstrated that the CD14 molecule which is expressed on monocytes and macrophages serves as a receptor for lipopolysaccharide (LPS) bound to LPS-binding protein (LBP) and thus mediates LPS-induced tumour necrosis factor (TNF) production. Here we report that CD14 is found as a soluble (s) molecule in serum. In healthy volunteers sCD14 levels (mean +/- s.e.m.) were 3.7 +/- 0.05 micrograms/ml (n = 30, 25-50 years of age) as determined by ELISA (detection limit 20 ng/ml serum) using two monoclonal antibodies in a sandwich technique. In polytraumatized patients (n = 16) significantly decreased levels (1.7 +/- 0.3) were detected immediately after the trauma, which increased to 4.9 +/- 0.3 micrograms/ml within the first 6 days post trauma. sCD14 remained elevated during the first 14 days post trauma in patients with the most severe injuries (injury severity score greater than 45 points), whereas a return to normal levels was observed in patients with an injury score of less than 45 points. In addition, the levels of the high-density lipoproteins that partially inactivate free endotoxin are significantly decreased post trauma. No correlation between parameters of inflammation (C3a and neopterin levels, leucocyte counts, amount of band cells), liver function and sCD14 levels was established. Comparable to polytraumatized patients, increased sCD14 serum levels were observed in five patients with burn trauma (burned area greater than 35%) within the second week post trauma when clinical signs of septicaemia were evident. PMID:1713813

  19. Self-perceptions of young adults who survived severe childhood burn injury.

    PubMed

    Russell, William; Robert, Rhonda S; Thomas, Christopher R; Holzer, Charles E; Blakeney, Patricia; Meyer, Walter J

    2013-01-01

    The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self-concept. To anticipate the need for and guide development of appropriate psychosocial interventions, this study examines how young adults who were burned as children perceive themselves and how this perception might affect their self-esteem. Eighty-two young adult burn survivors (45 male, 37 female) were assessed using the Tennessee Self-Concept Scale, 2nd edition (TSCS2) to determine how the participants perceive themselves and their interaction with society. To gain insight into the possible effects of these self-concept scores, relationships were analyzed between self-concept, a behavioral assessment (Young Adult Self-Report [YASR]), and a psychiatric symptom assessment (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID I]). This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 subscale scores of physical function, appearance, and sexuality, moral conduct, personal values, academics and work, and identity, than did the reference population. Pearson correlation coefficients showed that as moral, personal, family, and social aspects of self-concept decreased, clinical problems endorsed on the YASR subscales increased, including anxiety, somatic, attention, intrusive, and aggressive. Persons with lower self-concept scores on the TSCS2 personal, family, and social scales were more withdrawn on the YASR. Similarly, those with lower TSCS2 scores on the personal and family scales endorsed significantly more thought problems on the YASR. TSCS2 total self-concept, personal, and all of the supplementary scale scores were significantly lower for the group with an affective disorder. Those whose SCID I scores were consistent with a current anxiety disorder had significantly lower scores for the TSCS2 total self-concept and personal. Lower self-concept was associated with endorsement of SCID symptoms. In summary, the

  20. Population pharmacokinetic analysis of colistin in burn patients.

    PubMed

    Lee, Jongtae; Han, Seunghoon; Jeon, Sangil; Hong, Taegon; Song, Wonkeun; Woo, Heungjeong; Yim, Dong-Seok

    2013-05-01

    Colistin is increasingly used as a salvage therapy for nosocomial infections caused by multidrug-resistant Gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. However, the available pharmacokinetic (PK) data for colistin are limited to guide dosing. The aim of this study was to develop a population PK model of colistin and to identify the optimal dosage regimens for burn patients. Fifty patients with burns ranging from 4% to 85% of total body surface area who had been treated with colistimethate sodium (CMS) were studied. CMS, which is hydrolyzed in vivo to an active metabolite, was intravenously administered every 12 h. Blood samples were collected at 0, 1, 2, 4, 6, and 8 h after more than five infusions to measure the colistin concentration using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) system. The population PK model was developed using nonlinear mixed effect modeling (NONMEM, v. 6.2). A one-compartment linear PK model for colistin best described the data. The covariates included in the final model were creatinine clearance for the relative fraction of CMS converted into colistin and the presence of edema for the turnover rate constant of CMS converted into colistin. A steady-state 24-h area under the concentration-time curve was simulated from 1,000 virtual patients receiving 150 mg colistin base activity every 12 h using the final model. Relative to previous studies with critically ill patients, the elimination half-life of colistin (6.6 h) was much shorter, and continuous renal replacement therapy was not a significant covariate for any PK parameters.

  1. Construction of Skin Graft Seams in Burn Patients: A Prospective Randomized Double-Blinded Study.

    PubMed

    Isaac, Kathryn; Umraw, Nisha; Cartotto, Robert

    Prominent scars and contractures may form along the seams between adjacent skin grafts. Seams may be constructed either by approximating the graft edges (AP), or by slightly overlapping the graft edges (OV), but it is not known if one technique creates a less conspicuous seam scar. The purpose of this study was to compare seam scars between seams constructed using the AP and OV techniques. This was a prospective within-patient and within-seam controlled study in adult burn patients treated at an American Burn Association-verified burn center. At skin graft application and seam construction, study seams were divided in half. One half of the seam was made by approximating the graft edges (AP group), while the other half was made by overlapping graft edges (OV group), before identical staple or suture fixation of each half. The AP or OV technique was randomly assigned to the medial or lateral ends of transversely oriented seams or to the proximal and distal ends of longitudinally oriented seams. At 3, 6, and 12 months post surgery, a blinded rater compared the two halves of each study seam scar using the Vancouver Scar Score (VSS). Subjects were also blinded and rated each half of their study seam using a 0 (poor) to 10 (excellent) visual analogue scale. Values are shown as the median (Q1-Q3). There were 44 study seams among 19 subjects (age 51 [36-70] years, with % TBSA burn 10 [7-18], % BSA full-thickness burn 8 [6-15]). Study seams were constructed at 10 (4-15) days post burn. Study seam length was 14.5 (10.3-18.0) cm, with 25% transversely oriented and 75% longitudinally oriented, and with 35/44 seams (80%) between meshed grafts and 9/44 (20%) between sheet grafts. There were no significant differences in any of the individual domain VSS scores (height, pliability, vascularity, and pigmentation) or total VSS score between AP and OV seams at 3, 6, and 12 months. At 12 months, among the 30 study seams that were visible to the subjects, the visual analogue scale

  2. Burn Patient Acuity Demographics, Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes (ACT)

    DTIC Science & Technology

    2014-10-01

    Scar Contractures, and Rehabilitation Treatment Time Related to Patient Outcomes, conveniently referred to as the ACT for representing Acuity...acute and intermediate phases of burn rehabilitation through the collection of daily treatment information for analysis. In particular, the ACT is...primarily interested in investigating the influence that time spent receiving rehabilitation treatments has on patient outcomes as a reflection of

  3. Aerobic Fitness Is Disproportionately Low in Adult Burn Survivors Years After Injury.

    PubMed

    Ganio, Matthew S; Pearson, James; Schlader, Zachary J; Brothers, Robert Matthew; Lucas, Rebekah A I; Rivas, Eric; Kowalske, Karen J; Crandall, Craig G

    2015-01-01

    A maximal aerobic capacity below the 20th percentile is associated with an increased risk of all-cause mortality (Blair 1995). Adult Adult burn survivors have a lower aerobic capacity compared with nonburned adults when evaluated 38 ± 23 days postinjury (deLateur 2007). However, it is unknown whether burn survivors with well-healed skin grafts (ie, multiple years postinjury) also have low aerobic capacity. This project tested the hypothesis that aerobic fitness, as measured by maximal aerobic capacity (VO2max), is reduced in well-healed adult burn survivors when compared with normative values from nonburned individuals. Twenty-five burn survivors (36 ± 12 years old; 13 females) with well-healed split-thickness grafts (median, 16 years postinjury; range, 1-51 years) covering at least 17% of their BSA (mean, 40 ± 16%; range, 17-75%) performed a graded cycle ergometry exercise to test volitional fatigue. Expired gases and minute ventilation were measured via a metabolic cart for the determination of VO2max. Each subject's VO2max was compared with sex- and age-matched normative values from population data published by the American College of Sports Medicine, the American Heart Association, and recent epidemiological data (Aspenes 2011). Subjects had a VO2max of 29.4 ± 10.1 ml O2/kg body mass/min (median, 27.5; range, 15.9-53.3). The use of American College of Sports Medicine normative values showed that mean VO2max of the subjects was in the lower 24th percentile (median, 10th percentile). A total of 88% of the subjects had a VO2max below American Heart Association age-adjusted normative values. Similarly, 20 of the 25 subjects had a VO2max in the lower 25% percentile of recent epidemiological data. Relative to nongrafted subjects, 80 to 88% of the evaluated skin-graft subjects had a very low aerobic capacity. On the basis of these findings, adult burn survivors are disproportionally unfit relative to the general U.S. population, and this puts

  4. Colistin Pharmacokinetics in Burn Patients during Continuous Venovenous Hemofiltration

    PubMed Central

    Rowan, Matthew P.; Niece, Krista L.; Stewart, Ian J.; Mende, Katrin; Cota, Jason M.; Murray, Clinton K.; Chung, Kevin K.

    2014-01-01

    While colistin is considered a last resort for the treatment of multidrug-resistant Gram-negative bacterial infections, there has been an increase in its use due to the increasing prevalence of drug-resistant infections worldwide. The pharmacology of colistin is complex, and pharmacokinetic data are limited, especially in patients requiring renal replacement therapy. As a result, dosing for patients who require renal replacement remains a challenge. Here, we present pharmacokinetic data for colistin from two burn patients (37 and 68 years old) infected with colistin-susceptible isoclonal Acinetobacter baumannii and receiving continuous venovenous hemofiltration (CVVH). To our knowledge, we are the first to examine data from before and during CVVH (for one patient), allowing analysis of the effect of CVVH on colistin pharmacokinetics. Pharmacokinetic/pharmacodynamic analysis indicated that a dose increase from 1.5 to 2.2 mg/kg of body weight colistin base activity on CVVH was insufficient to satisfy the target parameter of an AUC24/MIC (area under the concentration-time curve over 24 h in the steady state divided by the MIC) of ≥60 at an MIC of ≥1 μg/ml in one patient with residual endogenous renal function. Plasma concentrations of colistin ranged from 0 to 15 μg/ml, with free colistin levels ranging from 0.4 to 2.2 μg/ml. While both patients resolved their clinical infections and survived to discharge, colistin-resistant colonizing isolates resulted from therapy in one patient. The variabilities observed in colistin concentrations and pharmacokinetic characteristics highlight the importance of pharmacokinetic monitoring of antibiotics in patients undergoing renal replacement therapy. PMID:25313211

  5. Effect of immune-enhancing diets on the outcomes of patients after major burns

    PubMed Central

    Mahmoud, W.H..; Mostafa, W.; Abdel-Khalek, A.H.; Shalaby, H.

    2014-01-01

    Summary The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns. PMID:26336366

  6. A Prospective Study of Burn Trauma in Adults at the University of Calabar Teaching Hospital, Calabar (South Eastern Nigeria)

    PubMed Central

    Asuquo, Maurice E.; Ekpo, R.; Ngim, Ogbu; Agbor, C.

    2008-01-01

    Background: Burn injuries are among the most devastating injuries seen in the emergency units. The epidemiology of this injury varies from one part of the world to another. This is a 3-year report in an attempt to provide information on the current epidemiology of burns in this center. Method: Patients admitted into the University of Calabar Teaching Hospital, with burn injuries were prospectively studied between February 2005 and January 2008. Results: The 59 patients (33 males and 26 females) accounted for 3.7% of trauma patients and their ages ranged from 15 to 70 years (mean 29.4 years). Flame burn was the commonest injury seen in 48 (81.3%) patients because of petrol and kerosene, whereas chemical burn that involved 7 (11.9%) patients ranked second. Morbidity included burns wound infection in 13 (22%) patients and contractures in 6 (10.2%) patients. The outcome was fatal in 15 (25.4%) patients. Conclusion: The establishment of burn support groups dedicated to publicity on prevention based on areas of risk highlighted in this study and provision of financial aid as well as provision of modern burn care facilities would improve outcome. PMID:18716653

  7. Early ICU Standardized Rehabilitation Therapy for the Critically Inijured Burn Patient

    DTIC Science & Technology

    2013-10-01

    AD_________________ Award Number: W81XWH-12-1-0550 TITLE: Early ICU Standardized Rehabilitation ... ICU Standardized Rehabilitation Therapy for the Critically Inijured Burn Patient 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-12-1-0550 5c...randomized controlled trial to determine whether early ICU rehabilitation , for Burn Intensive Care Unit (BICU) patients requiring mechanical ventilation

  8. Impact of Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae Infections in Severely Burned Patients

    DTIC Science & Technology

    2010-09-01

    versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance. J...Impact of Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae Infections in Severely Burned Patients Jason W Bennett, MD, MSPH, Janelle...Significantly higher mortality has been demonstrated in patients who suffer severe burns com- plicated by Klebsiella pneumoniae bacteremia. The specific

  9. Study or Evidence-Based Practice (EBP) Project : Prediction of Sepsis in the Burn ICU Patient

    DTIC Science & Technology

    2012-05-15

    suspected infection ? Study Aims: a) Develop a multivariable predictive model for detection of bacteremia in the burned ICU patient using 12...clinical measures associated with presence of infection (temperature, heart rate, respiratory rate, platelet count, insulin resistance, feeding intolerance...independent group of burn ICU patients during periods of documented sepsis and absence of infection ; Hypothesis: A multivariate prediction model will

  10. Wound Healing Trajectories in Burn Patients and Their Impact on Mortality

    DTIC Science & Technology

    2014-12-01

    Trauma 1970;10: 1103–8. 5. McManus WF, Mason AD Jr, Pruitt BA Jr. Excision of the burn wound in patients with large burns. Arch Surg 1989;124:718...combat casualties and civilian patients admitted to a burn unit. J Am Coll Surg 2009;208:348–54. 11. Danon D, Kowatch MA, Roth GS. Promotion of wound...a swine model. J Burn Care Rehabil 1999;20(1 Pt 1):15–21. 15. Graves TA, Cioffi WG, McManus WF, Mason AD Jr, Pruitt BA Jr. Fluid resuscitation of

  11. M2b monocytes predominated in peripheral blood of severely burned patients.

    PubMed

    Kobayashi, Makiko; Jeschke, Marc G; Shigematsu, Kenji; Asai, Akira; Yoshida, Shohei; Herndon, David N; Suzuki, Fujio

    2010-12-15

    Severely burned patients were shown to be carriers of M2 monocytes, and all of the monocytes isolated from peripheral blood of severely burned patients (19 of 19 patients) were demonstrated as M2b monocytes (IL-12(-)IL-10(+)CCL1(+) monocytes). Low levels of M2a (IL-12(-)IL-10(+)CCL17(+) monocytes) and M2c monocytes (IL-12(-)IL-10(+)CXCL13(+) monocytes) were demonstrated in peripheral blood of severely burned patients (M2a, 2 of 19 patients; M2c, 5 of 19 patients). M2b, M2a, and M2c monocytes were not detected in peripheral blood of healthy donors. However, M2b monocytes appeared when healthy donor monocytes were cultured in media supplemented with burn patient serum (15%). CCL2 was detected in sera of all burn patients, and M2b monocytes were not generated from healthy donor monocytes cultured with media containing 15% burn patient sera that were previously treated with anti-CCL2 mAb. In addition, M2b monocytes were generated from healthy donor monocytes in cultures supplemented with rCCL2. These results indicate that M2b monocytes are predominant in peripheral blood of severely burned patients who are carriers of CCL2 that functions to stimulate monocyte conversion from resident monocytes to M2b monocytes.

  12. Early excision and grafting of face and neck burns in patients over 20 years.

    PubMed

    Cole, Jana K; Engrav, Loren H; Heimbach, David M; Gibran, Nicole S; Costa, Beth A; Nakamura, Dana Y; Moore, Merilyn L; Blayney, Carolyn B; Hoover, Carolyn L

    2002-04-01

    Although excision and grafting of burns has become common and standard, many surgeons have been reluctant to excise and graft face burns. In fact, we could find photographic results at 1 year after grafting of only eight patients in the English literature. We began excision and grafting of face burns in 1979 and presented our first 16 patients in 1986 in this journal. With encouragement from Janzekovic and Jackson, we continued and have now used essentially the same procedure for more than 20 years in approximately 100 patients and, from this large series, are able to present outcomes. From January of 1979 to May of 1999, we performed excision and grafting on 91 patients with deep face burns. Data were recorded and 35-mm photographs were obtained throughout the 20-year period. We reviewed that database and the slide files of these patients. We found 45 patients with complete photographic sets including 1-year follow-up. Since, in our opinion, there is no useful, objective measure of appearance, we decided to simply publish all 45 sets of complete photographs, permitting the reader to subjectively form an opinion of the outcome of this procedure. The results are all shown as "full" face burns and two "partial" face burns. We continue to believe that early excision and grafting is indicated for face burns that will not heal within 3 weeks and that the procedure yields results that permit the burn victims to return to society and minimizes the time off work or out of school.

  13. Persistent lactic acidosis after chronic topical application of silver sulfadiazine in a pediatric burn patient: a review of the literature.

    PubMed

    Willis, Monte S; Cairns, Bruce A; Purdy, Ashley; Bortsov, Andrey V; Jones, Samuel W; Ortiz-Pujols, Shiara M; Willis, Tina M Schade; Joyner, Benny L

    2013-01-01

    A 3-year old male who sustained 2(nd) and 3(rd) degree burns that covered approximately 60% TBSA presented to a large adult and pediatric verified burn center. On hospital day (HD) 26 of his stay, Candida fungemia was identified by blood culture, delaying operative management until HD 47. On HD 47, after his first operative intervention, the patient developed a persistent metabolic and lactic acidosis. On HD 66, a search for a cause of his osmol gap of 56 mOsm/kg revealed a potential source-propylene glycol. Previous studies have implicated the propylene glycol emulsifier in the silver sulfadiazine that was being applied to his skin as a rare cause of lactic acidosis in severely burned patients. Within 24 hours of stopping the silver sulfadiazine therapy, his lactic acidosis and osmol gap resolved; within 72 hours his metabolic acidosis resolved. Silver sulfadiazine is commonly used adjunct therapy in the treatment of 2(nd) and 3(rd) degree burns and generally has few adverse reactions. The absorption of propylene glycol systemically can rarely occur when applied to extensive burns, presumably due to the disruption of the skin barrier; the half-life of PG is 10 hours and can be prolonged with renal disease because ~50% of the sulfadiazine is excreted in the urine unchanged. When propylene glycol is present systemically, it is metabolized to lactic acid in the liver, which can cause a lactic acidosis. Several commonly used drugs also use propylene glycol as an emulsifier, including IV preparations of lorazepam, pentobarbital, phenobarbital, and phenytoin. In all of these clinical scenarios, including severe burn patients that are being treated with silver sulfadiazine, both lactic acid and propylene glycol levels should be measured to monitor for this rare, potentially serious co-morbidity.

  14. 1082: Prevalence of Kidney Injury in Burn Patients Requiring Fluid Resuscitation

    DTIC Science & Technology

    2014-12-01

    DEC 2014 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE 1082: Prevalence of Kidney Injury in Burn Patients Requiring Fluid...measurements in one of the patients and never elevated in the other. There were no instances of acute kidney injury in either patient. Conclusions:The use...1082 PREVALENCE OF KIDNEY INJURY IN BURN PATIENTS REQUIRING FLUID RESUSCITATION Jose Salinas1, J Waters2, Craig Fenrich1, Maria Serio-Melvin1, John

  15. Nutritional and metabolic consequences in the pediatric burn patient.

    PubMed

    Schulman, Carl I; Ivascu, Felicia A

    2008-07-01

    Nutritional support is one of the many important considerations when treating severe burn injury in children. The type, route, timing, amount, and monitoring of nutritional support have been widely investigated, yet many questions remain. This review will highlight the current state of knowledge and the important aspects of nutritional support in severe burn injury in children.

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

    ERIC Educational Resources Information Center

    North Carolina State Dept. of Community Colleges, Raleigh.

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

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

    PubMed

    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.

  18. Blood Gases as an Indicator of Inhalation Injury and Prognosis in Burn Patients

    PubMed Central

    Megahed, M.A.; Ghareeb, F.; Kishk, T.; El-Barah, A.; Abou-Gereda, H.; El-Fol, H.; El-Sisy, A.; Omran, A.M.

    2008-01-01

    Summary Inhalation injury greatly increases the incidence of respiratory failure and the acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of our research was to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relation between inhalation injury and death in burn patients.This study included 130 burn patients with inhalation injury admitted to Menoufiya University Hospital Burn Center, Egypt, from January 2004 to April 2008 (61 males and 69 females). We found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury in our study was 46.3% (130 patients were identified as having inhalation injury out of 281). The overall mortality for patients with inhalation injury was 41.5% (54 patients out of 130) compared with 7.2% (11 patients out of 151) for patients without inhalation injury. These statistical data make it clear that inhalation injury is an important factor for the prediction of mortality in burn patients. Approximately 80% of fire-related deaths are due not to the burn injury to the airway but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, mostly confined to the upper airways.Major airway, pulmonary, and systemic complications may occur in cases of inhalation injury and thus increase the incidence of burn patient mortality PMID:21991136

  19. Burns from illegal drug manufacture: case series and management.

    PubMed

    Porter, C J W; Armstrong, J R

    2004-01-01

    This case series presents our experience with burns sustained while manufacturing illegal drugs. All adult burn admissions in an 18-month period were retrospectively reviewed. All patients suspected of sustaining burns from illegal drug manufacture were contacted. Information regarding the burn mechanism was sought. Nine of the 64 adult burn admissions were caused by explosions during the manufacture of cannabis oil. Young males with hand and face burns were heavily represented. First-aid treatment was often ignored in favor of hiding incriminating evidence. Only two patients gave honest admission histories. Illegal drug manufacture is becoming more common as synthetic drugs become more consumer desirable. Burns sustained may be thermal and/or chemical. Dishonest patient histories negatively influence burn management. A high level of suspicion is required for diagnosing and treating burns from illegal drug manufacture. Public education is unlikely to be effective as the financial rewards outweigh the perceived risks.

  20. Verified Centers, Nonverified Centers or Other Facilities: A National Analysis of Burn Patient Treatment Location

    PubMed Central

    Zonies, David; Mack, Christopher; Kramer, Bradley; Rivara, Frederick; Klein, Matthew

    2009-01-01

    Background Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, non-verified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. Study Design We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitve care facilities were categorized as American Burn Association verified centers, non-verified burn centers, or other facilities. Results Over the two years, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22%) patients were treated at verified centers, with 26% and 52% treated at non-verified or other facilities, respectively. Patients treated at verified centers were younger than those at non-verified or other facilities (33.1 years vs. 33.7 years vs. 41.9 years, p<0.001) and had a higher rate of inhalation injury (3.4% vs. 3.2% vs. 2.2%, p<0.001). Independent factors associated with treatment at verified centers include burns to the head/neck (RR 2.4, CI 2.1-2.7), hand (RR 1.8, CI 1.6-1.9), electrical injury (RR 1.4, CI 1.4, CI 1.2-1.7), and fewer co-morbidities (RR 0.55, CI 0.5-0.6). Conclusions More than two-thirds of significantly burned patients are treated at non-verified burn centers in the U.S. Many patients meeting ABA criteria for transfer to a burn center are being treated at non-burn center facilities. PMID:20193892

  1. Psychopathology and psychological problems in patients with burn scars: epidemiology and management.

    PubMed

    Van Loey, Nancy E E; Van Son, Maarten J M

    2003-01-01

    Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy

  2. [Psychiatric sequelae of severe burn injuries: emotional distress and resources of occupationally versus non occupationally insured patients 1 year after burn injury].

    PubMed

    Ripper, S; Stolle, A; Seehausen, A; Klinkenberg, M; Germann, G; Hartmann, B; Renneberg, B

    2010-11-01

    Severe burn injuries are traumatic events and can have serious impact on all areas of life frequently causing high emotional distress. In a multicentre study resources and emotional distress of patients with serious burn injuries were assessed during the first hospitalization and at 6 and 12 months follow-up. Patients with severe burn injuries after accidents in a private environment (NBG patients) and patients after occupational accidents covered by the German Social Accident Insurance (BG patients) were compared. All patients reported marked emotional impairment, particularly during the hospitalization. At follow-up a reduction of emotional distress was detected. Nearly half of the patients received a diagnosis of one or more mental disorders according to DSM-IV criteria. When treating patients with burns, special attention should be given to their mental health. They should be offered psychological support to cope with the aftermath of the accident, especially after discharge from hospital when returning to their normal surroundings.

  3. Primary cutaneous mucormycosis in a patient with burn wounds due to Lichtheimia ramosa.

    PubMed

    Kaur, Ravinder; Bala, Kiran; Ahuja, Rajeev B; Srivastav, Prabhat; Bansal, Umesh

    2014-10-01

    Mucormycosis is usually an invasive mycotic disease caused by fungi in the class mucormycetes. Here we report a case of cutaneous mucormycosis due to Lichtheimia ramosa in a 20-year-old female patient with burn injuries. She was admitted to the hospital with accidental flame burns covering 60 % total burn surface area. After 15 days of admission to hospital, the burn wound showed features of fungal infection. Culture showed white cottony growth belonging to the Mucorales order. Morphological identification confirmed it as L. ramosa. She was managed surgically and medically with the help of amphotericin B. Patient survived due to prompt diagnosis and appropriate medical and surgical treatment. Early diagnosis is critical in prevention of morbidity and mortality associated with the disease. Fungal infection in burn wounds can be difficult to diagnose and manage.

  4. Self-inflicted burns in patients with chronic combat-related post-traumatic stress disorder.

    PubMed

    Bras, Marijana; Loncar, Zoran; Boban, Maja; Gregurek, Rudolf; Brajković, Lovorka; Tomicić, Hrvoje; Muljacić, Ante; Micković, Vlatko; Kalenić, Barbara

    2007-12-01

    This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The authors have analyzed possible impacts of the sensationalistic way in which media present cases of self-inflicted burning that induce other, new cases of this suicide type, known in the literature as "Werther's syndrome". The importance of multidisciplinary approach in the treatment of burn patients is stressed with emphasis on the important role of liaison psychiatrist in treating these patients. It is necessary to educate media people to avoid sensational reporting on this kind of events. Continuous psychiatric treatment of vulnerable individuals could be useful in prevention of self-inflicted burns.

  5. A randomized controlled trial to compare the effects of liquid versus powdered recombinant human growth hormone in treating patients with severe burns

    PubMed Central

    CHEN, GUOXIAN; SHAO, HUAWEI; PAN, XUANLIANG

    2016-01-01

    Recombinant human growth hormone (rhGH) promotes protein utilization and synthesis, and is widely used as a therapy to treat severe burns. The present randomized controlled trial evaluated the effects of different forms of rhGH on patients with severe burns. A total of 29 adult severe burns patients were enrolled between February 2009 and November 2011, and randomly assigned to either treatment group (T, liquid rhGH) or control group (C, powder rhGH). From days 5 to 7 following the infliction of burns, both patient groups received rhGH at 0.067 mg/kg/d, once for 10 days. Median serum pre-albumin levels increased in both groups following treatment, the elevation from baseline was significantly higher in the T group on day 10 compared to the C group (88 mg/l vs. 65 mg/l, P=0.046). C-reactive protein, fasting plasma glucose and body weight decreased in both groups. Body weight was significantly lower in the T compared to the C group at baseline, Day 5 and Day 10 (P=0.046, P=0.018 and P=0.006, respectively), however the decrease from baseline levels were not significantly different. Wound healing time was similar between groups (P=0.270). In conclusion the early use of liquid rather than powder rhGH may be more beneficial for treating adult patients with severe burns. PMID:27123246

  6. Serum albumin level as a risk factor for mortality in burn patients

    PubMed Central

    Alejandra Aguayo-Becerra, Olivia; Torres-Garibay, Carlos; Dassaejv Macías-Amezcua, Michel; Fuentes-Orozco, Clotilde; de Guadalupe Chávez-Tostado, Mariana; Andalón-Dueñas, Elizabeth; Espinosa Partida, Arturo; Álvarez-Villaseñor, Andrea Del Socorro; Cortés-Flores, Ana Olivia; Alejandro González-Ojeda

    2013-01-01

    OBJECTIVE: Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients. METHODS: We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality. RESULTS: In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p = 0.000), full-thickness burns (p = 0.004), inhalation injuries (p = 0.000), burns affecting >30% of the body surface area (p = 0.001), and burns associated with infection (p = 0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality. CONCLUSION: Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality. PMID:23917657

  7. The experience of scar management for adults with burns: An interpretative phenomenological analysis.

    PubMed

    Martin, C; Bonas, S; Shepherd, L; Hedges, E

    2016-09-01

    Burns can have both physical and psychological effects on individuals. Pressure garments and silicone gels are used to improve the aesthetic appearance and functions of the skin, but these treatments have been associated with various physical, emotional, sexual and social difficulties. Interpretative phenomenological analysis (IPA) was used to explore participants' experiences of scar management. IPA examines individual experiences before comparing results across cases, and is suited to capture the different ways in which individuals experience a phenomena as well as cautiously looking at patterns across cases. Eight burn patients who had experienced scar management, including pressure garments, were interviewed. Two superordinate themes were identified: Assimilation of Pressure Garment Identity, and Psychosocial Functions of the Pressure Garments. The findings offered insight into the positive and negative experiences of scar management, describing the diverse personal and social functions of the pressure garments and how they became integrated into participants' identities. By understanding the individual nature of these experiences, healthcare professionals can enhance support around these issues and potentially aid adherence to treatment. Further research with different demographic groups as well as for other burn treatments would be useful to develop and contextualise these findings.

  8. A pediatric civil war burn victim: the patient's and caregivers' stress and coping.

    PubMed

    Fette, Andreas

    2005-01-01

    A patient's and the caregivers' threats and reliefs during nursing of a pediatric civil war burn victim, treated through a charity grant in a Western hospital, are discussed and supported by a literature review.

  9. [Clinical application of grafts of cultured epidermis in burn patients. Apropos of 16 patients].

    PubMed

    Foyatier, J L; Faure, M; Hezez, G; Masson, C; Paulus, C; Chomel, P; Latarjet, J; Delay, E; Thomas, L; Adam, C

    1990-01-01

    The authors report a series of 16 patients with extensive burns partially treated by epidermal culture between May 1985 and July 1988. This series consisted of 9 males and 7 females between the ages of 6 and 88 years (mean age: 34 years). The mean surface area of the burns was 66% (range: 30% to 92%). The technique of epidermis culture used was derived from that developed by Green and Rheinwald. A fragment of full-thickness skin taken from the patient was subjected to the action of trypsin. The keratinocytes were cultured on nutrient layers of 3T3 cells. After 10 days, the secondary cultures corresponded to stratified squamous epithelium with a differentiation similar to that of normal human epithelium. This cultured epithelium was used for autografts as well as allografts. Three deaths were related to septic or metabolic complications of the burn. The take rate of the initial graft was greater than 50% in 9 patients. In 3 patients the graft take rate was less than 50% and in 4 patients it was nil. The long-term evaluation of 12 patients revealed partial lysis of the grafts in 3 patients, a stable result in 6 patients and a healed surface greater than the grafted surface in three cases. The best results were obtained with autografts. The initial evaluation of taking of the graft is difficult, as the fine and shiny texture of the grafts is sometimes difficult to distinguish from non-covered zones. The good tolerance of cultured epidermis allografts is due to the fact that they are devoid of Langerhans cells. Although controversial, the reality of the taking of these allografts opens the way to establishing epidermis culture banks.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed Central

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

    2015-01-01

    Aims and Objective: The objectives of this study were to evaluate the epidemiology, clinical variable of chemical burns, and their outcomes to prevent or reduce the frequency and morbidity of such injuries. Materials and Methods: A retrospective analysis was performed on all the patients with chemical burns admitted at author's center between November 2008 and December 2013. All the patients were evaluated in terms of age, sex, total body surface area, etiology, treatment given, morbidity, mortality, final outcome, and then educated regarding specific preventive measures. Results: A total of 96 patients (2.4% of total burn admissions) (42 males and 54 females) were admitted to our hospital with chemical burn injuries. Most of the patients were in the age group of 16–30 years. Incidence in females was slightly higher than in males. Acid was found to be the most common cause of injury. We found 55% patients admitted had <10% total body surface area (TBSA) involvement, 35% had burns involving between 11 and 20% TBSA, and 4% had burns involving 21–30% TBSA, and 6% had burns in >30% TBSA. Morbidity was noticed in the form of skin defect in 80% of cases, soft tissue defect with exposed tendon, bone, or vessels in 16% of cases, and 4% of patients developed contracture and hypertrophic scar. Eighty-six percent of patients required operative intervention. A total of three deaths (3%) were recorded. Conclusion: It was found that chemical burns, though not very common, are deeper burns and can be accidental or non-accidental, and the high-risk age group is 16–25 years. Chemical burns are largely preventable and if properly managed have a good outcome. PMID:25810999

  11. Rates of dysfunction in parents of pediatric patients with burns.

    PubMed

    Kendall-Grove; Ehde, D M; Patterson, D R; Johnson, V

    1998-01-01

    The purpose of the current study was to examine the rates of family and child dysfunction in a prospectively, consecutively admitted sample of children. One hundred eleven parents of children consecutively admitted for burn treatment were interviewed using a demographic questionnaire during their child's stay. Results of the questionnaire indicated that in 36% of the families, at least one parent reported significant dysfunction (history of substance abuse, involvement with Child Protective Services, incarceration, or psychiatric history). Results also indicated that 29% of the children over the age of 4 years had significant dysfunction (physical or sexual abuse, or both, psychiatric disorder, behavior problems, or learning disability. It was concluded that (1) parents of children with burns had a substantially high rate of dysfunction, (2) psychologic and preventive interventions should be focused on parents as well as children, and (3) burn injuries often should be regarded as a symptom rather than a cause of psychosocial problems in the family.

  12. Social Support and Resilience Among Patients with Burn Injury in Lahore, Pakistan

    PubMed Central

    Naveed, Sadiq; Bhuiyan, Mariam M; Usman, Jawad; Inam-ul-Haq, Ahmed; Cheema, Sara S

    2016-01-01

    Introduction Social support and ego resiliency play a great role in maintaining the physical and mental health of patients with burn injuries. The present study has been designed to compare ego resiliency levels and the degree of social support in patients with a burn injury and their healthy counterparts. Methods This study was conducted in two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. A total of 80 burn patients presenting in outpatient departments of general surgery, plastic surgery, and burn centers of these hospitals were surveyed conveniently, and for comparison, 80 patients presenting in outpatient departments with minor ailments, for routine checkups or follow-ups were recruited. The questionnaire comprised three sections: demographics, the Urdu versions of the Ego Resiliency Scale (ER-89), and the Multidimensional Scale of Perceived Social Support (MSPSS). All data were analyzed in SPSS v. 20 (IBM Corp., Armonk, NY). Results Patients with a burn injury were associated with lower scores on the social support scale as well as its subscales assessing support from the significant other, family and friends than their healthy counterparts. However, no significant differences in scores on the ego resiliency scale were reported between these two groups. Conclusion Patients with a burn injury perceived low social support levels from society, which negatively affects their health outcomes. However, their resilience levels were not significantly different from their healthy counterparts. PMID:28070467

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

    PubMed

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

    2016-08-01

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

  14. [An epidemiological investigation of pediatric patients under 14 with large area burns: a multicenter study].

    PubMed

    Cheng, W F; Zhao, D X; Shen, Z A; Zhang, H Y; Tu, J J; Yuan, Z Q; Duan, P; Song, G D

    2017-02-14

    Objective: To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China. Methods: Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis. Results: Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ(2)=21.239, 59.442, 7.333, all P<0.01). Most of the patients (57.8%) were admitted within 2 hours after injury. However, when it came to the pre-hospital emergency management of burn wound, 164 patients (33.7%) did not use any drug or wound dressing, whereas the wound area of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without (P<0.01). The average length

  15. Automobile carburetor- and radiator-related burns.

    PubMed

    Renz, B M; Sherman, R

    1992-01-01

    Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. Four patients had an inhalation injury. Twenty-two surgical procedures were performed on 13 patients. One patient was an innocent bystander, and one patient died. The clothing of 16 patients had ignited, which resulted in larger, deeper burns and in one death. Burns predominantly involved the right sides of the face, head, and torso; the right upper extremity; and the right hand. Thirty-nine patients had scald burns that were associated with uncapping a radiator. These patients had a mean age of 29.6 years, a mean burn size of 8.9% total body surface area, and a mean length of stay of 6.4 days. There were 36 male patients and three innocent bystanders. One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.

  16. [The intermingled transplantation used in severe burn patients after eschar excision].

    PubMed

    Liao, Zhen-jiang

    2008-10-01

    In the early developing stage of burn surgery, severe burn patients with large and deep burn wound often died of complications because of shortage of auto-skin. The method of intermingled transplantation composed of a large sheet of partial thickness allo-skin with punched holes for in laying small pieces of partial thickness auto-skin was first advocated by Chinese doctors (Ruijin Hospital) in 1960's. This intermingled transplantation method has saved many severe burn patients with extensive full-thickness burn wound. The mortality rate of severe burn patients has decreased and the survival rate has increased remarkably since the intermingled transplantation treatment method used in the burn units. In this paper we review the process of formation of intermingled transplantation and the mechanisms of success of this Chinese method in repairing the large wound surface area after eschar excision. We will focus our discussion on the low systemic immunological reaction, the effect of auto-skin islet, local immunological tolerance induced by in layed auto skin, the balance of Th1 and Th2 cells and the effects of some cytokines such as IL-10 in local immunological tolerance and etc. after intermingled transplantation.

  17. Epidemiological analysis of burn patients in the military hospital, Rabat, Morocco.

    PubMed

    Elkafssaoui, S; Tourabi, K; Bouaiti, E; Ababou, K; Moussaoui, A; Ennouhi, M A; Boulmaarouf, A; Mrabet, M; Quyou, A; Soulaymani, A; Ihrai, H

    2011-09-30

    A retrospective study was conducted of burn patients admitted to the military hospital in Rabat, Morocco, in the 6-yr period from 2004 to 2009. This is the first multivariate study to be performed in Morocco. The epidemiological data from the 291 patients hospitalized were collected and studied. The type of burn was indicated in 284 of the patients: 94% of the injuries were thermal burns, 4% were electrical burns, and 1.5% chemical burns. In 261 cases the exact aetiology was noted: 56% of accidents were caused by flames, 38% by hot liquids, 4% by electric current, and 2% by chemicals. The distribution of the Moroccan population is as follows: 0-4 yr, 7%; 5-l4 yr, 8%; 15-19 yr, 8%; 20-59 yr, 70%; over 60 yr, 7%. The male/female sex ratio was 1.63. The mean duration of hospitalization stay was 42 ± 62 days. The mean body surface area burned was 21 ± 18%. Total mortality was 5%; 57% of deaths were due to septic shock. Our results were similar to data from other studies in the literature, with certain characteristics in our series, especially the age bracket most affected, the body surface area burned, and the mechanisms of injury.

  18. Prognostic significance of early cardiac index measurements in severely burned patients.

    PubMed

    Bernard, F; Gueugniaud, P Y; Bertin-Maghit, M; Bouchard, C; Vilasco, B; Petit, P

    1994-12-01

    Invasive monitoring during early resuscitation was performed. To compare the heamodynamic results of severely burned patients, the results of 38 patients hospitalized between 1988 and 1991 in the burn centre of Lyon were retrospectively reviewed. Survivors and non-Survivors' data were compared. No difference existed between the two groups in age, unit burn score, fluid requirement and dose of dobutamine. Survivors had a significantly higher cardiac index, O2 delivery and systolic blood pressure index than non-survivors. It is suggested that the ability to sustain a high cardiac index in response to the burn injury plays a role in the outcome of the patients. There is an indication that dobutamine could have a beneficial effect in this way. Further studies are needed to confirm the benefit of the maintenance of high cardiac index levels by the pressors.

  19. Coming to terms with it all: adult burn survivors' 'lived experience' of acknowledgement and acceptance during rehabilitation.

    PubMed

    Kornhaber, R; Wilson, A; Abu-Qamar, M Z; McLean, L

    2014-06-01

    Although studies have explored the 'lived experience' of burn survivors, little is known about their experiences encountered during rehabilitation. A descriptive phenomenological study was conducted to gain an in-depth insight into burn survivors' experiences' of acknowledgement and acceptance of their injury and the challenges experienced during their rehabilitation journey. A descriptive phenomenological methodology was used to construct themes depicting how burn survivors endeavoured to acknowledge and accept their injury and subsequent altered body image. Twenty men and one woman up to eight years after-burn within Australia were selected through purposeful sampling, and data were collected through in-depth individual interviews conducted in 2011 (N = 21). Interviews were analysed using Colaizzi's method of data analysis. The emergent theme acknowledgement identified four cluster themes that represented how burn survivors came to terms with their injury and an altered body image: (1) reasoning (2) humour (3) the challenge of acceptance (4) self-awareness. Coming to terms with a severe burn is a challenging experience. Reasoning and humour are strategies utilised by burn survivors that facilitate with acknowledgement and acceptance. Understanding these concepts through the burn survivors' perspective will, potentially, facilitate a better understanding of how to best provide for this cohort of patients.

  20. Comparison of measures of physiologic stress during treadmill exercise in a patient with 20% lower extremity burn injuries and healthy matched and nonmatched individuals.

    PubMed

    Wetzel, J L; Giuffrida, C; Petrazzi, A; Schlanser, J; McDowell-Montini, C; Pietrzyk, C; Landry, V L

    2000-01-01

    Patients with burn injuries are referred for rehabilitation within days after the injuries to encourage early ambulation and functional training. Many of these patients are hypermetabolic at rest. Metabolic demands of activity are added to the already hypermetabolic state and elevate total energy requirements and some physiologic measures. Reports on the physiologic stress imposed by therapeutic activities for patients with burn injuries are limited to low levels of metabolic demand (< or =2 metabolic equivalents [METS]). The degree of stress imposed by functional activities such as ambulation (3 METS) and stair climbing (5 METS) is not known for adults with burn injuries. The purpose of this study was to report the clinical measures of myocardial and physiologic stress in a patient with 20% lower extremity total body surface area burns during an exercise challenge equivalent to stair climbing. Physiologic measures were assessed before and during a treadmill activity (5 METS) for a 40-year-old obese man 3 weeks after he had lower extremity burn injuries. These measures were compared with mean values for 62 healthy counterparts and 6 healthy subjects matched for age, gender, and fitness level. Heart rate, systolic blood pressure, rate pressure product, and the rating of perceived exertion for the patient with burn injuries were higher at baseline and during exercise than the mean values for the 62 healthy individuals and the 6 matched subjects. The steady state exercise values for heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion at 6 minutes were 189 beats per minute, 190 mm Hg, 3591, and 17, respectively, for the patient with burn injuries and were 111.3 beats per minute, 149 mm Hg, 1680, and 11.7, respectively, for the 6 matched subjects. Ventilation during exercise also increased for the patient with burn injuries more than for the matched subjects (3/4 vs 1/4). Pain experienced by the patient with burn injuries

  1. Gender differences in resilience and psychological distress of patients with burns.

    PubMed

    Masood, Afsheen; Masud, Yusra; Mazahir, Shama

    2016-03-01

    This research explored the gender differences in resilience and psychological distress of patients with burns. In Pakistan, psychological states of patients with burns have not been widely studied, women making up as the neglected section of society lag far behind in availing the needful health facilities. It was hypothesized that there would be significant gender differences in resilience and psychological distress of patients with burns. The sample of the study consisted of 50 patients with burns, obtained from four different hospitals of Lahore. In order to investigate resilience and psychological distress, the State Trait Resilience Scales (Hiew, 2007) and Kessler Psychological Distress Scale (Kessler, 2001) were used. In addition to these, self-constructed demographic questionnaire was administered. The data was analyzed using SPSS version 16.0. Independent sample t-test was conducted to find gender differences in resilience and psychological distress. The findings from the current research revealed that there were significant gender differences in resilience and psychological distress of patients with burns. The insightful findings from the current research carry strong implications for the clinicians, psychologists and policy makers who can help to develop and implement the rehabilitation programs for the affected population and can launch resilience promoting programs that would help them in coping with burns in effective manner.

