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Sample records for adult burn patients

  1. Propranolol Dosing Practices in Adult Burn Patients: Implications for Safety and Efficacy.

    PubMed

    Brown, David A; Gibbons, Janet; Honari, Shari; Klein, Matthew B; Pham, Tam N; Gibran, Nicole S

    2016-01-01

    Studies in children with burn injuries have demonstrated that propranolol improves metabolism and reduces muscle protein wasting. However, safety and efficacy in adults are less well established than in children. The purpose of this study was to determine safety of propranolol use in adult patients with burn injuries. Medical records were reviewed for burn-injured adults receiving propranolol. Patients between 18 and 65 years old and with ≥20% TBSA burn were included. Fifty-four patients met the criteria with mean age of 37 years and mean burn size of 38% TBSA. Propranolol dosages ranged from 0.1 to 3.8 mg/kg/day, with an average maximum dosage of 0.61 mg/kg/day. Mean heart rate decreased by 25% during 4 weeks. Seventy-two percent of patients experienced at least one episode of hypotension and 15% experienced bradycardia. Propranolol doses were most frequently held for low blood pressure; 32% of patients had at least one dose held for hypotension. This retrospective analysis suggests that modest dosing of propranolol results in frequent episodes of hypotension or bradycardia. Our data suggest that adults do not tolerate the higher doses reported in a pediatric population. Despite potential beneficial anti-catabolic effects of propranolol, burn care providers must recognize potential iatrogenic hemodynamic effects of this intervention. Our data support the need for prospective multicenter studies to delineate the safety and efficacy of propranolol in adult burn-injured patients. PMID:25882517

  2. Temporal Cytokine Profiles in Severely Burned Patients: A Comparison of Adults and Children

    PubMed Central

    Finnerty, Celeste C; Jeschke, Marc G; Herndon, David N; Gamelli, Richard; Gibran, Nicole; Klein, Matthew; Silver, Geoff; Arnoldo, Brett; Remick, Daniel; Tompkins, Ronald G

    2008-01-01

    A severe burn leads to hypermetabolism and catabolism resulting in compromised function and structural changes of essential organs. The release of cytokines has been implicated in this hypermetabolic response. The severity of the hypermetabolic response following burn injury increases with age, as does the mortality rate. Due to the relationship between the hypermetabolic and inflammatory responses, we sought to compare the plasma cytokine profiles following a severe burn in adults and in children. We enrolled 25 adults and 24 children who survived a flame burn covering more than 20% of total body surface area (TBSA). The concentrations of 22 cytokines were measured using the Linco multiplex array system (St. Charles, MO, USA). Large perturbations in the expression of pro- and anti-inflammatory cytokines were seen following thermal injury. During the first week following burn injury, IFN-γ, IL-10, IL-17, IL-4, IL-6, and IL-8 were detected at significantly higher levels in adults compared with children, P < 0.05. Significant differences were measured during the second week post-burn for IL-1β (higher in children) and IL-5 (higher in adults), P < 0.05. IL-18 was more abundant in children compared with adults during the third week post-burn, P < 0.05. Between post-burn d 21 and d 66, IL-1α was detected at higher concentrations in pediatric compared with adult patients, P < 0.05. Only GM-CSF expression was significantly different at all time points; it was detected at lower levels in pediatric patients, P < 0.05. Eotaxin, G-CSF, IL-13, IL-15, IP-10, MCP-1, and MIP-1α were detected at significantly different concentrations in adult compared with pediatric patients at multiple time points, P < 0.05. There were no differences in IL-12, IL-2, IL-7, or TNF levels in adult compared with pediatric burn patients at any of these time points. Following severe flame burns, the cytokine profiles in pediatric patients differ compared with those in adult patients, which may

  3. Staphylococcal superantigens and toxins are detectable in the serum of adult burn patients.

    PubMed

    Prindeze, Nicholas J; Amundsen, Bethany M; Pavlovich, Anna R; Paul, Dereck W; Carney, Bonnie C; Moffatt, Lauren T; Shupp, Jeffrey W

    2014-07-01

    Bacterial infection in burn patients is still a devastating contributor to morbidity and mortality. Little is known regarding the presence of staphylococcal toxins in the burn-injured patient. The aim of this study was to characterize the prevalence of several of these toxins and their relationship to clinical metrics and mortality in burn patients. Levels of exotoxins staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B, toxic shock syndrome toxin 1 (TSST-1), and α-hemolysin were assayed from the serum of 207 adult burn patients aged 16-92 years. Clinical, demographic, and microbiological data from these patients were then compared to toxin levels. Staphylococcal exotoxins α-hemolysin and SEA were present in 45% and 25% of the population, respectively. Bacterial cultures concomitantly showed a high prevalence of Staphylococcus aureus in 48% of patients, of which 59% were methicillin resistant. Several metrics may be predictive of high toxin concentrations of α-hemolysin and TSST-1 and SEA including burn size, length of stay, and bacteremia. Mortality associations indicated that burn size, bacteremia, age, and the presence of α-hemolysin and SEA may be predictors of mortality. A high prevalence of staphylococcal toxin α-hemolysin and superantigens TSST-1 and SEA can be found in the circulation of the adult burn population. The presence of these toxins may contribute to the morbidity and mortality of the burn patient. PMID:24809857

  4. Gram Negative Wound Infection in Hospitalised Adult Burn Patients-Systematic Review and Metanalysis-

    PubMed Central

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

    2014-01-01

    Background Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. Methods Studies investigating adult hospitalised patients (2000–2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. Primary Findings Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens’ incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). Interpretation Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative “target organisms” facilitate clinical practice and target research towards a defined clinical demand. PMID:24751699

  5. [Nursing diagnoses for family members of adult burned patients near hospital discharge].

    PubMed

    Goyatá, Sueli Leiko Takamatsu; Rossi, Lídia Aparecida; Dalri, Maria Célia Barcellos

    2006-01-01

    This study aimed to identify the nursing diagnoses for family members of adult burned patients in the period near hospital discharge. We evaluated 10 family members of burned patients through interviews and observation. The nursing diagnoses were established on the basis of the NANDA International Taxonomy II and on Carpenito's interpretation of the NANDA Taxonomy I. We identified 11 different diagnosis categories, all of which were real. The most frequent diagnoses among the family members under analysis were knowledge deficit and anxiety. The former was characterized by the family members' need for information about care for the burned areas and infection prevention. The feeling of anxiety was mainly related to the changes in the appearance, structure or function of the burned patient's body and to the family members' expectations with respect to the patient's return to the family and work environment, accompanied by some physical, psycho-emotional or social consequence. PMID:16532246

  6. The use of arts and crafts in the rehabilitation of the adult burn patient.

    PubMed

    Sanford, S L; Cash, S H; Nelson, C

    1995-01-01

    The purpose of this study was to gain insight into one small aspect of occupational therapy: the use of arts and crafts in the rehabilitation of the adult burn patient. While burn care literature is plentiful, that related specifically to occupational therapy treatment of burn patients is scarce. A survey was mailed to occupational therapists in 165 burn units across the United States. Responses to survey questions indicate that a majority of respondents (73%%) do not use arts and crafts in the rehabilitation of adult burn patients, while 26%% do use these modalities. Those respondents who do use arts and crafts stated that they use leatherwork, painting, and woodworking most frequently. Therapists who do not use arts and crafts indicated that their primary reasons for not doing so were the acutely ill status of the patients and wound drainage/sterility issues. The entire scope of occupational therapy treatment of burn patients deserves greater attention as it is a challenging and rapidly-evolving area of practice. PMID:23947587

  7. Relations among arginine, citrulline, ornithine, and leucine kinetics in adult burn patients.

    PubMed

    Yu, Y M; Ryan, C M; Burke, J F; Tompkins, R G; Young, V R

    1995-11-01

    Plasma fluxes of arginine, citrulline, and leucine, and the rate of conversion of labeled citrulline to arginine (Qcit-->arg) were determined in nine severely burned patients (mean: 56% body surface burn area, mean 10 d postinjury) while they received total parenteral nutrition (TPN) including an L-amino acid mixture that supplied a generous amount of nitrogen (mean: 0.39 +/- 0.02 g.kg-1.d-1). Plasma fluxes were also studied in these patients during a basal state (low-dose intravenous glucose) by using a primed, 4-h constant intravenous tracer-infusion protocol. Stable-nuclide labeled tracers were L-[15N-15N-guanidino,5,5,2H2]arginine; L-[13C-ureido]citrulline; L-[1-13C]leucine; and NaH13CO3 (prime only), with blood and expired air samples drawn at intervals to determine isotopic abundance of arginine, citrulline, ornithine, and alpha-ketoisocaproate (KIC; for leucine) in plasma and 13CO2 in breath. Leucine kinetics (flux and disappearance into protein synthesis) confirmed the anticipated higher protein turnover in these burn patients compared with healthy control subjects. The plasma arginine fluxes were correspondingly higher in burn patients than in healthy control subjects. However, the citrulline flux and rate of conversion of citrulline to arginine were not higher than values obtained in our laboratories in healthy adult subjects. We hypothesize that the higher rates of arginine loss from the body after burn injury would need to be balanced by an appropriate exogenous intake of preformed arginine to maintain protein homeostasis and promote recovery from this catabolic condition. PMID:7572742

  8. Burns in diabetic patients

    PubMed Central

    Maghsoudi, Hemmat; Aghamohammadzadeh, Naser; Khalili, Nasim

    2008-01-01

    CONTEXT AND AIMS: Diabetic burn patients comprise a significant population in burn centers. The purpose of this study was to determine the demographic characteristics of diabetic burn patients. MATERIALS AND METHODS: Prospective data were collected on 94 diabetic burn patients between March 20, 2000 and March 20, 2006. Of 3062 burns patients, 94 (3.1%) had diabetes; these patients were compared with 2968 nondiabetic patients with burns. Statistical analysis was performed using the statistical analysis software SPSS 10.05. Differences between the two groups were evaluated using Student's t-test and the chi square test. P < 0.05 was considered as significant. RESULTS: The major mechanism of injury for the diabetic patients was scalding and flame burns, as was also the case in the nondiabetic burn patients. The diabetic burn patients were significantly older, with a lower percentage of total burn surface area (TBSA) than the nondiabetic burn population. There was significant difference between the diabetic and nondiabetic patients in terms of frequency of infection. No difference in mortality rate between diabetic and nondiabetic burn patients was observed. The most common organism in diabetic and nondiabetic burn patients was methicillin-resistant staphylococcus. Increasing %TBSA burn and the presence of inhalation injury are significantly associated with increased mortality following burn injury. CONCLUSIONS: Diabetics have a higher propensity for infection. Education for diabetic patients must include caution about potential burn mishaps and the complications that may ensue from burns. PMID:19902035

  9. Review of therapeutic agents for burns pruritus and protocols for management in adult and paediatric patients using the GRADE classification

    PubMed Central

    Goutos, Ioannis; Clarke, Maria; Upson, Clara; Richardson, Patricia M.; Ghosh, Sudip J.

    2010-01-01

    To review the current evidence on therapeutic agents for burns pruritus and use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) classification to propose therapeutic protocols for adult and paediatric patients. All published interventions for burns pruritus were analysed by a multidisciplinary panel of burns specialists following the GRADE classification to rate individual agents. Following the collation of results and panel discussion, consensus protocols are presented. Twenty-three studies appraising therapeutic agents in the burns literature were identified. The majority of these studies (16 out of 23) are of an observational nature, making an evidence-based approach to defining optimal therapy not feasible. Our multidisciplinary approach employing the GRADE classification recommends the use of antihistamines (cetirizine and cimetidine) and gabapentin as the first-line pharmacological agents for both adult and paediatric patients. Ondansetron and loratadine are the second-line medications in our protocols. We additionally recommend a variety of non-pharmacological adjuncts for the perusal of clinicians in order to maximise symptomatic relief in patients troubled with postburn itch. Most studies in the subject area lack sufficient statistical power to dictate a ‘gold standard’ treatment agent for burns itch. We encourage clinicians to employ the GRADE system in order to delineate the most appropriate therapeutic approach for burns pruritus until further research elucidates the most efficacious interventions. This widely adopted classification empowers burns clinicians to tailor therapeutic regimens according to current evidence, patient values, risks and resource considerations in different medical environments. PMID:21321658

  10. Modeling Fluid Resuscitation by Formulating Infusion Rate and Urine Output in Severe Thermal Burn Adult Patients: A Retrospective Cohort Study

    PubMed Central

    Luo, Qizhi; Li, Wei; Zou, Xin; Dang, Yongming; Wu, Jun

    2015-01-01

    Acute burn injuries are among the most devastating forms of trauma and lead to significant morbidity and mortality. Appropriate fluid resuscitation after severe burn, specifically during the first 48 hours following injury, is considered as the single most important therapeutic intervention in burn treatment. Although many formulas have been developed to estimate the required fluid amount in severe burn patients, many lines of evidence showed that patients still receive far more fluid than formulas recommend. Overresuscitation, which is known as “fluid creep,” has emerged as one of the most important problems during the initial period of burn care. If fluid titration can be personalized and automated during the resuscitation phase, more efficient burn care and outcome will be anticipated. In the present study, a dynamic urine output based infusion rate prediction model was developed and validated during the initial 48 hours in severe thermal burn adult patients. The experimental results demonstrated that the developed dynamic fluid resuscitation model might significantly reduce the total fluid volume by accurately predicting hourly urine output and has the potential to aid fluid administration in severe burn patients. PMID:26090415

  11. Adult patients looking at their burn injuries for the first time.

    PubMed

    Birdsall, C; Weinberg, K

    2001-01-01

    A total of 222 burn nurses from 30 burn centers completed a questionnaire about how and when a burn patient looks at their burn wound for the first time. The registered nurse is most frequently with the patient when the patient sees the wound for the first time (n = 187; 84%). Looking at the wound is not usually a planned event, and it is not documented in the patient record. Nurses use verbal and nonverbal patient cues to determine when it is appropriate for the patient to look initially at the wound and combine this initial look with an opportunity to teach wound healing. The patient asks the nurse for an opinion about the way the wound looks (n = 181; 81.5%). The nurse uses silence, presence-of-self, and gentle encouragement with the patient while remaining positive and honest. Respondents reported that the patient wants the truth but also needs reassurance and some degree of optimism when viewing the wound for the first time. PMID:11570538

  12. 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

  13. Adult patients are more catabolic than children during acute phase after burn injury: a retrospective analysis on muscle protein kinetics

    PubMed Central

    Tuvdendorj, Demidmaa; Chinkes, David L.; Zhang, Xiao-Jun; Ferrando, Arny A.; Elijah, Itoro E.; Mlcak, Ronald P.; Finnerty, Celeste C.; Wolfe, Robert R.; Herndon, David N.

    2011-01-01

    Purpose This study was performed to determine if there is an age-related specificity in the response of muscle protein metabolism to severe burn injury during acute hospitalization. This is a retrospective analysis of previously published data. Methods: Nineteen adult and 58 pediatric burn-injured patients (age 43.3 ± 14.3 vs. 7.2 ± 5.3 years, adult vs. children) participated in stable isotope [ring-2H5]phenylalanine (Phe) infusion studies. Femoral arterial and venous blood samples and muscle biopsy samples were collected throughout the study. Data are presented as means ± standard deviation (SD). A p value less than 0.05 was considered statistically significant. Results Muscle net protein balance (NB) was higher in children (adult vs. children, -43 ± 61 vs. 8 ± 68 nmol Phe/min/100 ml leg volume, p < 0.05). Muscle protein fractional synthesis rate (FSR) was higher in children (adult vs. children, 0.11 ± 0.05 vs. 0.16 ± 0.10 %/h, p < 0.05). Leg muscle protein breakdown was not different between the groups (adult vs. children, 179 ± 115 vs. 184 ± 124 nmol Phe/ min/100 ml leg volume, p < 0.05; synthesis rate was 134 ± 96 and 192 ± 128 nmol Phe/min/100 ml leg volume in adults and children, respectively (p = 0.07). Age significantly correlated with muscle protein NB (p = 0.01) and FSR (p = 0.02); but not with breakdown (p = 0.67) and synthesis (p = 0.07) rates measured by using a three-pool model. Conclusion In burn injury, the muscle protein breakdown may be affected to the same extent in adults and children, whereas synthesis may have age-related specificities, resulting in a better but still low NB in children. PMID:21647721

  14. Recovery trajectories after burn injury in young adults: does burn size matter?

    PubMed

    Ryan, Colleen M; Lee, Austin; Kazis, Lewis E; Schneider, Jeffrey C; Shapiro, Gabriel D; Sheridan, Robert L; Meyer, Walter J; Palmieri, Tina; Pidcock, Frank S; Reilly, Debra; Tompkins, Ronald G

    2015-01-01

    appearance remained below the non-burn levels throughout the 3-year period regardless of burn size. Three-year recovery trajectories of survivors with larger burn size showed improvements in most areas, but these improvements lagged behind those with smaller burns. Poor perceived appearance was persistent and prevalent regardless of burn size and was found to limit social function in these young adult burn survivors. Expectations for multidimensional recovery from burns in young adults can be benchmarked based on burn size with important implications for patient monitoring and intervening in clinical care. PMID:25501787

  15. 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. PMID:12927984

  16. Fatal rhabdomyolysis in a flame burn patient.

    PubMed

    Lazarus, D; Hudson, D A

    1997-08-01

    Rhabdomyolysis due to flame burns is not well described. A case of fatal rhabdomyolysis in an epileptic patient who sustained 65 per cent body surface area, very deep, flame burns is described. It appears as if the sustained muscle compression from the restrictive, circumferential eschar was the major factor in the aetiology of the rhabdomyolysis. Despite aggressive fluid management, the patient died of acute renal failure and adult respiratory distress syndrome. We have subsequently identified three other cases of pigmenturia occurring following burns. It would seem as if rhabdomyolysis following extensive full thickness burns may be more common than previously suggested. Fluid requirements are in excess of those proposed by traditional protocols. Rhabdomyolysis in flame burn patients indicates a poor prognosis. PMID:9426917

  17. Is Real-Time Feedback of Burn-Specific Patient-Reported Outcome Measures in Clinical Settings Practical and Useful? A Pilot Study Implementing the Young Adult Burn Outcome Questionnaire.

    PubMed

    Ryan, Colleen M; Lee, Austin F; Kazis, Lewis E; Shapiro, Gabriel D; Schneider, Jeffrey C; Goverman, Jeremy; Fagan, Shawn P; Wang, Chao; Kim, Julia; Sheridan, Robert L; Tompkins, Ronald G

    2016-01-01

    Long-term follow-up care of survivors after burn injuries can potentially be improved by the application of patient-reported outcome measures (PROMs). PROMs can inform clinical decision-making and foster communication between the patient and provider. There are no previous reports using real-time, burn-specific PROMs in clinical practice to track and benchmark burn recovery over time. This study examines the feasibility of a computerized, burn-specific PROM, the Young Adult Burn Outcome Questionnaire (YABOQ), with real-time benchmarking feedback in a burn outpatient practice. The YABOQ was redesigned for formatting and presentation purposes using images and transcribed to a computerized format. The redesigned questionnaire was administered to young adult burn survivors (ages 19-30 years, 1-24 months from injury) via an ipad platform in the office before outpatient visits. A report including recovery curves benchmarked to a nonburned relatively healthy age-matched population and to patients with similar injuries was produced for the domains of physical function and social function limited by appearance. A copy of the domain reports as well as a complete copy of the patient's responses to all domain questions was provided for use during the clinical visit. Patients and clinicians completed satisfaction surveys at the conclusion of the visit. Free-text responses, included in the satisfaction surveys, were treated as qualitative data adding contextual information about the assessment of feasibility. Eleven patients and their providers completed the study for 12 clinical visits. All patients found the ipad survey and report "easy" or "very easy" to use. In nine instances, patients "agreed" or "strongly agreed" that it helped them communicate their situation to their doctor/nurse practitioner. Patients "agreed" or "strongly agreed" that the report helped them understand their course of recovery in 10 visits. In 11 visits, the patients "agreed" or "strongly agreed" that

  18. Adult burn patients with more than 60% TBSA involved-Meek and other techniques to overcome restricted skin harvest availability--the Viennese Concept.

    PubMed

    Lumenta, David B; Kamolz, Lars-Peter; Frey, Manfred

    2009-01-01

    Despite the fact that early excision and grafting has significantly improved outcome over the last decades, the management of severely burned adult patients with >/=60% total body surface area (% TBSA) burned still represents a challenging task for burn care specialists all over the world. In this article, we present our current treatment concept for this entity of severely burned patients and analyze its effect in a comparative cohort study. Surgical strategy comprised the use of split-thickness skin grafts (Meek, mesh) for permanent coverage, fluidized microsphere bead-beds for wound conditioning, temporary coverage (polyurethane sheets, Epigard; nanocrystalline silver dressings, Acticoat; synthetic copolymer sheets based on lactic acid, Suprathel; acellular bovine derived collagen matrices, Matriderm; allogeneic cultured keratinocyte sheets; and allogeneic split-thickness skin grafts), and negative-pressure wound therapy (vacuum-assisted closure). The autologous split-thickness skin graft expansion using the Meek technique for full-thickness burns and the delayed approach for treating dorsal burn wounds is discussed in detail. To demonstrate differences before and after the introduction of the Meek technique, we have compared patients of 2007 with >/=60% TBSA (n = 10) to those in a matched observation period (n = 7). In the first part of the comparative analysis, all patients of the two samples were analyzed with regard to age, abbreviated burn severity index, Baux, different entities of % TBSA, and survival. In the second step, only the survivors of both years were separated in two groups as follows: patients receiving skin grafts, using the Meek technique (n = 6), were compared with those without Meek grafting (n = 4). When comparing the severely burned patients of 2007 with a cohort of 2006, there were no differences for age (2007: 46.4 +/- 13.4 vs. 2006: 39.1 +/- 14.8 years), abbreviated burn severity index score (2007: 12.2 +/- 1.0 vs. 2006: 12.1 +/- 1

  19. Immunosuppression of the burned patient.

    PubMed

    Robins, E V

    1989-12-01

    The burn patient is highly susceptible to infection due to the loss of the skin as a barrier to microorganisms. Immune defenses are activated in response to the burn injury; however, some of these defenses are altered. Neutrophil chemotaxis is compromised by decreased perfusion caused by hypovolemia and the formation of microthrombi. Chemotaxis and phagocytosis are dependent on complement components that are reduced in a large burn wound. Neutrophil intracellular killing power is reduced as oxygen delivery to the wound is decreased. Humoral immunity is altered with the drop in IgG levels. Cell-mediated immunity is depressed and T cell lymphocyte counts are deceased. Suppressor T cells are generated. Specific sources of infection for the burn patient include the patient's own bacterial flora; hospital personnel; respiratory equipment; and catheters, both urinary and intravascular. The best control for burn wound infection is the closure of the wound by early excision and grafting. When lack of donor sites prohibits this surgical therapy, control centers on the environment and wound care techniques. The selection of wound topical antibiotics on the basis of visual inspection and surface culturing assists in the prevention of burn wound sepsis. When wound sepsis does occur, systemic antibiotics are instituted. Although burn wound sepsis is an obvious cause of death for the burn patient, it is not the primary cause. Increasing sophistication in fluid resuscitation and in intensive care therapy has resulted in patients living beyond the initial insult and the following few days. Burn patient mortality is now associated with a syndrome presenting clinically as sepsis but without any identifiable septic source.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2697225

  20. 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

  1. Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes.

    PubMed

    van Twillert, Björn; Bremer, Marco; Faber, Albertus W

    2007-01-01

    Changing daily wound dressings provokes a substantial amount of pain in patients with severe burn wounds. Pharmacological analgesics alone often are inadequate to solve this problem. This study explored whether immersive virtual reality (VR) can reduce the procedural pain and anxiety during an entire wound care session and compared VR to the effects of standard care and other distraction methods. Nineteen inpatients ages 8 to 65 years (mean, 30 years) with a mean TBSA of 7.1% (range, 0.5-21.5%) were studied using a within-subject design. Within 1 week of admission, standard care (no distraction), VR, or another self-chosen distraction method was administered during the wound dressing change. Each patient received the normal analgesic regimen. Pain was measured with visual analog thermometer scores, and anxiety was measured with the state-version of the Spielberger State Trait Anxiety Inventory. After comparing different distraction methods, only VR and television showed significant pain reductions during wound dressing changes. The effects of VR were superior, but not statistical significant, to that of television. Thirteen of 19 patients reported clinically meaningful (33% or greater) reductions in pain during VR distraction. No side effects were reported. No correlations were found between the reduction in pain ratings and patient variables like age, sex, duration of hospital stay, or percentage of (deep) burns. There was no significant reduction of anxiety ratings. PMID:17667488

  2. 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

  3. Clinical review: The critical care management of the burn patient

    PubMed Central

    2013-01-01

    Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management. PMID:24093225

  4. Protocolized Resuscitation of Burn Patients.

    PubMed

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

    2016-10-01

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

  5. Uncoupled skeletal muscle mitochondria contribute to hypermetabolism in severely burned adults

    PubMed Central

    Herndon, David N.; Børsheim, Elisabet; Chao, Tony; Reidy, Paul T.; Borack, Michael S.; Rasmussen, Blake B.; Chondronikola, Maria; Saraf, Manish K.; Sidossis, Labros S.

    2014-01-01

    Elevated metabolic rate is a hallmark of the stress response to severe burn injury. This response is mediated in part by adrenergic stress and is responsive to changes in ambient temperature. We hypothesize that uncoupling of oxidative phosphorylation in skeletal muscle mitochondria contributes to increased metabolic rate in burn survivors. Here, we determined skeletal muscle mitochondrial function in healthy and severely burned adults. Indirect calorimetry was used to estimate metabolic rate in burn patients. Quadriceps muscle biopsies were collected on two separate occasions (11 ± 5 and 21 ± 8 days postinjury) from six severely burned adults (68 ± 19% of total body surface area burned) and 12 healthy adults. Leak, coupled, and uncoupled mitochondrial respiration was determined in permeabilized myofiber bundles. Metabolic rate was significantly greater than predicted values for burn patients at both time points (P < 0.05). Skeletal muscle oxidative capacity, citrate synthase activity, a marker of mitochondrial abundance, and mitochondrial sensitivity to oligomycin were all lower in burn patients vs. controls at both time points (P < 0.05). A greater proportion of maximal mitochondrial respiration was linked to thermogenesis in burn patients compared with controls (P < 0.05). Increased metabolic rate in severely burned adults is accompanied by derangements in skeletal muscle mitochondrial function. Skeletal muscle mitochondria from burn victims are more uncoupled, indicating greater heat production within skeletal muscle. Our findings suggest that skeletal muscle mitochondrial dysfunction contributes to increased metabolic rate in burn victims. PMID:25074988

  6. 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. PMID:20510518

  7. Candidemia in major burns patients.

    PubMed

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

    2016-06-01

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

  8. Incidence of cardiac events in burned patients.

    PubMed

    Meyers, David G; Hoestje, Sara M; Korentager, Richard A

    2003-06-01

    Given the increased level of adrenergic stimulation in burn patients, it would be expected that they would experience an increased incidence of cardiac arrhythmias and other cardiac events. We performed a retrospective chart review of 56 acute burn patients matched by age, length of hospital stay, and sex to 56 trauma patients, all of whom had been continuously monitored electrocardiographically. Burn and trauma patients were similar in injury severity, admission laboratory values, and prior history of cardiopulmonary diseases. Arrhythmias were noted in 34% of burn patients and 28% of trauma patients. One myocardial infarction and six deaths occurred in burn patients. No myocardial infarctions or deaths were observed in trauma patients. A past history of cardiopulmonary disease increased the risk of myocardial infarction or death by 6.6 times. Cardiac arrhythmias and other events are relatively infrequent and benign in burn patients and are similar to those experienced by other patients with acute injuries. PMID:12781616

  9. Characteristics of elderly Japanese patients with severe burns.

    PubMed

    Morita, Seiji; Higami, Shigeo; Yamagiwa, Takeshi; Iizuka, Shinichi; Nakagawa, Yoshihide; Yamamoto, Isotoshi; Inokuchi, Sadaki

    2010-11-01

    In this study, we report the clinical characteristics of elderly Japanese patients with severe burns. We studied the clinical features of 76 adult patients with severe burns, 35 of whom (46.1%) were ≥65 years old. We evaluated the characteristics of patients with respect to each type of burn. In addition, we studied the rate of death and survival in the elderly and also between the elderly and non-elderly patients. The following parameters were either assessed or compared between the elderly and non-elderly: gender, average age, vital signs (Glasgow Coma Scale, systolic blood pressure, heart rate and respiratory rate) and PaO(2)/FiO(2) (P/F) ratio at admission, cause of burn and a history of physical or psychiatric disease. Further, we investigated whether the burn was caused by attempting suicide and determined the percent total body surface area (%TBSA), second- and third-degree burn area, burn index (BI), prognostic burn index (PBI), presence of tracheal burns, presence of alcohol intoxication and overdose poisoning, presence of tracheal intubation, outcome and cause of death. The male:female ratio of the elderly patients was 17:18 (average age, 78.1 (8.2) years). Burns were mostly caused by flame (26/35), followed by scalding (8/35). Ten patients had attempted suicide. The %TBSA, second-degree burn area, third-degree burn area, BI and PBI, respectively were 46.6% (26.7%), 15.3% (19.0%), 35.6% (26.0%), 41.1 (25.2) and 119.2 (25.9). Of the 35 patients, 23 died. The notable characteristics of the elderly patients who died were flame as the cause of the burns: high %TBSA, BI and PBI, and a high rate of tracheal intubation. Elderly patients constituted approximately 45% of our study population. Most burns were caused by flames. The incidence of accidental bathtub-related burns was higher and that of suicide attempts was lower in the elderly patients, as compared with the non-elderly patients. Severe burns were fatal for elderly patients. Therefore, elderly

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

    PubMed

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

    2015-01-01

    Older patients with burn injury have a greater likelihood for discharge to nursing facilities. Recent research indicates that older patients discharged to nursing facilities are two to three times as likely to die within a 3-year period relative to those discharged to home. In light of these poor long-term outcomes, we conducted this study to identify predictors for discharge to independent vs nonindependent living status in older patients hospitalized for burns. We retrospectively reviewed all older adults (age ≥ 55 years) who were prospectively enrolled in a longitudinal multicenter study of outcomes from 1993 to 2011. Patient, injury, and treatment outcomes data were analyzed. Recognizing that transfer to inpatient rehabilitation may have impacted final hospital discharge disposition: we assessed the likelihood of inpatient rehabilitation stay, based on identified predictors of inpatient rehabilitation. We subsequently performed a logistic regression analysis on the clustered, propensity-matched cohort to assess associations of burn and injury characteristics on the primary outcome of final discharge status. A total of 591 patients aged ≥55 years were treated and discharged alive from three participating U.S. burn centers during the study period. Mean burn size was 14.8% (SD 11.2%) and mean age was 66.7 years (SD 9.3 years). Ninety-three patients had an inpatient rehabilitation stay before discharge (15.7%). Significant factors predictive of inpatient rehabilitation included a burn >20% TBSA, mechanical ventilation, older age, range of motion deficits at acute care discharge, and study site. These factors were included in the propensity model. Four hundred seventy-one patients (80%) were discharged to independent living status. By matched propensity analysis, older age was significantly associated with a higher likelihood of discharge to nonindependent living (P < .01 in both the 65-74 age group and the oldest age group when compared with the 55-64 age group

  11. Benchmarking Outcomes in the Critically Injured Burn Patient

    PubMed Central

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

    2014-01-01

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

  12. 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. PMID:19692919

  13. 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

  14. Drug and alcohol abuse in patients with acute burn injuries.

    PubMed

    Swenson, J R; Dimsdale, J E; Rockwell, E; Carroll, W; Hansbrough, J

    1991-01-01

    We reviewed records of adult patients admitted to our burn unit who were reported to abuse drugs or alcohol from 1985 to 1988. The proportion of patients reported as abusing drugs increased significantly from 1987 to 1988, compared to previous years. However, there was no increase in the proportion of patients reported to abuse alcohol. Patients identified as abusing drugs had longer hospital stays, compared to patients who were not reported to abuse substances. Methamphetamine and cocaine were the drugs most often abused by patients who abused drugs or both drugs and alcohol. Mechanisms of burn injury in these patients included "accidental" burn injury related to acute intoxication, and self-injury due to psychosis or depression. PMID:1882020

  15. 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

  16. Crusted scabies in the burned patient.

    PubMed

    Berg, Jais Oliver; Alsbjørn, Bjarne

    2011-01-01

    The objectives of this study were 1) to describe a case of crusted scabies (CS) in a burned patient, which was primarily undiagnosed and led to a nosocomial outbreak in the burn unit; 2) to analyze and discuss the difficulties in diagnosing and treating this subset of patients with burn injury; and 3) to design a treatment strategy for future patients. Case analysis and literature review were performed. The index patient had undiagnosed crusted scabies (sive Scabies norvegica) with the ensuing mite hyperinfestation when admitted to the department with minor acute dermal burns. Conservative healing and autograft healing were impaired because of the condition. Successful treatment of the burns was only accomplished secondarily to scabicide treatment. An outbreak of scabies among staff members indirectly led to diagnosis. CS is ubiquitous, and diagnosis may be difficult. This is the first report of a burned patient with CS in the English language literature. CS is also highly contagious and may lead to a nosocomial outbreak. Furthermore, CS seems to have a detrimental impact on the burned patient's course of treatment. A scabicide treatment is necessary to guarantee successful treatment of the burns. PMID:21427595

  17. Successful placement of an adult sternal intraosseous line through burned skin.

    PubMed

    Frascone, Ralph; Kaye, Koren; Dries, David; Solem, Lynn

    2003-01-01

    Obtaining vascular access can be difficult in the critical adult patient. This can be especially true in a severely burned patient, where the usual insertion site may be involved in the burn injury. We present a case in which a sternal intraosseous line was placed through a full-thickness injury, in a patient in full arrest, who subsequently underwent a successful cardiac resuscitation. PMID:14501399

  18. 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. PMID:27013315

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

    PubMed

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

    2016-01-01

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

  20. [Evaluation and first aid of burned patients].

    PubMed

    Wassermann, Daniel

    2002-12-15

    First cares of burned patients depend of an accurate evaluation of the injury severity. Total body surface area burned can be estimated taking into account the fact that the area of one hand face is equivalent to 1% of the total body surface (TBS) of the individual. Second-degree burns are characterized by the occurrence of phlyctena, third-degree burns appear like adhering necrosis without any sensibility. Smoke inhalation injuries are frequent and can be recognized on the presence of tare deposits inside the mouse and on the respiratory conducts. Taking care of the patient begins with making the victim safe from the thermal aggression. Then, cooling the burn is to be performed. The emergency medical care consists in securing respiratory function, and, as early as possible, in beginning perfusions of Ringer Lactate Lavoisier exceeding 20 mL/kg during the first post-burn hours for patient suffering of burns exceeding 10% of the total body area. Pain must be controlled using preferentially morphine or related products. Transport to the specialized unit, in case of severe injury, will be performed assuring thermal comfort, wound protection and vital function monitoring. PMID:12621940

  1. Infection control in severely burned patients

    PubMed Central

    Coban, Yusuf Kenan

    2012-01-01

    In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms. PMID:24701406

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

    PubMed

    Hsieh, Yu-Hsiu

    2016-02-01

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

  3. Gait variables of patients after lower extremity burn injuries.

    PubMed

    Silverberg, R; Lombardo, G; Gorga, D; Nagler, W; Himel, H; Yurt, R

    2000-01-01

    Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit

  4. Patient Eye Examinations - Adults

    MedlinePlus

    ... Examinations, Adults Patient Eye Examinations, Children Refractive Errors Scientists in the Laboratory Visual Acuity Testing Patient Eye Examinations, Adults × Warning message Automatic fallback to the cURL connection method kicked in to handle the request. Result code ...

  5. 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. PMID:9426915

  6. Analysis of antibiotic consumption in burn patients.

    PubMed

    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

  7. [Psychosocial nursing care patient with major burns].

    PubMed

    Callejas Herrero, Aurea; Cuadrado Rodríguez, Cristina; Peña Lorenzo, Alicia; Díez Sanz, Ma Jesús

    2014-02-01

    We must consider the patient as a human being from a holistic point of view; that is, not only from a physical point of view, but also from a mental emotional and spiritual perspective (not to be confused with religion). A patient with major burns is seen as a critical patient by the physician, and for him the most important issue is the survival of the patient. It is when the patient is admitted in the Burns Unit when the long and not easy road to recovery begins, in the understanding this is a new way to integrate, feel and ultimately learn to live again. The role of nursing during this journey will be vital. The prompt and better recovery of the patient will largely depend on the link established between nurse and patient, as well as his/her integration in the new life that awaits him. The following topics are developed in this article: Emotional evolution during his stage in the Burns Unit. Psychoemotional nursing care (fear, pain, image change, long hospital stay, resources). Management of the self-protection measures of the nursing staff to maintain its own emotional stability. PMID:24738175

  8. 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. PMID:24050979

  9. Epidemiology of burns throughout the World. Part II: intentional burns in adults.

    PubMed

    Peck, Michael D

    2012-08-01

    A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators. PMID:22325849

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

    PubMed Central

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

    2010-01-01

    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. PMID:21321648

  11. [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. PMID:16887086

  12. Cytomegalovirus Colitis in a Burn Patient.

    PubMed

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

    2016-01-01

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

  13. 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

  14. Infection prevention and treatment in patients with major burn injuries.

    PubMed

    Rowley-Conwy, G

    Infection is a significant challenge in burn care, particularly for those patients who have major burn injuries. This article aims to review the literature and establish best practice in prevention and treatment of infection in patients with major burns. The article considers the causes and clinical features of wound infection, and examines systemic and local methods of prevention and treatment. PMID:21138123

  15. [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. PMID:15633562

  16. 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. PMID:26724246

  17. 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

  18. Lipid Rescue in a Pediatric Burn Patient.

    PubMed

    Musielak, Matthew; McCall, John

    2016-01-01

    Pain control is a major concern for patients suffering burns. The addition of bupivacaine to the donor site infiltration solution containing epinephrine could offer a safe and effective means to treat postanesthesia pain. Despite the addition of epinephrine to localize the effects, systemic absorption occurs, and there exists the possibility of inadvertent intravascular injection, with potential CNS and cardiac toxicity. The patient is a 6-year-old boy who sustained flame burns to bilateral lower extremities and buttocks. A Pitkin's solution containing 2 mg epinephrine/L of normosol and a 0.5% bupivacaine at 3 mg/kg was injected. Shortly after the patient became bradycardic with decreasing end tidal CO2. Pediatric advanced life support protocol was begun. He underwent 30 minutes of cardiopulmonary resuscitation. At this time, intralipid therapy was initiated with a 1.5 mg/kg bolus. Shortly after therapy, a pulse was regained. It had been previously demonstrated that the addition of bupivacaine to a subcutaneous infiltrating solution for donor site harvesting was a safe and effective treatment of pain for skin graft harvesting. Care must be taken to stay within the therapeutic allotted dose. Inadvertent intravascular injection is a rare complication. Early recognition of clinical signs of local anesthetic toxicity is a key to the management and treatment. A lipid protocol should be in place, given the many positive case reports of local anesthetic toxicity. Surgeon judgment must be used when weighing the risks and benefits of pain control during skin harvesting vs the potential cardiac effects with local anesthetics. PMID:26035145

  19. Reimbursement for out-of-state burn patients is not always lower than that for in-state patients at regional burn centers.

    PubMed

    Peck, Michael D; Pressman, Melissa A; Caruso, Daniel M; Edelman, Linda S; Holmes, James H; Hughes, William B; Korentager, Richard A; Saffle, Jeffrey R; Voigt, David W

    2010-01-01

    Because burn care in the United States is regionalized, burn patients are often transported across state lines to receive their burn treatment. The authors hypothesized that there are differences between in-state and out-of-state reimbursement for burn care. This project was conducted by the American Burn Association (ABA) Government Affairs Committee through the ABA Multicenter Trials Group. Participation was open to any member of the ABA. This retrospective observational study was approved by the institutional review boards of each participating institution. Subjects were identified using registry of each site, selecting patients hospitalized for burn injuries during FY2004-FY2006 of the hospitals. Once identified by the registry, the ID numbers were used to collect billing and reimbursement data from the financial offices. Data were sorted by age (adult and pediatric), location (in state and out of state), and payor source (Medicare, Medicaid, commercial, workers compensation, and self-pay). The rate of reimbursement was calculated based on charges and recoveries. Comparisons on data of each center were performed using Student's t-test with type I error <1%. Six facilities contributed data. A total of 4850 burn patients were reviewed, of whom 3941 were in-state burn patients and 909 were out-of-state burn patients. When the results from all six states were analyzed together, reimbursement for adults from Medicaid and Medicare was higher for in-state patients than for out-of-state patients. However, when analyzed by state, Medicare reimbursement between in-state and out-of-state patients did not differ significantly. In one state (Kansas), in-state Medicaid reimbursement was higher, but in two others (Arizona and Pennsylvania), in-state Medicaid reimbursement was lower than that for out-of-state reimbursement. Reimbursement for the care of children did not differ significantly based on state of residence. From these data, we conclude that there are indeed

  20. An effective burn prevention program initiated by a recovered burn patient group.

    PubMed

    Schmeer, S; Stern, N; Monafo, W W

    1986-01-01

    The US death rate from house fires has remained constant during the past 50 years despite a sharp decline in mortality from other fires and causes of burns. The concensus is that smoke alarms can effectively decrease the incidence of this lethal type of burn injury. Our organization of recovered burn patients has focused its efforts around procuring and installing smoke alarms in areas of substandard housing, which predominantly account for house fire deaths and injuries in St. Louis. This effort has resulted in an effective burn prevention program ("Alarms for Life"), which also serves as a model for other communities. PMID:3429488

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

    PubMed

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

    1993-11-01

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

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

    PubMed Central

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

    2012-01-01

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

  3. 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. PMID:26873418

  4. Do burn patients need burn specific multidisciplinary outpatient aftercare: research results.

    PubMed

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

    2001-03-01

    In a cross-sectional study of patients 12-24 months after a burn injury, the need for a multidisciplinary burn specific outpatient clinic was examined in relation to aftercare consumption, physical and psychological problems. Four hundred and twenty nine patients were assessed by means of three self-report questionnaires: IES, SCL(PTSD-SL) and BSHS-SV-S. Results indicated that the current aftercare providers are almost exclusively medical doctors and that a quarter of the patients are dissatisfied with received aftercare. However, dissatisfaction about current aftercare was not the only criterion to determine whether patients wanted burn-specific aftercare. The severity of psychological and physical problems predicted interest in a multi-disciplinary outpatient clinic. Self-reported psychological and physical problems were found to be related to one another. Univariate logistic regression outcomes suggested that patients with serious psychological and physical problems are more likely to express interest in a burn-specific outpatient clinic, but that, in a multivariate regression analysis, physical problems and psychological problems measured on the SCL(PTSD-SLEEP) do not contribute to the prediction of the interest in a burn-specific outpatient clinic anymore once symptoms of PTSD are taken care of. Results suggest that psychological aftercare for burn patients needs to be improved. Possible steps to improve aftercare to meet patients' needs are discussed. PMID:11226643

  5. Air evacuation of critically burned patients.

    PubMed

    Santos, F X; Sanchez-Gabriel, J; Mayoral, E; Hamann, C

    1995-11-01

    We analyze the repercussions of air evacuation on the physiopathology of the critically burned patient based on the experience on 63 patients evacuated by air. Clinical repercussions are due to accelerations, vibrations, noise, and, primarily, to altitude. Accelerations are important during take-off and landing, and vibrations may be important in helicopter evacuations in the presence of craniofacial trauma. The noise, especially in helicopters, can interfere with diagnostic and therapeutic maneuvers in-flight. The altitude modifies atmospheric pressure, partial pressure of oxygen, and water concentration in inhaled air. In the aircraft we use, atmospheric pressure is between 550 and 532 mm Hg at the normal flight altitudes. This situation determines the expansion of body gases. Hypoxia seriously worsens any respiratory insufficiency, primarily in the presence of smoke inhalation. The decrease of water concentration in the inhaled air compels the increase of fluid perfusion. Pre-flight and in-flight measures are analyzed, especially with regard to smoke inhalation, pneumothorax, and parenteral perfusion. PMID:8538899

  6. Amputation Following Hand Escharotomy in Patients with Burn Injury

    PubMed Central

    Schulze, Scott M.; Choo, Joshua; Cooney, Damon; Moore, Alyssa L.; Sebens, Matt; Neumeister, Michael W.; Wilhelmi, Bradon J.

    2016-01-01

    Objective: Hand burns are commonly seen in patients with burn injury. In the past, focus was on lifesaving measures, but with advances in burn care during the last century, the paradigm shifted to digital salvage and eventually to functional digital salvage. Good outcomes are heavily dependent on the care that is rendered during the initial management of the burn. Methods: A retrospective medical record review was conducted through the Central Illinois Regional Burn Center Patient Registry. Patients with burn injury treated with upper extremity and hand escharotomy between January 1, 2000, and December 31, 2005, were included in the study. Results: We identified a total of 34 patients with 57 burned hands. Six hands required delayed amputation of digits despite recognition of neurovascular compromise and escharotomy, yielding a 10% amputation rate. No correlation could be drawn with regard to total body surface area, age, or sex. Conclusion: Important principles in the acute phase include early splinting, recognition of the need for escharotomy and complete escharotomy when necessary, early excision and grafting, and involvement of occupational therapy for splinting and to guide both active and passive exercises. Although uncommon, some extremity burns may require subsequent amputation despite prompt attention and optimal treatment. In our case series, the need for amputation after successful escharotomies of salvageable digits was associated with full-thickness and electrical burns. PMID:26977219

  7. Burns

    MedlinePlus

    ... doing so puts you in danger as well. Chemical and Electrical Burns For chemical and electrical burns, call 911 or your local ... the power source has been turned off. For chemical burns: Dry chemicals should be brushed off the ...

