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

PubMed

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

2017-01-01

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

A review of the burns caseload of a physician-based helicopter emergency medical service.

PubMed

Hall, Karina; Burns, Brian

2017-08-01

The aim of this study was to describe patient demographics, injuries, physiology and interventions performed by retrieval physicians in the care of burns patients in both a pre-hospital and interhospital setting. A retrospective review of patient records from a large Australian Helicopter Emergency Medical Service was conducted. Demographics, injury, burn type, physiology and intervention data were extracted into a database for statistical analysis. Basic descriptive statistics were calculated, and patient physiology measures were compared at arrival and destination. A total of 490 burns cases were identified from a 5 year period (January 2010-August 2015). The majority (78.6%) were interhospital transfers conducted by road (49.4%) or helicopter (36.9%). Patients were predominantly men (75.7%) with a median age of 37 years (interquartile range [IQR] 23-50). Median estimated total body surface area burned was 15% (IQR 8.5-20) and 18% (IQR 10-30) in pre-hospital and interhospital groups, respectively; however, retrieval physicians tended to overestimate total body surface area burned in comparison to destination burns units. Flash burn or explosion were the predominant aetiology of burn (49.4%), although the majority (95.3%) of patients had no associated traumatic injuries. Sixty patients were intubated by the Service. Escharotomies were performed on eight occasions resulting in improvement in circulation or ventilation. Overall mortality was 3.7% at 24 h. The Service cares for 80-100 burns patients annually, a proportion of whom require complex interventions such as intubation and escharotomy, which was performed by retrieval physicians appropriately. Associated traumatic injuries were infrequent in patients who sustained burns from flashes or explosions. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Developing a burn injury severity score (BISS): adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance.

PubMed

Cassidy, J Tristan; Phillips, Michael; Fatovich, Daniel; Duke, Janine; Edgar, Dale; Wood, Fiona

2014-08-01

There is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate. Data from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS). There were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2-10), and median age 36 years (IQR 23-50). The results show ISS is a good predictor of death for burns when ISS≤15 (OR 1.29, p=0.02), but not for ISS>15 (ISS 16-24: OR 1.09, p=0.81; ISS 25-49: OR 0.81, p=0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82-85%) and BISS of 95% (95% CI 92-98%), demonstrated superior performance of BISS as a mortality predictor for burns. ISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Effects of normal acceleration on transient burning rate augmentation of an aluminized solid propellant

NASA Technical Reports Server (NTRS)

Northam, G. B.

1972-01-01

Instantaneous burning rate data for a polybutadiene acrylic acid propellant, containing 16 weight percent aluminum, were calculated from the pressure histories of a test motor with 96.77 sq cm of burning area and a 5.08-cm-thick propellant web. Additional acceleration tests were conducted with reduced propellant web thicknesses of 3.81, 2.54, and 1.27 cm. The metallic residue collected from the various web thickness tests was characterized by weight and shape and correlated with the instantaneous burning rate measurements. Rapid depressurization extinction tests were conducted in order that surface pitting characteristics due to localized increased burning rate could be correlated with the residue analysis and the instantaneous burning rate data. The acceleration-induced burning rate augmentation was strongly dependent on propellant distance burned, or burning time, and thus was transient in nature. The results from the extinction tests and the residue analyses indicate that the transient rate augmentation was highly dependent on local enhancement of the combustion zone heat feedback to the surface by the growth of molten residue particles on or just above the burning surface. The size, shape, and number density of molten residue particles, rather than the total residue weight, determined the acceleration-induced burning rate augmentation.

Feasibility of an advanced thrust termination assembly for a solid propellant rocket motor

NASA Technical Reports Server (NTRS)

1975-01-01

A total of 68 quench tests were conducted in a vented bomb assembly (VBA). Designed to simulate full-scale motor operating conditions, this laboratory apparatus uses a 2-inch-diameter, end-burning propellant charge and an insulated disc of consolidated hydrated aluminum sulfate along with the explosive charge necessary to disperse the salt and inject it onto the burning surface. The VBA was constructed to permit variation of motor design parameters of interest; i.e., weight of salt per unit burning surface area, weight of explosive per unit weight of salt, distance from salt surface to burning surface, incidence angle of salt injection, chamber pressure, and burn time. Completely satisfactory salt quenching, without re-ignition, occurred in only two VBA tests. These were accomplished with a quench charge ratio (QCR) of 0.023 lb salt per square inch of burning surface at dispersing charge ratios (DCR) of 13 and 28 lb of salt per lb of explosive. Candidate materials for insulating salt charges from the rocket combustion environment were evaluated in firings of 5-inch-diameter, uncured end-burner motors. A pressed, alumina ceramic fiber material was selected for further evaluation and use in the final demonstration motor.

Improving the accuracy of burn-surface estimation.