  2. The Fenix II study: A longitudinal study of psychopathology among burn patients.

    PubMed

    Fidel-Kinori, Sara Guila; Eiroa-Orosa, Francisco Jose; Giannoni-Pastor, Anna; Tasqué-Cebrián, Ruth; Arguello, Jose Maria; Casas, Miguel

    2016-09-01

    Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopathological consequences of burns developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were screened and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as assessed with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Crash, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burns.

  3. Scald burns in young children--a review of Arizona burn center pediatric patients and a proposal for prevention in the Hispanic community.

    PubMed

    Rimmer, Ruth B; Weigand, Shannon; Foster, Kevin N; Wadsworth, Michelle M; Jacober, Katie; Matthews, Marc R; Drachman, David; Caruso, Daniel M

    2008-01-01

    Arizona Burn Center staff observed an increasing number of pediatric scald burn admissions. Therefore, a retrospective study was conducted to identify scald demographics and etiologies. Focus groups were subsequently conducted to determine burn prevention knowledge in the target community. Arizona Burn Center scald admission variables (ages 0-5 years) reviewed included age, sex, ethnicity, TBSA, body parts burned, occurrence month and location, caregiver present, child and caregiver activities when injured, payor source, length of stay, parental language, and zip code. High-risk zip code area focus groups were then conducted. There were a total of 170 pediatric patients, aged 0 to 5 years, admitted to the burn center during 2005 to 2006. Of this total, 124 of the patients were admitted for scald burns, accounting for 59% of all pediatric burn admissions. Scald burn patient's demographics included male (52%), female (48%) with a mean age of 1.7 years. Majority ethnicity was Hispanic (63%). The mean TBSA was 8% with mean length of stay of 8 days. The remaining pediatric admissions for children aged 0 to 5 were for burns caused by fire or flame 15%, contact with a hot object 13%, friction burns 7%, chemical burns 3%, and electrical burns 3%. Demographics for the combined etiologies included an identical sex breakdown with male (52%) and female (48%). The majority ethnicity in the nonscald group was also Hispanic at 59% with a mean length of stay of 7 days and an average TBSA of 9.5%. Main etiologies of scald burns included hot water (25%), soup (24%), and coffee or tea (21%). Most common child behaviors were pulling hot substance from stove (24%), from countertop (13%), and having liquid spilled on them (13%) typically while caregiver was cooking. Mean TBSA was 8% with mean length of stay (8 days). Scalds occurred in the kitchen (83%) and mainly in child's home (94%). Mother was primary caregiver (78%). Payor source was Medicaid (86%) and the average admission cost

  4. Monitoring and treatment of coagulation abnormalities in burn patients. an international survey on current practices.

    PubMed

    Lavrentieva, A; Depetris, N; Kaimakamis, E; Berardino, M; Stella, M

    2016-09-30

    The magnitude of coagulation abnormalities, and the definition and treatment of coagulopathy in burn patients are inadequately understood and continue to be discussed in the literature. We aimed to analyse physicians' views on monitoring and treating coagulation abnormalities in burn patients. A total of 350 questionnaires were distributed electronically to burn ICU physicians. Participation was voluntary and anonymous. Responses were analysed electronically and comparisons were made according to the region of the ICU or the specialty of the physician. Of the 350 questionnaires distributed, 55 (15.7%) were returned. The majority of burn specialists consider sepsis-induced coagulopathy to be the most frequent coagulopathy in burn patients, and 74.5% declare that they do not use any specific definition/scoring system in their department to detect coagulopathy. The majority of specialists (70.8%) use standard coagulation tests. The most frequent indications for plasma transfusion are massive bleeding (32.8%) and Disseminated Intravascular Coagulation syndrome treatment (20%). The main specific factors reported in our study are cryoprecipitate (23.2%) and fibrinogen concentrate (18.9%). 21.1% of respondents state that they do not use any specific coagulation factor substitution in burn patients. Specific coagulation factor substitution is not a routine practice. The low response rate precludes the generalization of our results.

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

    PubMed

    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 < .005). Clinicians in the "others" group (respiratory therapists, dieticians, pharmacists, etc.) reported less cognitive work than all other groups for both tasks (P < .05). The 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. Catechol-O-methyltransferase genotype predicts pain severity in hospitalized burn patients

    PubMed Central

    Orrey, Danielle C.; Bortsov, Andrey V.; Hoskins, Janelle M.; Shupp, Jeffrey W.; Jones, Samuel W.; Cicuto, Bryan J.; Hwang, James; Jordan, Marion H.; Holmes, James H.; Haith, Linwood R.; Roane, Brandon M.; Diatchenko, Luda; Cairns, Bruce A.; McLean, Samuel A.

    2011-01-01

    Background Increasing evidence suggests that stress system activation after burn injury may contribute to burn-related pain. If this is the case, then genetic variations influencing the function of important stress system components, such as the enzyme catechol-O-methyltransferase (COMT), may predict pain severity after thermal burn injury. Methods We evaluated the association between COMT genotype and pain intensity in 57 individuals hospitalized after thermal burn injury. Consenting participants at four burn centers were genotyped and completed daily 0-10 numeric rating scale pain assessments on two consecutive days including evaluation of waking, least, and worst pain. The association between COMT genotype and individual pain outcomes was calculated using a linear mixed model adjusting for sociodemographic and burn injury characteristics. Results Overall pain (combination of least, worst, and waking pain scores) was significantly higher in patients with a COMT pain vulnerable genotype (6.3 (.4) vs. 5.4 (.4), p=.037). Individuals with a COMT pain vulnerable genotype also had significantly higher “least pain” scores (3.8 (.5) vs. 2.6 (.4), p=.017) and significantly higher pain on awakening (6.8 (.5) vs. 5.3 (.4), p=.004). Differences in worst pain according to genotype group were not significant. COMT pain vulnerable genotype was a stronger predictor of overall pain severity than burn size, burn depth, or time from admission to pain interview assessment. Conclusions These findings suggest that genetic factors influencing stress system function may have an important influence on pain severity after burn injury. Further studies of genetic predictors of pain after burn injury are needed. PMID:22210062

  7. A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients

    DTIC Science & Technology

    2015-03-01

    MILITARY MEDICINE, 180, 3:56, 2015 A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients J Alan...Chung, MC USA*‡ ABSTRACT Background: The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and...Development of acute respiratory distress syndrome (ARDS) is a common complication of burn injury and is associated with poor outcomes. Previous reports using

  8. Demographic characteristics and outcome of burn patients requiring skin grafts: a tertiary hospital experience

    PubMed Central

    Shlash, Saud Othman Al; Madani, Jamal Omran Al; Deib, Jamal Ismail El; Alsubhi, Fatemah Suliman; Saifi, Sara Saud Al; Helmi, Ayman Mohammed Adel; Al-Mutairi, Sultan Khalaf; Khurram, Javed Akhtar

    2016-01-01

    Split thickness skin graft (STSG) and full thickness skin graft (FTSG) are the integral part of burn wound management. However the impact of these graft types on the outcome still remain a matter of controversy. The purpose of this study was to determine the demographic characteristics and outcome of graft surgery of the patients undergone STSG and FTSG at Plastic Surgery Department of Prince Sultan Military Medical City (PSMMC), Riyadh, Kingdom of Saudi Arabia. This retrospective study included 85 burn patients who received STSG (56 cases) and FTSG (29 cases) at PSMMC during 2010-2015. Demographic characteristics (age, gender, etiology of burn, and area of burn) and outcome (graft loss, graft contraction, skin pigmentation, altered sensation, infection rate and duration of hospital stay) were recorded among the patients who received STSG or FTSG. Out of 85 patients 50 patients were male and 35 female with a ratio of 1.42:1. The patients under the age of 10 years comprised the largest burn group with 28 cases (32.9%) out of total 85 patients. The number of patients above the age of 30 years was relatively smaller. Flame (49.3%) and scald (27%) burns constituted the majority of burn cases. The incidence of contraction among STSG (12.5%) and in FTSG (17.2%) cases was similar. Altered sensation was observed in 7.05% of STSG patients and 13.7% of FTSG cases. Loss of graft was observed in 16% of STSG and 20.6% of FTSG patients. The pigmentation was quite similar in STSG (21.4%) and FTSG (24. 1%). The hospitalization time in FTSG (28 days) patients was also comparable with STSG (26.9 days) group. This study showed that majority of the skin graft cases at PSMMC were male under the age of 30 years mostly affected by flame or scald burns. The outcome following STSG and FTSG surgery was comparable with no significant advantage of one over the other. It may be deduced that both STSG and FTSG have relative merits and demerits and either of these grafting procedure may be

  9. Cement Burns

    PubMed Central

    Alam, Munir; Moynagh, M.; Lawlor, C.

    2007-01-01

    Objective: Cement burns account for relatively few admissions to a burn unit; however, these burns deserve separate consideration because of special features of diagnosis and management. Cement burns, even though potentially disabling, have rarely been reported in literature. Methods: A retrospective review was performed of all patients admitted with cement burns injuries to the national burns unit at the St James's Hospital in Dublin, Ireland, over a 10-year period for the years 1996–2005. Results: A total of 46 patients with cement burns were admitted. The majority of patients were aged 16–74 years (mean age = 32 years). Eighty-seven percent of injuries occurred in an industrial and 13% in a domestic setting. The upper and lower extremities were involved in all the patients, and the mean total body surface area affected was 6.5%. The mean length of hospital stay was 21 days with a range of 1–40 days. Thirty-eight (82%) were surgically managed involving debridement and split-thickness skin graft (SSG) and four (9%) were conservatively managed. A further four did not have data available. Conclusion: Widespread inexperience in dealing with this group of cement burns patients and delays in referral to burns unit highlights the potential for greater levels of general awareness and knowledge in both prevention and treatment of these burns. As well, early debridement and split-thickness skin grafting at diagnosis constitutes the best means of reducing the high socioeconomic costs and allows for early return to work. PMID:18091981

  10. Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients

    PubMed Central

    Escolas, Sandra M.; Orman, Jean A.; Chung, Kevin K.; Renz, Evan M.

    2017-01-01

    Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner’s Office and the Office of the Secretary of Defense’s National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors. PMID:26629656

  11. Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients.

    PubMed

    Escolas, Sandra M; Archuleta, Debra J; Orman, Jean A; Chung, Kevin K; Renz, Evan M

    Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner's Office and the Office of the Secretary of Defense's National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors.

  12. [How to evaluate energy requirement of burn patients ---- a question still needs farther investigation].

    PubMed

    Wang, Shi-liang

    2008-12-01

    After a series of study of early feeding (EF), we consider the evaporative heat loss from the burn wound is not the main mechanism of burn hypermetabolism. EF could resuscitate the intestine, preserve its structural integrity and function, prevent bacterial translocation and release of inflammatory mediators, reduce muscle protein catabolism and hypermetabolism. Our studies concerning the relationship between EF and hypermetabolism have already extended to involve hypothalamus now. At the end of 1960s, the advancement in "Intravenous Hyperalimentation" has epoch-making significance, but it has been found later that energy has been oversupplied by this measure, thus it exacerbated visceral loading and led to disorder of internal environment, and it has been found not beneficial to alleviate hypermetabolism. Whether "hypocaloric nutrition" for post-operative patients of G-I (gastro-intestine) surgery is applicable to severe burn patients remains as a problem. Some specialists suggest it is better to supply 126 approximately 146 kJxkg(-1)x d(-1) in severe burn patients. After evaluating the bias and precision of 46 methods of estimating energy supply of burn patients reported from 1953 to 2000, Dickerson RN et al. concluded that the most precise, unbiased methods were those of Milner (1994), Zawacki (1970) and TMMU (1993, Third Military Medical University formula). Though formulas are simple and convenient to estimate energy supplementation, however, it is difficult to evaluate the requirement of energy when the patient's condition changes immensely.

  13. Emotional distress and psychosocial resources in patients recovering from severe burn injury.

    PubMed

    Wallis, Hanna; Renneberg, Babette; Ripper, Sabine; Germann, Günter; Wind, Gerhard; Jester, Andrea

    2006-01-01

    Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. However, patients also reported high levels of resources such as general optimism, self-efficacy, and perceived social support. Within the sample, no significant correlation between severity of emotional distress and severity of burn injury was found. By psychological assessments a subgroup of highly distressed patients was identified. These patients were highly emotionally distressed while having objective injury severity comparable with the other patients in the sample. Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.

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

    PubMed

    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 < 0.05), with the test group having lower times than the control group. The efficient rescue operation time was 14.90 ± 3.31 min in the test group and 30.42 ± 5.65 min in the control group. The efficient resuscitation time was 7.4 ± 3.2 h in the test group and 9.5 ± 2.7 h in the control group. A two-nurse 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.

  15. Physical outcomes of patients with burn injuries--a 12 month follow-up.

    PubMed

    Jarrett, Mark; McMahon, Margaret; Stiller, Kathy

    2008-01-01

    There is only limited research documenting functional ability, physical fitness, and health related quality of life after burn injury. The objective of this study was to measure a comprehensive range of physiotherapy-related outcomes over a 12-month period for patients with significant burn injuries. A prospective study was performed on consecutive patients admitted to the Royal Adelaide Hospital over a 12-month period. Outcomes were measured at admission and discharge from hospital and at 1, 3, 6, and 12 months, and comprised the: Medical Outcomes Study 36-Item Short Form Health Survey, Quick Disabilities of the Arm, Shoulder and Hand questionnaire, Lower Extremity Functional Scale questionnaire, shuttle walk test, grip strength and scar appearance using the Matching Assessment with Photographs of Scars. A total of 86 patients (74 male, mean age 38 years) participated. There was a significant deterioration in all outcomes in the first few months after burn injury, with most outcomes improving towards baseline levels by 6 months. However, lower limb function (Lower Extremity Functional Scale) remained significantly reduced at 12 months and functional exercise capacity (shuttle walk test) was still markedly reduced at 6 months compared with predicted normal values. The total burn surface area significantly affected many of the outcomes. In conclusion, for this sample of patients after burn injury, there was an acceptable rate of recovery for physiotherapy-related outcomes, in that most measures had returned to near baseline levels by 6 months postinjury, with the exception of lower limb function and functional exercise capacity.

  16. An audit of first-aid treatment of pediatric burns patients and their clinical outcome.

    PubMed

    Cuttle, Leila; Kravchuk, Olena; Wallis, Belinda; Kimble, Roy M

    2009-01-01

    This study describes the first aid used and clinical outcomes of all patients who presented to the Royal Children's Hospital, Brisbane, Australia in 2005 with an acute burn injury. A retrospective audit was performed with the charts of 459 patients and information concerning burn injury, first-aid treatment, and clinical outcomes was collected. First aid was used on 86.1% of patients, with 8.7% receiving no first aid and unknown treatment in 5.2% of cases. A majority of patients had cold water as first aid (80.2%), however, only 12.1% applied the cold water for the recommended 20 minutes or longer. Recommended first aid (cold water for >or=20 minutes) was associated with significantly reduced reepithelialization time for children with contact injuries (P=.011). Superficial depth burns were significantly more likely to be associated with the use of recommended first aid (P=.03). Suboptimal treatment was more common for children younger than 3.5 years (P<.001) and for children with friction burns. This report is one of the few publications to relate first-aid treatment to clinical outcomes. Some positive clinical outcomes were associated with recommended first-aid use; however, wound outcomes were more strongly associated with burn depth and mechanism of injury. There is also a need for more public awareness of recommended first-aid treatment.

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

    PubMed

    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.

  18. Development and evaluation of a DVD for the education of burn patients who were not admitted to hospital.

    PubMed

    Finlay, Vidya; Davidoss, Nishant; Lei, Cory; Huangfu, Juhui; Burrows, Sally; Edgar, Dale Wesley; Rea, Suzanne; Wood, Fiona M

    2012-01-01

    Patient involvement is an important component of burn care and is necessary to produce good outcomes. Patient education using multimedia resources is useful in facilitating self-management and recovery from burn injury. The study aims to provide and evaluate an instructional DVD to assist burn patients with their self-management. The project was divided into three phases: 1) research about the needs of patients, 2) production of the DVD based on those needs, and 3) evaluation of the effectiveness of the DVD. In phase III, 49 burn patients (73% male; median age 32 years, median TBSA 3%) completed a survey on confidence in their burn care before development of an educational DVD, the results of which were compared with those of 55 burn patients (58% male; median age 35 years, median TBSA 3%) who completed the same survey questions after viewing a burn care DVD. Patient confidence in all self-management activities showed a statistically significant improvement (P < .01). An instructional burns DVD improves confidence in self-management of patients who have not been admitted to hospital and is a useful adjunct to current burn practice.

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

    PubMed Central

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

    2013-01-01

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

  20. Intensive Insulin Therapy is Associated with Reduced Infectious Complications in Burn Patients

    PubMed Central

    Hemmila, Mark R.; Taddonio, Michael A.; Arbabi, Saman; Maggio, Paul M.; Wahl, Wendy L.

    2013-01-01

    Background Intensive insulin therapy to control blood glucose levels has reduced mortality in surgical, but not medical intensive care unit (ICU) patients. Control of blood glucose levels has also been shown to reduce morbidity in surgical ICU patients. There is very little data for use of intensive insulin therapy in the burn patient population. We sought to evaluate our experience with intensive insulin therapy in burn injured ICU patients with regard to mortality, morbidity, and use of hospital resources. Study Design Burn patients admitted to our American College of Surgeons Level 1 verified Burn Center ICU from 7/1/2004 to 6/30/2006 were studied. An intensive insulin therapy protocol was initiated for ICU patients admitted starting 7/1/2005 with a blood glucose target of 100–140 mg/dL. The two groups of patients studied were control (7/1/2004 to 6/30/2005) and intensive insulin therapy (7/1/2005 to 6/30/2006). All glucose values for the hospitalization were analyzed. Univariate and multivariate analyses were performed. Results 152 ICU patients admitted with burn injury were available for study. No difference in mortality was evident between the control and intensive insulin therapy groups. After adjusting for patient risk, the intensive insulin therapy group was found to have a decreased rate of pneumonia, ventilator-associated pneumonia, and urinary tract infection. In patients with a maximum glucose value > 140 mg/dL, the risk for an infection was significantly increased (OR 11.3, 95% CI 4–32, p-value <0.001). Presence of a maximum glucose value > 140 mg/dL was associated with a sensitivity of 91% and specificity of 62% for an infectious complication. Conclusion Intensive insulin therapy for burn injured patients admitted to the ICU was associated with a reduced incidence of pneumonia, ventilator associated pneumonia, and urinary tract infection. Intensive insulin therapy did not result in a change in mortality or length of stay when adjusting for

  1. Herpes simplex virus infection in burned patients: epidemiology of 11 cases.

    PubMed

    Bourdarias, B; Perro, G; Cutillas, M; Castede, J C; Lafon, M E; Sanchez, R

    1996-06-01

    Burned patients suffer significant immunosuppression during the first 3 or 4 weeks after hospitalization. Herpes simplex virus (HSV) infections are commonly seen in immunosuppressed patients and may account for considerable morbidity and some mortality. We studied retrospectively 11 patients with severe burn injury who became infected with HSV. We determined the prevalence of viral infection in this group of patients. Serological testing and viral culture was used to diagnose HSV infection. No general complications appeared in these 11 patients in association with HSV but two patients died of multiorgan failure. Locally, areas of active epidermal regeneration were most commonly affected. Acyclovir therapy was not used and the duration of hospitalization was normal in these 11 patients.

  2. The management of pain associated with wound care in severe burn patients in Spain

    PubMed Central

    Mendoza, Antonio; Santoyo, Fernando L; Agulló, Alberto; Fenández-Cañamaque, José L; Vivó, Carmen

    2016-01-01

    Objective: To describe the management of pain prevention associated with burn care. Methods: Multi-centre, observational, cross-sectional, descriptive study performed in 4 burn units in Spain. Results: A total of 55 patients undergoing 64 procedures were analysed. Burns were classified as severe (90.4%), third-degree (78.2%) and caused by thermal agents (81.8%). Background analgesia consisted of non-opioid drugs (87.5%) and opioids (54.7%) [morphine (20.3%), morphine and fentanyl (14.1%) or fentanyl monotherapy (15.6%)]. Burn care was performed by experienced nurses (96.9%); 36.5% followed guidelines. The mean duration of procedures was 44 minutes (Statistical Deviation, SD: 20.2) and the mean duration of pain was 27 minutes (SD: 44.6). Procedural pain was primarily managed with opioid analgesics: fentanyl monotherapy and in combination (84%) and fentanyl monotherapy (48%) administered sublingually (89.1%). Patients described pain as different to usual baseline pain (97%), with a mean maximum intensity score of 4.2 points (SD: 3.3) on the VAS scale and a 34% increase in the intensity of pain. The mean patient and healthcare professional satisfaction score per procedure was 6/10 (SD: 1.9) and 5.5/10 (SD: 1.7), respectively. Conclusion: The results of the study describe the management of pain associated with burn care in clinical practice, helping optimise pain control. PMID:27069760

  3. Burn-injured patients in a disaster: September 11th revisited.

    PubMed

    Yurt, Roger W; Bessey, Palmer Q; Alden, Nicole E; Meisels, Daniel; Delaney, John J; Rabbitts, Angela; Greene, William T

    2006-01-01

    We sought to review the steps taken by the New York Presbyterian Healthcare System to address disaster preparedness in the wake of the terrorist attacks of September 11, 2001. We reviewed the institutional records of emergency preparedness efforts, including improvements in infrastructure, employee education and training, and participation in intramural and extramural disaster response initiatives. We used a state discharge database to review burn injury triage within New York State (1995-2004). Since September 11, 2001, significant resources have been devoted to emergency preparedness: expansion of emergency services training, education, response, equipment, and communications; participation in regional disaster response exercises; revision of hospital preparedness plans; and development of municipal and regional responses to a burn mass casualty incident. A review of state and city burn triage patterns during the period of 1995 to 2004 revealed a decline in the number of burn cases treated in New York State-based hospitals by an average of 81 +/- 24 (mean +/- SEM) fewer cases/year (P = .01), occurring primarily in hospitals outside of New York City. Additionally, there was a steady increase in the proportion of New York City burn patients treated at burn center hospitals by 1.8 +/- 0.1 % per year (P < .0001). In response to the events of September 11, 2001, this health care system and this hospital has taken many steps to enhance its disaster response capabilities.

  4. [Caring for families of charcoal-burning suicide patients].

    PubMed

    Pien, Feng-Chen; Feng, Hsin-Pei; Tzeng, Wen-Chii

    2013-12-01

    Charcoal-burning is the second major cause of suicide death in Taiwan. Predicting the variable damage and sequelae in this suicide mode is difficult due to the rapid combination of carbon monoxide with red blood cells. Delayed neuropsychological sequelae (DNS) may result in significantly extended recovery times, causing additional stress to the family. Nurses may help increase family understanding and support and guide family members to more positive intra-family interactions, shared perspectives on the recovery process, and resource seeking behavior by depicting subsequent family life and helping the entire family develop coping strategies those allow all members to effect cognitive, emotional and behavioral change. This result may help families of attempted suicide individuals recover successfully.

  5. Cystic fibrosis lung disease in adult patients.

    PubMed

    Vender, Robert L

    2008-04-01

    As the longevity of all patients with cystic fibrosis (CF) continues to increase (median 2005 survival=36.8 years), more adult patients will be receiving their medical care from nonpediatric adult-care providers. Cystic fibrosis remains a fatal disease, with more than 80% of patients dying after the age of 18 years, and most deaths resulting from pulmonary disease. The changing epidemiology requires adult-care providers to become knowledgeable and competent in the clinical management of adults with CF. Physicians must understand the influence of specific genotype on phenotypic disease presentation and severity, the pathogenic factors determining lung disease onset and progression, the impact of comorbid disease factors such as CF-related diabetes and malnutrition upon lung disease severity, and the currently approved or standard accepted therapies used for chronic management of CF lung disease. This knowledge is critical to help alleviate morbidity and improve mortality for the rapidly expanding population of adults with CF.

  6. The evaluation of physical exam findings in patients assessed for suspected burn inhalation injury.

    PubMed

    Ching, Jessica A; Shah, Jehan L; Doran, Cody J; Chen, Henian; Payne, Wyatt G; Smith, David J

    2015-01-01

    The purpose of this investigation was to evaluate the utility of singed nasal hair (SN), carbonaceous sputum (CS), and facial burns (FB) as indicators of burn inhalation injury, when compared to the accepted standard of bronchoscopic diagnosis of inhalation injury. An institutional review board approved, retrospective review was conducted. All patients were suspected to have burn inhalation injury and subsequently underwent bronchoscopic evaluation. Data collected included: percent burn TBSA, burn injury mechanism, admission physical exam findings (SN, CS, FB), and bronchoscopy findings. Thirty-five males and twelve females met inclusion criteria (n = 47). Bronchoscopy was normal in 31 patients (66%). Data were analyzed as all patients and in subgroups according to burn TBSA and an enclosed space mechanism of injury. Physical exam findings (SN, CS, FB) were evaluated individually and in combination. Overall, the sensitivities, specificities, positive predictive values, and negative predictive values calculated were poor and inconsistent, and they did not improve within subgroup analysis or when physical findings were combined. Further statistical analysis suggested the physical findings, whether in isolation or in combination, have poor discrimination between patients that have and do not have inhalation injury (AUC < 0.7, P > .05) and poor agreement with the diagnosis made by bronchoscopy (κ < 0.4, P > .05). This remained true in the subgroup analysis as well. Our data demonstrated the findings of SN, CS, and FB are unreliable evidence for inhalation injury, even in the context of an enclosed space mechanism of injury. Thus, these physical findings are not absolute indicators for intubation and should be interpreted as one component of the history and physical.

  7. Dissociation of Blood Volume and Flow in Regulation of Salt and Water Balance in Burn Patients,

    DTIC Science & Technology

    1991-09-01

    Antidiuretic hormone (ADH) response following ther- ± standard error of the mean total blood volume in the patients al injury has been examined recently. 2...concluded that ADH levels were elevated after burn and antidiuretic hormone (ADH) levels were elevated and altered and remained so for 7 to 10 days...were control population. Antidiuretic hormone levels were within the reference normal range, while four patients normal for the three patients with

  8. Colonisation with toxigenic Corynebacterium diphtheriae in a Scottish burns patient, June 2015.

    PubMed

    Deshpande, Ashutosh; Inkster, Teresa; Hamilton, Kate; Litt, David; Fry, Norman; Kennedy, Iain T R; Shookhye-Dickson, Jacqueline; Hill, Robert L R

    2015-01-01

    On 12 June 2015, Corynebacterium diphtheriae was identified in a skin swab from a burns patient in Scotland. The isolate was confirmed to be genotypically and phenotypically toxigenic. Multilocus sequence typing of three patient isolates yielded sequence type ST 125. The patient was clinically well. We summarise findings of this case, and results of close contact identification and screening: 12 family and close contacts and 32 hospital staff have been found negative for C. diphtheriae.

  9. Care for the Critically Injured Burn Patient Modulation of Burn Scars Through Laser Deliver of Stem Cells

    DTIC Science & Technology

    2013-10-01

    fractional Erbium:YAG Figure 1: Third degree burn immediately after injury. There is loss of epidermis (char) and hair follicles . Blistering is...14. ABSTRACT The purpose of this study is to test the hypothesis that hypertrophic burn scars can be remodeled by fractional laser treatment and...effectiveness of these novel delivery systems and cell-based therapies for third degree burns in a porcine model. We will test the hypothesis that

  10. The Antibacterial Activity of Acetic Acid against Biofilm-Producing Pathogens of Relevance to Burns Patients

    PubMed Central

    Halstead, Fenella D.; Rauf, Maryam; Moiemen, Naiem S.; Bamford, Amy; Wearn, Christopher M.; Fraise, Adam P.; Lund, Peter A.; Oppenheim, Beryl A.; Webber, Mark A.

    2015-01-01

    Introduction Localised infections, and burn wound sepsis are key concerns in the treatment of burns patients, and prevention of colonisation largely relies on biocides. Acetic acid has been shown to have good antibacterial activity against various planktonic organisms, however data is limited on efficacy, and few studies have been performed on biofilms. Objectives We sought to investigate the antibacterial activity of acetic acid against important burn wound colonising organisms growing planktonically and as biofilms. Methods Laboratory experiments were performed to test the ability of acetic acid to inhibit growth of pathogens, inhibit the formation of biofilms, and eradicate pre-formed biofilms. Results Twenty-nine isolates of common wound-infecting pathogens were tested. Acetic acid was antibacterial against planktonic growth, with an minimum inhibitory concentration of 0.16–0.31% for all isolates, and was also able to prevent formation of biofilms (at 0.31%). Eradication of mature biofilms was observed for all isolates after three hours of exposure. Conclusions This study provides evidence that acetic acid can inhibit growth of key burn wound pathogens when used at very dilute concentrations. Owing to current concerns of the reducing efficacy of systemic antibiotics, this novel biocide application offers great promise as a cheap and effective measure to treat infections in burns patients. PMID:26352256

  11. Effect of growth hormone therapy in burn patients on conservative treatment.

    PubMed

    Singh, K P; Prasad, R; Chari, P S; Dash, R J

    1998-12-01

    Evaluation of growth hormone therapy in burns is limited and none is reported from developing countries where burns still carry high mortality. We analysed serial observations on the clinical and biochemical profiles in 13 patients with second and third degree burns who received recombinant human growth hormone (rhGH) (0.5 IU/kg body wt) for 2 weeks in addition to standard conservative treatment and in 9 patients who were managed with standard conservative treatment only. The two groups of patients had burns, comparable in extent and severity. Additional rhGH treatment resulted in improved wound healing (p < 0.001), delayed separation of eschars (p < 0.01), increase in haemoglobin (p < 0.05), serum albumin (p < 0.01), calcium (p < 0.05), phosphorus (p < 0.001), glomerular filtration rate (p < 0.05) and 7 fold elevation in IGF-1. Also, a reduction in weight loss (p < 0.01), nitrogen production rate (p < 0.05), catabolic index (p < 0.01), duration of sepsis (p < 0.01) and hospital stay by 40% (p < 0.01) was noted with rhGH therapy. Transient hypercalcemia (3 patients), albuminuria (2 patients) and elevated blood glucose (one patient) were noted in the rhGH treated group not necessitating any specific therapy. Mortality in rhGH treatment group was 8.3% compared to 44.5% in the "no rhGH" treatment group. These observations suggest significant benefits of short term rhGH treatment in burn patients on conservative management.

  12. Early detection of pneumonia as a risk factor for mortality in burn patients in Menoufiya University Hospitals, Egypt.

    PubMed

    Mgahed, M; El-Helbawy, R; Omar, A; El-Meselhy, H; Abd El-Halim, R

    2013-09-30

    Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mortality among them. Prediction of mortality in patients with severe burns remains unreliable. The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia, and to discuss the relationship between pneumonia and death in burn patients. This prospective study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department, Egypt, from September 2011 to March 2012. Our findings showed an overall burn patient mortality rate of 26.25 % (21/80), 15% (12/80) incidence of pneumonia, and a 50% (6/12) mortality rate among patients with pneumonia compared to 22 % (15/68) for those without pneumonia. The incidence of pneumonia was twice as high in the subset of patients with inhalation injury as among those without inhalation injury (P< 0.001). It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). In the late onset pneumonia, other associated factors also contributed to mortality. Severity of disease, severity of illness (APACHE score), organ failure, underlying co-morbidities, and VAP PIRO score all have significant correlations with mortality rate. Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.

  13. Effect of extracorporeal shock wave therapy on scar pain in burn patients

    PubMed Central

    Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

    2016-01-01

    Abstract Background: Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. Methods: A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm2 (0.05–0.15 mJ/mm2) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. Results: The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm2), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). Conclusion: ESWT significantly reduced scar pain in burn patients after wound recovery. PMID:27512886

  14. [Effect of arginine supplementation on T-lymphocyte function in burn patients].

    PubMed

    Lu, S L

    1993-09-01

    It is well accepted that nutritional support improves the immunologic functions in burn patients. Arginine has been demonstrated to have tissue--specific properties which influence certain components of the immune system. A series of experiments were carried out in this study, in order to evaluate the immune effect of arginine on T lymphocyte functions in burn patients. Two groups of burn patients with comparable clinical protocol receiving same nutritional administration except the amount of arginine in the nutrients were studied. In one group, 2% of energy supplied by arginine was added in their nutrients, while, the control group received 2% of energy from amino acid compounds instead. The T lymphocyte immune parameters were determined on days 3, 7, 14, 21 and 28 postburn. The data showed that the 2% of total energy supplied by arginine was found to significantly enhance the T lymphocyte response to PHA, CD4 phenotype expression, CD4/CD8 ratio, IL-2 production and IL-2 receptor expression, as compared with the control group. It suggests arginine should become one of the most important nutrients supplied to burn patients.

  15. The trauma bubble: patient and family experience of serious burn injury.

    PubMed

    Gullick, Janice G; Taggart, Susan B; Johnston, Rae A; Ko, Natalie

    2014-01-01

    The aim of this study was to understand the lived experience of burn injury for Australian patients and families. Of specific interest was the period covering emergency and inhospital care and early experiences of transition into the community. Eighteen participants including patients with serious burn injury and close family members engaged in indepth, semistructured interviews. Data were analysed using Heideggerian phenomenology and were interpreted within the framework of Merleau-Ponty's philosophy of the body. Participants experienced substantial emotional trauma that was unrelated to burn size or severity. Emotional distress was highest amongst people with facial burns. Strong recollections of the accident and poorly managed pain seemed to exacerbate the experience of trauma. Patients described physical otherness, memories of consuming, embodied pain, and recycling of the initial catastrophe. Family members expressed vicarious suffering and were confronted by the physical otherness of their loved one. Participants were isolated in their "bubble of trauma" as they tried to contain grief and loss, and protect loved ones from their distress. Emotional trauma persisted after discharge challenging family functioning and adjustment. These findings support a systematic approach to identifying and responding to the emotional needs of patients and family, including early information about possible emotional reactions to traumatic events and proactive engagement with psychology services. Best practice approaches for early pain management should be a focus for both clinical care and further research.

  16. The Ti-Epiplating system as an alternative for ear prostheses in burned patients.

    PubMed

    Gacto-Sanchez, Purificacion; Infante-Cossio, Pedro; Gomez-Cia, Tomas; Lagares, Araceli; Belmonte-Caro, Rodolfo

    2011-01-01

    Burned ear reconstruction remains one of the most difficult areas of plastic surgery, and the aesthetic results are not always acceptable. In this study, the authors describe the results of the prosthetic rehabilitation of patients needing burned ear total reconstruction with a plate-like system (Titanium Epiplating System, Medicon, Tuttlingen, Germany) treated in their hospital between 2006 and 2009. The goals of this study were to report on the use of bone anchor implants with a plate-like system for total ear reconstruction in burned patients, to analyze treatment outcomes, and to discuss important clinical variables encountered during treatment, as well as to determine criteria for success in the implants and prostheses. Two case reports are presented, and treatment outcomes have been analyzed. In both patients, implants became anchored, and neither demonstrated failure during the study period. The cosmetic results and patient acceptance were very satisfactory, with no postoperative complications. The plate-like system for the treatment of auricle burns is an acceptable technique that complements traditional reconstructive procedures.

  17. Outcomes of Bacteremia in Burn Patients Involved in Combat Operations Overseas

    DTIC Science & Technology

    2008-03-01

    TX and University of Tennessee Graduate School of Medicine, Knoxville, TN (Rasnake). Correspondence address: MAJ Clinton K Murray, Infectious...Providencia stuartii, Yersinia kristensenii, and Salmonella spp. Overall, burn patients with bacteremia had higher TBSA and ISS, and were more likely

  18. Visual analogue thermometer: a valid and useful instrument for measuring pain in burned patients.

    PubMed

    Choinière, M; Auger, F A; Latarjet, J

    1994-06-01

    This study assessed the psychometric qualities of a new pain rating instrument--the visual analogue thermometer (VAT)--which was developed to measure pain in burned patients. The validity and utility of the VAT was assessed and compared with a conventional numeric (NUM) and adjective pain scale (ADJ) with a group of 103 burned patients and 51 nurses. Analyses of the results support the concurrent and construct validity of the VAT as a pain measure. Furthermore, the VAT gave more sensitive and precise pain measures than the ADJ and/or NUM scales. No major difference between the three scales emerged in the patients' preference. The same was true for the nurses' evaluation except for those who had more clinical experience with the VAT and who tended to prefer this scale for its accuracy and ease of utilization. The VAT appears to be a valid, sensitive and clinically useful tool to measure pain in burned patients. A systematic pain assessment procedure which can be easily implemented in burn care facilities is presented.

  19. Effect of music intervention on burn patients' pain and anxiety during dressing changes.

    PubMed

    Hsu, Kuo-Cheng; Chen, Li Fen; Hsiep, Pi Hsia

    2016-12-01

    For burn patients, the daily dressing process causes pain and anxiety. Although drugs can relieve them, the degree of pain during dressing changes is often moderate to severe. Therefore, relevant supporting interventions, like music as an ideal intervention, could alleviate the patient's pain. This study investigated the impact of music intervention at dressing change time on burn patients' pain and anxiety. This was a prospective, randomized clinical trial; patients were randomly assigned into control (standard intervention) and experimental groups (crystal music intervention) for five consecutive days (35 patients in each group). Patients' pain and anxiety measurements were collected before, during, and after dressing changes and morphine usage was recorded. The study period was October 2014 to September 2015. There was no difference in morphine dosage for both groups. By the fourth day of music intervention, burn patients' pain before, during, and after dressing changes had significantly decreased; anxiety on the fourth day during and after dressing changes had also significantly decreased. Nurses may use ordered prescription analgesics, but if non-pharmacological interventions are increased, such as providing timely music intervention and creating a friendly, comfortable hospital environment, patients' pain and anxiety will reduce.

  20. [Surgical therapy and critical care medicine in severely burned patients - Part 2: the basics in definite care].

    PubMed

    Deisz, Robert; Kauczok, Jens; Dembinski, Rolf; Pallua, Norbert; Marx, Gernot

    2013-01-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial stabilization of the burn victim during the first 24 hours (Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours, AINS 9/12) is followed by a long lasting reconstructive period. During this time calculated fluid replacement to compensate evaporative losses by large bourn wounds is as essential as reconstruction of the integrity of the skin and the modulation of metabolic consequences following severe burn injury. Special attention has to be paid to local and systemic infections.

  1. Diagnosis of Adult Patients with Cystic Fibrosis.

    PubMed

    Nick, Jerry A; Nichols, David P

    2016-03-01

    The diagnosis of cystic fibrosis (CF) is being made with increasing frequency in adults. Patients with CF diagnosed in adulthood typically present with respiratory complaints, and often have recurrent or chronic airway infection. At the time of initial presentation individuals may appear to have clinical manifestation limited to a single organ, but with subclinical involvement of the respiratory tract. Adult-diagnosed patients have a good response to CF center care, and newly available cystic fibrosis transmembrane receptor-modulating therapies are promising for the treatment of residual function mutation, thus increasing the importance of the diagnosis in adults with unexplained bronchiectasis.

  2. Thrombocytopenia induces multiple intracranial hemorrhages in patients with severe burns: A review of 16 cases

    PubMed Central

    ZHOU, JIANDA; LIU, JINYAN; LUO, CHENGQUN; HU, FENG; LIU, RUI; CHEN, ZIZI; CHEN, YAO; XIONG, WU; XIE, JIANFEI; HE, QUANYONG; YIN, CHAOQI; WANG, SHAOHUA; ZHANG, YANWEN; ZENG, SAINAN

    2013-01-01

    The aim of this study was to explore the etiology and diagnosis of multiple intracranial hemorrhages (ICHs) following severe burns, with a retrospective review of 16 cases of severe burns further complicated by multiple ICHs. Using cranial CT scans of the brains, we identified that all patients presented with low platelet counts and coagulation abnormalities prior to intracranial hemorrhaging. Following conventional treatment and various supporting treatments, five cases succumbed following a progressive reduction in blood platelet levels and the ICHs were cured in 11 cases following the restoration of normal platelet levels. We conclude that low platelet counts and coagulation abnormalities may cause multiple ICHs following severe burns and early diagnosis and treatment is the key to successful treatment. PMID:23935750

  3. Urinary N-acetyl-beta-D-glucosaminidase and malondialdehyde as a markers of renal damage in burned patients.

    PubMed Central

    Kang, H. K.; Kim, D. K.; Lee, B. H.; Om, A. S.; Hong, J. H.; Koh, H. C.; Lee, C. H.; Shin, I. C.; Kang, J. S.

    2001-01-01

    This study was aimed to evaluate renal dysfunction during three weeks after the burn injuries in 12 patients admitted to the Hallym University Hankang Medical Center with flame burn injuries (total body surface area, 20-40%). Parameters assessed included 24-hr urine volume, blood urea nitrogen, serum creatinine, creatinine clearance, total urinary protein, urinary microalbumin, 24-hr urinary N-acetyl-beta-D-glucosaminidase (NAG) activity, and urinary malondialdehyde (MDA). Statistical analysis was performed using repeated measures ANOVA test. The 24-hr urine volume, creatinine clearance, and urinary protein significantly increased on day 3 post-burn and fell thereafter. The urine microalbumin excretion showed two peak levels on day 0 post-burn and day 3. The 24-hr urinary NAG activity significantly increased to its maximal level on day 7 post-burn and gradually fell thereafter. The urinary MDA progressively increased during 3 weeks after the burn injury. Despite recovery of general renal function through an intensive care of burn injury, renal tubular damage and lipid peroxidation of the renal tissue suggested to persist during three weeks after the burn. Therefore, a close monitoring and intensive management of renal dysfunction is necessary to prevent burn-induced acute renal failure as well as to lower mortality in patients with major burns. PMID:11641529

  4. Epidemiology of elderly patients' burns in the South West of France.

    PubMed

    Cutillas, M; Sesay, M; Perro, G; Bourdarias, B; Castede, J C; Sanchez, R

    1998-03-01

    A retrospective study of 716 patients aged 60 years and above (324 men, 392 women) was undertaken in order to determine quality control in burns management in the South West of France. The following epidemiological data was obtained: high hospitalization rate (7 per cent of the general admissions); monthly and seasonal periodicity; predominance of indoor accidents (86 per cent) with domestic accidents being more frequent in women (63 vs. 37 per cent). Outdoor accidents were mainly recreational and were five times more frequent in men than in women. The overall mortality was 39 per cent and was influenced by the burns extent, depth, predisposing factors and early management. More burns occurred in urban areas (53 per cent) but mortality was higher in patients from rural areas (62 vs. 38 per cent). It was observed that delay in management, especially fluid resuscitation of patients from the rural areas, was partly responsible for this outcome. Propositions were made to diffuse more information on the importance of early management of burns in rural areas.