  8. Long-term musculoskeletal morbidity after adult burn injury: a population-based cohort study

    PubMed Central

    Randall, Sean M; Fear, Mark W; Wood, Fiona M; Rea, Suzanne; Boyd, James H; Duke, Janine M

    2015-01-01

    Objective To investigate if adults who are hospitalised for a burn injury have increased long-term hospital use for musculoskeletal diseases. Design A population-based retrospective cohort study using linked administrative health data from the Western Australian Data Linkage System. Subjects Records of 17 753 persons aged at least 20 years when hospitalised for a first burn injury in Western Australia during the period 1980–2012, and 70 758 persons who were age and gender-frequency matched with no injury admissions randomly selected from Western Australia's electoral roll. Main outcome measures Admission rates and cumulative length of stay for musculoskeletal diseases. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and HRs with 95% CIs, respectively. Results After adjustment for pre-existing health status and demographic characteristics, the burn cohort had almost twice the hospitalisation rate for a musculoskeletal condition (IRR, 95% CI 1.98, 1.86 to 2.10), and spent 3.70 times as long in hospital with a musculoskeletal diagnosis (95% CI 3.10 to 4.42) over the 33-year period, than the uninjured comparison cohort. Adjusted survival analyses of incident post-burn musculoskeletal disease admissions found significant increases for the 15-year post burn discharge period (0–6 months: HR, 95% CI 2.51, 2.04 to 3.11; 6 months–2 years: HR, 95% CI 1.77, 1.53 to 2.05; 2–15 years: HR, 95% CI 1.32, 1.23 to 1.42). Incident admission rates were significantly elevated for 20 years post-burn for minor and severe burn injury for a range of musculoskeletal diseases that included arthropathies, dorsopathies, osteopathies and soft tissue disorders. Conclusions Minor and severe burn injuries were associated with significantly increased post-burn incident admission rates, long-term hospital use and prolonged length of stay for a range of musculoskeletal diseases. Further research is required

  9. Coagulopathy and its management in patients with severe burns.

    PubMed

    Glas, G J; Levi, M; Schultz, M J

    2016-05-01

    Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic and natural anticoagulation systems. Both the timing of onset and the severity of hemostatic derangements are related to the severity of the burn. The exact pathophysiology and time course of coagulopathy are uncertain, but, at least in part, result from hemodilution and hypothermia. As the occurrence of coagulopathy in patients with severe burns is associated with increased comorbidity and mortality, coagulopathy could be seen as a potential therapeutic target. Clear guidelines for the treatment of coagulopathy in patients with severe burns are lacking, but supportive measures and targeted treatments have been proposed. Supportive measures are aimed at avoiding preventable triggers such as tissue hypoperfusion caused by shock, or hemodilution and hypothermia following the usually aggressive fluid resuscitation in these patients. Suggested targeted treatments that could benefit patients with severe burns include systemic treatment with anticoagulants, but sufficient randomized controlled trial evidence is lacking. PMID:26854881

  10. Nutrition and anabolic pharmacotherapies in the care of burn patients.

    PubMed

    Abdullahi, Abdikarim; Jeschke, Marc G

    2014-10-01

    Thermal injury is a devastating injury that results in a number of pathological alterations in almost every system in the body. Hypermetabolism, muscle wasting, depressed immunity, and impaired wound healing are all clinical features of burns. Failure to address each of these specific pathological alterations can lead to increased mortality. Nutrition supplementation has been recommended as a therapeutic tool to help attenuate the hypermetabolism and devastating catabolism evident following burn. Despite the wide consensus on the need of nutrition supplementation in burn patients, controversy exists with regard to the type and amount of nutrition recommended. Nutrition alone is also not enough in these patients to halt and reverse some of the damage done by the catabolic pathways activated following severe burn injury. This has led to the use of anabolic pharmacologic agents in conjunction with nutrition to help improve patient outcome following burn injury. In this review, we examine the relevant literature on nutrition after burn injury and its contribution to the attenuation of the postburn hypermetabolic response, impaired wound healing, and suppressed immunological responses. We also review the commonly used anabolic agents clinically in the care of burn patients. Finally, we provide nutrition and pharmacological recommendations gained from prospective trials, retrospective analyses, and expert opinions based on our practice at the Ross Tilley Burn Center in Toronto, Canada. PMID:25606644

  11. Nutrition and Anabolic Pharmacotherapies in the Care of Burn Patients.

    PubMed

    Abdullahi, Abdikarim; Jeschke, Marc G

    2014-05-14

    Thermal injury is a devastating injury that results in a number of pathological alterations in almost every system in the body. Hypermetabolism, muscle wasting, depressed immunity, and impaired wound healing are all clinical features of burns. Failure to address each of these specific pathological alterations can lead to increased mortality. Nutrition supplementation has been recommended as a therapeutic tool to help attenuate the hypermetabolism and devastating catabolism evident following burn. Despite the wide consensus on the need of nutrition supplementation in burn patients, controversy exists with regard to the type and amount of nutrition recommended. Nutrition alone is also not enough in these patients to halt and reverse some of the damage done by the catabolic pathways activated following severe burn injury. This has led to the use of anabolic pharmacologic agents in conjunction with nutrition to help improve patient outcome following burn injury. In this review, we examine the relevant literature on nutrition after burn injury and its contribution to the attenuation of the postburn hypermetabolic response, impaired wound healing, and suppressed immunological responses. We also review the commonly used anabolic agents clinically in the care of burn patients. Finally, we provide nutrition and pharmacological recommendations gained from prospective trials, retrospective analyses, and expert opinions based on our practice at the Ross Tilley Burn Center in Toronto, Canada. PMID:24829299

  12. Burn injury in patients with dementia: an impetus for prevention.

    PubMed

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

    2005-01-01

    Current literature has reported an increase in the rates of morbidity and mortality in elderly dementia patients who have suffered from illnesses such as pneumonia or traumatic injuries such as falls, motor vehicle collisions, and other insults. The role of dementia in elderly burn patients has not been studied in depth. To assess the extent of this problem, a retrospective, case-control study of patients with dementia who were admitted to a large urban burn center was performed. The demographics, circumstance and severity of injury, critical care use, and discharge disposition of those patients admitted with dementia were reviewed and compared with the findings of age/burn size-matched controls. The results support the premise that burn injuries in this patient population can be severe. Although not statistically significant, 22.2% of the study group patients required ventilatory support, and 75% required monitoring in the intensive care unit compared with the 15.3% and 61.6% of control patients who required ventilatory support and monitoring in the intensive care unit, respectively. Also, although not statistically significant, the mortality rate of the study group was 25%, almost double that of the control group (13.8%). No other significant differences were observed. These findings support the need for assistance and supervision with daily activity and burn prevention education for this population. As our population ages and we are faced with caring for those with dementia, further burn prevention is warranted. PMID:15879750

  13. Mortality rates among 5321 patients with burns admitted to a burn unit in China: 1980-1998.

    PubMed

    Jie, Xiao; Baoren, Cai

    2003-05-01

    A retrospective study was conducted on 5321 burn patients hospitalized in a burn center in Jinzhou, China during the period 1980-1998. Of the 5321 patients, 57.8% were between 15 and 44 years old and 3.4% were > or =60 years old. Ninety-six percent had burns covering less than half of body surface area and 31.7% had only full thickness skin burn. The number of patients in the 1990s was three times that of the 1980s. Overall mortality rate was 0.86%. LA(50) for total body burn area (TBSA) and only full thickness skin burn (FTSB) was 94 and 87%, respectively. The high survival rate, may relate primarily to the low percentages of older patients and of patients with severe burns. Inhalation injuries, infection and MOD are the main causes of deaths in our patients and would be key targets to improve clinical care and in future study. PMID:12706617

  14. 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. PMID:24879397

  15. Epidemiology of 377 patients with chemical burns in Guangdong province.

    PubMed

    Xie, Youfu; Tan, Yanyan; Tang, Shuze

    2004-09-01

    A total of 377 patients with chemical burns from all over Guangdong province were admitted to the Guangzhou Red Cross Hospital during the period from January 1987 to December 2001. There were 296 males and 81 females with a male to female ratio of 3.65:1. The mean age of the patients was 26 years. The majority of patients (89.2%) were in the age range of 15-60 years. Professionally, 244 patients (64.7%) were workers, of whom, 232 (95%) of patients were peasant workers. Most of the chemical burns occurred at places away from home (94.4%), especially in the working environment (67.8%). Only 20 patients (5.5%) were injured at home. Chemical burns by accident and by criminal assault were 337 (88.5%) and 40 (10.5%). Strong acids (60.8%), mainly sulfuric acid, nitric acid, hydrofluoric acid, alkali (33.9%), mainly lime and sodium hydroxide were common causative agents. There was a relationship between the incidence of chemical burns and the season, with more patients in July-September and October-December. There were 215 (57.1%) patients who washed the burnsite with water immediately, but the volumes of water and time of washing were not adequate. Patients with total burn surface area (TBSA) of less than 10% comprised the majority of patients (72.7%), with 188 (65.7%) deep partial thickness burns, 116 (40.6%) with full thickness burns, and 60 (21%) with superficial burns. Extremities (lower limb 56.6% and upper limb 51.4%) were the most frequent area of injury. Ocular burns were the most common accompanying injury (14.7%). Operations of autografts and conjunctival flap were carried out on 159 (42.2%) patients. The average period of hospitalization was 22 days. Only 2 (0.7%) deaths occurred in this study. Counter measures to improve this situation must include safety productive education and professional training, use of protective clothing at work, enhancing the concept of legal responsibility, and restricting management and use of corrosive chemicals. Irrigation of the

  16. [Acute upper limb embolism in a severely burned patient].

    PubMed

    Wiebringhaus, P; Pierson, T; Menke, H

    2014-12-01

    Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days. PMID:25564950

  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. OPTIMIZED FLUID MANAGEMENT IMPROVES OUTCOMES OF PEDIATRIC BURN PATIENTS

    PubMed Central

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

    2012-01-01

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

  19. Burns

    MedlinePlus

    ... are burns treated? In many cases, topical antibiotics (skin creams or ointments) are used to prevent infection. For third-degree burns and some second-degree ones, immediate blood transfusion and/or extra fluids ... is skin grafting? There are two types of skin grafts. ...

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

    PubMed

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

    2016-09-01

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

  1. 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

  2. [Burns].

    PubMed

    Arai, Takao

    2016-02-01

    Burns extending deep into the skin and those affecting a wide surface area trigger various responses in the body and pose a serious threat to life. Therefore, the degree of severity needs to be determined accurately, and appropriate transfusion and local management should be provided accordingly. Systematic and meticulous management that considers not just the risk of death but also functional prognosis is essential from the early stage of burn injuries. Such management requires comprehensive care by a medical team concerning infections, nutrition and rehabilitation. This article outlines the current status of intensive care for severe burns. PMID:26915244

  3. Intensive Insulin Therapy in Severely Burned Pediatric Patients

    PubMed Central

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

    2010-01-01

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

  4. Burns

    MedlinePlus

    ... to your body's tissues caused by heat, chemicals, electricity, sunlight, or radiation. Scalds from hot liquids and ... to infections because they damage your skin's protective barrier. Treatment for burns depends on the cause of ...

  5. Burns

    MedlinePlus

    ... of Surgery . 18th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 22. Holmes JH, Heimbach DM. Burns. In: Brunicardi FC, Andersen DK, Billiar TR, et al, eds. Schwartz's Principles of Surgery . 9th ed. New ...

  6. Serum 25-Hydroxyvitamin D Levels in Pediatric Burn Patients

    PubMed Central

    Sobouti, Behnam; Riahi, Aina; Fallah, Shahrzad; Ebrahimi, Masoumeh; Shafiee Sabet, Azin; Ghavami, Yaser

    2016-01-01

    Background Previous studies have implicated the important and active role of vitamin D in the immune system. Objectives The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries. Materials and Methods In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone was recorded for each patient. Results Sixty-eight (57.6%) males and 50 (42.4%) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH)D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39%) cases were higher than 30 ng/mL, while 95 (81.35%) cases had levels lower than 20 ng/mL, and 19 (16.10%) cases had levels of 21 - 30 ng/mL. The level of 25(OH)D was below recommended levels in 96.61% of cases, while 81.34% had vitamin D deficiency and 16.1% had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001). Conclusions The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D. PMID:27218060

  7. An Evaluation of Factors Related to Postoperative Pain Control in Burn Patients.

    PubMed

    Wibbenmeyer, Lucy; Eid, Anas; Kluesner, Karen; Heard, Jason; Zimmerman, Bridget; Kealey, G Patrick; Brennan, Timothy

    2015-01-01

    Satisfactory treatment of burn pain continues to be elusive. The perioperative period is particularly challenging. The contributions of acute tolerance and opioid-induced hyperalgesia have not been previously explored in burn patients. As these phenomena have been identified perioperatively in other patient populations, we sought to characterize the burn perioperative period and to determine variables associated with poor postoperative (post-OR) pain control. A retrospective review of 130 adult burn patients who underwent surgical treatment for their burn injuries was performed. Variables collected included: demographics, burn injury data, perioperative self-reported pain scores, and perioperative opioid amounts. Correlations and multiple logistic regressions were used to assess the relationship between these variables and post-OR pain control. Pain increased throughout the perioperative period from 2.64 24 hours prior to the operation (pre-OR) to 3.81 24 hours following the OR (post-OR, P < .0001). Post-OR pain was correlated with pre-OR pain, pre-OR opioid amounts, OR opioid amounts, and post-OR opioid amounts. When the subgroup of patients with controlled pre-OR pain (<3 pain rating) was analyzed, only pre-OR opioids and post-OR opioids remained correlated with worse post-OR pain. While this study is retrospective, there is a suggestion that opioid amounts given pre-OR and intraoperatively are correlated with worse post-OR pain. While an increase in pain ratings postoperatively are anticipated, the additional contributions of acute tolerance and opioid-induced hyperalgesia need to be determined. Pharmacologic intervention directed at these mechanisms can then be administered to achieve better postoperative pain control. PMID:26335109

  8. [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. PMID:15469756

  9. [The Mental Rehabilitation of Burn Patients After a Major Disaster].

    PubMed

    Chou, Frank Huang-Chih

    2016-02-01

    Many catastrophic disasters have happened in Taiwan over the last decade. As disaster is not a special occurrence but rather a part of the norm, mental rehabilitation should be treated as a mainstream issue in psychiatry. The internalization of emergency psychological interventions is necessary for every mental-health professional. The two primary categories of major manmade disasters in Taiwan over the past decade have been gas explosions and powder burns. Both categories have led to the serious injury of many individuals. The physical deformities and job problems faced by burn patients affect their psychiatric and emotional states both directly and indirectly. The psychiatric comorbidities of burn patients include: major depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD), with GAD and PTSD comprising the most significant comorbidities in terms of numbers of diagnoses. To reduce psychological problems in the future, mental-health professionals should use appropriate psychological first aid (PFA) interventions in the early stages of treatment and rehabilitation. Mental rehabilitation is a major and comprehensive rehabilitation process. Mental-health professionals should thus use PFA to treat burn patients as well as provide long-term mental rehabilitation after discharge. PMID:26813061

  10. Abdominal compartment syndrome (ACS) in a severely burned patient.

    PubMed

    Kollias, S; Stampolidis, N; Kourakos, P; Mantzari, E; Koupidis, S; Tsaousi, S; Dimitrouli, A; Atiyeh, B; Castana, O

    2015-03-31

    Abdominal compartment syndrome (ACS) occurs when increasing intra abdominal-pressure (IAP) reduces blood flow to abdominal organs. This results in impairment of pulmonary, cardiovascular, renal, hepatic, central nervous system and gastro-intestinal (gi) function, causing multiple organ dysfunction syndrome and death. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. ACS generally occurs in patients who are critically ill due to any of a wide variety of medical and surgical conditions. it has been recently described as a rare complication of burn injury. it is fundamental to: 1) recognize IAP and ACS; 2) resuscitate effectively; and 3) prevent the development IAP-induced end-organ dysfunction and failure. We present our recent experience with one patient suffering from ACS secondary to burn injury and the physiologic results of abdominal wall escharotomy. PMID:26668555

  11. Abdominal compartment syndrome (ACS) in a severely burned patient

    PubMed Central

    kollias, S.; Stampolidis, N.; kourakos, P.; Mantzari, E.; Koupidis, S.; Tsaousi, S.; Dimitrouli, A.; Atiyeh, B.; Castana, O.

    2015-01-01

    Summary Abdominal compartment syndrome (ACS) occurs when increasing intra abdominal-pressure (IAP) reduces blood flow to abdominal organs. This results in impairment of pulmonary, cardiovascular, renal, hepatic, central nervous system and gastro-intestinal (gi) function, causing multiple organ dysfunction syndrome and death. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. ACS generally occurs in patients who are critically ill due to any of a wide variety of medical and surgical conditions. it has been recently described as a rare complication of burn injury. it is fundamental to: 1) recognize IAP and ACS; 2) resuscitate effectively; and 3) prevent the development IAP-induced end-organ dysfunction and failure. We present our recent experience with one patient suffering from ACS secondary to burn injury and the physiologic results of abdominal wall escharotomy. PMID:26668555

  12. Silver absorption on burns after the application of Acticoat: data from pediatric patients and a porcine burn model.

    PubMed

    Wang, Xue-Qing; Kempf, Margit; Mott, Jonathon; Chang, Hong-En; Francis, Rod; Liu, Pei-Yun; Cuttle, Leila; Olszowy, Henry; Kravchuk, Olena; Mill, Julie; Kimble, Roy M

    2009-01-01

    Silver dressings have been widely used to successfully prevent burn wound infection and sepsis. However, a few case studies have reported the functional abnormality and failure of vital organs, possibly caused by silver deposits. The aim of this study was to investigate the serum silver level in the pediatric burn population and also in several internal organs in a porcine burn model after the application of Acticoat. A total of 125 blood samples were collected from 46 pediatric burn patients. Thirty-six patients with a mean of 13.4% TBSA burns had a mean peak serum silver level of 114 microg/L, whereas 10 patients with a mean of 1.85% TBSA burns had an undetectable level of silver (<5.4 microg/L). Overall, serum silver levels were closely related to burn sizes. However, the highest serum silver was 735 microg/L in a 15-month-old toddler with 10% TBSA burns and the second highest was 367 microg/L in a 3-year old with 28% TBSA burns. In a porcine model with 2% TBSA burns, the mean peak silver level was 38 microg/L at 2 to 3 weeks after application of Acticoat and was then significantly reduced to an almost undetectable level at 6 weeks. Of a total of four pigs, silver was detected in all four livers (1.413 microg/g) and all four hearts (0.342 microg/g), three of four kidneys (1.113 microg/g), and two of four brains (0.402 microg/g). This result demonstrated that although variable, the level of serum silver was positively associated with the size of burns, and significant amounts of silver were deposited in internal organs in pigs with only 2% TBSA burns, after application of Acticoat. PMID:19165102

  13. 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

  14. Management of Pneumatosis Intestinalis in a Pediatric Burn Patient.

    PubMed

    Kalkwarf, Kyle J; Betzold, Richard D; Hung, Stephanie Y; Rinewalt, Anne N; Robertson, Ronald D

    2016-01-01

    Pneumatosis intestinalis is gas in the wall of the gastrointestinal tract. It is not well described in pediatric burn patients. The authors present the case of a 23-month-old girl who sustained 40% total body surface area deep-partial and full-thickness burns as well as a grade two inhalational injury. On postburn day two, radiographic imaging showed extensive pneumatosis of the colon. She was managed with bowel rest, broad-spectrum antibiotics, and parenteral nutrition. Radiographic resolution of pneumatosis intestinalis occurred several days later and was followed by reinitiation of enteral feeds and bowel function. The patient later developed an abscess and a subsequent colocutaneous fistula that resolved with percutaneous drainage and conservative management. She healed and was able to avoid a laparotomy with possible bowel resection. PMID:25377864

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

    PubMed

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

    2014-01-01

    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. PMID:24535909

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

    PubMed Central

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

    2014-01-01

    Background: Nowadays, the treatment of burned patients is difficult because of the high frequency of infection with antibiotic resistance bacteria. Objectives: This study was conducted to evaluate the level of antibiotic resistance in Gram-negative bacteria and its relation with the existence of plasmid. Materials and Methods: The samples were collected from two hundred twenty hospitalized burned patients in Isfahan burn hospital during a three-month period (March 2012 to June 2012). The samples were isolated and the Gram-negative bacteria were identified using phenotypic method and API 20E System. Antibiotic susceptibility and plasmid profile were determined by standard Agar disc diffusion and plasmid spin column extraction methods. Results: Totally 117 Gram-negative bacteria were isolated, the most common were Pseudomonas aerugionsa (37.6%), P. fluorescens (25.6%), Acinetobacter baumanii (20/5%) and Klebsiella pneumoniae (7.6%), respectively. The isolates showed high frequency of antibiotic resistance against ceftazidime and co-amoxiclave (100%) and low frequency of antibiotic resistance against amikacin with (70%).The results indicated that 60% of the isolates harboured plasmid. On the other hand, the patients infected with A. baumanii and P. aeruginosa were cured (with 60% frequency) whereas, those infected with P. fluorescens were not cured. Hence, probably antibiotic resistance markers of A. baumanii and P. aeruginosa are plasmid mediated; however, P. fluorescens is chromosomally mediated. Conclusions: Based on our findings, P. aerugionsa is a major causative agent of wound infections and amikacin could be considered as a more effective antibiotic for treatment of the burned patients. PMID:25789121

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

    PubMed

    Meunier, David; Dupré, Aurélie

    2012-01-01

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

  18. The effect of transfers between health care facilities on costs and length of stay for pediatric burn patients.

    PubMed

    Myers, John; Smith, Michael; Woods, Charles; Espinosa, Claudia; Lehna, Carlee

    2015-01-01

    Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic

  19. The use of exenatide in severely burned pediatric patients

    PubMed Central

    2010-01-01

    Introduction Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered. Methods This open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups. Results Glucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month). Conclusions Patients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting. Trial registration NCT00673309. PMID:20701787

  20. Methylene Blue for Acute Septic Cardiomyopathy in a Burned Patient.

    PubMed

    Schlesinger, Joseph J; Burger, Christina F

    2016-01-01

    The objective of this case summary was to describe the use of methylene blue (MB) in a burned patient with acute septic cardiomyopathy. A 60-year-old Caucasian man was admitted to the Burn Intensive Care Unit with 45% TBSA burns after a house explosion. During the course of his care, he experienced hypotension that was refractory to fluid therapy and vasoactive medications. Echocardiography and right heart catheterization showed new acute systolic dysfunction with concurrent elevated systemic vascular resistance (SVR). High-dose inotropic agents did not improve cardiac function, and septic shock rendered him a poor candidate for mechanical intra-aortic balloon pump support. MB was administered to sensitize the myocardium to catecholamines and improve contractility with the goal of weaning the other vasoactive medications and diuresing for afterload reduction when hemodynamic stability was achieved. MB has been described in critical care medicine predominately for vasoplegia after cardiopulmonary bypass and vasodilatory septic shock., Our patient had acute septic cardiomyopathy that was refractory to standard pharmacologic approaches to inotropy with concurrent elevated SVR. Hypothesizing the differential temporal effect of inducible nitric oxide synthase on the vasculature and myocardium, we administered MB to improve contractility and support the impending vasodilatory effects of distributive shock. Although MB is not a new drug, the application for septic cardiomyopathy with a supranormal SVR is a unique application. Because of the risk profile associated with MB, we recommend drug monitoring utilizing serial echocardiography and/or right heart catheterization. PMID:25798807

  1. The Healing Effect of Amniotic Membrane in Burn Patients

    PubMed Central

    Eskandarlou, Mahdi; Azimi, Mina; Rabiee, Soghra; Seif Rabiee, Mohammad Ali

    2016-01-01

    BACKGROUND Different methods for dressing of donor site of skin graft in burn patients have similarly pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has used for improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for donor site of skin graft to evaluate it’s efficacy in improvement of pain, move score and the risk of local infection. METHODS Study was done as clinical trial over 32 admitted patients in burn department of Beasat hospital. Amnion was prepared in elective caesarean section after rule out any placental site for risk of torch and viral infection. Skin graft was taken from two sites in every patient. One site dressed with amnion and another with routine dressing. Then two sites were compared about severity of pain, move score, infection and time of dressing sloughing. RESULTS Fourteen patients were women and 18 men. Mean score of pain and movement up to fourth and fifth post operative day respectively was less than control site. No difference is seen about infection and dressing slough in two sites. CONCLUSION It seems use of amnion for dressing of donor site probably cause rapid epithelialisation and wound healing and can improve pain and move score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization and following complications and earlier discharge of patients. PMID:27308239

  2. Body image, self-esteem, and depression in burn-injured adolescents and young adults.

    PubMed

    Orr, D A; Reznikoff, M; Smith, G M

    1989-01-01

    The present study was conducted to clarify the effects of burn-related variables (specifically, age at time of burn, years elapsed since burn, locus of burn, and percent of total body surface area burned), demographics, and perceived social support variables on psychological adjustment after injury within a well-defined sample. Subjects were 121 patients, currently 14 to 27 years old, burned within the past 10 years. They completed the following: Semantic Differential Measure of Body Image, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Perceived Social Inventory--Friends, and Perceived Social Inventory--Family. The mean age of the subjects was 17.8 years; the mean percent total body surface area burned was 27.3%, with 75% of the subjects having burns on a visible or socially sensitive area. Correlational and multiple regression analyses showed that subjects perceiving more social support (friends more than family) had more positive body images (p less than 0.01), greater self-esteem (p less than 0.01), and less depression (p less than 0.01) than others, with a significant impact from difference in subjects' gender. PMID:2793926

  3. 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]…

  4. 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. PMID:26594866

  5. [Emphasize the diagnosis and treatment of infective endocarditis in patients with severe burn].

    PubMed

    Huan, Jingning

    2016-02-01

    The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high, which are attributed to invasive procedures, bacteremia, and wound infection after burns. Clinical clues for IE in burns are usually masked by burn-related manifestations, so the diagnosis of IE may be delayed or missed. For burned patients with persistent bacteremia of unknown source, especially Staphylococcus aureus-induced bacteremia, the diagnosis of IE should be considered according to the Duke criteria, and early echocardiography performance is particularly important. Antibiotic therapy is the mainstay initial management, and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns. In order to lower the incidence and mortality of IE in burns, it is very important to take prophylactic procedures along with the whole course of burn management. PMID:26902272

  6. Plasma arginine and leucine kinetics and urea production rates in burn patients.

    PubMed

    Yu, Y M; Young, V R; Castillo, L; Chapman, T E; Tompkins, R G; Ryan, C M; Burke, J F

    1995-05-01

    We measured plasma arginine and leucine kinetics and rates of urea production (appearance) in 12 severely burned patients (mean body surface burn area, 48%) during a basal state (low-dose intravenous glucose) and while receiving routine, total parenteral nutrition ([TPN] fed state) including an L-amino acid mixture, supplying a generous level of nitrogen (mean, 0.36 g N.kg-1.d-1). The two nutritional states were studied in random order using a primed 4-hour constant intravenous tracer infusion protocol. Stable-nuclide-labeled tracers were L-[guanidino-13C]arginine, L-[1-13C]leucine, [18O]urea, and NaH13CO3 (prime only), with blood and expired air samples drawn at intervals to determine isotopic abundance of arginine, citrulline, ornithine, alpha-ketoisocaproate ([KIC] for leucine), and urea in plasma and 13CO2 in breath. Results are compared with data obtained in these laboratories in healthy adults. Leucine kinetics (flux and disappearance into protein synthesis) indicated the expected higher turnover in burn patients than in healthy controls. Mean leucine oxidation rates are also higher and compared well with values predicted from urea production rates, provided that urea nitrogen recycling via intestinal hydrolysis is taken into account. The plasma urea flux was also higher than for normal subjects. Arginine fluxes as measured in the systemic whole body, via the plasma pool, were correspondingly higher in burned patients than in healthy controls and were in good agreement with values predicted from leucine-KIC kinetics. However, systemic whole-body arginine flux measured via the plasma pool was only 20% of the arginine flux estimated from the urea flux plus the rate of protein synthesis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7752916

  7. A misdiagnosed burn: necrotising fasciitis in an elderly patient.

    PubMed

    Vijayan, Roshan; Magdum, Ashish; Critchley, Paul

    2013-01-01

    A 91-year-old man was admitted having been found unresponsive in his bed. He was previously well, but had sustained a laceration over the dorsum of his forearm after a recent fall. Initial appearances were innocuous, and suggestive of a superficial wound infection. A review of the wound by the plastic surgeons led to the diagnosis of a full-thickness burn, despite a lack of supporting evidence in the history. No clinician who had initially assessed the patient was involved in his ongoing care. Rapid clinical deterioration ensued, with sepsis and deteriorating mental state. Necrosis spread rapidly up his arm, and the diagnosis of necrotising fasciitis was made. The patient was urgently taken to theatre for circumferential excision of the necrotic tissue. He was subsequently managed on the intensive care unit where he made a promising initial recovery, but later died from pneumonia in the ward. PMID:23833100

  8. Engaging older adults in burn prevention education: results of a community-based urban initiative.

    PubMed

    Leahy, Nicole E; Sessler, Kelly A; Baggott, Kaitlin; Laverde, Louisa; Rabbitts, Angela; Yurt, Roger W

    2012-01-01

    The objective of the study is to educate New York City seniors aged 60 years and older about fire safety and burn prevention through the use of a community-based, culturally sensitive delivery platform. The ultimate goal is to reduce burn injury morbidity and mortality among this at-risk population. Programming was developed and provided to older adults attending community-based senior centers. Topics included etiology of injury, factors contributing to burn injuries, methods of prevention, emergency preparedness, and home safety. Attendees completed a postpresentation survey. Of the 234 senior centers invited to participate in the program, 64 (27%) centers requested presentations, and all received the educational programming, reaching 2196 seniors. An additional 2590 seniors received education during community-based health fairs. A majority reported learning new information, found the presentation helpful, and intended to apply this knowledge to daily routines. Data confirm that many opportunities exist to deliver culturally sensitive burn prevention programming to the older adult population of this large metropolitan area in settings that are part of their daily lives. A majority of respondents welcomed the information, perceived it as helpful, and reported that they were likely to integrate the information into their lives. PMID:22561308

  9. Pharmacokinetic evaluation of single-dose intravenous daptomycin in patients with thermal burn injury.

    PubMed

    Mohr, John F; Ostrosky-Zeichner, Luis; Wainright, David J; Parks, Donald H; Hollenbeck, Timothy C; Ericsson, Charles D

    2008-05-01

    Daptomycin pharmacokinetics were evaluated for burn patients. Burn patients had decreases in the maximum concentration of the drug in serum (44%) and the area under the concentration-time curve (47%) and increases in the volume of distribution (64%) and total clearance (77%) compared to healthy volunteers. In burn patients, daptomycin at 10 to 12 mg/kg of body weight/day would be required to achieve drug exposures similar to those for healthy volunteers receiving 6 mg/kg. PMID:18299410

  10. 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

  11. 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

  12. 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

  13. Improved markers for burn wound perfusion in the severely burned patient: the role for tissue and gastric Pco2.

    PubMed

    Jeng, James C; Jaskille, Amin D; Lunsford, Patricia M; Jordan, Marion H

    2008-01-01

    Improved markers of resuscitation are needed in patients with severe burn injuries. In previous animal and human work, we showed 1) wound hypoperfusion plays a role in burn depth progression, 2) that there are periods of repetitive ischemia and reperfusion which correlate closely to wound hypoperfusion, and 3) that wound and splanchnic bed CO2 measurements are dependent on the adequacy of resuscitation. We and others believe that current markers for resuscitation, urine output (U/O), and mean arterial pressure (MAP), lag behind in reflecting wound perfusion. In this study, we explore whether gastric and tissue tonometry are better in reflecting minute-to-minute changes in wound perfusion in humans. During the 48-hour experimental period, burn wound, gastric, and arterial pH, Pco2, and PaO2 were measured every 6 seconds using a Paratrend 7 monitor in four patients with life threatening burns. Slopes of change were analyzed and a proportion derived relative to pooled data on 5-minute intervals. Serum lactate, U/O, and MAP were recorded. Laser Doppler Imager (LDI) scans were performed on burn areas every 4 hours, allowing real-time determination of burn perfusion. Resuscitation followed current clinical guidelines. All four patients eventually succumbed, one doing so during the observation period. In the remaining three, U/O and MAP goals were met within 2 hours of resuscitation. Our analysis shows cyclic changes in burn wound pH, CO2, and PaO2, gastric CO2, and PaO2, and arterial base deficit (all P < .005). LDI showed cyclic changes in perfusion (P < .0001) which closely mimic the changes in wound pH, gastric CO2, and arterial base deficit. These changes preceded changes in U/O, MAP, and lactate. Although U/O, MAP, and serum lactate reflect changes in burn wound perfusion, they lag behind other markers. Tissue pH and CO2 and gastric CO2 seem to be more timely related to changes in actual burn perfusion. PMID:18182897

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

    PubMed

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

    2014-12-31

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

  15. Factors influencing energy expenditure in patients with burns.

    PubMed

    Allard, J P; Jeejheebhoy, K N; Whitwell, J; Pashutinski, L; Peters, W J

    1988-02-01

    Twenty-three consecutive patients with a mean burn size of 39% of total body surface area (%TBSA) were studied prospectively. Expected basal energy expenditure (EBEE) calculated by the Harris-Benedict formula, initial and twice weekly measurements of energy expenditure (MEE) by indirect calorimetry, and simultaneous estimation of nutrient intake were obtained. In the whole cohort the EBEE was 1,715 +/- 24 kcal/day and the MEE was 2,218 +/- 59 kcal/day. The degree of hypermetabolism was 29.0 +/- 2.8%. A subgroup of 16 patients had metabolic rates measured in both the fed and unfed states. The degree of hypermetabolism was only 6.5 +/- 4.5% in the unfed, but increased to 34.1 +/- 3.2% when the same patients were fed (p less than 0.001). The factors affecting MEE were then evaluated by stepwise multiple regression analysis which showed that MEE = -4343 + (10.5 X %TBSA) + (0.23 X Caloric intake [CI]) + (0.84 X EBEE) + (114 X Temp [C]) - (4.5 X Postburn days), r = 0.82, p less than .001. We conclude that 25% of the CI is used to increase the MEE, which suggests that these measurements done in the fasting state cannot be used to predict requirements. PMID:3126305

  16. Electrical Burn Injury: A Five-Year Survey of 682 Patients

    PubMed Central

    Ghavami, Yaser; Mobayen, Mohammad Reza; Vaghardoost, Reza

    2014-01-01

    Background: Electrical burn is less prevalent in comparison to other forms of burn injuries, however this type of injury is considered as one of the most devastating due to high morbidity and mortality. Understanding the epidemiologic pattern of electrical burns helps determine the contributing factors leading to this type of injury. Objectives: Epidemiologic studies on electrical burn are scarce in Iran. This study was conducted to evaluate electrical burn injury at our center. Materials and Methods: Demographic data, etiology, burn percentage and other measures related to electrical burn injury of 682 electrical burn patients treated from 2007 to 2011 were collected and analyzed. Results: We assessed 682 electrical burn patients (~10.8% of all burn patients); the mean age was 29.4 years and 97.8% were males. The mean hospital stay was 18.5 days and the mean burn extent was 14.43%. Severe morbidities caused 17 (2.5%) deaths. Amputation was performed in 162 cases. The most common amputation site was the fingers (35%). Most victims were workers and employees and 68.5% of electrical burns occurred at their workplace; 72% of electrical burns were due to high voltage electrical current (more than 1000 V). There was a correlation between voltage and amputation (P = 0.001) and also between voltage and fasciotomy (P = 0.033), but there was no correlation between voltage and mortality (P = 0.131) Conclusions: Electrical burn injuries are still amongst the highest accident-related morbidities and mortalities. Educating the population about the dangers and hazards associated with improper use of electrical devices and instruments is imperative. PMID:25717451

  17. Psychophysiological Processing of Itch in Patients with Chronic Post-burn Itch: An Exploratory Study.

    PubMed

    van Laarhoven, Antionette I M; Ulrich, Dietmar J O; Wilder-Smith, Oliver H; van Loey, Nancy E E; Nieuwenhuis, Marianne; van der Wee, Nic J A; Evers, Andrea W M

    2016-06-15

    A substantial proportion of patients with burn injury develop chronic itch, which can severely affect their quality of life. As found in research on chronic pain, different psychophysiological processes may also play a role in chronic itch, of which central sensitization, conditioned modulation, and attentional processes have been studied most frequently. This study aimed to explore psychophysiological processes of chronic post-burn itch by comparing 15 patients with long-term itch due to burn injury with 15 matched healthy controls. Exploratory results indicated tendencies for higher itch sensitivity in patients than in controls, for mechanical stimuli and histamine, but not for electrical stimulation. Results further suggest that the efficacy of itch modulation by an itch- or pain-conditioning stimulus or directing attention towards itch stimuli do not differ between these patients and controls. Further elucidation of the processes underlying post-burn itch may improve the early identification and treatment of burn patients developing chronic itch. PMID:26694745

  18. Self Perceptions of Young Adults who Survived Severe Childhood Burn Injury

    PubMed Central

    Russell, W; Robert, RS; Thomas, CR; Holzer, CE; Blakeney, P; Meyer, WJ

    2012-01-01

    Objective The transition of pediatric burn survivors into adulthood is accompanied by a reformulation of their self concept. In order 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. Method 82 young adult burn survivors (45 males, 37 females) were assessed using the Tennessee Self-Concept, 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). Results This group of burn survivors scored significantly lower in self-concepts, reflected in TSCS2 sub-scale 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 sub-scales 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. Affective distress on the SCID I was associated with significantly lower self concept. 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

  19. 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…

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

    PubMed Central

    NOVAC, M.; DRAGOESCU, ALICE; STANCULESCU, ANDREEA; DUCA, LUCICA; CERNEA, DANIELA

    2014-01-01

    Purpose: Statistical evaluation of the prognosis of burned patients based on the analysis of prognostic scores as quickly and easily obtainable that track the evolution of burned patient in ICU. Material / Methods: The prospective study included 92 patients were performed with severe burns on 35-67% body surface large area, aiming to establish a cut-off score for each studied and statistically significant prognostic parameter for assessing the risk of mortality. The control group was represented by 20 patients with burns on the body surface of <10%. Results: The death rate was not statistically significant on burned (p> 0.05) sex (male / female), but we had p <0.001 when we referred to the total body surface area, and p <0.05 when we took into account the degree burns, acute respiratory distress syndrome and age. For each index / prognostic score studied by making ROC curve when they take different values, we set a cut-off. Quantification of variables by calculating the area under the ROC curve (AUC), sensitivity and sensitivity, positive predictive value (PPV) and negative predictive value (NPV), allowed a better appreciation of these prognostic scores. Conclusions: These systems applicable to the burned patient scores, making a cut-off of each index / mortality probability score, he can manifest usefulness in medical decision making process and strategy to reduce the risk of death in patients with severe burns. PMID:26793322

  1. Burn injury in epileptic patients: an experience in a tertiary institute.

    PubMed

    Akhtar, M S; Ahmad, I; Khan, A H; Fahud Khurram, M; Haq, A

    2014-09-30

    The objective of this study was to evaluate the incidence, types and severity of burn injuries, including sites involved, morbidities, operative procedures, and their outcomes, to prevent or reduce the frequency and morbidity of such injuries in epileptic patients. This retrospective study was conducted at our centre between February 2008 and January 2012. The study included 54 patients who sustained burn injuries due to epileptic seizures, accounting for 1.3% of all burn admissions. All patients, irrespective of the severity of their injuries, were admitted to our centre, assessed, treated and educated regarding specific preventive measures. All study data were evaluated from patient medical records. Causes of burn injury were as follows: scald burns (30), contact with hot surfaces (12), electrical burns in the bathroom (6), and flame burns (6). Second degree burns were the most common (18 out of 54 patients) and third degree burns were the least common. Upper limb and trunk were the most common sites involved (36 out of 54 patients). Thirty patients required surgical intervention whereas the remainder was conservatively managed. Most of the injuries occurred in the age group between 30-37 years. Injuries occurred predominantly in females [42 females, 12 males; F:M=3.5:1]. The study revealed that patients with epilepsy should be categorized as a high risk group considering the sudden and unpredictable attack of epileptic seizures leading to loss of consciousness and accidental burn injuries. Early surgical intervention and targeting of all epileptic patients for education and instituting the specific preventive measures gives good outcomes. PMID:26170789

  2. Analysis of the microcirculation after soft tissue reconstruction of the outer ear with burns in patients with severe burn injuries.

    PubMed

    Medved, Fabian; Medesan, Raluca; Rothenberger, Jens Martin; Schaller, Hans-Eberhard; Schoeller, Thomas; Manoli, Theodora; Weitgasser, Lennart; Naumann, Aline; Weitgasser, Laurenz

    2016-07-01

    Reconstruction of soft tissue defects of the ear with burns remains one of the most difficult tasks for the reconstructive surgeon. Although numerous reconstructive options are available, the results are often unpredictable and worse than expected. Besides full and split skin grafting, local random pattern flaps and pedicled flaps are frequently utilized to cover soft tissue defects of the outer auricle. Because of the difficulty and unpredictable nature of outer ear reconstruction after burn injury, a case-control study was conducted to determine the best reconstructive approach. The microcirculatory properties of different types of soft tissue reconstruction of the outer ear with burns in six severely burned Caucasian patients (three men and three women; mean age, 46 years (range, 22-70)) were compared to those in the healthy tissue of the outer ear using the O2C device (Oxygen to See; LEA Medizintechnik, Gießen, Germany). The results of this study revealed that the investigated microcirculation parameters such as the median values of blood flow (control group: 126 AU), relative amount of hemoglobin (control group: 59.5 AU), and tissue oxygen saturation (control group: 73%) are most similar to those of normal ear tissue when pedicled flaps based on the superficial temporal artery were used. These findings suggest that this type of reconstruction is superior for soft tissue reconstruction of the outer ear with burns in contrast to random pattern flaps and full skin grafts regarding the microcirculatory aspects. These findings may improve the knowledge on soft tissue viability and facilitate the exceptional and delicate process of planning the reconstruction of the auricle with burns. PMID:26997326

  3. [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. PMID:26564564

  4. Determination of Optimal Amikacin Dosing Regimens for Pediatric Patients With Burn Wound Sepsis.

    PubMed

    Yu, Tian; Stockmann, Chris; Healy, Daniel P; Olson, Jared; Wead, Stephanie; Neely, Alice N; Kagan, Richard J; Spigarelli, Michael G; Sherwin, Catherine M T

    2015-01-01

    This study aimed to develop optimal amikacin dosing regimens for the empirical treatment of Gram-negative bacterial sepsis in pediatric patients with burn injuries. A pharmacodynamic (PD) target in which the peak concentration (Cmax) is ≥8 times the minimum inhibitory concentration (MIC) (Cmax/MIC ≥ 8) is reflective of optimal bactericidal activity and has been used to predict clinical outcomes. Population pharmacokinetic modeling was performed in NONMEM 7.2 for pediatric patients with and without burn injuries. Amikacin pharmacokinetic parameters were compared between the two groups and multiple dosing regimens were simulated using MATLAB to achieve the PD target in ≥90% of patients with burn injuries. The pharmacokinetic analysis included 282 amikacin concentrations from 70 pediatric patients with burn injuries and 99 concentrations from 32 pediatric patients without burns. A one-compartment model with first-order elimination described amikacin pharmacokinetics well for both groups. Clearance (CL) was significantly higher in patients with burn injuries than in patients without (7.22 vs 5.36 L/h, P < .001). The volume of distribution (V) was also significantly increased in patients with burn injuries (22.7 vs 18.7 L, P < .01). Weight significantly influenced amikacin CL (P < .001) and V (P < .001) for both groups. Model-based simulations showed that a higher amikacin dose (≥25 mg/kg) achieved a Cmax/MIC ≥8 in ≥90% of patients with assumed infections of organisms with an MIC = 8 mg/L. Amikacin pharmacokinetics are altered in patients with burn injuries, including a significant increase in CL and V. In simulations, increased doses (≥25 mg/kg) led to improved PD target attainment rates. Further clinical evaluation of this proposed dosing regimen is warranted to assess clinical and microbiological outcomes in pediatric patients with burn wound sepsis. PMID:25185930

  5. Circulating plasma factors induce tubular and glomerular alterations in septic burns patients

    PubMed Central

    Mariano, Filippo; Cantaluppi, Vincenzo; Stella, Maurizio; Romanazzi, Giuseppe Mauriello; Assenzio, Barbara; Cairo, Monica; Biancone, Luigi; Triolo, Giorgio; Ranieri, V Marco; Camussi, Giovanni

    2008-01-01

    Background Severe burn is a systemic illness often complicated by sepsis. Kidney is one of the organs invariably affected, and proteinuria is a constant clinical finding. We studied the relationships between proteinuria and patient outcome, severity of renal dysfunction and systemic inflammatory state in burns patients who developed sepsis-associated acute renal failure (ARF). We then tested the hypothesis that plasma in these patients induces apoptosis and functional alterations that could account for proteinuria and severity of renal dysfunction in tubular cells and podocytes. Methods We studied the correlation between proteinuria and indexes of systemic inflammation or renal function prospectively in 19 severe burns patients with septic shock and ARF, and we evaluated the effect of plasma on apoptosis, polarity and functional alterations in cultured human tubular cells and podocytes. As controls, we collected plasma from 10 burns patients with septic shock but without ARF, 10 burns patients with septic shock and ARF, 10 non-burns patients with septic shock without ARF, 10 chronic uremic patients and 10 healthy volunteers. Results Septic burns patients with ARF presented a severe proteinuria that correlated to outcome, glomerular (creatinine/urea clearance) and tubular (fractional excretion of sodium and potassium) functional impairment and systemic inflammation (white blood cell (WBC) and platelet counts). Plasma from these patients induced a pro-apoptotic effect in tubular cells and podocytes that correlated with the extent of proteinuria. Plasma-induced apoptosis was significantly higher in septic severe burns patients with ARF with respect to those without ARF or with septic shock without burns. Moreover, plasma from septic burns patients induced an alteration of polarity in tubular cells, as well as reduced expression of the tight junction protein ZO-1 and of the endocytic receptor megalin. In podocytes, plasma from septic burns patients increased

  6. Low Level of TSST-1 Antibody in Burn Patients With Toxic Shock Syndrome Caused by Methicillin-Resistant Staphylococcus aureus.