  5. Complications of chlorine inhalation in a pediatric chemical burn patient: a case report.

    PubMed

    Mangat, Harshdeep Singh; Stewart, Tara Lynn; Dibden, Lionel; Tredget, Edward E

    2012-01-01

    The majority of burn injuries in the pediatric population occur at home, and a significant proportion are the result of exposure to household cleaning products. A common injury-causing agent is bleach, which has the potential to release chlorine gas, a potent respiratory irritant that leads to the added risk of inhalation injury. The survival of pediatric patients with chemical burns is extremely high, and the 3 strongest predictors of mortality are large burn size, age <48 months, and the presence of inhalation injury. The authors present a rare case of a pediatric fatality from a chemical bleach burn that resulted in acute respiratory distress syndrome as well as hemodynamic and pulmonary instability that required extracorporeal membrane oxygenation. The authors critically appraised the management of this patient to determine the possible effect certain events had on the unexpected and poor outcome of this patient, including fluid resuscitation, the effect of the chemical inhalation injury, sedation, and the need for invasive extracorporeal membrane oxygenation life support.

  6. A necessary evil? Intra-abdominal hypertension complicating burn patient resuscitation

    PubMed Central

    2014-01-01

    Objective Severe burns are devastating injuries that result in considerable systemic inflammation and often require resuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures leading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective of this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to burn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid resuscitation with a goal to identify optimal strategies for fluid resuscitation. Design A comprehensive 10-year retrospective review of burn injuries from 1999. Outcome Measures Age, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of transport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS, ICU LOS, and events surrounding the injury. Results One hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn injuries with a mean ISS score of 21.8 (±8.3). The mean age was 41.6 (±17.5) (range 14-94) years. Nearly half (49.7%) of patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related. One hundred and ten patients required ICU admission. ICU LOS 18.5 (±8.8) days. Hospital LOS 38.0 (±37.8) days. The mean extent of burn injury was 31.4 (±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild 12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring began in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5 (±5.7) cm H2O (range: 1-40) with an average of 58 (±97) IAP measurements per patient. Those patients with IAP monitoring had an average TBSA of 35.0 (±16.0)%, ISS of 47.5 (±7

  7. Central Nervous System Infections in Patients with Severe Burns

    DTIC Science & Technology

    2010-01-01

    both patients had bacteremia with identical microorganisms as isolated from CSF ( Acinetobacter baumannii and methicillin resistant Staphylococcus...multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J

  8. Effects of Granulocyte-Macrophage Colony-Stimulating Factor in Burn Patients

    DTIC Science & Technology

    1991-01-01

    aber- Although the specific cause of the immune dysfunction rant response was associated with a relative failure of granu - following thermal iriury is...during tended to have an increased percentage of band forms and postbum week 4 when treated patients had significantly fewer granu - myelocytes during...cell production of neutrophils, monocytes, cyte stem cells in nonsurviving patients with large burns, and eosinophils . Significant increases in

  9. Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics.

    PubMed

    Sveen, J; Sjöberg, F; Öster, C

    2014-08-01

    Although many children with burns recover well and have a satisfying quality of life after the burn, some children do not adjust as well. Health-related quality of life (HRQoL) focuses on the impact health status has on quality of life. The aim of this study was to assess HRQoL with the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) in a nationwide Swedish sample of children with burns 0.3-9.0 years after injury. Participants were parents (n=109) of children aged up to 18 years at the time of investigation who were treated at the Linköping or Uppsala Burn Center between 2000 and 2008. The majority of children did not have limitations in physical function and they did not seem to experience much pain. However, there were indications of psychosocial problems. Parents of preschool children reported most problems with the children's behavior and family disruption, whereas parents of children aged 5-18 years reported most problems with appearance and emotional health. There were mainly burn-related variables associated with suboptimal HRQoL in children aged 5-18 years, while family-related variables did not contribute as much.

  10. Long hair, smoking, and deep facial burns.

    PubMed

    Koljonen, Virve

    2008-01-01

    The purpose of this article is to describe deep facial burn injuries by cigarette lighters in longhaired adults and to report our experience in their treatment. Eight consecutive cigarette lighter burn victims are treated in the Helsinki Burn Center in the year 2006. Seven of the patients were women; their mean age was 50 years. All were under the influence of alcohol at the time of injury. The mean burnt area was 3.5% TBSA. The burnt areas were primarily forehead, cheek, and ipsilateral ear. After a conservative treatment, all the patients underwent an operation, whereby the nonhealing burns were excised and covered with autologous split thickness skin grafts. Postoperative period was uneventful in all the patients. Besides having severe detrimental effects on general health status and wound healing, smoking is the leading cause of residential and total fire deaths worldwide. The patients in this article suffered deep facial burns because of cigarette lighters.

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

    PubMed

    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.

  12. Effects of Environment on Infection in Burn Patients

    DTIC Science & Technology

    1986-01-01

    conceivable that the infections with Pseudomonas aeru.ginosa and Providencia drug-sensitive bacteria prevalent in the late period were stuartii were...about the causes of death in those patients he described existed, for example, once Providencia got into that particular new as noninfected. area

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

    PubMed

    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.

  14. Burning Mouth Syndrome and "Burning Mouth Syndrome".

    PubMed

    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.

  15. Humoral-Phagocyte Axis of Immune Defense in Burn Patients

    DTIC Science & Technology

    1982-02-01

    specimen contained 21.800 leukocytes per microliter with 58% segmented end 7% band neutrophils, 3% eosinophils , 4% monocytes. and 28% lymphocytes. Twenty...minute Fig 3.-Plot of integral chemoluminescence (CL) for 117-minute interval following stimulation plotted against total number of granu - interval...occurred in three nonsurviving opsonic capacity can be expressed as the rate of activation patients, as well as changes in total leukocyte and granu - of

  16. Analysis of Anaerobic Blood Cultures in Burned Patients

    DTIC Science & Technology

    2007-01-01

    34 3 (9.0) Escherichia coli 14 (4.1) 17 (2.8) – – Enterobacter cloacae 13 (3.8) 24 (3.9) 18 2 (11.1) Enterobacter aerogenes 13 (3.8) 18 (2.9...cultures: patient characteristics and potential risk factors. Clin Chem Lab Med 2003;41(3):293–7. [10] James PA, Al-Shafi KM. Clinical value of anaerobic

  17. Population pharmacokinetics of micafungin in adult patients.

    PubMed

    Gumbo, Tawanda; Hiemenz, John; Ma, Lei; Keirns, James J; Buell, Donald N; Drusano, George L

    2008-03-01

    We performed population pharmacokinetic analysis of micafungin in adult patients treated with doses between 12.5 and 200 mg/day. Our analysis identified a breakpoint patient weight of 66.3 kg above which serum clearance increased by approximately 50%. Patients with weight >66.3 kg may need larger doses to achieve similar exposures to those <66.3 kg. However, the clinical implications are still unknown.

  18. Urban-Rural Dichotomy of Burn Patients in Georgia and South Carolina: A Geographic Information System Study.

    PubMed

    Mian, Mohammad Anwarul Huq; Haque, Akhlaque; Mullins, Robert Fred; Fiebiger, Barbara; Hassan, Zaheed

    2015-01-01

    This study uses a 4-year (2006-2009) cross-section of epidemiological burn injury data from Georgia and South Carolina. The results from the study show that the burn patients from rural areas differ from their urban counterparts in terms of relative burn injury incidence. Younger population groups that live in lower socioeconomic status communities especially in the urban areas are at a higher risk than other population groups. The differences in the types of burns in the urban-rural communities can give us further insights to the patients' association with injury sites. The presence of fewer burn injury treatment and care facilities in rural areas and the high incidence of burn in low-income communities in the urban areas should carry important policy implications for health planners. This study will enable researchers to understand the epidemiology of burn injuries at the local and national levels in the United States. It also carries important implications for using Geographic Information Systems for studying spatial distribution of burn injuries for disaster planning and mitigation of burn injuries.

  19. Comparison of three cooling methods for burn patients: A randomized clinical trial.

    PubMed

    Cho, Young Soon; Choi, Young Hwan

    2016-10-01

    Tap water may not be readily available in numerous places as a first aid for burns and, therefore, tea tree oil products are recommended alternatives. Our aim in this study was to compare the cooling effects of three burn-cooling methodologies, running tap water, Burnshield(®), and Burn Cool Spray(®), and suggest indications for each cooling method. This randomized, controlled, study enrolled patients with burns who used the emergency service of Seoul Bestian Hospital from June 2015 to October 2015. The allocation of the cooling methods was randomly generated using a computer. We cooled the burn wounds by applying one of the three methods and measured the skin surface temperature and pain level using a visual analog scale (VAS) scoring. Ninety-six patients were enrolled in this study. The variability in the median(IQR) skin temperatures of the three groups was from 33.5°C (31.5-35.0) to 28.7°C (25.9-30.9), 33.8°C (32.0-35.4) to 33.2°C (30.5-35.0), and 34.0°C (32.0-35.1) to 34.4°C (32.7-35.6) for the tap water, Burn Cool Spray(®), and Burnshield(®), respectively. The variability of the mean VAS pain scores was 6.9 to 4.8 (tap water), 5.6 to 4.5 (Burn Cool Spray(®)), and 5.5 to 3.3 (Burnshield(®)). The reduction of skin surface temperature by tap water was significantly greater than that by the other two methods. All three methods reduced the VAS pain score after 20min of treatment (p<0.001). The tap water had a similar effect to that of the Burn Cool Spray(®) but significantly better than that of Burnshield(®). There was a significant difference in the skin surface temperature and VAS pain score reduction (p=0.014 and p=0.007, respectively) between the groups cooled by tap water below and above 24°C. The patients who visited the center within 30min showed a significantly higher skin temperature than those who came after 30min did (p=0.033). Tap water and Burn Cool Spray(®) reduced the skin surface temperature, but the Burnshield(®) slightly

  20. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.

    PubMed

    Hoffman, H G; Doctor, J N; Patterson, D R; Carrougher, G J; Furness, T A

    2000-03-01

    For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.

  1. Salivary concentrations of nickel and chromium in patients with burning mouth syndrome.

    PubMed

    Baričević, Marinka; Mravak-Stipetić, Marinka; Stanimirović, Andrija; Blanuša, Maja; Kern, Josipa; Lončar, Božana; Andabak, Ana; Baričević, Denis

    2011-01-01

    It has been documented in vitro and in vivo that metal dental appliances release metal ions due to corrosion. Dentists must choose among many dental casting alloys available, often without knowledge of their biological properties and effect on oral mucosa. The aim of this study was to measure metal content of nickel (Ni) and chromium (Cr) in whole saliva of 85 patients with and without metal dental appliances. Unstimulated whole saliva was collected and analyzed by using electrothermal atomic absorption spectrometry. History data, subjective complaints and objective findings on oral mucosa were recorded. The concentration of metal ions was investigated in correlation to burning mouth syndrome, erythema of oral mucosa, pH and smoking habit. Results showed a higher Ni concentration in patients with metal restorations, especially wearers of predominantly base metal appliances. The concentration of Cr showed no difference between patient groups. Although burning mouth syndrome was more frequent in the group with dental casting alloys, there was no correlation between higher Ni and Cr concentrations and burning mouth syndrome. Erythema of oral mucosa was a common finding in study patients, but did not correlate with salivary Ni and Cr ion concentrations. Salivary Ni and Cr concentrations were not related to either pH or smoking habit.

  2. The Adult Diabetic Patient: An Education Challenge

    DTIC Science & Technology

    1993-05-01

    finding that he/she, too, must care for sicker patients. To better prepare these patients for life after discharge, patient education must be initiated as...admitted, patient education often begins at the physicians’ office. This paper explores diabetes mellitus in relation to concepts of self-care and adult...betting foj.L eduuation and iio.w, wore ofteni, patient education and follow-up sercvices- a:leL beiny p~rovided on ani outpatient bcdtsis" (p. 36) . Thet

  3. Bacterial Respiratory Tract Infections are Promoted by Systemic Hyperglycemia after Severe Burn Injury in Pediatric Patients

    PubMed Central

    Kraft, Robert; Herndon, David N; Mlcak, Ronald P; Finnerty, Celeste C; Cox, Robert A; Williams, Felicia N; Jeschke, Marc G

    2014-01-01

    Background Burn injuries are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complication. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients. Methods One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS <150 mg/dl). Incidences of pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student’s t-test and chi-square test. Significance was set at p<0.05. Results Patient groups were similar in demographics and injury characteristics. Pneumonia in patients on the mechanical ventilation (L: 21% H: 32%) and off mechanical ventilation (L: 5% H: 15%), as well as ARDS were significantly higher in the high group (L: 3% H: 19%), p<0.05, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients (p<0.05). Furthermore, incidence of infection and sepsis were significantly higher in the high group, p<0.05. Conclusion Our results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia confirming the previous studies in critically ill patients. PMID:24074819

  4. [Plasma endotoxin, procalcitonin, C-reactive protein, and organ functions in patients with major burns].

    PubMed

    Ulrich, D; Noah, E M; Pallua, N

    2001-07-01

    Sepsis is one of the most frequent causes of death after major burn injury. Usually, sepsis appears as a consequence of a gram-negative bacteriaemia with release of endotoxins. In this study, the plasma endotoxin levels of seven patients (three female, four male; average age 51.3 +/- 23.8 years) with burns between 43.5 and 78 % Total Body Surface Area (Abbreviated Burn Severity Index 8 - 12) were determined for five days after thermal trauma every three hours by ELISA and compared with the concentration of procalcitonin (PCT) and C-reactive protein (CRP). A calculation of the Horrowitz-Index (PaO(2)/FiO(2)) and the Pressure-Adjusted Heart Rate (HR x CVP/MAP) took place to show a possible correlation between the endotoxin concentration and the cardiopulmonary organ function. Additionally, we analysed whether operative treatment can influence the level of plasma endotoxin in the early phase after burn injury. At any time after burn trauma, endotoxins could be detected in the plasma of all patients. Between the second and third day, there was a considerable increase in the endotoxin concentration with a maximum after 57 hours of 0.48 +/- 0.32 EU/ml. Two patients with sepsis and death in the further course had a rather distinctive increase. From the fourth day on, occasional episodes of increases in endotoxin concentration were noted. Postoperatively, there was a short increase in plasma endotoxin on the second and fourth day. The plasma endotoxin level showed no correlation with the PCT and CRP or with the oxygenation in the patients' blood. However, a positive correlation could be observed with the Pressure-Adjusted Heart Rate (p = 0.0061; r(2) = 0.212). An explanation for the endotoxin increase after 57 hours could be the translocation of intestinal bacteria, the beginning of bacterial colonisation or decomposition products of the burn wound with protein-protein complexes. Later on, infectious diseases such as pneumonia with gram-negative bacteria are of importance

  5. Pathophysiologic Response to Burns in the Elderly.

    PubMed

    Jeschke, Marc G; Patsouris, David; Stanojcic, Mile; Abdullahi, Abdikarim; Rehou, Sarah; Pinto, Ruxandra; Chen, Peter; Burnett, Marjorie; Amini-Nik, Saeid

    2015-10-01

    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. Interestingly, we could not find a higher incidence of infection or sepsis in elderly, 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.

  6. Disseminated Trichosporonosis in a Burn Patient: Meningitis and Cerebral Abscess Due to Trichosporon asahii▿

    PubMed Central

    Heslop, Orville D.; Nyi Nyi, May-Phyo; Abbott, Sean P.; Rainford, Lois E.; Castle, Daphney M.; Coard, Kathleen C. M.

    2011-01-01

    A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis. PMID:22012010

  7. Fournier's gangrene in a patient after third-degree burns: a case report

    PubMed Central

    2009-01-01

    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. PMID:19830156

  8. Biofilm Formation and Virulence Factors Among Pseudomonas aeruginosa Isolated From Burn Patients

    PubMed Central

    Ghanbarzadeh Corehtash, Zahra; Khorshidi, Ahmad; Firoozeh, Farzaneh; Akbari, Hosein; Mahmoudi Aznaveh, Azam

    2015-01-01

    Background: Pseudomonas aeruginosa possesses a variety of virulence factors and infections caused by multidrug-resistant P. aeruginosa (MDRPA) in burn patients are a public health problem. Objectives: The aim of this study was to determine the antibiotic resistance pattern, the biofilm formation, the prevalence of MDRPA and two virulence genes (nan1 and exoA) among P. aeruginosa isolated from burn patients. Patients and Methods: A total of 144 isolates of P. aeruginosa were collected from burn patient at the Burn Centre of Tehran, Iran, between March 2013 and July 2013. Antibiotic susceptibility test was performed via agar disk diffusion method. The ability of producing biofilm was examined by crystal violet microtiter plate assay and the prevalence of the exoA and nan1 genes among the isolates was determined by polymerase chain reaction (PCR). Results: A high rate of resistance was seen against ciprofloxacin (93.7%), aztreonam (86.8%), piperacillin (85.4%), ceftazidime (82.6%), amikacin (82%) and imipenem (79.2%). In total, 93.1% of the isolates were characterized as MDRPA. Biofilm formation was seen in 92.4% of the isolates. The prevalence of the exoA and nan1 genes were 75% and 11.8% among the isolates, respectively. Conclusions: The high rate of MDRPA and its ability to produce biofilm is an alarm for public health. The statistical analysis showed that biofilm production in the MDRPA isolates was significantly higher than that in the non–MDRPA isolates (P < 0.001). PMID:26587205

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

    PubMed

    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 < 10%. Data are medians [interquartile range]. There were 38 patients with complete data; 25 had documentation of successful 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 (P<.001). Patients with a positive healing 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).

  10. The epidemiology of burns in rural Ethiopia.

    PubMed Central

    Courtright, P; Haile, D; Kohls, E

    1993-01-01

    STUDY OBJECTIVE--The aims were (1) to review inpatient burn records of Attat Hospital (Ethiopia) for the years 1983-1989, and (2) to determine the prevalence of burns and knowledge of first aid for burns in 16 communities served by Attat Hospital in rural Ethiopia. DESIGN--A retrospective review of all records was used to describe characteristics of the inpatient with burns and cost of the service. Adult members of a systematic random sample (20%) of households from 16 communities (total population = 10,183) were interviewed. Questions focused on what to do to put out the fire, what to do for first aid for a burn, the major cause of adult and childhood burns, and a history of burn in any household member. SETTING--The study was conducted at Attat Hospital and in the surrounding Gurage-Chaha Region of West Shoa Province of Ethiopia. STUDY SUBJECTS--There were 271 burn inpatients during the 7 year period from 1983-1989; 163 households were selected for interview; there were no refusals. MAIN RESULTS--During the 7 year period the cost of tertiary inpatient burn treatment at Attat Hospital has been estimated to be US$86,366.72, of which the hospital absorbed 66%. From community based information the cumulative incidence of burns in this population was found to be 5-11%. The absence of a cumulative increase in burns over time in men suggests that female respondents may not fully recall burn histories in adult male household members. The study population possess inadequate knowledge regarding burn prevention and burn first aid. Deleterious traditional compounds were used on 32% of burn patients in the villages. CONCLUSIONS--Since most burns are related to household fires, generally in the domain of women in rural Ethiopia, women's groups may be the most appropriate setting for education on burn prevention and first aid. Burn prevention and first aid education should also be recognised as a priority in schools and in the training of community health workers. PMID:8436886

  11. Detection of blaPER-1 & blaOxa10 among imipenem resistant isolates of Pseudomonas aeruginosa isolated from burn patients hospitalized in Shiraz Burn Hospital

    PubMed Central

    Emami, Amir; Bazargani, Abdollah; Mohammadi, Ali Akbar; Zardosht, Mitra; Seyed Jafari, Seyed Morteza

    2015-01-01

    Background and Objectives: Pseudomonas aeruginosa is one of the most important Gram negative opportunistic bacteria which causes infection among burn patients. Resistance to the antibiotics in this group of bacteria is increased due to the activity of extended spectrum β-lactamase (ESBLs) genes. In the current study, we investigated the prevalence of two genes (blaPER-1 & blaOxa10) related β-lactamase genes among imipenem resistance clinical isolates of P. aeruginosa in hospitalized patients. Materials and Methods: From May 2010 to March 2011, 270 P. aeruginosa isolated from hospitalized burned patients’ wounds in Shiraz Burn Hospital, were tested for Imipenem resistance by disk diffusion method. Presence of ESBLs exo-enzyme, blaPER-1 and blaOxa10 genes were also evaluated in the resistant isolate. Results: 210 (77.7%) of 270 P. aeruginosa isolates were resistant to imipenem. blaPER-1 and blaOxa10 were detected among 168 (80.0%) of imipenem resistant isolates. Furthermore, 160 (76.2%) of them had blaOxa10 gene and 84 (40.0%) of them had blaPER-1 while 63 (30.0%) resistant isolates contained both genes simultaneously. Conclusion: This study showed a high prevalence of blaPER-1 and blaOxa10 genes in hospitalized burn patients in south west of Iran. Therefore, it’s highly recommended to perform such tests routinely to evaluate the resistance pattern in order to better antibiotic selection in the burned patients. PMID:26644867

  12. Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease: An Analysis of Outcomes in the United States.

    PubMed

    Maximus, Steven; Phelan, Michael; Joe, Victor C

    2016-01-01

    With the incidence of burns decreasing nationally, burn units are caring for more patients with nonburn conditions. The American Burn Association National Burn Repository does not currently report data regarding patients cared for in burn units without a diagnosis of burn. Using the National Inpatient Sample, we examined if there was a difference in characteristics and outcomes of patients admitted for burns compared with those with a primary admitting diagnosis of necrotizing skin infections and soft-tissue infections and exfoliative skin conditions. This is a retrospective study querying the National Inpatient Sample database to identify 56,102 patients from 2007 to 2012 who were admitted with a diagnosis of a burn (burn group). This group was then compared with 375,857 patients who had a primary admitting diagnosis of a necrotizing skin and/or soft-tissue infection or exfoliative skin conditions (nonburn group). Clinical and demographic variables were analyzed to determine characteristics of each patient group including length of stay, disposition, complications, comorbidities, and mortality. The average age of the nonburn group was 63.7 years, whereas the average age of the burn group was 40.1 years. Overall length of stay was higher in the nonburn patients than in burn patients (10.5 vs 8.4 days, P < .001). Nonburn patients had a higher rate of medical comorbidities. Nonburn patients had higher rates of mortality (6.9% vs 2.7%) and complications. After adjusting for confounders, such as age, gender, ethnicity, and comorbidities, the nonburn group was found to have higher rates of all recorded complications. Burn patients were more likely to undergo a major operating room procedure (39.3% vs 28.1%) and routine discharge (68.4% vs 26.3%) compared with the nonburn group. Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions are older, have more comorbidities, higher complication rates, and higher mortality rates than burn

  13. Investigation of Head Burns in Adult Salmonids : Phase 1 : Examination of Fish at Lower Granite Dam, July 2, 1996. Final Report.

    SciTech Connect

    Elston, Ralph

    1996-08-01

    Head burn is a descriptive clinical term used by fishery biologists to describe exfoliation of skin and underlying connective tissue of the jaw and cranial region of salmonids, observed at fish passage facilities on the Columbia and Snake Rivers. The observations are usually made on upstream migrant adult salmon or steelhead. An expert panel, convened in 1996, to evaluate the risk and severity of gas bubble disease (GBD) in the Snake and Columbia River system believed that, while head burns appeared to be distinct from GBD, the relationship between dissolved gas saturation in the rivers and head burns was uncertain.

  14. Incidence of methemoglobinemia in patients receiving cerium nitrate and silver sulfadiazine for the treatment of burn wounds: a burn center's experience.

    PubMed

    Kath, Melissa A; Shupp, Jeffrey W; Matt, Sarah E; Shaw, Jesse D; Johnson, Laura S; Pavlovich, Anna R; Brant, Jennifer D; Mete, Mihriye; Jeng, James C; Jordan, Marion H

    2011-01-01

    In 1976, the combination of cerium nitrate and silver sulfadiazine was introduced as a topical therapy for burn wounds. Experience with a locally prepared combination agent has shown physical change of the eschar and delayed subeschar bacterial colonization. A potential systemic complication of this treatment is the development of methemoglobinemia (Met-Hba) due to the oxidizing nature of Ce(NO(3))(3). Met-Hba has a spectrum of clinical consequences, ranging from headache and cyanosis to cardiac ischemia, hypotension, and even death. Given the frequent use of this combination agent at our burn center, a retrospective review was conducted to evaluate the incidence of Met-Hba. A query of pharmacy records revealed 170 patients from January 2005 to October 2009 that had received this treatment. Eighteen patients (∼10%) developed Met-Hba as noted on arterial blood gas (methemoglobin>3%) and only three patients (∼2%) had methemoglobin levels >10%. In the majority of cases, there were no clinical symptoms of Met-Hba. Most patients' relative hypoxia resolved with cessation of treatment; however, five patients required treatment with methylene blue. The presence of Met-Hba associated with this topical therapy can be diagnosed early by vigilant monitoring, thereby reducing morbidity and mortality. In our experience, cerium combined with silver sulfadiazine is a valuable and safe treatment for deep partial and full-thickness burn wounds.

  15. Increasing the utility of the Functional Assessment for Burns Score: Not just for major burns.

    PubMed

    Smailes, Sarah T; Engelsman, Kayleen; Rodgers, Louise; Upson, Clara

    2016-02-01

    The Functional Assessment for Burns (FAB) score is established as an objective measure of physical function that predicts discharge outcome in adult patients with major burn. However, its validity in patients with minor and moderate burn is unknown. This is a multi-centre evaluation of the predictive validity of the FAB score for discharge outcome in adult inpatients with minor and moderate burns. FAB assessments were undertaken within 48 h of admission to (FAB 1), and within 48 h of discharge (FAB 2) from burn wards in 115 patients. Median age was 45 years and median burn size 4%. There were significant improvements in the patients' FAB scores (p<0.0001), 98 patients were discharged home (no social care) and 17 patients discharged to further inpatient rehabilitation or home with social care. FAB 1 score (≤ 14) is strongly associated with discharge to inpatient rehabilitation or home with social care (p=0.0001) and as such can be used to facilitate early discharge planning. FAB 2 (≤ 30) independently predicts discharge outcome to inpatient rehabilitation or home with social care (p<0.0001), increasing its utility to patients with minor and moderate burns.

  16. Combining Ketamine and Virtual Reality Pain Control During Severe Burn Wound Care: One Military and One Civilian Patient

    DTIC Science & Technology

    2011-01-01

    Case Reports Combining Ketamine and Virtual Reality Pain Control During Severe Burn Wound Care: One Military and One Civilian Patientpme_1091 673...patients are treated at the US Army Institute of Surgical Research. Burn patients expe- rience extrem pain during wound care, and they typi- cally...receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain

  17. Neuropathic Pain in Patients with Burning Mouth Syndrome Evaluated Using painDETECT.

    PubMed

    Lopez-Jornet, Pia; Molino-Pagan, Diana; Parra-Perez, Paco; Valenzuela, Sara

    2017-01-04

    OBJECTIVE : This study set out to identify the neuropathic component of pain experienced by burning mouth syndrome (BMS) patients evaluated using painDETECT, a diagnostic tool that could easily be introduced into clinical practice. MATERIALS AND METHODS : This study included 64 patients (33 BMS and 31 suffering nociceptive pain). Each completed the painDETECT neuropathic pain questionnaire, the Hospital Anxiety and Depression Scale, and pain intensity was also measured using a visual analogue scale (VAS). RESULTS : Pain among BMS patients (evaluated by VAS) was 6.1 ± 1.9, and 4.3 ± 1.7 among nociceptive patients (P < 0.001). PainDETECT obtained total scores ≥ 19 in 21% of BMS patients, indicating the presence of neuropathic pain. When painDETECT pain descriptors were analyzed comparing the BMS group with nociceptive pain subjects, statistically significant differences were found for burning sensation (P < 0.010), prickling (P < 0.001), electric shock-like sensation (P = 0.046), thermal sensation (P < 0.001), and numbness (P = 0.002). Logistic regression analysis found that VAS scoring was the strongest determinant predicting neuropathic pain. CONCLUSION : The present study suggests that almost a third of BMS patients present neuropathic pain, which is strongly associated with the intensity of pain measured using VAS. These data could provide the basis for further research.

  18. [Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours].

    PubMed

    Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot

    2012-09-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.

  19. Association of Rhabdomyolysis with Renal Outcomes and Mortality in Burn Patients

    DTIC Science & Technology

    2013-05-01

    estimates of rates of AKI in the burn population widely varied, in part because of differences in both definitions of AKI and inclusion criteria...and AKIN-3 as a >3-fold increase from baseline (or an increase of 0.5 mg/dl when the baseline was more than 4 mg/dl).10 By definition , all patients...patients requiring RRT who survived to discharge, only one required maintenance hemodialysis . The prevalence of AKIN-2 or AKIN-3, death, and RRT

  20. Electric heating pad burns.

    PubMed

    Bill, T J; Edlich, R F; Himel, H N

    1994-01-01

    Patients with sensory deficits are especially prone to heating pad burns. Two cases are reported of patients with anesthetic skin who received partial and full-thickness burns of their feet from an electric heating pad. These burn injuries could have been prevented if the patients understood the potential hazard of heating pads.

  1. Clinical Impact of Sample Interference on Intensive Insulin Therapy in Severely Burned Patients: A Pilot Study

    PubMed Central

    Tran, Nam K.; Godwin, Zachary R.; Bockhold, Jennifer C.; Passerini, Anthony G.; Cheng, Julian; Ingemason, Morgan

    2013-01-01

    Objective Severely burned patients benefit from intensive insulin therapy (IIT) for tight glycemic control (TGC). We evaluated the clinical impact of automatic correction of hematocrit and ascorbic acid interference for bedside glucose monitoring performance in critically ill burn patients. Methods The performance of two point-of-care glucose monitoring systems (GMS): (a) GMS1, an autocorrecting device, and (b) GMS2, a non-correcting device were compared. Sixty remnant arterial blood samples were collected in a prospective observational study to evaluate hematocrit and ascorbic acid effects on GMS1 vs. GMS2 accuracy paired against a plasma glucose reference. Next we enrolled 12 patients in a pilot randomized controlled trial (RCT). Patients were randomized 1:1 to receive IIT targeting a TGC interval of 111–151 mg/dL and guided by either GMS1 or GMS2. GMS bias, mean insulin rate, and glycemic variability were calculated. Results In the prospective study, GMS1 results were similar to plasma glucose results (mean bias: −0.75[4.0] mg/dL, n=60, P=0.214). GMS2 results significantly differed from paired plasma glucose results (mean bias: −5.66[18.7] mg/dL, n=60, P=0.048). Ascorbic acid therapy elicited significant GMS2 performance bias (29.2[27.2], P<0.001). RCT results reported lower mean bias (P<0.001), glycemic variability (P<0.05), mean insulin rate (P<0.001), and frequency of hypoglycemia (P<0.001) in the GMS1 group than the GMS2 group. Conclusions Anemia and high dose ascorbic acid therapy negatively impact GMS accuracy and TGC in burn patients. Automatic correction of confounding factors improves glycemic control. Further studies are warranted to determine outcomes associated with accurate glucose monitoring during IIT. PMID:23884048

  2. Decellularized human amniotic membrane: more is needed for an efficient dressing for protection of burns against antibiotic-resistant bacteria isolated from burn patients.

    PubMed

    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.

  3. Veno-venous continuous renal replacement therapy for burned patients with acute renal failure.

    PubMed

    Tremblay, R; Ethier, J; Quérin, S; Béroniade, V; Falardeau, P; Leblanc, M

    2000-11-01

    From 1995 to 1998, 12 burned patients with acute renal failure (ARF) were treated by veno-venous continuous renal replacement therapy (CRRT) at the Burn Unit of Hôtel-Dieu de Montréal. Their mean (+/-SD) age was 51+/-12 years, and the mean burned surface covered 48.6+/-15.8% of total body surface area. All patients were mechanically ventilated and presented evidence of sepsis. The mean delay before occurrence of ARF was 15+/-6 days and ARF was mainly related to sepsis and hypotension. Main reasons for CRRT initiation were azotemia and fluid overload. A total of 15 CRRT modalities were applied (12 continuous veno-venous hemodiafiltration, CVVHDF; two continuous veno-venous hemofiltration, CVVH; and one continuous veno-venous hemodialysis, CVVHD) over 14+/-13 days. For CRRT, nine patients received heparin and three were not anticoagulated. Mean values for dialysate and reinjection flow rates were 1134+/-250 ml/h and 635+/-327 ml/h, respectively. Admission weight was 78.8+/-12.7 kg with a mean weight gain before CRRT initiation of 10.0+/-5.8 kg and a mean weight loss during CRRT of 8.9+/-5.5 kg. Nine patients received enteral plus parenteral nutrition, and three, parenteral nutrition only; the total caloric intake was 31.5+/-7.0 kcal/kg/day and protein intake, 1.8+/-0.4 g/kg/day. The normalized protein catabolic rate (nPCR) was evaluated at 2.28+/-0.78 g/kg/day during CRRT. The mortality rate was 50%. The six survivors all recovered normal renal function with four of them requiring intermittent hemodialysis for short periods. In conclusion, veno-venous CRRT is particularly well suited for this selected population allowing smooth fluid removal and aggressive nutritional support.

  4. The blue man: burn from muriatic acid combined with chlorinated paint in an adult pool construction worker.

    PubMed

    O'Cleireachain, Marc R; Macias, Luis H; Richey, Karen J; Pressman, Melissa A; Shirah, Gina R; Caruso, Daniel M; Foster, Kevin N; Matthews, Marc R

    2014-01-01

    Muriatic acid (hydrochloric acid), a common cleaning and resurfacing agent for concrete pools, can cause significant burn injuries. When coating a pool with chlorinated rubber-based paint, the pool surface is initially cleansed using 31.45% muriatic acid. Here we report a 50-year-old Hispanic male pool worker who, during the process of a pool resurfacing, experienced significant contact exposure to a combination of muriatic acid and blue chlorinated rubber-based paint. Confounding the clinical situation was the inability to efficiently remove the chemical secondary to the rubber-based nature of the paint. Additionally, vigorous attempts were made to remove the rubber paint using a variety of agents, including bacitracin, chlorhexidine soap, GOOP adhesive, and Johnson's baby oil. Resultant injuries were devastating fourth-degree burns requiring an immediate operative excision and amputation. Despite aggressive operative intervention and resuscitation, he continued to have severe metabolic derangements and ultimately succumbed to his injuries. We present our attempts at debridement and the system in place to manage patients with complex chemical burns.

  5. [Treatment of pain in children burns].

    PubMed

    Latarjet, J; Pommier, C; Robert, A; Comparin, J P; Foyatier, J L

    1997-03-01

    Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. Continuous pain from injury and intermittent pain caused by therapeutic procedures must be evaluated and treated separately. Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.

  6. Nosocomial infections in burn patients: etiology, antimicrobial resistance, means to control.

    PubMed

    Leseva, M; Arguirova, M; Nashev, D; Zamfirova, E; Hadzhyiski, O

    2013-03-31

    The aim of our study was to determine the etiology of nosocomial infections, their changes over a period of five years (2007-2011), and the measures for control of infections and antimicrobial resistance in the Burns Clinic of the N.I. Pirogov University Multi-Profile Hospital for Active Treatment and Emergency Medicine, Sofia, Bulgaria. The medical records for all the patients and the database of the "Clinical Microbiology and Surveillance of Infections" National Information System were reviewed and analyzed to identify the microbial pathogens isolated in our burns Clinic. The three most frequent nosocomial pathogens were S. aureus, A. baumannii and P. aeruginosa. In order to control effectively nosocomial infections, a system of anti-infective and anti- microbial resistance measures has been developed and routinely implemented in our Clinic since 2008. Since 2009, thanks to this system, there has been a significant decrease in the rates of multi-resistant Staphylococcus aureus strains. Although at present the incidence of the nosocomial infections in our burns clinic is lower than in neighboring countries, several important infection control issues still need to be solved. We mainly rely on updating and strengthening the existing anti-infective system in order to control the spread of multi-drug resistant organisms, such as A. baumannii, extended spectrum beta-lactamase-producing Enterobacteriaceae, and carbapenem-resistant P. aeruginosa.

  7. LA50 in burn injuries

    PubMed Central

    Seyed-Forootan, K.; Karimi, H.; Motevalian, S.A.; Momeni, M.; Safari, R.; Ghadarjani, M.

    2016-01-01

    Summary Burn injuries put a huge financial burden on patients and healthcare systems. They are the 8th leading cause of mortality and the 13th most common cause of morbidity in our country. We used data from our Burn Registry Program to evaluate risk factors for mortality and lethal area fifty percent (LA50) in all burn patients admitted over two years. We used multiple logistic regressions to identify risk factors for mortality. LA50 is a reliable aggregate index for hospital care quality and a good measure for comparing results, also with those of other countries. 28,690 burn patients sought medical attention in the Emergency Department, and 1721 of them were admitted. Male to female ratio was 1,75:1. 514 patients were under 15 years old. Median age was 25 (range: 3 months – 93 years). Overall, probability of death was 8.4%. LA50 was 62.31% (CI 95%: 56.57-70.02) for patients aged 15 and over and 72.52% (CI 95%: 61.01-100) for those under 15. In the final model, we found that Adjusted OR was significant for age, female sex, TBSA and inhalation injury (P < 0.05). LA50 values showed that children tolerate more extensive burns. Female sex, burn size, age and inhalation injury were the main risk factors for death. Authorities should pay special attention to these variables, especially in prevention programs, to reduce mortality and improve patient outcome. Children have better outcome than adults given equal burn size. Suicide rates are higher for women than men in our country PMID:27857645

  8. LA50 in burn injuries.

    PubMed

    Seyed-Forootan, K; Karimi, H; Motevalian, S A; Momeni, M; Safari, R; Ghadarjani, M

    2016-03-31

    Burn injuries put a huge financial burden on patients and healthcare systems. They are the 8th leading cause of mortality and the 13th most common cause of morbidity in our country. We used data from our Burn Registry Program to evaluate risk factors for mortality and lethal area fifty percent (LA50) in all burn patients admitted over two years. We used multiple logistic regressions to identify risk factors for mortality. LA50 is a reliable aggregate index for hospital care quality and a good measure for comparing results, also with those of other countries. 28,690 burn patients sought medical attention in the Emergency Department, and 1721 of them were admitted. Male to female ratio was 1,75:1. 514 patients were under 15 years old. Median age was 25 (range: 3 months - 93 years). Overall, probability of death was 8.4%. LA50 was 62.31% (CI 95%: 56.57-70.02) for patients aged 15 and over and 72.52% (CI 95%: 61.01-100) for those under 15. In the final model, we found that Adjusted OR was significant for age, female sex, TBSA and inhalation injury (P < 0.05). LA50 values showed that children tolerate more extensive burns. Female sex, burn size, age and inhalation injury were the main risk factors for death. Authorities should pay special attention to these variables, especially in prevention programs, to reduce mortality and improve patient outcome. Children have better outcome than adults given equal burn size. Suicide rates are higher for women than men in our country.

  9. Epidemiology and outcome of burns at the Saud Al Babtain Burns, Plastic Surgery and Reconstructive Center, Kuwait: our experience over five years (from 2006 to 2010).

    PubMed

    Khashaba, H A; Al-Fadhli, A N; Al-Tarrah, K S; Wilson, Y T; Moiemen, N

    2012-12-31

    Aim To determine the epidemiology and clinical presentation, and any contributing factors responsible for burns and outcome of care in Kuwait over the 5-yr period January 2006 to December 2010. Patients and methods. The study reviewed 1702 burn patients admitted over the study period to the Saud Al Babtain Burns, Plastic and Reconstructive Surgery Center, Kuwait. Patient characteristics, including age, sex, type of burn, nationality, total body surface area (TBSA) burn, hospital stay in days, and mortality were recorded. Results. Seventy-one per cent of the 1702 burn patients admitted were males; 540 were children. The majority of patients (64%) had less than 15% TBSA burns and only 14% had more than 50% TBSA burns. Flame burns were the most common cause of burn injuries (60%), followed by scalds (29%). Scalds were most common in children. The mortality rate was 5.75%. Flame burn was the leading cause of mortality. Lethal dose 50 (% TBSA at which a certain group has a 50% chance of survival) for adults (16-40 yr) and for the elderly (>65 yr) was 76.5% and 41.8% TBSA respectively. Conclusion. Burn injury is an important public health concern and is associated with high morbidity and mortality. Flame and scald burns are commonly a result of domestic and occupational accidents and they are preventable. Effective initial resuscitation, infection control, and adequate surgical treatment improve outcomes.

  10. Caloric and nitrogen balances as predictors of nutritional outcome in patients with burns.

    PubMed

    Mancusi-Ungaro, H R; Van Way, C W; McCool, C

    1992-01-01

    Measurement of energy expenditure with indirect calorimetry allows determination of caloric balance. The present study was done to determine the predictive value of caloric and nitrogen balances for nutritional outcome. Energy expenditure was obtained weekly and interpolated between measurements for daily caloric balance. Nitrogen balance was obtained weekly. Because nitrogen output fluctuated, interpolation of daily values was not possible. Nutritional outcome was defined by whether body weight was lost or maintained and by levels of visceral proteins (albumin, prealbumin, and transferrin). The study group included 12 patients with 7% to 82.5% total body surface area burns. Eleven patients survived their burn injuries, and one died of congestive heart failure at 38 days, after her burn wounds had healed. Nine patients had good nutritional outcomes (group 1) and three had poor nutritional outcomes (group 2) (including the one who died). Nitrogen balance was 1.3 +/- 1.0 gm/day in group 1 and 4.5 +/- 1.7 gm/day in group 2 (mean +/- SEM; p > 0.10). Caloric balance was 515 +/- 130 kcal/day in group 1 and -667 +/- 140 in group 2 (p < 0.001). Caloric balance was significantly different between the two groups, whereas nitrogen balance was not. Caloric intake correlated positively with nitrogen intake (r = 0.92). Nitrogen intake was 16% of total caloric intake. Nitrogen intake from blood products was appreciable and averaged 15% of total nitrogen intake (range, 0% to 47%); 11.3 +/- 1.6 gm/day in group 1 and 14.8 +/- 3 gm/day in group 2 (p > 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Upper Airway Sequelae in Burn Patients Requiring Endotracheal Intubation or Tracheostomy

    DTIC Science & Technology

    1985-03-01

    airways. In adult patients, our experi - It was remarkable that autopsy findings in 12 patients ence is that as long as the nasotracheal tube is not...tracheostomy. Acta Anaesthesiol TB et al., eds. Progress in Anaesthesiology : Proceedings of the Scand 1979; 23:57-68. Fourth World Congress of

  12. Delayed rupture of a pseudoaneurysm in the brachial artery of a burn reconstruction patient

    PubMed Central

    2013-01-01

    A brachial artery pseudoaneurysm is a rare but serious condition that can be limb threatening. A number of reports have found that it may be the result of damage to the blood vessels around the brachial artery, either directly or indirectly, due to trauma or systemic diseases. We present our experience of delayed pseudoaneurysm rupture of the brachial artery in a rehabilitation patient with burns of the upper extremity who underwent fasciotomy and musculocutaneous flap coverage. We also provide a review of the brachial artery pseudoaneurysm. PMID:23758847

  13. Clinical Trial of Imipenem/Cilastatin in Severely Burned and Infected Patients

    DTIC Science & Technology

    1987-07-01

    parainfluenzae ventricular F contractions (slight) for one day 7 ...... 43.0 Positive Broncho- Proteus vulgaris , 3 9 Improved Reduced in None 27 pneumonia...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...antibiotic nary, two urinary tract, one wound and one bacte re- mia. Treatment was clinically successful in 13patie-; resistant organisms in the

  14. Roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients

    PubMed Central

    Nogueira, Glaucia R.; Azevedo, Paula S.; Polegato, Bertha F.; Zornoff, Leonardo A.M.; Paiva, Sergio A.R.; Nogueira, Celia R.; Araujo, Natalia C.; Carmona, Bruno H.M.; Conde, Sandro J.; Minicucci, Marcos F.