    PubMed

    Matsushima, Asako; Kuroki, Yuich; Nakajima, Shinji; Sakai, Tomohiko; Kojima, Hiroki; Ueyama, Masashi

    2015-01-01

    Toxic shock syndrome (TSS) caused by methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection is a growing concern in both adult and pediatric patients. The reason why TSS appears in only some patients with MRSA infection remains unclear. In this study, we analyzed serial TSS toxin-1 (TSST-1) antibody in patients with burn injury to investigate the mechanisms of TSS caused by MRSA nosocomial infection. This study comprised of patients with burn injury in our burn care unit from September, 2010 to August, 2011. Serum samples were collected serially on admission, at 48 to 72 hours after injury, on the day MRSA infection appeared, and on the day MRSA infection resolved. TSST-1 antibody was measured by enzyme-linked immunosorbent assay (ELISA). TSS was diagnosed according to the criteria of the Centers for Disease Control. Serial serum samples were collected from 24 patients and nosocomial MRSA infection was detected in 12 patients. In these 12 patients, TSS occurred in five patients (TSS+ group) but did not occur in the other seven patients (TSS- group). TSST-1 antibody level was significantly lower in the TSS+ group than TSS- group on admission and on the day MRSA infection appeared. All patients in the TSS+ group received intravenous immune globulin when TSS was diagnosed, and no patients died of TSS. Patients suffering from TSS had a lower level of TSST-1 antibody than patients not suffering from TSS. Testing for TSST-1 antibody in the clinical setting might help to predict and prevent the appearance of TSS caused by nosocomial MRSA infection. PMID:25094005

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  10. Profile of infections and antimicrobial treatment among burn-injury patients.

    PubMed

    Sakabe, Delmo; Del Fiol, Fernando de Sá

    2016-08-01

    Infections are the leading cause of morbidity and mortality among burn-injury patients. Even in the absence of documented infection, antibiotics are often given to burn-injury patients at the beginning of treatment, an empirical measure in response to signs and symptoms of infection. The choice of antimicrobial therapy for these patients should be based on technical criteria, based on laboratory findings, at the risk of further increasing antimicrobial resistance levels. PMID:27324611

  11. A Competing Risk Analysis for Hospital Length of Stay in Patients With Burns

    PubMed Central

    Taylor, Sandra L.; Sen, Soman; Greenhalgh, David G.; Lawless, MaryBeth; Curri, Terese; Palmieri, Tina L.

    2016-01-01

    IMPORTANCE Current outcome predictors for illness and injury are measured at a single time point—admission. However, patient prognosis often changes during hospitalization, limiting the usefulness of those predictions. Accurate depiction of the dynamic interaction between competing events during hospitalization may enable real-time outcome assessment. OBJECTIVE To determine how the effects of burn outcome predictors (ie, age, total body surface area burn, and inhalation injury) and the outcomes of interest (ie, mortality and length of stay) vary as a function of time throughout hospitalization. DESIGN, SETTING, AND PARTICIPANTS In this retrospective study, we used the American Burn Association’s National Burn Repository, containing outcomes and patient and injury characteristics, to identify 95 579 patients admitted with an acute burn injury to 80 tertiary American Burn Association burn centers from 2000 through 2009. We applied competing risk statistical methods to analyze patient outcomes. MAIN OUTCOMES AND MEASURES We estimated the cause-specific hazard rates for death and discharge to assess how the instantaneous risk of these events changed across time. We further evaluated the varying effects of patient age, total body surface area burn, and inhalation injury on the probability of discharge and death across time. RESULTS Maximum length of stay among patients who died was 270 days and 731 days among those discharged. Total body surface area, age, and inhalation injury had significant effects on the subdistribution hazard for discharge (P < .001); these effects varied across time (P < .002). Burn size (coefficient –0.046) determined early outcomes, while age (coefficient –0.034) determined outcomes later in the hospitalization. Inhalation injury (coefficient –0.622) played a variable role in survival and hospital length of stay. CONCLUSIONS AND RELEVANCE Real-time measurement of dynamic interrelationships among burn outcome predictors using competing

  12. Pediatric facial burns.

    PubMed

    Kung, Theodore A; Gosain, Arun K

    2008-07-01

    Despite major advances in the area of burn management, burn injury continues to be a leading cause of pediatric mortality and morbidity. Facial burns in particular are devastating to the affected child and result in numerous physical and psychosocial sequelae. Although many of the principles of adult burn management can be applied to a pediatric patient with facial burns, the surgeon must be cognizant of several important differences. Facial burns and subsequent scar formation can drastically affect the growth potential of a child's face. Structures such as the nose and teeth may become deformed due to abnormal external forces caused by contractures. Serious complications such as occlusion amblyopia and microstomia must be anticipated and urgently addressed to avert permanent consequences, whereas other reconstructive procedures can be delayed until scar maturation occurs. Furthermore, because young children are actively developing the concept of self, severe facial burns can alter a child's sense of identity and place the child at high risk for future emotional and psychologic disturbances. Surgical reconstruction of burn wounds should proceed only after thorough planning and may involve a variety of skin graft, flap, and tissue expansion techniques. The most favorable outcome is achieved when facial resurfacing is performed with respect to the aesthetic units of the face. Children with facial burns remain a considerable challenge to their caregivers, and these patients require long-term care by a multidisciplinary team of physicians and therapists to optimize functional, cosmetic, and psychosocial outcomes. PMID:18650717

  13. Effect of zinc supplement in the prognosis of burn patients in iraq.

    PubMed

    Al-Kaisy, A A; Salih Sahib, A; Al-Biati, H A H K

    2006-09-30

    Many studies have reported that zinc plasma levels significantly decrease after a burn, leading to zinc deficiency, and that increased free radical generation and decreased natural antioxidant may negatively affect wound healing and burn outcome in general. Targeting of these changes is considered an important strategy in the treatment of burns in an attempt to improve burn outcome in the clinical setting. Zinc was given orally in a nutritional dose (15 mg elemental zinc) as a zinc sulphate capsule to burn patients in order to improve post-burn zinc deficiency and burn outcome. The study was carried out in 58 burn patients of different age groups, sex, and occupation with different burn size. The patients were allocated to two groups: group A patients (43 in number) were treated with topical povidone-iodine ointment for the first four days post-injury followed by topical silver sulphadiazine cream 1% until discharge in addition to other prescribed drugs according to our burn unit policy; group B patients (15) received the same treatment as group A plus a single daily oral dose of zinc sulphate in a 66 mg capsule, equivalent to 15 mg elemental zinc. In each group, using standard methods, we considered plasma zinc and copper levels, oxidative stress parameters, thyroid, liver, and renal function tests, microbiological factors, mortality rate, healing time, and cost effectiveness. The administration of zinc in dietary doses significantly increased the plasma zinc level in burn patients to around normal control levels and improved the antioxidant status, as represented by elevation of the natural antioxidant level (glutathione), in addition to improving healing time, the incidence of eschar formation, and the mortality rate, compared with the zinc-nonsupplemented group. We conclude that dietary zinc supplementation in zinc-deficient burn patients led to great improvements in their outcome and that zinc deficiency was as an important goal to target during treatment

  14. Design considerations for adult patient education.

    PubMed

    Walsh, P L

    1982-01-01

    A variety of factors require attention in the design of patient education programs for adults. Andragogy, the art and science of helping adults learn, describes certain conditions of learning that are more conducive to growth and development for adults and prescribes practices in the learning-teaching transaction to meet them. Stigma, a special discrepancy between virtual and actual social identity, reduces a patient's self-esteem and fosters a feeling of dependence on others for care. Anxiety related to diagnosis and illness creates a situation in which patients cannot productively learn. The stages in acceptance of diagnosis provide a roadmap for understanding a patient's feelings/psychological processes and insight into opportunities to intervene with patient education. The specific disease a patient has effects his ability to learn. Each of these factors is considered with implications described for designing and implementing patient education activities for adults. PMID:10258421

  15. 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

  16. The results of a national survey regarding nutritional care of obese burn patients.

    PubMed

    Coen, Jennifer R; Carpenter, Annette M; Shupp, Jeffrey W; Matt, Sarah E; Shaw, Jesse D; Flanagan, Katherine E; Pavlovich, Anna R; Jeng, James C; Jordan, Marion H

    2011-01-01

    Little is known about the nutritional needs of obese burn patients. Given the impact of obesity on the morbidity and mortality of these patients, a uniform understanding of perceptions and practices is needed. To elucidate current practices of clinicians working with the obese burn population, the authors constructed a multidisciplinary survey designed to collect this information from practitioners in United States burn centers. An electronic approach was implemented to allow for ease of distribution and completion. A portable document format (pdf) letter was e-mailed to the members of the American Burn Association and then mailed separately to additional registered dietitians identified as working in burn centers. This letter contained a link to a 29-question survey on the SurveyMonkey.com server. Questions took the form of multiple choice and free text entry. Responses were received from physicians, mid-level practitioners, registered dietitians, and nurses. Seventy-five percent of respondents defined obesity as body mass index >30. The Harris-Benedict equation was identified as the most frequently used equation to calculate the caloric needs of burn patients (32%). Fifty-eight percent indicated that they alter their calculations for the obese patient by using adjusted body weight. Calculations for estimated protein needs varied among centers. The majority did not use hypocaloric formulas for obese patients (79%). Enteral nutrition was initiated within the first 24 hours for both obese and nonobese patients at most centers. Sixty-three percent suspend enteral nutrition during operative procedures for all patients. Oral feeding of obese patients was the most preferred route, with total parenteral nutrition being the least preferred. Longer length of stay, poor wound healing, poor graft take, and prolonged intubation were outcomes perceived to occur more in the obese burn population. In the absence of supporting research, clinicians are making adjustments to the

  17. 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

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

    PubMed Central

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

    2014-01-01

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

  19. Environmental decontamination following occupancy of a burns patient with multiple carbapenemase-producing organisms.

    PubMed

    Garvey, M I; Bradley, C W; Jumaa, P

    2016-06-01

    Over the last decade, carbapenemase-producing organisms (CPOs) have spread worldwide, becoming a major public health concern. This article reports the authors' experience in dealing with a burns patient infected with CPOs, and the decontamination methods employed to render a burns shock room safe for re-use. The shock room was cleaned after being vacated, but environmental sampling cultured multiple CPOs. A second decontamination was undertaken comprising a detergent, steam and hypochlorite clean followed by hydrogen peroxide misting, and no CPOs were cultured after subsequent environmental sampling. A burns patient harbouring CPOs contaminates the surroundings heavily, so standard cleaning is insufficient to reduce the environmental bioburden. PMID:26895617

  20. 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

  1. 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. PMID:27233675

  2. Emergent burn care.

    PubMed

    Harvey, J S; Watkins, G M; Sherman, R T

    1984-02-01

    The estimated 32,600,000 fires that occur annually in the United States produce over 300,000 injuries and 7,500 deaths. Ten percent of hospitalized burn victims die as a direct result of the burn. Initial evaluation and management of the burn patient are critical. The history should include the burn source, time of injury, burn environment, and combustible products. The burn size is best estimated by the Lund and Browder chart, and the burn depth is determined by clinical criteria. Pulmonary involvement and circumferential thoracic or extremity burns require detection and aggressive treatment to maintain organ viability. Hospitalization is usually necessary for adults with burns larger than 10% of the total body surface area (TBSA) or children with burns larger than 5% of TBSA. Major burns, those of 25% or more of TBSA or of 10% or more of full thickness, should be considered for treatment at a burn center, as well as children or elderly victims with burns of greater than 10% TBSA. Lactated Ringer's solution, infused at 4 ml/kg/% TBSA, is generally advocated for initial fluid restoration. After the acute phase (48 hours), replacement of evaporative and hypermetabolic fluid loss is necessary. These losses may constitute 3 to 5 liters per day for a 40% to 70% TBSA burn. Blood transfusion is often required because of persistent loss of red blood cells (8% per day for about ten days). Many electrolyte abnormalities may occur in the first two weeks. Pulmonary injury commonly is lethal. Circumoral burns, oropharyngeal burns, and carbonaceous sputum are indicative of inhalation injury, but arterial blood gas determinations, fiberoptic bronchoscopy, and xenon lung scans are useful for confirming the diagnosis. Humidified oxygen, intubation, positive-pressure ventilation, and pulmonary toilet are the mainstays of therapy for inhalation injury. Wound care is initially directed at preservation of vital function by escharotomy, if restrictive eschar impairs ventilatory or

  3. Regulation of the insulin-like growth factor system by insulin in burn patients.

    PubMed

    Lang, C H; Fan, J; Frost, R A; Gelato, M C; Sakurai, Y; Herndon, D N; Wolfe, R R

    1996-07-01

    The aim of the present investigation was to determine whether there is a net uptake of insulin-like growth factor I (IGF-I) or IGF-binding proteins (IGFBPs) by the leg after burn injury and to elucidate the regulatory role of insulin exerted on this system under in vivo conditions in burn patients. Studies were performed on nine patients after burn injury (approximately 60% body surface area). Each patient was studied twice during a continuous infusion of a carbohydrate-rich enteral diet. Blood was collected simultaneously from the femoral artery and vein for the measurement of various elements of the IGF system after 7 days of enteral diet alone (basal period) and after 7 days of the enteral diet plus the infusion of insulin (insulin period). Data from these patients were compared to values in age-matched fed healthy volunteers. During the basal period, burn patients demonstrated a significant reduction in the venous concentration of IGF-I and an increase in both IGFBP-1 and -2 compared to control values. Insulin produced a significant 15% increase in the IGF-I concentration in burn patients, but decreased the circulating levels of IGFBP-1 by 50%. The IGF-I and IGFBP-1 concentrations at the end of the insulin period were still significantly different from those in control subjects. Burn patients also exhibited a marked reduction in intact IGFBP-3 and the acid-labile subunit under basal conditions, and these alterations were not reversed by insulin. Under basal conditions, all burn patients had a positive arterio-venous (A-V) difference for IGF-I across the leg. The A-V difference was increased 50% in response to insulin. The net uptake of IGF-I by the leg was 2.4 micrograms/min under basal conditions, and as leg blood flow also tended to increase in response to insulin, IGF-I uptake was elevated more than 3-fold during the insulin period. No A-V difference across the leg was detected for IGFBP-1, -2, or -3 in burn patients. In conclusion, burn injury in humans

  4. Use of the videophone to collect quality of life data from burn patients

    PubMed Central

    Yoder, Linda H; McFall, D Curk; Cancio, Leopoldo C

    2012-01-01

    Collecting quality of life (QOL) data longitudinally from burn survivors is difficult; especially if they live in geographically distant areas from the burn center. Although mailed surveys can be used, response rates to these surveys may be low. The purpose of this feasibility study was to examine the use of the videophone to collect QOL data from burn patients over 5 time points after discharge from the U.S. Army Institute of Surgical Research Burn Center. Twenty-five patients agreed to participate, using the Starview 2000 Pro II videophone. Participant satisfaction with the technology was measured using the Telemedicine Perception Questionnaire. Qualitative comments from participants and the researchers conducting the videophone data collection sessions also were collected. Military participants were approximately 20 years younger than civilian participants. Most burns were from a thermal cause and civilian patients had a slightly shorter length of stay in the burn center than military participants. The majority of participants were relatively happy with the telehealth technology, rating it with a mean score of 61.84 out of a possible total score of 85. Qualitative comments also reflected a positive attitude about the use of the videophone for research data collection; 60% of the participants said they remained in the study because they were allowed to use the videophone rather than using only the telephone or a mailed survey. The researchers collecting the data also commented about the ease of using the videophone. Negative comments were related to dropped calls or lack of audio or video at certain times. Findings from this study are consistent with the two other studies that reported use of telemedicine to clinically evaluate burn patients. With the rapid advancement of technology, QOL research data could be collected longitudinally from burn patients by using laptops with high resolution, portable video cameras. PMID:23272295

  5. Heart Rate Variability as a Predictor of Death in Burn Patients.

    PubMed

    Loguidice, Michael J; Schutt, Robert C; Horton, Jureta W; Minei, Joseph P; Keeley, Ellen C

    2016-01-01

    Heart rate variability (HRV), a noninvasive technique used to quantify fluctuations in the interval between normal heart beats (NN), is a predictor of mortality in some patient groups. The aim of this study was to assess HRV in burn trauma patients as a predictor of mortality. The authors prospectively performed 24-hour Holter monitoring on burn patients and collected demographic information, burn injury details, and in-hospital clinical events. Analysis of HRV in the time and frequency domains was performed. A total of 40 burn patients with a mean age of 44 ± 15 years were enrolled. Mean %TBSA burn was 27 ± 22% for the overall population and was significantly higher in those who died compared with those who survived (55 ± 23% vs 19 ± 13%; P < .0001). There was a statistically significant inverse linear correlation between SD of NN intervals and %TBSA (r = -.337, R = 0.113, 95% CI = -0.587 to -0.028, two-tailed P = .034), as well as with ultra low frequency power and %TBSA burn (r = -0.351, R = 0.123, 95% CI = -0.152 to -0.009; P = .027). The receiver-operator characteristic showed the area under the curve for %TBSA as a predictor of death was 0.82 (P < .001), for SDANN was 0.94 (P < .0001), and for ultra low frequency power was 0.96 (P < .0001). Deranged HRV in the early postburn period is a strong predictor of death. PMID:26061155

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

    PubMed Central

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

    2015-01-01

    BACKGROUND Burn patients experience high levels of predictable anxiety during dressing changes while anti-anxiety drugs cannot control these anxieties. The nurses can limit the side effects of medications by undertaking complementary therapies. Hand pressure massage was introduced as a technique that can reduce these anxieties. This study aimed to investigate the effect of hand pressure massage using Shiatsu method on underlying anxiety in burn patients. METHODS In an available randomized study, 60 burn patients with underlying pain were enrolled. They were randomly allocated in two groups of hand massage and the control. The anxiety of underlying burn pain before and after the massage was evaluated using Burn Specific Pain Anxiety Scale (BSPAS). RESULTS The difference for anxiety scores in the hand Shiatsu massage group before and after massage were statistically significant, but in the control group was not significant. CONCLUSION Based on our findings, 20 minutes of hand Shiatsu massage in conjunction with analgesic medications can be beneficial to control the anxiety of burn patients. PMID:25606475

  7. 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

  8. Hospital Patients Are Adult Learners.

    ERIC Educational Resources Information Center

    Caffarella, Rosemary S.

    Patient education is recognized by health care providers and patients themselves as an important component of adequate health care for hospital patients. Through this informational process, patients receive information about specific health problems, learn the necessary competencies to deal with them, and develop accepting attitudes toward the…

  9. 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

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

    PubMed Central

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

    2015-01-01

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

  11. [Fluid management and care for multiple organ dysfunction syndrome in patients with extensive burns].

    PubMed

    Shinozawa, Yotaro

    2005-12-01

    Burn shock and multiple organ dysfunction syndrome (MODS) are the main causes of death in patients with extensive burns, and thus fluid management and care for MODS are crucial in the treatment of these patients. Several fluid formulas have been developed, although there is still controversy over the best formula. The important point is to understand how to deal with the different side effects inevitable with each fluid therapy: fluid restriction and/or diuretic administration in the refilling phase in fluid therapy with crystalloid, care for hypernatremia and/or a hyperosmolar state in fluid therapy with hypertonic lactated solution (HLS), etc. Precise fluid management is needed for aged patients, patients with extensive inhalation injury, extensive electric injury, and myocardial dysfunction, or patients in whom the start of fluid treatment was delayed. MODS in extensively burned patients is attributed to overwhelming burn stress and complicated sepsis, including bacterial translocation (BT). A dysfunctioning organ impairs another organ (organ interrelationships), and therefore substitution and/or recovery of a dysfunctioning organ are crucial. Debridement of skin with third-degree burns, suppression of BT, sanitary airway management, avoidance of unnecessary stress, and mediator modulation to stop the mediator cascade inducing MODS are also crucial. PMID:16869126

  12. 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. PMID:26857767

  13. Long-Term Administration of Oxandrolone Improves Lung Function in Pediatric Burned Patients.

    PubMed

    Sousse, Linda E; Herndon, David N; Mlcak, Ronald P; Lee, Jong O; Andersen, Clark R; Zovath, Andrew J; Finnerty, Celeste C; Suman, Oscar E

    2016-01-01

    Pulmonary dysfunction is a significant contributor to morbidity and mortality in the pediatric burned population. We have previously reported that the administration of a synthetic testosterone derivative, oxandrolone, significantly reduced hypermetabolism, and significantly increased height percentile, bone mineral content, lean body mass, and strength in pediatric burned patients. We hypothesize that the administration of oxandrolone will improve pulmonary function in burned pediatric subjects. A subset of severely burned pediatric subjects from a prospective clinical trial (n = 222) were included in our study (n = 54, 7-18 years, ≥30% TBSA burn). The subjects were previously randomized to either the control arm (n = 35) or the oxandrolone arm (0.1 mg/kg twice/day for 12 months, n = 19). Maximum voluntary ventilation, the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects. Subjects treated with oxandrolone had a significantly higher maximum voluntary ventilation (98 ± 53 L/min vs 115 ± 56 with treatment, P = .03). During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects (32.0 ± 8.7 L/min vs 43.7 ± 13.6 with treatment, P = .02). The administration of oxandrolone was associated with improved lung function in pediatric burned patients. PMID:27171844

  14. Long-Term Propranolol Use in Severely Burned Pediatric Patients: A Randomized Controlled Study

    PubMed Central

    Herndon, David N.; Rodriguez, Noe A.; Diaz, Eva C.; Hegde, Sachin; Jennings, Kristofer; Mlcak, Ronald P.; Suri, Jaipreet S.; Lee, Jong O.; Williams, Felicia N.; Meyer, Walter; Suman, Oscar E.; Barrow, Robert E.; Jeschke, Marc G.; Finnerty, Celeste C.

    2012-01-01

    Objective To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective randomized single-center controlled study in pediatric patients with large burns. Summary Background Data Severe burns trigger a hypermetabolic response that persists for up to 2 years after burn. Propranolol given for 1 month post burn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear. Methods One-hundred seventy nine pediatric patients with >30% total body surface area burns were randomized to receive control (n = 89) or 4 mg/kg/d propranolol (n = 90) for 12 months after burn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjust for non-normality, repeated measures, and regression analyses. P <0.05 was considered significant. Results Long-term propranolol treatment significantly reduced the percent of the predicted heart rate and percent of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used. Conclusions Propranolol treatment for 12 months, following thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov, NCT00675714. PMID:22895351

  15. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review.

    PubMed

    Adjepong, Mary; Agbenorku, Pius; Brown, Patricia; Oduro, Ibok

    2016-01-01

    Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations. PMID:27574687

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

    PubMed

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

    2013-06-01

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

  17. Acinetobacter infection is associated with acquired glucose intolerance in burn patients.

    PubMed

    Furniss, Dominic; Gore, Sinclair; Azadian, Berge; Myers, Simon R

    2005-01-01

    Infection with antibiotic-resistant Acinetobacter spp. is an increasing problem in critical care environments worldwide. Acinetobacter spp. are known to produce an insulin-cleaving protease. We hypothesized that infection with Acinetobacter spp. was associated with the acquisition of glucose intolerance in burn patients. Data were collected prospectively on all 473 patients admitted to the Burns Centre between January 2002 and March 2003. A total of 3.4% of patients acquired glucose intolerance during admission. Patients with Acinetobacter spp. infection were 9.8 times more likely to develop glucose intolerance than those without the infection (P < .0001). The association persisted after controlling for TBSA (P < .001). In patients with deep Acinetobacter spp. infection, 47% had glucose intolerance, compared with 12% in those with infection of the burn only (P = .03). In patients with pre-existing diabetes mellitus, 27% developed Acinetobacter spp. infection compared with only 8.5% of patients without diabetes (P = .04). This study demonstrates a clear association between Acinetobacter spp. infection and glucose intolerance in burns patients. PMID:16151285

  18. Sleep Disorders in Adult Sickle Cell Patients

    PubMed Central

    Sharma, Sunil; Efird, Jimmy T.; Knupp, Charles; Kadali, Renuka; Liles, Darla; Shiue, Kristin; Boettger, Peter; Quan, Stuart F.

    2015-01-01

    Study Objectives: While sleep apnea has been studied in children with sickle cell disease (SCD), little is known about sleep disorders in adult sickle cell patients. The objective of this study was to evaluate sleep disordered breathing and its polysomnographic characteristics in adult patients with sickle cell disease. Methods: The analysis cohort included 32 consecutive adult SCD patients who underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center after reporting symptoms suggesting disordered sleep or an Epworth Sleepiness Scale score ≥ 10. Epworth score, sleep parameters, comorbid conditions, and narcotic use were reviewed and compared in patients with and without sleep disordered breathing. SCD complication rates in the two groups also were compared. Results: In adult SCD patients who underwent overnight polysomnography, we report a high prevalence (44%) of sleep disordered breathing. Disease severity was mild to moderate (mean apnea-hypopnea index = 17/h (95% CI: 10–24/h). Concomitant sleep disorders, including insomnia complaints (57%) and delayed sleep-phase syndrome (57%), also were common in this population. In this limited cohort, we did not find increased SCD complications associated with sleep disordered breathing in adult patients with sickle cell disease. Conclusions: A high burden of sleep disordered breathing and other sleep-related complaints were identified in the adult sickle cell population. Our results provide important information on this unique population. Citation: Sharma S, Efird JT, Knupp C, Kadali R, Liles D, Shiue K, Boettger P, Quan SF. Sleep disorders in adult sickle cell patients. J Clin Sleep Med 2015;11(3):219–223. PMID:25515282

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

    PubMed Central

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

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on body mass index percentiles. Results Patients stratified below (normal) and ≥ 85th percentile had similar age, gender distribution, and total burn size. No significant differences were detected in the incidence of sepsis (11% for obese vs. 10% for normal), the incidence of multiple organ failure (21% for obese and 16% for normal), or mortality (11% for obese vs. 8% for normal). Compared to the normal group, the ≥ 85th percentile group had low levels of constitutive proteins (α2macroglobulin and Apolipoprotein A-1) (p < 0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (p < 0.05 for both) up to 60 days after injury. Patients ≥ 85th percentile showed a significant higher loss of bone mineral density and lipolysis compared to normal individuals. Stepwise logistic regression analysis revealed that body mass index had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (p < 0.001). Conclusions BMI ≥ 85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, multiple organ failure, or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered inflammatory response occurs already in patients starting at the 85th percentile BMI. PMID:22143622

  20. Redefining the outcomes to resources ratio for burn patient triage in a mass casualty.

    PubMed

    Taylor, Sandra; Jeng, James; Saffle, Jeffrey R; Sen, Soman; Greenhalgh, David G; Palmieri, Tina L

    2014-01-01

    Recent disasters highlight the need for predisaster planning, including the need for accurate triage. Data-driven triage tables, such as that generated from the 2002 National Burn Repository, are vital to optimize resource use during a disaster. The study purpose was to generate a burn resource disaster triage table based on current burn-treatment outcomes. Data from the NBR after the year 2000 were audited. Records that missed age, burn size, or survival status were excluded from analysis. Duplicate records, readmissions, transfers, and nonburn injuries were eliminated. Resource use was divided into expectant (predicted mortality >90%), low (mortality 50-90%), medium (mortality 10-50%), high (mortality <10%, admission 14-21 days), very high (mortality <10%, admission <14 days), and outpatient. Tables were created for all patient admissions and with/without inhalation injury. Of the 286,293 records, 210,683 were from the year 2000 or later. Expectant status for those aged >70 years began at 50% burn; a 20- to 29-year-old never reached expectant status. Inhalation injury lowered the expectant category to a burn size of 40% in >70-year-olds, and at >90% in 20- to 29-year-olds. The 0- to 1.9-year old group without inhalation injury never reached expectant status; with inhalation injury, expectant status was reached at >80% burn. Changes in the triage tables suggest that burn care has changed in the past 10 years. Inhalation injury significantly alters triage in a burn disaster. Use of these updated tables for triage in a disaster may improve our ability to allocate resources. PMID:24270085

  1. [Review and prospect of parenteral nutrition support for burn patients in China].

    PubMed

    Deng, Shi-lin

    2008-10-01

    Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standardized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immuno nutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immuno nutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly, the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parenteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition. PMID:19103029

  2. 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. PMID:8781721

  3. [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. PMID:24310557

  4. [Fatal hyperpyrexia in an adolescent patient with severe burns after a traffic accident].

    PubMed

    Jaehn, T; Sievers, R; Junger, A; Graunke, F; Blings, A; Reichert, B

    2016-07-01

    After a motorcycle accident a 16-year-old patient suffered severe burns to 40.5 % of the total body surface area (TBSA) of which 37 % were deep subdermal burns. After tangential and partly epifascial necrosectomy, Integra® was used as a temporary dermis replacement material for the lower extremities, combined with extensive negative pressure wound therapy (NPWT). In the further course of the treatment the patient developed uncontrollable hyperpyrexia with a fatal outcome. Possible influencing factors, such as the dermis replacement material combined with NPWT over large areas as well as the differential diagnoses propofol infusion syndrome, heatstroke and malignant hyperthermia are discussed. PMID:26767381

  5. 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

  6. 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

  7. Effect of propranolol administration on hemodynamic and metabolic responses of burned pediatric patients.

    PubMed Central

    Herndon, D N; Barrow, R E; Rutan, T C; Minifee, P; Jahoor, F; Wolfe, R R

    1988-01-01

    Hypermetabolism, increased heart rate, and lipolysis are responses to high catecholamine levels associated with burn injury. This study tests the hypothesis that adrenergic beta blockade in burns could reduce myocardial work, lipolysis, and negative nitrogen balance without adversely affecting cardiac or metabolic function. Eighteen patients with burns of 70 +/- 3% total burn surface area (TBSA) (Mean +/- SEM), were studied after a 5-day infusion of 2 mg/Kg of intravenous (I.V.) propranolol infusion every 24 hours without their cardiac output or resting energy expenditure being adversely reduced. Heart rate, left ventricular work, and rate pressure product were significantly reduced by 20, 22, and 36%, respectively (P less than 0.05). Plasma glucose, free fatty acids, triglycerides, and insulin levels remained unchanged. The rate of urea production, however, was significantly increased by 54 +/- 12% in fasted patients, and to a much lesser 12 +/- 2% in fed patients. The marked decrease in myocardial work afforded by propranolol administration may be of clinical benefit in the treatment of large burns. Variations in drug dosage and feeding regimens will, however, need to be perfected to limit catabolic effects. PMID:3052328

  8. Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation.

    PubMed

    Klein, H J; Schanz, U; Hivelin, M; Waldner, M; Koljonen, V; Guggenheim, M; Giovanoli, P; Gorantla, V S; Fehr, T; Plock, J A

    2016-03-01

    Sensitization describes the acquired ability of the immune system to react to foreign human leukocyte antigens (HLA) by producing antibodies and developing memory cells. In the field of transplantation, recipient preformed HLA antibodies due to previous sensitization have been identified - beneath ABO incompatibility - as a major factor for acute graft rejection. Several reasons for sensitization have largely been studied, such as previous blood transfusions, pregnancies or former transplants. Recent studies indicate that the use of assist devices (e.g. ECMO) or cadaveric skin allotransplantation providing temporary coverage in burn patients may lead to additional sensitization. As vascularized composite allotransplantation (VCA) has become a rapidly advancing therapeutic option for reconstruction of complex tissue defects in burns, it seems even more important to become familiar with immunological principles and to be cautiously aware of both sources of sensitization and therapeutic concepts in burns avoiding sensitization. This may also include emergency VCAs in burn patients as potential strategy for early definitive reconstruction avoiding procedures triggering HLA antibody formation. We hereby provide an overview on current evidence in the field of pre- and peritransplant sensitization, followed by posttransplant strategies of desensitization and their potential impact on future treatments of burn patients. PMID:26392022

  9. 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. PMID:16998395

  10. Long-Term Outcomes in Patients Surviving Large Burns: The Musculoskeletal System.

    PubMed

    Holavanahalli, Radha K; Helm, Phala A; Kowalske, Karen J

    2016-01-01

    The authors have previously described long-term outcomes related to the skin in patients surviving large burns. The objective of this study was to describe the long-term musculoskeletal complications following major burn injury. This is a cross-sectional descriptive study that includes a one-time evaluation of 98 burn survivors (mean age = 47 years; mean TBSA = 57%; and mean time from injury = 17 years), who consented to participate in the study. A comprehensive history and physical examination was conducted by a senior and experienced Physical Medicine and Rehabilitation physician. In addition to completing a Medical Problem Checklist, subjects also completed the Burn-Specific Health Scale (Abbreviated 80 item), a self-report measure used to review the level of functional adaptation. Joint pain, joint stiffness, problems walking or running, fatigue, and weak arms and hands are conditions that continue to be reported at an average of 17 years from the time of burn injury. Seventy-three percent (68 of 93) of the study sample were found to have a limitation of motion and areas most affected were the neck (47%), hands (45%), and axilla (38%). The global (Burn-Specific Health Scale-total) score for the overall sample was 0.78. Subjects with limitation of motion had significant difficulty in areas of mobility, self-care, hand function, and role activities. This study underscores the importance of long-term follow-up care and therapeutic interventions for survivors of major burn injury, as they continue to have significant and persistent burn-related impairments even several years following injury. PMID:26056761

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

    PubMed Central

    Aksoy, Nilgün; Arli, Senay; Yigit, Ozlem

    2014-01-01

    Introduction: Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim’s families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. Methods: This is a cross-sectional study was conducted by evaluation of patients’ files and forensic reports of burned patients’ referred to the emergency department (ED) of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies’ differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. Results: Two hundred thirty patients were enrolled (53.9% female). The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%). The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046), intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047), referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001), and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001) were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035). Conclusion: This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from other

  12. Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration▿

    PubMed Central

    Akers, Kevin S.; Cota, Jason M.; Frei, Christopher R.; Chung, Kevin K.; Mende, Katrin; Murray, Clinton K.

    2011-01-01

    Amikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (Cmax/MIC) was achieved in only 8.5% of patients, with a small reduction of Cmax in patients receiving CVVH and no difference in amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg amikacin dose. Overall, CVVH did not appear to have a major impact on amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher amikacin MICs rather than more rapid clearance of amikacin related to CVVH therapy. PMID:21825289

  13. 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

  14. Outcomes of a shoulder treatment flowchart in patients with axillary burns.

    PubMed

    Webb, Darren C; Byrne, Martin; Kolmus, Alison; Law, Henrietta Y; Holland, Anne E; Cleland, Heather

    2011-01-01

    The purpose of this study was to evaluate the effects of a structured shoulder treatment flowchart on range of motion (ROM) and function of the upper limb in patients at high and low risk of contracture after an axillary burn injury. Consecutive patients with axillary burns were managed according to a structured pathway based on risk of contracture. Those patients with deep partial- or full-thickness burns to more than one area of the axilla or requiring more than one split skin graft were classified as high risk; these patients underwent a more aggressive approach to splinting and exercise. Measurements of shoulder ROM and functional ability (upper extremity functional index) were made at admission, hospital discharge, and at 12 weeks postdischarge. Twenty patients (19 men) with an average age of 39 years and a median TBSA of 20% were recruited. Median length of stay was 18 days. Ten patients were classified as high risk. Both low-risk and high-risk patients showed good range of movement outcomes at discharge and 12 weeks, with no significant differences between risk groups (abduction at 12 weeks, mean [SD]: 168° [22°] vs 166° [28°], P = .60; flexion at 12 weeks, mean [SD]: 172° [20°] vs 167° [31°], P = .60, respectively). There were no differences in functional outcomes at 12 weeks postdischarge. Use of a shoulder treatment pathway was associated with good shoulder ROM and functional capacity in patients at high and low risk of axillary contracture. PMID:21336045

  15. 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

  16. A new approach: role of data mining in prediction of survival of burn patients.

    PubMed

    Patil, Bankat Madhavrao; Joshi, Ramesh C; Toshniwal, Durga; Biradar, Siddeshwar

    2011-12-01

    The prediction of burn patient survivability is a difficult problem to investigate till present times. In present study a prediction Model for patients with burns was built, and its capability to accurately predict the survivability was assessed. We have compared different data mining techniques to asses the performance of various algorithms based on the different measures used in the analysis of information pertaining to medical domain. Obtained results were evaluated for correctness with the help of registered medical practitioners. The dataset was collected from SRT (Swami Ramanand Tirth) Hospital in India, which is one of the Asia's largest rural hospitals. Dataset contains records of 180 patients mainly suffering from burn injuries collected during period from the year 2002 to 2006. Features contain patients' age, sex and percentage of burn received for eight different parts of the body. Prediction models have been developed through rigorous comparative study of important and relevant data mining classification techniques namely, navie bayes, decision tree, support vector machine and back propagation. Performance comparison was also carried out for measuring unbiased estimate of the prediction models using 10-fold cross-validation method. Using the analysis of obtained results, we show that Navie bayes is the best predictor with an accuracy of 97.78% on the holdout samples, further, both the decision tree and support vector machine (SVM) techniques demonstrated an accuracy of 96.12%, and back propagation technique resulted in achieving accuracy of 95%. PMID:20703764

  17. Multi Drug Resistant Klebsiella Isolates in Burn Patients: A Comparative Study

    PubMed Central

    Prakash, S. Kirshna; Siddiqui, Oves

    2015-01-01

    Introduction Infections are the most common complications in the burn patients admitted to the hospitals leading to high morbidity and mortality. Klebsiella is one of the most frequently isolated bacteria from burn wounds. Materials and Methods We studied antimicrobial susceptibility patterns of Klebsiella isolates from burn patients. In this cross- sectional study wound swabs from 1294 patients hospitalized in burnward were collected for bacteriological examination. Antibiotic sensitivity testing of Klebsiella isolates was done by modified Stokes disc diffusion method. Results Out of 883 isolates from 1294 patients 195 were found to be Klebsiella spp. Based on the biochemical properties 153 isolates were Klebsiella pneumoniae, 37 were Klebsiella oxytoca and 5 were others species. In our study we found that 54% of the Klebsiella isolates were multidrug resistant as they were resistant to at least one antibiotic of three or more different groups of antibiotics. [Table/Fig-1]: Isolation of different organism in burn wound infection Bacteria Number Percentage (%) Acinetobacter 70 7.92 Citrobacter 9 1.01 E. coli 125 14.15 Enterobacter 8 0.9 Klebsiella 195 22.08 Morganella 1 0.1 Proteus 71 8.04 Providentia 15 1.6 Pseudomonas 248 28.08 Staphylococcus 141 15.96 Total 883 99.84 Conclusion Rate of isolation of Klebsiella as well as its resistance for commonly used antibiotics is increasing over the time. PMID:26500905

  18. Microfluidics for T- Lymphocyte Cell Separation and Inflammation Monitoring in Burn Patients

    PubMed Central

    Rosenbach, Alan E.; Koria, Piyush; Goverman, Jeremy; Kotz, Kenneth T.; Gupta, Amit; Yu, Ming; Fagan, Shawn P.; Irimia, Daniel; Tompkins, Ronald G.

    2011-01-01

    Severe burns result in T-lymphocyte specific immunologic changes. In addition to decreased levels of circulating lymphocytes, changes in cytokine secretion and receptor expression also take place. Our finer understanding of the inflammatory response has led to the development of immune-targeted therapeutics, requiring specialized gene-expression monitoring. The emerging field of bio-micro-electromechanical systems can be used to isolate highly pure T-lymphocytes in a clinically relevant and timely manner for downstream genomic analysis. Blood samples from healthy volunteers and burn-injured patients were introduced into microfluidic devices developed in our laboratory. Utilizing cell-affinity-chromatography for positive selection of T-lymphocytes, the devices served as a platform for RNA extraction and downstream cytokine analysis via quantitative real time PCR. From a 0.5-mL whole blood sample, the microfluidic devices captured highly pure T-lymphocytes from healthy volunteers and burn-injured patients. Cell capture was of sufficient quantity, and extracted RNA was of sufficient quality, for evaluating the gene expression of cytokines: interferon-gamma, interleukin-2, interleukin-4, and interleukin-10. Microfluidics is a useful tool in processing blood from burn-injured patients. Though in its very early stages of development, cell-specific information obtained by this platform/technology will likely be an important component of near-patient molecular diagnostics and personalized medicine. PMID:21348958

  19. Prevalence of Antibody to Toxic Shock Syndrome Toxin-1 in Burn Patients

    PubMed Central

    Park, Ji-Young

    2015-01-01

    Background Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS. Methods A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene. Results One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged ≥61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%. Conclusions Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS. PMID:25553286

  20. 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

  1. 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. PMID:9625238

  2. Validation of a new formula for calculating the energy requirements of burn patients.

    PubMed

    Allard, J P; Pichard, C; Hoshino, E; Stechison, S; Fareholm, L; Peters, W J; Jeejeebhoy, K N

    1990-01-01

    In a previous study, we analyzed the roles of the estimated basal energy expenditure (EBEE) calculated by the Harris-Benedict equation, caloric intake (CI), total burn surface area (TBSA), body temperature (Temp) and number of post-burn days (PBD) in order to estimate the resting energy expenditure (EE) of burn patients. By multiple regression analysis we found that the measured EE (MEE) is best approximated by the following formula: -4343 + (10.5 x %TBSA) + (0.23 x CI) + (0.84 x EBEE) + (114 x Temp (degree C)) - (4.5 x PBD), r = 0.82, p less than 0.001, (Toronto formula (TF)). To validate this, 10 patients with a mean TBSA of 49.1 +/- 5.5% had their resting MEE done by indirect calorimetry when fed either by the TF or by 2 x EBEE. The caloric intake when on 2 x EBEE was 3260 +/- 45 kcal/day which significantly exceeded the MEE (2765 +/- 101 kcal/day, p less than 0.001). The caloric intake when on the TF was 2542 +/- 52 kcal/day and matches the MEE which was 2537 +/- 86 kcal/day (NS). These results show that the TF matches the MEE very closely. With the addition of a factor of activity for the 24-hr EE, it can be used to accurately feed individual burn patients. PMID:2112617

  3. Scald Burns From Hair Braiding.

    PubMed

    Meizoso, Jonathan P; Ramaley, Stephen R; Ray, Juliet J; Allen, Casey J; Guarch, Gerardo A; Varas, Robin; Teisch, Laura F; Pizano, Louis R; Schulman, Carl I; Namias, Nicholas

    2016-01-01

    Only one previous case report has described scald burns secondary to hair braiding in pediatric patients. The present case study is the largest to date of scald burns as a result of hair braiding in children and adults. Charts of all 1609 female patients seen at a single burn center from 2008 to 2014 were retrospectively reviewed to identify patients with scald burns attributed to hair braiding. Demographics, injury severity, injury patterns, and complications were analyzed. Twenty-six patients (1.6%) had scald burns secondary to hair braiding with median TBSA 3%. Eighty-five percent of patients were pediatric with median age 8 years. Injury patterns were as follows: back (62%), shoulder (31%), chest (15%), buttocks (15%), abdomen (12%), arms (12%), neck (12%), and legs (4%). No patients required operative intervention. Three patients were admitted to the hospital. Two patients required time off from school for 6 and 10 days post burn for recovery. Complications included functional limitations (n = 2), hypertrophic scarring (n = 1), cellulitis requiring antibiotics (n = 1), and anxiety requiring medical/psychological therapy (n = 2). This peculiar mechanism of injury not only carries inherent morbidity that includes the risks of functional limitations, infection, and psychological repercussions but also increases usage of resources through hospital admissions and multiple clinic visits. Further work in the form of targeted outreach programs is necessary to educate the community regarding this preventable mechanism of injury. PMID:26594857

  4. Plasma and skeletal muscle amino acids following severe burn injury in patients and experimental animals.

    PubMed Central

    Stinnett, J D; Alexander, J W; Watanabe, C; MacMillan, B G; Fischer, J E; Morris, M J; Trocki, O; Miskell, P; Edwards, L; James, H

    1982-01-01

    This study describes and analyzes sequential changes in plasma and skeletal muscle free amino acids following severe burn injury. Plasma free amino acids were determined in children (n = 9) with burns averaging 60% total body surface area and were compared with laboratory beagles (n = 44) which received a flame burn totaling 30% of their body surface area. In addition, needle biopsy specimens were obtained from the semitendonosus muscle in the animals to determine free intracellular amino acids. In both patients and animals the amount of total free amino acids in plasma fell following burn, suggesting relative protein deficiency. This drop was primarily due to a 47% drop in nonessential amino acids. However, plasma phenylalanine was consistently higher than normal following burn, and was strongly associated with death and weight loss in both animals and patients, especially when analyzed as a ratio with tyrosine. This finding suggested excessive catabolism, hepatic dysfunction, or both. Plasma levels of several amino acids correlated significantly with weight loss. Alterations in muscle free amino acids generally were similar to plasma amino acids. Exceptions were muscle alanine and glycine which strongly correlated with weight loss. However, the determination of muscle free amino acid profiles did not yield clinically useful information not available from plasma profiles. Plasma levels of liver enzymes suggested progressive hepatic dysfunction. These studies show that the laboratory beagle is a good model for studying the metabolic alterations of amino acids that accompany burn injury, since they mimic humans in many parameters which appear to be most useful with respect to clinical evaluation. PMID:7055386

  5. Blood pressure alterations in burn patients with septic shock under hydro-cortisone treatment

    PubMed Central

    Alinejad, Faranak; Momeni, Mahnoush; Fatemi, Mohammad Javad; Saberi, Mohsen; Sattarzade, Mahboobeh; Babajani, Rafat; Rahbar, Hossein

    2015-01-01

    Background and Objectives: Hydrocortisone is widely used in septic shock cases resistant to fluid and vasopressor therapy. It may result in increased blood pressure and survival. However the efficacy is no established among patients with severe burn and septic shock. Accordingly it was assessed in this study. Materials and Methods: The patients older than 14 years of age with resistant septic shock were enrolled during one-year period. The hydrocortisone was prescribed 100 mg three times per day and the alterations in systolic and diastolic blood pressures were recorded. Results: Twenty-nine patients were enrolled including 19 men and 10 women. The mean age was 37 ± 19 years and the mean burn surface area was 60 ± 20. Fourteen patients had positive blood culture. The most common isolated microorganism were Pseudomonas aeuroginosa in 34.6%(10 cases), and then Acinetobacter in 13.8%(4 cases). The infection was from wound in 79% and the remaining 21% had pneumonia. Twenty-one patients had good response to hydrocortisone and the increase in systolic and diastolic blood pressures was significant; but the mortality rate was similar. Conclusion: Treatment with hydrocortisone would result in increase in systolic and diastolic blood pressure in burn patients with resistant septic shock. PMID:26885331

  6. Quantifying bacterial transfer from patients to staff during burns dressing and bed changes: implications for infection control.

    PubMed

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

    2013-03-01

    Routine nursing activities such as dressing/bed changes increase bacterial dispersal from burns patients, potentially contaminating healthcare workers (HCW) carrying out these tasks. HCW thus become vectors for transmission of nosocomial infection between patients. The suspected relationship between %total body surface area (%TBSA) of burn and levels of bacterial release has never been fully established. Bacterial contamination of HCW was assessed by contact plate samples (n=20) from initially sterile gowns worn by the HCW during burns patient dressing/bed changes. Analysis of 24 gowns was undertaken and examined for relationships between %TBSA, time taken for activity, and contamination received by the HCW. Relationships between size of burn and levels of HCW contamination, and time taken for the dressing/bed change and levels of HCW contamination were best described by exponential models. Burn size correlated more strongly (R(2)=0.82, p<0.001) than time taken (R(2)=0.52, p<0.001), with levels of contamination received by the HCW. Contamination doubled with every 6-9% TBSA increase in burn size. Burn size was used to create a model to predict bacterial contamination received by a HCW carrying out bed/dressing changes. This may help with the creation of burn-specific guidelines on protective clothing worn by HCW caring for burns patients. PMID:23318217

  7. Use of negative pressure wound therapy in burn patients.

    PubMed

    Teng, Shou-Cheng

    2016-09-01

    According to previous research, adjunctive negative pressure wound therapy (NPWT) can help manage infected wounds when applied along with appropriate debridement and antibiotic therapy as deemed clinically relevant. NPWT not only removes fluid, and reduces oedema, but also promotes perfusion around the wounds. In addition, NPWT may lead to improved graft fixation when used as a bolster, especially in patients who are less compliant or have poor graft fixation that result from using traditional methods. NPWT is a good choice to bolster skin grafts in young, active and less-compliant patients. We propose an enhanced segmental compartment-covered technique, which uses NPWT adjunctively as first-line wound treatment to help manage postoperative infection. Moreover, NPWT promotes granulation tissue formation to prepare the wound bed for subsequent skin graft and may be used as a bolster over the graft, which helps to attain skin graft viability. PMID:27547959

  8. 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

  9. The practical evaluation and management of patients with symptoms of a sore burning mouth.

    PubMed

    Steele, John C

    2016-01-01

    There are many etiologic factors to consider in a patient who presents with symptoms or sensations of a sore burning mouth. These range from local causes within the oral cavity to underlying systemic disease, including psychologic factors. This paper aims to describe the different clinical presentations and to outline a systematic approach to the evaluation and management of such patients. The clinician will be directed to the relevant diagnosis by following the traditional medical model of taking a focused history, performing a thorough clinical examination, considering the potential differential diagnoses, and requesting pertinent and appropriate investigations. The various differential diagnoses and broad treatment options will also be discussed and outlined. This paper will not, however, discuss burning mouth syndrome (oral dysesthesia), which is a diagnosis of exclusion, whereby the oral mucosa is clinically normal and there are no identifiable medical or dental causes to account for the patient's symptoms. PMID:27343959

  10. [Difficult situations in radiotherapy: agitated adult patients].

    PubMed

    Noël, S; Noël, G

    2013-10-01

    The causes of agitation in adult patients are numerous. Agitation may cause difficulty or impossibility to initiate the radiotherapy technique but also can lead to accidents harmful to patients. However, the decision to not irradiate agitated patients may lead to a loss of curability chance or chance to palliate symptoms. Before taking such a decision, thinking about the possibilities available to calm the patient should be undertaken with the patient and the referring practitioners to attempt to make this therapy if it is considered major in the management of cancer. In all cases, current adaptations of radiotherapy should be used to deliver an effective radiation of a suitable time and safely. It is notable that the medical literature is extremely rare on this subject. PMID:23932645

  11. Factors impacting the likelihood of death in patients with small TBSA burns.

    PubMed

    Travis, Taryn E; Moffatt, Lauren T; Jordan, Marion H; Shupp, Jeffrey W

    2015-01-01

    Survival rates of burn patients have increased greatly over the past several decades. There are, however, still patients with relatively small burns who do not survive their hospitalizations. This work aimed to elucidate factors common to this select subset of patients. The NBR Main dataset was queried for record numbers associated with TBSA between 0.1 and 10 and a discharge status indicating death. Using SAS statistical software, the patients were matched for age, sex, and TBSA. Chi-square analyses of independence on categorical variables and unpaired, two-tailed Students' t-tests with unequal variance on continuous variables were used to identify fields of further interest. SAS was then used to build multivariate logistic regression models examining variables affecting discharge status. The NBR complications child dataset was queried and categorized for the types of complications for analysis. Multivariate logistic regression for discharge status, comorbidities, and complications showed that the presence of a complication significantly impacted discharge status. The presence of an identified complication (other than death) increased the odds ratio of a discharge status of death by a factor of 3.023 (95% confidence interval [2.306, 3.964], P < .0001). Pulmonary and infection-related complications were the most frequently seen across all the records analyzed, but infection-related complications did not reach statistical significance in relation to discharge status. Multivariate logistic regression of complications in a model for discharge status identified four categories as statistically significant: neurologic, cardiovascular, pulmonary, and renal. In patients with small TBSA burns, the presence of complications significantly increases the odds ratio of death as judged by the NBR data. The complications which appear to be of particular interest are cardiovascular, neurologic, renal, and pulmonary, and those patients who are likely most susceptible to these

  12. ASSOCIATION BETWEEN DIETARY FAT CONTENT AND OUTCOMES IN PEDIATRIC BURN PATIENTS

    PubMed Central

    Lee, Jong O.; Gauglitz, Gerd G.; Herndon, David N.; Hawkins, Hal K.; Halder, Stefanie C.; Jeschke, Marc G.

    2012-01-01

    Background The aim of the study was to compare a low fat/high-carbohydrate diet and a high-fat diet on clinical outcomes by a retrospective cohort study. Methods Nine-hundred forty-four children with burns ≥40% of their total body surface area (TBSA) were divided into two groups: patients receiving Vivonex®T.E.N. (low-fat/high-carbohydrate diet; n=518) and patients receiving milk (high-fat diet; n=426). Patient demographics, caloric intake, length of hospital stay and incidence of sepsis, mortality, hepatic steatosis and organomegaly at autopsy were determined. Results Demographics and caloric intake were similar in both groups. Patients receiving Vivonex®T.E.N. had shorter ICU stays (Vivonex®T.E.N.: 31±2 days; milk: 47±2 days; p<.01), shorter ICU stay per % TBSA burn (Vivonex®T.E.N.: 0.51±0.02 days/%; milk: 0.77±0.03 days/%; p<0.01), lower incidence of sepsis (Vivonex®T.E.N.: 11%; milk: 20%; p<0.01) and lived significantly longer until death than those receiving milk (Vivonex®T.E.N.: 20±3 days; milk: 10±2 days; p<0.01). There was no difference in overall mortality between the two groups (Vivonex®T.E.N.:15% vs. milk: 13%; p<0.9). Autopsies revealed decreased hepatic steatosis and decreased enlargement of kidney and spleen in patients receiving Vivonex®T.E.N. Conclusions The period with a low-fat/high-carbohydrate diet was associated with lower LOS, decreased incidence of organomegaly, infection, and hepatic steatosis post-burn as compared to the period when a high-fat diet was used. We suggest that a low-fat/high-carbohydrate diet should be considered in severely burned patients. PMID:21109263

  13. Propranolol Decreases Splanchnic Triacylglycerol Storage in Burn Patients Receiving a High-Carbohydrate Diet

    PubMed Central

    Morio, Beatrice; Irtun, Oivind; Herndon, David N.; Wolfe, Robert R.

    2002-01-01

    Objective To quantify the various components of splanchnic free fatty acid and very-low-density lipoprotein-triacylglycerol (VLDL-TAG) metabolism in order to gain insight into the mechanisms responsible for the development of fatty liver in severely burned patients, and to determine if decreasing free fatty acid availability by use of propranolol could potentially reduce hepatic fatty acid accumulation. Summary Background Data Hepatic fat accumulation results from an imbalance between fatty acid uptake, oxidation, and release via VLDL-TAG. Fatty acid delivery is accelerated in burn patients because of stimulated lipolysis. Since propranolol decreases lipolysis, it should also decrease hepatic fatty acid uptake and thus TAG synthesis. Methods Stable isotope-labeled tracers and regional catheterization enabled quantification of various parameters of lipid metabolism across the splanchnic bed in severely burned patients. The acute effects of propranolol treatment were studied in all patients, and in a subgroup of patients the chronic (3 weeks) effects of propranolol were assessed. Results The rate of splanchnic uptake of palmitate was 1.68 ± 1.3 μmol/kg/min, whereas the rates of oxidation and VLDL-TG secretion were only 0.12 ± 0.11 and 0.003 ± 0.02 μmol/kg/min, respectively. Propranolol significantly reduced palmitate delivery, and thus palmitate uptake, without significantly affecting oxidation or VLDL-TAG secretion. Thus, palmitate storage was reduced from 1.53 ± 1.30 μmol/kg/min without propranolol to 0.76 ± 0.58 μmol/kg/min after propranolol. Conclusions Hepatic fat storage in burn patients is due to low rates of both fatty acid oxidation and VLDL-TAG secretion. Propranolol can decrease hepatic fat storage by limiting fatty acid delivery. PMID:12170027

  14. Characterization of growth hormone enhanced donor site healing in patients with large cutaneous burns.

    PubMed Central

    Herndon, D N; Hawkins, H K; Nguyen, T T; Pierre, E; Cox, R; Barrow, R E

    1995-01-01

    BACKGROUND: Human growth hormone is an anabolic agent that attenuates injury-induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft donor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insulin-like growth factor-1 (IGF-1) by the liver to increase circulating IGF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-regulates IGF-1 receptors and IGF-1 levels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering > 40% of total body surface area. OBJECTIVE: The authors assessed the efficacy of rhGH in promoting several major building materials in the donor site of patients with massive burns. METHODS: Ten massively burned patients with full-thickness burns covering more than 40% of total body surface area were participants in a placebo-controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to identify some of the major components involved in wound healing and its integrity. RESULTS: Donor sites in burn patients receiving rhGH showed an increased coverage by the basal lamina of 26% for placebo to 68% coverage of the dermal-epidermal junction. Insulin-like growth factor-1 receptors and laminin, types IV and VII collagen, and cytokeratin-14 all increased significantly. Healing times of the donor sites were significantly decreased compared with patients receiving placebo. CONCLUSION: Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural

  15. Possible risk factors associated with burn wound colonization in burn units of Gaza strip hospitals, Palestine.

    PubMed

    Al Laham, N A; Elmanama, A A; Tayh, G A

    2013-06-30

    The epidemiological pattern and risk factors of burns and burn infections varies widely in different parts of the world. This study aims to determine the epidemiologic pattern of burn injuries and possible risk factors associated with burn infections in burn units of Gaza strip hospitals. A total of 118 patients were included in the study. The data collected included: patient age and gender, the causes, site, degree, and TBSA of the burns, as well as surgical operations, length of hospital stay, and microbiological profile of samples collected from patients, the environment, and from health care staff. Pediatric and adult patients accounted for 72% and 28% respectively. 58.5% of all patients were male and 41.5% were female. The most common etiological factors in children were scalding, while in adults these were open fire and flammable liquids. The mean TBSA was 12% with a range from 1-90%. Second and third degree burns accounted for 78% and 22% respectively. The area of the body most often affected was the torso (39%), followed by the lower limb (29.7%), and upper limb (17.8%). The predominant microorganisms isolated from burn wounds were Pseudomonas aeruginosa, Enterobacter spp. and Staphylococcus spp. The study showed the highest risk groups to be children and males, and enabled us to identify possible risk factors that can help in future efforts toward prevention and minimizing nosocomial infections in burn units of Gaza strip hospitals. PMID:24133399

  16. 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

  17. TIMP-1, MMP-2, MMP-9, and PIIINP as serum markers for skin fibrosis in patients following severe burn trauma.

    PubMed

    Ulrich, Dietmar; Noah, Ernst-Magnus; von Heimburg, Dennis; Pallua, Norbert

    2003-04-01

    The wound-healing process of patients with severe burns often leads to the formation of extensive fibrotic scars. In this study, serum concentrations of tissue inhibitors of metalloproteinase-1 (TIMP-1), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and amino-terminal propeptide of procollagen type III (PIIINP) were measured by enzyme-linked immunosorbent assay as markers for excessive cicatrization in 22 patients with acute burn injuries. All patients were followed up for 6 months to determine a fibrotic reaction during the wound-healing process after operative treatment using the Burn Scar Index. Blood samples were drawn immediately before the operation; at postoperative days 1, 3, 7, and 14; and 1, 3, and 6 months after the operation. Twenty patients who underwent elective plastic surgical operations served as the control group. There was a significant increase (p < 0.05) of TIMP-1 in the burned patients by the third postoperative day. Later in the follow-up period, the serum concentrations remained at a significantly elevated level (p < 0.05) compared with preoperative values. In comparison with the control group, the postoperative serum concentrations of TIMP-1 of the burned patients were significantly higher (p < 0.05) at any time and correlated with the total body surface area burned at the third and seventh postoperative days (p < 0.05; r2 = 0.46 versus r2 = 0.53) and the Burn Scar Index after 6 months (p < 0.05; r2 = 0.65). Serum levels of MMP-2 and MMP-9 showed a significant elevation (p < 0.05) only between postoperative days 3 and 14 in patients with burn wounds. PIIINP increased significantly (p < 0.05) in the sera of the burned patients at postoperative day 3 and remained significantly elevated up to 6 months after injury. At any time after trauma, PIIINP serum levels were significantly higher (p < 0.05) in the burned patients than in the control group and correlated with the total body surface area burned at postoperative

  18. Closed-loop and decision-assist resuscitation of burn patients.

    PubMed

    Salinas, Jose; Drew, Guy; Gallagher, James; Cancio, Leopoldo C; Wolf, Steven E; Wade, Charles E; Holcomb, John B; Herndon, David N; Kramer, George C

    2008-04-01

    Effective resuscitation is critical in reducing mortality and morbidity rates of patients with acute burns. To this end, guidelines and formulas have been developed to define infusion rates and volume requirements during the first 48 hours postburn. Even with these standardized resuscitation guidelines, however, over- and under-resuscitation are not uncommon. Two approaches to adjust infusion rate are decision-assist and closed-loop algorithms based on levels of urinary output. Specific decision assist guidelines or a closed-loop system using computer-controlled feedback technology that supplies automatic control of infusion rates can potentially achieve better control of urinary output. In a properly designed system, closed-loop control has the potential to provide more accurate titration rates, while lowering the incidence of over- and under-resuscitation. Because the system can self-adjust based on monitoring inputs, the technology can be pushed to environments such as combat zones where burn resuscitation expertise is limited. A closed-loop system can also assist in the management of mass casualties, another scenario in which medical expertise is often in short supply. This article reviews the record of fluid balance of contemporary burn resuscitation and approaches, as well as the engineering efforts, animal studies, and algorithm development of our most recent autonomous systems for burn resuscitation. PMID:18385584

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

    PubMed

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

    1990-02-01

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

  20. A submaximal dose of insulin promotes net skeletal muscle protein synthesis in patients with severe burns.

    PubMed Central

    Ferrando, A A; Chinkes, D L; Wolf, S E; Matin, S; Herndon, D N; Wolfe, R R

    1999-01-01

    OBJECTIVE: To investigate the hypothesis that a submaximal insulin dose reverses the net muscle catabolism associated with severe burns, and to determine its effects on amino acid kinetics. SUMMARY BACKGROUND DATA: The authors previously showed that a maximal dose of insulin administered to patients with severe burns promoted skeletal muscle glucose uptake and net protein synthesis. However, this treatment was associated with caloric overload resulting from the large quantities of exogenous glucose required to maintain euglycemia, and hypoglycemia was a potential problem. METHODS: Thirteen patients were studied after severe burn injury (>60% total body surface area). Patients were randomly treated by standard care (n = 5) or with exogenous insulin (n = 8). Data were derived from an arteriovenous model with primed-continuous infusions of stable isotopes and biopsies of the vastus lateralis muscle. RESULTS: Net amino acid balance was significantly improved with insulin treatment. Skeletal muscle protein synthesis was significantly greater in the group receiving insulin, whereas muscle protein breakdown was not different between the groups. This submaximal dose of insulin did not affect glucose or amino acid uptake or require a greater caloric intake to avoid hypoglycemia. CONCLUSIONS: Submaximal insulin can promote muscle anabolism without eliciting a hypoglycemic response. PMID:9923795

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

    PubMed

    Leeder, C J

    1979-01-01

    When a person is confined to bed, whatever the reason, small areas of soft tissues are compressed between the skeleton and the supporting surfaces. Transient circulatory disturbances resulting in epidermis to dermis damage or finally deep penetrating necrosis involving subcutaneous tissues, fascia muscle and bone may result. In the case of the severely burned patient who has already sustained gross trauma, any further destruction of tissues is to be avoided at all costs. The Low Air Loss Bed System offers many advantages in the care and management of the burns patient. There is a definite saving of nursing time by rendering unnecessary constant attention to the patient for preventative skin care, positioning, bed pan etc. The nurse is then able to devote her time positively to the more involved needs of the patient and family. It will also provide for periods of rest that are so often lacking, especially in the initial stages of treatment. The patient does not have to be kept on a rigid regime of Q2H turning. He is turned only for wound care, physio- and general body cleansing. His position may be contoured without having to touch him circumferentially. Any lifting and positioning necessary is easier for staff members due to the design of the unit, and more comfortable for the patient. Over a period of two years, eighteen patients with varying extent and degree of burn injuries were treated on the bed. This paper will describe the mechanical operation of the bed and experiences with nursing management and monitoring of the system. PMID:451464

  2. 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. PMID:27209717

  3. Relationship between zolpidem concentrations and sleep parameters in pediatric burn patients.

    PubMed

    Stockmann, Chris; Gottschlich, Michele M; Healy, Daniel; Khoury, Jane C; Mayes, Theresa; Sherwin, Catherine M T; Spigarelli, Michael G; Kagan, Richard J

    2015-01-01

    Zolpidem is a short-acting non-benzodiazepine hypnotic that is used to improve sleep architecture in patients with burn injuries. This study evaluated the relationship between zolpidem administration and sleep parameters in a cohort of children with severe burn injuries. Standard age-based zolpidem dosing practices were employed. Polysomnography data were recorded at 30-second intervals throughout the night. Serum concentrations of zolpidem were measured at 0, 1, 2, 4, 5, 6, and 8 hours after administration of the first dose. The relationship between zolpidem concentrations and sleep parameters was evaluated using Markov mixed-effects pharmacodynamic models. Ten children received two doses of zolpidem at 22:00 and 02:00 hours. The median total amount of sleep was 361.0 (interquartile range [IQR]: 299.0-418.5) minutes; approximately 65% of the normal reference value for an 8-hour period. Slow-wave and rapid eye movement (REM) sleep were also dramatically reduced (18-37% of normal). With two doses of zolpidem, stage 2 sleep was 99% of normal levels. Higher peak zolpidem concentrations were associated with increased stage 2 sleep (r = .54; P = .04). Despite this, a median of 120.0 (IQR: 99.5-143.5) transitions between nocturnal sleep stages were recorded, with a median of 55.5 (IQR: 36-75) night-time awakenings per patient. In pediatric burn patients, higher zolpidem serum concentrations were associated with restoration of stage 2 sleep to normal levels. Nonetheless, slow-wave and REM sleep were profoundly depressed with frequent transitions between sleep stages, suggesting that alternative hypnotic agents may be required to restore normal sleep architecture in severely burned children. PMID:25185933

  4. Lack of pain in schizophrenia: a patient whose arm was burned and amputated.

    PubMed

    Virit, Osman; Savas, Haluk Asuman; Altindag, Abdurrahman

    2008-01-01

    Diminished pain sensitivity or loss of pain sensation in schizophrenic patients has previously been reported. We report an interesting case of a schizophrenia patient who had the disease for 20 years and who had his forearm amputated below the elbow level due to severe burn injury to his muscles, tendons, nerve fibers and bone tissue, caused by direct exposure to flames from a liquefied petroleum gas cylinder, in an attempt to make himself warm during a medicine-free period with active symptoms and without pain sensation. PMID:18585546

  5. A novel subpopulation of peripheral blood mononuclear cells presents in major burn patients.

    PubMed

    Liu, Hongbin; Ding, Jie; Ma, Zengshuan; Zhu, Zhenshen; Shankowsky, Heather A; Tredget, Edward E

    2015-08-01

    Hypertrophic scars (HTS) are generally believed to result from proliferation and activation of resident connective tissue fibroblasts after burns. To demonstrate a potential role of blood-borne cells, the peripheral blood mononuclear cells (PBMCs) and the effect of PBMCs on dermal fibroblast behavior was investigated. Flow cytometry was used to analyze the surface and intracellular protein expression of PBMCs and fibroblasts. Transwell migration assay, enzyme-linked immunosorbent assay and real-time reverse transcription polymerase chain reaction was performed to assess fibroblast functions. We identified a novel subpopulation of PBMCs in burn patients in vivo that appears at an early stage following major thermal injuries, which primarily express procollagen 1, leukocyte specific protein 1, CD204, toll-like receptor 4 and stromal cell-derived factor 1 (SDF-1) receptor CXCR4. In vitro, the conditioned media from burn patient PBMCs up-regulated the expression of fibrotic growth factors and extracellular matrix molecules, down-regulated antifibrotic factor decorin, enhanced cell chemotaxis and promoted cell differentiation into contractile myofibroblasts in dermal fibroblasts. After thermal injury, this novel subpopulation of PBMCs is systemically triggered and attracted to the wounds under SDF-1/CXCR4 signaling where they appear to modulate the functions of resident connective tissue cells and thus contribute to the development of HTS. PMID:25683215

  6. Systematic review: which topical agent is more efficacious in the prevention of infections in burn patients?

    PubMed

    Rosanova, María Teresa; Stamboulian, Daniel; Lede, Roberto

    2012-08-01

    Topical agents are widely used in the care of burn patients; however the efficacy to prevent local infections and/or sepsis has not been clearly established in studies with a high level of evidence. This systematic review was conducted to assess the comparative efficacy among different topical agents. Material and Methods. The literature search was performed using the Medline database. Key MESH terms were: (burn* or scald*) AND (antibacterial or antibiotic*) AND (topic*) AND (therap* or prophylax*). Only randomized or quasi-randomized clinical trials, with a primary endpoint of local infection and/or sepsis were included. Studies were scored and classified regarding methodological key issues according to their level of evidence. Results. The initial search identified 457 studies of which 14 were eligible for final evaluation, and full text was available for 11 of them. Conclusions. The evidence found in our review does not support differences in efficacy of topical agents to reduce sepsis and/or local infections in burn patients. PMID:22859322

  7. [Pathophysiologic changes in patients with severe burns: role of hormones and chemical mediators].

    PubMed

    Ikeda, H; Kobayashi, K

    1998-01-01

    The body's general response to serious thermal injury is characterized by increased vascular permeability immediately after injury and subsequent hypovolemic shock. Skeleto-muscular proteolysis, lipolysis, gluconeogenesis, increased metabolic rate, and a severe systemic inflammatory response induced by local infections or surgical procedures. The increased vascular permeability is mediated by histamine and numerous vasoactive substances, including serotonin, bradykinin, prostaglandins, leukotrienes, and platelet activating factor. Hyper-metabolism is mediated by hormones such as catecholamines, glucagon, and particularly cortisol. In addition, among the putative mediators of the metabolic response to injury, attention has recently been focused on cytokines and lipid mediators which are mainly produced by activated reticuloendothelial cells. Cytokines such as interleukin-1, interleukin-6 and tumor necrosis factor and cortisol responses are interrelated, since cytokines activate the hypothalamo-adrenal axis. The cytokine storm seen in burn patients may be associated with depression of the immune system and with susceptibility to infection. Thermal injury can also lead to activation of the renin-angiotensin-aldosterone system, increased ADH production, and production of atrial natriuretic polypeptide to maintain the circulatory volume. Burn wound infections or surgical procedures can produce and perpetuate a mediator-induced systemic inflammatory response that may lead to multiple organ failure. Serum levels of interleukin-6 are very sensitive to surgical stress, and may be a useful indicator of the general condition of severely burned patients. PMID:9547740

  8. Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients?

    PubMed Central

    Jeschke, Marc G; Finnerty, Celeste C; Kulp, Gabriela A; Kraft, Robert; Herndon, David N

    2013-01-01

    This is a large cohort analysis in severely burned pediatric children to determine whether C-reactive protein (CRP) can be used as a predictor for severe infection or sepsis. Nine-hundred eighteen pediatric burn patients were enrolled in this study. CRP values were measured throughout acute hospitalization and for up to 6 months postburn. Demographic data, incidence of infection, surgical interventions and other relevant clinical information was compiled from medical records. We performed an extensive literature search to identify models that other groups have developed to determine the effects of CRP levels postburn to assess the value of these parameters as predictors of sepsis or severe infection. Statistical analysis was performed using ANOVA and regression analysis where appropriate. Three-hundred fifteen female and 603 male pediatric patients were enrolled in this study. Average total body surface area (TBSA) burn was 45±23%, with full thickness burn over 32±27% TBSA, and patients were 7±6 years old. CRP values significantly correlated with burn size, survival and gender. Significantly higher levels of CRP were found in large burns, in non-survivors, and in females, p<0.05. Using various described models to determine whether CRP levels change before and after an event can predict sepsis or severe infection, we found that CRP cannot predict severe infection or sepsis. Although CRP is a marker of the inflammatory response postburn, CRP fails to predict infection or sepsis in severely burn patients. PMID:23875119

  9. 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

  10. 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.

  11. Intensive insulin treatment increases donor site wound protein synthesis in burn patients

    PubMed Central

    Tuvdendorj, Demidmaa; Zhang, Xiao-Jun; Chinkes, David L.; Aarsland, Asle; Kulp, Gabriela A.; Jeschke, Marc G.; Herndon, David N.

    2013-01-01

    Background In the treatment of burns, patients’ own skin is the preferred material to cover burn wounds, resulting in the need to create a donor site wound. Enhancement of healing of the donor site wound would be beneficial in burn patients. Insulin, an anabolic agent, is routinely used to treat hyperglycemia after injury. We investigated whether intensive insulin treatment (INS) increases fractional synthesis rate (FSR) of the donor site wound protein and decreases the length of hospitalization normalized for total body surface area burned (LOS/TBSA). Methods FSR of the donor site wound protein was measured in pediatric patients randomized to control (CNT) (n = 13) and INS (n = 10) treatments. Depending on the postoperative day when the tracer study was done studies were divided into “Early” (days < 5) and “Late” (days >=5) periods. Results FSR of the donor site wound protein was greater in the INS group at the “Early” period of wound healing (CNT vs. INS, 8.2±3.8 vs. 13.1±6.9 %/day, p: < 0.05); but not at the “Late” (CNT vs. INS, 19.7±4.6 vs. 16.6±4.0 %/day, p > 0.05). Despite these differences LOS/TBSA was not decreased in the INS group. Correlation analyses demonstrated that independently of the treatment regimen FSR positively correlated (p < 0.05) with time post creation of the donor site and negatively correlated (p < 0.05) with LOS/TBSA. Conclusions Insulin treatment increased FSR of the donor site wound protein in the early period of wound healing; FSR correlated with LOS/TBSA independently of the treatment regimen. PMID:21236451

  12. A case review of patients presenting to Royal North Shore Hospital, with hair removal wax burns between January and November 2006.

    PubMed

    Zoumaras, Jack; Kwei, Johnny Sheng-Sun; Vandervord, John

    2008-03-01

    To date there is no published literature on the dangers of hair removal wax burns. This case review illustrates the steady influx of patients presenting to Royal North Shore Hospital (RNSH) with hair removal wax burns. Between January and December 2006, 10 patients out of 395 with burns (2.5%) presented to our dressing clinic with hair removal wax burns. All sustained burns under 5% total body surface area (TBSA) and two required debriding and split skin grafting (SSG). The mechanism of the burns was re-heating the hair removal wax in the microwave for too long. PMID:17716822

  13. High Recovery Rate of Non-albicans Candida Species Isolated From Burn Patients With Candidemia in Iran

    PubMed Central

    Lotfi, Nazanin; Shokohi, Tahereh; Nouranibaladezaei, Seyed Zahra; Nasrolahi Omran, Ayatollah; Kondori, Nahid

    2015-01-01

    Background: Blood stream infections (BSIs) are major causes of morbidity and mortality in burn patients. Microorganisms responsible for BSI are generally bacteria; however, Candida spp. are the infection agents in as many as 8% of all cases. Burn wound colonization and infections are generally the first steps to systemic infection. Candidemia in burn patients has been associated with high mortality and a prolonged hospital stay. Objectives: Candidemia in burn patients has been defined as a preterminal event, leading to high morbidity and mortality rates among these patients. The aim of this study was to establish the incidence of candidemia in burn patients in Iran. Patients and Methods: We consecutively collected 405 blood samples from 113 burn patients. The yeast isolates were identified to the species level using conventional procedures. In vitro antifungal susceptibility of the Candida isolates to amphotericin B, fluconazole, voriconazole and caspofungin was performed using the Etest. Results: Twenty-seven samples (6.7%) of the blood cultures from 13 patients (12%) were positive for Candida species. Candida parapsilosis (38%) and C. tropicalis (38%) were the most commonly found Candida species, followed by C. albicans (15%) and C. guilliermondii (15%) in the patients. The incidence of candidemia was significantly correlated with increased duration of hospitalization, increased time of stay in the intensive care unit, and higher mortality. The antifungal susceptibility tests demonstrated that amphotericin B and voriconazole had the lowest minimum inhibitory concentrations (MICs) against Candida spp. Conclusions: Non-albicans Candida should be considered as significant pathogens in burned patients with candidemia. PMID:26587207

  14. Anti-HLA sensitization in extensively burned patients: extent, associated factors, and reduction in potential access to vascularized composite allotransplantation.

    PubMed

    Duhamel, Patrick; Suberbielle, Caroline; Grimbert, Philippe; Leclerc, Thomas; Jacquelinet, Christian; Audry, Benoit; Bargues, Laurent; Charron, Dominique; Bey, Eric; Lantieri, Laurent; Hivelin, Mikael

    2015-05-01

    Extensively burned patients receive iterative blood transfusions and skin allografts that often lead to HLA sensitization, and potentially impede access to vascularized composite allotransplantation (VCA). In this retrospective, single-center study, anti-HLA sensitization was measured by single-antigen-flow bead analysis in patients with deep, second- and third-degree burns over ≥40% total body surface area (TBSA). Association of HLA sensitization with blood transfusions, skin allografts, and pregnancies was analyzed by bivariate analysis. The eligibility for transplantation was assessed using calculated panel reactive antibodies (cPRA). Twenty-nine patients aged 32 ± 14 years, including 11 women, presented with a mean burned TBSA of 54 ± 11%. Fifteen patients received skin allografts, comprising those who received cryopreserved (n = 3) or glycerol-preserved (n = 7) allografts, or both (n = 5). An average 36 ± 13 packed red blood cell (PRBC) units were transfused per patient. In sera samples collected 38 ± 13 months after the burns, all patients except one presented with anti-HLA antibodies, of which 13 patients (45%) had complement-fixing antibodies. Eighteen patients (62%) were considered highly sensitized (cPRA≥85%). Cryopreserved, but not glycerol-preserved skin allografts, history of pregnancy, and number of PRBC units were associated with HLA sensitization. Extensively burned patients may become highly HLA sensitized during acute care and hence not qualify for VCA. Alternatives to skin allografts might help preserve their later access to VCA. PMID:25683513

  15. OCCURRENCE OF MULTI-ORGAN DYSFUNCTION IN PEDIATRIC BURN PATIENTS - INCIDENCE AND CLINICAL OUTCOME

    PubMed Central

    Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Shahrokhi, Shahriar; Jeschke, Marc G

    2013-01-01

    Objective To examine the incidence of single or multiple organ failure postburn and its resultant clinical outcomes during acute hospitalization. Summary Background Data Patient outcomes are inherently dependent on intact organ function; however, burn injury affects the structure and function of almost every organ, but especially lung, liver, kidney and heart. Therefore, single-organ failure and/or multiorgan failure (MOF) are thought to contribute significantly to postburn morbidity and mortality but to date no large trial examining the effects of MOF on postburn outcomes exists. Methods Incidence of MOF was monitored in 821 pediatric burn patients during acute hospitalization. Patients were divided into groups based on the incidence of single organ specific failure, MOF, and non-MOF. The DENVER2 score was used to assess organ specific scores for lung, liver, kidney and heart. The patient’s demographics, injury characteristics, and outcome parameters were recorded. Results Respiratory failure has the highest incidence in the early phase of postburn injury, and decreases starting 5 days postburn. Cardiac failure was noted to have the highest incidence throughout hospital stay. Incidence of hepatic failure increases with the length of hospital stay and is associated with a high mortality during the late phase of the acute hospital stay. Renal failure has an unexpectedly low incidence but is associated with a high mortality during the first three weeks postburn injury. Three or more organ failure is associated with very high mortality. Conclusion This is the first large study in burn patients to determine the incidence of organ specific failure and outcome. The results of this study confirmed the expected chronologic incidence of organ-specific failure and yield the long-term mortality of liver and renal failure. (NCT00673309) PMID:23511841

  16. Laboratory-based evaluation of MDR strains of Pseudomonas in patients with acute burn injuries

    PubMed Central

    Zhang, Hong-Tu; Liu, Hui

    2015-01-01

    Localization of burn was variable: head and face in 76 patients (29%), trunk in 58 (49%), upper limb in 37 (52%), lower limbs in 44 (41%), hands in 16 (15%), perinea area in 26 (5.5%) and whole body except perinea area in 10 (9%) patients. Inhalation syndrome was present in 56 (44%) patients. Ninety patients (82%) had indwelling venous catheters, 83 (75.5%) patients’ arterial catheter and 86 (78%) patients’ urinary catheters. By multivariate analysis: age ≤4 years, Garcés 4, colistin use in documented multiresistant infections, and mechanical ventilation were independent variables related with mortality and graft requirement was a protective factor for mortality. Despite advances in care, gram negative bacterial infections and infection with Pseudomonas aeruginosa remain the most common cause of bacteria related mortality early in the hospital course. Viral infections are also associated with mortality and numbers have remained stable when compared to data from prior years. PMID:26629178

  17. Monoblock Expanded Full-thickness Graft for Resurfacing of the Burned Face in Young Patients.

    PubMed

    Allam, A M; El Khalek, A E A; Mustafa, W; Zayed, E

    2007-12-31

    It has been emphasized by many authors that to obtain better aesthetic results in a burned facial area to be resurfaced - if it extends into more than one aesthetic territory - the units involved should be combined into a single large composite unit allowing the largest possible skin graft to be used. Unfortunately, the donor site for full-thickness grafts is limited in young patients and hence tissue expansion is used. A monoblock expanded full-thickness skin graft for facial resurfacing after post-burn sequelae excision was used in 12 young patients after expansion of the superolateral aspect of the buttock. Females made up the majority of the patients (75%) and the ages ranged between 8 and 18 yr. The operating time was 3-3.5 hours, in two sessions. Post-operatively, we recorded partial graft necrosis in two cases (16.7%) and infection in one (8.3%), and some minor donor-site-related complications were reported, such as haematoma in one patient (8.3%), wound infection in one patient (8.3%), and wide scarring in two patients (16.7%). At follow-up, eight of the patients (66.7%) were satisfied with their new facial look as the mask effect of facial scarring had been overcome. With monoblock expanded full-thickness graft we were able to resurface the face in nine cases (75%). A second complementary procedure to reconstruct the eyebrows or reshape the nose was required in two cases (16.7%). We concluded that the monoblock expanded full-thickness graft was a suitable solution for limitation of the donor site in young patients, as the resulting wound could be closed primarily with a scar that could be concealed by the underwear, with lim. PMID:21991093

  18. Measuring coping behavior in patients with major burn injuries: a psychometric evaluation of the BCOPE.

    PubMed

    Amoyal, Nicole R; Mason, Shawn T; Gould, Neda F; Corry, Nida; Mahfouz, Soad; Barkey, Adam; Fauerbach, James A

    2011-01-01

    Burn injuries involve significant physiological, psychological, and social challenges with which individuals must cope. Although the brief COPE (BCOPE) is frequently used, knowledge of its factor structure and construct validity is limited, thus limiting confidence with interpreting results. This study assessed psychometric properties of the BCOPE in hospitalized patients with burn injury. Participants had a major burn injury (n = 362). Measures assessed coping behavior and physical, psychological, and social functioning. Exploratory factorial analysis was conducted to evaluate patterns of coping strategies. To assess construct validity, the BCOPE scale scores were correlated with the distress measures across time points. Exploratory factorial analysis revealed seven factors accounting for 51% of total variance. The pattern matrix indicated four items loaded onto factor 1 (active coping = 0.47-0.80) and four onto factor 2 (avoidant coping = 0.59-0.73). The remaining factors were consistent with original scale assignments reported by Carver (Int J Behav Med 1997;4:92-100). Construct validity of BCOPE scales (active and avoidant) was demonstrated by their association with the Davidson trauma scale, short form-12, and satisfaction with appearance scale. The results indicate that the BCOPE is valid, reliable, and can be meaningfully interpreted. Research using these factors may improve knowledge about interrelationships among stress, coping, and outcome, thus building the evidence base for managing distress in this population. PMID:21562462

  19. α-Tocopherol adipose tissue stores are depleted after burn injury in pediatric patients123

    PubMed Central

    Leonard, Scott W; Traber, Daniel L; Traber, Lillian D; Gallagher, James; Bobe, Gerd; Jeschke, Marc G; Finnerty, Celeste C; Herndon, David

    2010-01-01

    Background: We previously showed that thermal injury depletes plasma vitamin E in pediatric burn patients; however, plasma changes may reflect immediate alterations in vitamin E nutriture. Adipose tissue α-tocopherol concentrations are generally accepted to reflect long-term vitamin E status. Objective: To test the hypothesis that thermal injury depletes body stores of vitamin E, α-tocopherol concentrations were measured in adipose tissue samples. Design: Pediatric patients (n = 8) were followed up to 1 y after burn injury. Surgically obtained samples were collected at various intervals and stored at −80°C in a biorepository. α- and γ-Tocopherols, cholesterol, and triglycerides were measured in the same tissue aliquot. Results: During the first week after injury, adipose tissue α-tocopherol concentrations were within the expected normal range of 199 ± 40 nmol/g adipose tissue but were substantially lower at weeks 2 and 3 (133 ± 13 and 109 ± 8 nmol/g adipose tissue, respectively). Individual rates of decrease, estimated by linear regression, showed that adipose tissue α-tocopherol decreased by an average of 6.1 ± 0.6 nmol/g daily. During the first month after injury, adipose tissue triglyceride concentrations also decreased, whereas no changes in cholesterol concentrations occurred. Conclusions: These data emphasize that the burn injury experienced by these pediatric patients altered their metabolism such that vitamin E status diminished during the month after injury. Further studies are needed to evaluate the mechanism and consequences of the observed vitamin E depletion. This trial was registered at clinicaltrials.gov as NCT00675714. PMID:20881067

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

    PubMed Central

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

    2008-01-01

    Introduction Severely burned patients suffering from inhalation injury have a significantly increased risk for mortality compared with burned patients without inhalation injury. Severe burn is associated with a distinct serum cytokine profile and alterations in cytokines that contribute to morbidity and mortality. The aim of the present study was therefore to determine whether severely burned pediatric patients with concomitant inhalation injury who had a fatal outcome exhibited a different serum cytokine profile compared with burn patients with inhalation injury who survived. Early identification followed by appropriate management of these high-risk patients may lead to improved clinical outcome. Methods Thirteen severely burned children with inhalation injury who did not survive and 15 severely burned pediatric patients with inhalation injury who survived were enrolled in the study. Blood was collected within 24 hours of admission and 5 to 7 days later. Cytokine levels were profiled using multiplex antibody coated beads. Inhalation injury was diagnosed by bronchoscopy during the initial surgery. The number of days on the ventilator, peak inspiratory pressure rates, arterial oxygen tension (PaO2)/fraction of inspired oxygen (FiO2) ratio and incidence of acute respiratory distress syndrome were recorded for those patients. Results Significantly altered levels of IL-4, IL-6, IL-7, IL-10, and IL-13 were detected within the first 7 days after admission in serum from burn pediatric patients with concomitant inhalation injury who did not survive when compared with similar patients who did (P < 0.05). Alterations in these cytokines were associated with increased incidence of acute respiratory distress syndrome, number of days under ventilation, increased peak inspiratory pressure, and lower PaO2/FiO2 ratio in this patient population. Multiple logistic regression analysis revealed that patients with increased IL-6 and IL-10 as well as decreased IL-7 serum levels had a

  2. Pain and anxiety with burn dressing changes: patient self-report.

    PubMed

    Weinberg, K; Birdsall, C; Vail, D; Marano, M A; Petrone, S J; Mansour, E H

    2000-01-01

    Pain and anxiety are integral parts of burn dressing care. Descriptions of pain and anxiety from the patients' perspectives enhance our understanding of their experiences. This descriptive study measured relationships between self-reported pain and anxiety. Twenty-four patients who had an uncomplicated flame or scald wound reported scores immediately before, immediately after, and 1/2 hour after dressing changes. Results indicated that pain and anxiety increased until day 4. Pain correlated with anxiety. Self-report scores showed that pain and anxiety are perceived by patients in a similar manner. Self-report scores are of great value because they indicate the degree of relief achieved with medication. Through the descriptive study, we found that the pain score immediately after dressing changes was greater than 3 on all study days. This finding indicates a need to further examine the way pain is managed with dressing changes. PMID:10752749

  3. First experience of the use bone marrow mesenchymal stem cells for the treatment of a patient with deep skin burns.

    PubMed

    Rasulov, M F; Vasilchenkov, A V; Onishchenko, N A; Krasheninnikov, M E; Kravchenko, V I; Gorshenin, T L; Pidtsan, R E; Potapov, I V

    2005-01-01

    Female patient with extensive skin burn (I-II-IIIAB skin burn, total area 40%, area of IIIB degree 30%) was treated using transplantation of allogenic fibroblast-like bone marrow mesenchymal stem cells onto the surface of deep thermal burn. The study of wound healing dynamics after transplantation of allogenic fibroblast-like mesenchymal stem cells confirmed high tempo of wound regeneration in the presence of active neoangiogenesis. Due to this, autodermoplasty of burn wounds could be carried out with good results as early as on day 4 after transplantation of fibroblast-like mesenchymal stem cells; this led to more rapid healing of donor zones and accelerated rehabilitation of the patient. PMID:16142297

  4. 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.