    2016-01-01

    OBJECTIVE: The aim of this study was to evaluate the roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients. METHODS: In total, 105 consecutive burn injury patients over 18 years in age who were admitted to the Burn Unit of Bauru State Hospital from January to December 2013 were prospectively evaluated. Upon admission, patient demographic information was recorded and a blood sample was taken for biochemical analysis to identify the presence of the Taql(rs731236) and Bsml(rs1544410) polymorphisms. All of the patients were followed over their hospital stay and mortality was recorded. RESULTS: Eighteen of the patients did not sign the informed consent form, and there were technical problems with genotype analysis for 7 of the patients. Thus, 80 patients (mean age, 42.5±16.1 years) were included in the final analysis. In total, 60% of the patients were male, and 16.3% died during the hospital stay. The genotype frequencies for the Taql polymorphism were 51.25% TT, 41.25% TC and 7.50% CC; for the Bsml polymorphism, they were 51.25% GG, 42.50% GA and 6.25% AA. In logistic regression analysis, after adjustments for age, gender and total body surface burn area, there were no associations between the Taql (OR: 1.575; CI95%: 0.148-16.745; p=0.706) or Bsml (OR: 1.309; CI95%: 0.128-13.430; p=0.821) polymorphisms and mortality for the burn patients. CONCLUSIONS: Our results suggest that the Taql and Bsml vitamin D receptor gene polymorphisms are not associated with hospital mortality of burn patients. PMID:27626478

  15. The Reliability and Validity of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among an Adult Burn Survivor Sample

    ERIC Educational Resources Information Center

    Lawrence, John W.; Fauerbach, James A.; Heinberg, Leslie J.; Doctor, Marion; Thombs, Brett D.

    2006-01-01

    In this study, 361 adult burn survivors completed the Perceived Stigmatization Questionnaire (PSQ), the Social Comfort Questionnaire (SCQ), and other measures. Both the PSQ and SCQ had good internal consistency indices. Factor analysis of the PSQ yielded 3 factors (absence of friendly behavior, confused/staring behavior, and hostile behavior). The…

  16. Ab interno trabeculectomy in the adult patient.

    PubMed

    SooHoo, Jeffrey R; Seibold, Leonard K; Kahook, Malik Y

    2015-01-01

    Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient.

  17. Ab Interno Trabeculectomy in the Adult Patient

    PubMed Central

    SooHoo, Jeffrey R.; Seibold, Leonard K.; Kahook, Malik Y.

    2015-01-01

    Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient. PMID:25624670

  18. Trauma injury in adult underweight patients

    PubMed Central

    Hsieh, Ching-Hua; Lai, Wei-Hung; Wu, Shao-Chun; Chen, Yi-Chun; Kuo, Pao-Jen; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun

    2017-01-01

    Abstract The aim of this study was to investigate and compare the injury characteristics, severity, and outcome between underweight and normal-weight patients hospitalized for the treatment of all kinds of trauma injury. This study was based on a level I trauma center Taiwan. The detailed data of 640 underweight adult trauma patients with a body mass index (BMI) of <18.5 kg/m2 and 6497 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m2) were retrieved from the Trauma Registry System between January 1, 2009, and December 31, 2014. Pearson's chi-square test, Fisher's exact test, and independent Student's t-test were performed to compare the differences. Propensity score matching with logistic regression was used to evaluate the effect of underweight on mortality. Underweight patients presented a different bodily injury pattern and a significantly higher rate of admittance to the intensive care unit (ICU) than did normal-weight patients; however, no significant differences in the Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital mortality, and hospital length of stay were found between the two groups. However, further analysis of the patients stratified by two major injury mechanisms (motorcycle accident and fall injury) revealed that underweight patients had significantly lower GCS scores (13.8 ± 3.0 vs 14.5 ± 2.0, P = 0.020), but higher ISS (10.1 ± 6.9 vs 8.4 ± 5.9, P = 0.005), in-hospital mortality (odds ratio, 4.4; 95% confidence interval, 1.69–11.35; P = 0.006), and ICU admittance rate (24.1% vs 14.3%, P = 0.007) than normal-weight patients in the fall accident group, but not in the motorcycle accident group. However, after propensity score matching, logistic regression analysis of well-matched pairs of patients with either all trauma, motorcycle accident, or fall injury did not show a significant influence of underweight on mortality. Exploratory data analysis revealed that underweight patients

  19. The interrelationships between wound management, thermal stress, energy metabolism, and temperature profiles of patients with burns.

    PubMed

    Wallace, B H; Caldwell, F T; Cone, J B

    1994-01-01

    This prospective randomized study was performed to evaluate the metabolic and thermal responsiveness of patients with burns to thermal stress with three protocols of wound care: group I (n = 7) treated with dressings and variable ambient temperature selected for patients subjective comfort; group II (n = 7) treated without dressings and variable ambient temperature for patient comfort; group III (n = 6) treated without dressings and ambient temperature of 25 degrees C, electromagnetic heaters were set to achieve patient subjective comfort; and group IV (n = 6) healthy volunteers. After baseline partitional calorimetry was performed, individual patients were cold-challenged while subjectively comfortable by sequentially lowering either the ambient temperature or the output from the electromagnetic heaters. Heat balance and temperatures were obtained after each perturbation in external energy support. For patients in groups I and II, subjective perception of thermal comfort (warm, neutral, neutral and fed, cool, or cold) was more strongly correlated (p < 0.02) with the changes in the rate of heat production than the actual ambient temperature. For patients treated with electromagnetic heaters, changes in heat production were most strongly correlated with the energy output from the electromagnetic heaters. Even though the environmental conditions required to achieve a particular level of comfort are quite different between treatment groups, the difference in temperature between the patient's surface and ambient is approximately the same for groups I, II, and IV for each subjective state.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. [The correction of metabolic disorders in severely burned patients by enteral hyperalimentation].

    PubMed

    Zaets, T L; Tarasov, A V

    1992-01-01

    An investigation was carried out of the metabolic processes, and some procedures for standardizing them, for patients with severe burns receiving uniformly distributed dosified high-calorie catheter alimentation, i.e. enteral hyperalimentation, in addition to the hospital's daily diet. Fifteen types of mixtures of Combustal were used, made and preserved ad hoc, and two commercial probe alimentation liquid products--Biosorbin-MCT (Pfrimmer-Kabi) and Fresubin (Fresenius AG). The average period taken to normalize the nitrogen balance was sixteen days counted from commencement of hyperalimentation. While it shifted the nitrogen balance figures from negative to positive, it was also seen to reduce A and C phospholipase activities in serum, while the level of excretion of nitrogenated amino acids and creatine remained high. During this time, pseudocholinesterase activity dropped, with the concentration of fibronectine in serum, which indicates low levels of biosynthetic processes and insufficiency in the reticuloendothelial system. The average value for the determination of lipids in general remained normal throughout the catheter feeding period. To ensure complete normalization of the metabolic process in patients suffering severe burns, enteral hyperalimentation must be extended for at least one month.

  1. Grey matter changes of the pain matrix in patients with burning mouth syndrome.

    PubMed

    Sinding, Charlotte; Gransjøen, Anne Mari; Schlumberger, Gina; Grushka, Miriam; Frasnelli, Johannes; Singh, Preet Bano

    2016-04-01

    Burning mouth syndrome (BMS) is characterized by a burning sensation in the mouth, usually in the absence of clinical and laboratory findings. Latest findings indicate that BMS could result from neuropathic trigeminal conditions. While many investigations have focused on the periphery, very few have examined possible central dysfunctions. To highlight changes of the central system of subjects with BMS, we analysed the grey matter concentration in 12 subjects using voxel-based morphometry. Data were compared with a control group (Ct). To better understand the brain mechanisms underlying BMS, the grey matter concentration of patients was also compared with those of dysgeusic patients (Dys). Dysgeusia is another oral dysfunction condition, characterized by a distorted sense of taste and accompanied by a reduced taste function. We found that a major part of the 'pain matrix' presented modifications of the grey matter concentration in subjects with BMS. Six regions out of eight were affected [anterior and posterior cingulate gyrus, lobules of the cerebellum, insula/frontal operculum, inferior temporal area, primary motor cortex, dorsolateral pre-frontal cortex (DLPFC)]. In the anterior cingulate gyrus, the lobules of the cerebellum, the inferior temporal lobe and the DLPFC, pain intensity correlated with grey matter concentration. Dys also presented changes in grey matter concentration but in different areas of the brain. Our results suggest that a deficiency in the control of pain could in part be a cause of BMS and that BMS and dysgeusia conditions are not linked to similar structural changes in the brain.

  2. The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis

    PubMed Central

    Cabral, Luís; Afreixo, Vera; Almeida, Luís; Paiva, José Artur

    2016-01-01

    The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop. Among a large array of laboratory tests, procalcitonin (PCT) emerged as the leading biomarker to accurately and time-effectively indicate the presence of systemic infection. In the presence of systemic infection, PCT blood levels undergo a sudden and dramatic increase, following the course of the infection, and quickly subside after the control of the septic process. This work is a meta-analysis on PCT performance as a biomarker for sepsis. This meta–analysis showed that overall pooled area under the curve (AUC) is 0.83 (95% CI = 0.76 to 0.90); the estimated cut-off is 1.47 ng/mL. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% CI = 1.1 to 3.2). This meta–analysis showed PCT may be considered as a biomarker with a strong diagnostic ability to discriminate between the septic from the non-septic burn patients. Thus, this work encourages the determination of PCT levels in clinical practice for the management of these patients, in order to timely identify the susceptibility to sepsis and to initiate the antimicrobial therapy, improving the patients’ outcomes. PMID:28005932

  3. Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study.

    PubMed

    Christ-Libertin, Cheryl; Black, Sharon; Latacki, Theresa; Bair, Tina

    2015-01-01

    The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days.

  4. The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

    PubMed

    Fullerton, J K; Smith, C E; Milner, S M

    2000-10-01

    Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

  5. Increasing blood glucose variability is a precursor of sepsis and mortality in burned patients.

    PubMed

    Pisarchik, Alexander N; Pochepen, Olga N; Pisarchyk, Liudmila A

    2012-01-01

    High glycemic variability, rather than a mean glucose level, is an important factor associated with sepsis and hospital mortality in critically ill patients. In this retrospective study we analyze the blood glucose data of 172 nondiabetic patients 18-60 yrs old with second and third-degree burns of total body surface area greater than 30% and 5%, respectively, admitted to ICU in 2004-2008. The analysis identified significant association of increasing daily glucose excursion (DELTA) accompanied by evident episodes of hyperglycemia (>11 mmol/l) and hypoglycemia (<2.8 mmol/l), with sepsis and forthcoming death, even when the mean daily glucose was within a range of acceptable glycemia. No association was found in sepsis complication and hospital mortality with doses of intravenous insulin and glucose infusion. A strong increase in DELTA before sepsis and death is treated as fluctuation amplification near the onset of dynamical instability.

  6. [Standardisation of the Initial Treatment of Severely Burned Patients: The Necessary Transfer of Concepts from Trauma Care].

    PubMed

    Münzberg, M; Harbers, T; Kneser, U; Grützner, P A; Reichert, B; Kremer, T; Wölfl, C G; Horter, J; Hirche, C

    2016-12-01

    The initial treatment of severely burned patients remains a huge challenge for first responders in emergency services as well as emergency doctors who do not work in a centre for severe burn injuries. The reason for this is the low number of cases in developed countries and a lack of training concepts for the specific aspects of the initial treatment of severe burn injuries. Because of guidelines with limited evidence (S1, S2k) and a lack of structured treatment approaches, uncertainties with respect to initial treatment are still visible. Even within the professional societies and on international comparison, controversial aspects remain. In contrast, optimised and standardised procedures are available for the treatment of severely injured (trauma) patients, based on PHTLS® (Pre Hospital Trauma Life Support) for preclinical and ATLS® (Advanced Trauma Life Support) for in-hospital first aid. This article takes stock of the current structure of care and the relevant evidence for the initial treatment of severe burns. Also it discusses a possible transfer and further development of concepts for primary trauma care by all disciplines involved. Nine essential steps in the primary care of burned patients are identified and evaluated. The need for the introduction of a uniform treatment algorithm is illustrated. The treatment algorithm presented in this article addresses all first responders who are faced with initial treatment in the first 24 hours outside of burn centres. As an essential, new aspect, it offers a transfer and adaptation of concepts from trauma care to standardise the care of severely burned patients.

  7. A European hospital survey to determine the extent of psychological services offered to patients with severe burns.

    PubMed

    Van Loey, N E; Faber, A W; Taal, L A

    2001-02-01

    Analogous to a hospital survey in North America (the US and Canada) a survey in Europe was performed to determine the extent of psychological services offered in burn units. The questionnaire used to acquire this information was exactly the same in both continents. One hundred and seventy questionnaires and self-addressed stamped envelopes were sent to the medical manager of the European burn units with the request to pass the questionnaire to the person who provides psychological care to patients in the burn units. The questionnaire was translated into four other languages. Response was 103 (62.8%). The questions posed inquired after what percentage of patients received psychological testing, psychological therapy, displayed symptoms of depression and post-traumatic stress, what percentage is given referral and if emotional follow-up is arranged. Also questions about whether staff members of the burn unit displayed symptoms of depression and post-traumatic stress were enclosed. Results indicated that few burn units in Europe provide formal psychological testing for their patients and in half of the European hospitals, less than 20% of the patients receive psychological therapy or counselling during their stay in the hospital. Aftercare services are also capable of improvement. Compared with North America, Europe provided less psychological services. No statistical differences were found between countries within Europe.

  8. Impacting Care and Treatment of the Burn Patient Conversion to Electronic Documentation.

    PubMed

    Hampe, Holly M; Keeling, Terri; Fontana, Michelle; Balcik, Debbie

    Improving patient care through enhanced electronic communication among health care providers is aimed at reducing the number of medication and medical errors. The American Reinvestment and Recovery Act (ARRA) was signed into law in 2009, supporting the federal government's commitment to the improvement of health care quality, safety, and efficiency through requirements to implement an electronic health record by October 2015 or hospitals and eligible providers potentially realizing penalties or reduced reimbursement rates. In addition to ARRA, Congress presented another initiative to further advance the delivery of high-quality health care, the Health Information Technology for Economic and Clinical Health Act (HITECH), leading to the authorization of $27 billion to encourage health care providers to achieve meaningful use of the electronic health record. However, the conversion of the paper medical records to an electronic version has been challenging, particularly in specialty departments. The burn unit of a tertiary hospital located in the Pittsburgh area experienced such challenges. A project plan, developed in 2009 prior to the electronic medical record going live, involved a multidisciplinary team, consisting of providers, nurses, and information system builders who came together to determine how to capture the totality of the burn unit documentation. The goal of the project was to develop an electronic documentation tool and provide a system to accurately and efficiently evaluate documentation compliance with the staff. The Lund Browder documentation tool, used with the paper medical record, was the selected tool for the electronic conversion. This tool has been regarded by most health care organizations as being the most accurate in measuring the extent and degree of the burn. With the paper documentation tool, the staff was, on average, 74% compliant with the Lund Browder tool. The electronic version and availability of the tool increased compliance to 100

  9. The effects of electroacupuncture on analgesia and peripheral sensory thresholds in patients with burn scar pain.

    PubMed

    Cuignet, Olivier; Pirlot, A; Ortiz, S; Rose, T

    2015-09-01

    The aim of this study is to observe if the effects of electro-acupuncture (EA) on analgesia and peripheral sensory thresholds are transposable from the model of heat pain in volunteers to the clinical setting of burn scar pain. After severe burns, pathological burn scars (PPBS) may occur with excruciating pain that respond poorly to treatment and prevent patients from wearing their pressure garments, thereby leading to unesthetic and function-limiting scars. EA might be of greater benefit in terms of analgesia and functional recovery, should it interrupt this vicious circle by counteracting the peripheral hyperalgesia characterizing PPBS. Therefore we enrolled 32 patients (22 males/10 females) aged of 46±11 years with clinical signs of PPBS and of neuropathic pain despite treatment. The study protocol consisted in 3 weekly 30-min sessions of standardized EA with extra individual needles in accordance to Traditional Chinese Medicine, in addition of previous treatments. We assessed VAS for pain and quantitative sensory testing (QST) twice: one week before and one after protocol. QST measured electrical thresholds for non-nociceptive A-beta fibers, nociceptive A-delta and C fibers in 2 dermatomes, respectively from the PPBS and from the contralateral pain-free areas. Based on heat pain studies, EA consisted in sessions at the extremity points of the main meridian flowing through PPBS (0.300s, 5Hz, sub noxious intensity, 15min) and at the bilateral paravertebral points corresponding to the same metameric level, 15min. VAS reduction of 3 points or below 3 on a 10 points scale was considered clinically relevant. Paired t-test compared thresholds (mean [SD]) and Wilcoxon test compared VAS (median [IQR]) pre and after treatment, significant p<0.05. The reduction of VAS for pain reached statistical but not clinical relevance (6.8 [3] vs. 4.5 [3.6]). This was due to a large subgroup of 14 non-responders whose VAS did not change after treatment (6.6 [2.7] vs. 7.2 [3

  10. Long term functional outcomes and quality of life following severe burn injury.

    PubMed

    Druery, Martha; Brown, Tim La H; La H Brown, Tim; Muller, Michael

    2005-09-01

    This study was designed to examine functional and psychological outcome of severely burned patients adults. Adult patients (n=38) admitted to the Royal Brisbane hospital with burns >40% TBSA were assessed two years post injury using the Abbreviated BSHS and a supplemental questionnaire relating to specific physiotherapy and occupational health issues. An average return to driving occurred at 36 weeks and return to work at 51 weeks. Involvement of the hands and face significantly altered the physical domain of the questionnaire and the sub-domain examining role. Genital burns altered the sexual sub-domain, but this was not gender dependant. Mobility and self care were significantly altered when a burn was >20% TBSA full thickness. The study demonstrates that these patients can develop functional independence and good quality of life. The long term outlook for patients with large burns is generally positive. Consequently, burn care professionals can be reassured that the effort is worthwhile.

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

    PubMed

    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.

  12. Impaired glucose tolerance in pediatric burn patients at discharge from the acute hospital stay

    PubMed Central

    Fram, Ricki Y.; Cree, Melanie G.; Wolfe, Robert R.; Barr, David; Herndon, David N.

    2013-01-01

    Objective Hyperglycemia, secondary to the hypermetabolic stress response, is a common occurrence after thermal injury. This stress response has been documented to persist up to 9 months post burn. The purpose of this study was to measure insulin sensitivity in severely burned children prior to discharge when wounds are 95% healed. Methods Twenty-four children, aged 4–17 years, with burns ≥ 40% total body surface area (TBSA) underwent a 2 hour oral glucose tolerance test (OGTT) prior to discharge from the acute pediatric burn unit. Plasma glucose and insulin levels, as well as the Homeostasis Model Assessment for Insulin Resistance (HOMAIR) were compared to published OGTT data from healthy, non-burned children. Results There was a significant difference between severely burned children and non-burned, healthy children with respect to the HOMAIR. Severely burned children had a HOMAIR of 3.53±1.62 compared to the value in non-burned healthy children was 1.28±0.16 (p<0.05). Conclusion Insulin resistance secondary to the hypermetabolic stress response persists in severely burned children when burn wounds are at least 95% healed. The results of this study warrant future investigations into therapeutic options for the burned child during the rehabilitative phase of their care after injury. PMID:20634704

  13. The role of exercise in the rehabilitation of patients with severe burns.

    PubMed

    Porter, Craig; Hardee, Justin P; Herndon, David N; Suman, Oscar E

    2015-01-01

    Severe burn trauma results in persistent skeletal muscle catabolism and prolonged immobilization. We hypothesize that structured rehabilitative exercise is a safe and efficacious strategy to restore lean body mass and physical function in burn victims. Here, we review the evidence for the utility of rehabilitative exercise training in restoring physiological function in burn survivors.

  14. Insulin therapy in burn patients does not contribute to hepatic triglyceride production.

    PubMed Central

    Aarsland, A; Chinkes, D L; Sakurai, Y; Nguyen, T T; Herndon, D N; Wolfe, R R

    1998-01-01

    Lipid kinetics were studied in six severely burned patients who were treated with a high dose of exogenous insulin plus glucose to promote protein metabolism. The patients were 20+/-2-yr-old (SD) with 63+/-8% total body surface area burned. They were studied in a randomized order (a) in the fed state on the seventh day of a control period (C) of continuous high-carbohydrate enteral feeding alone, and (b) on the seventh day of enteral feeding plus exogenous insulin (200 pmol/h = 28 U/h) with extra glucose given as needed to avoid hypoglycemia (I+G). Despite a glucose delivery rate approximately 100% in excess of energy requirements, the following lipid parameters were unchanged: (a) total hepatic VLDL triglyceride (TG) secretion rate (0.165+/-0.138 [C] vs. 0.154+/- 0.138 mmol/kg . d-1 [I+G]), (b) plasma TG concentration (1.58+/-0.66 [C] vs. 1. 36+/-0.41 mmol/liter [I+G]), and (c) plasma VLDL TG concentration (0. 68+/-0.79 [C] vs. 0.67+/- 0.63 mmol/liter [I+G]). Instead, the high-carbohydrate delivery in conjunction with insulin therapy increased the proportion of de novo-synthesized palmitate in VLDL TG from 13+/-5% (C) to 34+/-14% (I+G), with a corresponding decreased amount of palmitate from lipolysis. In association with the doubling of the secretion rate of de novo-synthesized fatty acid (FA) in VLDL TG during insulin therapy (P > 0.5), the relative amount of palmitate and stearate increased from 35+/-5 to 44+/-8% and 4+/-1 to 7+/-2%, respectively, in VLDL TG, while the relative concentration of oleate and linoleate decreased from 43+/-5 to 37+/-6% and 8+/-4% to 2+/-2%, respectively. A 15-fold increase in plasma insulin concentration did not change the rate of release of FA into plasma (8.22+/-2.86 [C] vs. 8.72+/-6.68 mmol/kg.d-1 [I+G]. The peripheral release of FA represents a far greater potential for hepatic lipid accumulation in burn patients than the endogenous hepatic fat synthesis, even during excessive carbohydrate intake in conjunction with insulin

  15. Cognitive profile of patients with burning mouth syndrome in the Japanese population.

    PubMed

    Matsuoka, Hirofumi; Himachi, Mika; Furukawa, Hirokazu; Kobayashi, Shiho; Shoki, Harumi; Motoya, Ryo; Saito, Masato; Abiko, Yoshihiro; Sakano, Yuji

    2010-07-01

    The present study investigated which cognitive characteristics, including cancer phobia, self-efficacy, pain-related catastrophizing, and anxiety sensitivity, affect burning mouth syndrome (BMS) symptoms in the Japanese population. A total of 46 BMS patients (44 women and 2 men; mean age, 59.98 +/- 9.57 years; range, 30-79 years) completed a battery of questionnaires, including measures of pain severity, oral-related quality of life (QOL), stress-response, pain-related catastrophizing, self-efficacy, anxiety sensitivity, and tongue cancer phobia. The Pain Catastrophizing Scale (PCS), General Self-Efficacy Scale (GSES), and Anxiety Sensitivity Index (ASI) scores in the BMS patients were compared with the scores of Japanese healthy participants (PCS, n = 449; GSES, n = 278; ASI, n = 9603) reported in previous studies. Catastrophizing and anxiety sensitivity were significantly higher in the BMS patients than in the healthy subjects (P < 0.001). In BMS patients, catastrophizing was significantly correlated with pain severity, stress-response, psychological disability, social disability, and handicap. Cancer phobia was significantly correlated with psychological disability and handicap. Since catastrophizing showed a higher correlation with BMS symptoms than cancer phobia, catastrophizing might be a more significant cognitive factor affecting symptoms than cancer phobia in BMS patients in the Japanese population.

  16. Inpatient peer support for adult burn survivors-a valuable resource: a phenomenological analysis of the Australian experience.

    PubMed

    Kornhaber, R; Wilson, A; Abu-Qamar, M; McLean, L; Vandervord, J

    2015-02-01

    Peer support has long been recognised as an essential component of a supportive network for people facing adversity. In particular, burn survivor peer support is a valuable and credible resource available to those rehabilitating from a severe burn. The aim of this study was to explore burn survivors' experiences of providing and receiving inpatient peer support to develop an in-depth understanding of the influence during the rehabilitation journey. In 2011, twenty-one burn survivors were recruited from four severe burn units across Australia. A qualitative phenomenological methodology was used to construct themes depicting survivors' experiences. Participants were selected through purposeful sampling, and data collected through in-depth individual semi-structured interviews. Data were analysed using Colaizzi's phenomenological method of data analysis. Central to burn rehabilitation was the notion of peer support having a significant impact on burn survivors' psychosocial rehabilitation. The emergent theme 'Burn Survivor Peer Support' identified five cluster themes: (1) Encouragement, inspiration and hope (2) Reassurance (3) The Importance of Timing (4) The Same Skin (5) Appropriate Matching. These findings demonstrate that peer support assists with fostering reassurance, hope and motivation in burn rehabilitation. A national network based on a clinician led inpatient burn survivor peer support programme could provide burn survivors across Australia, and in particular remote access locations, with the benefits of peer support necessary to endure the rehabilitation journey.

  17. Clinical phenotypes in adult patients with bronchiectasis.

    PubMed

    Aliberti, Stefano; Lonni, Sara; Dore, Simone; McDonnell, Melissa J; Goeminne, Pieter C; Dimakou, Katerina; Fardon, Thomas C; Rutherford, Robert; Pesci, Alberto; Restrepo, Marcos I; Sotgiu, Giovanni; Chalmers, James D

    2016-04-01

    Bronchiectasis is a heterogeneous disease. This study aimed at identifying discrete groups of patients with different clinical and biological characteristics and long-term outcomes.This was a secondary analysis of five European databases of prospectively enrolled adult outpatients with bronchiectasis. Principal component and cluster analyses were performed using demographics, comorbidities, and clinical, radiological, functional and microbiological variables collected during the stable state. Exacerbations, hospitalisations and mortality during a 3-year follow-up were recorded. Clusters were externally validated in an independent cohort of patients with bronchiectasis, also investigating inflammatory markers in sputum.Among 1145 patients (median age 66 years; 40% male), four clusters were identified driven by the presence of chronic infection with Pseudomonas aeruginosaor other pathogens and daily sputum: "Pseudomonas" (16%), "Other chronic infection" (24%), "Daily sputum" (33%) and "Dry bronchiectasis" (27%). Patients in the four clusters showed significant differences in terms of quality of life, exacerbations, hospitalisations and mortality during follow-up. In the validation cohort, free neutrophil elastase activity, myeloperoxidase activity and interleukin-1β levels in sputum were significantly different among the clusters.Identification of four clinical phenotypes in bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease.

  18. [Application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns].

    PubMed

    Zang, C Y; Cao, Y Q; Xue, W J; Zhao, R; Zhang, M; Zhang, Y H; Feng, Z; Wang, Y B

    2017-02-20

    Objective: To investigate the application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns. Methods: Twenty-six patients with deep partial-thickness burns conforming to the study criteria were hospitalized in our unit from March 2015 to March 2016. Patients were all performed with dermabrasion. The structure of skin tissue and blood flow signals of uninjured side and wounds before dermabrasion, and those of wounds immediately post dermabrasion and on post dermabrasion day (PDD) 1, 3, 5, 7, 10, 14, and 21 were detected with high-frequency ultrasound, and the percentage of blood flow signals was calculated. According to the results of comparison between percentage of blood flow signals of wounds and that of normal skin before dermabrasion, patients were divided into no significant decrease group (NSD, n=19) and significant decrease group (SD, n=7). Wound healing time of patients in two groups was recorded. Data were processed with analysis of variance of repeated measurement, LSD test, t test and Chi-square test. The correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients were analyzed by Spearman correlation analysis. Results: (1) Epidermis of normal skin of patients in two groups before dermabrasion showed continuous smooth linear hyperecho, which was stronger than that of dermis, and boundary of dermis and subcutaneous tissue showed stronger discontinuous linear echo than that of dermis, which gradually transited to subcutaneous tissue. In group NSD, epidermis of wound of patients before dermabrasion showed intermittent rough linear echo, which was weaker than that of normal skin epidermis, and there was no obvious abnormity of boundary between dermis and subcutaneous tissue. Immediately post dermabrasion and on PDD 1, no linear hyperecho of epidermis was observed, showing complete attrition of epidermis, and the echo of dermis and subcutaneous tissue had

  19. The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns.

    PubMed

    Bache, Sarah E; Fitzgerald O'Connor, Edmund; Theodorakopoulou, Evgenia; Frew, Quentin; Philp, Bruce; Dziewulski, Peter

    2017-02-01

    Hand burns represent a unique challenge to the burns team due to the intricate structure and unrivalled functional importance of the hand. The initial assessment and prognosis relies on consideration of the specific site involved as well as depth of the burn. We created a simple severity score that could be used by referring non-specialists and researchers alike. The Hand Burn Severity (HABS) score stratifies hand burns according to severity with a numerical value of between 0 (no burn) and 18 (most severe) per hand. Three independent assessors scored the photographs of 121 burned hands of 106 adult and paediatric patients, demonstrating excellent inter-rater reliability (r=0.91, p<0.0001 on testing with Lin's correlation coefficient). A significant relationship was shown between the HABS score and a reliable binary outcome of the requirement for surgical excision on Mann-Whitney U testing (U=152; Z=9.8; p=0.0001). A receiver operator characteristic (ROC) curve analysis found a cut off score of 5.5, indicating that those with a HABS score below 6 did not require an operation, whereas those with a score above 6 did. The HABS score was shown to be more sensitive and specific that assessment of burn depth alone. The HABS score is a simple to use tool to stratify severity at initial presentation of hand burns which will be useful when referring, and when reporting outcomes.

  20. Assisting sexually abused adults. Practical guide to interviewing patients.

    PubMed Central

    Leach, M. M.; Bethune, C.

    1996-01-01

    Millions of adults have been sexually abused. Patients often confide in their family physicians concerning their abuse. Physicians must understand their own issues surrounding sexual abuse and its sequelae before they attempt to treat sexually abused patients. The PLISSIT model offers a practical guide for assisting abused adult patients. PMID:8924817

  1. Predictors of Muscle Protein Synthesis after Severe Pediatric Burns

    PubMed Central

    Diaz, Eva C.; Herndon, David N.; Lee, Jinhyung; Porter, Craig; Cotter, Matthew; Suman, Oscar E.; Sidossis, Labros S.; Børsheim, Elisabet

    2015-01-01

    Background 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 post-injury, and identify predictors that influence this response. Study design 87 children with ≥40% total body surface area (TBSA) burn were included. Patients participated in stable isotope infusion studies at 1, 2 and ~ 4 weeks post-burn, and at 6, 12 and 24 months post-injury to determine skeletal muscle fractional synthesis rate. Generalized estimating equations with log link normal distribution were applied to account for clustering of patients and control for patient characteristics. Results Patients (8±6 years) had large (62, 51–72% TBSA) and deep (47±21% TBSA third degree) burns. Muscle fractional synthesis rate was elevated throughout the first 12 months post-burn compared to established values from healthy young adults. Muscle fractional synthesis rate was lower in boys, children >3 years old, and when burns were >80% TBSA. Conclusions Muscle protein synthesis is elevated for at least one year after injury, suggesting that greater muscle protein turnover is a component of the long-term pathophysiological response to burn trauma. Muscle protein synthesis is highly affected by gender, 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 victims. PMID:25807408

  2. Safety and efficacy of excision and direct closure in acute burns surgery: outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons' attitudes.

    PubMed

    Bain, Charles J; Wang, Tim; McArthur, Gordon; Williams, Greg; Atkins, Joanne; Jones, Isabel

    2014-12-01

    Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p=0.008), as were those with wound dehiscence (p=0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p=0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases.

  3. Causes of Mortality by Autopsy Findings of Combat Casualties and Civilian Patients Admitted to a Burn Unit

    DTIC Science & Technology

    2009-03-01

    of multiple causes of attributable mortality. ATN, acute tubular necrosis; CHF, congestive heart failure; ESLD, end-stage liver disease. 350 Gomez et...in burn patients involved in combat operations overseas. J Am Coll Surg 2008;206:439–444. 16. Albrecht MC, Griffith ME, Murray CK, et al. Impact of

  4. Stress disorder and PTSD after burn injuries: a prospective study of predictors of PTSD at Sina Burn Center, Iran

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Maghsoudi, Hemmat; Soudmand-Niri, Mohsen; Ranjbar, Fatemeh; Mashadi-Abdollahi, Hossein

    2011-01-01

    Background: A burn injury can be a traumatic experience with tremendous social, physical, and psychological consequences. The aim of this study was to investigate the existence of post-traumatic stress disorder (PTSD) and predictors of PTSD Checklist score initially and 3 months after injury in burns victims admitted to the Sina Burn Center in north-west Iran. Methods: This prospective study examined adult patients aged 16–65 years with unintentional burns. The PTSD Checklist was used to screen for PTSD. Results: Flame burns constituted 49.4% of all burns. Mean PTSD score was 23.8 ± 14.7 early in the hospitalization period and increased to 24.2 ± 14.3, 3 months after the burn injury. Twenty percent of victims 2 weeks into treatment had a positive PTSD screening test, and this figure increased to 31.5% after 3 months. The likelihood of developing a positive PTSD screening test increased significantly after 3 months (P < 0.01). Using multivariate regression analysis, factors independently predicting PTSD score were found to be age, gender, and percentage of total body surface area burned. Conclusion: PTSD was a problem in the population studied and should be managed appropriately after hospital admission due to burn injury. Male gender, younger age, and higher total body surface area burned may predict a higher PTSD score after burn injury. PMID:21857783

  5. Evaluation of Demographic and Clinical Characteristics of Patients who Attempted Suicide by Self-Inflicted Burn Using Catalyzer

    PubMed Central

    Yabanoglu, Hakan; Aytac, Huseyin Ozgur; Turk, Emin; Karagulle, Erdal; Belli, Sedat; Sakallioglu, Ayse Ebru; Tarim, Mehmet Akin; Moray, Gokhan; Haberal, Mehmet

    2015-01-01

    Our aim was to assess demographic and clinical characteristics of patients treated at our units who attempted suicide by self-incineration, and to compare the results of burns with or without catalyzer use. Twenty patients who attempted suicide by self-incineration were examined in terms of clinical and demographic characteristics. Average age of the study population was 35 years (range 13−85 years). Average percentage of total body surface area burn was 53% (9%−100%). Six (30%) patients used gasoline and 5 (25%) used paint thinner in order to catalyze burning. Of these 11 patients who used a catalyzer, 5 (45.4%) had inhalation injury and 7 (63.6%) died. Among 9 patients who did not use any catalyzer, 1 (11.1%) had inhalation injury and 4 (44.4%) died. In general, inhalation injury was diagnosed in 6 patients (30%) while 11 (55%) patients died. A high morbidity and mortality rate was found in patients who used a catalyzer. PMID:25692434

  6. Wide distribution of carbapenem resistant Acinetobacter baumannii in burns patients in Iran

    PubMed Central

    Farshadzadeh, Zahra; Hashemi, Farhad B.; Rahimi, Sara; Pourakbari, Babak; Esmaeili, Davoud; Haghighi, Mohammad A.; Majidpour, Ali; Shojaa, Saeed; Rahmani, Maryam; Gharesi, Samira; Aziemzadeh, Masoud; Bahador, Abbas

    2015-01-01

    Antimicrobial resistance in carbapenem non-susceptible Acinetobacter baumannii (CNSAb) is a major public health concern globally. This study determined the antibiotic resistance and molecular epidemiology of CNSAb isolates from a referral burn center in Tehran, Iran. Sixty-nine CNSAb isolates were tested for susceptibility to antimicrobial agents using the E test methodology. Multiple locus variable number tandem repeat analysis (MLVA), Multilocus sequence typing (MLST) and multiplex PCR were performed. PCR assays tested for ambler classes A, B, and D β-lactamases. Detection of ISAba1, characterization of integrons, and biofilm formation were investigated. Fifty-three (77%) isolates revealed XDR phenotypes. High prevalence of blaOXA-23-like (88%) and blaPER-1 (54%) were detected. ISAba1 was detected upstream of blaADC, blaOXA-23-like and blaOXA51-like genes in, 97, 42, and 26% of isolates, respectively. Thirty-one (45%) isolates were assigned to international clone (IC) variants. MLVA identified 56 distinct types with six clusters and 53 singleton genotypes. Forty previously known MLST sequence types forming 5 clonal complexes were identified. The Class 1 integron (class 1 integrons) gene was identified in 84% of the isolates. The most prevalent (33%) cassette combination was aacA4-catB8-aadA1. The IC variants were predominant in the A. baumannii lineage with the ability to form strong biofilms. The XDR-CNSAb from burned patients in Iran is resistant to various antimicrobials, including tigecycline. This study shows wide genetic diversity in CNSAb. Integrating the new Iranian A. baumannii IC variants into the epidemiologic clonal and susceptibility profile databases can help effective global control measures against the XDR-CNSAb pandemic. PMID:26539176

  7. Clinical Utility of Fungal Screening Assays in Adults with Severe Burns

    DTIC Science & Technology

    2013-01-01

    available test, FungitellTM Glucan Assay for (1,3) b D glucan (BG) in serum (Associates of Cape Cod Inc., East Falmouth, MA), is a qualitative...considered a positive test in the United States and was used as a positive value in this study. A positive test is reported with a b D glucan concentration... Glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous

  8. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part II)*.

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-09-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  9. Nutritional and pharmacological modulation of the metabolic response of severely burned patients: review of the literature (part 1).

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-06-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  10. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part III)*.

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-12-31

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society.Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  11. Disaster planning: the past, present, and future concepts and principles of managing a surge of burn injured patients for those involved in hospital facility planning and preparedness.

    PubMed

    Kearns, Randy D; Holmes, James H; Alson, Roy L; Cairns, Bruce A

    2014-01-01

    The 9/11 attacks reframed the narrative regarding disaster medicine. Bypass strategies have been replaced with absorption strategies and are more specifically described as "surge capacity." In the succeeding years, a consensus has coalesced around stratifying the surge capacity into three distinct tiers: conventional, contingency, and crisis surge capacities. For the purpose of this work, these three distinct tiers were adapted specifically to burn surge for disaster planning activities at hospitals where burn centers are not located. A review was conducted involving published plans, other related academic works, and findings from actual disasters as well as modeling. The aim was to create burn-specific definitions for surge capacity for hospitals where a burn center is not located. The three-tier consensus description of surge capacity is delineated in their respective stratifications by what will hereinafter be referred to as the three "S's"; staff, space, and supplies (also referred to as supplies, pharmaceuticals, and equipment). This effort also included the creation of a checklist for nonburn center hospitals to assist in their development of a burn surge plan. Patients with serious burn injuries should always be moved to and managed at burn centers, but during a medical disaster with significant numbers of burn injured patients, there may be impediments to meeting this goal. It may be necessary for burn injured patients to remain for hours in an outlying hospital until being moved to a burn center. This work was aimed at aiding local and regional hospitals in developing an extemporizing measure until their burn injured patients can be moved to and managed at a burn center(s).

  12. Burn Resuscitation

    DTIC Science & Technology

    2009-01-01

    areas involving large areas of skin the patient is exposed to death first from shock . . .’’ [10]. In describing the pathophysiology leading to the shock...state seen in burns he postulated that various irritants , mental and physical, caused vasomotor paresis leading to accumulation of blood in the...resuscitation volumes. Subsequent studies suggested a decrease in abdominal compartment syndrome (ACS). Oda et al., in 2006, published their experience

  13. Skeletal Muscle Is Anabolically Unresponsive to an Amino Acid Infusion in Pediatric Burn Patients 6 Months Postinjury

    PubMed Central

    Tuvdendorj, Demidmaa; Chinkes, David L.; Zhang, Xiao-Jun; Sheffield-Moore, Melinda; Herndon, David N.

    2013-01-01

    Objective To evaluate leg muscle, whole-body muscle, and whole-body non-muscle protein response to anabolic signaling of amino acids in pediatric burn patients at 6 months after injury. Background Burn injury is associated with a catabolic state persisting years after the injury. The tissue response to nutritional signaling (eg, amino acids) plays a critical role in tissue protein net balance via coordination of protein synthesis and breakdown mechanisms. Methods A total of 10 patients (7.4 ± 3.8 years; 27.4 ± 14.7 kg) and 5 healthy young males (22 ± 3 years; 76 ± 15 kg) underwent an 8-hour stable isotope infusion study. During the last 3 hours, an amino acid solution (10% Travasol, Clintec Nutrition, Deerfield, IL) was infused. Femoral arterial and venous blood samples and muscle biopsy samples were collected throughout the study. A P value of less than 0.05 was considered statistically different. Results During amino acid infusion, leg muscle protein synthesis rate significantly increased (P < 0.05) in both groups, however, in the burn group, protein breakdown also increased, although nonsignificantly. As a result, protein net balance remained negative. In the control group, breakdown nonsignificantly decreased resulting in a significant increase (P < 0.05) in muscle protein net balance. Whole-body protein breakdown was significantly higher in the burn patients. Conclusion In pediatric burn patients at 6 months postinjury, leg muscle protein net deposition is unresponsive to amino acid infusion; and whole-body protein breakdown is significantly higher than in the control group. PMID:21263308

  14. Impaired glucose tolerance in pediatric burn patients at discharge from the acute hospital stay.

    PubMed

    Fram, Ricki Y; Cree, Melanie G; Wolfe, Robert R; Barr, David; Herndon, David N

    2010-01-01

    Hyperglycemia, secondary to the hypermetabolic stress response, is a common occurrence after thermal injury. This stress response has been documented to persist up to 9 months postburn. The purpose of this study was to measure insulin sensitivity in severely burned children before discharge when wounds are 95% healed. Twenty-four children, aged 4 to 17 years, with burns > or = 40% TBSA underwent a 2-hour oral glucose tolerance test before discharge from the acute pediatric burn unit. Plasma glucose and insulin levels as well as the Homeostasis Model Assessment for Insulin Resistance (HOMAIR) were compared with published oral glucose tolerance test data from healthy, nonburned children. There was a significant difference between severely burned children and nonburned, healthy children with respect to the HOMAIR. Severely burned children had a HOMAIR of 3.53 +/- 1.62 compared with the value in nonburned, healthy children of 1.28 +/- 0.16 (P < .05). Insulin resistance secondary to the hypermetabolic stress response persists in severely burned children when burn wounds are at least 95% healed. The results of this study warrant future investigations into therapeutic options for the burned child during the rehabilitative phase of their care after injury.

  15. A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients.

    PubMed

    Baghel, P S; Shukla, S; Mathur, R K; Randa, R

    2009-07-01

    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 with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the

  16. [Anesthetic management in a patient with head and neck burn by asphalt].

    PubMed

    Suzuki, Nao; Niiyama, Yukitoshi; Tokinaga, Yasuyuki; Yamakage, Michiaki

    2013-10-01

    In cases of facial burns caused by molten asphalt, examination for possible airway burns and early removal of the asphalt should be carried out to prevent chemical-induced tissue damage and infection. However, asphalt that has adhered to tissues is difficult to remove. A 35-year-old male with burns caused by molten asphalt was scheduled for emergency debridement. He had 6% body surface area burns on his face and neck. He was not able to open his eyes due to the adherence of asphalt. His respiratory condition was stable and a perioperative fiberoptic view revealed no airway burns. After awake intubation, orange peel oil was used to remove the asphalt from his face and eyes. Since orange peel oil does not contain any harmful substances, it is effective for removing asphalt without causing tissue damage.

  17. Mitral valve repair via right thoracotomy for multidrug resistant pseudomonal endocarditis in a burn patient: case report and review of the literature.

    PubMed

    Mohebali, Jahan; Ibrahim, Amir E; MacGillivray, Thomas E; Goverman, Jeremy; Fagan, Shawn P

    2015-05-01

    Diagnosis and management of infectious endocarditis are particularly challenging in patients with severe burns. Cases requiring operative intervention are likely to have higher complication rates as a result of poor wound healing, recurrent bacteremia secondary to burn wound manipulation, and sequelae of anticoagulation in patients who require repeated reconstructive and cosmetic procedures. Few case reports exist describing mitral valve replacement for infectious endocarditis in burn patients. In this article, we review the literature to describe and address these challenges, and present what we believe to be the first case of mitral valve repair for infectious endocarditis in a thermally injured patient.

  18. Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country.

    PubMed

    Puri, Vinita; Khare, Nishant A; Chandramouli, M V; Shende, Nilesh; Bharadwaj, Sumit

    2016-01-01

    The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. The patients were divided into two groups of 10 patients each. Group I included those patients who underwent early excision and grafting within 5 days of burn injury. Group II included those patients who were treated conservatively and the residual raw area was grafted 3 weeks or more after sustaining the burn. The two groups were compared for the amount of blood loss, transfusion requirement, graft take, and the total hospital stay. Statistical significance was tested by the application of Mann-Whitney U test. The mean percentage area burn was 29.1 ± 5.6% in group I and 24.7 ± 4.9% in group II. Mean percentage area resurfaced by skin grafting in group I was 9.4 ± 2.3% and 8.1 ± 1.6% in group II. Graft take in group I was 90 ± 7.8%, whereas that in group II was 95 ± 6.7%. Mean blood loss in group I and group II was 346 ± 17.6 ml and 241 ± 14.7 ml respectively. (P = .001). Mean transfusion requirement in the perioperative period was 1.6 pints in group I and 1.1 pints in group II. The mean hospital stay in the patients who underwent early excision and grafting was 15.1 ± 4.1 days, whereas that in the patients who underwent delayed grafting was 36.2 ± 6.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.

  19. Assessment of vitamin and trace element supplementation in severely burned patients undergoing long-term parenteral and enteral nutrition.

    PubMed

    Perro, G; Bourdarias, B; Cutillas, M; Higueret, D; Sanchez, R; Iron, A

    1995-10-01

    The efficacy of an oral supplement of vitamins and trace elements during a longterm artificial parenteral and enteral nutrition was investigated for 3 months in patients with extensive burns. Thirty severely burned patients (22 male, 8 female, age 41 +/- 18 years, range 23-59 years, 33 +/- 12% total body surface area burn, 22% +/- 8 full thickness burn surface area) were included. Every 10 days, from day 10 until day 90, we determined serum levels of: *vitamins B1, B12, A, E, *folic acid, *copper, zinc, iron, *transferrin, albumin, prealbumin, total proteins, *fibronectin, retinol binding protein (RBP), *calcium, *phosphorus, *triglycerides, *total cholesterol, *C reactive protein (CRP), *erythrocyte folic acid. The mean daily nutritional support was 60 Kcals and 0.4 g N per kg of body weight, 70% enterally and 30% parenterally administered, with enteral vitamin and trace element supplementation. On day 10, there was a decrease of the serum level of 19/20 parameters. For 8 parameters (vitamin A, total cholesterol, iron, transferrin, fibronectin, phosphorus, RBP, total proteins), the level was lower than usual. Between day 10 and day 20, a significant normalization of 6 of them was noted, the average levels of transferrin and iron remaining below normal values until day 50. There was a significant decrease in C-reactive protein levels, however above normal limits. No deficiency in vitamins or trace elements was found. Cyclic variations of serum levels occurred which may be more related to volemic, hydroelectrolytic, endocrine and inflammatory disorders than to nutritional problems.

  20. Use of cyanide antidotes in burn patients with suspected inhalation injuries in North America: a cross-sectional survey.

    PubMed

    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.

  1. The Effect of Burn Center Volume on Mortality in a Pediatric Population: An Analysis of the National Burn Repository.

    PubMed

    Hodgman, Erica I; Saeman, Melody R; Subramanian, Madhu; Wolf, Steven E

    2016-01-01

    The effect of burn center volume on mortality has been demonstrated in adults. The authors sought to evaluate whether such a relationship existed in burned children. The National Burn Repository, a voluntary registry sponsored by the American Burn Association, was queried for all data points on patients aged 18 years or less and treated from 2002 to 2011. Facilities were divided into quartiles based on average annual burn volume. Demographics and clinical characteristics were compared across groups, and univariate and multivariate logistic regressions were performed to evaluate relationships between facility volume, patient characteristics, and mortality. The authors analyzed 38,234 patients admitted to 88 unique facilities. Children under age 4 years or with larger burns were more likely to be managed at high-volume and very high-volume centers (57.12 and 53.41%, respectively). Overall mortality was low (0.85%). Comparing mortality across quartiles demonstrated improved unadjusted mortality rates at the low- and high-volume centers compared with the medium-volume and very high-volume centers although univariate logistic regression did not find a significant relationship. However, multivariate analysis identified burn center volume as a significant predictor of decreased mortality after controlling for patient characteristics including age, mechanism of injury, burn size, and presence of inhalation injury. Mortality among pediatric burn patients is low and was primarily related to patient and injury characteristics, such as burn size, inhalation injury, and burn cause. Average annual admission rate had a significant but small effect on mortality when injury characteristics were considered.

  2. The media glorifying burns: a hindrance to burn prevention.

    PubMed

    Greenhalgh, David G; Palmieri, Tina L

    2003-01-01

    The media have a profound influence on the actions of children and adults. Burns and burn prevention tend to be ignored or even mocked. The purpose of this presentation is to reveal the callousness of the media in its dealings with burns and burn prevention. Printed materials with a relationship to burns, risk of burning, or disrespect for the consequences of burns were collected. The materials were tabulated into four categories: comics, advertisements (ads), articles that made light of burns, and television shows that portrayed behavior that would risk burn injury. Most burn-related materials were found in comics or advertisements. Several comics made light of high-risk behavior with flames, scald injury, contact injury, or burns. In addition, several advertisements showed people on fire or actions that could easily lead to burns. Several articles and televisions shows portrayed high-risk behavior that, in some instances, led to copycat injuries. Flames are frequently used to sell items that target adolescent boys or young men. The high incidence injuries that frequent this population parallel the high-risk behaviors portrayed by the media. The media portrays flames and high-risk behavior for burn injury as being cool, funny, and without consequence. The use of flames on clothing and recreational equipment (skateboards, hot rods) particularly targets the high-risk adolescent male. The burn community should make the media aware of the harm it causes with its callous depiction and glorification of burns.

  3. Biomass Burning

    Atmospheric Science Data Center

    2015-07-27

    Projects:  Biomass Burning Definition/Description:  Biomass Burning: This data set represents the geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ...

  4. Burn Institute

    MedlinePlus

    ... Programs - Fire and Burn Prevention - - Fire Safe Kids - - Senior Smoke Alarm Program - - National Scald Campaign - - Community Services - Burn Survivor Support - - Camp Beyond the Scars - - Retreats - - Burn Survivor & Caregiver Support Groups - - Scholarship Program - - Emergency Needs & Special Assistance Fund - - Red ...

  5. Burn Wound Infections

    PubMed Central

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-01-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

  6. Assessment of biochemical markers in the early post-burn period for predicting acute kidney injury and mortality in patients with major burn injury: comparison of serum creatinine, serum cystatin-C, plasma and urine neutrophil gelatinase-associated lipocalin

    PubMed Central

    2014-01-01

    Introduction The reported mortality rates range from 28% to 100% in burn patients who develop acute kidney injury (AKI) and from 50% to 100% among such patients treated with renal replacement therapy. Recently, the serum cystatin C and plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) levels have been introduced as early biomarkers for AKI; the levels of these biomarkers are known to increase 24 to 48 hours before the serum creatinine levels increase. In this study, we aimed to estimate the diagnostic utility of the cystatin C and plasma and urine NGAL levels in the early post-burn period as biomarkers for predicting AKI and mortality in patients with major burn injuries. Methods From May 2011 to July 2012, 90 consecutive patients with a burn wound area comprising ≥ 20% of the total body surface area (TBSA) were enrolled in this study. Whole blood and urine samples were obtained for measuring the serum creatinine, serum cystatin C, and urine and plasma NGAL levels at 0, 3, 6, 12, 24, and 48 hours after admission. Receiver operating characteristic curve, area under the curve, and multivariate logistic regression analyses were performed to assess the predictive values of these biomarkers for AKI and mortality. Results In the multivariate logistic regression analysis, all variables, including age, percentage TBSA burned, sex, inhalation injury, and serum creatinine levels, serum cystatin C levels, and plasma and urine NGAL levels were independently associated with AKI development. Moreover, age, sex, percentage TBSA burned, and plasma and urine NGAL levels were independently associated with mortality. However, inhalation injury and the serum creatinine and cystatin C levels were not independently associated with mortality. Conclusions Massively burned patients who maintained high plasma and urine NGAL levels until 12 hours after admission were at the risk of developing early AKI and early mortality with burn shock. However, the plasma and urine

  7. Exploring Adult Care Experiences and Barriers to Transition in Adult Patients with Sickle Cell Disease

    PubMed Central

    Bemrich-Stolz, CJ; Halanych, JH; Howard, TH; Hilliard, LM; Lebensburger, JD

    2015-01-01

    Background Young adults with sickle cell anemia are at high risk for increased hospitalization and death at the time of transition to adult care. This may be related to failure of the transition system to prepare young adults for the adult healthcare system. This qualitative study was designed to identify factors related to transition that may affect the health of adults with sickle cell anemia. Procedure Ten patients currently treated in an adult hematology clinic participated in semi-structured qualitative interviews to describe their experience transitioning from pediatric to adult care and differences in adult and pediatric healthcare systems. Results Participants were generally unprepared for the adult healthcare system. Negative issues experienced by participants included physician mistrust, difficulty with employers, keeping insurance, and stress in personal relationships. Positive issues experienced by participants included improved self efficacy with improved self care and autonomy. Conclusions In the absence of a formalized transition program, adults with sickle cell anemia experience significant barriers to adult care. In addition to medical history review and identification of an adult provider, transition programs should incorporate strategies to navigate the adult medical system, insurance and relationships as well as encouraging self efficacy. PMID:26900602

  8. [Bacterial parotitis in an immunocompromised patient in adult ICU].

    PubMed

    Vassal, O; Bernet, C; Wallet, F; Friggeri, A; Piriou, V

    2013-09-01

    Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult--particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.

  9. Clinical and Autopsy Diagnoses of Visceral Affections of Patients Who Died Because of Complicated Burns with Multi-organ Failure

    PubMed Central

    Taran, A.; Baciu, N.; Rafulea, V.; German, A.

    2005-01-01

    Summary The anatomicopathological investigations carried out in a total number of 186 cadavers during the last decade were reviewed. In these retrospective studies of necropsy protocols related to different affections of visceral organ systems that evolved asymptomatically, 30.1% involved the neurological system, 36.0% the uropoiesis system, 34.4% the gastrointestinal system, 52.0% the hepatobiliary system, and 39.7% the cardiovascular system, with a prevalence in the pulmonary system of 64.2%. A comparative analysis of the incidence of affections detected in various visceral organs (on the basis of necropsy data in the 186 burn patients) and the incidence of their clinical manifestations showed that in 35% of patients with extensive and deep burns all of these conditions developed asymptomatically and were diagnosed only through autopsy. PMID:21991003

  10. Acute Resuscitation and Transfer Management of Burned and Electrically Injured Patients,

    DTIC Science & Technology

    1994-01-01

    result in organ dysfunction talloid (17). However, no clinical benefit or failure, whereas overzealous admin- with colloid resuscitation was evident...cardiac or renal dysfunction Trauma Quarterly, Vol. 11. No. 2, 1994 RESUSCITATION AND TRANSFER MANAGEMENT 103 is evident, the use of a flow-directed...of full- visable. thickness burns. If such burns occur Pulmonary dysfunction is a major circumferentially around an extremity, morbidity in thermally

  11. Burning mouth syndrome and secondary oral burning.

    PubMed

    Minor, Jacob S; Epstein, Joel B

    2011-02-01

    Burning mouth syndrome is a complex disorder of unclear etiology that is most prevalent in perimenopausal women. It is often accompanied by dysguesia and subjective xerostomia. Recent evidence implicates both central and peripheral neuropathies, possibly representing a phantom pain syndrome in some patients. Ensuring that the patient's oral burning is not secondary to some other local or systemic factor is central to appropriate management. Current standard therapies include clonazepam, paroxetine, and cognitive behavioral therapy, and several promising new alternatives are described.

  12. Physical and psychosocial challenges in adult hemophilia patients with inhibitors

    PubMed Central

    duTreil, Sue

    2014-01-01

    Numerous challenges confront adult hemophilia patients with inhibitors, including difficulty in controlling bleeding episodes, deterioration of joints, arthritic pain, physical disability, emotional turmoil, and social issues. High-intensity treatment regimens often used in the treatment of patients with inhibitors also impose significant scheduling, economic, and emotional demands on patients and their families or primary caregivers. A comprehensive multidisciplinary assessment of the physical, emotional, and social status of adult hemophilia patients with inhibitors is essential for the development of treatment strategies that can be individualized to address the complex needs of these patients. PMID:25093002

  13. Hypocupremia in a major burn.

    PubMed

    Brian, J E; Caldwell, F T; Woody, R C; Bowser-Wallace, B H

    1987-03-01

    Trace element deficiency in burns is an area which apparently has not been investigated. We recently encountered a severely burned patient with profound copper depletion. Neuropsychiatric symptoms and delayed healing may have been secondary to this deficiency. Further study is needed to clearly delineate the role of acquired copper deficiency in recovering burned patients.

  14. Approximate Quantification in Young, Healthy Older Adults', and Alzheimer Patients

    ERIC Educational Resources Information Center

    Gandini, Delphine; Lemaire, Patrick; Michel, Bernard Francois

    2009-01-01

    Forty young adults, 40 healthy older adults, and 39 probable AD patients were asked to estimate small (e.g., 25) and large (e.g., 60) collections of dots in a choice condition and in two no-choice conditions. Participants could choose between benchmark and anchoring strategies on each collection of dots in the choice condition and were required to…

  15. Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

    PubMed

    Dahmardehei, Mostafa; Kazemikhoo, Nooshafarin; Vaghardoost, Reza; Mokmeli, Soheila; Momeni, Mahnoush; Nilforoushzadeh, Mohammad Ali; Ansari, Fereshteh; Amirkhani, Amir

    2016-04-01

    Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.

  16. [The pain from burns].

    PubMed

    Latarjet, J

    2002-03-01

    The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres.

  17. Burn Wound Infection

    DTIC Science & Technology

    1981-09-01

    wound invasion was identified only Nine of 97 patients (9%) with histologic burn wound after septic or cardiogenic shock had been present in invasion...051= ADA12589 Th JouRHAL oP TRAUMA Vol. 21, No. 9 Copyright 0 1981 by The Williams & Wilkins Co. ,r, Prin U.S.A. . Burn Wound Infection WILLIAM F...admitted to a burn center during a 3-year period C had histologically confirmed bacterial or tungal burn wound invasion. Nine of t X Q these 97

  18. Burns Fact Sheet

    MedlinePlus

    ... for fluid resuscitation, wound cleaning, skin replacement, infection control and nutritional support. What is on the horizon for burn research? Improving methods for wound healing and tissue repair offer tremendous opportunities to enhance the quality of life for burn patients and may also ...

  19. The effectiveness of session rating of perceived exertion to monitor resistance training load in acute burns patients.

    PubMed

    Grisbrook, Tiffany L; Gittings, Paul M; Wood, Fiona M; Edgar, Dale W

    2017-02-01

    Session-rating of perceived exertion (RPE) is a method frequently utilised in exercise and sports science to quantify training load of an entire aerobic exercise session. It has also been demonstrated that session-RPE is a valid and reliable method to quantify training load during resistance exercise, in healthy and athletic populations. This study aimed to investigate the effectiveness of session-RPE as a method to quantify exercise intensity during resistance training in patients with acute burns. Twenty burns patients (mean age=31.65 (±10.09) years), with a mean TBSA of 16.4% (range=6-40%) were recruited for this study. Patients were randomly allocated to the resistance training (n=10) or control group (n=10). All patients completed a four week resistance training programme. Training load (session-RPE×session duration), resistance training session-volume and pre-exercise pain were recorded for each exercise session. The influence of; age, gender, %TBSA, exercise group (resistance training vs. control), pre-exercise pain, resistance training history and session-volume on training load were analysed using a multilevel mixed-effects linear regression. Session-volume did not influence training load in the final regression model, however training load was significantly greater in the resistance training group, compared with the control group (p<0.001). Pre-exercise pain significantly influenced training load, where increasing pain was associated with a higher session-RPE (p=0.004). Further research is indicated to determine the exact relationship between pain, resistance training history, exercise intensity and session-RPE and training load before it can be used as a method to monitor and prescribe resistance training load in acute burns patients.

  20. Medical workers' cognition of using 50% nitrous oxide in children with burns: a qualitative study.

    PubMed

    Wang, Hai-Xia; Li, Yu-Xiang; Zhou, Ru-Zhen; Zhao, Ji-Jun

    2015-09-01

    Pain caused by dressing among children with burns is an issue worth discussing. Medical workers' understanding of pain during dressing in children with burns is correlated with the quality of pain management. Effective pain management is significant to improve anxiety and reduce pain and psychological distress during dressing for children with burns. We aimed to investigate medical workers' understanding of current pain management during dressing among children with burns and their attitudes toward the application of 50% nitrous oxide in pain management. Interviews were conducted with seven doctors and nurses from a burn center in East China. Data were collected by in-depth interviews and qualitative description after full transcription of each interview. Three themes were identified: (1) Medical workers felt sympathy for children with burns and believed that a gap existed between the current and expected situation in pain management. In addition, the prescription of analgesics during dressing for children with burns was not favored. (2) Given the fact that 50% nitrous oxide is effective in pain management for adult patients with burns, medical workers tended to apply it to children with burns during dressing after being provided the literature on the use of 50% nitrous oxide in children. (3) Guidelines for the application of 50% nitrous oxide during dressing for children with burns require further modification. Medical workers deemed the pain management for children with burns unsatisfactory, and they supported the application of 50% nitrous oxide during dressing for children with burns. Meanwhile, they hoped that administrators would also support it.

  1. The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: a structural equation modelling analysis.

    PubMed

    He, Fei; Cao, Rong; Feng, Ziqi; Guan, Hao; Peng, Jiaxi

    2013-01-01

    Burn wounds are severely stressful events that can have a significant impact on the mental health of patients. However, the impact of burns on individuals with different personality traits can be different. The present study aimed to investigate the impact of dispositional optimism on the subjective well-being of burn patients, and mainly focused on the confirmation of the mediator role of psychological resilience. 410 burn patients from five general hospitals in Xi'an accomplished the revised Life Orientation Test, Connor-Davidson Resilience Scale, and Subjective Well-Being (SWB) scale. The results revealed that both dispositional optimism and psychological resilience were significantly correlated with SWB. Structural equation modelling indicated that psychological resilience partially mediated the relationship between dispositional optimism and SWB. The current findings extended prior reports and shed some light on how dispositional optimism influenced SWB. Limitations of the study were considered and suggestions for future studies were also discussed.

  2. Intensive care of the adult patient with congenital heart disease.

    PubMed

    Allan, Catherine K

    2011-01-01

    Prevalence of congenital heart disease in the adult population has increased out of proportion to that of the pediatric population as survival has improved, and adult congenital heart disease patients make up a growing percentage of pediatric and adult cardiac intensive care unit admissions. These patients often develop complex multiorgan system disease as a result of long-standing altered cardiac physiology, and many require reoperation during adulthood. Practitioners who care for these patients in the cardiac intensive care unit must have a strong working knowledge of the pathophysiology of complex congenital heart disease, and a full team of specialists must be available to assist in the care of these patients. This chapter will review some of the common multiorgan system effects of long-standing congenital heart disease (eg, renal and hepatic dysfunction, coagulation abnormalities, arrhythmias) as well as some of the unique cardiopulmonary physiology of this patient population.

  3. Burning mouth syndrome.

    PubMed

    Thoppay, Jaisri R; De Rossi, Scott S; Ciarrocca, Katharine N

    2013-07-01

    Burning mouth syndrome (BMS) is a chronic condition that is characterized by burning symptoms of the oral mucosa without obvious clinical examination findings. This syndrome has complex characteristics, but its cause remains largely enigmatic, making treatment and management of patients with BMS difficult. Despite not being accompanied by evident organic changes, BMS can significantly reduce the quality of life for such patients. Therefore, it is incumbent on dental professionals to diagnose and manage patients with BMS as a part of comprehensive care.

  4. Burn disaster response planning: an urban region's approach.

    PubMed

    Yurt, Roger W; Lazar, Eliot J; Leahy, Nicole E; Cagliuso, Nicholas V; Rabbitts, Angela C; Akkapeddi, Vijay; Cooper, Arthur; Dajer, Antonio; Delaney, Jack; Mineo, Frank P; Silber, Steven H; Soloff, Lewis; Magbitang, Kevin; Mozingo, David W

    2008-01-01

    The objective of this study was to describe a draft response plan for the tiered triage, treatment, or transportation of 400 adult and pediatric victims (50/million population) of a burn disaster for the first 3 to 5 days after injury using regional resources. Review of meeting minutes and the 11 deliverables of the draft response plan was performed. The draft burn disaster response plan developed for NYC recommended: 1) City hospitals or regional burn centers within a 60-mile distance be designated as tiered Burn Disaster Receiving Hospitals (BDRH); 2) these hospitals be divided into a four-tier system, based on clinical resources; and 3) burn care supplies be provided to Tier 3 nonburn centers. Existing burn center referral guidelines were modified into a hierarchical BDRH matrix, which would vector certain patients to local or regional burn centers for initial care until capacity is reached; the remainder would be cared for in nonburn center facilities for up to 3 to 5 days until a city, regional, or national burn bed becomes available. Interfacility triage would be coordinated by a central team. Although recommendations for patient transportation, educational initiatives for prehospital and hospital providers, city-wide, interfacility or interagency communication strategies and coordination at the State or Federal levels were outlined, future initiatives will expound on these issues. An incident resulting in critically injured burn victims exceeding the capacity of local and regional burn center beds may be a reality within any community and warrants a planned response. To address this possibility within New York City, an initial draft of a burn disaster response has been created. A scaleable plan using local, state, regional, or federal health care and governmental institutions was developed.

  5. [Experience with percutaneous endoscopic gastrostomy in the nutrition of a patient with 3rd and 4th degree facial burns].

    PubMed

    Halmy, C; Szücs, A; Gyökeres, T; Dékány, K; Mezeine, T I; Kertész, E

    1998-05-17

    Recovery after thermal injury depends in great proportion on nutrition. A major problem is accounted in patients with facial burn, because they can not be nourished per vias naturales. Eliminating disadvantages of parenteral nutrition, but utilizing the advantages of enteral nutrition, we have tried a new method of treatment in a patient whose case is presented. On the second day after injury a percutaneous endoscopic gastrostomy was made. On the 7th day after injury and on the 4th day from the beginning of enteral nutrition complete intake of food and liquid was assured through the percutaneous endoscopic gastrostoma. We had no complication related to the gastrostoma. Nutrition through the percutaneous endoscopic gastrostoma at our patient provided a "natural" route to assure liquid, electrolite and energy balance, prevented atrophy of intestinal mucosa and its metabolic and immunologic complications. With the use of percutaneous endoscopic gastrostoma the possible complications of central line catheter were omitted. Our opinion is that percutaneous endoscopic gastrostomy is a safe and effective method for the clinical nutrition of burned patients.

  6. Adult-onset amenorrhea: a study of 262 patients.

    PubMed

    Reindollar, R H; Novak, M; Tho, S P; McDonough, P G

    1986-09-01

    A series of 262 patients with amenorrhea of adult onset are reported. Hypothalamic suppression followed by inappropriate positive feedback, and then hyperprolactinemia and ovarian failure are the most frequently encountered etiologies. Other etiologies are diverse and numerically less frequent. Amenorrhea after use of oral contraceptives, or postpill amenorrhea, occurred in 77 (29%) of all patients. The average age of presentation, prior menstrual history, associated morbidity, and subsequent reproductive potential of each diagnostic group are reported. Adult-onset amenorrhea has a less significant impact on future wellbeing than was reported for a similar-sized group of patients whose amenorrhea developed as a result of pubertal aberrancy.

  7. Burn Wise

    EPA Pesticide Factsheets

    Burn Wise is a partnership program of the U.S. Environmental Protection Agency that emphasizes the importance of burning the right wood, the right way, in the right appliance to protect your home, health, and the air we breathe.

  8. Activity of Topical Antimicrobial Agents Against Multidrug-Resistant Bacteria Recovered from Burn Patients

    DTIC Science & Technology

    2010-01-01

    both the prophylaxis and treatment of burn wound infections [18]. Agents such as silver sulfadiazine , silver nitrate, mupirocin, honey, mafenide...include emerging resistance of staphylococci to mupirocin and of Pseudomonas aeruginosa to silver sulfadiazine (Table 1) [9,18–21]. Prior studies...administered routinely peri-operatively and various topical antimicrobials are used to include silver sulfadiazine , mafe- nide acetate, silver nitrate

  9. Investigation of Head Burns in Adult Salmonids : Phase 1, Examination of Fish at Lookingglass Hatchery in 1996 : Addendum to Final Report.

    SciTech Connect

    Groberg, Warren J.

    1996-11-01

    This information is an addendum to the report 'Investigation of Head Burns in Adult Salmonids, Phase 1: Examination of Fish at Lower Granite Dam, July 2, 1996' by Ralph Elston because there may be relevant observations included here. The author of this document participated in the examinations at Lower Granite Dam described in that report. Because of Endangered Species Act issues, the Rapid River stock of spring chinook salmon reared at Lookingglass Hatchery on the Grande Ronde River in northeastern Oregon are annually being captured as returning adults at Lower Granite Dam on the Snake River and trucked to Lookingglass. During the peak migration period they are held in an adult holding facility at Lower Granite for as long as 72 hours and then transported by truck to Lookingglass for holding in an adult pond for spawning. In 1996 a total of 572 adults were transported from Lower Granite Dam between May 3 and August 6. Two-hundred eighty-one of these were later transported from Lookingglass to Wallowa Hatchery for artificial spawning and the remaining 291 were held for spawning at Lookingglass. On May 21, 24, 30 and June 2, 1996 hatchery personnel identified a total of 32 off-loaded fish with lesions on the dorsal area of the head they described as having the appearance of blisters (Robert Lund personal communication). By date these are shown in Table 1 (fish with similar lesions were also observed on May 27 but the number of these was not recorded). Such lesions were not observed on fish offloaded on any other dates. On May 24, 1996 hatchery personnel took photographs of fish with these lesions but do to light-meter problems the photographs did not turn out. On June 28, 1996 personnel of the Oregon Department of Fish and Wildlife (ODFW) Fish Pathology laboratory in La Grande were notified by James Lauman, ODFW Northeast Region supervisor, of discussions and concerns of head burn on returning adult chinook while he was on a visitation to Lower Granite Dam. That led

  10. Beach and campfire burns: a site of pleasure and tragedy.

    PubMed

    Fraga, Andrea M A; Fraga, Gustavo P; Noordenbos, John; Tenenhaus, Mayer; Castle, Shanon; Bhavsar, Dhaval; Lee, Jeanne G; Coimbra, Raul; Potenza, Bruce M

    2010-01-01

    Seasonal use of campground bonfires and beach fire pits is a common practice. A sense of fellowship is derived from this experience. Unfortunately, many people are injured by these fires. It was the objective of this study to quantify and better identify those factors that lead to these injuries. A retrospective review of patients injured from a beach or campground, fire pits, or bonfires was conducted using data from a regional burn registry (1999-2007). Patients sustaining burns serious enough to merit admission were included in this study. Demographic information, circumstances surrounding the injury events, size and location of burn, operative procedures, length of stay, and outcomes were analyzed. There were 3083 patients admitted to the burn center of which 241 met criteria for inclusion in this study. Each year, between 12 and 39 patients were injured by this mechanism; 84% were men. Ages fell into two discrete groups; young age (2-9 years) and adults (18-64 years). Alcohol was a contributing factor in 60.6% of adult burns. The areas of burn, by location and rank order include upper extremities (35.3% of patients), thorax/abdomen/buttocks (32.8%), lower extremities (30.7%), and hands (29.5%). The mean TBSA was 6.1% (1-100%). Approximately 80.7% of the patients sustained combination partial- and full-thickness burns whereas, 4.2% were only partial and 5.1% only full-thickness burns; 36.6% of the patients required skin grafting. The mean length of stay was 8.6 days. There were four fatalities including one suicide. Burn injuries from recreational bonfires remain a problem in our community. Beaches were the most common location for these injuries. Universal safeguards to prevent burn injury should be implemented, including designated areas for fires, protective mechanical barriers to keep children and adults from inadvertently walking or falling into the fire pit. Disposal areas for hot coals from fires or charcoal grills must be furnished and usage strictly

  11. How important is hydrotherapy? Effects of dynamic action of hot spring water as a rehabilitative treatment for burn patients in Switzerland.

    PubMed

    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.

  12. Acne in the adult female patient: a practical approach.

    PubMed

    Kamangar, Faranak; Shinkai, Kanade

    2012-10-01

    Acne vulgaris is a common reason why adult women present to dermatologists and can be a clinical challenge to treat. It may also be an important sign of an underlying endocrine disease such as Polycystic Ovary Syndrome (PCOS). Although standard acne therapies can be successfully used to treat acne in adult female patients, hormonal treatment is a safe and effective therapeutic option that may provide an opportunity to better target acne in this population, even when other systemic therapies have failed. In this article, a practical approach to the adult female patient with acne will be reviewed to enhance the dermatologist's ability to use hormonal acne therapies and to better identify and evaluate patients with acne in the setting of a possible endocrine disorder.

  13. Diabetes and burns: retrospective cohort study.

    PubMed

    McCampbell, Beth; Wasif, Nabil; Rabbitts, Angela; Staiano-Coico, Lisa; Yurt, Roger W; Schwartz, Suzanne

    2002-01-01

    infection, line infection, and osteomyelitis, were consistently higher in the diabetic population. Partial graft slough was 6% in diabetics 18 to 65 years with a 3% regraft rate, whereas nondiabetics had a 1% regraft rate. Comparing diabetics with controlled vs uncontrolled glucose levels, diabetics with uncontrolled glucose had higher rates of infection (72 vs 55%; P < or = 0.025), all burn-related procedures (68 vs 45%; P < or = 0.025), and longer ICU stays (24 vs 10 days; P = 0.048). Mortality rate was 2% for diabetics and for nondiabetics. In summary, presence of diabetes in the burn patient was associated with a worse outcome. A predilection for burn injuries in the diabetic was noted in the older adult population. Deeper burns, delayed presentation, higher rates of infection, graft failure and operations, and longer lengths of stay translate into an increased cost to society both economically and in lives. This data would suggest a need for better burn education for diabetics and health care professionals, recognizing the elderly population as a "high-risk" group. We believe that targeted prevention measures and treatment strategies, emphasizing earlier and more aggressive intervention for this population, may have a favorable effect on morbidity and mortality.

  14. Lifetime Increased Risk of Adult Onset Atopic Dermatitis in Adolescent and Adult Patients with Food Allergy

    PubMed Central

    Yu, Hsu-Sheng; Tu, Hung-Pin; Hong, Chien-Hui; Lee, Chih-Hung

    2016-01-01

    Food allergy can result in life-threatening anaphylaxis. Atopic dermatitis (AD) causes intense itching and impaired quality of life. Previous studies have shown that patients with classical early-onset AD tend to develop food allergy and that 10% of adults with food allergies have concomitant AD. However, it is not known whether late-onset food allergy leads to adult-onset AD, a recently recognized disease entity. Using an initial cohort of one-million subjects, this study retrospectively followed-up 2851 patients with food allergy (age > 12 years) for 14 years and compared them with 11,404 matched controls. While 2.8% (81) of the 2851 food allergy patients developed AD, only 2.0% (227) of the 11,404 controls developed AD. Multivariate regression analysis showed that food allergy patients were more likely to develop AD (adjusted hazard ratio = 2.49, p < 0.0001). Controls had a 1.99% risk of developing AD, while food allergy patients had a significantly higher risk (7.18% and 3.46% for patients with ≥3 and <3 food allergy claims, respectively) of developing adult-onset AD. This is the first study to describe the chronological and dose-dependent associations between food allergy in adolescence and the development of adult-onset AD. PMID:28035995

  15. Dreaming during anaesthesia in adult patients.

    PubMed

    Leslie, Kate; Skrzypek, Hannah

    2007-09-01

    Dreaming during anaesthesia is defined as any recalled experience (excluding awareness) that occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Dreaming is a commonly-reported side-effect of anaesthesia. The incidence is higher in patients who are interviewed immediately after anaesthesia (approximately 22%) than in those who are interviewed later (approximately 6%). A minority of dreams, which include sensory perceptions obtained during anaesthesia, provide evidence of near-miss awareness. These patients may have risk factors for awareness and this type of dreaming may be prevented by depth of anaesthesia monitoring. Most dreaming however, occurs in younger, fitter patients, who have high home dream recall, who receive propofol-based anaesthesia and who emerge rapidly from anaesthesia. Their dreams are usually short and pleasant, are related to work, family and recreation, are not related to inadequate anaesthesia and probably occur during recovery. Dreaming is a common, fascinating, usually pleasant and harmless phenomenon.

  16. The immunocompromised adult patient and surgery.

    PubMed

    Littlewood, Keith E

    2008-09-01

    The perioperative management of immunosuppressed patients remains relatively unsophisticated. Rational management involves understanding the normal immune response to injury as modified by the preexisting or imposed abnormalities that immunosuppressed patients manifest on the basis of their disease and/or treatment. Patients with cancer, infected with human immunodeficiency virus, and having had an organ transplant are extreme examples of disordered immunity and it is important to understand the effects of their diseases and treatments. In the future, however, more appropriate management will require anticipation and appreciation of frequent preoperative immunotherapy, a more complete understanding of the immunological response to anesthesia and surgery, the ability to assess immune reserve and stratify risk within the context of that profile, and a better knowledge of the immunological effect of anesthetic agents.

  17. Body Composition in Adult Patients with Thalassemia Major.

    PubMed

    Vlychou, Marianna; Alexiou, Evangelos; Thriskos, Paschalis; Fezoulidis, Ioannis; Vassiou, Katerina

    2016-01-01

    Objective. To assess body composition in adult male and female patients with thalassemia major by dual-energy X-ray absorptiometry (DXA) and to compare the findings with a group of healthy age-matched controls. Methods. Our study group included sixty-two patients (27 males, mean age 36 years, and 35 females, mean age 36.4 years) and fifteen age-matched healthy controls. All patients had an established diagnosis of thalassemia major and followed a regular blood transfusion scheme since childhood and chelation treatment. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy X-ray absorptiometry. Ferritin levels and body mass index of all patients and controls were also recorded. Student t-test and Wilcoxon test were performed and statistical significance was set at p < 0.05. Results. BMD and whole body lean mass are lower in both male and female adult patients compared with controls (p < 0.01 in both groups), whereas whole body fat mass was found to have no statistically significant difference compared to controls. Regional trunk fat around the abdomen was found to be lower in male patients compared to controls (p = 0.02). Conclusion. Severe bone loss and diminished lean mass are expected in adult male and female patients with thalassemia major. Fat changes seem to affect mainly male patients.

  18. Body Composition in Adult Patients with Thalassemia Major

    PubMed Central

    Alexiou, Evangelos; Thriskos, Paschalis; Fezoulidis, Ioannis; Vassiou, Katerina

    2016-01-01

    Objective. To assess body composition in adult male and female patients with thalassemia major by dual-energy X-ray absorptiometry (DXA) and to compare the findings with a group of healthy age-matched controls. Methods. Our study group included sixty-two patients (27 males, mean age 36 years, and 35 females, mean age 36.4 years) and fifteen age-matched healthy controls. All patients had an established diagnosis of thalassemia major and followed a regular blood transfusion scheme since childhood and chelation treatment. Fat, lean, and bone mineral density (BMD) were assessed with dual-energy X-ray absorptiometry. Ferritin levels and body mass index of all patients and controls were also recorded. Student t-test and Wilcoxon test were performed and statistical significance was set at p < 0.05. Results. BMD and whole body lean mass are lower in both male and female adult patients compared with controls (p < 0.01 in both groups), whereas whole body fat mass was found to have no statistically significant difference compared to controls. Regional trunk fat around the abdomen was found to be lower in male patients compared to controls (p = 0.02). Conclusion. Severe bone loss and diminished lean mass are expected in adult male and female patients with thalassemia major. Fat changes seem to affect mainly male patients. PMID:27956899

  19. [Diabetes education in adult diabetic patients].

    PubMed

    Weitgasser, Raimund; Clodi, Martin; Cvach, Sarah; Grafinger, Peter; Lechleitner, Monika; Howorka, Kinga; Ludvik, Bernhard

    2016-04-01

    Diabetes education and self management has gained a critical role in diabetes care. Patient empowerment aims to actively influence the course of the disease by self-monitoring and treatment modification, as well as integration of diabetes in patients' daily life to achieve changes in lifestyle accordingly.Diabetes education has to be made accessible for all patients with the disease. To be able to provide a structured and validated education program adequate personal as well as space, organizational and financial background are required. Besides an increase in knowledge about the disease it has been shown that structured diabetes education is able to improve diabetes outcome measured by parameters like blood glucose, HbA1c, blood pressure and body weight in follow-up evaluations. Modern education programs emphasize the ability of patients to integrate diabetes in everyday life and stress physical activity besides healthy eating as a main component of lifestyle therapy and use interactive methods in order to increase the acceptance of personal responsibility.

  20. Intravenous lipids in adult surgical patients.

    PubMed

    Klek, Stanislaw; Waitzberg, Dan L

    2015-01-01

    Parenteral nutrition is considered an essential element of the perioperative management of surgical patients. It is recommended in patients who require nutritional therapy but in whom the enteral route is contraindicated, not recommended or non-feasible. The new generation of lipid emulsions (LEs) based on olive and fish oils are safe and may improve clinical outcome in surgical patients. The increased provision of n-3 polyunsaturated fatty acids in fish oil-containing LEs seems to be associated with fewer infectious complications and shorter ICU and hospital stays following major abdominal surgery. Increased provision of olive oil in the absence of fish oil may also exert beneficial effects, but a clear conclusion on this is limited due to the low number of available studies. Hence, at the moment, the evidence supports the use of n-3-polyunsaturated fatty acid-enriched LEs as a part of the parenteral nutrition regimen for selected groups of patients, such as those with major surgical trauma or those undergoing extended resections or liver transplantation.

  1. Burning Mouth Syndrome.

    PubMed

    Kamala, K A; Sankethguddad, S; Sujith, S G; Tantradi, Praveena

    2016-01-01

    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.

  2. Burning mouth syndrome.

    PubMed

    Nasri-Heir, Cibele

    2012-01-01

    According to the International Association for the Study of Pain, burning mouth Syndrome (BMS) is defined as a burning pain in the tongue or other oral mucous membrane in the absence of clinical signs or laboratory findings. The etiology is unknown and presents a challenge for both researchers and clinicians. The management of BMS is still not satisfactory. The prognosis is poor and the burning sensation can last for many years causing a dramatic impact on the patient's quality of life. It is important to distinguish between true BMS and symptomatic burning sensation which occurs when the burning sensation is secondary to a local or systemic pathologic condition. Currently, there are no defined diagnostic criteria for BMS. A diagnosis is usually reached by exclusion of other diseases. This may lead to misdiagnoses, presenting an obstacle to successful treatment.

  3. Effect of a combined continuous and intermittent transcutaneous electrical nerve stimulation on pain perception of burn patients evaluated by visual analog scale: a pilot study

    PubMed Central

    Pérez-Ruvalcaba, Irma; Sánchez-Hernández, Viridiana; Mercado-Sesma, Arieh R

    2015-01-01

    Aim The aim of this study was to assess the effect of continuous and intermittent electrical transcutaneous nerve stimulation on the perception of pain in patients with burns of different types. Materials and methods A pilot study was conducted in 14 patients (age 30.9±7.5 years) with second- and third-degree burns of different types. The burn types included electrical, fire/flame, and chemical. All patients received continuous and intermittent electrical transcutaneous nerve stimulation sessions three times per week for 4 weeks. Each session had a duration of 30 minutes. A pair of electrodes were placed around the burn. The primary efficacy endpoint was the perception of pain assessed by a visual analog scale at baseline and at the 30th day. Results A significant reduction of pain perception was reported (8.0±1.7 vs 1.0±0.5; P=0.027) by all patients after electrical stimulation therapy. There were no reports of adverse events during the intervention period. Conclusion Electrical stimulation could be a potential nonpharmacological therapeutic option for pain management in burn patients. PMID:26719723

  4. Epidemiology and virulence of VIM-4 metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from burn patients in eastern Algeria.

    PubMed

    Meradji, Samah; Barguigua, Abouddihaj; Bentakouk, Mohamed Cherif; Nayme, Kaotar; Zerouali, Khalid; Mazouz, Dekhil; Chettibi, Houria; Timinouni, Mohammed

    2016-06-01

    In this study, we investigated the prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in burn patients from eastern Algeria, CRPA virulence factors and the molecular epidemiology of CRPA. The overall prevalence of CRPA was 48.38%. Seven (46.66%) isolates were metallo-β-lactamases (MBL) producers and contained the MBL genes blaVIM-4 (n=6) and blaVIM-2 (n=1). Risk factors for CRPA infection were urinary catheter use and intubation (p=0.008). A high percentage of virulence factors (86.6% of these isolates were able to produce protease; 73.3% of isolates has DNase; and 66.6% were haemolysin positive) was observed in CRPA isolates. Among the seven MBL-producing isolates, four had the same clonal profile. The class 1 integrons, which contained the aadA7 gene cassette, were detected in six isolates. The 16SrRNA methylase gene, rmtB, was detected in one strain. All CRPA isolates were biofilm formers. A study on the kinetics of biofilm production revealed that biofilm production increased when the concentration of imipenem or ciprofloxacin and the incubation time increased. This is the first study to report the presence of VIM-4-producing P. aeruginosa from North Africa and also of the high prevalence of CRPA isolates. Based on our study of burn unit patients, the high percentage of P. aeruginosa with virulence factors and multi-drug resistance is alarming.