  5. 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. PMID:26741696

  6. 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…

  7. Pathophysiology of burns.

    PubMed

    Keck, Maike; Herndon, David H; Kamolz, Lars P; Frey, Manfred; Jeschke, Marc G

    2009-01-01

    Burn injury represents a significant problem worldwide. Advances in therapy strategies, based on better understanding of the pathophysiologic responses after burn injury have improved the clinical outcome of patients with burn injuries over the past years. This article describes the present understanding of the pathophysiology of a burn injury including both the local and systemic responses, focusing on the many facets of organ and systemic effects directly resulting from hypovolemia and circulating mediators following burn trauma. PMID:19652939

  8. Matrix Metalloproteinases -8 and -9 and Tissue Inhibitor of Metalloproteinase-1 in Burn Patients. A Prospective Observational Study

    PubMed Central

    Hästbacka, Johanna; Fredén, Filip; Hult, Maarit; Bergquist, Maria; Wilkman, Erika; Vuola, Jyrki; Sorsa, Timo; Tervahartiala, Taina; Huss, Fredrik

    2015-01-01

    Introduction Matrix metalloproteinases (MMPs) -8 and -9 are released from neutrophils in acute inflammation and may contribute to permeability changes in burn injury. In retrospective studies on sepsis, levels of MMP-8, MMP-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) differed from those of healthy controls, and TIMP-1 showed an association with outcome. Our objective was to investigate the relationship between these proteins and disease severity and outcome in burn patients. Methods In this prospective, observational, two-center study, we collected plasma samples from admission to day 21 post-burn, and burn blister fluid samples on admission. We compared MMP-8, -9, and TIMP-1 levels between TBSA<20% (N = 19) and TBSA>20% (N = 30) injured patients and healthy controls, and between 90-day survivors and non-survivors. MMP-8, -9, and TIMP-1 levels at 24-48 hours from injury, their maximal levels, and their time-adjusted means were compared between groups. Correlations with clinical parameters and the extent of burn were analyzed. MMP-8, -9, and TIMP-1 levels in burn blister fluids were also studied. Results Plasma MMP-8 and -9 were higher in patients than in healthy controls (P<0.001 and P = 0.016), but only MMP-8 differed between the TBSA<20% and TBSA>20% groups. MMP-8 and -9 were not associated with clinical severity or outcome measures. TIMP-1 differed significantly between patients and controls (P<0.001) and between TBSA<20% and TBSA>20% groups (P<0.002). TIMP-1 was associated with 90-day mortality and correlated with the extent of injury and clinical measures of disease severity. TIMP-1 may serve as a new biomarker in outcome prognostication of burn patients. PMID:25945788

  9. Adverse reaction to sulphonamides in a burned patient--a case report.

    PubMed

    Sawada, Y

    1985-12-01

    This is a case report of a patient who developed severe drug eruptions suspected to have been caused by sulphamethoxazole-trimethoprim (ST) administered orally for the treatment of urinary infection after burn injury. He had been treated topically with silver sulphadiazine (AgSD) after injury. The immunological examinations revealed positive reactions to both drugs, so that it is surmised that AgSD created the sensitivity and might be concerned in these drug eruptions. For such reasons, it is advisable, especially in patients who have been previously treated with topical or oral sulphonamides or have had episodes of hypersensitivity to such drugs, to administer sulphonamides carefully, or if possible to avoid administration. PMID:2936433

  10. Increasing Blood Glucose Variability Is a Precursor of Sepsis and Mortality in Burned Patients

    PubMed Central

    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. PMID:23056354

  11. Stimulation of muscle protein synthesis by long-term insulin infusion in severely burned patients.

    PubMed Central

    Sakurai, Y; Aarsland, A; Herndon, D N; Chinkes, D L; Pierre, E; Nguyen, T T; Patterson, B W; Wolfe, R R

    1995-01-01

    OBJECTIVE: To determine if long-term (7 days) infusion of insulin can ameliorate altered protein kinetics in skeletal muscle of severely burned patients and to investigate the hypothesis that changes in protein kinetics during insulin infusion are associated with an increased rate of transmembrane amino acid transport from plasma into the intracellular free amino acid pool. SUMMARY BACKGROUND DATA: In critically ill patients, vigorous nutritional support alone may often fail to entirely curtail muscle catabolism; insulin stimulates muscle protein synthesis in normal volunteers. METHODS: Nine patients with severe burns were studied once during enteral feeding alone (control period), and once after 7 days of high-dose insulin. The order of treatment with insulin was randomized. Data were derived from a model based on a primed-continuous infusion of L-[15N]phenylalanine, sampling of blood from the femoral artery and vein, and biopsies of the vastus lateralis muscle. RESULTS: Net leg muscle protein balance was significantly (p < 0.05) negative during the control period. Exogenous insulin eliminated this negative balance by stimulating protein synthesis approximately 350% (p < 0.01). This was made possible in part by a sixfold increase in the inward transport of amino acids from blood (p < 0.01). There was also a significant increase in leg muscle protein breakdown. The new rates of synthesis, breakdown, and inward transport during insulin were in balance, such that there was no difference in the intracellular phenylalanine concentration from the control period. The fractional synthetic rate of protein in the wound was also stimulated by insulin by approximately 50%, but the response was variable and did not reach significance. CONCLUSIONS: Exogenous insulin may be useful in promoting muscle protein synthesis in severely catabolic patients. PMID:7677459

  12. 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

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

    PubMed Central

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

    2016-01-01

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

  14. Phylogenetic study of metallo-β-lactamase producing multidrug resistant Pseudomonas aeruginosa isolates from burn patients.

    PubMed

    Jena, Jayanti; Debata, Nagen Kumar; Sahoo, Rajesh Kumar; Subudhi, Enketeswara

    2015-12-01

    The present study was carried out to understand the clonal relationship using enterobacteriaceae repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) among metallo-β-lactamase (MBL) producing multidrug resistant Pseudomonas aeruginosa isolates from burn victims and their susceptibility to commonly used anti-pseudomonal agents. In the present study 94 non-duplicate P. aeruginosa strains from the wound samples of burn patients were included. Identification of the isolates was done by biochemical methods and antibiotic sensitivity was done by disc diffusion method following CLSI (Clinical Laboratory Standard Institute) guidelines. By using imipenem (IPM)-EDTA disk diffusion/double disc synergy method carbapenem resistant organisms were tested for MBL. To define the clonal relationship ERIC-PCR was used. Of the 94 isolates, 18 (19.14%) were found resistant to IPM and MBL production was shown 11 (11.70%) by the IPM-EDTA disc diffusion method. From dendrogram of the ERIC-PCR profile four major clusters were obtained (A, B, C and D). Cluster B contained the majority of the isolates (6 strains 1, 4, 8, 9, 10 and 11). This study using ERIC-PCR of randomly collected isolates exhibits high genetic diversity which rules out cross contamination frequency. PMID:26188888

  15. 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

  16. 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

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

    PubMed Central

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

    2014-01-01

    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 restores 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. PMID:25390300

  18. Comparison of positive pressure gloves on hand function in adults with burns.

    PubMed

    O'Brien, Kimberly A; Weinstock-Zlotnick, Gwen; Hunter, Hope; Yurt, Roger W

    2006-01-01

    The purpose of this study was to analyze the impact of a standard, custom-made pressure glove vs The NewYork-Presbyterian Dexterity Glove (NYPDG) with silon application on the palmer surface on functional hand use of burn survivors. A standard, custom-made pressure glove and NYPDG were given to 18 participants in a randomized order. Subjects wore each glove for 7 to 10 days during all activities of daily living (ADL). Variables such as hand function, difficulty of fine and gross motor ADL, and participant glove preference were assessed with each glove condition. Data collection of the second glove took place 7 to 10 days later incorporating a quasiexperimental, repeated measure design. A crossover design was used to analyze the data. The NYPDG demonstrated significantly better results in all of the four outcome categories measured: time to complete the Jebsen, the Jebsen Likert scale, fine motor ADL, and gross motor ADL. This study demonstrated that functional tasks took less time to complete and were more easily performed when using the NYPDG. PMID:16679904

  19. Severe Burns and Amputation of Both Arms in the First Psychotic Episode of a Schizophrenic Patient

    PubMed Central

    Cruzado, Lizardo; Villafane-Alva, Ronald; Caballero-Atencio, Katia; Cortez-Vergara, Carla; Núñez-Moscoso, Patricia

    2015-01-01

    An alleged reduction of sensitivity to pain in people with schizophrenia has been reported, but the nature of this complex phenomenon has not been elucidated yet. Reports of insensitivity to burns from people with schizophrenia are extremely rare. We report the case of a 24-year-old man who set both of his arms on fire during the first break of paranoid schizophrenia. As a result of severe tissue damage, both of his limbs had to be amputated. Today, at the age of 59, the patient is physically and mentally rehabilitated and is adherent to treatment. Additionally, given the uncertainty about the true nature of the alleged hypoalgesia in schizophrenia, we postulate the need for a comprehensive phenomenological approach in the study of embodiment in people with this condition. PMID:26417469

  20. Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome.

    PubMed

    Honda, Mika; Iida, Takashi; Komiyama, Osamu; Masuda, Manabu; Uchida, Takashi; Nishimura, Hitoshi; Okubo, Masakazu; Shimosaka, Michiharu; Narita, Noriyuki; Niwa, Hideo; Kubo, Hideyuki; De Laat, Antoon; Kawara, Misao; Makiyama, Yasuhide

    2015-01-01

    The aim of this study was to evaluate the relationship between pain intensities and psychosocial characteristics in middle-aged and older patients with temporomandibular disorders (TMDs) and burning mouth syndrome (BMS). Subjects were selected according to the Research Diagnostic Criteria for TMD (n = 705) and International Association for the Study of Pain criteria for BMS (n = 175). Patients were then divided into two age groups: 45-64 years (middle-aged, Group A) and 65-84 years (older, Group B). Pain intensity and depression and somatization scores were evaluated in both groups. In BMS patients, present and worst pain intensities were significantly higher in Group B than in Group A {4.6 [95% confidence interval (CI) = 4.0-5.2] vs. 3.5 [95% CI = 3.1-3.9] and 5.9 [95% CI = 5.2-6.4] vs. 5.0 [95% CI = 4.5-5.6], respectively; P < 0.05}, with no difference observed in TMD patients. The depression and somatization scores were significantly higher in Group A than in Group B among BMS patients [0.57 (95% CI = 0.45-0.69) vs. 0.46 (95% CI = 0.34-0.59) and 0.537 (95% CI = 0.45-0.63) vs. 0.45 (95% CI = 0.34-0.55); P < 0.05], with no difference observed in TMD patients. The results of the present study indicate that pain intensities and psychosocial characteristics in BMS appear to differ between middle-aged and older patients. PMID:26666859

  1. Burn epidemiology: the patient, the nation, the statistics, and the data resources.

    PubMed

    LaBorde, Pam

    2004-03-01

    Throughout the years, bum care treatment in the United States has made major strides in the ability to save the lives of those once rendered helpless as a result of an extensive bum injury. Bum care professionals are able to assist these individuals to live as normal a life as possible as they heal from one of the most devastating injuries a human being can endure. The only way to remedy the suffering and the costs in health care resources and in productivity is to reduce the incidence of bum injuries and death. Communities must be concerned with consistently establishing preventive measures and with the proactive treatment of bums to help decrease incidence. Activities on the community, state, and national level to obtain accurate data regarding the epidemiologic characteristics must be implemented to provide a more accurate picture of bum injuries in the United States. Addressing issues surrounding the persons at high risk of bum injury will help to decrease the incidence of bum trauma. Funding must be strengthened to ensure the continued existence of bum programs that truly provide high-quality standards of care. In these programs, the burn victim is given every opportunity to become a survivor. In light of the recent terrorist activity in the United States, the nation must address another area that might affect the history of bum care and treatment, the multiple-trauma victim with an extensive burn injury caused by massive explosions, chemical warfare,missiles, and weapons of mass destruction. One out-come from the recent terrorist attack was recognition of the need for facilities to be capable of providing care for this type of patient. Efforts to strengthen these programs and bum care facilities must be continued to maintain and strengthen the care needed for bum patients of the future. PMID:15062410

  2. 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. PMID:24927991

  3. Clinical forensic evidence in burns: rescuer burns.

    PubMed

    Kumar, Pramod; Gopal, Kirun; Ramnani, Sunil

    2006-12-01

    In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1-4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer. Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1--upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2--upper extremity/extremities and face involvement, Grade 3--upper extremity/extremities, face-neck, adjacent chest and lower extremity involvement. PMID:17011132

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

    PubMed

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

    2015-02-01

    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

  5. 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

  6. Genome Sequence of a Virulent Pseudomonas aeruginosa Strain, 12-4-4(59), Isolated from the Blood Culture of a Burn Patient

    PubMed Central

    Karna, S. L. Rajasekhar; Chen, Tsute; Chen, Ping; Peacock, Trent J.; Abercrombie, Johnathan J.

    2016-01-01

    Pseudomonas aeruginosa is an opportunistic pathogen that frequently infects wounds, significantly impairs wound healing, and causes morbidity and mortality in burn patients. Here, we report the genome sequence of a virulent strain of P. aeruginosa, 12-4-4(59), isolated from the blood culture of a burn patient. PMID:26941150

  7. 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

  8. Effect of Orem Self-Care Program on the Life Quality of Burn Patients Referred to Ghotb-al-Din-e-Shirazi Burn Center, Shiraz, Iran: A Randomized Controlled Trial

    PubMed Central

    Hashemi, Fatemeh; Rahimi Dolatabad, Fatemeh; Yektatalab, Shahrzad; Ayaz, Mehdi; Zare, Najaf; Mansouri, Parisa

    2014-01-01

    Background: Advances in treatment and critical care have largely improved the survival following burns; therefore, the importance of quality of life in burn patients is an issue beyond question. The aim of this study was to determine the effects of Orem self-care program on Quality of Life of burn patients. Methods: A randomized clinical trial study was conducted on 110 eligible burn patients who were selected using easy sampling method and allocated randomly into two groups of experiment and control. The instrument for data collection was a questionnaire, containing demographic and burn information and burn-specific health scale–brief (BSHS-B) questionnaire. For the experiment group, 5 sessions of theoretical training and 75-90 minutes of practical training were accomplished. The quality of life of the patients with burns was assessed in three phases by the BSHS-B questionnaire. The data were analyzed in SPSS-17 using Chi-square test, Fisher’s exact test, Independent t-test and repeated measurement multivariate test. Results: After one month and two months of the use of self-care model, the quality of life of the cases improved from 73.33% to 83.78% and 98.12%, respectively (P<0.001). But the changes in the quality of life of the patients in the control group were not statistically significant (P>0.05). Conclusion: Based on the obtained results of this study, designing and implementing a self-care program based on Orem’s model and the needs of burn patients will improve their quality of life. Therefore, it is recommended that this program should be considered as a part of treatment program for these patients. Trial Registration Number: 2013042112129N1 PMID:25349844

  9. 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…

  10. Evaluation of oral-motor movements and facial mimic in patients with head and neck burns by a public service in Brazil

    PubMed Central

    Magnani, Dicarla Motta; Sassi, Fernanda Chiarion; Vana, Luiz Philipe Molina; Alonso, Nivaldo; de Andrade, Claudia Regina Furquim

    2015-01-01

    OBJECTIVES: The purpose of this study was to analyze the characteristics of oral-motor movements and facial mimic in patients with head and neck burns. METHODS: An observational descriptive cross-sectional study was conducted with patients who suffered burns to the head and neck and who were referred to the Division of Orofacial Myology of a public hospital for assessment and rehabilitation. Only patients presenting deep partial-thickness and full-thickness burns to areas of the face and neck were included in the study. Patients underwent clinical assessment that involved an oral-motor evaluation, mandibular range of movement assessment, and facial mimic assessment. Patients were divided into two groups: G1 - patients with deep partial-thickness burns; G2 - patients with full-thickness burns. RESULTS: Our final study sample comprised 40 patients: G1 with 19 individuals and G2 with 21 individuals. The overall scores obtained in the clinical assessment of oral-motor organs indicated that patients with both second- and third-degree burns presented deficits related to posture, position and mobility of the oral-motor organs. Considering facial mimic, groups significantly differed when performing voluntary facial movements. Patients also presented limited maximal incisor opening. Deficits were greater for individuals in G2 in all assessments. CONCLUSION: Patients with head and neck burns present significant deficits related to posture, position and mobility of the oral myofunctional structures, including facial movements. PMID:26039950

  11. A Proper Enteral Nutrition Support Improves Sequential Organ Failure Score and Decreases Length of Stay in Hospital in Burned Patients

    PubMed Central

    Ostadrahimi, Alireza; Nagili, Behrooz; Asghari-Jafarabadi, Mohammad; Beigzali, Sanaz; Zalouli, Hossein; Lak, Sima

    2016-01-01

    Background: Severe burned patients developed metabolic imbalances and systemic inflammatory response syndrome (SIRS), which can lead to malnutrition, impaired immunologic response, multiple organ failure and death. Studies have shown that providing an early and adequate nutrition support can lower hypermetabolic response and improve the outcome. Unfortunately, little emphasis has been given to the role of nutritional support, especially for demonstrating the importance of a proper nutritional support in determining the outcome of critically burned patients. Objectives: This study was designed to determine the possible protective effect of early and adequate nutrition support on sequential organ failure assessment (SOFA) score and length of stay (LOS) in hospital, in thermal burn victims. Patients and Methods: Thirty patients with severe thermal burn (More than 20% of total body surface area [TBSA] burn), on the first day in the intensive care unit, joined this double-blinded randomized controlled clinical trial. Patients were randomly divided into two groups: control group (group C, 15 patients) received hospital routine diet (liquid and chow diet, ad libitum) while intervention group (group I, 15 patients) received commercially prepared solution, with oral or tube feeding. The caloric requirement for these patients was calculated, according to the Harris-Benedict formula. The SOFA score was also measured on admission (SOFA0), day 2 (SOFA1), day 5 (SOFA2) and day 9 (SOFA3), consequently. The difference between the last measurement (SOFA3) and day 2 (SOFA1) was calculated. Results: The results showed that there was a significant change between SOFA3 and SOFA1, {-1[(-1) – 0], P = 0.013 vs. -1 [(-2) - 0], P = 0.109}. Mean LOS in hospital, for patients consuming commercial standard food, also proved to be shorter than those consuming hospital routine foods (17.64 ± 8.2 vs. 23.07 ± 11.89). Conclusions: This study shows that an adequate nutritional support, in

  12. Serious occupational burn injuries treated at a regional burn center.

    PubMed

    Taylor, Allison J; McGwin, Gerald; Cross, James M; Smith, Donald R; Birmingham, Barbara R; Rue, Loring W

    2002-01-01

    This article will present the epidemiology of occupational burn injuries among patients admitted to a regional burn center. Patients admitted to University of Alabama at Birmingham University Hospital Burn Center between November 1994 and December 1999 for occupational burn injuries were studied. Descriptive statistics were generated for demographic, clinical, and outcome characteristics. Approximately one-quarter of all burn center admissions had sustained occupational burn injuries. The most common burns were flame, electrical, and scald burns. The most heavily represented occupations were "manufacturing" (19.1%), "electrician" (16.2%), and "laborer" (16.2%). Burn type varied with occupation. Over $16 million in hospital charges was accrued by patients sustaining occupational burn injuries. Understanding the epidemiology of serious burn injuries in the workplace is crucial to directing prevention efforts toward worker groups at highest risk. PMID:12142576

  13. Antibiotic Susceptibility Patterns and Molecular Epidemiology of Metallo-β-Lactamase Producing Pseudomonas Aeruginosa Strains Isolated From Burn Patients

    PubMed Central

    Japoni, Aziz; Anvarinejad, Mojtaba; Farshad, Shohreh; Giammanco, Giovanni M; Rafaatpour, Noroddin; Alipour, Ebrahim

    2014-01-01

    Background: Failure in the treatment of burn patients infected with Pseudomonas aeruginosa could happen as a result of the acquisition of antibiotic resistance, including carbapenems. Objectives: The aim of the present study was to investigate the phenotypic and genotypic characteristics of the Pseudomonas aeruginosa strains, isolated from burn patients. Patients and Methods: During a 12 month period, in this cross-sectional study, two hundred seventy strains of Pseudomonas aeruginosa were isolated from the burn patients in Ghotbeddin Burn Hospital, Shiraz, Iran. Screening for the carbapenem resistance in the isolates was carried out by the E test method. Sensitivity patterns of metallo-β-lactamase (MβLs) producing strains of pseudomonas to eleven antibiotics were determined by the mentioned method. The epidemiological associations of these strains were determined by Pulsed-field gel electrophoresis (PFGE). Results: Of the 270 strains, 60 (22.2%) were resistant to imipenem and meropenem, classified as MβLs producing. MβLs producing strains of pseudomonas were completely resistant to five tested antibiotics while their sensitivities to the three most effective antibiotics including ceftazidime, amikacin and ciprofloxacin were 23.4%, 6.7 % and 1.7%, respectively. In PFGE, 37 patterns from the genome of Pseudomonas aeruginosa were observed. Majority of the strains (43; 71.6%) exhibited more than 80% similarity, based on the drawn dendrogram. Conclusions: According to the results, none of the tested antibiotics is safe to prescribe. As PFGE revealed, a limited number of Pseudomonas aeruginosa types are predominant in the hospitals which infect the burn patients. PMID:25031843

  14. Creation and validation of a simple venous thromboembolism risk scoring tool for thermally injured patients: analysis of the National Burn Repository.

    PubMed

    Pannucci, Christopher John; Osborne, Nicholas H; Wahl, Wendy L

    2012-01-01

    Venous thromboembolism (VTE) has been identified as a major patient safety issue. The authors report their use of the National Burn Repository (NBR) to create and validate a weighted risk scoring system for VTE. Adult patients with thermal injury from the NBR admitted between 1995 and 2009 were included. Independent variables were either known or could be derived at the time of admission, including TBSA burned, inhalation injury, gender, and age. The dependent variable was VTE, a composite variable of patients with deep venous thrombosis, and pulmonary embolus. The dataset was split into working and validation sets using a random number generator. Multivariable logistic regression identified independent predictors. β-coefficients for independent predictors were used to generate a weighted risk score. The NBR contained 22,618 patients who met inclusion criteria. The working and validation sets were not statistically different for demographics or risk factors. In the working set, the presence of inhalation injury and increased TBSA were independent predictors of VTE. Adjusted β-coefficients were used to generate a weighted risk score, which showed excellent discrimination for VTE in both the working (c-statistic 0.774) and the validation (c-statistic 0.750) sets. As risk score increased, a linear increase in observed VTE rate was demonstrated in both working and validation sets. The authors have created and validated a simple risk score model to predict VTE risk in thermally injured patients using the NBR. The model is based on risk factors that are easily identified during initial patient contact. PMID:21979848

  15. Early enteral feeding for burned patients--an effective method which should be encouraged in developing countries.

    PubMed

    Lam, Nguyen Nhu; Tien, Nguyen Gia; Khoa, Chu Manh

    2008-03-01

    A randomized control trial was conducted to investigate impact of early enteral feeding on immune, metabolic aspects and outcomes of 82 severe burned patients admitting to National Institute of Burns, Hanoi, Vietnam from November 2003 to November 2004. Fourty-one patients were in early enteral group and 41 patients were in total parenteral nutrition group. Blood samples were collected at admission and 7th day postburn to determine plasma level of IgG, IgM, insulin, corrtisol and blood absolute number of TCD4, TCD8. Intestinal chyme was drawn through a weighted feeding tube to determine intestinal secreted IgA. Results showed that, at the 7th day after burn, both humoral and cellular immunology recovered faster in enteral nutrition group as compared to total parenteral group (p<0.05). In the early enteral nutrition group, after 1 week, plasma concentration of cortisol decreased from 599.70 to 437nmol/l and that of insulin increased from 12.07 to 30.34micromol/ml. Vice versa, in the control group the change was in the reverse direction (p<0.01). Overall complication decreased in the enteral nutrition group in comparison with parenteral group. Finally, mortality was significantly lower in early enteral nutrition group as compared to the parenteral group (14.65% and 36.58%, respectively). In conclusion, early enteral nutrition after burn has positive effects on immune and metabolic function, and reduces complication as well as death rate. PMID:17804169

  16. Aeromedical Pediatric Burn Transportation: A Six-Year Review.

    PubMed

    Warner, Petra; Bailey, John K; Bowers, Laura; Hermann, Rachel; James, Laura E; McCall, John E

    2016-01-01

    Aeromedical transportation has been shown to be a safe and efficient mode of transportation for critical care patients, including adult burn patients. Common flight concerns specific to the care of the burn patient are maintenance of intravenous lines and airway access, precision of ongoing fluid resuscitation, and effective treatment of hemodynamic instability. These concerns are particularly crucial when patients are transported by flight teams with limited burn experience. The purpose of this study was to review the safety and outcomes associated with 6 years of aeromedical pediatric burn transportation and to ascertain if differences exist when using a dedicated burn pediatric flight team versus a non-dedicated burn pediatric flight teams. Through a retrospective, IRB approved, chart review from January 2007 to January 2013, all aeromedical admissions were evaluated for demographic data, flight data, complications, and medical interventions. A total of 333 patients were transported by air, of which 282 transfers occurred during the first week of burn injury. In-flight complications occurred in <10% of patients and primarily involved airway and hemodynamic issues. There were no in-flight deaths. Patients transported by alternate teams were noted to be more hypothermic and hypotensive on admission (p < .001). Alternate teams were also noted to transfer older patients, spend less time with initial patient evaluation, and travelled shorter distances (p < .05). Aeromedical transportation of the pediatric burn patient is safe and associated with minimal complications. Communications with the transferring hospitals can facilitate transfer of the pediatric burn patient. When using alternate flight teams, particular attention should focus on resuscitation and maintenance of euthermia with large burn patients. PMID:25423443

  17. Mass spectrometry based data of the blister fluid proteome of paediatric burn patients.

    PubMed

    Zang, Tuo; Broszczak, Daniel A; Cuttle, Leila; Broadbent, James A; Tanzer, Catherine; Parker, Tony J

    2016-09-01

    The data presented here are associated with the article "The blister fluid proteome of paediatric burns" (Zang et al., 2016) [1]. Burn injury is a highly traumatic event for children. The degree of burn severity (superficial-, deep-, or full-thickness injury) often dictates the extent of later scar formation which may require long term surgical operation or skin grafting. The data were obtained by fractionating paediatric burn blister fluid samples, which were pooled according to burn depth and then analysed using data dependent acquisition LC-MS/MS. The data includes a table of all proteins identified, in which burn depth category they were found, the percentage sequence coverage for each protein and the number of high confidence peptide identifications for each protein. Further Gene Ontology enrichment analysis shows the significantly over-represented biological processes, molecular functions, and cellular components of the burn blister fluid proteome. In addition, tables include the proteins associated with the biological processes of "wound healing" and "response to stress" as examples of highly relevant processes that occur in burn wounds. PMID:27536711

  18. 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

  19. 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). PMID:23817001

  20. Pathophysiologic Response to Burns in the Elderly☆

    PubMed Central

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

    2015-01-01

    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. PMID:26629550

  1. 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. PMID:26629550

  2. Metabolism of platelet activating factor (PAF) and lyso-PAF in polymorphonuclear granulocytes from severely burned patients.

    PubMed

    Schönfeld, W; Kasimir, S; Köller, M; Erbs, G; Müller, F E; König, W

    1990-12-01

    We studied the metabolism of 3H-platelet activating factor (PAF) and lyso-PAF in human polymorphonuclear granulocytes (PMN) from severely burned patients (n = 6) on days 1, 5, 9, 15, and 25 post-trauma. All patients suffered from a severe burn trauma of more than 30% total body surface area. Stimulation of PMN in healthy donors (n = 10) with the Ca-ionophore resulted in the conversion of 3H-lyso-PAF into PAF (18 +/- 2% of total radioactivity) and alkyl-acyl-glycero-phosphorylcholine (alkyl-acyl-GPC, 50 +/- 6%). In burned patients a significantly reduced formation of 3H-PAF was observed between days 1 and 15 post-trauma (day 9: 1 +/- 1%, p less than 0.0001). This pattern was normalized again in patients (n = 5) who survived the trauma after septic periods and was observed during the second week post-trauma. In one patient who succumbed to his injuries a sustained inhibition of PAF formation was observed up to his death. The decreased formation of PAF correlated weakly with the appearance of immature granulocytes within the analyzed cell fraction (ratio of immature cells versus PAF-formation, r = -0.55, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2258972

  3. The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

    PubMed

    Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Haghani, Hamid

    2016-01-01

    This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach. PMID:26132048

  4. Burning Issue: Handling Household Burns

    MedlinePlus

    ... hot objects or liquid, fire, friction, the sun, electricity, or certain chemicals. Each year, about a half- ... infant or elderly. the burn was caused by electricity, which can lead to “invisible” burns. Burns Burns ...

  5. 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. PMID:16843945

  6. Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis.

    PubMed

    Zhang, Yi; Wang, Tao; He, Jinguang; Dong, Jiasheng

    2016-06-01

    Growth factor (GF) therapy has shown promise in treating a variety of refractory wounds. However, evidence supporting its routine use in burn injury remains uncertain. We performed this systematic review and meta-analysis assessing randomised controlled trials (RCTs) to investigate efficacy and safety of GFs in the management of partial-thickness burns. Electronic searches were conducted in PubMed and the Cochrane databases. Endpoint results analysed included wound healing and scar formation. Thirteen studies comprising a total of 1924 participants with 2130 wounds (1131 GF receiving patients versus 999 controls) were identified and included, evaluating the effect of fibroblast growth factor (FGF), epidermal growth factor (EGF) and granulocyte macrophage-colony stimulating factor (GM-CSF) on partial-thickness burns. Topical application of these agents significantly reduced healing time by 5·02 (95% confidence interval, 2·62 to 7·42), 3·12 (95% CI, 1·11 to 5·13) and 5·1 (95% CI, 4·02 to 6·18) days, respectively, compared with standard wound care alone. In addition, scar improvement following therapy with FGF and EGF was evident in terms of pigmentation, pliability, height and vascularity. No significant increase in adverse events was observed in patients receiving GFs. These results suggested that GF therapy could be an effective and safe add-on to standard wound care for partial-thickness burns. High-quality, adequately powered trials are needed to further confirm the conclusion. PMID:25040572

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

    PubMed Central

    Maani, Christopher V.; Hoffman, Hunter G.; Fowler, Marcie; Maiers, Alan J.; Gaylord, Kathryn M.; DeSocio, Peter A.

    2015-01-01

    Background US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extrem pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain. We describe the first use of ketamine combined with immersive VR to reduce excessive pain during wound care. Case Report A 21-year-old male US Army soldier stationed in Iraq, and a 41-year-old civilian male sustained a 13% and 50% total body surface area (TBSA) burn, respectively. Each patient received 40 mg ketamine intraveneous (IV) for wound care. Using a within-subject design, nurses conducted half of a painful segment of wound care treatments with no VR and the other half with immersive VR. Graphic pain rating scores for each of the two treatment conditions served as the dependent variables. Results Compared to ketamine + no VR, both patients reported less pain during ketamine + VR for all three pain ratings. Both patients rated wound care during no VR as “no fun at all”, but those same patients rated wound care during virtual reality as either “pretty fun” or “extremely fun”, and rated nausea as either “mild” or “none”. Conclusions Results from these first two cases suggest that a moderate dose of ketamine combined with immersive virtual reality distraction may be an effective multimodal analgesic regimen for reducing acute procedural pain during severe burn wound cleanings. PMID:21481162

  8. Extrapulmonary factors influencing the ratio of arterial oxygen tension to inspired oxygen concentration in burn patients.

    PubMed

    Martyn, J A; Aikawa, N; Wilson, R S; Szyfelbein, S K; Burke, J F

    1979-11-01

    The ratio of arterial oxygen tension to inspired oxygen concentration (PaO2/FIO2) as an index of respiratory function was evaluated in 22 patients with body surface area burns of 15--80%. These results indicate that this ratio is limited in its applicability because extrapulmonary factors, such as cardiac output, oxygen consumption, and arterial oxygen content, can affect this index by alterations in the amount of venous desaturation. Useful estimates of intrapulmonary right to left shunt (Qs/Qt) from PaO2/FIO2 were obtained only when arteriovenous oxygen content differences (avDO2) were between 3--5 ml/dl. There were avDO2 values above and below 3--5 ml/dl in at least 35% of the observations. Under these circumstances, PaO2/FIO2 did not correctly reflect changes in Qs/Qt. Blood gases from central venous catheters did not mirror changes in true mixed venous blood and, thus, can lead to erroneous estimations of Qs/Qt. Rational therapy of reduced arterial oxygen saturation requires measurement of both extra- and intrapulmonary factors contributing to arterial desaturation. Measurement of PaO2/FIO2 alone will not estimate these factors. PMID:487845

  9. Pulmonary manifestations in adult patients with chronic granulomatous disease.

    PubMed

    Salvator, Hélène; Mahlaoui, Nizar; Catherinot, Emilie; Rivaud, Elisabeth; Pilmis, Benoit; Borie, Raphael; Crestani, Bruno; Tcherakian, Colas; Suarez, Felipe; Dunogue, Bertrand; Gougerot-Pocidalo, Marie-Anne; Hurtado-Nedelec, Margarita; Dreyfus, Jean-François; Durieu, Isabelle; Fouyssac, Fanny; Hermine, Olivier; Lortholary, Olivier; Fischer, Alain; Couderc, Louis-Jean

    2015-06-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by failure of superoxide production in phagocytic cells. The disease is characterised by recurrent infections and inflammatory events, frequently affecting the lungs. Improvement of life expectancy now allows most patients to reach adulthood. We aimed to describe the pattern of pulmonary manifestations occurring during adulthood in CGD patients. This was a retrospective study of the French national cohort of adult patients (≥16 years old) with CGD. Medical data were obtained for 67 adult patients. Pulmonary manifestations affected two-thirds of adult patients. Their incidence was significantly higher than in childhood (mean annual rate 0.22 versus 0.07, p=0.01). Infectious risk persisted despite anti-infectious prophylaxis. Invasive fungal infections were frequent (0.11 per year per patient) and asymptomatic in 37% of the cases. They often required lung biopsy for diagnosis (10 out of 30). Noninfectious respiratory events concerned 28% of adult patients, frequently associated with a concomitant fungal infection (40%). They were more frequent in patients with the X-linked form of CGD. Immune-modulator therapies were required in most cases (70%). Respiratory manifestations are major complications of CGD in adulthood. Noninfectious pulmonary manifestations are as deleterious as infectious pneumonia. A specific respiratory monitoring is necessary. PMID:25614174

  10. Mediastinal Tuberculosis in an Adult Patient with Cystic Fibrosis▿

    PubMed Central

    Morand, Philippe C.; Burgel, Pierre-Régis; Carlotti, Agnès; Desmazes-Dufeu, Nadine; Farhi, David; Martin, Clémence; Kanaan, Reem; Mangialavori, Luigi; Palangié, Estelle; Dusser, Daniel; Poyart, Claire; Hubert, Dominique

    2011-01-01

    Tuberculosis (TB) is rarely observed in cystic fibrosis (CF) patients. We report the first case of mediastinal TB, associated with leg pain and skin rash, in an adult patient with CF, and discuss factors suggestive of TB in the course of CF. PMID:21106788

  11. Burns associated with fondues.

    PubMed Central

    Laliberté, D; Beaucage, C; Watts, N

    1992-01-01

    OBJECTIVE: To describe the causes of burns associated with fondues. DESIGN: Descriptive case series. PATIENTS: All 17 patients admitted to a burn centre between Apr. 1, 1985, and Mar. 31, 1990, whose burns were associated with fondue. Eleven agreed to complete a telephone interview. RESULTS: The age of the 17 patients varied from 2 to 56 (mean 27) years. Two causes were identified: spilling of the contents of the fondue pot and explosion of the fondue fuel when added to the burner during a meal. The telephone interview revealed that eight people other than the respondents were burned during the same accidents. CONCLUSION: Although we identified only badly burned patients the problem may be more extensive. The knowledge of specific causes of burns from handling fondue equipment indicates that preventive action should be undertaken. More epidemiologic information is needed to obtain a precise estimate of the magnitude of this public health problem. PMID:1393897

  12. Burns and epilepsy.

    PubMed

    Berrocal, M

    1997-01-01

    This is a report of the first descriptive analytic study of a group of 183 burn patients, treated in the Burn Unit at the University Hospital of Cartagena, Colombia during the period since January 1985 until December 1990. There is presented experience with the selected group of 24 patients in whom the diagnosis of burn was associated with epilepsy. There is also analysed and described the gravity of the scars sequels, neurological disorders, the complication of the burn and an impact of this problem on the patient, his (her) family and the community. It is very important to report that there was found Neurocisticercosis in 66.6% of the group of burn patients with epilepsy, and it is probably the first risk factor of burn in this group. PMID:9212488

  13. Burning vasculitis.

    PubMed

    Chadha, Priyanka; Hobday, Dorian; Fitzgerald O'Connor, Edmund; D'Cruz, David

    2016-01-01

    We present the case of a 69-year-old man who was found collapsed close to a heat source and admitted to hospital for severe sepsis. He was also found to have widespread blistering and ulceration of his right leg; however, a history was unobtainable due to reduced consciousness levels. The leg lesions had the initial appearance of mixed depth burns and a management plan was made to transfer the patient to a burns unit for debridement. It was subsequently noted that the patient had a previous diagnosis of seropositive erosive rheumatoid arthritis. A biopsy of the leg lesion was performed and a diagnosis of rheumatoid vasculitis confirmed. Treatment with systemic steroids, intravenous antibiotics and intravenous immunoglobulin therapy for severe hypogammaglobulinaemia was started, and the patient was not transferred for surgical debridement. Rheumatoid vasculitis is a rare and extremely serious complication of rheumatoid arthritis that can manifest in a number of ways, occasionally mimicking other conditions. This case is essential to raise awareness of rare, severe rheumatoid vasculitis and of the potential for its misdiagnosis as a mixed depth burn. PMID:27118745

  14. Pediatric burn patients from Vietnamese camps in Hong Kong from 1989 to 1997.

    PubMed

    Chan, E S; King, W W

    2000-05-01

    Over the 9 years from 1989 to 1997, many children who suffered from scald burns in the Vietnamese camps in the New Territories of Hong Kong were treated. The profile of these children was examined and analyzed. PMID:10741594

  15. Wilms Tumor: An Uncommon Entity in the Adult Patient

    PubMed Central

    Mahmoud, Fade; Allen, M Brandon; Cox, Roni; Davis, Rodney

    2016-01-01

    Wilms tumor, the most common kidney tumor in children, is rarely seen in adults, making it a challenge for the adult oncologist to diagnose and treat. Unlike with renal cell carcinoma, patients with Wilms tumor should receive adjuvant chemotherapy with or without radiation therapy. Adult oncologists may not be familiar with pediatric oncology protocols, so it is important to consult with pediatric oncologists who have more experience in this disease. Multimodal therapy based on pediatric protocols improved the outcomes of adults with Wilms tumor worldwide. We report a rare case of a 24-year-old woman with a slow-growing mass of the left kidney during a 4-year period. The mass was surgically removed and final diagnosis confirmed by pathology to be Wilms tumor. The patient received adjuvant chemotherapy and has been free of disease since 2014. PMID:27043834

  16. [Mesial temporal sclerosis syndrome in adult patients].

    PubMed

    Consalvo, D; Giobellina, R; Silva, W; Rugilo, C; Saidón, P; Schuster, G; Kochen, S; Sica, R

    2000-01-01

    Magnetic resonance imaging (MRI) has become an essential tool in the work-up of epilepsy. Since its appearance it has been possible to identify pathologies, such as hippocampal sclerosis (HS), that had previously only been detected by histopathological assays. The aim of this study was to analyze the clinical manifestations, EEG and the outcome of patients with HS as shown by MRI. We revised the clinical histories of 384 outpatients from the Epilepsy Center, Ramos Mejía Hospital, who had been studied by MRI. Thirty five of them (15.5%) had a diagnosis of HS, based on the structural changes observed on the images. Six patients were excluded because of incomplete clinical data. Therefore, we studied 29 patients including 15 men. The mean age was 32.7 +/- 10.2 years (range: 19-58). All of them had partial seizures. Ten subjects had had febrile convulsions (34.5%) in childhood. Neurological examination was normal in all subjects. Interictal EEG showed focal abnormalities that were coincident in their location with the MRI abnormalities in 16 patients (55.1%). Fourteen patients (48.3%) showed right side hippocampal lesions on MRI, thirteen on the left side (44.9%) and 2 bilateral HS (6.8%). Twenty-seven patients (93.1%) had intractable epilepsy. Anterior temporal lobectomy was performed in 3 subjects with good outcome. The identification of these patients who present certain clinical and MRI characteristics, provides an opportunity to define the mesial temporal sclerosis syndrome. This could benefit patients in their prognosis and for specific treatments. PMID:10962804

  17. [Awake intubation using Pentax Airway Scope as an alternative to awake fiberoptic intubation in management of anticipated difficult tracheal intubation in major burn patients].

    PubMed

    Fayolle-Pivot, L; Magnin, C; Tissot, S; Bertin-Maghit, M; Allaouchiche, B

    2013-05-01

    Intubating patients with facial burn is difficult to most anesthesiologists. Awake flexible fiberoptic intubation is the gold standard for management of anticipated difficult tracheal intubation. However, serious facial burn and dysmorphic syndrome can make fiberoptic intubation more difficult or impossible. We report the use of awake oral intubation using the Pentax-Airway Scope (AWS) in two major burn patients with facial injury, in whom awake fiberoptic intubation was impossible. As shown in morbidly obese patient and in patients with unstable necks, AWS could be useful to facilitate tracheal intubation in awake, facial burn patients presenting with a potentially difficult airway. Awake AWS intubation seems as a potential alternative to awake fiberoptic intubation. PMID:23453928

  18. A pregnant patient with fetal distress with severe post burn contracture of anterior trunk and perineum: A surgeon's nightmare!

    PubMed Central

    Vathulya, Madhubari; Joshi, Meenakshi

    2014-01-01

    Introduction: A case report of a pregnant lady in the third trimester, presenting in the emergency with absent fetal movements is being described. A multi-speciality expertise was involved and a full term female baby was delivered. Presentation: The patient presented in a Government hospital, Dehradun, India. At the time of presentation the fetal heart sounds were absent and subsequently the severe post-burn deformity involving the anterior trunk, perineum and thighs were discovered. Management: Immediately a multi-speciality approach involving the plastic, obstetrics and pediatrics field were called for and an emergency caesarean with simultaneous contracture release with split skin grafts were performed after optimizing the patient for surgery. Conclusion: This is one of the first case reports reporting this rare combination of post burn contracture of trunk and perineum with fetal distress requiring emergency caesarean section along with release of abdominal and perineal post-burn contracture. This case interestingly reinforces that in such complicated cases a systematic and a combined multi-speciality approach still holds the key to patient's treatment even in district hospitals. PMID:25593442

  19. 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. PMID:22994662

  20. Practical fluoride and remineralization protocols for adult patients.

    PubMed

    Chan, Daniel C N; Wefel, James S; Caughman, W Frank

    2004-12-01

    There is a wealth of information on preventive measures and procedures that can be used to care for paediatric and adolescent patients. However, few studies have been conducted in adult or geriatric populations, and an understanding of preventive and non-surgical treatment regimens for these patients is lacking. Traditionally, caries incidence is high among risk groups of low income, low dental IQ and certain ethnic subgroups, but we are now witnessing a high incidence of caries among middle-income and healthy adult patients with an imbalance of protective factors and cariogenic factors. We will direct our attention to the adult population and attempt to address some of the most common questions. PMID:15736834

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

    PubMed Central

    Hodgman, Erica I.; Saeman, Melody R.; Subramanian, Madhu

    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. PMID:26146907

  2. Pyridoxine deficiency in adult patients with status epilepticus.

    PubMed

    Dave, Hina N; Eugene Ramsay, Richard; Khan, Fawad; Sabharwal, Vivek; Irland, Megan

    2015-11-01

    An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 μg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n=132). Reported normal pyridoxine range is >10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels. PMID:26418265

  3. [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. PMID:27052242

  4. Approach to Adult Patients with Acute Dyspnea.

    PubMed

    DeVos, Elizabeth; Jacobson, Lisa

    2016-02-01

    Undifferentiated patients in respiratory distress require immediate attention in the emergency department. Using a thorough history and clinical examination, clinicians can determine the most likely causes of dyspnea. Understanding the pathophysiology of the most common diseases contributing to dyspnea guides rational testing and informed, expedited treatment decisions. PMID:26614245

  5. 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. PMID:26868033

  6. [Combined mechanical-cold and mechanical-burn injuries in patients injured in maritime disasters].

    PubMed

    Zakrevskii, Yu N; Shevchenko, A G; Peretechikov, A V; Serdyuk, V I; Arkhangelskii, D A

    2015-06-01

    On the basis of analysis of 372 medical histories and total amount of victims (2691 people) of marine accidents it was revealed that 303 (83.1%) survivors suffered from combined mechanical-cold injuries, combined two-factor mechanical-burn injuries were diagnosed in 115 of wounded (15.7%), combined three-factor mechanical-cold-burn injuries were diagnosed in 162 of wounded (22.5%). It was established that in case of capsizing and shipwrecking chest and abdomen injuries prevail in wounded (22.4%). Pelvic fractures, injuries of the lower extremities and spine traumas prevail in wounded evacuated from the crash area after explosion and fire on the ships (43.3%). The above-mentioned injuries prevail due to mine-blast nature of injuries. Typical injuries in wounded survived in maritime disasters are in non-severe combined mechanical-cold, mechanical-burn, and mechanical-cold-burn injuries, minor and moderate hypothermia, mild burn injuries and mild carbon monoxide poisoning. PMID:26442314

  7. Burns in Malawi

    PubMed Central

    Virich, G.; Lavy, C.B.D.