  5. Clinical profile of patients with adult-onset eosinophilic asthma

    PubMed Central

    Storm, Huib; Amelink, Marijke; de Nijs, Selma B.; Eichhorn, Edwin; Reitsma, Bennie H.; Bel, Elisabeth H.D.; ten Brinke, Anneke

    2016-01-01

    Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma. 130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×109 L−1) were compared with 361 adult-onset asthma patients with low (<0.3×109 L−1) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters. Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had higher levels of total IgE without more sensitisation to common inhaled allergens. In addition, these patients had worse lung function, and more often showed fixed airflow limitation, air trapping, nasal polyposis and abnormalities on sinus computed tomography scanning. Chronic rhinosinusitis, air trapping and male sex were three independent factors associated with blood eosinophilia (adjusted OR 3.8 (95% CI 1.7–8.1), 3.0 (95% CI 1.1–8.1) and 2.4 (95% CI 1.3–4.4), respectively). Patients with adult-onset asthma with elevated blood eosinophils exhibit a distinct profile, which can readily be recognised in clinical practice. PMID:27730197

  6. Clinical profile of patients with adult-onset eosinophilic asthma.

    PubMed

    de Groot, Jantina C; Storm, Huib; Amelink, Marijke; de Nijs, Selma B; Eichhorn, Edwin; Reitsma, Bennie H; Bel, Elisabeth H D; Ten Brinke, Anneke

    2016-04-01

    Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma. 130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×10(9) L(-1)) were compared with 361 adult-onset asthma patients with low (<0.3×10(9) L(-1)) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters. Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had higher levels of total IgE without more sensitisation to common inhaled allergens. In addition, these patients had worse lung function, and more often showed fixed airflow limitation, air trapping, nasal polyposis and abnormalities on sinus computed tomography scanning. Chronic rhinosinusitis, air trapping and male sex were three independent factors associated with blood eosinophilia (adjusted OR 3.8 (95% CI 1.7-8.1), 3.0 (95% CI 1.1-8.1) and 2.4 (95% CI 1.3-4.4), respectively). Patients with adult-onset asthma with elevated blood eosinophils exhibit a distinct profile, which can readily be recognised in clinical practice.

  7. Burn sepsis and burn toxin

    PubMed Central

    Allgöwer, Martin; Städtler, Karl; Schoenenberger, Guido A

    1974-01-01

    The salient steps of a 20-year programme of research into the nature of burn disease are described. By burn disease we mean the late mortality and morbidity following burns. We have isolated a burn toxin which is derived from a thermal polymerization of cell membrane lipoproteins within the dermis and have studied its influence on the effects of sepsis. We have also used it in the development of active and passive immunization therapy of severe burns. ImagesFig. 2Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:4429330

  8. Movement disorders in adult patients with classical galactosemia.

    PubMed

    Rubio-Agusti, Ignacio; Carecchio, Miryam; Bhatia, Kailash P; Kojovic, Maja; Parees, Isabel; Chandrashekar, Hoskote S; Footitt, Emma J; Burke, Derek; Edwards, Mark J; Lachmann, Robin H L; Murphy, Elaine

    2013-06-01

    Classical galactosemia is an autosomal recessive inborn error of metabolism leading to toxic accumulation of galactose and derived metabolites. It presents with acute systemic complications in the newborn. Galactose restriction resolves these symptoms, but long-term complications, such as premature ovarian failure and neurological problems including motor dysfunction, may occur despite adequate treatment. The objective of the current study was to determine the frequency and phenotype of motor problems in adult patients with classical galactosemia. In this cross-sectional study, adult patients with a biochemically confirmed diagnosis of galactosemia attending our clinic were assessed with an interview and neurological examination and their notes retrospectively reviewed. Patients were classified according to the presence/absence of motor dysfunction on examination. Patients with motor dysfunction were further categorized according to the presence/absence of reported motor symptoms. Forty-seven patients were included. Thirty-one patients showed evidence of motor dysfunction including: tremor (23 patients), dystonia (23 patients), cerebellar signs (6 patients), and pyramidal signs (4 patients). Tremor and dystonia were often combined (16 patients). Thirteen patients reported motor symptoms, with 8 describing progressive worsening. Symptomatic treatment was effective in 4 of 5 patients. Nonmotor neurological features (cognitive, psychiatric, and speech disorders) and premature ovarian failure were more frequent in patients with motor dysfunction. Motor dysfunction is a common complication of classical galactosemia, with tremor and dystonia the most frequent findings. Up to one third of patients report motor symptoms and may benefit from appropriate treatment. Progressive worsening is not uncommon and may suggest ongoing brain damage in a subset of patients.

  9. Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients.

    PubMed

    Moon, Suk-Ho; Lee, So-Young; Jung, Sung-No; Kim, Sang-Wha; Seo, Bommie F; Kwon, Ho; Sohn, Won-Il

    2011-06-01

    Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture. 19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS). The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site. The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.

  10. Nutritional profile of adult patients with celiac disease.

    PubMed

    Abenavoli, L; Delibasic, M; Peta, V; Turkulov, V; De Lorenzo, A; Medić-Stojanoska, M

    2015-11-01

    Celiac disease (CD) is a chronic immune-mediated gluten dependent enteropathy induced by ingestion of gluten, characterized by intestinal malabsorption and subtotals or total atrophy of intestinal villi. The predominant consequence of CD in untreated patients, is malnutrition as a result of malabsorption. Moreover, several and increasing extra-intestinal clinical manifestations have been described in the CD patients. Strict adherence to a gluten-free diet (GFD) improves nutritional status, inducing an increase in fat and bone compartments, but does not completely normalize body composition and nutritional deficiencies. An early and accurate evaluation of nutritional status can be of the pivotal step in the clinical management of the adult CD patients. The aim of this review is to present the most important and recent data on nutritional and metabolic features in the CD adult patients, the related implications and the effects of the GFD on these conditions.

  11. Rhabdomyosarcoma in adolescent and young adult patients: current perspectives

    PubMed Central

    Egas-Bejar, Daniela; Huh, Winston W

    2014-01-01

    Rhabdomyosarcoma (RMS), a malignant tumor of mesenchymal origin, is the third most common extracranial malignant solid tumor in children and adolescents. However, in adults, RMS represents <1% of all solid tumor malignancies. The embryonal and alveolar histologic variants are more commonly seen in pediatric patients, while the pleomorphic variant is rare in children and seen more often in adults. Advances in the research of the embryonal and alveolar variants have improved our understanding of certain genes and biologic pathways that are involved in RMS, but much less is known for the other variants. Multimodality therapy that includes surgery and chemotherapy with or without radiation therapy is the mainstay of treatment for RMS. Improvements in the risk stratification of the pediatric patients based on presurgical (primary tumor site, tumor size, regional lymph node involvement, presence of metastasis) and postsurgical parameters (completeness of resection or presence of residual disease or metastasis) has allowed for the treatment assignment of patients in different studies and therapeutic trials, leading to increases in 5-year survival from 25%–70% over the past 40 years. However, for adult patients, in great part due to rarity of the disease and the lack of consensus on optimal treatment, clinical outcome is still poor. Many factors have been implicated for the differing outcomes between pediatric RMS versus adult RMS, such as the lack of standardized treatment protocols for adult RMS patients and the increased prevalence of advanced presentations. Now that there are increased numbers of survivors, we can appreciate the sequelae from therapy in these patients, such as bone growth abnormalities, endocrinopathies, and infertility. Improvements in risk stratification have led to clinical trials using lower doses of chemotherapy or radiation therapy with the intention of decreasing the incidence of side effects without compromising survival outcome. PMID

  12. Effect of oral olive oil on healing of 10-20% total body surface area burn wounds in hospitalized patients.

    PubMed

    Najmi, Mahtab; Vahdat Shariatpanahi, Zahra; Tolouei, Mohammad; Amiri, Zohreh

    2015-05-01

    The purpose of this study was to evaluate the effect of consumption of oral olive oil on clinical outcomes and wound healing of thermally injured patients with hospital stays. One hundred patients (mean age; 33.34±7 years) with 10-20% total body surface area, deep second degree and more burn wounds were randomized to receive either oral olive oil or sunflower oil as the oil in their diet. Patients were evaluated daily for occurrence of wound infection, sepsis and healing of the grafted skin. Also the duration of hospitalization and admission to the intensive care unit were compared in two groups. Results showed that there was no significant difference between the olive oil group and the control group in percent of TBSA involvement (14.28±0.53 vs. 13.02±0.48, P=0.7), albumin concentration (3.25±0.5 vs. 3.13±0.5, P=0.5) and mean calorie intake (2034±216.9 kcal vs2118±192.1 kcal, P=0.2). We found a significant difference in the duration of wound healing (7.2±0.5 vs. 8.7±0.5, P=0.04) and duration of hospitalization (7.4±0.5 vs. 8.9±0.4, P=0.05) in the olive oil group versus the control group. We did not find any difference in ICU admission, wound infection and occurrence of sepsis between two groups. This study showed that an oral diet provided with olive oil in patients with burn may accelerate wound healing and decrease the duration of hospitalization.

  13. A Future for Adult Educators in Patient Education

    ERIC Educational Resources Information Center

    Fleming, Jean E.

    2014-01-01

    Adult education in healthcare comes in several forms: degree and certificate programs aimed at preparing better academic and clinical educators; and community education programs aimed at wellness, rehabilitation, or learning to live with chronic diseases. Patient-centered healthcare, however, is part of something new: coordinated and transitional…

  14. Improvement with Duloxetine in an Adult ADHD Patient

    ERIC Educational Resources Information Center

    Tourjman, Smadar Valerie; Bilodeau, Mathieu

    2009-01-01

    Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common and disabling disorder among adults and is treated with stimulant and non stimulant medication. Objective: To report the case of a patient with ADHD showing good clinical response to duloxetine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Case…

  15. Patient-specific FDG dosimetry for adult males, adult females, and very low birth weight infants

    NASA Astrophysics Data System (ADS)

    Niven, Erin

    Fluorodeoxyglucose is the most commonly used radiopharmaceutical in Positron Emission Tomography, with applications in neurology, cardiology, and oncology. Despite its routine use worldwide, the radiation absorbed dose estimates from FDG have been based primarily on data obtained from two dogs studied in 1977 and 11 adults (most likely males) studied in 1982. In addition, the dose estimates calculated for FDG have been centered on the adult male, with little or no mention of variations in the dose estimates due to sex, age, height, weight, nationality, diet, or pathological condition. Through an extensive investigation into the Medical Internal Radiation Dose schema for calculating absorbed doses, I have developed a simple patient-specific equation; this equation incorporates the parameters necessary for alterations to the mathematical values of the human model to produce an estimate more representative of the individual under consideration. I have used this method to determine the range of absorbed doses to FDG from the collection of a large quantity of biological data obtained in adult males, adult females, and very low birth weight infants. Therefore, a more accurate quantification of the dose to humans from FDG has been completed. My results show that per unit administered activity, the absorbed dose from FDG is higher for infants compared to adults, and the dose for adult women is higher than for adult men. Given an injected activity of approximately 3.7 MBq kg-1, the doses for adult men, adult women, and full-term newborns would be on the order of 5.5, 7.1, and 2.8 mSv, respectively. These absorbed doses are comparable to the doses received from other nuclear medicine procedures.

  16. Neuropsychological profile of adult patients with nonsymptomatic occipital lobe epilepsies.

    PubMed

    Bilo, Leonilda; Santangelo, Gabriella; Improta, Ilaria; Vitale, Carmine; Meo, Roberta; Trojano, Luigi

    2013-02-01

    To explore the neuropsychological and neurobehavioral profile in adult patients affected by nonsymptomatic (cryptogenic and idiopathic) occipital lobe epilepsy (OLE), with normal intelligence, we enrolled 20 adult patients with nonsymptomatic OLE and 20 age-, sex-, and education-matched healthy subjects. All participants underwent neuropsychiatric assessment scales, and standardized neuropsychological tests tapping memory, executive functions, constructional, visuospatial and visuoperceptual skills. After Bonferroni correction for multiple comparisons, patients performed significantly worse than controls on several tests tapping complex visuospatial skills and frontal lobe functions. The analysis of single patients' performance revealed that a significantly higher number of OLE patients achieved age- and education-adjusted pathological scores on three tests (Benton Judgment of Line Orientation Test, Freehand Copying of Drawings Test, color-word interference task of Stroop test) with respect to controls. Patients did not differ from control subjects on neuropsychiatric aspects. The direct comparison between OLE subtypes showed that cryptogenetic OLE patients tended to achieve lower scores than idiopathic OLE patients on most tests, but no difference between the two groups was fully significant. In summary, patients with nonsymptomatic OLE can be affected by clinically relevant impairments in selected neuropsychological domains: complex visuospatial skills and executive functions. It could be speculated that frontal and visuospatial cognitive deficits might be the result of epileptic activity spreading within a neural network that includes structures far beyond the occipital lobe.

  17. Food hypersensitivity among adult patients: epidemiological and clinical aspects.

    PubMed

    Castillo, R; Delgado, J; Quiralte, J; Blanco, C; Carrillo, T

    1996-01-01

    Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

  18. Cerebral activation during thermal stimulation of patients who have burning mouth disorder: an fMRI study.

    PubMed

    Albuquerque, Romulo J C; de Leeuw, Reny; Carlson, Charles R; Okeson, Jeffrey P; Miller, Craig S; Andersen, Anders H

    2006-06-01

    The pathophysiology of burning mouth disorder (BMD) is not clearly understood, but central neuropathic mechanisms are thought to be involved. The aim of this study was to gain insight into the pathophysiology associated with BMD by using functional magnetic resonance imaging (fMRI). Areas of brain activation following thermal stimulation of the trigeminal nerve of eight female patients with BMD (mean age 49.1+/-10.1) were mapped using fMRI and compared with those of eight matched pain-free volunteers (mean age 50.3+/-12.3). Qualitative and quantitative differences in brain activation patterns between the two study groups were demonstrated. BMD patients displayed greater fractional signal changes in the right anterior cingulate cortex (BA 32/24) and bilateral precuneus than did controls (p<0.005). The control group showed larger fractional signal changes in the bilateral thalamus, right middle frontal gyrus, right pre-central gyrus, left lingual gyrus, and cerebellum than did the BMD patients (p<0.005). In addition, BMD patients had less volumetric activation throughout the entire brain compared to the control group. Overall, BMD patients displayed brain activation patterns similar to those of patients with other neuropathic pain conditions and appear to process thermal painful stimulation to the trigeminal nerve qualitatively and quantitatively different than pain-free individuals. These findings suggest that brain hypoactivity may be an important feature in the pathophysiology of BMD.

  19. [Diagnosis and therapy of adult patients with facial asymmetry].

    PubMed

    Takano-Yamamoto, Teruko; Kuroda, Shingo

    2009-09-01

    The goal of orthodontic treatment is to improve the patient's life by enhancing dental and jaw functions and dentofacial esthetics [Graber TM, et al., Orthodontics current principles and techniques. 4(e) ed. St Louis: Elsevier, 2005.]. Harmonious occlusion is achieved following improvements of malocclusion via orthodontic treatment [Ehmer U and Broll P, Int J Adult Orthod Orthognath Surg 1992;7:153-159. Throckmorton GS, et al., J Prosthet Dent 1984;51:252-261.]. Perfect facial symmetry is extremely rare, and normal faces have a degree of asymmetry. Patients with dentofacial deformity more frequently have asymmetry of the face and jaws. There was a relationship between the type of malocclusion and the prevalence of asymmetry; 28% of the Class III group, but 40% to 42% of the Class I, Class II and long face groups respectively, were asymmetric [Severt TR and Proffit WR, Int J Adult Orthod Orthogn Surg 1997;12:171-176.]; therefore, facial asymmetry is a common complaint among orthodontic patients. Treatment of severe facial asymmetry in adults consists mainly of surgically repositioning the maxilla or the mandible [Bardinet E, et al., Orthod Fr 2002;73:243-315. Guyuron B, Clin Plast Surg 1989;16:795-801. Proffit WR, et al., Contemporary treatment of dentofacial deformity. 2003. St Louis: Mosby, 2003:574-644.], however, new methods, i.e. orthodontic tooth movement with implant anchorage, have recently been introduced [Costa A, et al., Int J Adult Orthod Orthognath Surg 1998;3:201-209. Creekmore TD and Eklund MK, J Clin Orthod 1983;17:266-269. Miyawaki S,et al., Am J Orthod Dentofacial Orthop 2003;124:373-378. Park HS, et al., J Clin Orthod 2001;35:417-422. Roberts WE, et al., Angle Orthod 1989;59:247-256.], and various treatment options can be chosen in patients with facial asymmetry. In this article, we describe the diagnosis and treatment of adult patients with facial asymmetry.

  20. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

    PubMed Central

    Agbenorku, Pius

    2013-01-01

    Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains. PMID

  1. Pneumococci Can Persistently Colonize Adult Patients with Chronic Respiratory Disease

    PubMed Central

    Domenech, A.; Balsalobre, L.; Marti, S.; Calatayud, L.; De la Campa, A. G.; Brueggemann, A. B.; Liñares, J.

    2012-01-01

    Streptococcus pneumoniae plays an important role in causing acute exacerbations in patients with chronic respiratory disease. However, few data are available regarding pneumococcal persistence in adult patients with chronic respiratory diseases. Fifty pneumococci recovered from sputum samples (1995 to 2010) from 13 adult patients with ≥3 episodes of acute exacerbation or pneumonia, with the same serotype and pulsed-field gel electrophoresis (PFGE) pattern, were studied. Multilocus sequence typing (MLST) loci, penicillin-binding protein (PBP) genes (pbp2x, pbp1a, pbp2b), and the quinolone-resistant determining regions (QRDRs) of parC, parE, and gyrA were PCR amplified and sequenced. The average time between the first and last episode was 582 days (standard deviation [SD], ±362). All but two patients received multiple courses of β-lactam treatment, and all persistent strains were resistant to penicillin; however, the PBP sequences were stable over time apart from one variable nucleotide in pbp2x, observed among pneumococci isolated from three patients. In contrast, 7/11 patients treated with fluoroquinolones had fluoroquinolone-resistant pneumococci. In three patients, the initially fluoroquinolone-susceptible strain developed resistance after fluoroquinolone therapy, and in the remaining four patients, the persistent strain was fluoroquinolone resistant from the first episode. QRDR changes involved in fluoroquinolone resistance were frequently observed in persistent strains after fluoroquinolone treatment; however, the PBP sequences and MLST genotypes of these strains were stable over time. PMID:23052300

  2. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    PubMed

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  3. Burn patients' return to daily activities and participation as defined by the International Classification of Functioning, Disability and Health: A systematic review.

    PubMed

    Osborne, Candice L; Meyer, Walter J; Ottenbacher, Kenneth J; Arcari, Christine M

    2016-12-29

    The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a universal classification system of health and health-related domains. The ICF has been successfully applied to a wide range of health conditions and diseases; however, its application in the field of burn recovery has been minimal. This systematic review uses the domains of the ICF component 'activities and participation' to explore: (1) the extent to which return to daily activities and community participation after burn has been examined in the pediatric population, (2) the most common assessments used to determine activity and participation outcomes, and (3) what activity and participation areas are most affected in the pediatric burn population after discharge from acute care. Results determined that it is difficult to draw overarching conclusions in the area of return to 'activities and participation' for children with burn based on the paucity of current evidence. Of the studies conducted, few examined the same subtopics or used similar measurements. This suggests a need for more robust studies in this area in order to inform and improve burn rehabilitation practices to meet the potential needs of burn patients beyond an acute care setting.

  4. Amelogenesis imperfecta - lifelong management. Restorative management of the adult patient.

    PubMed

    Patel, M; McDonnell, S T; Iram, S; Chan, M F W-Y

    2013-11-08

    The biggest challenge restorative dentists face in rehabilitating patients with amelogenesis imperfecta (AI) is trying to restore aesthetics, function and occlusal stability while keeping the treatment as conservative as possible. The goals of treatment should be to prolong the life of the patient's own teeth and avoid or delay the need for extractions and subsequent replacement with conventional fixed, removable or implant retained prostheses. In order to achieve these goals a stepwise approach to treatment planning is required starting with the most conservative but aesthetically acceptable treatment. This article discusses the management of AI and presents the various treatment options available for restoring the adult patient who presents to the dentist with AI.

  5. Optimal serum phenylalanine for adult patients with phenylketonuria.

    PubMed

    Okano, Yoshiyuki; Nagasaka, Hironori

    2013-12-01

    High serum phenylalanine in adult patients with phenylketonuria (PKU) causes neuropsychological and psychosocial problems that can be resolved by phenylalanine-restricted diet. Therefore, PKU patients must continue to adhere to phenylalanine-restricted diet for life, although the optimal serum phenylalanine level in later life has yet to be established. The purpose of this review was to establish the optimal serum phenylalanine level in later life of PKU patients. We evaluated oxidative stress status, nitric oxide metabolism, cholesterol-derived oxysterols, vitamin D and bone status, and magnetic resonance imaging (MRI) in adult PKU patients according to serum phenylalanine level. Oxidative stress increased markedly at serum phenylalanine of 700-800 μmol/L. Serum phenylalanine higher than 700-850 μmol/L correlated with the disturbance of nitric oxide regulatory system. Adult PKU patients had poor vitamin D status and exhibited predominance of bone resorption over bone formation. In the brain, the levels of 24S-hydroxycholesterol, a marker of brain cholesterol elimination, were low at serum phenylalanine levels exceeding 650 μmol/L. MRI studies showed high signal intensity in deep white matter on T2-weighted and FLAIR images of PKU patients with serum phenylalanine greater than 500 μmol/L, with decreased apparent diffusion coefficients. Changes in most parameters covering the entire body organs in adult PKU were almost acceptable below 700-800 μmol/L of phenylalanine level. However, the optimal serum phenylalanine level should be 500 μmol/L or less in later life for the brain to be safe.

  6. Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes

    PubMed Central

    Albeyoglu, Sebnem; Aldag, Mustafa; Ciloglu, Ufuk; Sargin, Murat; Oz, Tugba Kemaloglu; Kutlu, Hakan; Dagsali, Sabri

    2017-01-01

    Objective The aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes. Methods Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted. Results A total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation. Conclusion The decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.

  7. Burn Teams and Burn Centers: The Importance of a Comprehensive Team Approach to Burn Care

    PubMed Central

    Al-Mousawi, Ahmed M.; Mecott-Rivera, Gabriel A.; Jeschke, Marc G.; Herndon, David N.

    2009-01-01

    Synopsis Advances in burn care have been colossal, but while extra work is needed, it is clear that the organized effort of burn teams can continue making improvements in survival rates and quality of life possible for patients. Burn patients are unique, representing the most severe model of trauma,33 and hence this necessitates treatment in the best facilities available for that endeavor. Burn centers have developed to meet these intricate needs but can only function productively and most efficiently through well organized, multifaceted, patient-centered teams in areas of clinical care and research. PMID:19793550

  8. Use of a pediatric oxygenator integrated in a veno-venous hemofiltration circuit to remove CO2: a case report in a severe burn patient with refractory hypercapnia.

    PubMed

    Rousseau, Anne-Françoise; Damas, Pierre; Renwart, Ludovic; Amand, Théo; Erpicum, Marie; Morimont, Philippe; Dubois, Bernard; Massion, Paul B

    2014-11-01

    Acute respiratory distress syndrome management is currently based on lung protective ventilation. Such strategy may lead to hypercapnic acidosis. We report a case of refractory hypercapnia in a severe burn adult, treated with simplified veno-venous extracorporeal carbon dioxide removal technique. We integrated a pediatric oxygenator in a continuous veno-venous hemofiltration circuit. This technique, used during at least 96h, was feasible, sure and efficient with carbon dioxide removal rate up to 32%.

  9. 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

    PubMed Central

    Bikmoradi, Ali; Harorani, Mehdi; Roshanaei, Ghodratollah; Moradkhani, Shirin; Falahinia, Golam Hossein

    2016-01-01

    Background: 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. Materials and Methods: 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. Results: There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05). 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. PMID:27186201

  10. A Prospective Multi-Center Audit of Nutrition Support Parameters Following Burn Injury.

    PubMed

    Kurmis, Rochelle; Heath, Kathryn; Ooi, Selena; Munn, Zachary; Forbes, Sharon; Young, Vicki; Rigby, Paul; Wood, Kate; Phillips, Frances; Greenwood, John

    2015-01-01

    The importance of nutrition support delivery to the severe burn-injured patient is well recognized, however, nutrition provision to the patient may be sub optimal in practice. The aim of this study was to conduct a prospective multi-center audit across Australia and New Zealand using the Joanna Briggs Institute Burns Node Nutrition audit criteria. Thirty-four patients with severe burn injury (≥20% TBSA in adults and ≥10% TBSA in children) were identified on admission or on referral to the Dietitian at the eight participating Burn Units between February 1, 2012 and April 30, 2012 for inclusion in the study. De-identified patient data was analyzed using the Joanna Briggs Institute, Practical Application of Clinical Evidence System. Compliance with individual audit criterion ranged from 33 to 100%. Provision of prescribed enteral feed volumes and weekly weighing of patients were highlighted as key areas for clinical improvement. Clinical audit is a valuable tool for evaluating current practice against best evidence to ensure that quality patient care is delivered. The use of the Joanna Briggs Institute Burns Node audit criteria has allowed for a standardized multi-center audit to be conducted. Improving nutrition support delivery in burn patients was identified as a key area requiring ongoing clinical improvement across Australia and New Zealand. Clinician feedback on use of the audit criteria will allow for future refinement of individual criterion, and presentation of results of this audit has resulted in a review of the Bi-National Burns Registry nutrition quality indicators.

  11. Unique medical issues in adult patients with mucopolysaccharidoses.

    PubMed

    Mitchell, John; Berger, Kenneth I; Borgo, Andrea; Braunlin, Elizabeth A; Burton, Barbara K; Ghotme, Kemel A; Kircher, Susanne G; Molter, David; Orchard, Paul J; Palmer, James; Pastores, Gregory M; Rapoport, David M; Wang, Raymond Y; White, Klane

    2016-10-01

    The mucopolysaccharidoses are a group of inherited metabolic diseases caused by deficiencies in enzymes involved in the sequential degradation of glycosaminoglycans (GAGs) leading to substrate accumulation in various tissues and organs. GAG accumulation can cause growth retardation and progressive damage to respiratory, cardiovascular, musculoskeletal, nervous, gastrointestinal, auditory, and visual systems. In the past, few people with severe phenotypic mucopolysaccharidosis (MPS) reached adulthood. However, better methods for diagnosis, multi-disciplinary care, and new therapies have extended lifespan, leading to an increasing number of patients surviving beyond childhood. The growing number of adult MPS patients poses significant challenges for clinicians who may not be familiar with the clinical manifestations of MPS. In addition, as new interventions have changed the natural history of these disorders, it is difficult to anticipate both the impact on life expectancy and other complications that may occur as these patients age. Because the MPS disorders are multi-organ diseases, their management requires a coordinated multi-disciplinary approach. Here we discuss the unique pattern of medical issues and multi-organ involvement in adult patients with MPS and identify the challenges that are associated with management of MPS. This review is based on information from an expert investigator meeting with MPS specialists held October 2-4, 2014 in Dublin, Ireland, as well as on current literature searches focusing on MPS and adults.

  12. Effect of gamma-hydroxybutyrate on keratinocytes proliferation: A preliminary prospective controlled study in severe burn patients

    PubMed Central

    Rousseau, Anne-Françoise; Bargues, Laurent; Bever, Hervé Le; Vest, Philippe; Cavalier, Etienne; Ledoux, Didier; Piérard, Gérald E.; Damas, Pierre

    2014-01-01

    Background: Hypermetabolism and hyposomatotropism related to severe burns lead to impaired wound healing. Growth hormone (GH) boosts wound healing notably following stimulation of the production of insulin-like growth factor-1 (IGF1), a mitogen factor for keratinocytes. Gamma-hydroxybutyrate (GHB) stimulates endogenous GH secretion. Aim: To assess effects of GHB sedation on keratinocytes proliferation (based on immunohistochemical techniques). Design: Monocentric, prospective, controlled trial. Materials and Methods: Patients (aging 18-65 years, burn surface area >30%, expected to be sedated for at least one month) were alternately allocated, at the 5th day following injury, in three groups according to the intravenous GHB dose administered for 21 days: Evening bolus of 50 mg/kg (Group B), continuous infusion at the rate of 10 mg/kg/h (Group C), or absence of GHB (Group P). They all received local standard cares. Immunohistochemistry (Ki67/MIB-1, Ulex europaeus agglutinin-1 and Mac 387 antibodies) was performed at D21 on adjacent unburned skin sample for assessing any keratinocyte activation. Serum IGF1 levels were measured at initiation and completion of the protocol. Statistical Analysis: Categorical variables were compared with Chi-square test. Comparisons of medians were made using Kruskal-Wallis test. Post hoc analyses were performed using Mann-Whitney test with Bonferroni correction for multiple comparisons. A P < 0.05 was considered to be statistically significant. Results: A total of 14 patients completed the study (Group B: n = 5, Group C: n = 5, Group P: n = 4). Continuous administration of GHB was associated with a significant higher Ki67 immunolabeling at D21 (P = 0.049) and with a significant higher increase in the IGF1 concentrations at D21 (P = 0.024). No adverse effects were disclosed. Conclusions: Our preliminary data support a positive effect of GHB on keratinocyte proliferation and are encouraging enough to warrant large prospective studies. PMID

  13. Neuropsychological Assessment of Adult Patients with Shunted Hydrocephalus

    PubMed Central

    Bakar, Emel Erdogan

    2010-01-01

    Objective This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. Methods The research group contained healthy adults (control group, n : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Results Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. Conclusion This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life. PMID:20379471

  14. Ebstein's anomaly in adult patients over 50 years of age.

    PubMed

    Aoyagi, Shigeaki; Yoshitake, Kiyonobu; Matsuo, Atsutoshi; Tayama, Kei-Ichiro; Hida, Satoru; Mito, Takahiro

    2014-01-01

    Ebstein's anomaly (EA) is a rare congenital heart disease of the tricuspid valve, and less than 5% of patients with EA survive beyond the age of 50. We report two unoperated cases of EA in adult patients aged over 50 years. Two patients, a 70-year-old Japanese woman and a 59-year-old Chinese woman, were referred to us for tachyarrhythmias. Transthoracic echocardiography demonstrated apical displacement (>8 mm/m(2) body surface area) of the septal leaflet of the tricuspid valve from the atrioventricular ring with tricuspid regurgitation in both patients. The former suddenly expired 20 months later after suffering from repetitive supraventricular tachyarrhythmias and/or heart failure, and the latter is alive with minimal signs of heart failure 12 months after the diagnosis of EA. Although the natural history of EA is extremely variable, these two patients are exceptional in that they tolerated EA well for over 50 years without any surgical intervention.

  15. Reconstruction of the pediatric burned hand.

    PubMed

    McCauley, Robert L

    2009-11-01

    Though the hand constitutes only 3% of the total body surface area, a burned hand is a major injury. Reconstruction of the burned hand is key to the overall rehabilitation of the burned patient. Whether an isolated injury, or part of burns to a large overall body surface area, loss of the hand represents a major functional impairment. The American Burn Association recognizes the importance of the burned hand by designating it a major injury. In addition, loss of the hand constitutes a 57% loss of function for the whole person. Thus, successful management of the burned hand is important.

  16. Infective Dermatitis in an Adult Patient With HTLV-1

    PubMed Central

    Riveros, Rosalba; Medina, Raquel; Morel, Maida

    2015-01-01

    Abstract: Infective dermatitis is a chronic exudative eczematous eruption presenting in human T-lymphotropic virus type 1 (HTLV-1)–infected people. It presents with relapsing erythematous, scaly, and crusted lesions affecting simultaneously the scalp, external ear, retroauricular area, eyelid, paranasal skin, neck axilla, and groin. Superimposed Staphylococcus and Streptococcus infection are common. It mainly affects children and exceptionally adults, and there are only a few published cases. The authors present the first reported case in Paraguay of an adult patient who had symptoms of human T-lymphotropic virus type 1–associated progressive tropical spastic paraparesis, and 6 years after the onset of the neurological symptoms, the patient developed infective dermatitis lesions on the skin, with frequent exacerbations since then. PMID:26588341

  17. [Pulmonary arterial hypertension in adult patients with congenital heart disease].

    PubMed

    Serino, G; Giacomazzi, F

    2010-01-01

    Pulmonary Hypertension (PH) is definited by a mean pulmonary artery pressure (PAPm) >25 mmHg at rest. The Dana Point 2008 Revised Classification System represents the most recent classification system update with respect of various etiologies of PH. About 10 % of adolescents or adults with uncorrected congenital heart disease (CHD) with left-to-right shunt and high pulmonary blood flow develop Pulmonary Arterial Hypertension (PAH) . Progressive vascular remodeling and increase in pulmonary vascular resistance (PVR) may ultimately lead to reversal of the shunt (pulmonary to systemic) causing cyanosis and determining the so-called Eisenmenger Syndrome (ES). Recent advances in the early diagnosis and medical targeted treatment of adult patients with CHD-PAH and ES can improve PAP, PVR and exercise tolerance, together with NYHA Class and survival, and may potentially reverse the vascular remodeling process in selected patients.

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

    PubMed Central

    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

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

    PubMed

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

    2016-09-30

    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.

  20. Modified Fontan Conversion: An Alternative Technique for Adult Patients.

    PubMed

    González-López, María-Teresa; Pita-Fernández, Ana-María; Gil-Jaurena, Juan-Miguel; Pérez-Caballero-Martínez, Ramón; Sánchez-Valenzuela, Diego; Las, Cynthia-Jahavee

    2015-07-01

    A need persists for Fontan conversion that provides alternative approaches for the individual anatomical challenges occurring in these unusual and complex adult patients. The pulmonary arteries present unique variations and the surgical technique needs to be intraoperatively addressed. We describe a technique for Fontan conversion for performing the distal anastomosis of the extracardiac conduit, allowing adequate matching to the pulmonary arteries and preserving an optimal flow into the Fontan circuit.

  1. Hypohidrosis induced by topiramate in an adult patient.

    PubMed

    Karachristianou, Styliani; Papamichalis, Evangelos; Sarantopoulos, Alexandros; Boura, Panagiota; Georgiadis, George

    2013-06-01

    Hypohidrosis is an uncommon and reversible side effect of topiramate treatment, reported mainly in children. This report presents an adult patient with complex partial seizures who was treated with topiramate and developed hypohidrosis coupled with hyperthermia, related to high environmental temperature and physical exercise. Reduced sweat response was confirmed using the Neuropad test. Signs and symptoms ceased after drug discontinuation. During topiramate treatment, it is important to recognise this side effect, although the exact causal mechanism has not yet been clarified.

  2. Alterations in airway microbiota in patients with PaO2/FiO2 ratio ≤ 300 after burn and inhalation injury

    EPA Science Inventory

    BACKGROUND: Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15-45% increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly character...

  3. Regarding Critical Care of the Burn Patient: The First 48 Hours

    DTIC Science & Technology

    2010-01-01

    occur. Although duration and relapse of delirium may influence its association with outcome, they were not considered in the statistical analysis used...cardiac output state with high systemic vascular resistance (2). Both dopamine and adrenalin have been used in the low car- diac output state. However...other catecholamines in septic shock in adults. A recent review (6) on vasoactive drugs noted the case against adrenaline as a first-line agent in

  4. Relationship of Hemoglobin Concentration in Adult Asthmatic Patients.

    PubMed

    Nasreen, S; Nessa, A; Islam, M F; Husain, M F; Khatun, N; Wahed, F; Zannat, M R; Tajkia, T

    2016-10-01

    Asthma is a chronic inflammatory disorder of the airways, in which many cells and cellular elements play a role. Asthma is one of the most common diseases globally and currently affects 300 million people. The epidemic rise in anemia, asthma, and related allergic disease is a common major public health problem worldwide. Asthma and anemia associated with acute infections occur both in children and adults. This descriptive type of cross sectional study was done to find out the levels of hemoglobin concentration in adult asthmatic patients and carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2014 to January 2016. Fifty (50) male and 50 (fifty) female adult asthmatic patients aged 18-60 years were included in the study group. They are enrolled from the Department of Medicine, Mymensingh Medical College, Mymensingh, Bangladesh and also from locality. For comparison age matched 50 male and 50 female apparently healthy persons were also studied as control. Hemoglobin concentration was estimated by Cyanmethemoglobin method. For statistical analysis unpaired student's 't' test was used. Mean hemoglobin concentration was significantly decreased in study group in comparison to control group and the result was statistically significant (p<0.001). The study findings showed a high prevalence of anemia among asthmatic patients than non asthmatic healthy persons.

  5. Organ doses to adult patients for chest CT

    SciTech Connect

    Huda, Walter; Sterzik, Alexander; Tipnis, Sameer; Schoepf, U. Joseph

    2010-02-15

    Purpose: The goal of this study was to estimate organ doses for chest CT examinations using volume computed tomography dose index (CTDI{sub vol}) data as well as accounting for patient weight. Methods: A CT dosimetry spreadsheet (ImPACT CT patient dosimetry calculator) was used to compute organ doses for a 70 kg patient undergoing chest CT examinations, as well as volume computed tomography dose index (CTDI{sub vol}) in a body CT dosimetry phantom at the same CT technique factors. Ratios of organ dose to CTDI{sub vol} (f{sub organ}) were generated as a function of anatomical location in the chest for the breasts, lungs, stomach, red bone marrow, liver, thyroid, liver, and thymus. Values of f{sub organ} were obtained for x-ray tube voltages ranging from 80 to 140 kV for 1, 4, 16, and 64 slice CT scanners from two vendors. For constant CT techniques, we computed ratios of dose in water phantoms of differing diameter. By modeling patients of different weights as equivalent water cylinders of different diameters, we generated factors that permit the estimation of the organ doses in patients weighing between 50 and 100 kg who undergo chest CT examinations relative to the corresponding organ doses received by a 70 kg adult. Results: For a 32 cm long CT scan encompassing the complete lungs, values of f{sub organ} ranged from 1.7 (thymus) to 0.3 (stomach). Organs that are directly in the x-ray beam, and are completely irradiated, generally had f{sub organ} values well above 1 (i.e., breast, lung, heart, and thymus). Organs that are not completely irradiated in a total chest CT scan generally had f{sub organ} values that are less than 1 (e.g., red bone marrow, liver, and stomach). Increasing the x-ray tube voltage from 80 to 140 kV resulted in modest increases in f{sub organ} for the heart (9%) and thymus (8%), but resulted in larger increases for the breast (19%) and red bone marrow (21%). Adult patient chests have been modeled by water cylinders with diameters between

  6. Vaccination of Adult Patients with Systemic Lupus Erythematosus in Portugal

    PubMed Central

    Moraes-Fontes, Maria Francisca; Antunes, Ana Margarida; Gruner, Heidi; Riso, Nuno

    2016-01-01

    In the wake of the Portuguese vaccination program 50th anniversary it seems appropriate to review vaccination in patients with systemic lupus erythematosus. Controversial issues as regards the association between autoimmune diseases, infections, and vaccines are discussed as well as vaccine safety and efficacy issues as regards chronic immunosuppressant (IS) drug therapy. After a brief overview of national policies, specific recommendations are made as regards vaccination for adult patients with SLE with a particular focus on current IS therapy and unmet needs. PMID:27069477

  7. Stepping to stability and fall prevention in adult psychiatric patients.

    PubMed

    Emory, Sara L; Silva, Susan G; Christopher, Eric J; Edwards, Pamela B; Wahl, Leanne E

    2011-12-01

    Fall prevention is a major area of concern in inpatient settings. This article reports on the feasibility of implementing a daily exercise program that features line dancing to promote stability, balance, and flexibility in adult psychiatric patients and describes the impact of that program. Six hundred sixty-five patient charts drawn from before and after the practice change were reviewed. The fall rate after the introduction of line dancing was 2.8% compared with 3.2% before implementation. In a setting that treats both men and women of many ages and with varying levels of mobility, line dancing offers a viable approach to exercise in a secure setting.

  8. Outcomes with the Use of Recombinant Human Erythropoietin in Critically Ill Burn Patients

    DTIC Science & Technology

    2010-09-01

    human erythropoietin (rhEPO) has been approved by the U.S. Food and Drug Administration for use in anemic patient with chronic kidney disease ( CKD ).7...January 1, 2007 to December 31, 2008). Patients treated with rhEPO who also had any other indication for erythropoiesis before BICU to in- clude CKD ...17 In addition, mechanisms that lead to benefit in anemic patient with CKD may be at play in AK1. 18 Whether there may be a mortality benefit

  9. [The organization of burn care].

    PubMed

    Latarjet, Jacques

    2002-12-15

    In 2002, the organisation of burn care is confronted to a great deficiency in burn epidemiological datas. The main mechanisms of hospitalized burns are somehow wellknown in industrialized countries: about 60% scalds and 30% flame burns; as well as the place of occurrence (60% at home, and 20% at work), and the risk groups (3 times more important for the age group 0-4 years old). The incidence of burns needing medical care (all levels) (250/100,000 inh/yr) or hospitalization (15-20/100,000 inh/yr) is much more uncertain. The statistics of Diagnosis Related Groups (DRG), for hospitalized patients will allow in France very shortly to know more about the most rational ways of dispatching and treating them. They already show that only 30% of hospitalized burned patients are treated in specialized facilities.

  10. [The definition of the medical clown's role with adult patients].

    PubMed

    Scheyer, Rachel; Nuttman-Shwartz, Orit; Ziyoni, Herzel

    2008-01-01

    In recent years, the healthcare system has grown increasingly aware of the need to develop and adopt new models and intervention methods aimed at improving patients' quality of life. As part of this perception, medical clowns have been integrated into hospitals, primarily in work with children. Recently, there have been attempts to integrate clowns into work with adult patients in emergency rooms, but this intervention method has not yet been systematically implemented and studied. This article describes and examines the definition of the medical clown's role as an intervention strategy with adult outpatients suffering from chronic and life-threatening illnesses. The study is qualitative and based on a content analysis of the documentation of the work of two medical clowns over two years. The dominant theme arising from this analysis involves the definition of the clown's role within the medical space of the hospital and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The findings indicate that, from the clowns' point of view, integrated medical clowns as part of the medical team, would contribute to the functioning of both patients and staff. This is in accord with additional studies conducted recently in medical centers around the world. Since this is a pioneering study, there is room to further probe and research the medical clown's contribution to assisting and improving patients' and staff's quality of life and to develop ways of increasing his integration and professionalism.

  11. Study of inhaler technique in asthma patients: differences between pediatric and adult patients

    PubMed Central

    Manríquez, Pablo; Acuña, Ana María; Muñoz, Luis; Reyes, Alvaro

    2015-01-01

    Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients. PMID:26578130

  12. [Resuscitation of the burned child in critical condition].

    PubMed

    Sanabria Carretero, P; Vogel, C; Reinoso-Barbero, F; López Gutíerrez, J C

    1998-01-01

    Recent advances in surgical techniques, control of infection and nutritional support have dramatically increased the survival rates of burned children. The characteristics of severely burned pediatric patients dictate that management be different from that required for adults in the intensive care unit. The formulas for fluid replacement should be based on body surface rather than weight in children and adjusted for degree of stress and age, with appropriate monitoring and treatment of hypothermia, pain and associated psychological disorders. Early assessment and treatment of airway obstruction and gas and smoke inhalation syndromes with high FiO2 is necessary; prophylactic endotracheal intubation may be required.