    2006-01-01

    Summary Objective: To describe burns seen at the largest hospital in Malawi. Methods: In a prospective study conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, a series of twelve accidental burns was analysed over a four-week period. Results: Hot water was the commonest source of burns (6 out of 12). Open-fire and petroleum lamp accidents were the commonest cause of burns among epileptic patients. Males were affected more than females (male:female ratio = 8:4). Most burns were superficial (11 out of 12). One patient had deep burns requiring grafting. All patients were treated with topical silver sulphadiazine and a combination antibiotic regime. Children aged six yr or under were a major subgroup at risk of suffering burns (7 out of 12) and only one patient was aged over 30 yr. Lack of anti-epileptic medication resulted in potentially avoidable burns in four epileptic patients. Conclusions: There is a need for cheap preventive health promotion measures as well as the provision of simple resources as most burns encountered can be managed effectively by simple measures. PMID:21991045

  8. A quantitative, cross-sectional study of depression and self-esteem in teenage and young adult burn victims in rehabilitation.

    PubMed

    Teixeira Nicolosi, Júlia; Fernandes de Carvalho, Viviane; Llonch Sabatés, Ana

    2013-09-01

    Burns can have a negative physiological and emotional impact, particularly among teenage victims. To assess the presence of depression and level of self-esteem, a cross-sectional study was conducted among 63 teenage and young adult burn victims ages 12 to 20 years undergoing physical and psychological rehabilitation at the Outpatient Unit for Plastic Surgery and Burns at the Central Institute of the Clínicas Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil. Assessment instruments included Beck's Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). Internal consistency within and between the two scales was established via Cronbach's-α coefficient. All variables were analyzed using descriptive statistics, and the statistical difference between means was compared using Student's t-test. The majority of participants were female (38, 60.3%) and unmarried (59, 93.7%) with a mean total body surface area (TBSA) burn of 23.84%. Most burns (58, 92.10%) were the result of accidents and were located on the trunk (47, 74.6%), head (43, 68%), arms (41, 65%), hands (38, 60%), neck (34, 54%), and forearm (29, 46%). Participants had received physical and psychological rehabilitation for an average of 124.74 months (SD 63.67) from a multidisciplinary team. The majority of participants (33, 52.4%) reported functional and aesthetic after-effects and appraised their scar as visible (51, 81.0%). BDI results showed low levels or absence of depression (mean = 7.63, SD 8.72; scale 0 = no depression to 63 = serious depression); the RSE showed adequate levels of self-esteem (mean = 8.41, SD 4.74; scale 0-30, where higher scores indicate worst levels of self-esteem). Burn location did not affect depression (BDI: P = 0.26) or self-esteem (RSE: P = 0.21). However, depression and self-esteem were more significant in participants who were not able to work and/or go to school than in those who were (BDI: P = 0.04 and self-esteem RSE: P = 0

  9. 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 ...

  10. Determinants of Skeletal Muscle Catabolism After Severe Burn

    PubMed Central

    Hart, David W.; Wolf, Steven E.; Chinkes, David L.; Gore, Dennis C.; Mlcak, Ronald P.; Beauford, Robert B.; Obeng, Michael K.; Lal, Sophia; Gold, Warren F.; Wolfe, Robert R.; Herndon, David N.

    2000-01-01

    Objective To determine which patient factors affect the degree of catabolism after severe burn. Summary Background Data Catabolism is associated with severe burn and leads to erosion of lean mass, impaired wound healing, and delayed rehabilitation. Methods From 1996 to 1999, 151 stable-isotope protein kinetic studies were performed in 102 pediatric and 21 adult subjects burned over 20–99.5% of their total body surface area (TBSA). Patient demographics, burn characteristics, and hospital course variables were correlated with the net balance of skeletal muscle protein synthesis and breakdown across the leg. Data were analyzed sequentially and cumulatively through univariate and cross-sectional multiple regression. Results Increasing age, weight, and delay in definitive surgical treatment predict increased catabolism (P < .05). Body surface area burned increased catabolism until 40% TBSA was reached; catabolism did not consistently increase thereafter. Resting energy expenditure and sepsis were also strong predictors of net protein catabolism. Among factors that did not significantly correlate were burn type, pneumonia, wound contamination, and time after burn. From these results, the authors also infer that gross muscle mass correlates independently with protein wasting after burn. Conclusions Heavier, more muscular subjects, and subjects whose definitive surgical treatment is delayed are at the greatest risk for excess catabolism after burn. Sepsis and excessive hypermetabolism are also associated with protein catabolism. PMID:10998644

  11. 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. PMID:12792237

  12. [Adult patients with congenital heart disease].

    PubMed

    Grabitz, R G; Kaemmerer, H; Mohr, F-W

    2013-01-01

    Unlike a few decades ago, today most patients with congenital heart disease reach adulthood after intervention or reparative surgery. As complete correction is generally not possible, a patient population with great complexity and a particular challenge to medical management is rising and a regular follow-up is mandatory. The aim of care is the timely recognition of residual or associated problems. Frequency and intensity of follow-up examinations depend on type and complexity of the lesion. The standard repertoire at follow-up consists of a specific history, clinical examination, ECG, Holter-monitoring, exercise tests, and echocardiography. Depending on the indication, cardio-MRI, CT scan, and sophisticated cardiac catheterization may become necessary. Long-term complications like rhythm disturbances, pulmonary hypertension, or heart failure are frequent, despite optimal care. Acute complications like arrhythmias, infective endocarditis, cerebral events, cerebral abscesses, aortic dissection, pulmonary embolism, and bleeding have to be recognized early and treated appropriately. Additional focus has to be placed on counseling and management of noncardiac disease and surgery, pregnancy and delivery, exercise at work and in private life, driving, and insurance issues. Training and certification of physicians as well as the establishment of specialized centers will help to ensure high quality health care for the affected patient population. PMID:23318541

  13. Peculiarities of Anxiety Score Distribution in Adult Cancer Patients.

    PubMed

    Blank, Mikhail; Blank, Olga; Myasnikova, Ekaterina; Denisova, Daria

    2015-01-01

    The goal of the present research is to investigate and analyze possible peculiarities of the psychological state of cancer patients undergoing treatment. Scores characterizing the trait and state anxiety were acquired using the Integrative Anxiety Test from four groups: adults with no appreciable disease, pregnant women, cancer patients examined during the specific antitumor treatment, and cancer patients brought into lasting clinical remission. Statistical analysis of the testing results revealed the bimodal type of the distribution of scores. The only statistically significant exception was the distribution of the state anxiety scores in cancer patients undergoing treatment that was clearly unimodal. PMID:26176239

  14. 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. PMID:26636515

  15. 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

  16. Comparision of clinical and histopathological results of hyalomatrix usage in adult patients.

    PubMed

    Erbatur, Serkan; Coban, Yusuf Kenan; Aydın, Engin Nasuhi

    2012-01-01

    Clinical and histopathological results of the hyaluronic acid skin substitute treatment of the patients who admitted to Inonu University Medical Faculty Plastic Reconstructive and Aesthetic Surgery clinic between january 2011 and march 2012 were evaluated. The patients were divided into two groups. HA were used for treatment of Hypertrophic scar (HS) or Keloid (K) in 10 patients of the first group. Skin biopsies obtained at peroperative and postoperative 3rd month were subjected to histopathologic examination in this group. In the second group, 10 patients with full thickness soft tissue loss secondary to burns, trauma or excisional reasons were also treated with HA application. Vancouver scar scale were used to determine the scar quality in both groups. Mean age was 25. 2 ± 10.2 and mean follow-up duration was 6.3±3.6 months in group 1. Preoperative and postoperative VSS scores in group 1 were 10.7±1.16 and 6.2±0.91, respectively. This difference was statistically significant (p<0,005). No HS or K development was seen in any patient in group 2 during the following period. Collagenisation scores of preoperative skin biopsies were significantly higher than postoperative scores (p<0,0001).Vascularisation scores of preoperative skin biopsies were significantly lower than postoperative scores (p<0,00001). The use of HA skin substitute in adults for treatment of HS or K provided the desired clinical healing in the 6 months' follow-up periods. At the same time, HA application as an alternative to other treatment modalities led to a durable skin coverage in full thickness tissue loss in adult patients. PMID:23071910

  17. Pain Assessment in Noncommunicative Adult Palliative Care Patients.

    PubMed

    McGuire, Deborah B; Kaiser, Karen Snow; Haisfield-Wolfe, Mary Ellen; Iyamu, Florence

    2016-09-01

    Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients. PMID:27497016

  18. Increased poly(ADP-ribosyl)ation in skeletal muscle tissue of pediatric patients with severe burn injury: prevention by propranolol treatment

    PubMed Central

    Oláh, Gábor; Finnerty, Celeste; Sbrana, Elena; Elijah, Itoro; Gerö, Domokos; Herndon, David; Szabó, Csaba

    2011-01-01

    Summary Activation of the nuclear enzyme poly (ADP-ribose) polymerase (PARP) has been shown to promote cellular energetic collapse and cellular necrosis in various forms of critical illness. Most of the evidence implicating the PARP pathway in disease processes is derived from preclinical studies. With respect to PARP and burns, studies in rodent and large animal models of burn injury have demonstrated the activation of PARP in various tissues and the beneficial effect of its pharmacological inhibition. The aim of the current study was to measure the activation of PARP in human skeletal muscle biopsies at various stages of severe pediatric burn injury and to identify the cell types where this activation may occur. Another aim of the study was to test the effect of propranolol (an effective treatment of patients with burns), on the activation of PARP in skeletal muscle biopsies. PARP activation was measured by Western blotting for its product, poly(ADP-ribose) (PAR). The localization of PARP activation was determined by PAR immunohistochemistry. The results showed that PARP becomes activated in the skeletal muscle tissue after burns, with the peak of the activation occurring in the middle stage of the disease (13–18 days after burns). Even at the late stage of the disease (69–369 days post-burn) an elevated degree of PARP activation persisted in some of the patients. Immunohistochemical studies localized the staining of PAR primarily to vascular endothelial cells, and occasionally to resident mononuclear cells. There was a marked suppression of PARP activation in the skeletal muscle biopsies of patients who received propranolol treatment. We conclude that human burn injury is associated with the activation of PARP. We hypothesize that this response may contribute to the inflammatory responses and cell dysfunction in burns. Some of the clinical benefit of propranolol in burns may be related to its inhibitory effect on PARP activation. PMID:21368715

  19. 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…

  20. 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…

  1. A ten-year review of lower extremity burns in diabetics: small burns that lead to major problems.

    PubMed

    Barsun, Alura; Sen, Soman; Palmieri, Tina L; Greenhalgh, David G

    2013-01-01

    Diabetes mellitus with its resulting neurovascular changes may lead to an increased risk of burns and impaired wound healing. The purpose of this article is to review 10 years of experience with foot and lower leg burns in patients with diabetes at a single adult burn center. Patients with lower extremity burns and diabetes mellitus, between May 1999 and December 2009, were identified in the Trauma Registry of the American College of Surgeons database, and their charts were reviewed for data related to their outcomes. Sixty-eight diabetic patients, 87% male, with a mean age of 54 years, sustained foot or lower extremity burns with 37 having burns resulting from insensate feet. The pathogenesis included walking on a hot or very cold surface (8), soaking feet in hot water (22), warming feet on or near something hot such as a heater (13), or spilling hot water (7). The majority of patients were taking insulin (59.6%) or oral hyperglycemic medications (34.6%). Blood sugar levels were not well controlled (mean glucose, 215.8 mg/dl; mean hemoglobin A1c, 9.08%). Renal disease was common with admission serum blood urea nitrogen (27.5 mg/dl) and creatinine (2.21 mg/dl), and 13 were on dialysis preinjury. Cardiovascular problems were common with 39 (57%) having hypertension or cardiac disease, 3 having peripheral vascular disease, and 9, previous amputations. The mean burn size was 4.2% TBSA (range, 0.5-15%) with 57% being full thickness. Despite the small burn, the mean length of stay was 15.2 days (range, 1-95), with 5.65 days per 1% TBSA. Inability to heal these wounds was evident in 19 patients requiring readmission (one required 10 operative procedures). At least one patient sustained more than one burn. There were 62 complications with 30 episodes of infection (cellulitis, 28; osteomyelitis, 4; deep plantar infections, 2; ruptured Achilles tendon, 1) and 3 deaths. Eleven patients needed amputations (7 below-knee amputations, 4 transmetatarsal amputations, and 20 toe

  2. Medication adherence among adult patients on hemodialysis.

    PubMed

    Alkatheri, Abdulmalik M; Alyousif, Sarah M; Alshabanah, Najla; Albekairy, Abdulkareem M; Alharbi, Shemylan; Alhejaili, Fayze F; Alsayyari, Abdullah A; Qandil, Abeer Ma; Qandil, Amjad M

    2014-07-01

    Medication adherence was assessed in 89 patients on hemodialysis (HD) at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8). The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012), being married (P = 0.012) increased the level of adherence, being of medium level of education (P = 0.024) decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence. PMID:24969185

  3. 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. PMID:22903808

  4. Management of acute burns and burn shock resuscitation.

    PubMed

    Faldmo, L; Kravitz, M

    1993-05-01

    Initial management of minor and moderate, uncomplicated burn injury focuses on wound management and patient comfort. Initial management of patients with major burn injury requires airway support, fluid resuscitation for burn shock, treatment for associated trauma and preexisting medical conditions, management of adynamic ileus, and initial wound treatment. Fluid resuscitation, based on assessment of the extent and depth of burn injury, requires administration of intravenous fluids using resuscitation formula guidelines for the initial 24 hours after injury. Inhalation injury complicates flame burns and increases morbidity and mortality. Electrical injury places patients at risk for cardiac arrest, metabolic acidosis, and myoglobinuria. Circumferential full-thickness burns to extremities compromise circulation and require escharotomy or fasciotomy. Circumferential torso burns compromise air exchange and cardiac return. Loss of skin function places patients at risk for hypothermia, fluid and electrolyte imbalances, and systemic sepsis. The first 24 hours after burn injury require aggressive medical management to assure survival and minimize complications. PMID:8489882

  5. 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.

  6. 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. PMID:24358241

  7. Outpatient burn management.

    PubMed

    Warner, Petra M; Coffee, Tammy L; Yowler, Charles J

    2014-08-01

    Most burn patients have injuries that may be treated on an outpatient basis. Newer silver-based dressings and improved medications for the treatment of pain and pruritus have led to further growth of outpatient care. The final barrier of distance from the burn center will decrease with the growth of telemedicine. It is incumbent for burn centers to develop outpatient guidelines to facilitate this growth of outpatient care. PMID:25085094

  8. [Chemotherapy for brain tumors in adult patients].

    PubMed

    Weller, M

    2008-02-01

    Chemotherapy has become a third major treatment option for patients with brain tumors, in addition to surgery and radiotherapy. The role of chemotherapy in the treatment of gliomas is no longer limited to recurrent disease. Temozolomide has become the standard of care in newly diagnosed glioblastoma. Several ongoing trials seek to define the role of chemotherapy in the primary care of other gliomas. Some of these studies are no longer only based on histological diagnoses, but take into consideration molecular markers such as MGMT promoter methylation and loss of genetic material on chromosomal arms 1p and 19q. Outside such clinical trials chemotherapy is used in addition to radiotherapy, e.g., in anaplastic astrocytoma, medulloblastoma or germ cell tumors, or as an alternative to radiotherapy, e.g., in anaplastic oligodendroglial tumors or low-grade gliomas. In contrast, there is no established role for chemotherapy in other tumors such as ependymomas, meningiomas or neurinomas. Primary cerebral lymphomas are probably the only brain tumors which can be cured by chemotherapy alone and only by chemotherapy. The chemotherapy of brain metastases follows the recommendations for the respective primary tumors. Further, strategies of combined radiochemotherapy using mainly temozolomide or topotecan are currently explored. Leptomeningeal metastases are treated by radiotherapy or systemic or intrathecal chemotherapy depending on their pattern of growth. PMID:18253773

  9. Pediatric scalp burns: hair today, gone tomorrow?

    PubMed

    Menon, Seema; Jacques, Madeleine; Harvey, John G; Holland, Andrew J A

    2015-01-01

    Scalp burns in the pediatric population appear relatively uncommon, with most reported cases occurring in adults secondary to electrical burns. We reviewed our experience with the management of these injuries in children. A retrospective review was conducted at our institution from March 2004 to July 2011. Scalp burns were defined as any burn crossing over the hairline into the scalp region. During the 7-year 4-month study, there were 107 scalp burns, representing 1.8% of the 6074 burns treated at our institution during that time. The cause was scald in 97, contact in 4, flame in 3, friction in 2, and chemical in 1. The majority (n = 93, 87%) appeared superficial to mid-dermal, with an average time to complete healing of 10.3 days. The remaining 14 cases (13%) were mid-dermal to full thickness, with an average time to complete healing of 50.8 days. Grafting was required in 12 cases (11%). The mean time to grafting was 4 weeks (range, 2 weeks to 2.5 months). The main complication of scalp burns was alopecia, which occurred in all grafted sites as well as in 4 patients treated conservatively. There were no other complications after grafting and no cases of graft loss. In our pediatric series, scalp burns were most commonly caused by scald injuries and were superficial to mid-dermal in depth. These generally healed rapidly but occasionally resulted in alopecia. The management of deep dermal and full-thickness scalp burns remains challenging in children, with the decision to graft often delayed. PMID:24823325

  10. Gunpowder-related burns.

    PubMed

    Navarro-Monzonis, A; Benito-Ruiz, J; Baena-Montilla, P; Mena-Yago, A; de la Cruz-Ferrer, L I

    1992-04-01

    Gunpowder misuse is a frequent cause of burn injury in our area. The injuries are mostly minor lesions which may be treated on an outpatient basis, the more serious injuries need surgical treatment. Experience of the management of these burns is reported by reviewing 123 clinical charts of patients admitted between 1983 and 1990. The most frequent victims are teenage males who are involved mainly in accidents in the street. The most serious burns followed work-related accidents, with a fatal outcome in 47 per cent of the patients. The serious burns are usually deep dermal or full skin thickness. A common pattern affects groins, genitalia, hypogastrium and hands, and are produced when fireworks ignite in the pockets of the patient's trousers. The management of these lesions does not differ from burns caused by other agents, although attention should be paid to the presence of associated lesions, chiefly to eyes, ears and hands, due to the shockwave and shrapnel. PMID:1590935

  11. ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient.

    PubMed

    McClave, Stephen A; DiBaise, John K; Mullin, Gerard E; Martindale, Robert G

    2016-03-01

    The value of nutrition therapy for the adult hospitalized patient is derived from the outcome benefits achieved by the delivery of early enteral feeding. Nutritional assessment should identify those patients at high nutritional risk, determined by both disease severity and nutritional status. For such patients if they are unable to maintain volitional intake, enteral access should be attained and enteral nutrition (EN) initiated within 24-48 h of admission. Orogastric or nasogastric feeding is most appropriate when starting EN, switching to post-pyloric or deep jejunal feeding only in those patients who are intolerant of gastric feeds or at high risk for aspiration. Percutaneous access should be used for those patients anticipated to require EN for >4 weeks. Patients receiving EN should be monitored for risk of aspiration, tolerance, and adequacy of feeding (determined by percent of goal calories and protein delivered). Intentional permissive underfeeding (and even trophic feeding) is appropriate temporarily for certain subsets of hospitalized patients. Although a standard polymeric formula should be used routinely in most patients, an immune-modulating formula (with arginine and fish oil) should be reserved for patients who have had major surgery in a surgical ICU setting. Adequacy of nutrition therapy is enhanced by establishing nurse-driven enteral feeding protocols, increasing delivery by volume-based or top-down feeding strategies, minimizing interruptions, and eliminating the practice of gastric residual volumes. Parenteral nutrition should be used in patients at high nutritional risk when EN is not feasible or after the first week of hospitalization if EN is not sufficient. Because of their knowledge base and skill set, the gastroenterologist endoscopist is an asset to the Nutrition Support Team and should participate in providing optimal nutrition therapy to the hospitalized adult patient. PMID:26952578

  12. 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

  13. 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. PMID:25681958

  14. 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. PMID:26336365

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

    PubMed Central

    Moufarrij, S.; Deghayli, L.; Raffoul, W.; Hirt-Burri, N.; Michetti, M.; de Buys Roessingh, A.; Norberg, M.; Applegate, L.A.

    2014-01-01

    Summary 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. PMID:26336365

  16. 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

  17. 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

  18. 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

  19. 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. PMID:27156788

  20. Osteosarcoma in Adult Patients Living with HIV/AIDS

    PubMed Central

    Marais, Leonard C.; Ferreira, Nando

    2013-01-01

    Background. HIV infection has reached epidemic proportions in South Africa, with an estimated prevalence of 21.5% in adults living in the province of KwaZulu-Natal. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Very few reports, however, exist regarding the occurrence of non-AIDS-defining sarcomas in the extremities or limb girdles. Methods. A retrospective review was performed on all adult patients, between the ages of 30 and 60 years, with histologically confirmed osteosarcomas of the appendicular skeleton referred to a tertiary-level orthopaedic oncology unit. Results. Five out of the nine patients (62.5%) included in the study were found to be HIV positive. The average CD4 count of these patients was 278 (237–301) cells/mm3, indicating advanced immunological compromise. Three of the malignancies in HIV-positive patients occurred in preexisting benign or low-grade tumours. Conclusion. A heightened index of suspicion is required in HIV patients presenting with unexplained bone and joint pain or swelling. Judicious use of appropriate radiological investigation, including magnetic resonance imaging of suspicious lesions and timely referral to an appropriate specialized orthopaedic oncology unit, is recommended. PMID:23762607

  1. Maggot therapy for repairing serious infective wound in a severely burned patient.

    PubMed

    Wu, Jun-Cheng; Lu, Ren-Rong; Huo, Ran; Fu, Hong-Bin

    2012-01-01

    The larvae of musca domestica were put in use to discard the dead tissue of a case of severe burn. A total of 50 000 aseptic maggots were put onto the infective wound surface, and aseptic dressings overlaid the surface. Three days later, another 20 000 maggots were put onto the wound for the second therapy. After twice maggot debridement, most necrotic muscle tissues of the wound were cleaned up, and eventually fresh granulation tissue grew and later the wound was covered and healed by 3 times of skin grafting. The result demonstrates that maggot therapy is safe and effective with no adverse complications except pain. PMID:22480679

  2. 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

  3. High Tidal Volume Decreases ARDS, Atelectasis, and Ventilator Days Compared to Low Tidal Volume in Pediatric Burned Patients with Inhalation Injury

    PubMed Central

    Sousse, Linda E; Herndon, David N; Andersen, Clark R; Ali, Arham; Benjamin, Nicole C; Granchi, Thomas; Suman, Oscar E; Mlcak, Ronald P

    2015-01-01

    Background Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of the present study is to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia and ARDS in pediatric burned patients with inhalation injury within one year post burn injury. Methods From 1986–2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n=932). Patients were divided into three groups: (1) unventilated (n=241), (2) high tidal volume (HTV, 15 ± 3 ml/kg, n=190), and (3) low tidal volume (LTV, 9 ± 3 ml/kg, n = 501). Results HTV was associated with significantly decreased ventilator days (p<0.005) and maximum positive end expiratory pressure (p<0.0001) and significantly increased maximum peak inspiratory pressure (p<0.02) and plateau pressure (p<0.02) compared to patients with LTV. The incidence of atelectasis (p<0.0001) and ARDS (p<0.02) was significantly decreased with HTV compared to LTV. However, the incidence of pneumothorax was significantly increased in the HTV group compared with LTV (p<0.03). Conclusions HTV significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared to low tidal volume in pediatric burned patients with inhalation injury. Thus, the use of HTV may interrupt sequences leading to lung injury in our patient population. PMID:25724604

  4. Experimental identification of potential falls in older adult hospital patients.

    PubMed

    Cloutier, Aimee; Yang, James; Pati, Debajyoti; Valipoor, Shabboo

    2016-05-01

    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. PMID:26920507

  5. 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. PMID:25306088

  6. Approach to the Patient: The Adult With Congenital Adrenal Hyperplasia

    PubMed Central

    Arlt, Wiebke

    2013-01-01

    The most common form of congenital adrenal hyperplasia is steroid 21-hydroxylase deficiency (21OHD). When the nonclassical (mild) form is included, 21OHD is the most common genetic disease in human beings. With the advent of pharmaceutical preparation of glucocorticoids starting in the 1960s and newborn screening starting in the 1990s, the majority of children with 21OHD are reaching adulthood, which has yielded a cohort of patients with, in essence, a new disease. Only recently have some data emerged from cohorts of adults with 21OHD, and in some centers, experience with the management of these patients is growing. These patients suffer from poor health, infertility, characteristic tumors in the adrenal glands and gonads, and consequences of chronic glucocorticoid therapy. Their care is fragmented and inconsistent, and many stop taking their medications out of frustration. Internal medicine residents and endocrinology fellows receive little training in their care, which further discourages their seeking medical attention. Adults with 21OHD have a different physiology from patients with Addison's disease or other androgen excess states, and their needs are different than those of young children with 21OHD. Consequently, their care requires unorthodox treatment and monitoring strategies foreign to most endocrine practitioners. Our goal for this article is to review their physiology, complications, and needs in order to develop rational and effective treatment and monitoring strategies. PMID:23837188

  7. Clinical features in adult patient with Wolf-Hirschhorn syndrome.

    PubMed

    Martínez-Quintana, E; Rodríguez-González, F

    2014-06-01

    The Wolf-Hirschhorn syndrome (WHS) encompasses deletions at the distal part of the short arm of one chromosome 4 (4p16 region). Clinical signs frequently include a typical facial appearance, mental retardation, intrauterine and postnatal growth retardation, hypotonia with decreased muscle bulk and seizures besides congenital heart malformations, midline defects, urinary tract malformations and brain, hearing and ophthalmologic malformations. Pathogenesis of WHS is multigenic and many factors are involved in prediction of prognosis such as extent of deletion, the occurrence of severe chromosome anomalies, the severe of seizures, the existence of serious internal, mainly cardiac, abnormalities and the degree of mental retardation. The phenotype of adult with WHS is in general similar to that of childhood being facial dysmorphism, growth retardation and mental retardation the rule in both adults and children. Avoid long-term complications and provide rehabilitation programs and genetic counseling may be essential in these patients. PMID:24656633

  8. Clostridium difficile infections among Jordanian adult hospitalized patients.

    PubMed

    Nasereddin, Lina M; Bakri, Fares G; Shehabi, Asem A

    2009-12-01

    This prospective study investigated the important epidemiologic aspects of Clostridium difficile infections (CDIs) among Jordanian adult hospitalized patients. A total of 300 stool specimens were investigated using culture and polymerase chain reaction methods for detection of C difficile, its toxins, and fluoroquinolone resistance. C difficile-positive cultures were found in 13.7% of the patients, and 73% of the isolates carried tcdA and/or tcdB toxin genes, and all C difficile isolates were negative for binary toxin. The isolates showed moderate level of resistance to both ciprofloxacin and levofloxacin, whereas metronidazole and vancomycin were highly susceptible. This study indicates the need for early detection of CDIs and prevention of its severe disease in hospitalized patients. PMID:19712999

  9. Urinary considerations for adult patients with spinal dysraphism.

    PubMed

    Veenboer, Paul W; de Kort, Laetitia M O; Chrzan, Rafal J; de Jong, Tom P V M

    2015-06-01

    The incidence of newborns with spinal dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with spinal dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of spinal dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future developments. PMID:25963964

  10. Amelogenesis imperfecta - lifelong management. Restorative management of the adult patient.

    PubMed

    Patel, M; McDonnell, S T; Iram, S; Chan, M F W-Y

    2013-11-01

    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. PMID:24201615

  11. Asthma Economic Costs in Adult Asthmatic Patients in Tehran, Iran

    PubMed Central

    SHARIFI, Laleh; POURPAK, Zahra; FAZLOLLAHI, Mohammad Reza; BOKAIE, Saied; MOEZZI, Hamid Reza; KAZEMNEJAD, Anoushirvan; MOIN, Mostafa

    2015-01-01

    Background: High prevalence and increasing rate of asthmatic patients around the word witnesses the high burden of asthma. We have limited data on asthma burden and economic costs in Iran. This study aimed to find direct and indirect economic costs of asthma and their association with some background factors in one of the referral tertiary centers for adult patients with asthma. Methods: We surveyed asthma related economic costs of 197 adult patients who referred to Milad Hospital, Tehran, Iran from Jun 2007 to January 2010. The patients were followed up for a period of one-year ±1 month and asthma related costs and its control status were registered. Results: Patients were consisted of 125 (64.1%) females and 70 (35.9%) males. Total cost of asthma was 590.22 ±32.18 USD for one patient per one year, the cost of drug, paraclinic, doctor visit, hospitalization, emergency, transportation, and absent days were 327.02, 4.76, 35.44, 3.82, 0.26, 113.03, 105.89 USD respectively. Men showed a significant elevation in their total (P=0.009) and drug costs (P=0.028). In addition, we found significant differences between total asthma costs and asthma control status (P=0.002). Conclusions: According to the high proportion of asthma, related cost compare to Total Income of an Iranian family, the necessity of public coverage of health assurance is quite clear. We suggest that improving asthma management and accessibility to specialized treatment centers can result in decreasing asthma medication and transportation costs as major direct and indirect asthma related costs. PMID:26587495

  12. 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

  13. 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. PMID:26962284

  14. Burning Mouth Syndrome

    PubMed Central

    Kamala, KA; Sankethguddad, S; Sujith, SG; 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. PMID:26962284

  15. Embryonal Sarcoma of the Liver in an Adult Patient

    PubMed Central

    Lightfoot, Nicole; Nikfarjam, Mehrdad

    2012-01-01

    Undifferentiated embryonal sarcomas (UESs) are uncommon tumours that are seen predominantly in late childhood. Cases in adults are rare and generally present once a large mass develops and may be mistaken for other tumours. A case of an UES of the liver with an isolated peritoneal metastasis is described. The patient presented with a palpable mass with imaging findings suggestive of a cystic tumour. She had complete surgical resection of the liver mass and isolated peritoneal metastasis. She was tumour-free on imaging at 6 months without adjuvant chemotherapy. An UES should be considered in the differential of large cystic hepatic lesions, with aggressive surgical resection considered when possible. PMID:22690347

  16. Midface fracture in an unoperated adult patient with cleft palate

    PubMed Central

    Pathak, Sanyog; Baliga, Shridhar; Kotrashetti, Sharadaindu Mahadevappa; Pillai, Ajay

    2014-01-01

    In western countries, it is hard to find an unoperated cleft palate due to better healthcare services and awareness. Here, we present an unoperated adult case of cleft palate that had midfacial fractures following a road traffic accident. The patient's cleft lip was repaired when he was 2 years old but the palate was not operated because of poor follow-up. We would like to share the difficulties encountered in diagnosis and treatment planning for this rare kind of trauma case. After routine investigations, a palatal acrylic splint was constructed for fixation and an acceptable degree of function and aesthetics was achieved postoperatively. PMID:25150231

  17. 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

  18. Management of the Acute Partial-thickness Burned Hand; Moist Exposed Burn Ointment or Silver Sulphadiazine Cream both Combined with a Polyethylene Bag

    PubMed Central

    Allam, A.M.; Mostafa, W.; Zayed, E.; El-Gamaly, J.

    2007-01-01

    Summary Hand burns predominantly affect young adults, and therefore have serious social and financial implications. In the present work, 106 patients with less than 25% body surface area burns and acute partial-thickness burned hands were managed using polyethylene bags and 1% local silver sulphadiazine (SSD) cream or moist exposed burn ointment (MEBO). Females made up 61.3% of the cases and flame burn was the majority cause (54.7%). There were no significant differences between the two groups regarding either the analgesic effect after local ointment application or hand movement inside the polyethylene bag. Local agent crustation over the wound was very evident in the hands managed by local 1% SSD cream (69.81%). On follow-up, the burned hands healed faster using local MEBO (10.48 versus 14.53 days), with fewer post-burn hand deformities and better active hand movements; however, the total cost until complete hand burn wound healing was higher with MEBO than with 1% SSD, although the final results were superior, with early return to work, when MEBO was used. We concluded that the use of MEBO as a topical agent and of polyethylene bags for the dressing of the acute partial-thickness burned hand accelerated healing; daily wound evaluation was easy as there was no crustation over it of the agent. It was more expensive than 1% SSD cream but presented fewer post-burn complications and more rapid healing, with shorter hospital stay. PMID:21991086

  19. 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

  20. HEPBURN - investigating the efficacy and safety of nebulized heparin versus placebo in burn patients with inhalation trauma: study protocol for a multi-center randomized controlled trial

    PubMed Central

    2014-01-01

    Background Pulmonary coagulopathy is a hallmark of lung injury following inhalation trauma. Locally applied heparin attenuates lung injury in animal models of smoke inhalation. Whether local treatment with heparin benefits patients with inhalation trauma is uncertain. The present trial aims at comparing a strategy using frequent nebulizations of heparin with standard care in intubated and ventilated burn patients with bronchoscopically confirmed inhalation trauma. Methods The Randomized Controlled Trial Investigating the Efficacy and Safety of Nebulized HEParin versus Placebo in BURN Patients with Inhalation Trauma (HEPBURN) is an international multi-center, double-blind, placebo-controlled, two-arm study. One hundred and sixteen intubated and ventilated burn patients with confirmed inhalation trauma are randomized to nebulizations of heparin (the nebulized heparin strategy) or nebulizations of normal saline (the control strategy) every four hours for 14 days or until extubation, whichever comes first. The primary endpoint is the number of ventilator-free days, defined as days alive and breathing without assistance during the first 28 days, if the period of unassisted breathing lasts for at least 24 consecutive hours. Discussion As far as the authors know, HEPBURN is the first randomized, placebo-controlled trial, powered to investigate whether local treatment with heparin shortens duration of ventilation of intubated and ventilated burn patients with inhalation trauma. Trial registration NCT01773083 (http://www.clinicaltrials.gov), registered on 16 January 2013. Recruiting. Randomisation commenced on 1 January 2014. PMID:24661817

  1. Psychopharmacological options for adult patients with anorexia nervosa.

    PubMed

    Miniati, Mario; Mauri, Mauro; Ciberti, Agnese; Mariani, Michela Giorgi; Marazziti, Donatella; Dell'Osso, Liliana

    2016-04-01

    The aim of this review was to summarize evidence from research on psychopharmacological options for adult patients with anorexia nervosa (AN). Database searches of MEDLINE and PsycINFO (from January 1966 to January 2014) were performed, and original articles published as full papers, brief reports, case reports, or case series were included. Forty-one papers were screened in detail, and salient characteristics of pharmacological options for AN were summarized for drug classes. The body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, the quality of observations was questionable (eg, the majority were not blinded), and sample size was often small. More trials are needed, while considering that nonresponse and nonremission are typical of patients with AN. PMID:26145463

  2. [Salmonella enteritidis: an unusual meningitis agent in an adult patient].

    PubMed

    Metan, Gökhan; Alp, Emine; Eşel, Duygu; Aygen, Bilgehan; Sümerkan, Bülent

    2005-10-01

    Salmonella species may cause wide spectrum of infections changing from enterocolitis to sepsis. However, Salmonella meningitis in adults is a rare but important clinical condition with a high mortality rate. In this report, a 71 years old male patient with Salmonella enteritidis meningitis who was followed-up with the diagnosis of immune thrombocytopenic purpura and had been administered azothioprin and prednisolone, has been presented and similar cases in the literature have been reviewed. The cerebrospinal fluid culture yielded S. enteritidis, and the isolate was intermediate susceptible to ampicillin, susceptible to cefotaxime, trimethoprim-sulphametoxasole, ciprofloxacin and chloramphenicol. Our patient was successfully treated with ceftriaxone (2 x 2 gr i.v.) and discharged with total cure. PMID:16544553

  3. [Humoral nonspecific immunity in patients with post-burn cicatrical strictures of the esophagus].

    PubMed

    Mumladze, R B; Babaian, S S; Bobkov, Iu I; Chernyshev, V S; Taratuta, O V

    1983-03-01

    The authors have studied the significance of factors of the humoral non-specific defense (HND) in 37 patients with cicatricial constrictions of the oesophagus and stomach. The data obtained were used for choosing the optimum terms for gastrostoma and oesophagoplasty. In 14 patients treatment with lysozyme was performed due to decreased indices of HND. PMID:6857955

  4. 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.

  5. Intravenous fish oil in adult intensive care unit patients.

    PubMed

    Heller, Axel R

    2015-01-01

    Omega-3 fatty acids contained in fish oils have shown efficacy in the treatment of chronic and acute inflammatory diseases due to their pleiotropic effects on inflammatory cell signalling pathways. In a variety of experimental and clinical studies, omega-3 fatty acids attenuated hyperinflammatory conditions and induced faster recovery. This chapter will shed light on the effects of intravenous fish oil in adult intensive care unit (ICU) patients and will discuss clinical data and recent meta-analyses on the topic. While significant beneficial effects on infection rates and the lengths of ICU and hospital stays have concordantly been identified in three recent meta-analyses on non-ICU surgical patients, the level of evidence is not so clear for critically ill patients. Three meta-analyses published in 2012 or 2013 explored data on the ICU population. Although the present data suggest the consideration of enteral nutrition enriched with fish oil, borage oil and antioxidants in mild to severe acute respiratory distress syndrome, only one of the three meta-analyses found a trend (p = 0.08) of lower mortality in ICU patients receiving intravenous omega-3 fatty acids. Two of the meta-analyses indicated a significantly shorter hospital stay (5.17-9.49 days), and one meta-analysis found a significant reduction in ICU days (1.92). As a result of these effects, cost savings were postulated. Unlike in surgical patients, the effects of fish oil on infection rates were not found to be statistically significant in ICU patients, and dose-effect relationships were not established for any cohort. Thus, obvious positive secondary outcome effects with intravenous fish oil have not yet been shown to transfer to lower mortality in critically ill patients. There is a need for adequately powered, well-planned and well-conducted randomized trials to give clear recommendations on the individual utility and dosage of intravenous omega-3 fatty acids in critical illness. PMID:25471809

  6. 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

  7. Neostigmine to Relieve a Suspected Colonic Pseudo-Obstruction in a Burn Patient: A Case-Based Review of the Literature

    PubMed Central

    Gebre-Giorgis, Abel A.; Roderique, Ensign Joseph D.; Stewart, Dane; Feldman, Michael J.; Pozez, Andrea L.

    2013-01-01

    Objective: Neostigmine is one of the treatment options for colonic pseudo-obstruction in the medical patient. However, experience in using neostigmine for this indication in burn patients has not been reported in the literature. We will present a case of a woman who developed colonic pseudo-obstruction during her hospital stay. When conservative management failed, neostigmine was administered with no adverse effects and resolution of the pseudo-obstruction. We will review the literature regarding the pathophysiology and treatment options for acute colonic pseudo-obstruction in burn patients. Methods: A 27-year-old woman with 35% total body surface area deep-partial and full-thickness flame burns. On hospital day 17, she developed a nonobstructive ileus. She failed conservative medical therapy. After consultation with colleagues in trauma surgery and a review of the literature (MeSH/PubMed/NLM), the decision was made to try neostigmine therapy rather than a surgical/procedural option such as colonoscopy. Results: The patient was moved to the intensive care unit and 2 mg of neostigmine was administered intravenously over 4 minutes. After 30 minutes, all abdominal examination findings had returned to baseline. No significant adverse effects were noted, and she did not redevelop abdominal distension afterward. Conclusion: This case report provides an alternative treatment modality in which neostigmine was used successfully in a burn patient after conservative medical treatment had failed. The authors believe that neostigmine may be a viable alternative to decompressive colonoscopy in burn patients for whom mechanical obstruction is properly excluded. PMID:23359843

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

    PubMed

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

    2016-01-01

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

  9. Prosthodontic treatment of the edentulous adult cleft palate patient.

    PubMed

    Sykes, Leanne M

    2003-03-01

    Clefts of the upper lip and plate are relatively common, yet dental treatment of these patients is still very poor and many grow up suffering dental neglect. Dental practitioners should become involved in the treatment team as dental needs are present from birth to death. Adult cleft patients often need tooth replacement with obturation of any residual clefts. They are best treated with tooth-supported removable appliances including partial and complete overdentures, thus preservation of their natural dentition is desirable. Edentulous cleft palate patients present with restorative difficulties due to their compromised maxillary arches as well as the presence of scar tissue in their palates and lips. An outline of these complications and guidelines for their treatment is illustrated in the form of three case reports from members of one family all presenting with varying cleft lip and palate defects. This article highlights the need for dental students to be exposed to dentally compromised patients so that they will feel confident enough to treat them in private practice. PMID:12800267

  10. 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

  11. Burn injuries resulting from hot water bottle use: a retrospective review of cases presenting to a regional burns unit in the United kingdom.

    PubMed

    Jabir, Shehab; Frew, Quentin; El-Muttardi, Naguib; Dziewulski, Peter

    2013-01-01

    Introduction. Hot water bottles are commonly used to relieve pain and for warmth during the colder months of the year. However, they pose a risk of serious burn injuries. The aim of this study is to retrospectively review all burn injuries caused by hot water bottles presenting to our regional burns unit. Methods. Patients with burns injuries resulting from hot water bottle use were identified from our burns database between the periods of January 2004 and March 2013 and their cases notes reviewed retrospectively. Results. Identified cases involved 39 children (aged 17 years or younger) and 46 adults (aged 18 years or older). The majority of burns were scald injuries. The mean %TBSA was 3.07% (SD ± 3.40). Seven patients (8.24%) required debridement and skin grafting while 3 (3.60%) required debridement and application of Biobrane. One patient (1.18%) required local flap reconstruction. Spontaneous rupture accounted for 48.20% of injuries while accidental spilling and contact accounted for 33% and 18.80% of injuries, respectively. The mean time to heal was 28.87 days (SD ± 21.60). Conclusions. This study highlights the typical distribution of hot water bottle burns and the high rate of spontaneous rupture of hot water bottles, which have the potential for significant burn injuries. PMID:24455234

  12. Burn Injuries Resulting from Hot Water Bottle Use: A Retrospective Review of Cases Presenting to a Regional Burns Unit in the United Kingdom

    PubMed Central

    Frew, Quentin; El-Muttardi, Naguib; Dziewulski, Peter

    2013-01-01

    Introduction. Hot water bottles are commonly used to relieve pain and for warmth during the colder months of the year. However, they pose a risk of serious burn injuries. The aim of this study is to retrospectively review all burn injuries caused by hot water bottles presenting to our regional burns unit. Methods. Patients with burns injuries resulting from hot water bottle use were identified from our burns database between the periods of January 2004 and March 2013 and their cases notes reviewed retrospectively. Results. Identified cases involved 39 children (aged 17 years or younger) and 46 adults (aged 18 years or older). The majority of burns were scald injuries. The mean %TBSA was 3.07% (SD ± 3.40). Seven patients (8.24%) required debridement and skin grafting while 3 (3.60%) required debridement and application of Biobrane. One patient (1.18%) required local flap reconstruction. Spontaneous rupture accounted for 48.20% of injuries while accidental spilling and contact accounted for 33% and 18.80% of injuries, respectively. The mean time to heal was 28.87 days (SD ± 21.60). Conclusions. This study highlights the typical distribution of hot water bottle burns and the high rate of spontaneous rupture of hot water bottles, which have the potential for significant burn injuries. PMID:24455234

  13. 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

  14. Beneficial effects of silver foam dressing on healing of wounds with ulcers and infection control of burn patients

    PubMed Central

    Yang, Bo; Wang, Xudong; Li, Zhonghua; Qu, Qi; Qiu, Yan

    2015-01-01

    Objective: To assess the beneficial effects of silver foam dressing on the healing of wounds with ulcers and infection control of burn patients. Methods: Eighty-four second-degree burn patients were selected and divided into a study group and a control group (n=42). After disinfection and cleaning, wound beds of the study group were covered with silver-containing soft-silicone foam dressing, and wound surfaces of the control group were wiped with 1% silver sulfadiazine cream (60 g/100 cm2). The two groups were checked weekly to observe wound healing progress and adverse reactions of the skin around wounds. Wound secretions were collected and subjected to bacterial culture. Related indices were recorded and quantified. Results: Thirty seven cases of the study group (88.1%) and 36 cases of the control group (85.7%) recovered to normal, and 3 (7.1%) and 2 cases (4.8%) in the two groups failed to recover. The recovery rates of the two groups were similar (P>0.05), but unrecovered patients in the study group had significantly higher proportions of repaired wounds (P<0.05). Wounds of the study group were healed significantly more rapidly than those of the control group (22.3±3.1 vs. 25.1±4.4, P<0.05). The study group had significantly higher proportions of repaired wounds from Day 7 to Day 21 (P<0.05), but the difference became less obvious with extended time to Day 28. The bacterial culture-positive (exceeding 105 organisms per gram of tissue) rates of both groups significantly reduced after treatment (Day 7 for the study group and Day 14 for the control group), and the rate of the study group was significantly lower at last (P<0.05). The study and control groups were observed 134 and 149 person-times respectively, with the normal wound-surrounding skin rates of 96.3% (129/134) and 88.6% (132/149) (P>0.05 except for on Day 14). Except for on Day 28, the study group had significantly lower pain scores than those of the control group (P<0.05), especially on Day 7 and

  15. 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

  16. Attachment and Parenting in Adult Patients with Anxiety Disorders

    PubMed Central

    Picardi, Angelo; Caroppo, Emanuele; Fabi, Elisa; Proietti, Serena; Gennaro, Giancarlo Di; Meldolesi, Giulio Nicolò; Martinotti, Giovanni

    2013-01-01

    Background: The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxiety disorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill. Methods: A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxiety disorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI). Results: The patients with anxiety disorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxiety disorder, panic disorder, other anxiety disorders). Patients with anxiety disorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI father's care than patients with drug-resistant epilepsy. Conclusions: Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlby's seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxiety disorders and for planning therapeutic interventions. PMID:24155770

  17. Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes.

    PubMed

    Thompson, Katherine; Shi, Sandra; Kiraly, Carmela

    2016-06-01

    Older adults are the fastest growing segment of the US population and the majority of older adults are women. Primary care for the older adult patient requires a wide variety of skills, reflecting the complexity and heterogeneity of this patient population. Individualizing care through consideration of patients' goals, medical conditions, and prognosis is paramount. Quality care for the older adult patient requires familiarity with common geriatric syndromes, such as dementia, falls, and polypharmacy. In addition, developing the knowledge and communication skills necessary for complex care and end-of-life care planning is essential. PMID:27212097

  18. [Comparison of serum trace element spectrum of liver cancer patients and healthy adults].

    PubMed

    Yin, D Z

    1990-05-01

    The contents of 15 trace elements in the sera of 30 liver cancer patients and 30 healthy adults were assayed by ICP-AES method. The data obtained were analysed by routine statistical tests, multi-variate discrimination analysis, multi-variate stepwise regression analysis and non-linear mapping algorithm. The results showed that the contents of copper, vanadium, cadmium, stannum, cobalt, nickel in liver cancer patients were significantly higher than those in healthy adults. The serum trace element spectrum of liver cancer patients was different from that of healthy adults. Hence, the liver cancer patients could be differentiated from healthy adults by serum trace element spectrum. PMID:2249593

  19. 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

  20. Research proposal: evaluation of ART in adult patients.

    PubMed

    Zanata, Régia Luzia

    2006-01-01

    The primary objective of the Atraumatic Restorative Treatment (ART) is to reduce the indication of tooth extraction by means of a low-cost technique. Considering the difficulties of Brazilian public services to meet the demand of care of the low-income population, with lack of care to the adult population, which usually receives only emergency care, the aim of this study is to assess the performance of high-viscosity glass ionomer cements accomplished by the modified atraumatic restorative treatment in one- and multiple-surface cavities, compared to the conventional restorative approach. It will be analyzed the clinical performance of the materials; cost (material and human resources); patient satisfaction with the treatment received; and preventive effect of treatment. PMID:19089083

  1. Adult patients with Fontan circulation: What we know and how to manage adults with Fontan circulation?

    PubMed

    Ohuchi, Hideo

    2016-09-01

    Most of patients after the Fontan operation can reach their adulthood, however, the management strategy for this complex pathophysiology has not been yet established. In general, elevated central venous pressure (CVP) and low cardiac output (CO) due to impaired ventricular preload characterize the Fontan circulation and the ideal hemodynamics could be a combination of a lower CVP with a higher CO. Thus, preserved functional systemic ventricle with low pulmonary artery resistance is thought to be crucial for better long-term outcome. However, on the other hand, because of the unique hemodynamics, these patients have significantly higher incidence of complications, sequelae, and even mortality. The major complications are supraventricular arrhythmias, heart failure, and Fontan-related problems, including protein-losing enteropathy and pulmonary arteriovenous fistulae, both of which are refractory to the treatments, and most of these "Fontan inconveniences" increase as patients age. In addition, one of the recent emerging problems is Fontan-associated liver disease that includes liver cirrhosis and hepatocellular carcinoma. Furthermore, women with Fontan circulation also reach childbearing age and there have been increasing numbers of reports showing a high incidence of pregnancy-associated complications. All these problems may be a part of "Fontan inconveniences" because most of the current Fontan patients are still "young" i.e. in their twenties or thirties and it may be not surprising that more new Fontan-associated pathophysiology emerges as patients age. Recent evidence reminds us of the concept that adult Fontan pathophysiology is not just a cardiovascular disease, rather, a multiorgan disease with many interactions between cardiovascular and non-cardiovascular organs. Therefore, a multidisciplinary approach is mandatory to take care of and anticipate the better long-term outcome. PMID:27134136

  2. 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. PMID:27352341

  3. Potential Harm of Prophylactic Platelet Transfusion in Adult Dengue Patients

    PubMed Central

    Lee, Tau-Hong; Wong, Joshua G. X.; Leo, Yee-Sin; Thein, Tun-Linn; Ng, Ee-Ling; Lee, Linda K.; Lye, David C.

    2016-01-01

    Background Thrombocytopenia is a hallmark of dengue infection, and bleeding is a dreaded complication of dengue fever. Prophylactic platelet transfusion has been used to prevent bleeding in the management of dengue fever, although the evidence for its benefit is lacking. In adult dengue patients with platelet count <20,000/mm3 without bleeding, we aimed to assess if prophylactic platelet transfusion was effective in reducing clinical bleeding and other outcomes. Method We conducted a retrospective non-randomised observational study of dengue patients with platelet count < 20,000/mm3 without bleeding (except petechiae) admitted to Tan Tock Seng Hospital from January 2005 to December 2008. Baseline characteristics and clinical outcomes were compared between the non-transfused vs. transfused groups. Outcomes studied were clinical bleeding, platelet increment, hospital length of stay, intensive care unit admission and death. Results Of the 788 patients included, 486 received prophylactic platelet transfusion. There was no significant difference in the presence of clinical bleeding in the two groups (18.2% in non-transfused group vs. 23.5% in transfused group; P = 0.08). Patients in the transfused group took a median of 1 day longer than the non-transfused group to increase their platelet count to 50,000/mm3 or more (3 days vs. 2 days, P <0.0001). The median duration of hospital stay in the non-transfused group was 5 days vs. 6 days in the transfused group (P< 0.0001). There was no significant difference in the proportion requiring ICU admission (non-transfused 0.66% vs. transfused 1.23%, P = 0.44) and death (non-transfused 0% vs. transfused 0.2%, P = 0.43). Conclusion Platelet transfusion in absence of bleeding in adult dengue with platelet count <20,000/mm3 did not reduce bleeding or expedite platelet recovery. There was potential harm by slowing recovery of platelet count to >50,000/mm3 and increasing length of hospitalization. PMID:27015272

  4. 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

  5. [Infection in burn patients: the problems of pathogenesis, prevention and treatment].

    PubMed

    Alekseev, A A; Iakovlev, V P; Fedorov, V D

    1999-01-01

    Urgent issues of pathogenesis, prophylaxis and treatment of infection in patients with thermal injuries are considered. Analysis of the results of multifactorial dynamic examinations of immunological reactivity and nonspecific resistance of 198 burnet patients is presented. For the first time a substantial decrease of B-lymphocytes count in normal or elevated level of immunoglobulins of the main classes is shown as well as a decrease in plasma fibronectin content. Lowering of T-lymphocytes content and polymorphonuclear leucocytes function disturbances, dominant role of St. aureus and P. aeruginosa in etiology of infections in burnt patients and high antibiotic resistance of these microorganisms are demonstrated. Pathogenetic substantiation of combined therapeutic usage of thymus and interferon preparations and when indicated--immunoglobulines is recorded. Positive experience in application of recombinant interleukine-2 (Ronkoleukine) is outlined. The data are provided on advisability of application of new cephalosporines and fluorine-quinolones for antibiotic therapy and prophylaxis in the burnet. In complicated forms of gram-negative infections the combination of aminoglycosides with ureidopenicillines or cyprofloxacine is recommended, in infections provoked by polyresistant strains of S. aureus vancomycin is indicated. With prophylactic aim in case of early surgical treatment it is recommended to apply modern antibacterial preparations with broad spectrum of action. Prophylaxis of hospital infections inpatients of specialised clinics for the burnt is discussed. PMID:10410507

  6. Review of Burn Research for Year 2014.

    PubMed

    Sen, Soman; Palmieri, Tina; Greenhalgh, David

    2015-01-01

    Management of burn injuries requires treatments and interventions from many disciplines. Worldwide, burn patients suffer from physical and psychological challenges that impact their lives socially and economically. In this review, we will highlight a handful of the numerous articles published in multiple areas of burn care. The areas of burn care addressed in the article are: epidemiology; burn resuscitation, critical care, and infection; nutrition and metabolism; pain and rehabilitation; prevention and firefighter safety; psychology; and reconstruction and wounds. PMID:26204384

  7. A protocol of early aggressive acceleration of tube feeding increases ileus without perceptible benefit in severely burned patients.

    PubMed

    Kesey, Jennifer; Dissanaike, Sharmila

    2013-01-01

    Optimal nutrition is essential to the recovery of burned patients. The authors evaluated the efficacy of an aggressive nutrition delivery protocol. The following protocol was implemented: initiation of tube feeds within 4 hours, acceleration to goal rate within 8 hours, and tolerance of gastric residual volumes of 400 ml. Patients on the protocol formed the study group whereas patients admitted immediately before implementation served as controls for a study period of 7 days after admission. Outcome variables included ileus, prokinetic medication use, intensive care unit and overall length of stay, ventilator days and mortality. Variables were compared using bivariate analysis. The 42 study subjects and 34 controls were similar at baseline. Time to initiation was similar (6.8 vs 9.4 hours; P = .226), however, goal rate was achieved much sooner in the study group (11.2 vs 20.9 hours; P < .001). Number of hours spent at goal was different on days 1 and 2 (6.62 vs 2.74, P = .003 and 17.24 vs 13.18, P = .032) with no difference thereafter. Residual volumes in the study group were higher from day 2 onward, and remained increased throughout the study period (401 vs 234 ml average; P = .449). Clinical ileus was much more common in the study group (8 cases vs 1, P = .037). There was no difference in length of stay or mortality. The protocol was successfully implemented and resulted in early achievement of goal tube feed rates. However, this resulted in tube feed intolerance as manifested by more cases of clinical ileus. PMID:23966117

  8. Escharotomies, fasciotomies and carpal tunnel release in burn patients--review of the literature and presentation of an algorithm for surgical decision making.

    PubMed

    Piccolo, N S; Piccolo, M S; Piccolo, P D P; Piccolo-Daher, R; Piccolo, N D P; Piccolo, M T S

    2007-06-01

    Escharotomies are usually performed in patients with circumferential third degree burns of the extremities or anterior trunk. Fasciotomies are recommended for patients who sustained high voltage (or associated crush) injuries, with entrance or exit wounds in one or more extremities. Carpal tunnel release is practiced routinely in some services for cases of electrical injury. We have reviewed the literature which provides relatively little information as to when should these procedures actually be performed and what would happen if they were not done. We present a series of patients treated at our institution when an algorithm was used for surgical decision making as to when (or not) to operate (perform an escharotomy, a fasciotomy or a carpal tunnel release), based on clinical signs and monitoring alternatives, using the oximeter and the Doppler flowmeter. 13 938 burn patients were treated at our institution during the year of 2005. Of these, 571, with an average of 22.3 % TBSA, were treated as inpatients. Of these, 58 (10.3 %) had circumferential or electrical burns of one or more extremities. Patients were monitored hourly from admission and decision to operate was based on clinical signs and in absent or below 90 % oximetry, regardless of Doppler flow signs. 68 % were males, 6 (11.3 %) patients had immediate escharotomies, while 4 (7.5 %) had immediate fasciotomies. 2 of these patients were operated regardless of positive Doppler sign but no oximetry. All patients recovered oximetry over 90 % immediately after the operations. 3 patients had negative Doppler sign but oximetry > 90 % and were not operated. 3 patients had carpal tunnel releases based on oximetry < 90 % and symptoms of compression of the median nerve. Patients who were not operated fared well with no signs or symptoms of impairment of circulation or nerve damage up to their 3 and 6 months reevaluations. PMID:17602377

  9. 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. PMID:26166242

  10. Metabolic aspects of adult patients with nonalcoholic fatty liver disease.

    PubMed

    Abenavoli, Ludovico; Milic, Natasa; Di Renzo, Laura; Preveden, Tomislav; Medić-Stojanoska, Milica; De Lorenzo, Antonino

    2016-08-21

    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

  11. 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

  12. Genetic risk factors of cisplatin induced ototoxicity in adult patients.

    PubMed

    Talach, T; Rottenberg, J; Gal, B; Kostrica, R; Jurajda, M; Kocak, I; Lakomy, R; Vogazianos, E

    2016-01-01

    Ototoxicity is an important adverse effect of using Cisplatin (cis-diamminedichloroplatinum) (CDDP) as a form of chemotherapy. The clinical picture of CDDP induced ototoxicity includes perceptive hearing impairment (reversible or permanent) and tinnitus. Ototoxicity manifests with considerable variability between patients. The objective of this prospective study was to investigate a possible genetic background to this variability. We assessed ototoxicity induced by therapeutic doses of CDDP in adult patients with germinative testicular tumors, or other tumors treated with an identical CDDP dosage scheme. Audiological examination before, during and after the treatment has shown deterioration in hearing; first in the high-frequencies and with increased CDDP cumulative doses, impairment in other frequencies as well. Occurrence of tinnitus was not dependent on the administered dose of CDDP, or the other risk factors examined in this study. The association of CDDP induced ototoxicity with genetic polymorphisms in candidate genes was examined. Our study has demonstrated an association of early onset of CDDP induced ototoxicity with the presence of two copies of GSTT1 gene (p=0,009) and with T allele of rs9332377 polymorphism in COMT gene (p=0,001). PMID:26774148

  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. PMID:27480635

  14. Using Adult Learning Concepts To Assist Patients in Completing Advance Directives.

    ERIC Educational Resources Information Center

    Meyer, Rose Mary

    2000-01-01

    Advance directives that enable individuals to control their health care are underused due to lack of patient knowledge. Nurses can teach patients about them using adult learning principles, transformation theory, and skills for learning how to learn. (SK)

  15. Impact of Oxandrolone Treatment on Acute Outcomes After Severe Burn Injury

    PubMed Central

    Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Silver, Geoffrey M.; Jeschke, Marc G.; Finnerty, Celeste C.; Tompkins, Ronald G.; Herndon, David N.

    2013-01-01

    Pharmacologic modulation of hypermetabolism clearly benefits children with major burns, however, its role in adult burns remains to be defined. Oxandrolone appears to be a promising anabolic agent although few outcome data are as yet available. We examined whether early oxandrolone treatment in severely burned adults was associated with improved outcomes during acute hospitalization. We evaluated for potential associations between oxandrolone treatment and outcomes in a large cohort of severely burned adults in the context of a multicenter observational study. Patients were dichotomized with respect to oxandrolone treatment, defined as administration within 7 days after admission, with duration of at least 7 days. Acute hospitalization outcomes were compared with univariate and multivariate analyses. One hundred seventeen patients were included in this analysis. Mean patient age was 42.6 years (range, 18–86); 77% were male, with an average TBSA of 44.1%. Baseline and injury characteristics were similar among treatment and nontreatment cohorts. Oxandrolone treatment (N =59) did not impact length of stay but was associated with a lower mortality rate (P = .01) by univariate analysis. Oxandrolone treatment was independently associated with higher survival by adjusted analyses (P = .02). Examination of early oxandrolone treatment in this cohort of severely burned adults suggests that this therapy is safe and may be associated with improved survival. Further studies are necessary to define the exact mechanisms by which oxandrolone is beneficial during inpatient treatment. PMID:18849836

  16. Burn injury in children.

    PubMed

    Zámecníková, I; Stĕtinský, J; Tymonová, J; Kadlcík, M

    2005-01-01

    The authors have analyzed the data files of 580 child patients up to 15 years of age who were hospitalized at the Burn Center of the FNsP Hospital in Ostrava in the years 1999 - 2003. The authors focused on mechanisms of burn injury in relation to the age of a child as well as extent, depth, localization, and local treatment of the injury. The data file was divided to four age groups: up to two years of age, 2 - 5 years of age, 5 - 10 years of age, and 10 - 15 years of age. As regards the mechanisms of injury, the authors have analyzed scalding by hot liquids, burns due to contact with a hot object, burns due to electric current, explosion, and injury caused by burning clothing. Injury by scalding prevails to a very significant degree in the youngest children. In the second age group the incidence of burn following contact with hot objects increases, as does the percentage of children injured by burning of clothing in children aged 5 - 10. The older children have increased prevalence of injuries caused by explosions. The greatest average extent of an injury is from burning of clothing. Most of the areas are burned deeply, localized in more areas of the body, and almost half of the cases required surgical intervention. Scalding comes second in terms of average extent of an injury. More than half of the injured areas are superficial, and areas of injury are different in the individual age groups. We addressed about a fifth of the cases surgically. The explosion of combustible materials caused a smaller extent of injury, on average, taking third place. The injuries were predominantly superficial, most commonly involving the head, trunk, and upper extremities. In none of the cases it was necessary for us to operate. Burn injuries caused by contact with hot objects are of a smaller extent. More than half of the burned areas are deep, localized most commonly in the upper extremities. Surgical intervention was necessary in more than half the cases. In terms of average

  17. Cystic Fibrosis below the Diaphragm: Abdominal Findings in Adult Patients.

    PubMed

    Lavelle, Lisa P; McEvoy, Sinead H; Ni Mhurchu, Elaine; Gibney, Robert G; McMahon, Colm J; Heffernan, Eric J; Malone, Dermot E

    2015-01-01

    Cystic fibrosis (CF) is the most common lethal autosomal recessive disease in the white population. Mutation of the CF transmembrane conductance regulator gene on chromosome 7 results in production of abnormally viscous mucus and secretions in the lungs of patients with CF. A similar pathologic process occurs in the gastrointestinal tract, pancreas, and hepatobiliary system. Inspissated mucus causes luminal obstruction and resultant clinical and radiologic complications associated with the disease process. Pancreatic involvement can result in exocrine and endocrine insufficiency, pancreatic atrophy, fatty replacement, or lipomatous pseudohypertrophy. Acute and chronic pancreatitis, pancreatic calcification, cysts, and cystosis also occur. Hepatic manifestations include hepatic steatosis, focal biliary and multilobular cirrhosis, and portal hypertension. Biliary complications include cholelithiasis, microgallbladder, and sclerosing cholangitis. The entire digestive tract can be involved. Distal ileal obstruction syndrome, intussusception, appendicitis, chronic constipation, colonic wall thickening, fibrosing colonopathy, pneumatosis intestinalis, gastroesophageal reflux, and peptic ulcer disease have been described. Renal manifestations include nephrolithiasis and secondary amyloidosis. The educational objectives of this review are to reveal the abdominal manifestations of CF to facilitate focused analysis of cross-sectional imaging in adult patients. Life expectancy in patients with CF continues to improve because of a combination of aggressive antibiotic treatment, improved emphasis on nutrition and physiotherapy, and development of promising new CF transmembrane conductance regulator modulators. As lung function and survival improve, extrapulmonary conditions, including hepatic and gastrointestinal malignancy, will be an increasing cause of morbidity and mortality. Awareness of the expected abdominal manifestations of CF may assist radiologists in identifying

  18. Accidental radioisotope burns - Management of late sequelae.

    PubMed

    Varghese, Bipin T; Thomas, Shaji; Nair, Balakrishnan; Mathew, P C; Sebastian, Paul

    2010-09-01

    Accidental radioisotope burns are rare. The major components of radiation injury are burns, interstitial pneumonitis, acute bone marrow suppression, acute renal failure and adult respiratory distress syndrome. Radiation burns, though localized in distribution, have systemic effects, and can be extremely difficult to heal, even after multiple surgeries. In a 25 year old male who sustained such trauma by accidental industrial exposure to Iridium192 the early presentation involved recurrent haematemesis, pancytopenia and bone marrow suppression. After three weeks he developed burns in contact areas in the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal wound healed spontaneously but the former became a non-healing ulcer. Pancytopenia and bone marrow depression followed. He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL) flap. Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap. Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions. PMID:21321664

  19. Biomass Burning

    NASA Technical Reports Server (NTRS)

    Levine, Joel S.; Cofer, Wesley R., III; Pinto, Joseph P.

    1993-01-01

    Biomass burning may be the overwhelming regional or continental-scale source of methane (CH4) as in tropical Africa and a significant global source of CH4. Our best estimate of present methane emissions from biomass burning is about 51.9 Tg/yr, or 10% of the annual methane emissions to the atmosphere. Increased frequency of fires that may result as the Earth warms up may result in increases in this source of atmospheric methane.

  20. 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…

  1. 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…

  2. Demographics of pediatric burns in Vellore, India.

    PubMed

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

    2009-01-01

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

  3. Ball lightning burn.

    PubMed

    Selvaggi, Gennaro; Monstrey, Stan; von Heimburg, Dennis; Hamdi, Mustapha; Van Landuyt, Koen; Blondeel, Phillip

    2003-05-01

    Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics. It can be considered a mix of fire and electricity, concentrated in a fireball with a diameter of 20-cm that most commonly appears suddenly, even in indoor conditions, during a thunderstorm. It moves quickly for several meters, can change direction, and ultimately disappears. During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back. In this article, the authors report the first two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning. Emphasis is placed on the nature of injuries after ball lightning contact, the therapy used, and the long-term complications. PMID:12792547

  4. 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. PMID:26709106

  5. Reducing the Indication for Ventilatory Support in the Severely Burned Patient: Results of a New Protocol Approach at a Regional Burn Center.

    PubMed

    Gille, Jochen; Bauer, Nicole; Malcharek, Michael J; Dragu, Adrian; Sablotzki, Armin; Taha, Hischam; Czeslick, Elke

    2016-01-01

    Initial management of the severely injured routinely includes sedation and mechanical ventilatory support. However, nonjudiciously applied mechanical ventilatory support can itself lead to poorer patient outcomes. In an attempt to reduce this iatrogenic risk, a standardized, in-house, five-point protocol providing clinical guidance on the use and duration of ventilation was introduced and analyzed, and the impact on patient outcomes was assessed. In 2007, a protocol for early spontaneous breathing was introduced and established in clinical practice. This protocol included: 1) early extubation (≤6 hours after admission) in the absence of absolute ventilatory indication; 2) avoidance of "routine intubation" in spontaneously breathing patients; 3) early postoperative extubation, including patients requiring multiple surgical interventions; 4) intensive chest and respiratory physiotherapy with routine application of expectorants; and 5) early active mobilization. A retrospective clinical study compared patients (group A) over a 2-year period admitted under the new protocol with a historical patient group (group B). Patients in group A (n = 38) had fewer ventilator days over the time-course of treatment (3 [1; 5.8] vs 18.5 days [0.5; 20.5]; P = .0001) with a lower rate of tracheostomies (15.8 vs 54%; P = .0003). Patients on ventilation at admission in group A had shorter ventilation periods after admission (4.75 [4; 22.25] vs 378 hours [8.5; 681.5]; P = .0003), and 66.7% of these patients were extubated within 6 hours of admission (vs 9.1% in group B). No patients fulfilling the inclusion criteria required re- or emergency intubation. In the first 5 days of treatment, significantly lower Sequential Organ Failure Assessment scores were recorded in group A. There was also a trend for lower mortality rates (0 [0%] vs 6 [14%]), sepsis rates (24 [63.2%] vs 37 [88.1%]), and cumulative fluid balance on days 3 and 7 in group A. In contrast, group A demonstrated an elevated

  6. The Prevalence of ISAba1 and ISAba4 in Acinetobacter baumannii Species of Different International Clone Lineages Among Patients With Burning in Tehran, Iran

    PubMed Central

    Bahador, Abbas; Raoofian, Reza; Farshadzadeh, Zahra; Beitollahi, Leyli; Khaledi, Azad; Rahimi, Sara; Mokhtaran, Masoumeh; Mehrabi Tavana, Ali; Esmaeili, Davood

    2015-01-01

    Background: Multidrug resistant strains of Acinetobacter baumannii (MDR-AB) have emerged as alarming nosocomial pathogens among patients with burning. Objectives: The current study aimed to determine the susceptibility of A. baumannii species, carbapenems resistance patterns, and their association with ISAba1 and ISAba4 elements upstream of the blaOXA-like genes, and the distribution of international clone (IC) of A. baumannii isolates among patients with burning in Tehran, Iran. Materials and Methods: In the current study, 62 A. baumannii species isolates from patients with burning in Tehran, Iran, in 2012 were evaluated for the antimicrobial susceptibility, genetic relationships, ICs, carbapenemase encoding genes, and insertion elements ISAba upstream of blaOXA-like genes. Results: The highest rates of susceptibility were observed with colistin (88.7%) and tigecycline (82.2%). The extensively drug-resistance and pan drug-resistance were observed in 37.1% and 8.1% of the isolates, respectively. About 98.3% of 17 genotypes categorized into three distinct clusters. Thirty-six of the 62 isolates (58%) belonged to the IC II lineage. The most prevalent acquired OXA-type carbapenemase was blaOXA-23-like (62.9%). ISAba1 and ISAba4 were detected upstream of blaOXA-23-like genes in 45.1% and 12.9% of isolates, respectively. In 32.2% of all isolates, ISAba1 laid upstream of blaOXA-51-like genes. The PCR results were negative for carbapenemase genes of Ambler class A and B, except blaVIM-2. (1.6%). Conclusions: It was the first study that attempted to detect the insertion elements ISAba and IC lineages in MDR-AB species isolated from patients with burning in Iran. PMID:26396712

  7. The application of platelet-rich plasma in the treatment of deep dermal burns: A randomized, double-blind, intra-patient controlled study.

    PubMed

    Marck, Roos E; Gardien, Kim L M; Stekelenburg, Carlijn M; Vehmeijer, Marielle; Baas, D; Tuinebreijer, Wim E; Breederveld, Roelf S; Middelkoop, Esther

    2016-07-01

    Platelet-rich plasma (PRP) is a fraction of blood with a platelet concentration above baseline. When platelets get activated, growth factors involved in wound healing are released. The application of PRP has shown good results in wound care, however, up to date no substantial research has been performed on the effect of PRP in burn treatment. This randomized double blind intra-patient controlled study investigates the effect of autologous PRP on wound healing in burns that require surgery with a meshed split skin graft (SSG). Fifty-two patients with various areas of deep dermal to full thickness burns, receiving surgery with a SSG were included after informed consent. Comparable study areas A and B (intra-patient) were appointed, randomized and either treated with a SSG and PRP or with a SSG alone. At day 5 to 7 postoperative, the epithelialization and graft take rate were assessed. Three, six, and twelve months postoperative, follow-up measurements were performed in the form of POSAS-questionnaires, DermoSpectroMeter, and Cutometer measurements. There was no statistically significant difference between the mean take rate nor the mean epithelialization rate at day 5-7 between the PRP-treated and control areas. However, PRP-treated wound areas showed more often better or equal epithelialization and take rates at day 5-7 than the standard treated areas. Minor effects were also seen in the reoperated and early operated subgroups. At 3, 6, and 12 months postoperative, POSAS scores from the patients and the observers, Dermaspectro-, and Cutometer measurements did not depict a significant difference between the PRP and standard treated areas. Concluding, the addition of PRP in the treatment of burn wounds did not result in improved graft take and epithelialization, nor could we demonstrate better scar quality. There was, however, a considerable variation in our clinical population. PMID:27169627

  8. Chest CT findings of influenza virus‐associated pneumonia in 12 adult patients

    PubMed Central

    Fujita, Jiro; Bandoh, Shuji; Yamaguchi, Masahiro; Higa, Futoshi; Tateyama, Masao

    2008-01-01

    Objective  In this study, we describe the chest computed tomography findings of influenza virus‐associated pneumonia in adult patients. Methods  Our retrospective study included 12 adult patients who had proven influenza virus ‐ associated pneumonia. Results  Out of 12 patients, six were diagnosed as having pure influenza virus pneumonia, five as having bronchopneumonia caused by bacteria associated with influenza A infection, and one as having a cryptogenic organizing pneumonia associated with influenza A infection. Conclusion  Radiographic findings of influenza virus pneumonia in adult patients consist of ground‐glass attenuation. Localized patchy consolidations were observed in cases of bronchopneumonia. PMID:19453425

  9. Responding to requests from adult patients for neuroenhancements

    PubMed Central

    Larriviere, Dan; Williams, Michael A.; Rizzo, Matt; Bonnie, Richard J.

    2009-01-01

    In the last decade, persons who have no diagnosed medical or mental health condition are increasingly seeking and utilizing, for the ostensible purpose of enhancing their memory or cognitive skills, prescription drugs that were originally developed to improve executive function or memory in persons diagnosed with disorders such as attention deficit hyperactivity disorder or Alzheimer disease. Evidence suggests that this practice, now known as neuroenhancement, is gathering momentum. As a result, neurologists may be encountering patients without a diagnosed illness asking for medications with the goal of improving their memory, cognitive focus, or attention span. Strong arguments have been made for and against this practice, often reflecting strongly held convictions concerning the appropriate practice of medicine. The purpose of this report is to provide neurologists with an overview of the ethical, legal, and social issues surrounding the use of pharmaceuticals prescribed to enhance or augment normal cognitive or affective functioning, as well as practical guidance for responding to an adult patient’s request for neuroenhancement. GLOSSARY ELHC = Ethics, Law and Humanities Committee; FDA = Food and Drug Administration. PMID:19776378

  10. [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. PMID:21991179

  11. Acute assessment and management of burn injuries.

    PubMed

    Purdue, Gary F; Arnoldo, Brett D; Hunt, John L

    2011-05-01

    Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability. Larger burns are associated with morbidity and mortality disproportionate to their initial appearance. Electrical and chemical burns are less common injuries but are often associated with significant morbidity. PMID:21624716

  12. 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. PMID:25687834

  13. Beta-blockade lowers peripheral lipolysis in burn patients receiving growth hormone. Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged.

    PubMed Central

    Aarsland, A; Chinkes, D; Wolfe, R R; Barrow, R E; Nelson, S O; Pierre, E; Herndon, D N

    1996-01-01

    OBJECTIVE: The purpose of this study was to determine the effect of propranolol on peripheral lipolysis in massively burned children during treatment with recombinant human growth hormone (rhGH), and to ascertain whether decreased free fatty acid availability for re-esterification would alter the hepatic rate of secretion of triglycerides (TGs) bound to very low density lipoproteins (VLDLs). BACKGROUND: Fatty liver occurs in severely burned patients, often resulting in a twofold increase in liver size. This could be the result of an imbalance between increased provision of free fatty acids from peripheral lipolysis, coupled with no increase in fat oxidation, and insufficient rate of secretion of TGs from the liver. METHODS: In a cross-over study, six burned children were treated with either rhGH or rhGH plus propranolol. On the sixth day of treatment, isotopic tracer infusions were conducted to determine the rate of release of free fatty acid (Ra FFA) from peripheral tissue and the rate of secretion of VLDL-bound TGs by the liver. RESULTS: Exogenous rhGH increased Ra FFA in children with large third-degree burns. Propranolol decreased Ra FFA, but the rate of secretion of fatty acids in the form of VLDL-TG from the liver was maintained. Plasma FFA, as opposed to fatty acids newly synthesized in the liver, were the primary precursors for hepatic triglyceride synthesis. CONCLUSIONS: The administration of propranolol to burned children receiving rhGH is safe, has salutary cardiovascular effects, decreases the release of FFA from adipose tissue and increases the efficiency of the liver in secreting fatty acids as VLDL TGs. PMID:8645051

  14. Burning rubber

    SciTech Connect

    Not Available

    1987-09-01

    Mario Andretti, look out You are about to be surpassed in the burning rubber category by a joint venture between Oxford Energy Company and General Electric. The two companies are building the first whole tire-to-energy facility in the US in Modesto, California. This $41 million facility does not require tires to be shredded prior to incineration; it has the capacity to burn 700 tires per minute. The electricity generated will be provided to a utility company. Oxford says there are two billion waste tires on the ground and this number is increasing by 220 million a year. Of that amount, only 18 million a year are recycled.

  15. Psychosocial Functioning of Adult Epileptic and MS Patients and Adult Normal Controls on the WPSI.

    ERIC Educational Resources Information Center

    Tan, Siang-Yang

    1986-01-01

    Psychosocial functioning of adult epileptic outpatients as assessed by the Washington Psychosocial Seizure Inventory (WPSI) was compared to that of adult multiple sclerosis (MS) outpatients and normal subjects. When only valid WPSI profiles were considered, the only significant finding was that the epilepsy group and the MS group had more…

  16. A systematic review of heparin to treat burn injury.

    PubMed

    Oremus, Mark; Hanson, Mark D; Whitlock, Richard; Young, Edward; Archer, Carolyn; Dal Cin, Arianna; Gupta, Alok; Raina, Parminder

    2007-01-01

    This systematic review was conducted to assess the evidence for using heparin to treat burn injury. The following databases were searched for relevant studies: MEDLINE, EMBASE, CINAHL, The Cochrane Central Database of Controlled Trials, Web of Science, and BIOSIS. Additional searches involved the reference lists of included studies, the "grey " literature (eg, government reports), and consultations with experts to obtain unpublished manuscripts. Included studies were summarized descriptively and in tabular form, and assessed for methodological quality. A metaanalysis was conducted to obtain a summary estimate for the association between heparin use and postburn mortality. Nine studies were abstracted and included in the review. Five studies contained adult and pediatric patients, one contained adults only, and three contained pediatric patients only. Burn etiologies included flame, scald, thermal, or smoke inhalation. Heparin administration was done topically, subcutaneously, intravenously, or via aerosol. Heparin was reported to have a beneficial impact on mortality, graft and wound healing, and pain control. For mortality, the overall estimate (relative risk) of heparin's effect was 0.32 (95% confidence interval = 0.18-0.57). Heparin's reported benefits may be severely biased because the abstracted studies were beset by poor methodological quality (eg, inadequate definitions of treatment and outcome, no control of confounding). Given poor study quality, there is no strong evidence to indicate that heparin can improve clinical outcomes in the treatment of burn injury. Further research is needed to assess the clinical utility of using heparin in the treatment of burn injury. PMID:17925636

  17. Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment--A Cross-Sectional Study of 414 Clinically Diagnosed Adult ADHD Patients

    ERIC Educational Resources Information Center

    Halmoy, Anne; Fasmer, Ole Bernt; Gillberg, Christopher; Haavik, Jan

    2009-01-01

    Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24%…

  18. Prevalence and impact of late defecation in the critically ill, thermally injured adult patient.

    PubMed

    Trexler, Scott T; Lundy, Jonathan B; Chung, Kevin K; Nitzschke, Stephanie L; Burns, Christopher J; Shields, Beth A; Cancio, Leopoldo C

    2014-01-01

    The aim of this study was to determine the prevalence of late defecation (absence of laxation for more than 6 days after admission) as an indicator of lower-gastrointestinal (GI) tract dysfunction in burn patients. In addition, the authors wanted to determine whether the addition of polyethylene glycol 3350 to the standard bowel regimen led to improvement in markers of lower-GI function and outcomes. The authors conducted a retrospective chart review of patients admitted to the burn intensive care unit during a 26-month period. Inclusion criteria were 20% or more TBSA burn, requirement for mechanical ventilation, and age over 18 years. Of 83 patients included, the prevalence of late defecation was 36.1% (n = 30). There was no association between late defecation and mortality. Patients with late defecation had more frequent episodes of constipation after first defecation (P =.03), of feeding intolerance (P =.007), and received total parenteral nutrition more frequently (P =.005). The addition of polyethylene glycol to the standard bowel regimen did not affect markers of lower-GI function. Late defecation occurs in more than one third of critically ill burn patients. Late defecation was associated with ongoing lower-GI dysfunction, feeding intolerance, and the use of total parenteral nutrition. The causal relationship between these problems has not been determined. A prospective study at the authors' institution is currently planned to attempt to validate late defecation as a marker of lower-GI tract dysfunction, determine its relationship to various outcomes, and determine risk factors for its development. PMID:23877139

  19. 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 makes sense…

  20. Histopathological Characteristics of Distal Middle Cerebral Artery in Adult and Pediatric Patients with Moyamoya Disease.

    PubMed

    Takagi, Yasushi; Hermanto, Yulius; Takahashi, Jun C; Funaki, Takeshi; Kikuchi, Takayuki; Mineharu, Yohei; Yoshida, Kazumichi; Miyamoto, Susumu

    2016-06-15

    Moyamoya disease (MMD) is a unique progressive steno-occlusive disease of the distal ends of bilateral internal arteries and their proximal branches. The difference in clinical symptoms between adult and children MMD patients has been well recognized. In this study, we sought to investigate the phenomenon through histopathological study. Fifty-one patients underwent surgical procedures for treatment of standard indications of MMD at Kyoto University Hospital. Fifty-nine specimens of MCA were obtained from MMD patients during the surgical procedures. Five MCA samples were also obtained in the same way from control patients. The samples were analyzed by histopathological methods. In this study, MCA specimens from MMD patients had significantly thinner media and thicker intima than control specimens. In subsequent analysis, adult (≥ 20 years) patients had thicker intima of MCA compared to pediatric (< 20 years) patients. There is no difference in internal elastic lamina pathology between adult and pediatric patients. Our results indicated that the pathological feature of MMD in tunica media occurs in both adult and pediatric patients. However, the MMD feature in tunica intima of MCA is more prominent in adult patients. Further analysis from MCA specimens and other researches are necessary to elucidate the pathophysiology of MMD. PMID:27087193

  1. A review of hydrofluoric acid burn management.

    PubMed

    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

  2. Recognising falls risk in older adult mental health patients and acknowledging the difference from the general older adult population.

    PubMed

    Wynaden, Dianne; Tohotoa, Jenny; Heslop, Karen; Al Omari, Omar

    2016-01-01

    Older adults admitted to inpatient mental health units present with complex mental health care needs which are often compounded by the challenges of living with physical co-morbidities. They are a mobile population and a high risk group for falling during hospitalisation. To address quality and safety concerns around the increased risk for falls, a qualitative research study was completed to obtain an improved understanding of the factors that increase the risk of falling in this patient cohort. Focus groups were conducted with mental health professionals working across older adult mental health services in metropolitan Western Australia. Data were analysed using content analysis and three themes emerged that were significant concepts relevant to falls risk in this patient group. These themes were (1) limitations of using generic falls risk assessment and management tools, (2) assessment of falls risk not currently captured on standardised tools, and (3) population specific causes of falls. The findings demonstrate that older adult mental health patients are a highly mobile group that experience frequent changes in cognition, behaviour and mental state. The mix of patients with organic or functional psychiatric disorders within the same environment also presents complex and unique care challenges and multi-disciplinary collaboration is central to reduce the risk of falls. As this group of patients are also frequently admitted to both general inpatient and aged care settings, the findings are relevant to the assessment and management of falls risk across all health care settings. PMID:27188045

  3. Comparing illness presentation, treatment and functioning between patients with adolescent- and adult-onset psychosis.

    PubMed

    Hui, Christy Lai-Ming; Li, Adrienne Wing-Yee; Leung, Chung-Ming; Chang, Wing-Chung; Chan, Sherry Kit-Wa; Lee, Edwin Ho-Ming; Chen, Eric Yu-Hai

    2014-12-30

    Studies have shown that early- and adult-onset schizophrenia patients differ in pre-morbid traits, illness presentation, psychopathology, and prognosis. We aimed to compare adult-onset patients (age range 26-55 years) with an adolescent-onset cohort (15-25 years) in demographics, illness presentation and functioning at baseline. Participants were from two territory-wide early intervention services for adolescent-onset (n=671) and adult-onset psychosis patients (n=360) in Hong Kong. The adolescent-onset cohort had their initial psychotic episode from 2001-2003; retrospective data collection was done through systematic case note review. The adult-onset cohort was recruited for a larger interventional study from 2009-2011; information was collected via face-to-face interviews. Adult-onset psychosis was significantly associated with more females, more smokers, more non-local birth, more full-time employment, better functioning, poorer medication adherence, more psychiatric hospitalization and fewer with schizophrenia than adolescent-onset psychosis (mean age: 20.4). The effect sizes were small, except for medication adherence where a robust effect was found. No group difference in DUP was found. The finding that adult-onset patients had better functioning challenges the view that adolescent- and adult-onset psychoses share a similar prognostic trajectory. Implications for adapting intervention processes for adolescent- and adult-onset psychosis are discussed. PMID:25238985

  4. Reduced Capacity in a Dichotic Memory Test for Adult Patients with ADHD

    ERIC Educational Resources Information Center

    Dige, Niels; Maahr, Eija; Backenroth-Ohsako, Gunnel

    2010-01-01

    Objective: To evaluate whether a dichotic memory test would reveal deficits in short-term working-memory recall and long-term memory recall in a group of adult patients with ADHD. Methods: A dichotic memory test with ipsilateral backward speech distraction in an adult ADHD group (n = 69) and a control group (n = 66) is used to compare performance…

  5. Symptoms and socio-economic impact of ependymoma on adult patients: results of the Adult Ependymoma Outcomes Project 2.

    PubMed

    Walbert, Tobias; Mendoza, Tito R; Vera-Bolaños, Elizabeth; Acquaye, Alvina; Gilbert, Mark R; Armstrong, Terri S

    2015-01-01

    Ependymoma is a rare central nervous system tumor of adults. Reports of patient symptoms, interference patterns and costs encountered by patients and families are limited. Adult ependymoma patients completed the online Ependymoma Outcomes Questionnaire II. The survey assesses disease and functional status as well as socio-economic factors. Descriptive statistics were used to report disease characteristics as well as economic and social impact. Independent samples t test was used to test if differences exist between high- and low-income groups in terms of symptom severity. Correlations were calculated between symptoms and cost estimates. 86 international patients participated (male = 50 %). The economic analysis focused on 78 respondents from the US. 48 % were employed and 55 % earned ≥$60,000. Tumors were located in the brain (44 %), spine (44 %) or both (12 %). Spine patients compared to brain patients reported significantly worse pain (4.4 versus 2.2, p < .003), numbness (5.3 versus 2.2, p < .001), fatigue (5.1 versus 3.6, p < .03), changes in bowel patterns (3.8 versus 1.4, p < .003) and weakness (4.2 versus 2.1, p < .006). Brain patients compared with spine patients had increased lack of appetite (.4 versus 2, p < .014). Patients with lower income (≤$59,999) had more problems concentrating (p < .024) and worse cognitive module severity scores (p < .024). Estimated average monthly out-of-pocket spending was $168 for medical co-pays and $59 for prescription medication. Patients with ependymoma are highly affected by their symptoms. Spinal patients report higher severity of symptoms. Patients in the lower income group report significantly higher severity of cognitive symptoms independent of disease site. PMID:25359395

  6. [Reconstructions after periorbital burn injuries].

    PubMed

    Klett, A; Rebane, R

    2013-01-01

    Nowadays burn patients who also have periocular symptoms are usually treated by reconstructive surgeons and the role of the ophthalmic surgeon has decreased.Although periocular complications occur in a minority of burned patients, they pose a greater challenge in surgical and non-surgical treatment. Chemical, electrical and thermal burns can lead to disfiguring scar formations and delayed treatment can lead to devastating ocular complications. Achieving a successful reconstruction requires a comprehensive approach, entailing many advanced techniques with an emphasis on preserving function and balancing intricate aesthetic requirements. The theory is illustrated in this article with clinical examples. PMID:23345146

  7. The Lateral Position Improved Airway Patency in Anesthetized Patient With Burn-Induced Cervico-Mento-Sternal Scar Contracture

    PubMed Central

    Arai, Young-Chang P.; Kawanishi, Jun; Sakakima, Yoshikazu; Ohmoto, Koichi; Ito, Akihiro; Maruyama, Yuki; Ikemoto, Tatsunori

    2016-01-01

    A 78-year-old woman with burn-induced cervico-mento-sternal scar contracture was scheduled for laparoscopic cholecystectomy. During inhalational induction of sevoflurane, her airway patency deteriorated. The right lateral position and assist ventilation using a breathing bag dramatically improved her airway patency. PMID:27252906

  8. Variation in Insurance Status by Patient Demographics and Tumor Site Among Nonelderly Adult Patients With Cancer

    PubMed Central

    Grant, Stephen R.; Walker, Gary V.; Guadagnolo, B. Ashleigh; Koshy, Matthew; Allen, Pamela K.; Mahmood, Usama

    2016-01-01

    BACKGROUND In the United States, an estimated 48 million individuals live without health insurance. The purpose of the current study was to explore the variation in insurance status by patient demographics and tumor site among nonelderly adult patients with cancer. METHODS A total of 688,794 patients aged 18 to 64 years who were diagnosed with one of the top 25 incident cancers (representing 95% of all cancer diagnoses) between 2007 and 2010 in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patient characteristics included age, race, sex, marital status, and rural or urban residence. County-level demographics included percent poverty level. Insurance status was defined as having non-Medicaid insurance, Medicaid coverage, or no insurance. RESULTS On multivariate logistic regression analyses, younger age, male sex, nonwhite race, being unmarried, residence in counties with higher levels of poverty, and rural residence were associated with being uninsured versus having non-Medicaid insurance (all P <.001). The highest rates of non-Medicaid insurance were noted among patients with prostate cancer (92.3%), melanoma of the skin (92.5%), and thyroid cancer (89.5%), whereas the lowest rates of non-Medicaid insurance were observed among patients with cervical cancer (64.2%), liver cancer (67.9%), and stomach cancer (70.9%) (P <.001). Among uninsured individuals, the most prevalent cancers were lung cancer (14.9%), colorectal cancer (12.1%), and breast cancer (10.2%) (P <.001). Lung cancer caused the majority of cancer mortality in all insurance groups. CONCLUSIONS Rates of insurance coverage vary greatly by demographics and by cancer type. The expansion of health insurance coverage would be expected to disproportionally benefit certain demographic populations and cancer types. PMID:25917222

  9. 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

  10. Transition from Pediatric to Adult Health Care in Patients with Chronic Illnesses: An Integrative Review.

    PubMed

    Lewis, Jennifer; Slobodov, Gennady

    2015-01-01

    A systematic review of the literature was performed to identify barriers, themes, or additional insight specific to the transitional care processes from a pediatric to an adult health care setting for patients with spina bifida. PMID:26630779

  11. 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

  12. The utility of a video game system in rehabilitation of burn and nonburn patients: a survey among occupational therapy and physiotherapy practitioners.