  13. Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration

    DTIC Science & Technology

    2011-10-01

    Stenotrophomonas maltophilia (11 isolates), Enterobacter aerogenes (9 isolates), Aeromonas hydro- philia (6 isolates), Serratia marcescens (4 isolates), Escherichia...64 Acinetobacter baumannii (35) 39.1% 23 64/64 Other Enterobacteriaciae (43) Stenotrophomonas maltophilia (11), Enterobacter aerogenes (9...Patient and infection characteristics . Sixty patients received amikacin and had sufficient dosing and postinfusion data to calculate pharmacokinetic

  14. Burn, freeze, or photo-ablate?: comparative symptom profile in Barrett's dysplasia patients undergoing endoscopic ablation

    NASA Astrophysics Data System (ADS)

    Gill, Kanwar Rupinder S.; Gross, Seth A.; Greenwald, Bruce D.; Hemminger, Lois L.; Wolfsen, Herbert C.

    2009-06-01

    Background: There are few data available comparing endoscopic ablation methods for Barrett's esophagus with high-grade dysplasia (BE-HGD). Objective: To determine differences in symptoms and complications associated with endoscopic ablation. Design: Prospective observational study. Setting: Two tertiary care centers in USA. Patients: Consecutive patients with BE-HGD Interventions: In this pilot study, symptoms profile data were collected for BE-HGD patients among 3 endoscopic ablation methods: porfimer sodium photodynamic therapy, radiofrequency ablation and low-pressure liquid nitrogen spray cryotherapy. Main Outcome Measurements: Symptom profiles and complications from the procedures were assessed 1-8 weeks after treatment. Results: Ten BE-HGD patients were treated with each ablation modality (30 patients total; 25 men, median age: 69 years (range 53-81). All procedures were performed in the clinic setting and none required subsequent hospitalization. The most common symptoms among all therapies were chest pain, dysphagia and odynophagia. More patients (n=8) in the porfimer sodium photodynamic therapy group reported weight loss compared to radio-frequency ablactation (n=2) and cryotherapy (n=0). Four patients in the porfimer sodium photodynamic therapy group developed phototoxicity requiring medical treatment. Strictures, each requiring a single dilation, were found in radiofrequency ablactation (n=1) and porfimer sodium photodynamic therapy (n=2) patients. Limitations: Small sample size, non-randomized study. Conclusions: These three endoscopic therapies are associated with different types and severity of post-ablation symptoms and complications.

  15. Clofarabine in Adult Patients With Advanced Solid Tumors

    ClinicalTrials.gov

    2014-02-04

    Solid Tumors; Leukemia, Lymphocytic, Acute, Pediatric; Leukemia, Lymphocytic, Acute, Adult; Leukemia, Myelocytic, Acute, Pediatric; Leukemia, Myelocytic, Acute, Adult; Myelodysplastic Syndromes, Adult

  16. [Epidemiology of burns in France].

    PubMed

    Latarjet, Jacques; Ravat, François

    2012-01-01

    As with most traumas, the epidemiology of the "burn" health-event has long been neglected by public health doctors and rarely considered by burns specialists. There were therefore few verified data and many approximations and preconceived ideas. The gathering of information recently undertaken in France enables the reliability of the data to be improved and the diagnostic and demographic elements relating to hospitalised patients with burns to be established.

  17. The epidemiology of adult Rapid Response Team patients in Australia.

    PubMed

    Jones, D

    2014-03-01

    Rapid Response Teams (RRT) are specialised teams that review deteriorating ward patients in an attempt to prevent morbidity and mortality. Most studies have assessed the effect of implementing an RRT into a hospital. There is much less literature on the characteristics and outcomes of RRT patients themselves. This article reviews the epidemiology of adult RRT patients in Australia and proposes three models of RRT syndromes. The number of RRT calls varies considerably in Australian hospitals from 1.35 to 71.3/1000 hospital admissions. Common causes of RRT calls include sepsis, atrial fibrillation, seizures and pulmonary oedema. Approximately 20% of patients to whom an RRT has responded have more than one RRT call, and up to one-third have issues around end-of-life care. Calls are least common overnight. Between 10 to 25% of patients are admitted to a critical care area after the call. The in-hospital mortality for RRT patients is approximately 25% overall but only 15% in patients without a limitation of medical therapy. RRT syndromes can be conceptually described by the trigger for the call (e.g. hypotension) or the clinical condition causing the call (e.g. sepsis). Alternatively, the RRT call can be described by the major theme of the call: "end-of-life care", "requiring critical care" and "stable enough to initially remain on the ward". Based on these themes, education strategies and quality improvement initiatives may be developed to reduce the incidence of RRT calls, further improving patient outcome.

  18. Experimental identification of potential falls in older adult hospital patients.

    PubMed

    Cloutier, Aimee; Yang, James; Pati, Debajyoti; Valipoor, Shabboo

    2016-05-03

    Patient falls within hospitals have been identified as serious but largely preventable incidents, particularly among older adult patients. Previous literature has explored intrinsic factors associated with patient falls, but literature identifying possible extrinsic or situational factors related to falls is lacking. This study seeks to identify patient motions and activities along with associated environmental design factors in a patient bathroom and clinician zone setting that may lead to falls. A motion capture experiment was conducted in a laboratory setting on 27 subjects over the age of seventy using scripted tasks and mockups of the bathroom and clinician zone of a patient room. Data were post-processed using Cortex and Visual3D software. A potential fall was characterized by a set of criteria based on the jerk of the upper body׳s center of mass (COM). Results suggest that only motion-related factors, particularly turning, pushing, pulling, and grabbing, contribute most significantly to potential falls in the patient bathroom, whereas only pushing and pulling contribute significantly in the clinician zone. Future work includes identifying and changing precise environmental design factors associated with these motions for an updated patient room and performing motion capture experiments using the new setup.

  19. Burn Pits

    MedlinePlus

    ... unexploded ordnance, petroleum and lubricant products, plastics, rubber, wood, and discarded food. Burning waste in open air ... Regulations Web Policies No FEAR Act Whistleblower Rights & Protections Site Index USA.gov White House Inspector General ...

  20. A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds

    PubMed Central

    Munteanu, A; Florescu, IP; Nitescu, C

    2016-01-01

    Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes. PMID:27974941

  1. A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds.

    PubMed

    A, Munteanu; Ip, Florescu; C, Nitescu

    2016-01-01

    Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes.

  2. Burning mouth syndrome.

    PubMed

    Torgerson, Rochelle R

    2010-01-01

    Burning mouth syndrome (BMS) is a chronic condition characterized by burning of the oral mucosa, with or without dysgeusia and xerostomia, in the setting of no underlying systemic disease or identifiable abnormalities on physical examination or laboratory testing. BMS disproportionately affects postmenopausal women. The pathophysiology of the disease is unknown; no single treatment has proven universally successful. In light of these shortcomings, having a practical approach to the evaluation and management of patients with BMS can improve both patient quality of life and physician satisfaction.

  3. Modified ultrafiltration in adult patients undergoing cardiac surgery.

    PubMed

    Zakkar, Mustafa; Guida, Gustavo; Angelini, Gianni D

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was the impact of modified ultrafiltration on adult patients undergoing cardiac surgery in terms of inflammatory and metabolic changes, blood loss and early clinical outcomes. A total of 155 papers were identified using the search as described below. Of these, six papers presented the best evidence to answer the clinical question as they reported data to reach conclusions regarding the issues of interest for this review. The author, date and country of publication, patient group, study type and weaknesses and relevant outcomes were tabulated. Modified ultrafiltration in adult patients undergoing cardiac surgery seems to attenuate the levels of inflammatory molecules associated with surgery, reduces blood loss and blood transfusion and improves cardiac output, index and systemic vascular resistance. However, this was not translated in any reduction in length of stay in intensive care unit or hospital. Most studies were single-centre prospective non-blinded trials that included a small cohort of elective coronary artery bypass grafting patients, which makes it underpowered to provide unbiased evidence regarding clinical outcomes. Properly designed and conducted prospective randomized studies are required to answer whether the beneficial effect of modified ultrafiltration on systemic inflammatory molecules associated with surgery can translate with improvement in clinical outcome.

  4. The Effect of Continuous Sedation Therapy on Immunomodulation, Plasma Levels of Antioxidants, and Indicators of Tissue Repair in Post-Burn Sepsis Patients.

    PubMed

    Chen, Li; Meng, Ke; Su, Wei; Fu, Yanjie

    2015-11-01

    Our objective was to investigate the effect of continuous therapeutic sedation on the immune response, plasma levels of antioxidants, and tissue repair indicators in burn-induced sepsis patients. A total of 104 burn-induced sepsis patients hospitalized during March, 2008 to March, 2013 were selected for the study and randomly divided into the experimental and control groups, each with 53 cases. All of these patients received conventional treatment and the patients in the experimental group were given an additional therapy of continuous sedation. The number of T lymphocytes, plasma levels of tissue repair indicators, and antioxidants were measured before and after the treatment. Continuous midazolam treatment induced a significant increase in plasma levels of gelsolin, heat shock protein 70, nitric oxide, superoxide dismutase, and tumor necrosis factor-alpha (p < 0.05). Likewise, the relative counts of CD3(+), CD4(+), CD8(+) T lymphocytes, T cells exhibiting HLA-DR and CD4(+)/CD8(+) ratio were significantly increased in the patients treated with midazolam. No adverse reaction including respiratory depression, midazolam resistance, or withdrawal syndrome was observed. Continuous sedation therapy was found to enhance immune response, increase the plasma levels of antioxidants, and tissue protective/repair mediators in burn-induced sepsis patients. This therapy caused no adverse reaction or over-inhibition of the oxidative stress suggesting its effectiveness in improving the prognosis without the risk of safety.

  5. Development and Validation of the Satisfaction with Appearance Scale: Assessing Body Image among Burn-Injured Patients.

    ERIC Educational Resources Information Center

    Lawrence, John W.; Heinberg, Leslie J.; Roca, Robert; Munster, Andrew; Spence, Robert; Fauerbach, James A.

    1998-01-01

    The Satisfaction with Appearance Scale (SWAP) was administered to 165 burn victims. SWAP showed a high level of internal consistency (Cronbach's alpha, r(a)=0.87); an 84-subject retest measured reliability (r(tt)=0.59). SWAP is both a reliable and valid measure of body image for a burn-injured population. (Author/MAK)

  6. A retrospective study of 572 patients with hand burns treated at the Department of Plastic Surgery Kosovo during the period 2000-2010.

    PubMed

    Arifi, Hysni M; Duci, Shkelzen B; Zatriqi, Violeta K; Ahmeti, Hasan R; Haxhiu, Isa I; Mekaj, Agon Y; Gashi, Musli M; Buja, Zejn A; Derguti, Shkelqim H

    2014-01-01

    Hands participate in everyday human activities and they are the most vulnerable parts of a human body. The objective of this study is to understand the common causes of hand burns, the methods of surgical interventions, duration of hospitalization and distribution of hand burns in 11 year period regarding the age. This is a retrospective study that included 572 patients with hand burns treated at the Department of Plastic Surgery Kosovo during the period 2000-2010. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Data processing was done with the statistical package InStat 3. From statistical parameters were calculated structural index, arithmetic median and standard deviation. Data testing is done with X (2) test and the difference is significant if P<0.05. The Ministry of Health of our country should make efforts to organize training for health workers about treatment for minor burns in order to reduce the number of referral patients from other primary (Familiar Medicine) and secondary centers (regional Hospitals).

  7. Five Patients With Burning Mouth Syndrome in Whom an Antidepressant (Serotonin-Noradrenaline Reuptake Inhibitor) Was Not Effective, but Pregabalin Markedly Relieved Pain.

    PubMed

    Ito, Mikiko; Tokura, Tatsuya; Yoshida, Keizo; Nagashima, Wataru; Kimura, Hiroyuki; Umemura, Eri; Tachibana, Masako; Miyauchi, Tomoya; Kobayashi, Yuka; Arao, Munetaka; Ozaki, Norio; Kurita, Kenichi

    2015-01-01

    Burning mouth syndrome (BMS) causes idiopathic pain or a burning sensation in clinically normal oral mucosa. Burning mouth syndrome is a chronic disease with an unknown etiology. Burning mouth syndrome is also idiopathic, and a consensus regarding diagnosis/treatment has not been reached yet. Recent studies have supported the suggestion that BMS is a neuropathic pain disorder in which both the peripheral and central nervous systems are involved. Tricyclic antidepressants (nortriptyline and amitriptyline), serotonin-noradrenaline reuptake inhibitors (SNRIs) (duloxetine and milnacipran), and antiepileptic drugs, potential-dependent calcium channel α2δ subunit ligands (gabapentine and pregabalin), are currently recommended as the first-choice drugs for neuropathic pain. In this study, we report 5 patients with BMS in whom there was no response to SNRI (milnacipran or duloxetine), or administration was discontinued because of adverse reactions, but in whom pregabalin therapy markedly reduced or led to the disappearance of pain in a short period. Pregabalin, whose mechanism of action differs from that of SNRIs, may become a treatment option for BMS patients who are not responsive to or are resistant to SNRIs.

  8. Plasma Cytokines Following Thermal Injury and Their Relationship with Patient Mortality, Burn Size, and Time Postburn,

    DTIC Science & Technology

    1993-09-01

    infections, mechanical trauma, sepsis, septic Furthermore, IL-1 is involved in a cascade of regulatory shock, &nd rheumatoid arthritis are examples...1987 plasma and tsupernatanta from cultured cells of patients with S. Marinkovic 8, Jabreis GP, Wong GG, et al: IL-6 modulates the rheumatoid arthritis and

  9. Thyroid gland diseases in adult patients with diabetes mellitus.

    PubMed

    Vondra, K; Vrbikova, J; Dvorakova, K

    2005-12-01

    This review concerns the relation between most frequent thyroid gland diseases and diabetes mellitus in adult patients. Special attention is paid to autoimmune thyroiditis, Graves' disease, thyroid autoimmunity in pregnant diabetic women, and iodine metabolism. We focused on mechanisms leading to coexistence of both endocrine disorders, and on distinctions in the prevalence, diagnosis, clinical course and treatment of thyroid diseases in diabetic patients. The prevalence of thyroid diseases in diabetic patients is 2-3 times higher than in nondiabetic subjects; it raises with age, and is strongly influenced by female gender and autoimmune diabetes. Clinical relevance of thyroid diseases, especially in diabetic patients, significantly increases if it is associated with deteriorated function, which always cause a number problems with metabolic compensation of diabetes. Most serious consequences are increased frequency of hypoglycaemia in hypothyroidism and development of potentially life-threatening ketoacidosis in thyrotoxicosis. In spite of that, little attention is paid to the diagnosis of thyroid diseases in diabetics, as they are diagnosed in only about half of the patients. At the end, we provide recommendations for the thyroid disease screening and diagnosis in patients with diabetes mellitus based on our experience.

  10. Updates in vaccination: Recommendations for adult inflammatory bowel disease patients

    PubMed Central

    Chaudrey, Khadija; Salvaggio, Michelle; Ahmed, Aftab; Mahmood, Sultan; Ali, Tauseef

    2015-01-01

    Treatment regimens for inflammatory bowel disease (IBD) incorporate the use of a variety of immunosuppressive agents that increase the risk of infections. Prevention of many of these infections can be achieved by the timely and judicious use of vaccinations. IBD patients tend to be under-immunized. Some of the contributing factors are lack of awareness regarding the significance of vaccinating IBD patients, misperception about safety of vaccinations in immunocompromised patients, ambiguity about the perceived role of the gastroenterologist in contrast to the primary care physician and unavailability of vaccination guidelines focused on IBD population. In general, immunocompetent IBD patients can be vaccinated using standard vaccination recommendations. However there are special considerations for IBD patients receiving immunosuppressive therapy, IBD travelers and pregnant women with IBD. This review discusses current vaccination recommendations with updates for adult IBD patients. Centers for Disease Control and Prevention 2013 vaccination guidelines with 2014 updates and the Advisory Committee on Immunization Practices recommendations have been highlighted as a primary source of recommendations. PMID:25805924

  11. [Burns caused by paint thinner].

    PubMed

    Benbrahim, A; Jerrah, H; Diouri, M; Bahechar, N; Boukind, E H

    2009-12-31

    Flame deriving from paint thinner is not a rare cause of burns in Morocco and we thus considered it useful to conduct an epidemiological survey of paint thinner flame burns (PTFB) in the National Burns Centre (NBC) in the Ibn-Rochd University Hospital Centre in Casablanca, Morocco. The research covered the 10-month period from September 2007 to June 2008.The aim of our work was to present the characteristic features of such burns in order to prevent them by increasing public knowledge regarding the risks involved in using paint thinner, i.e. burns in particular. During the period in question, we colligated 17 cases of PTFB out of a total number of 356 patients admitted to the NBC for acute burns of all aetiologies. The patients' average was 32 yr and they were nearly all male (16 men/1 woman), with past histories of drug addiction and/or delinquency. They were all of low-level socioeconomic class and lived mainly in shanty towns. The burn was often secondary to street violence (92% of the cases).The mean burn surface area was 23% and the burns were often deep and located mainly in the upper limbs and the trunk.

  12. Men, fire, and burns: Stories of fighting, healing, and emotions.

    PubMed

    Thakrar, Sulaye; Hunter, Tevya A; Medved, Maria I; Hiebert-Murphy, Diane; Brockmeier, Jens; Sareen, Jitender; Logsetty, Sarvesh

    2015-12-01

    Burn recovery is a difficult process full of physical and psychological challenges. With increasing survival rates, there has been renewed interest in the psychological aspects of burn recovery. As men represent over 70% of all burn patients, it is particularly important to study how men experience and interpret this process. We interviewed a purposeful sample of ten adult male burn survivors from different age and cultural groups in the first 16 weeks of their recovery and asked them to discuss the problems they faced. Narrative analysis was used to interpret the interviews. In their narratives, the men tended to emphasize gains in their physical recovery; that is, they often used metaphors of "fighting" to demonstrate how committed they were to their healing. Further, they put less emphasis on the emotional aspects of their recovery. In our discussion, we compare these complex storylines to coping strategies identified in the literature and discuss why men may choose these strategies. Based on our findings we argue that it is important for health care providers to be aware of societal pressures which may influence burn survivors to minimize affective elements of burn recovery. Additionally, we encourage exploring and capitalizing on men's "fighting" stories during rehabilitation in order to foster an active role which men can take in their recovery.

  13. Epidemiology and resistance features of Acinetobacter baumannii isolates from the ward environment and patients in the burn ICU of a Chinese hospital.

    PubMed

    Gong, Yali; Shen, Xiaodong; Huang, Guangtao; Zhang, Cheng; Luo, Xiaoqiang; Yin, Supeng; Wang, Jing; Hu, Fuquan; Peng, Yizhi; Li, Ming

    2016-08-01

    Acinetobacter baumannii is an important opportunistic pathogen that causes severe nosocomial infections, especially in intensive care units (ICUs). Over the past decades, an everincreasing number of hospital outbreaks caused by A. baumannii have been reported worldwide. However, little attention has been directed toward the relationship between A. baumannii isolates from the ward environment and patients in the burn ICU. In this study, 88 A. baumannii isolates (26 from the ward environment and 62 from patients) were collected from the burn ICU of the Southwest Hospital in Chongqing, China, from July through December 2013. Antimicrobial susceptibility testing results showed that drug resistance was more severe in isolates from patients than from the ward environment, with all of the patient isolates being fully resistant to 10 out of 19 antimicrobials tested. Isolations from both the ward environment and patients possessed the β-lactamase genes bla OXA-51, bla OXA-23, bla AmpC, bla VIM, and bla PER. Using pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST), these isolates could be clustered into 4 major PFGE types and 4 main sequence types (ST368, ST369, ST195, and ST191) among which, ST368 was the dominant genotype. Epidemiologic and molecular typing data also revealed that a small-scale outbreak of A. baumannii infection was underway in the burn ICU of our hospital during the sampling period. These results suggest that dissemination of β-lactamase genes in the burn ICU might be closely associated with the high-level resistance of A. baumannii, and the ICU environment places these patients at a high risk for nosocomial infection. Cross-contamination should be an important concern in clinical activities to reduce hospitalacquired infections caused by A. baumannii.

  14. Group B streptococcal necrotizing pneumonia in a diabetic adult patient.

    PubMed

    Pacha, Andrea; Luna Cian, Ramiro; Bonofiglio, Laura; Solari, Melisa; Strada, Virginia; Suárez, Mariana; Vigliarolo, Laura; Tersigni, Carina; Mollerach, Marta; Lopardo, Horacio

    2017-03-18

    The aim of this report is to describe a rare case of necrotizing pneumonia due to group B Streptococcus serotype III in a relatively young male adult (48 years old) suffering from diabetes. The organism was isolated from his pleural fluid and was only resistant to tetracycline. The patient first received ceftazidime (2g/8h i.v.)+clindamycin (300mg/8h) for 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid (1g/12h) for 23 days with an uneventful evolution. As in the cases of invasive infection by Streptococcus pyogenes, clindamycin could prevent streptococcal toxic shock syndrome.

  15. Factors Influencing Cognitive Functioning Following Mild Traumatic Brain Injury in OIF/OEF Burn Patients

    DTIC Science & Technology

    2010-01-01

    Archives of Clinical Neuropsychology 19 (2004), 825–834. [5] H.G. Belanger, T. Kretzmer, R. Yoash-Gantz, T. Pickett and L.A. Tupler...Poppe, N. Davis, B. Schmaus and S.E. Hobbs, Cognitive functioning and postconcussive symptoms in trau- ma patients with and without mild TBI, Archives of Clinical Neuropsychology 21...Koffler, C.R. Reynolds and C.H. Silver, Neuropsychological evalua- tion in the diagnosis and management of sports-related con- cussion, Archives of

  16. Is visualising ureter before pyeloplasty necessary in adult patients?

    PubMed

    Cakan, M; Yalçinkaya, F; Demirel, F; Satir, A

    2000-01-01

    In this study, we aimed to detect whether or not visualising ureter and ureteropelvic junction (UPJ) preoperatively is necessary in adult patients who have primer UPJ obstruction. Between January 1995 to June 1999, 46 renal units in 45 patients with primer UPJ obstruction were evaluated. The patients were separated into 2 groups. In group 1, intravenous pyelography (IVP) and renal scintigraphy were performed to 17 renal units preoperatively. In group 2, in addition to these methods, either retrograde pyelography (RGP) or antegrade pyelography (AGP) were performed to 29 renal units. Renal/bladder sonogram was used in patients with poor renal function in IVP or in renal scintigraphy. All the operations were performed through a flank incision. In group 2, additional information was gained for 8 (27.5%) of the renal units preoperatively. No additional information for this group found intraoperatively. In group 1, we found additional information in 4 (23.53%) of the units intraoperatively. All the pathologies in both groups were corrected intraoperatively. Double-J (D-J) stent was used in 6 (35.29%) of the units in group 1 and 8 (27.58%) of the units in group 2 intraoperatively (p > 0.05). In group 2, 4 (13.79%) preoperative complications were seen due to RGP and they were treated either medically or conservatively. In the early postoperative period, a complication observed in 1 (5.88%) of the patients in group 1 and 1 of the patients in group 2 (3.44%) (p > 0.05). The first patient was treated with inserting D-J and the latter one was treated conservatively. In the 3rd postoperative month, success rate was found to be 94.11% in group 1 and 96.55% in group 2 (p > 0.05). Additional pathologies in adult patients with primer UPJ obstruction can be corrected intraoperatively through a flank incision. Therefore, imaging of ureter and UPJ may not be necessary in these patients.

  17. Trimethoprim-induced hyperkalemia in burn patients treated with intravenous or oral trimethoprim sulfamethoxazole for methicillin-resistant Staphylococcus aureus and other infections: nature or nurture?

    PubMed

    Ackerman, Bruce H; Patton, Mary L; Guilday, Robert E; Haith, Linwood R; Stair-Buchmann, Megan; Reigart, Cynthia L

    2013-01-01

    Trimethoprim is well known to cause rashes; however, what is not commonly known is that it causes sudden and profound hyperkalemia in 10 to 20% of treated patients. The uniqueness of burn patients begs the question whether changes known to occur in these patients might also increase this trimethoprim effect. After institutional review board approval, a retrospective study evaluated 224 patients with thermal injury who had been treated with trimethoprim sulfamethoxazole (TMP-SMX), 24 of whom had underlying renal impairment (creatinine clearances <50 ml/min) and were excluded, leaving 200 patients for analysis. Three definitions of drug-induced hyperkalemia were used: 1) a ≥ 1 mEq/L rise, 2) a >0.8 mEq rise in potassium in <24 hours warranting early discontinuation of TMP-SMX, and 3) "marked" hyperkalemia defined as serum potassium of ≥ 5.5 mEq/L within 48 hours. A potassium level before trimethoprim exposure (TxK) and after TxK were collected retrospectively. Demographic data were analyzed with Student's t-test and trimethoprim dose alone, demonstrating a significant difference. Analysis of 200 patients exposed to trimethoprim demonstrated an elevation of potassium (first definition) in 31 patients (15.5%), a rapid change in serum potassium in two patients (second definition), and marked hyperkalemia (>5.5 mEq/L) in 13 patients (6.5%). Hyperkalemia never occurred in 166 of 200 patients (82%; before TxK, 3.9 ± 0.4; after TxK, 4.3 ± 0.5 mEq/L). Change in serum potassium among patients with hyperkalemia was 4.0 ± 0.5 mEq/L before TxK and 5.3 ± 0.7 mEq/L after TxK. Twelve published hyperkalemia risk factors were reviewed in these 200 patients and only history of hypertension and need for intubation was more common in those with hyperkalemia. A nearly 20% incidence of hyperkalemia and 6% serious hyperkalemia in burn patients is consistent with reports in patients without burn injury. These data also suggest that the metabolic and hormonal changes associated with

  18. Alterations in airway microbiota in patients with PaO2/FiO2 ratio ≤ 300 after burn and inhalation injury

    PubMed Central

    McCullough, Shaun D.; Yourstone, Scott; Jones, Samuel W.; Cairns, Bruce A.; Jones, Corbin D.; Jaspers, Ilona; Diaz-Sanchez, David

    2017-01-01

    Background Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15–45% increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly characterized by hypoxemia in the airways. While ARDS has been associated with bacterial infection, the impact of hypoxemia on airway microbiota is unknown. Our objective was to identify differences in microbiota within the airways of burn patients who develop hypoxemia early after inhalation injury and those that do not using next-generation sequencing of bacterial 16S rRNA genes. Results DNA was extracted from therapeutic bronchial washings of 48 patients performed within 72 hours of hospitalization for burn and inhalation injury at the North Carolina Jaycee Burn Center. DNA was prepared for sequencing using a novel molecule tagging method and sequenced on the Illumina MiSeq platform. Bacterial species were identified using the MTToolbox pipeline. Patients with hypoxemia, as indicated by a PaO2/FiO2 ratio ≤ 300, had a 30% increase in abundance of Streptococcaceae and Enterobacteriaceae and 84% increase in Staphylococcaceae as compared to patients with a PaO2/FiO2 ratio > 300. Wilcoxon rank-sum test identified significant enrichment in abundance of OTUs identified as Prevotella melaninogenica (p = 0.042), Corynebacterium (p = 0.037) and Mogibacterium (p = 0.048). Linear discriminant effect size analysis (LefSe) confirmed significant enrichment of Prevotella melaninognica among patients with a PaO2/FiO2 ratio ≤ 300 (p<0.05). These results could not be explained by differences in antibiotic treatment. Conclusions The airway microbiota following burn and inhalation injury is altered in patients with a PaO2/FiO2 ratio ≤ 300 early after injury. Enrichment of specific taxa in patients with a PaO2/FiO2 ratio ≤ 300 may indicate airway environment and patient changes that favor these microbes

  19. An unsuspected cause of meal-time morbidity: instant noodle scald burns.

    PubMed

    Koltz, Peter F; Wasicek, Philip; Mays, Chester; Bell, Derek E

    2013-01-01

    Observational analysis revealed a concerning frequency of scald burns secondary to instant noodles. A literature review reveals studies with small sample sizes of pediatric populations and analysis of container engineering. The adult cohort, treatments, and short-term outcomes have been neglected. Considering these deficiencies, we reviewed our institution's experience with burns secondary to instant noodles. Patient encounters due to instant noodle burns from January 1, 2007, through May 15, 2011, were reviewed. Demographics, burn characteristics, treatment, length of stay, number of operative interventions, and complications were analyzed. Eight hundred fifty-two patients were seen (460 were admitted) for scald burns of all pathogenesis. Of these, 121 (14%) were seen for burns secondary to noodles (63 men and 58 women). Of these, 48 were older than age 4 (group 1), and 73 were younger than age 4 (group 2). TBSA was 2.34 in group 1 and 1.64 in group 2 (P = .04). The most commonly burned areas in group 1 were extremities (n = 43) and in group 2 were chest (n = 32) and extremities (n = 31). Seven patients in group 1 and two patients in group 2 required operative intervention. Length of stay in groups 1 and 2 were 3.5 and 6 days, respectively. Noodle scald burns cause morbidity at all ages. Pediatric burns due to noodles are frequently managed conservatively but more often necessitate inpatient treatment. The nonpediatric population has larger TBSA and requires more frequent operative intervention. The morbidity of noodle burns is significant. Increased public education and container re-engineering is warranted.

  20. Fungal Burn Wound Infection

    DTIC Science & Technology

    1991-01-01

    severely limits the may prove to be useful in burn patients. Clotrimazole , applied clinical utility of such a culture. Biopsy and frozen-section and as...useful in wound and permit prompt institution of appropriate the treatment of systemic fungal infections. Clotrimazole is treatment. poorly absorbed

  1. Ileal function in patients with untreated adult coeliac disease.

    PubMed Central

    Silk, D B; Kumar, P J; Webb, J P; Lane, A E; Clark, M L; Dawson, A M

    1975-01-01

    A double-lumen perfusion technique has been used to investigate jejunal and ileal absorption of glucose, water, and electrolytes in a group of patients with untreated adult coeliac disease. Correct positioning of the tube was confirmed by measuring the differential jejunal and ileal handling of bicarbonate. Eight control subjects and eight patients with coeliac disease were perfused with an isotonic electrolyte solution containing 50 mM glucose and 25 mM bicarbonate. The group of coeliac patients had impaired jejunal absorption of glucose (P less than 0.001), water (P less than 0.01), sodium (P less than 0.02), and chloride (P greater than 0.05) compared with the control group. In contrast the group of coeliac patients had normal ileal glucose and water absorption and increased ileal sodium (P greater than 0.01) and chloride (P greater than 0.05) absorption compared with the controls. Evidence for ileal adaptation was found in three individual patients who had absorptive values outside 2SD of the normal mean. The results indicate that the distal small intestine in coeliac disease has the ability to adopt to the damage and loss of absorptive capacity in the proximal small intestine. PMID:1132801

  2. A comprehensive Fabry-related pain questionnaire for adult patients.

    PubMed

    Üçeyler, Nurcan; Magg, Barbara; Thomas, Phillip; Wiedmann, Silke; Heuschmann, Peter; Sommer, Claudia

    2014-11-01

    Pain may be the earliest symptom in Fabry disease and presents with a distinct phenotype including triggerable pain attacks, evoked pain, pain crises, and chronic pain. Current pain questionnaires do not reflect the special phenotype of Fabry disease-associated pain, which hampers its systematic evaluation as the basis of correct diagnosis and effective treatment. A questionnaire specifically designed to assess Fabry disease-associated pain is thus urgently needed. At the Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), Germany, we developed and validated the first face-to-face Fabry Pain Questionnaire (FPQ) for adult patients. The initial version of the FPQ was tested in a pilot study with 20 consecutive Fabry disease patients. The performance of the revised FPQ was assessed in a first (n=56) and second (n=20) validation phase in consecutive Fabry disease patients. For this, patients were interviewed at baseline and 2 weeks later. We determined the test-retest reliability and validity of the FPQ in comparison to data obtained with the Neuropathic Pain Symptom Inventory. The FPQ contains 15 questions on the 4 pain phenotypes of Fabry disease (pain attacks, pain crises, evoked pain, chronic pain) in childhood and adulthood, on pain development during life with and without enzyme replacement therapy, and on everyday life impairment due to pain. This first disease-specific questionnaire is a valuable tool for baseline and follow-up assessment of pain in Fabry disease patients and may guide treatment in this distinct pain phenotype.

  3. Unexplained lymphadenopathies: autoimmune lymphoproliferative syndrome in an adult patient

    PubMed Central

    Leal-Seabra, Fatima; Costa, Gonçalo Sarmento; Coelho, Henrique Pereira; Oliveira, Agripino

    2016-01-01

    Autoimmune lymphoproliferative syndrome (ALPS) is characterised by massive enlargement of the lymphoid organs, autoimmune cytopenias and a predisposition to develop lymphoid malignancies. The basic defect is a disturbance of the lymphocyte apoptosis, and a high number of circulating TCRab CD3+CD4−CD8− T-cells (double-negative T cells (DNT cells)). We describe a case of a 41-year-old man with fever, hepatosplenomegaly, multiple lymphadenopathy, autoimmune haemolytic anaemia and severe thrombocytopenia. Peripheral blood immunophenotyping revealed elevation of the characteristic DNT cells in 8% and high levels of interleukin 10. Histopathological analysis of lymph nodes showed lymphadenitis with paracortical hyperplasia. It was assumed as a probable diagnosis of ALPS, and the procedure was to medicate the patient with steroids. As a result, a significant clinical improvement was achieved, and he has been in remission for 2 years. To our knowledge, this is the first case reported in a Portuguese adult patient. PMID:27979843

  4. Unexplained lymphadenopathies: autoimmune lymphoproliferative syndrome in an adult patient.

    PubMed

    Leal-Seabra, Fatima; Costa, Gonçalo Sarmento; Coelho, Henrique Pereira; Oliveira, Agripino

    2016-12-15

    Autoimmune lymphoproliferative syndrome (ALPS) is characterised by massive enlargement of the lymphoid organs, autoimmune cytopenias and a predisposition to develop lymphoid malignancies. The basic defect is a disturbance of the lymphocyte apoptosis, and a high number of circulating TCRab CD3(+)CD4(-)CD8(-) T-cells (double-negative T cells (DNT cells)). We describe a case of a 41-year-old man with fever, hepatosplenomegaly, multiple lymphadenopathy, autoimmune haemolytic anaemia and severe thrombocytopenia. Peripheral blood immunophenotyping revealed elevation of the characteristic DNT cells in 8% and high levels of interleukin 10. Histopathological analysis of lymph nodes showed lymphadenitis with paracortical hyperplasia. It was assumed as a probable diagnosis of ALPS, and the procedure was to medicate the patient with steroids. As a result, a significant clinical improvement was achieved, and he has been in remission for 2 years. To our knowledge, this is the first case reported in a Portuguese adult patient.

  5. High frequency of multidrug-resistant Staphylococcus aureus with SCCmec type III and Spa types t037 and t631 isolated from burn patients in southwest of Iran.

    PubMed

    Parhizgari, Najmeh; Khoramrooz, Seyed Sajjad; Malek Hosseini, Seyed Ali Asghar; Marashifard, Masoud; Yazdanpanah, Mahboobeh; Emaneini, Mohammad; Gharibpour, Farzaneh; Mirzaii, Mehdi; Darban-Sarokhalil, Davood; Moein, Masoud; Naraki, Mahmood

    2016-03-01

    Methicilin resistance Staphylococcus aureus (MRSA) infections are the major challenges in hospitals, especially in the burn units. The use of molecular typing methods is essential for tracking the spread of S. aureus infection and epidemiological investigations. The aim of this study was to find the profile of the spa types and also the prevalence of each SCCmec type of S. aureus strains in a central burn hospital in southwest of Iran. A total of 81 non-duplicate S. aureus were isolated from burn patients between April 2011 and February 2012. The susceptibility of the isolates against 13 different antibiotics was tested by disk agar diffusion (DAD) method. MRSA strains were identified by amplification of mecA gene. Multiplex-polymerase chain reaction (PCR) technique was used to determine the SCCmec types of MRSA strains and all the S. aureus isolates were typed by spa typing method. Detection of mecA gene showed that 70 (86.4%) of the isolates were MRSA. The highest rate of resistance was observed for penicillin (97.5%) and erythromycin (77.8%). None of the isolates were resistant to vancomycin. Sixty-seven of the 70 MRSA isolates harbored only SCCmec type III and three untypeable isolates. Five different spa types were detected. The most common spa types were t037 (42.5%) and t631 (34.5%) and were only found in MRSA isolates. Only SCCmec type III was found in burn patients which emphasizes the HA-MRSA origin of these strains. Only five different spa types identified in this study are in accordance with one SCCmec type which indicates that a limited number of bacterial colons are circulated in the burn unit in this hospital.

  6. Recommended vaccinations for asplenic and hyposplenic adult patients

    PubMed Central

    Grazzini, Maddalena; Niccolai, Giuditta; Paolini, Diana; Varone, Ornella; Bartoloni, Alessandro; Bartalesi, Filippo; Santini, Maria Grazia; Baretti, Simonetta; Bonito, Carlo; Zini, Paola; Mechi, Maria Teresa; Niccolini, Fabrizio; Magistri, Lea; Pulci, Maria Beatrice; Bechini, Angela

    2017-01-01

    ABSTRACT Asplenic or hyposplenic (AH) individuals are particularly vulnerable to invasive infections caused by encapsulated bacteria. Such infections have often a sudden onset and a fulminant course. Infectious diseases (IDs) incidence in AH subjects can be reduced by preventive measures such as vaccination. The aim of our work is to provide updated recommendations on prevention of infectious diseases in AH adult patients, and to supply a useful and practical tool to healthcare workers for the management of these subjects, in hospital setting and in outpatients consultation. A systematic literature review on evidence based measures for the prevention of IDs in adult AH patients was performed in 2015. Updated recommendations on available vaccines were consequently provided. Vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended and should be administered at least 2 weeks before surgery in elective cases or at least 2 weeks after the surgical intervention in emergency cases. In subjects without evidence of immunity, 2 doses of live attenuated vaccines against measles-mumps-rubella and varicella should be administered 4–8 weeks apart from each other; a booster dose of tetanus, diphtheria and pertussis vaccine should be administered also to subjects fully vaccinated, and a 3-dose primary vaccination series is recommended in AH subjects with unknown or incomplete vaccination series (as in healthy people). Evidence based prevention data support the above recommendations to reduce the risk of infection in AH individuals. PMID:27929751

  7. Anomalous systemic arterial supply of pulmonary sequestration in adult patients

    PubMed Central

    Hou, Xiaomeng; Li, Ji; Li, Jing; Cai, Baiqiang

    2017-01-01

    OBJECTIVES: This study described the characteristics of the systemic arterial supply of pulmonary sequestration (PS) in an attempt to better distinguish PS from other acquired lesions. METHODS: We identified 25 patients hospitalized at the Peking Union Medical College Hospital during January 2013 to December 2015 with the assistance of medical catalogers. Twenty-three patients with a definite diagnosis of “pulmonary sequestration” clinically or pathologically were included in the study. The medical records, imaging information, and pathological data were reviewed retrospectively. The general characteristics of the patients and the features of the anomalous arteries were summarized. RESULTS: Aberrant arterial supply of PS was found in all 23 (100%) cases. Among them, twenty patients received surgery, including 14 (70%) with aberrant arterial supply found before surgery, and the other 6 (30%) found during surgery. Nineteen (82.6%) patients had a single systematic arterial supply, with a median diameter of 8 mm. More than one arterial supplies were found in four (17.4%) cases. In 21 (91.3%) cases, the anomalous systemic artery originated from the descending thoracic aorta just adjacent to the sequestrated lung which it supplied, without the presence of accompanying bronchi. In twenty (87.0%) patients who received the surgical intervention, samples of 12 (85.7%) were proved to have elastic vessel walls, out of the 14 samples in which the anomalous systemic arteries were available for analysis. CONCLUSIONS: There are no certain pathology diagnostic criteria for the diagnosis of PS. The detecting of the aberrant systematic artery and distinguishing it from the bronchial arteries corresponded to certain lung abnormalities are the keys to the accurate diagnosis of pulmonary sequestration in adult patients. We propose that the characteristic features of the anomalous arteries include: Originating from aorta and its main branches, adjacent to the sequestrated area

  8. Use of Procalcitonin for the Detection of Sepsis in the Critically Ill Burn Patient: A Systematic Review of the Literature

    DTIC Science & Technology

    2011-01-01

    01 JUN 2011 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Use of procalcitonin for the detection of sepsis in the critically...1. Introduction Severe burn frequently results in multiple organ dysfunction and sepsis [1]. The cause of death in 28 65% of fatal burn cases...has been attributed to sepsis [2,3]. Yet due to chronic baseline inflammatory response [4] and immune dysregulation [5] the traditional markers of

  9. A review of hydrofluoric acid burn management

    PubMed Central

    McKee, Daniel; Thoma, Achilleas; Bailey, Kristy; Fish, Joel

    2014-01-01

    Hydrofluoric acid (HF) causes a unique chemical burn. Much of the current treatment knowledge of HF burns is derived from case reports, small case series, animal studies and anecdotal evidence. The management can be challenging because clinical presentation and severity of these burns vary widely. Plastic surgeons managing burn patients must have a basic understanding of the pathophysiology, the range of severity in presentation and the current treatment options available for HF burns. The present article reviews the current understanding of the pathophysiology and systemic effects associated with severe HF burns. Furthermore, it distinguishes between minor and life-threatening HF burns and describes several of the basic techniques that are available to treat patients with HF burns. PMID:25114621

  10. Serum Vancomycin Levels Resulting from Continuous or Intermittent Infusion in Critically Ill Burn Patients With or Without Continuous Renal Replacement Therapy

    DTIC Science & Technology

    2012-12-01

    pneumoniae , two (1.9%) were Strepto- coccus viridans, two (1.9%) were Streptococcus aga- lactiae, two (1.9%) were nonenterococcal Group D Streptococci...drug monitoring guidelines for vancomycin were unavailable during this period for infections other than pneumonia , dose adjust- ment to achieve trough...hospital-acquired pneumonia ,7 was generally followed for burn patients with nonpneumo- nia infections out of concern for increased vancomy- cin

  11. Are Adult Patients More Tolerant of Treatment Risks Than Parents of Juvenile Patients?

    PubMed Central

    Johnson, F. Reed; Özdemir, Semra; Mansfield, Carol; Hass, Steven; Siegel, Corey A.; Sands, Bruce E.

    2010-01-01

    Understanding patient-specific differences in risk tolerance for new treatments that offer improved efficacy can assist in making difficult regulatory and clinical decisions for new treatments that offer both the potential for greater effectiveness in relieving disease symptoms, but also risks of disabling or fatal side effects. The aim of this study is to elicit benefit-risk trade-off preferences for hypothetical treatments with varying efficacy and risk levels using a stated-choice (SC) survey. We derive estimates of “maximum acceptable risk” (MAR) that can help decisionmakers identify welfare-enhancing alternatives. In the case of children, parent caregivers are responsible for treatment decisions and their risk tolerance may be quite different than adult patients' own tolerance for treatment-related risks. We estimated and compared the willingness of Crohn's disease (CD) patients and parents of juvenile CD patients to accept serious adverse event (SAE) risks in exchange for symptom relief. The analyzed data were from 345 patients over the age of 18 and 150 parents of children under the age of 18. The estimation results provide strong evidence that adult patients and parents of juvenile patients are willing to accept tradeoffs between treatment efficacy and risks of SAEs. Parents of juvenile CD patients are about as risk tolerant for their children as adult CD patients are for themselves for improved treatment efficacy. SC surveys provide a systematic method for eliciting preferences for benefit-risk tradeoffs. Understanding patients' own risk perceptions and their willingness to accept risks in return for treatment benefits can help inform risk management decision making. PMID:18826414

  12. Respiratory pattern in an adult population of dystrophic patients.

    PubMed

    D'Angelo, M G; Romei, M; Lo Mauro, A; Marchi, E; Gandossini, S; Bonato, S; Comi, G P; Magri, F; Turconi, A C; Pedotti, A; Bresolin, N; Aliverti, A

    2011-07-15

    We studied respiratory function and Chest Wall kinematics in a large population of adult patients affected by slow course muscular dystrophies such as Limb-Girdle Muscular Dystrophy (LGMD, n=38), Becker Muscular Dystrophy (BMD, n=20) and Facio-Scapulo Humeral Dystrophy (FSHD, n=30), through standard spirometry and through the Optoelectronic Plethysmography, to measure the thoraco-abdominal motion during Quiet Breathing and Slow Vital Capacity maneuvers. Within the restrictive pulmonary syndrome characterizing LGMD and FSHD, several different thoraco-abdominal patterns compared to those of healthy subjects were present in the more advanced stages of the disease. These differences were present in the seated position, during the execution of a maximal maneuver such as Slow Vital Capacity. A global respiratory (both inspiratory and expiratory) muscle involvement was more pronounced in the LGMD and FSHD than in the BMD patients, and a significant reduction of abdominal contribution in wheelchair bound patients was observed. In conclusion, OEP technique is able to reveal mild initial modifications in the respiratory muscles in FSHD and LGMD patients, which could be helpful for functional and new therapeutic strategy evaluation.

  13. Interpretation of multiple isolate urine cultures in adult male patients.

    PubMed Central

    Khalifa, M. A.; Abdoh, A. A.; Silva, F. G.; Flournoy, D. J.

    1995-01-01

    A retrospective analytical study examined the records of 220 adult males (mean age 64.9 years) to determine the relative probability that multiple urine culture isolates (MUI) represent urinary tract infection (UTI) versus contamination or colonization. Nonculture laboratory data were used to determine the likelihood of UTI. Patients were classified into three categories: group 1 (those with single isolate cultures; n = 110), group 2 (those with MUI and either symptomatic UTI or an underlying pathologic condition; n = 71) and group 3 (those with MUI and either surgically altered urinary passages or absence of UTI symptoms; n = 39). Nonculture laboratory data suggested UTI in 48.2% of patients in group 1, 46.5% in group 2, and 23.1% in group 3. Patients in groups 1 or 2 with cultures yielding isolate counts of 10(5) colony forming units/mL were 6.2 times more likely to be classified as having a UTI (by nonculture laboratory data) compared with patients having only one or more of these two criteria. This study proposes a more objective approach to interpretation of MUI cultures using the results of nonculture laboratory data, clinical profiles, and colony counts. PMID:7897687

  14. Reliability and validity of the body image quality of life inventory: version for Brazilian burn victims.

    PubMed

    Assunção, Flávia Fernanda Oliveira; Dantas, Rosana Aparecida Spadoti; Ciol, Márcia Aparecida; Gonçalves, Natália; Farina, Jayme Adriano; Rossi, Lidia Aparecida

    2013-06-01

    The aims of this study were to adapt the Body Image Quality of Life Inventory (BIQLI) into Brazilian Portuguese (BP) and to assess the psychometric properties of the adapted version. Construct validity was assessed by correlating the BIQLI-BP scores with the Rosenberg's Self-Esteem Scale, with Burns Specific Health Scale-Revised (BSHS-R), and with gender, total body surface area burned, and visibility of the scars. Participants were 77 adult burn patients. Cronbach's alpha for the adapted version was .90 and moderate linear correlations were found between body image and self-esteem and between BIQLI-BP scores and two domains of the BSHS-R: affect and body image and interpersonal relationships. The BIQLI-BP showed acceptable levels of reliability and validity for Brazilian burn patients.

  15. Burning Man

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2006-01-01

    Former Baltimore cop and teacher Ed Burns isn't a masochist. The writer-producer for "The Wire," a critically applauded HBO series about life and death on the streets of Baltimore, is just feverishly trying to save public schools. He thinks American education is hopelessly screwed up, but that it's also the country's only hope. So it…

  16. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

    PubMed Central

    2014-01-01

    This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

  17. Burn Wise - Outreach Materials

    EPA Pesticide Factsheets

    Burn Wise outreach material. Burn Wise is a partnership program of that emphasizes the importance of burning the right wood, the right way, in the right wood-burning appliance to protect your home, health, and the air we breathe.

  18. Civilian blast-related burn injuries

    PubMed Central

    Patel, J.N.; Tan, A.; Dziewulski, P.

    2016-01-01

    Summary There is limited English literature describing the experience of a civilian hospital managing blast-related burn injuries. As the largest regional burn unit, we reviewed our cases with the aim of identifying means to improve current management. A 6-year retrospective analysis of all patients coded as sustaining blast-related burns was conducted through the unit’s burns database. Medical case notes were reviewed for information on burn demographics, management and outcomes. 42 patients were identified. Male to female ratio was 37:5. Age range was 12-84 years, (mean=33 years). Total body surface area (%TBSA) burn ranged from 0.25% to 60%, (median=1%). The most common burn injury was flame (31/42, 73.8%). Gas explosions were the most common mechanism of injury (19 cases; 45.2%). 7/42 cases (16.7%) had full ATLS management pre-transfer to the burns unit. The Injury Severity Score (ISS) ranged from 0-43 (median=2). 17/42 (40.4%) patients required admission. 37/36 (88.1%) patients were managed conservatively of which 1 patient later required surgery due to deeper burns. 5/42 (11.9%) patients required surgical management at presentation and these were noted to be burns with >15% TBSA requiring resuscitation. One case required emergency escharotomies and finger amputations. All patients survived their burn injuries. Blast-related burn injuries are generally uncommon in the civilian setting. Following proper assessment, most of these cases can be deemed as minor injuries and managed conservatively. Improvement in burns management education and training at local emergency departments would provide efficient patient care and avoid unnecessary referrals to a burns unit. PMID:27857651

  19. Orthodontics in the adult patient, with special reference to the periodontally compromised patient.

    PubMed

    Johal, A; Ide, M

    1999-04-01

    There is increasing demand from adult patients for orthodontic treatment, either purely for aesthetics, to improve aesthetics or function following previous disease, or to facilitate the stabilization, restoration or replacement of teeth. Orthodontics may have a major role in the rehabilitation of patients suffering the effects of advanced periodontal disease, but there are a number of important factors to be considered in the management of such patients if the optimal outcome is to be obtained. This paper summarizes important aspects of treatment and the potential complications and how to avoid them.

  20. Preference for One or Two Hearing Aids among Adult Patients

    PubMed Central

    Cox, Robyn M; Schwartz, Kathryn S.; Noe, Colleen M.; Alexander, Genevieve C.

    2010-01-01

    Objectives Most practitioners believe that use of two hearing aids is the ideal fitting for adults with bilateral symmetrical hearing loss. However, previous research has consistently shown that a substantial proportion of these patients actually prefer to use only one hearing aid. The current study explored whether this pattern of preferences is seen with technologically advanced hearing aids. In addition, a selection of variables that were available pre-fitting were used to attempt to predict which patients will prefer one hearing aid rather than two. Design The study was designed as a 12-week field trial including structured and unstructured use of one and two hearing aids. Ninety-four subjects with mild to moderate bilaterally symmetrical hearing loss were bilaterally fit with 2005-2007 era hearing aids. Potential predictors included demographic, audiometric, auditory lifestyle, personality, and binaural processing variables. After the field trial, each subject stated his/her preference for one or two hearing aids and completed three self-report outcome questionnaires for their preferred fitting. Results Previous research was confirmed with modern technology hearing aids: after the field trial 46% of the subjects preferred to use one hearing aid rather than two. Subjects who preferred two hearing aids tended to report better real-world outcomes than those who preferred one. Subjects who reported more hearing problems in daily life, who experienced more binaural loudness summation, and whose ears were more equivalent in dichotic listening were more likely to prefer to use two hearing aids. Contrary to conventional wisdom (ideas that are generally accepted as true), audiometric hearing loss and auditory lifestyle were not predictive of aiding preference. However, the best predictive approach from these data yielded accurate predictions for only two-thirds of subjects. Conclusions Evidence-based practice calls for a conscientious melding of current evidence

  1. Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy.

    PubMed

    Amani, Hamed; Lozano, Daniel D; Blome-Eberwein, Sigrid

    2012-01-01

    Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. Those suspected of inhalation injury are intubated for airway control. In the English literature, there is a paucity of data discussing the need for intubation. To date, this is the largest study to determine whether intubated patients had inhalation injury as observed by bronchoscopy and whether intubation was necessary. All patient's charts who sustained burns while on home oxygen therapy from May 2000 to May 2010 were retrospectively reviewed (n = 86). Data collected were age, sex, TBSA, ventilator days, length of stay (LOS), and presence or absence of inhalation. Of those patients intubated, a subset analysis was performed to determine whether intubation in the "Field" or "Outside Hospital" correlated with inhalation injury compared with intubation in our Emergency Department. Eighty-six patients (mean age 64 years, mean %TBSA 2.6) were included. Before transfer to the burn unit, 32 patients (37%) were intubated and 52 patients (61%) were not intubated. Of the 32 intubated patients, bronchoscopy confirmed inhalation injury in 12 patients (39%). No significant difference was seen in %TBSA between intubated vs nonintubated patients (3.5 vs 2.0, respectively). However, there was a difference in LOS between the two groups (12.7 vs 2.8, respectively). No difference was found in incidence of inhalation injury between patients intubated in the "Field/Outside Hospital" compared with patients intubated in our Emergency Department (39% and 37.5%, respectively). Between the subgroups, no difference was found in %TBSA, ventilator days, or LOS. One patient admitted for airway observation required intubation and one patient failed extubation

  2. Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients.

    PubMed

    Hoffman, Hunter G; Meyer, Walter J; Ramirez, Maribel; Roberts, Linda; Seibel, Eric J; Atzori, Barbara; Sharar, Sam R; Patterson, David R

    2014-06-01

    For daily burn wound care and therapeutic physical therapy skin stretching procedures, powerful pain medications alone are often inadequate. This feasibility study provides the first evidence that entering an immersive virtual environment using very inexpensive (∼$400) wide field of view Oculus Rift Virtual Reality (VR) goggles can elicit a strong illusion of presence and reduce pain during VR. The patient was an 11-year-old male with severe electrical and flash burns on his head, shoulders, arms, and feet (36 percent total body surface area (TBSA), 27 percent TBSA were third-degree burns). He spent one 20-minute occupational therapy session with no VR, one with VR on day 2, and a final session with no VR on day 3. His rating of pain intensity during therapy dropped from severely painful during no VR to moderately painful during VR. Pain unpleasantness dropped from moderately unpleasant during no VR to mildly unpleasant during VR. He reported going "completely inside the computer generated world", and had more fun during VR. Results are consistent with a growing literature showing reductions in pain during VR. Although case studies are scientifically inconclusive by nature, these preliminary results suggest that the Oculus Rift VR goggles merit more attention as a potential treatment for acute procedural pain of burn patients. Availability of inexpensive but highly immersive VR goggles would significantly improve cost effectiveness and increase dissemination of VR pain distraction, making VR available to many more patients, potentially even at home, for pain control as well as a wide range of other VR therapy applications. This is the first clinical data on PubMed to show the use of Oculus Rift for any medical application.

  3. Human acellular dermal matrix allograft: A randomized, controlled human trial for the long-term evaluation of patients with extensive burns.

    PubMed

    Li, Xueyong; Meng, Xianghai; Wang, Xiaolin; Li, Yuejun; Li, Wangzhou; Lv, Xiaoxing; Xu, Xiaoli; Lei, Zhanjun; Li, Jinqing

    2015-06-01

    The potential of acellular dermal matrix (ADM) to improve cosmetic and functional outcomes has been demonstrated; however, there have been few clinical comparative studies assessing the long-term morphological, histological and functional changes after ADM placement. This study was designed to retrospectively evaluate the long-term outcomes of the cograft acellular dermal matrix with autologous thin split-thickness skin for the coverage of wounds in extensively burned patients. Thirty burn patients treated with a composite graft of ADM with autologous split-thickness skin from January 2007 to December 2009 were enrolled in this study. Another group of thirty patients who received only an autogenous split-thickness skin implant served as the control. Our study revealed that the collagen in the dermis treated with ADM were ordered, and the proportion of collagen III/I was much higher in the control group than in the ADM group. The basement membrane was prominent and continuous. Meanwhile, the VBSS (Vancouver Burn Skin Score) was used to evaluate skin quality, which shows a significant differences between the two group (P<0.001). Then the functional level was evaluated by the BI (Barthel Index), and the ADM group was much better than the control group (P=0.005). Based on these results, we concluded that the composite graft of ADM with autologous thin split-thickness skin was suitable for repairing the defects in functional areas after a burn. This technique might facilitate wound management with acceptable esthetic outcomes, good functional recovery and less scar hyperplasia at the donor site.

  4. Cardiac output after burn injury.

    PubMed Central

    Porter, J. M.; Shakespeare, P. G.

    1984-01-01

    Cardiac output after burn injury has been measured by the non-invasive method of impedance plethysmography. An initial study of 143 normal subjects was undertaken in order to investigate variations in cardiac output with age. Fifteen patients were monitored during resuscitation after extensive burns. Fourteen patients showed a depression of stroke volume below the lower limits of the normal range, derived from the initial study on normal people. PMID:6691694

  5. Burns Caused by Medical Therapy

    DTIC Science & Technology

    2016-06-07

    Insensate skin and chronic medical illness such as diabetes mellitus were common risk factors. The scald potential from hydrotherapy in patients with... diabetic or other neuropathy is well document- cd.46.47 A second group at risk arc patients requiring cutaneous, fusciocuraneous, or myocutancous flap...excrcmity burns related to scnsorv loss in diabetes mellitus. 1 fam Pract 1987;24 (2):149-51. 47. Balakrishnan C, Rak TP, Meininger MS. Burns of the

  6. Car radiator burns: a prevention issue.

    PubMed

    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.

  7. Scrotal tuberculosis in adult patients: a 10-year clinical experience.

    PubMed

    Lee, Ing-Kit; Yang, Wen-Chou; Liu, Jien-Wei

    2007-10-01

    Twenty-nine adults (mean age, 59.9 +/- 13.5 years) with scrotal tuberculosis (TB) were retrospectively analyzed. The mean interval from emergence of symptoms suggestive of scrotal TB to diagnosis established was 142.44 +/- 227.66 days. Scrotal TB was initially suspected in only five (17.2%) patients, and infection caused by bacteria other than Mycobacterium tuberculosis (55.2%) was the leading presumptive diagnosis. Of 28 patients with chest radiographs available, 7 (25%) disclosed active pulmonary TB, and 9 (32.1%) showed a TB scar. All patients received anti-TB chemotherapy; 20 (69%) additionally underwent surgery. Pathologic examination of resected tissue at therapeutic surgery, biopsy, or polymerase chain reaction assay of urine led to rapid diagnosis of scrotal TB. Although evidence of scrotal TB was easily obtainable, the lack of alertness made clinicians avert from the appropriate diagnostic approaches and rendered a delayed diagnosis. Our report underscores the urgent need for improving clinicians' awareness of scrotal TB.

  8. Staphylococcus aureus isolated from tonsillectomized adult patients with recurrent tonsillitis.

    PubMed

    Katkowska, Marta; Garbacz, Katarzyna; Stromkowski, Józef

    2017-01-01

    The aim of this study was to analyze the prevalence and antibiotic resistance of Staphylococcus aureus strains from 118 tonsillectomized adults due to recurrent tonsillitis (RT). The study included strains isolated from the tonsillar surface prior to tonsillectomy, recovered from the tonsillar core at the time of surgery, and from the posterior throat 2-4 weeks after the procedure. Susceptibility of isolates to 19 antibiotics was tested in line with the Clinical and Laboratory Standards Institute recommendations. Irrespective of the stage, the most commonly isolated bacteria were gram-positive cocci, and among them S. aureus. The tonsillar core was the most common site of S. aureus isolation (30.5%), followed by the tonsillar surface (10.8%) and the posterior pharynx (5.9%). This difference turned out to be statistically significant (p < 0.001). Beta-hemolytic streptococci, most often Streptococcus pyogenes (5.1%), were isolated from 2.5% to 10.2% of patients. Staphylococcal isolates were susceptible to most tested antibiotics (except from penicillin and ampicillin) and rarely showed methicillin resistance (n = 1). Staphylococcus aureus seems to be the most common pathogen isolated from patients tonsillectomized due to RT. Staphylococcal isolates associated with RT are present mostly within the tonsillar core and susceptible to most antibiotics. They are typically isolated from patients between 21 and 30 years of age. Tonsillectomy results in less frequent isolation of S. aureus strains.

  9. Cephalometric appraisal of posttreatment vertical changes in adult orthodontic patients.

    PubMed

    Ahn, J G; Schneider, B J

    2000-10-01

    The purpose of this study was to evaluate vertical facial changes in adult orthodontic patients and to evaluate the stability of these changes. Thirty-three patients (8 males and 25 females) were examined. The patients had been treated with full fixed edgewise appliance mechanics and exhibited at least 1.0 degrees of clockwise rotation of the mandible during treatment. Mandibular rotation was determined by the angular change in the Y-axis to the Frankfort plane. Twelve angular and 14 linear skeletal and dental measurements and 3 skeletal ratios were derived from pretreatment (T1), posttreatment (T2), and postretention (T3) cephalometric radiographs. Paired t tests were used to compare vertical changes that occurred as a result of orthodontic treatment and their stability or relapse tendency during the retention and postretention periods. Twenty-five percent (P <.001) of the opening rotation of the mandible recovered during the posttreatment period, resulting in a significant overall rotation that was maintained. Both treatment and posttreatment changes in the Y-axis angle showed a high correlation with the horizontal position of pogonion (r = -0.797 and -0.889, respectively). Only overjet showed a low correlation between treatment changes and posttreatment changes in the Y-axis angle. Stepwise regression analysis of pretreatment variables and treatment changes failed to predict the behavior of the Y-axis angle change.

  10. Humidification during Mechanical Ventilation in the Adult Patient

    PubMed Central

    Al Ashry, Haitham S.; Modrykamien, Ariel M.

    2014-01-01

    Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions. PMID:25089275

  11. [Hydrofluoric acid burns].

    PubMed

    Holla, Robin; Gorter, Ramon R; Tenhagen, Mark; Vloemans, A F P M Jos; Breederveld, Roelf S

    2016-01-01

    Hydrofluoric acid is increasingly used as a rust remover and detergent. Dermal contact with hydrofluoric acid results in a chemical burn characterized by severe pain and deep tissue necrosis. It may cause electrolyte imbalances with lethal consequences. It is important to identify high-risk patients. 'High risk' is defined as a total affected body area > 3% or exposure to hydrofluoric acid in a concentration > 50%. We present the cases of three male patients (26, 31, and 39 years old) with hydrofluoric acid burns of varying severity and describe the subsequent treatments. The application of calcium gluconate 2.5% gel to the skin is the cornerstone of the treatment, reducing pain as well as improving wound healing. Nails should be thoroughly inspected and possibly removed if the nail is involved, to ensure proper healing. In high-risk patients, plasma calcium levels should be evaluated and cardiac monitoring is indicated.

  12. Heating pad burns in anesthetic skin.

    PubMed

    Stevenson, T R; Hammond, D C; Keip, D; Argenta, L C

    1985-07-01

    Patients requiring reconstruction by muscle or musculocutaneous flaps often have an associated area of skin anesthesia. This skin is susceptible to trauma because of its insensibility. This study reports 3 cases in which patients sustained deep partial-thickness burns of anesthetic skin following flap reconstruction. All burns healed by reepithelialization. Following flap reconstruction, patients should be warned regarding the use of heating pads. Burns of this type represent a preventable complication of flap reconstruction.

  13. Exercise behaviors after burn injury.

    PubMed

    Baldwin, Jennifer; Li, Frank

    2013-01-01

    The purpose of this study was to investigate exercise behaviors in adult burn survivors and to identify barriers to exercise in this population. A two-page questionnaire developed by the authors was administered on a single occasion to adults attending the ambulatory burns clinic at a metropolitan hospital. Data from 68 adult burn survivors were analyzed. Within this cohort, 59% of subjects reported exercising several times per week or more and the remaining 41% exercised once per week or less. There was no correlation among exercise frequency and age, TBSA, or hospital length of stay. Walking was the most common type of exercise, and subjects reported lower compliance with stretching and strengthening exercises. Physical condition and motivation were identified as the main barriers to exercise. Although this preliminary study reveals that a higher proportion of burn survivors engage in exercise compared with their healthy counterparts, a substantial number are exercising just once per week or less, below the recommended guidelines to improve physical fitness. Physical and occupational therapists play an important role in providing exercise prescription and education, as well as addressing barriers to exercise in burn survivors. The potential for further research into physical activity across all domains of life using a validated questionnaire is identified.

  14. Population Pharmacokinetics of Benznidazole in Adult Patients with Chagas Disease

    PubMed Central

    Aldasoro, E.; Guerrero, L.; Posada, E.; Serret, N.; Mejía, T.; Urbina, J. A.; Gascón, J.

    2015-01-01

    The aim of the present study was to build a population pharmacokinetic (popPK) model to characterize benznidazole (BNZ) pharmacokinetics in adults with chronic Chagas disease. This study was a prospective, open-label, single-center clinical trial approved by the local ethics committee. Patients received BNZ at 2.5 mg/kg of body weight/12 h (Abarax, Elea Laboratory, Argentina) for 60 days. Plasma BNZ samples were taken several times during the study and analyzed by high-performance liquid chromatography with UV-visible detection (HPLC-UV). The popPK analysis was done with NONMEMv.7.3. Demographic and biological data were tested as covariates. Intraindividual, interoccasion, and residual variabilities were modeled. Internal and external validations were completed to assess the robustness of the model. Later on, simulations were performed to generate BNZ concentration-time course profiles for different dosage regimens. A total of 358 plasma BNZ concentrations from 39 patients were included in the analysis. A one-compartment PK model characterized by clearance (CL/F) and the apparent volume of distribution (V/F), with first-order absorption (Ka) and elimination, adequately described the data (CL/F, 1.73 liters/h; V/F, 89.6 liters; and Ka, 1.15 h−1). No covariates were found to be significant for CL/F and V/F. Internal and external validations of the final model showed adequate results. Data from simulations revealed that a dose of 2.5 mg/kg/12 h might lead to overexposure in most patients. A lower dose (2.5 mg/kg/24 h) was able to achieve trough BNZ plasma concentrations within the accepted therapeutic range of 3 to 6 mg/liter. In summary, we developed a population PK model for BNZ in adults with chronic Chagas disease. Dosing simulations showed that a BNZ dose of 2.5 mg/kg/24 h will adequately keep BNZ trough plasma concentrations within the recommended target range for the majority of patients. (This study has been registered at EudraCT under number 2011

  15. Burn prevention in Zambia: a targeted epidemiological approach.

    PubMed

    Heard, Jason P; Latenser, Barbara A; Liao, Junlin

    2013-01-01

    The aim of this study is to assess primary burn prevention knowledge in a rural Zambian population that is disproportionately burdened by burn injuries. A 10-question survey was completed by youths, and a 15-question survey was completed by adults. The survey was available in both English and Nyanja. The surveys were designed to test their knowledge in common causes, first aid, and emergency measures regarding burn injuries. Logistic regression analysis was used to explore relationships between burn knowledge, age, school, and socioeconomic variables. A burn prevention coloring book, based on previous local epidemiological data, was also distributed to 800 school age youths. Five hundred fifty youths and 39 adults completed the survey. The most significant results show knowledge deficits in common causes of burns, first aid treatment of a burn injury, and what to do in the event of clothing catching fire. Younger children were more likely to do worse than older children. The adults performed better than the youths, but still lack fundamental burn prevention and treatment knowledge. Primary burn prevention data from the youths and adults surveyed demonstrate a clear need for burn prevention and treatment education in this population. In a country where effective and sustainable burn care is lacking, burn prevention may be a better investment to reduce burn injury than large investments in healthcare resources.

  16. Assault by burning in Jordan.

    PubMed

    Haddadin, W

    2012-12-31

    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.

  17. Firework injuries presenting to a national burn's unit.

    PubMed

    Jones, D; Lee, W; Rea, S; Donnell, M O; Eadie, P A

    2004-09-01

    The sale to the general public of fireworks is illegal in Ireland. However, many fireworks are readily available on the black market from illegal traders. The number of firework injuries presenting to our unit during the three week run-up to Hallowe'en October 2001 was recorded. In addition, each patient was contacted to determine how the fireworks were obtained, the average amount of money spent, and the level of adult supervision present at the time of injury. A total of 19 patients presented, 18 from the local catchment area, with a mean age of 16 yrs (range 5-46 yrs). Thirteen patients required admission. Sixteen patients sustained hand injuries including burns, and three sustained burns to other body areas. The amount of money spent varied between adults and children, the average amount among the paediatric group was Euro 2-4, but Euro 45 in the adult group. None were willing to identify the local source of their fireworks, but most fireworks originated in Northern Ireland. This small review highlights an ongoing problem in Ireland; fireworks are illegal, yet they are easily and cheaply available without quality or safety controls. Our public awareness campaign has failed to reach its target audience, and the illegal traders who sell these often inferior products are seldom charged. Children and adults will continue to sustain serious injuries as a result.

  18. Management of burns in the elderly

    PubMed Central

    Abu-Sittah, G.S.; Chahine, F.M.; Janom, H.

    2016-01-01

    Summary Burns are one of the most devastating forms of trauma worldwide. While geriatric burns are uncommon in the developing world - accounting for less than 5% of burns in South Asian and Middle Eastern countries - they account for almost 20% of burns in economically developed countries such as the USA. The elderly population in general is at higher risk for burn injury, moreover mortality rate, as well as severity of complications, is more pronounced in this group of patients. A review of the literature was conducted to evaluate risk factors as well as pathophysiological and immunological conditions that affect response to burn injury in the elderly population. Surgical and medical interventions used for the management of geriatric burns remain a field of controversy and ongoing debate. Improvement of burn management with reduction in mortality in this age group warrants addressing survivors’ quality of life, with a special focus on rehabilitation and support. PMID:28289356

  19. Relationship between perceived sleep and polysomnography in older adult patients

    PubMed Central

    dos Santos Silva, Mayra; Bazzana, Caroline Moreira; de Souza, Altay Lino; Ramos, Luiz Roberto; Tufik, Sergio; Lucchesi, Lígia M.; Lopes, Guiomar Silva

    2015-01-01

    Background and aims Aging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep. Objective The objective of this study was to use polysomnography to compare sleep reported by senior citizens. Methods We selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography. Results The results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001). Conclusion These results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography. PMID:26483948

  20. Metabolic aspects of adult patients with nonalcoholic fatty liver disease

    PubMed Central

    Abenavoli, Ludovico; Milic, Natasa; Di Renzo, Laura; Preveden, Tomislav; Medić-Stojanoska, Milica; De Lorenzo, Antonino

    2016-01-01

    Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease and it encompasses a spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved in the occurrence of NAFLD and its progression are probably due to a metabolic profile expressed within the context of a genetic predisposition and is associated with a higher energy intake. The metabolic syndrome (MS) is a cluster of metabolic alterations associated with an increased risk for the development of cardiovascular diseases and diabetes. NAFLD patients have more than one feature of the MS, and now they are considered the hepatic components of the MS. Several scientific advances in understanding the association between NAFLD and MS have identified insulin resistance (IR) as the key aspect in the pathophysiology of both diseases. In the multi parallel hits theory of NAFLD pathogenesis, IR was described to be central in the predisposition of hepatocytes to be susceptible to other multiple pathogenetic factors. The recent knowledge gained from these advances can be applied clinically in the prevention and management of NAFLD and its associated metabolic changes. The present review analyses the current literature and highlights the new evidence on the metabolic aspects in the adult patients with NAFLD. PMID:27610012

  1. Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis

    PubMed Central

    Lin, Ann Hsu-An; Kendrick, Jennifer G; Wilcox, Pearce G; Quon, Bradley S

    2017-01-01

    Background and objectives Patient knowledge of lung function (ie, forced expiratory volume in 1 s [FEV1]% predicted) and the intended benefits of their prescribed pulmonary medications might play an important role in medication adherence, but this relationship has not been examined previously in patients with cystic fibrosis (CF). Methods All patients diagnosed with CF and without prior lung transplantation were invited to complete knowledge and self-reported medication adherence questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul’s Hospital, Vancouver, Canada from June 2013 to August 2014. Results A total of 142 out of 167 (85%) consecutive adults attending CF clinic completed patient knowledge and medication adherence survey questionnaires. Sixty-four percent of the patients recalled their last FEV1% predicted value within 5%, and 70% knew the intended benefits of all their prescribed medications. Self-reported adherence rates were highest for inhaled antibiotics (81%), azithromycin (87%), and dornase alpha (76%) and lowest for hypertonic saline (47%). Individuals who knew their FEV1% predicted value within 5% were more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06) and inhaled antibiotics (88% vs 64%, P=0.06) compared to those who did not, but these associations were not statistically significant. There were no significant associations observed between patient knowledge of intended medication benefits and self-reported medication adherence. Conclusion Contrary to our hypothesis, disease- and treatment-related knowledge was not associated with self-reported medication adherence. This suggests other barriers to medication adherence should be targeted in future studies aiming to improve medication adherence in adults with CF.

  2. A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

    PubMed Central

    2013-01-01

    Introduction The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion. Methods We conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m2 and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test. Results A total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m2) and the ITBVI (709 ± 254 mL/m2). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m2). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels. Conclusions Initial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood

  3. [Some aspects of the orthodontic-prosthetic approach for adult patients. A case report].

    PubMed

    Fábián, G; Gáspár, J; Fábián, T K

    2000-08-01

    Authors present a case report of an adult patient treated with the combination of orthodontic and prosthetic treatment methods. The importance of periodontal and psychological management of such patients is pointed out.

  4. Game-based mass casualty burn training.

    PubMed

    Kurenov, Sergei N; Cance, William W; Noel, Ben; Mozingo, David W

    2009-01-01

    An interactive, video game-based training module, Burn Center, was developed to simulate the real-life emergency events of a mass casualty disaster scenario, involving in 40 victims.The game contains two components - triage and resuscitation. The goal of the triage game is to correctly stabilize, sort, tag and transport burn victims during a mass casualty event at a busy theme park. After complete the triage component, the player will then take on the role of a burn care provider, balancing the clinical needs of multiple burn patients through a 36-hour resuscitation period, using familiar computer-simulated hospital devices. Once complete, players of Burn Center will come away with applicable skills and knowledge of burn care, for both field triage and initial resuscitation of the burn patients.

  5. Effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection

    PubMed Central

    Zhang, Yu; Gu, Fang; Wang, Fengxian; Zhang, Yuanda

    2016-01-01

    Objective: To evaluate the effects of early enteral nutrition on the gastrointestinal motility and intestinal mucosal barrier of patients with burn-induced invasive fungal infection. Methods: A total of 120 patients with burn-induced invasive fungal infection were randomly divided into an early enteral nutrition (EN) group and a parenteral nutrition (PN) group (n=60). The patients were given nutritional support intervention for 14 days, and the expression levels of serum transferrin, albumin, total protein, endotoxin, D-lactic acid and inflammatory cytokines were detected on the 1st, 7th and 14th days respectively. Results: As the treatment progressed, the levels of serum transferrin, albumin and total protein of the EN group were significantly higher than those of the PN group (P<0.05), while the levels of serum endotoxin and D-lactic acid of the form group were significantly lower (P<0.05). After treatment, the expression levels of IL-6 and TNF-α were decreased in the EN group, which were significantly different from those of the PN group (P<0.05). During treatment, the incidence rates of complications such as abdominal distension, diarrhea, sepsis, nausea, vomiting and gastric retention were similar. The mean healing time of wound surface was 9.34±0.78 days in the EN group and 12.46±2.19 days in the PN group, i.e. such time of the former was significantly shorter than that of the latter (P<0.05). Conclusion: Treating patients having burn-induced invasive fungal infection by early enteral nutrition support with arginine can safely alleviate malnutrition and stress reaction, strengthen cellular immune function and promote wound healing, thereby facilitating the recovery of gastrointestinal motility and the function of intestinal mucosal barrier. PMID:27375697

  6. The Burn Wound Microenvironment

    PubMed Central

    Rose, Lloyd F.; Chan, Rodney K.

    2016-01-01

    Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice. PMID:26989577

  7. Rasch Measurement in the Assessment of Growth Hormone Deficiency in Adult Patients.

    ERIC Educational Resources Information Center

    Prieto, Luis; Roset, Montse; Badia, Xavier

    2001-01-01

    Tested the metric properties of a Spanish version of the Assessment of Growth Hormone Deficiency in Adults (AGHDA) questionnaire through Rasch analysis with a sample of 356 adult patients in Spain. Results suggest that the Spanish AGHDA could be a useful complement of the clinical evaluation of growth hormone deficiency patients at group and…

  8. Warming up Improves Speech Production in Patients with Adult Onset Myotonic Dystrophy

    ERIC Educational Resources Information Center

    de Swart, B.J.M.; van Engelen, B.G.M.; Maassen, B.A.M.

    2007-01-01

    This investigation was conducted to study whether warming up decreases myotonia (muscle stiffness) during speech production or causes adverse effects due to fatigue or exhaustion caused by intensive speech activity in patients with adult onset myotonic dystrophy. Thirty patients with adult onset myotonic dystrophy (MD) and ten healthy controls…

  9. Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi.

    PubMed

    Ali, S A; Hamiz-Ul-Fawwad, S; Al-Ibran, E; Ahmed, G; Saleem, A; Mustafa, D; Hussain, M

    2016-03-31

    Burn injuries are a leading cause of morbidity and mortality, with 195,000 deaths annually. This study was conducted to identify the demographics of burn victims and the effect of different variables on the outcome of their injuries. 4016 patients admitted to the Burns Centre, Civil Hospital Karachi from January 2006 to December 2011 were retrospectively analyzed. Demographics, burn injury details and their outcome were recorded in a pre-designed questionnaire. Injuries were categorized as: fire, chemical, scald or electrical. To estimate total body surface area (TBSA) burned in adults, the rule of nines was used. For children and infants, the Lund-Browder chart was employed. SPSS v16.0 software was used for analysis. Frequencies and percentages of all variables, and the measure of central tendencies and dispersion for continuous variables were calculated. Cross tabs were used to assess mortality. Mean age was 28.13 years. More than half of the cases (n=2337, 58.2%) were aged between 16-30 years. Labourers, housewives and students were the most commonly affected groups. Burn injuries by flame/fire and electricity were most common. Most cases were accidental, followed by suicide attempts and homicides. Mean percentage of TBSA affected was 35.49%. Mean duration of hospital stay was 16.45 days. 50.6% of the expired cases were females. The mean age of expired patients was 30.07 while for patients who survived it was 27.01 years. The outcome of burn injuries is related to various demographic factors. Female gender, increasing age, burn injuries following suicide attempts and greater surface area involvement predict poor outcome.

  10. Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi

    PubMed Central

    Ali, S.A.; Hamiz-ul-Fawwad, S.; Al-Ibran, E.; Ahmed, G.; Saleem, A.; Mustafa, D.; Hussain, M.

    2016-01-01

    Summary Burn injuries are a leading cause of morbidity and mortality, with 195,000 deaths annually. This study was conducted to identify the demographics of burn victims and the effect of different variables on the outcome of their injuries. 4016 patients admitted to the Burns Centre, Civil Hospital Karachi from January 2006 to December 2011 were retrospectively analyzed. Demographics, burn injury details and their outcome were recorded in a pre-designed questionnaire. Injuries were categorized as: fire, chemical, scald or electrical. To estimate total body surface area (TBSA) burned in adults, the rule of nines was used. For children and infants, the Lund-Browder chart was employed. SPSS v16.0 software was used for analysis. Frequencies and percentages of all variables, and the measure of central tendencies and dispersion for continuous variables were calculated. Cross tabs were used to assess mortality. Mean age was 28.13 years. More than half of the cases (n=2337, 58.2%) were aged between 16-30 years. Labourers, housewives and students were the most commonly affected groups. Burn injuries by flame/fire and electricity were most common. Most cases were accidental, followed by suicide attempts and homicides. Mean percentage of TBSA affected was 35.49%. Mean duration of hospital stay was 16.45 days. 50.6% of the expired cases were females. The mean age of expired patients was 30.07 while for patients who survived it was 27.01 years. The outcome of burn injuries is related to various demographic factors. Female gender, increasing age, burn injuries following suicide attempts and greater surface area involvement predict poor outcome. PMID:27857643

  11. Smartphones and burn size estimation: "Rapid Burn Assessor".

    PubMed

    Kamolz, L P; Lumenta, D B; Parvizi, D; Dirnberger, J; Owen, R; Höller, J; Giretzlehner, M

    2014-06-30

    Estimation of the total body surface area burned (%TBSA) following a burn injury is used in determining whether to transfer the patient to a burn center and the required fluid resuscitation volumes. Unfortunately, the commonly applied methods of estimation have revealed inaccuracies, which are mostly related to human error. To calculate the %TBSA (quotient), it is necessary to divide the burned surface area (Burned BSA) (numerator in cm2) by the total body surface area (Total BSA) (denominator in cm2). By using everyday objects (eg. credit cards, smartphones) with well-defined surface areas as reference for estimations of Burned BSA on the one hand and established formulas for Total BSA calculation on the other (eg. Mosteller), we propose an approximation method to assess %TBSA more accurately than the established methods. To facilitate distribution, and respective user feedback, we have developed a smartphone app integrating all of the above parameters, available on popular mobile device platforms. This method represents a simple and ready-to-use clinical decision support system which addresses common errors associated with estimations of Burned BSA (=numerator). Following validation and respective user feedback, it could be deployed for testing in future clinical trials. This study has a level of evidence of IV and is a brief report based on clinical observation, which points to further study.

  12. First Aid: Burns

    MedlinePlus

    ... Your 1- to 2-Year-Old First Aid: Burns KidsHealth > For Parents > First Aid: Burns A A A Scald burns from hot water and other liquids are the most common burns in early childhood. Because burns range from mild ...

  13. The use of immunonutrition in burn injury care: where are we?

    PubMed

    Kurmis, Rochelle; Parker, Andrea; Greenwood, John

    2010-01-01

    The aim of this study is to review the current evidence for immunonutrition use in patients with burn injury. Nutrients of interest included glutamine, arginine, and omega-3 fatty acids (fish oil). A literature review was conducted to identify studies that evaluated the use of immunonutrients in pediatric and adult patients with burn injury. Search terms included burns, immunonutrition, pharmaconutrition, glutamine, arginine, omega-3, and fish oil. Glutamine: Nine randomized controlled trials (four represented in abstract only) investigating enteral supplementation and two trials investigating parenteral supplementation of glutamine were identified. Arginine: Five trials investigating the effect of arginine supplementation were identified (three represented in abstract only). Omega-3 fatty acids: Three studies investigating the effect of enteral fish oil supplementation were identified (one represented in abstract only). Combined immunonutrients: Six studies were identified that investigated immunonutrients as a combination of active dietary constituents (rather than as individual nutrients). Despite the semiessential nature of arginine after burn injury, there were surprisingly little data regarding nutritional supplementation. Literature around supplementation of omega-3 fatty acids is found to be lacking in the burn injury population. The combination of immunonutrients as a component of enteral formulae limits identification of the active nutrient and ideal dosage. Current evidence supports the use of enteral glutamine supplementation for patients with severe burn injuries. Questions remain regarding dosage, timing, and length of supplementation.

  14. Chemical Debridement of Burns

    PubMed Central

    Levenson, Stanley M.; Kan, Dorinne; Gruber, Charles; Crowley, Leo V.; Lent, Richard; Watford, Alvin; Seifter, Eli

    1974-01-01

    The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. The usefulness and limitations of surgical excision for patients with extensive third degree burns are discussed. Chemical debridement lends itself to complementary use with surgical excision and has the potential advantage over surgical excision in not requiring anesthesia or a formal surgical operation. The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme21 and Travase.39,48 It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and

  15. Localized Tetanus in an Adult Patient: Case Report

    PubMed Central

    Gulamhussein, Mohamed Amirali; Li, Yueyang; Guha, Abhijit

    2016-01-01

    Introduction: Tetanus is a severe and potentially fatal infection caused by the bacterium Clostridium tetani. Of all the cases described in literature, generalized tetanus is by far the most common presentation, but it may also present as neonatal tetanus, cephalic tetanus, and localized tetanus, the latter two being much rarer. In this case report, we present the rare form of this disease, i.e., localized tetanus in an adult male with a history of minimal trauma as well as a late, unusual mode of presentation. Case Report: A 35-year-old Caucasian male presented with an acutely painful, swollen right thumb associated with a small superficial collection on the dorsal aspect of the base of the thumb. A formal wound exploration and washout were carried out in theater, however, at the time of tourniquet inflation, the right hand went into a carpopedal spasm and remained in that position until an infusion of a muscle relaxant was given. The findings were consistent with a case of localized tetanus. The patient was treated with human immunoglobulin and tetanus toxoid and safely discharged home 48 h later without any complications. Conclusion: This case report emphasizes the importance of the recognition of a rare form of this fatal infectious disease, which may present with prodromal symptoms before the generalized form shows its clinical effects. Moreover, the astute clinician should be aware of the variable presentations of this infectious disease, with early identification greatly reducing the associated risks of morbidity and mortality. PMID:28164065

  16. Antibiotic prophylaxis against infective endocarditis in adult and child patients

    PubMed Central

    Al-Fouzan, Afnan F.; Al-Shinaiber, Rafif M.; Al-Baijan, Refal S.; Al-Balawi, Mohammed M.

    2015-01-01

    Objectives: To evaluate dentists’ knowledge regarding the prevention of infective endocarditis in Saudi Arabia and their implementation of the 2007 American Heart Association guidelines. Methods: In this cross-sectional study, in March 2014, 801 dentists who practice in different regions of Saudi Arabia completed a questionnaire regarding the need for antibiotic prophylaxis for specific cardiac conditions and specific dental procedures, prophylaxis regimens in adults and children, and recommendations for patients on chronic antibiotics, and in dental emergencies. The data were analyzed using one-way analyses of variance (ANOVAs) and independent t-tests, and a p-value <0.05 was considered statistically significant. Results: The total knowledge level regarding antibiotic prophylaxis among all participants was 52.2%, with a significant difference between dentists who graduated before and after 2007. Comparing the level of knowledge among different dental specialists, surgeons and periodontists had the highest level of knowledge regarding the use of antibiotic prophylaxis. Amoxicillin was prescribed as the drug of choice by 63.9% of the participants. Conclusion: This study emphasized the need for continuous education and for formal inclusion of the guidelines in the students’ curriculum, as well as for strategic placement of the guidelines in locations throughout dental clinics. PMID:25935175

  17. Burning Mouth Syndrome: update.

    PubMed

    Spanemberg, Juliana Cassol; Rodríguez de Rivera Campillo, Eugenia; Salas, Enric Jané; López López, José

    201