    PubMed

    Fung, Vera; So, Ken; Park, Esther; Ho, Aileen; Shaffer, Jennifer; Chan, Elaine; Gomez, Manuel

    2010-01-01

    The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii™ (Nintendo of America Inc., Redmond, WA) in rehabilitation. Occupational therapists and physiotherapists in a rehabilitation hospital trialed four Wii games that addressed physical movement, balance, coordination, and cognitive performance. Then, they completed an opinion survey on the utility of Wii in rehabilitation. The results were compared between burn care therapists (BTs) and nonburn care therapists, using chi(2) with a P < .05 considered significant. The participation rate was 79% (63/80), and they agreed that Wii was easy to set up (71%), operate (68%), and safe to use (76%). Participants agreed that Wii would be beneficial in outpatient (76%) and inpatient (65%) settings and that it could improve treatment compliance (73%). Participants recommended 15 to 30-minute Wii intervention (59%) daily (81%) and twice per week (43%). Participants believed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Wii intervention but not cardiac (43%) or organ transplant patients (18%). Participants believed that outcomes using Wii could be measured reliably (49%), and skills learned while playing could be transferable to daily function (60%). The significant differences between BTs and nonburn care therapists' perceptions are that BT-treated younger patients (21-40 years vs >60 years, P < .05) and BT favored the therapeutic benefit of Wii in rehabilitation (93% vs 58%, P = .02), specifically in burn rehabilitation (85% vs 39%, P = .001). Occupational therapists and physiotherapists favored the use of Wii in rehabilitation as an adjunct to traditional therapy because it is therapeutic, engaging, and may increase patient participation in rehabilitation. PMID:20628305

  13. Epidemiology of U.K. military burns.

    PubMed

    Foster, Mark Anthony; Moledina, Jamil; Jeffery, Steve L A

    2011-01-01

    The authors review the etiology of U.K. military burns in light of increasing hybrid warfare. Analysis of the nature of these injured personnel will provide commanders with the evidence to plan for on-going and future operations. Case notes of all U.K. Armed Forces burn injured patients who were evacuated to the Royal Centre for Defence Medicine were reviewed. Demographics, burn severity, pattern, and mortality details were included. There were 134 U.K. military personnel with burns requiring return to the United Kingdom during 2001-2007. The median age was 27 (20-62) years. Overall, 60% of burns seen were "accidental." Burning waste, misuse or disrespect of fuel, and scalds were the most prevalent noncombat burns. Areas commonly burned were the face, legs, and hands. During 2006-2007 in the two major conflicts, more than 59% (n = 36) of the burned patients evacuated to the United Kingdom were injured during combat. Burns sustained in combat represent 5.8% of all combat casualties and were commonly associated with other injuries. Improvised explosive device, minestrike, and rocket-propelled grenade were common causes. The mean TBSA affected for both groups was 5% (1-70). The majority of combat burn injuries have been small in size. Greater provision of flame retardant equipment and clothing may reduce the extent and number of combat burns in the future. The numbers of noncombat burns are being reduced by good military discipline. PMID:21422938

  14. Increased serum NKG2D-ligands and downregulation of NKG2D in peripheral blood NK cells of patients with major burns.

    PubMed

    Haik, Josef; Nardini, Gil; Goldman, Noga; Galore-Haskel, Gilli; Harats, Moti; Zilinsky, Isaac; Weissman, Oren; Schachter, Jacob; Winkler, Eyal; Markel, Gal

    2016-01-19

    Immune suppression following major thermal injury directly impacts the recovery potential. Limited data from past reports indicate that natural killer cells might be suppressed due to a putative soluble factor that has remained elusive up to date. Here we comparatively study cohorts of patients with Major and Non-Major Burns as well as healthy donors. MICB and ULBP1 are stress ligands of NKG2D that can be induced by heat stress. Remarkably, serum concentration levels of MICB and ULBP1 are increased by 3-fold and 20-fold, respectively, already within 24h post major thermal injury, and are maintained high for 28 days. In contrast, milder thermal injuries do not similarly enhance the serum levels of MICB and ULBP1. This kinetics coincides with a significant downregulation of NKG2D expression among peripheral blood NK cells. Downregulation of NKG2D by high concentration of soluble MICB occurs in cancer patients and during normal pregnancy due to over production by cancer cells or extravillous trophoblasts, respectively, as an active immune-evasion mechanism. In burn patients this seems an incidental outcome of extensive thermal injury, leading to reduced NKG2D expression. Enhanced susceptibility of these patients to opportunistic viral infections, particularly herpes viruses, could be explained by the reduced NKG2D expression. Further studies are warranted for translation into innovative diagnostic or therapeutic technologies. PMID:26745675

  15. Increased serum NKG2D-ligands and downregulation of NKG2D in peripheral blood NK cells of patients with major burns

    PubMed Central

    Haik, Josef; Nardini, Gil; Goldman, Noga; Galore-Haskel, Gilli; Harats, Moti; Zilinsky, Isaac; Weissman, Oren; Schachter, Jacob; Winkler, Eyal; Markel, Gal

    2016-01-01

    Immune suppression following major thermal injury directly impacts the recovery potential. Limited data from past reports indicate that natural killer cells might be suppressed due to a putative soluble factor that has remained elusive up to date. Here we comparatively study cohorts of patients with Major and Non-Major Burns as well as healthy donors. MICB and ULBP1 are stress ligands of NKG2D that can be induced by heat stress. Remarkably, serum concentration levels of MICB and ULBP1 are increased by 3-fold and 20-fold, respectively, already within 24h post major thermal injury, and are maintained high for 28 days. In contrast, milder thermal injuries do not similarly enhance the serum levels of MICB and ULBP1. This kinetics coincides with a significant downregulation of NKG2D expression among peripheral blood NK cells. Downregulation of NKG2D by high concentration of soluble MICB occurs in cancer patients and during normal pregnancy due to over production by cancer cells or extravillous trophoblasts, respectively, as an active immune-evasion mechanism. In burn patients this seems an incidental outcome of extensive thermal injury, leading to reduced NKG2D expression. Enhanced susceptibility of these patients to opportunistic viral infections, particularly herpes viruses, could be explained by the reduced NKG2D expression. Further studies are warranted for translation into innovative diagnostic or therapeutic technologies. PMID:26745675

  16. Optimizing Management of Patients with Adult T Cell Leukemia-Lymphoma

    PubMed Central

    Yared, Jean A.; Kimball, Amy S.

    2015-01-01

    Adult T cell leukemia-lymphoma is a rare disease with a high mortality rate, and is challenging for the clinician. Early allogeneic stem cell transplant can confer durable remission. As novel therapeutic agents become available to treat T cell malignancies, it is increasingly important that medical oncologists, hematologists, and hematopathologists recognize and accurately diagnose adult T cell leukemia-lymphoma. There is no uniform standard of treatment of adult T cell leukemia-lymphoma, and clinical trials remain critical to improving outcomes. Here we present one management approach based on the recent advances in treatment for adult T cell leukemia-lymphoma patients. PMID:26610571

  17. 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. PMID:15353940

  18. Impaired respiratory function and heightened pulmonary inflammation in episodic binge ethanol intoxication and burn injury.

    PubMed

    Shults, Jill A; Curtis, Brenda J; Chen, Michael M; O'Halloran, Eileen B; Ramirez, Luis; Kovacs, Elizabeth J

    2015-11-01

    Clinical data indicate that cutaneous burn injuries covering greater than 10% of the total body surface area are associated with significant morbidity and mortality, in which pulmonary complications, including acute respiratory distress syndrome (ARDS), contribute to nearly half of all patient deaths. Approximately 50% of burn patients are intoxicated at the time of hospital admission, which increases days on ventilators by 3-fold, and doubles the length of hospitalization, compared to non-intoxicated burn patients. The most common drinking pattern in the United States is binge drinking, where an individual rapidly consumes alcoholic beverages (4 for women, 5 for men) in 2 h. An estimated 38 million Americans binge drink, often several times per month. Experimental data demonstrate that a single binge-ethanol exposure, prior to scald injury, impairs innate and adaptive immune responses, thereby enhancing infection susceptibility and amplifying pulmonary inflammation, neutrophil infiltration, and edema, and is associated with increased mortality. Since these characteristics are similar to those observed in ARDS burn patients, our study objective was to determine whether ethanol intoxication and burn injury and the subsequent pulmonary congestion affect physiological parameters of lung function, using non-invasive and unrestrained plethysmography in a murine model system. Furthermore, to mirror young adult binge-drinking patterns, and to determine the effect of multiple ethanol exposures on pulmonary inflammation, we utilized an episodic binge-ethanol exposure regimen, where mice were exposed to ethanol for a total of 6 days (3 days ethanol, 4 days rest, 3 days ethanol) prior to burn injury. Our analyses demonstrate mice exposed to episodic binge ethanol and burn injury have higher mortality, increased pulmonary congestion and neutrophil infiltration, elevated neutrophil chemoattractants, and respiratory dysfunction, compared to burn or ethanol intoxication alone

  19. 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. PMID:23292574

  20. Major burn injuries among restaurant workers in New York City: an underappreciated public health hazard.

    PubMed

    Suzman, M S; Sobocinski, K; Himel, H; Yurt, R W

    2001-01-01

    Major burns among food service workers appears to be an underappreciated source of morbidity and public expense in New York City. A retrospective study was conducted to identify workers requiring hospital admission over the past 3 years. Seventy-six restaurant workers (3.8% of all adult admissions) were identified. They averaged 33 years of age, and sustained burns with a mean %TBSA of 12.5, resulting in a mean length of stay of 12.8 days. Scalds predominated, with water/coffee burns most common (n = 29), followed by oil (n = 27), and soup/sauce burns (n = 12). Burns to the extremities occurred in 97% of patients. Surgery was required in 32 of 76 patients (42.1%). Oil burns were more likely to require surgery than aqueous scalds (59 vs 34%; P < 0.01). Hospitalization expenses averaged $1.13 million dollars per year. There were no mortalities. Restaurant-related major burns are a frequent occurrence, particularly scald injuries. Hospital care and further disability result in enormous publicly funded expenses. The morbidity and lost wages are a severe detriment to workers and their families. Greater public health awareness measures are warranted. PMID:11761396

  1. Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy.

    PubMed

    Bakker, Sjoerd F; Tushuizen, Maarten E; von Blomberg, Boudewina M E; Bontkes, Hetty J; Mulder, Chris J; Simsek, Suat

    2016-01-01

    This review aims at summarizing the present knowledge on the clinical consequences of concomitant coeliac disease (CD) in adult patients with type 1 diabetes mellitus (T1DM). The cause of the increased prevalence of CD in T1DM patients is a combination of genetic and environmental factors. Current screening guidelines for CD in adult T1DM patients are not uniform. Based on the current evidence of effects of CD on bone mineral density, diabetic complications, quality of life, morbidity and mortality in patients with T1DM, we advise periodic screening for CD in adult T1DM patients to prevent delay in CD diagnosis and subsequent CD and/or T1DM related complications. PMID:27478507

  2. Rules for improving pharmacotherapy in older adult patients: part 1 (rules 1-5).

    PubMed

    Wooten, James M

    2015-02-01

    The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers. PMID:25688894

  3. Strengthening the effectiveness of patient education: applying principles of adult education.

    PubMed

    Padberg, R M; Padberg, L F

    1990-01-01

    In spite of the recognized significance of patient education, many factors contribute to difficulties in providing effective patient teaching: diminished time from reduced hospital stays, the shortage of nursing personnel, and often, the patient's compromised physical and emotional status. With these constraints, teaching must be effective and efficient. In reviewing the literature, primary emphasis was found on providing sound clinical information with little attention to the techniques of effective methods for teaching adults. This article draws upon the principles of andragogy--the methods of teaching adults delineated by Malcolm Knowles--to provide a conceptual framework for developing effective patient education practice. Examples of both effective and ineffective practice are provided from the nursing literature. The information provided should assist nurses in understanding how adults learn and provide them with a structure to use in tailoring their teaching to meet the individual needs of their patients. PMID:2300506

  4. Prevalence of vitamin D deficiency and insufficiency among adult asthmatic patients in Karachi.

    PubMed

    Kamran, Afshan; Alam, Syed Mahboob; Qadir, Farida

    2014-11-01

    Vitamin D deficiency has assumed pandemic proportions all over the world. It has been documented as a frequent problem in studies of young adults, elderly person and children in other countries, but there is no reliable data on vitamin D status of adult asthmatic patients in Pakistan. To determine the prevalence of vitamin D deficiency and insufficiency in adult asthmatic patients with moderate to severe asthma using a cross-sectional study design in Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi.311 adult asthmatic patients with moderate to severe asthma were recruited from JPMC, tertiary care hospital in Karachi. Questionnaires were administered together demographics, height, weight, nutritional and physical activity assessment. Blood samples for vitamin D measurement were also taken. Results show high prevalence of vitamin D deficiency and insufficiency (88.10%) in adult patients with moderate to severe persistent asthma. Vitamin D deficiency and insufficiency was more frequently observed in female than in male patients.67.66% of the female patients had serum vitamin D level less than 20 ng/ml as compare to 56.1% of the male patients (p=0.01). PMID:26045376

  5. Adult Day Care for Alzheimer's Patients and Their Families.

    ERIC Educational Resources Information Center

    Sands, Dan; Suzuki, Thelma

    1983-01-01

    Harbor Area Adult Day Care Center has operated for two years with a primary purpose of providing respite care to families caring for a relative with Alzheimer's disease or related disorders. The rationale, history, program, staffing, funding, and experience for the first two years of the project are provided. (Author/RC)

  6. Low Literacy Levels in Adults: Implications for Patient Education.

    ERIC Educational Resources Information Center

    Fisher, Evelyn

    1999-01-01

    Health-education materials often require reading levels higher than that of many patients. Nurses need awareness of the prevalence of low literacy and the ability to assess reading levels so they can develop appropriate patient-education materials. (SK)

  7. Psychotherapy Interventions for Managing Anxiety and Depressive Symptoms in Adult Brain Tumor Patients: A Scoping Review

    PubMed Central

    Kangas, Maria

    2015-01-01

    Background Adult brain tumor (BT) patients and longer-term survivors are susceptible to experiencing emotional problems, including anxiety and/or depression disorders, which may further compromise their quality-of-life (QOL) and general well-being. The objective of this paper is to review psychological approaches for managing anxiety and depressive symptoms in adult BT patients. A review of psychological interventions comprising mixed samples of oncology patients, and which included BT patients is also evaluated. The review concludes with an overview of a recently developed transdiagnostic psychotherapy program, which was specifically designed to treat anxiety and/or depressive symptoms in adult BT patients. Methods Electronic databases (PsycINFO, Medline, Embase, and Cochrane) were searched to identify published studies investigating psychological interventions for managing anxiety and depressive symptoms in adult BT patients. Only four randomized controlled trials (RCTs) were identified. Results Only one of the RCTs tested a psychosocial intervention, which was specifically developed for primary BT patients, and which was found to improve QOL including existential well-being as well as reducing depressive symptoms. A second study tested a combined cognitive rehabilitation and problem-solving intervention, although was not found to significantly improve mood or QOL. The remaining two studies tested multidisciplinary psychosocial interventions in heterogeneous samples of cancer patients (included BT patients) with advanced stage disease. Maintenance of QOL was found in both studies, although no secondary gains were found for improvements in mood. Conclusion There is a notable paucity of psychological interventions for adult BT patients across the illness trajectory. Further research is required to strengthen the evidence base for psychological interventions in managing anxiety and depressive symptoms, and enhancing the QOL of distressed adults diagnosed with a BT

  8. Complicated Burn Resuscitation.

    PubMed

    Harrington, David T

    2016-10-01

    More than 4 decades after the creation of the Brooke and Parkland formulas, burn practitioners still argue about which formula is the best. So it is no surprise that there is no consensus about how to resuscitate a thermally injured patient with a significant comorbidity such as heart failure or cirrhosis or how to resuscitate a patient after an electrical or inhalation injury or a patient whose resuscitation is complicated by renal failure. All of these scenarios share a common theme in that the standard rule book does not apply. All will require highly individualized resuscitations. PMID:27600129

  9. Nutrition in adult patients with inflammatory bowel disease.

    PubMed

    Hebuterne, Xavier; Filippi, Jerome; Schneider, Stephane M

    2014-01-01

    Seventy five percent of hospitalized patients with Crohn's disease suffer from malnutrition. One third of Crohn's disease patients have a body mass index below 20. Sixty percent of Crohn's disease patients have sarcopenia. However some inflammatory bowel disease (IBD) patients are obese or suffer from sarcopenic-obesity. IBD patients have many vitamin and nutrient deficiencies, which can lead to important consequences such as hyperhomocysteinemia, which is associated with a higher risk of thromboembolic disease. Nutritional deficiencies in IBD patients are the result of insufficient intake, malabsorption and protein-losing enteropathy as well as metabolic disturbances directly induced by the chronic disease and its treatments, in particular corticosteroids. Screening for nutritional deficiencies in chronic disease patients is warranted. Managing the deficiencies involves simple nutritional guidelines, vitamin supplements, and nutritional support in the worst cases. PMID:25266810

  10. 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

  11. Fluid therapy LiDCO controlled trial-optimization of volume resuscitation of extensively burned patients through noninvasive continuous real-time hemodynamic monitoring LiDCO.

    PubMed

    Tokarik, Monika; Sjöberg, Folke; Balik, Martin; Pafcuga, Igor; Broz, Ludomir

    2013-01-01

    This pilot trial aims at gaining support for the optimization of acute burn resuscitation through noninvasive continuous real-time hemodynamic monitoring using arterial pulse contour analysis. A group of 21 burned patients meeting preliminary criteria (age range 18-75 years with second- third- degree burns and TBSA ≥10-75%) was randomized during 2010. A hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group), whereas those without LiDCO monitoring were defined as the control group. The modified Brooke/Parkland formula as a starting resuscitative formula, balanced crystalloids as the initial solutions, urine output of 0.5 ml/kg/hr as a crucial value of adequate intravascular filling were used in both groups. Additionally, the volume and vasopressor/inotropic support were based on dynamic preload parameters in the LiDCO group in the case of circulatory instability and oligouria. Statistical analysis was done using t-tests. Within the first 24 hours postburn, a significantly lower consumption of crystalloids was registered in LiDCO group (P = .04). The fluid balance under LiDCO control in combination with hourly diuresis contributed to reducing the cumulative fluid balance approximately by 10% compared with fluid management based on standard monitoring parameters. The amount of applied solutions in the LiDCO group got closer to Brooke formula whereas the urine output was at the same level in both groups (0.8 ml/kg/hr). The new finding in this study is that when a fluid resuscitation is based on the arterial waveform analysis, the initial fluid volume provided was significantly lower than that delivered on the basis of physician-directed fluid resuscitation (by urine output and mean arterial pressure). PMID:23511280

  12. Epilepsy in Adults with Supratentorial Glioblastoma: Incidence and Influence Factors and Prophylaxis in 184 Patients

    PubMed Central

    Liang, Shuli; Zhang, Junchen; Zhang, Shaohui; Fu, Xiangping

    2016-01-01

    Aim To analyze the incidence of epilepsy in adult patients with supratentorial glioblastoma, assess the factors influencing the development of epilepsy in these cases, and evaluate patients’ response to antiepileptic drugs (AEDs) in a series of 184 patients. Methods We retrospectively analyzed the 184 adult patients diagnosed with supratentorial glioblastoma. All subjects were treated within our hospital and subsequently died between 2003 and 2013. The incidence of epilepsy was assessed before and after initial resection and reexamined every 2 months thereafter. We evaluated the efficacy of prophylactic AEDs in this patient population based on the gathered incidence data. Results Of 184 patients, 43 (23.37%) were diagnosed with epilepsy before their initial resection. The total incidence of epilepsy (both pre- and postoperative) was 68.48%. The prevalence of active epilepsy reached over 80% in patients with epilepsy and survival of greater than 13 months postoperatively. Patients with glioblastoma in the frontal and/or temporal lobes had a higher prevalence of epilepsy. In the 43 patients with preoperative epilepsy, total resection of glioblastoma resulted in significantly lower seizure frequency. Patients who received epilepsy prophylaxis with AEDs for at least 6 months had significantly fewer seizures and higher Karnofsky scores than those receiving AEDs for less than one month or not at all. Conclusion The incidence of epilepsy in adult patients with glioblastoma was high and responded poorly to AEDs in the short term. However, when taken for longer periods, AEDs can reduce the frequency of seizures in patients with glioblastoma. PMID:27438472

  13. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review.

    PubMed

    Bogunovic, Ljiljana; Matava, Matthew J

    2013-11-01

    Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged > 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient. PMID:24231595

  14. Effects of neurofeedback on adult patients with psychiatric disorders in a naturalistic setting.

    PubMed

    Cheon, Eun-Jin; Koo, Bon-Hoon; Seo, Wan-Seok; Lee, Jun-Yeob; Choi, Joong-Hyeon; Song, Shin-Ho

    2015-03-01

    Few well-controlled studies have considered neurofeedback treatment in adult psychiatric patients. In this regard, the present study investigates the characteristics and effects of neurofeedback on adult psychiatric patients in a naturalistic setting. A total of 77 adult patients with psychiatric disorders participated in this study. Demographic data and neurofeedback states were retrospectively analyzed, and the effects of neurofeedback were evaluated using clinical global impression (CGI) and subjective self-rating scales. Depressive disorders were the most common psychiatric disorders (19; 24.7 %), followed by anxiety disorders (18; 23.4 %). A total of 69 patients (89.6 %) took medicine, and the average frequency of neurofeedback was 17.39 ± 16.64. Neurofeedback was applied to a total of 39 patients (50.6 %) more than 10 times, and 48 patients (62.3 %) received both β/SMR and α/θ training. The discontinuation rate was 33.8 % (26 patients). There was significant difference between pretreatment and posttreatment CGI scores (<.001), and the self-rating scale also showed significant differences in depressive symptoms, anxiety, and inattention (<.001). This is a naturalistic study in a clinical setting, and has several limitations, including the absence of a control group and a heterogenous sample. Despite these limitations, the study demonstrates the potential of neurofeedback as an effective complimentary treatment for adult patients with psychiatric disorders. PMID:25740085

  15. 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. PMID:19377134

  16. Burns caused by carburetors.

    PubMed

    Still, Joseph; Law, Edward; Orlet, Hermann; Wilson, Joan

    2003-01-01

    During a 10-year period 4645 patients were admitted to the Joseph M. Still Burn Center with acute burns. Of these, 83 (1.79%) were caused by carburetor-related accidents. There were 79 males and 4 females. Ages ranged from 10 to 72 years. Burn size ranged from 1 to 97.5% (mean, 12.3%). There was one death in the group. Eighteen patients required only topical care; 65 patients required a total of 108 operations for debridement and grafting. Length of stay ranged from 1 to 63 days (mean, 11 days). The mechanism of injury was usually the same; in 81 cases the accident occurred while someone was pouring gasoline into a carburetor. In 63 cases the vehicle was an automobile or pickup truck. Explosions resulted in 12 instances; in 65 instances fires were started. These injuries are serious, expensive, fairly common, and may be life threatening. Proper handling of gasoline is stressed. Newer vehicles have fuel injector systems, which may gradually eliminate the problem over time, because pouring gasoline is not required. PMID:12543992

  17. Burns, hypertrophic scar and galactorrhea.

    PubMed

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-07-01

    An 18-year-old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected.She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. PMID:23456048

  18. [Primary care and assessment of extended burn].

    PubMed

    Shimamoto, Minoru; Kawai, Makoto; Yamamoto, Yasuhiro

    2005-12-01

    Extended burn is a severe trauma makes patients easily critical status without appropriate cure and assessment. In order to ride out hypovolemic shock, it is necessary to manage the internal water, the state of respiration and wound treatment and assess the depth of burn wound. Initialy we assess the burned area and it's depth, then we calculate the amount of water which will be necessary on acute phase for the patient We will resect the part of deep dermal burn immediately to reduce the causes of infection. The patient will need a graft operation as soon as we can to avoid the severe infection. PMID:16869125

  19. Nonoperative management of pediatric burn injuries.

    PubMed

    Pizano, Louis R; Corallo, Joseph P; Davies, Jennifer

    2008-07-01

    There are an estimated 1.2 million burn injuries per year in the United States, one third of which occur in children. Most of these injuries will be treated nonoperatively, frequently in an outpatient setting. This article aims to provide the practitioner with a understanding of the pathophysiology of burn injuries, a guide to the initial assessment of the patient, and management recommendations for nonoperative treatment of the burned pediatric patient. PMID:18650703

  20. 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

  1. Suicidal burn in Hong Kong.

    PubMed

    Chan, R C; Burd, A

    2012-09-01

    The aim of our study is to review our experience in the management of patients who sustained burns associated with suicidal attempts over a 10-year period. In particular, we look into the outcome and incidence of self-harm/suicide after discharge among the survivors. Thirty-one patients with median age 36 years, ranging from 10 to 74, were included. Twenty-three (74%) were males and eight (26%) were females. Nearly three quarters (74%) of our patients had a known history of psychiatric illness: 11 had known history of substance abuse; 3 of them had drug-induced psychosis; 6 had schizophrenia; 5 had depression; 4 had personality disorders; 1 had pathological gambling and another one had adjustment disorder. Relationship problems and work/financial difficulties were the commonest reason for the suicidal attempts. Self-inflicted flame burn was the most frequent (39%; 12 patients) method of burning. Six patients (19%) died. The remaining 25 patients healed and were discharged. Seventeen patients required ICU care. The median length of stay in ICU was 7 days. The overall median length of stay was 35 days. The median follow up time for those survived is 63 months. Only 4 of these patients had further suicidal/parasuicidal attempts. Despite the high mortality, once these patients survived the initial injury, they are unlikely to commit suicide again. Thus, we believe that aggressive resuscitation should therefore be advocated for all suicidal burn patients. PMID:22360959

  2. Practical review of immunizations in adult patients with cancer

    PubMed Central

    Ariza-Heredia, Ella J; Chemaly, Roy F

    2015-01-01

    Compared with the general population, patients with cancer in general are more susceptible to vaccine-preventable infections, either by an increased risk due to the malignancy itself or immunosuppressive treatment. The goal of immunizations in these patients is therefore to provide protection against these infections, and to decrease the number of vulnerable patients who can disseminate these organisms. The proper timing of immunization with cancer treatment is key to achieving better vaccine protection. As the oncology field continues to advance, leading to better quality of life and longer survival, immunization and other aspects of preventive medicine ought to move to the frontline in the care of these patients. Herein, we review the vaccines most clinically relevant to patients with cancer, as well as special cases including vaccines after splenectomy, travel immunization and recommendations for family members. PMID:26110220

  3. Anaplastic large cell lymphoma in paediatric and young adult patients.

    PubMed

    Turner, Suzanne D; Lamant, Laurence; Kenner, Lukas; Brugières, Laurence

    2016-05-01

    Anaplastic large cell lymphoma (ALCL) is a heterogeneous disease of debateable origin that, in children, is largely anaplastic lymphoma kinase (ALK) positive with aberrant ALK activity induced following the formation of chromosomal translocations. Whilst the survival rates for this disease are relatively high, a significant proportion (20-40%) of patients suffer disease relapse, in some cases on multiple occasions and therefore suffer the toxic side-effects of combination chemotherapy. Traditionally, patients are treated with a combination of agents although recent data from relapse patients have suggested that low risk patients might benefit from single agent vinblastine and, going forward, the addition of ALK inhibitors to the therapeutic regimen may have beneficial consequences. There are also a plethora of other drugs that might be advantageous to patients with ALCL and many of these have been identified through laboratory research although the decision as to which drugs to implement in trials will not be trivial. PMID:26913827

  4. 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. PMID:25094004

  5. Parental substance abuse, reports of chronic pain and coping in adult patients with sickle cell disease.

    PubMed Central

    Edwards, Christopher; Whitfield, Keith; Sudhakar, Shiv; Pearce, Michele; Byrd, Goldie; Wood, Mary; Feliu, Miriam; Leach-Beale, Brittani; DeCastro, Laura; Whitworth, Elaine; Abrams, Mary; Jonassaint, Jude; Harrison, M. Ojinga; Mathis, Markece; Scott, Lydia; Johnson, Stephanie; Durant, Lauren; Holmes, Anita; Presnell, Katherine; Bennett, Gary; Shelby, Rebecca; Robinson, Elwood

    2006-01-01

    There is increasing interest from a social learning perspective in understanding the role of parental factors on adult health behaviors and health outcomes. Our review revealed no studies, to date, that have evaluated the effects of parental substance abuse on reports of chronic pain and coping in adult patients with sickle cell disease (SCD). We explored the effects of parental substance (alcohol or drug) abuse on reports of the sensory, affective and summary indices of pain in 67 adult patients, mean age 38.9 (13.5), with SCD. We also explored the effects of parental substance abuse on psychopathology associated with pain and active coping. Twenty-four percent of patients reported that their parent(s) abused substances. Patients whose parent(s) were characterized as substance abusers reported greater sensory (p=0.02), affective (p=0.01) and summary (VAS; p=0.02) indices of pain as compared to their counterparts, whose parent(s) were not characterized as substance abusers. Patients did not differ in average age, education or the propensity to respond in a socially acceptable manner. There was a significant trend towards patients who characterized their parents as abusers scoring higher than their counterparts on active coping. We propose a Social Learning Theory to explain the current findings and suggest a need for additional prospective research to simultaneously explore biological (genetic) and social factors that influence the interpretation, experience and reporting of chronic pain in adult patients with chronic disease. PMID:16573309

  6. 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. PMID:26170784

  7. Intensive care outcomes in adult hematopoietic stem cell transplantation patients

    PubMed Central

    Bayraktar, Ulas D; Nates, Joseph L

    2016-01-01

    Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of non-beneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients’ functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pre-transplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients’ functional status at the time of critical illness. PMID:26862493

  8. Effect of topical local anesthetic application to skin harvest sites for pain management in burn patients undergoing skin-grafting procedures.

    PubMed Central

    Jellish, W S; Gamelli, R L; Furry, P A; McGill, V L; Fluder, E M

    1999-01-01

    OBJECTIVE: To determine if topical administration of local anesthesia, applied to fresh skin-harvest sites, reduces pain and analgesic requirements after surgery. SUMMARY BACKGROUND DATA: Nonopioid treatments for pain after therapeutic procedures on patients with burns have become popular because of the side effects associated with narcotics. The topical administration of local anesthesia originally offered little advantage because of poor epidermal penetration. METHODS: This study compares 2% lidocaine with 0.5% bupivacaine or saline, topically applied after skin harvest, to determine what effect this may have on pain and narcotic use. Sixty patients with partial- or full-thickness burns to approximately 10% to 15% of their body were randomly divided into three groups: group 1 received normal saline, group 2 had 0.5% bupivacaine, and group 3 had 2% lidocaine sprayed onto areas immediately after skin harvest. Blood samples were subsequently obtained to measure concentrations of the local anesthetic. Hemodynamic variables after surgery, wake-up times, emetic symptoms, pain, and narcotic use were compared. RESULTS: Higher heart rates were noted in the placebo group than in those receiving lidocaine or bupivacaine. No differences were noted in recovery from anesthesia or emetic symptoms. Pain scores were lower and 24-hour narcotic use was less in patients who received lidocaine. Plasma lidocaine levels were greater than bupivacaine at all time points measured. CONCLUSIONS: Topical lidocaine applied to skin-harvest sites produced an analgesic effect that reduced narcotic requirements compared with patients who received bupivacaine or placebo. Local anesthetic solutions aerosolized onto skin-harvest sites did not affect healing or produce toxic blood concentrations. PMID:9923808

  9. Management of Spinal Deformity in Adult Patients With Neuromuscular Disease.

    PubMed

    Protopsaltis, Themistocles S; Boniello, Anthony J; Schwab, Frank J

    2016-09-01

    A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs. Patients with neuromuscular disease are susceptible to postoperative medical complications, such as delirium, epidural hematomas, pulmonary emboli, and cardiac events. Compared with outcomes in the typical patient with spinal deformity, postoperative outcomes in patients with neuromuscular disease have higher rates of surgical complications, such as instrumentation failure, proximal junctional kyphosis, loss of correction, and the need for revision surgery, regardless of the magnitude of surgical treatment. PMID:27471900

  10. Transfusions for anemia in adult and pediatric patients with malignancies.

    PubMed

    Shah, Neil; Andrews, Jennifer; Goodnough, Lawrence Tim

    2015-09-01

    Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings. PMID:25796130

  11. Use of Patient Portals for Personal Health Information Management: The Older Adult Perspective.

    PubMed

    Turner, Anne M; Osterhage, Katie; Hartzler, Andrea; Joe, Jonathan; Lin, Lorelei; Kanagat, Natasha; Demiris, George

    2015-01-01

    The personal health information management (PHIM) practices and needs of older adults are poorly understood. We describe initial results from the UW SOARING project (Studying Older Adults & Researching Information Needs and Goals), a participatory design investigation of PHIM in older adults (60 years and older). We conducted in-depth interviews with older adults (n=74) living in a variety of residential settings about their management of personal health information. A surprising 20% of participants report using patient portals and another 16% reported prior use or anticipated use of portals in the future. Participants cite ease of access to health information and direct communication with providers as valuable portal features. Barriers to the use of patient portals include a general lack of computer proficiency, high internet costs and security concerns. Design features based on consideration of needs and practices of older adults will facilitate appeal and maximize usability; both are elements critical to adoption of tools such as patient portals that can support older adults and PHIM. PMID:26958263

  12. Use of Patient Portals for Personal Health Information Management: The Older Adult Perspective

    PubMed Central

    Turner, Anne M.; Osterhage, Katie; Hartzler, Andrea; Joe, Jonathan; Lin, Lorelei; Kanagat, Natasha; Demiris, George

    2015-01-01

    The personal health information management (PHIM) practices and needs of older adults are poorly understood. We describe initial results from the UW SOARING project (Studying Older Adults & Researching Information Needs and Goals), a participatory design investigation of PHIM in older adults (60 years and older). We conducted in-depth interviews with older adults (n=74) living in a variety of residential settings about their management of personal health information. A surprising 20% of participants report using patient portals and another 16% reported prior use or anticipated use of portals in the future. Participants cite ease of access to health information and direct communication with providers as valuable portal features. Barriers to the use of patient portals include a general lack of computer proficiency, high internet costs and security concerns. Design features based on consideration of needs and practices of older adults will facilitate appeal and maximize usability; both are elements critical to adoption of tools such as patient portals that can support older adults and PHIM. PMID:26958263

  13. A clarion to recommit and reaffirm burn rehabilitation.

    PubMed

    Richard, Reginald L; Hedman, Travis L; Quick, Charles D; Barillo, David J; Cancio, Leopoldo C; Renz, Evan M; Chapman, Ted T; Dewey, William S; Dougherty, Mary E; Esselman, Peter C; Forbes-Duchart, Lisa; Franzen, Beth J; Hunter, Hope; Kowalske, Karen; Moore, Merilyn L; Nakamura, Dana Y; Nedelec, Bernedette; Niszczak, Jon; Parry, Ingrid; Serghiou, Michael; Ward, R Scott; Holcomb, John B; Wolf, Steven E

    2008-01-01

    Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed. PMID:18388581

  14. Epidemiology of burns in Malaga, Spain.

    PubMed

    Fernández-Morales, E; Gálvez-Alcaraz, L; Fernández-Crehuet-Navajas, J; Gómez-Gracia, E; Salinas-Martínez, J M

    1997-06-01

    The incidence of burns in the province of Malaga, Spain, was determined by means of a descriptive, cross-sectional, population-based study, and the individual, social and environmental conditions of the patients were analysed. Five hundred families (1846 persons), selected by a three-stage, stratified sampling, were interviewed in their homes. Five hundred and six burns were found in 406 persons (1.25 burns/person); 89.5 per cent of these were in an urban environment and 10.5 per cent in a rural environment. Eighteen and a half per cent of the sample had burnt themselves only once and 4.7 per cent more than once. The burns affected 23.3 per cent of the population, although the majority were of little clinical importance. The risk of burns is greater in the urban environment than in the rural environment, with burns occurring most often in the home (65.8 per cent), and especially in the kitchen. The most frequent burns involve hot liquids with special risk from cooking oil. The other burns (in the strict sense of the word, proper burns or true burns), were primarily caused by contact. The incidence was higher in women (33.0 vs. 21.1 per cent), with burns occurring mostly on the hands. Only 21.9 per cent of the burns received the correct first aid after the accident. PMID:9248642

  15. Undifferentiated embryonal sarcoma of the liver in an adult patient.

    PubMed

    Lee, Kyu Ho; Maratovich, Mussin Nadiar; Lee, Kyoung-Bun

    2016-06-01

    Undifferentiated embryonal sarcoma of the liver (UESL) is rare primary hepatic sarcoma and is known to occur in pediatric patients. This case is the UESL occurred in a 51-year old male patient. Multilocular cystic lesion was composed of primitive spindle cells without specific differentiation. This rare case would help to review differential diagnosis of primary sarcoma in liver and cystic neoplasm of the liver. PMID:27377912

  16. Patient satisfaction and ethnic identity among American Indian older adults.

    PubMed

    Garroutte, Eva Marie; Kunovich, Robert M; Jacobsen, Clemma; Goldberg, Jack

    2004-12-01

    Work in the field of culturally competent medical care draws on studies showing that minority Americans often report lower satisfaction with care than White Americans and recommends that providers should adapt care to patients' cultural needs. However, empirical evidence in support of cultural competence models is limited by reliance upon measurements of racial rather than ethnic identity and also by a near-total neglect of American Indians. This project explored the relationship between ethnic identity and satisfaction using survey data collected from 115 chronically ill American Indian patients >or=50 years at a Cherokee Nation clinic. Satisfaction scores were high overall and comparable to those found in the general population. Nevertheless, analysis using hierarchical linear modeling showed that patients' self-rated American Indian ethnic identity was significantly associated with satisfaction. Specifically, patients who rated themselves high on the measure of American Indian ethnic identity reported reduced scores on satisfaction with health care providers' social skill and attentiveness, as compared to those who rated themselves lower. Significant associations remained after controlling for patients' sex, age, education, marital status, self-reported health, wait time, and number of previous visits. There were no significant associations between patients' American Indian ethnic identity and satisfaction with provider's technical skill and shared decision-making. Likewise, there were no significant associations between satisfaction and a separate measure of White American ethnic identity, although a suggestive trend was observed for satisfaction with provider's social skill. Our findings demonstrate the importance of including measures of ethnic identity in studies of medical satisfaction in racial minority populations. They support the importance of adapting care to patient's cultural needs, and they highlight the particular significance of interpersonal

  17. Undifferentiated embryonal sarcoma of the liver in an adult patient

    PubMed Central

    Lee, Kyu Ho; Maratovich, Mussin Nadiar; Lee, Kyoung-Bun

    2016-01-01

    Undifferentiated embryonal sarcoma of the liver (UESL) is rare primary hepatic sarcoma and is known to occur in pediatric patients. This case is the UESL occurred in a 51-year old male patient. Multilocular cystic lesion was composed of primitive spindle cells without specific differentiation. This rare case would help to review differential diagnosis of primary sarcoma in liver and cystic neoplasm of the liver. PMID:27377912

  18. Burning Mouth Syndrome.

    PubMed

    Klasser, Gary D; Grushka, Miriam; Su, Nan

    2016-08-01

    Burning mouth syndrome (BMS) is an enigmatic, misunderstood, and under-recognized painful condition. Symptoms associated with BMS can be varied, thereby providing a challenge for practitioners and having a negative impact on oral health-related quality of life for patients. Management also remains a challenge for practitioners because it is currently only targeted for symptom relief without a definitive cure. There is an urgent need for further investigations to determine the efficacy of different therapies because this is the only way viable therapeutic options can be established for patients with this chronic and painful syndrome. PMID:27475513

  19. Long term mortality in burned children

    PubMed Central

    Stamboulian, Daniel; Lede, Roberto

    2015-01-01

    Studies about risk factors for mortality in burn children are scarce and are even less in the follow up of this population across time. Usually, after complete event attendance, children are not follow-up as risk patients, burn injury affects all facets of life. Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns. In this editorial we comment the paper of Duke et al. The authors highlight the importance of maintaining a long-term monitoring of children who suffered burns. The importance of this original study is to promote the reconsideration of clinical guides of long-term follow-up of burn patients. PMID:26835375

  20. Long term mortality in burned children.

    PubMed

    Rosanova, María Teresa; Stamboulian, Daniel; Lede, Roberto

    2015-07-01

    Studies about risk factors for mortality in burn children are scarce and are even less in the follow up of this population across time. Usually, after complete event attendance, children are not follow-up as risk patients, burn injury affects all facets of life. Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns. In this editorial we comment the paper of Duke et al. The authors highlight the importance of maintaining a long-term monitoring of children who suffered burns. The importance of this original study is to promote the reconsideration of clinical guides of long-term follow-up of burn patients. PMID:26835375

  1. Spreading of genes encoding enterotoxins, haemolysins, adhesin and biofilm among methicillin resistant Staphylococcus aureus strains with staphylococcal cassette chromosome mec type IIIA isolated from burn patients.

    PubMed

    Motallebi, Mitra; Jabalameli, Fereshteh; Asadollahi, Kheirollah; Taherikalani, Morovat; Emaneini, Mohammad

    2016-08-01

    The emergence of antibiotic-resistant Staphylococcus aureus in particular methicillin-resistant S. aureus (MRSA) is an important concern in burn medical centers either in Iran or worldwide. A total of 128 S. aureus isolates were collected from wound infection of burn patients during June 2013 to June 2014. Multiplex-polymerase chain reaction (MPCR) assay was performed for the characterization of the staphylococcal cassette chromosome mec (SCCmec). Genes encoding virulence factors and biofilm were targeted by PCR. Of 128 S. aureus isolates, 77 (60.1%) isolates were MRSA. Fifty four (70.1%) isolates were identified as SCCmec type IIIA. The most frequently detected toxin genes among MRSA isolates with SCCmec type IIIA were sea (64.1%) and hla (51.8%). The rate of coexistence of sea with hla and sea with hla and hlb was 37% and12.9%, respectively. The sec, eta, tst, pvl, hla and hlb genes were not detected in any of the MRSA isolates. The most prevalent genes encoding biofilm was eno, found in 61.1% of isolates, followed by fib and icaA found in 48.1% and 38.8% of the isolates, respectively. The rate of coexistence of fib + eno + icaA + icaD and fib + eno was 20.3% and 9.2%, respectively. The ebps gene was not detected in any of the isolates. In conclusion, our study indicated that the sea, hla, fib and icaA were most frequent genes encoding virulence factors among MRSA with SCCmec type IIIA isolated from burn wound infection. Moreover, the results of this study shows that the rate of coexistence of genes encoding different virulence factor were high. PMID:27238459

  2. Coexistence of Extended Spectrum Beta-Lactamases, AmpC Beta-Lactamases and Metallo-Beta-Lactamases in Acinetobacter baumannii from burns patients: a report from a tertiary care centre of India

    PubMed Central

    Gupta, V.; Garg, R.; Garg, S.; Chander, J.; Attri, A.K.

    2013-01-01

    Summary Multidrug-resistant Acinetobacter baumanii is a major pathogen encountered in pyogenic infections, especially from burns patients in hospital settings. Often there is also coexistence of multiple beta-lactamase enzymes responsible for beta-lactam resistance in a single isolate, which further complicates treatment options. We conducted a study on burn wound pus samples obtained from the burns unit of our hospital. Phenotypic tests were used to determine the Extended Spectrum Beta-Lactamase, AmpC Beta-Lactamase and Metallo-Beta-Lactamase producing status of the isolates. Almost half of the samples from the burn wounds yielded Acinetobacter baumanii as the predominant pathogen (54.05%). Coexistence of the three resistance mechanisms was seen in 25 of the 100 (25%) isolates of Acinetobacter baumanii. This study emphasizes the need for the detection of isolates that produce these enzymes to avoid therapeutic failures and nosocomial outbreaks. PMID:24799848

  3. Coexistence of Extended Spectrum Beta-Lactamases, AmpC Beta-Lactamases and Metallo-Beta-Lactamases in Acinetobacter baumannii from burns patients: a report from a tertiary care centre of India.

    PubMed

    Gupta, V; Garg, R; Garg, S; Chander, J; Attri, A K

    2013-12-31

    Multidrug-resistant Acinetobacter baumanii is a major pathogen encountered in pyogenic infections, especially from burns patients in hospital settings. Often there is also coexistence of multiple beta-lactamase enzymes responsible for bet