PubMed

Nichter, L S; Williams, J; Bryant, C A; Edlich, R F

1985-09-01

A user-friendly computer-assisted method of calculating total body surface area burned (TBSAB) has been developed. This method is more accurate, faster, and subject to less error than conventional methods. For comparison, the ability of 30 physicians to estimate TBSAB was tested. Parameters studied included the effect of prior burn care experience, the influence of burn size, the ability to accurately sketch the size of burns on standard burn charts, and the ability to estimate percent TBSAB from the sketches. Despite the ability for physicians of all levels of training to accurately sketch TBSAB, significant burn size over-estimation (p less than 0.01) and large interrater variability of potential consequence was noted. Direct benefits of a computerized system are many. These include the need for minimal user experience and the ability for wound-trend analysis, permanent record storage, calculation of fluid and caloric requirements, hemodynamic parameters, and the ability to compare meaningfully the different treatment protocols.

Clinical and demographic features of pediatric burns in the eastern provinces of Turkey

PubMed Central

2011-01-01

Background The aim of this study is to perform a retrospective analysis of the causes of burns observed in children in the eastern provinces of Turkey. Method In this study, patients were studied retrospectively with regard to their age, sex, cause of burns, seasonal variations, social and economic factors, length of hospital stay, burned body surface area, medical history, site of injury, and mortality. Results A total of 125 patients undergoing inpatient treatment were male, (53.2%) and 110 were female (46.8%). The most common causes of burns in patients treated on an inpatient basis were scald burns (65.5%) and tandir burns (15.7%). The mean total body surface area of all the patients was 12.17+9.86%. When the patients were grouped according to tandir, cauldron, and others burn causes, a significant difference was seen between the in burn percentages caused by tandir and cauldron burns and other causes (p < 0.001). Higher burn percentages were seen for cauldron burns than for tandir burns (p < 0.05). The average length of hospital stay was 17.67+13.64 days. When the patients were grouped according to burn causes (tandir, cauldron, and others), a significant difference was determined between the hospitalization periods of patients with tandir burns and other burn causes (p = 0.001) The most commonly proliferating microorganism in burned areas was Pseudomonas aeruginosa (20.4%). Of the 235 patients, 61 were treated in operating rooms. During the 24-month period of the study, 2 of the 235 patients died (0.85%). Conclusion Pediatric burns in the eastern part of Turkey are different from those in other parts of Turkey, as well as in other countries. Due to the lifestyle of the region, tandir and cauldron burns, which cause extensive burn areas and high morbidity, are frequently seen in children. Therefore, precautions and educational programs related to the use of tandirs and cauldrons are needed in this region. PMID:21244683

Total body surface area overestimation at referring institutions in children transferred to a burn center.

PubMed

Swords, Douglas S; Hadley, Edmund D; Swett, Katrina R; Pranikoff, Thomas

2015-01-01

Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs (P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater (P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.

[Etiological analysis of subambient temperature burn in 351 cases of Hefei area].

PubMed

Shi, Jie; Qi, Weiwei; Xu, Qinglian; Zhou, Shunying; Wang, Guobao

2010-06-01

To study the preventive measure of the subambient temperature burn by analysing the pathogenesis feature. The clinical data were analysed from 351 cases of subambient temperature burn between February 2004 and February 2009, including age, sex, burn season, burn factors, burn position, burn area, burn degree, treatment way, and wound healing. Subambient temperature burn occurred in every age stage. The susceptible age stages included infant, children, and the elderly. Female patients were more than male patients. The common burn reasons were hot-water bottle burn, honey warm keeper burn, and heating device burn. The peak season was winter. Lower limb was the most common site of the subambient temperature burn. The deep II degree to III degree were the most common level, and the burn area was always small, often < or = 1% of total body surface area. Most of patients were treated with changing dressings at clinic and few patients needed hospitalization. Though the surface of wound could heal finally, and the wound healed well with no obvious scar in patients who received operation. Subambient temperature burn is the frequently encountered disease in winter. Use of the warming articles should be cautious, at the same time safety awareness should be strengthened so as to decrease the incidence rate of subambient temperature burn and the injury degree.

Relationship between Slivering Point and Gas Generation Rules of 19-Perforation TEGDN Propellants with Different Length/Outside Diameter Ratios and Perforation Diameters

NASA Astrophysics Data System (ADS)

Xiao, Zhenggang; Xu, Fuming

2018-04-01

In order to investigate the relationship between the slivering point and burning progressivity, a set of 19-perforation propellants containing triethylene glycol dinitrate (TEGDN) with different lengths/outside diameter ratios and perforation diameters was prepared and tested in a closed vessel. The mass fraction of burnt propellant was derived from the recorded pressure-time history of 19-perforation TEGDN propellants in the closed vessel according to the gas state equation and the form function of tested propellants. Based on the form function calculation and the mass fraction of burnt propellant, instantaneous burning surface area and the burning rate were obtained. The influence of length/outside diameter ratios and perforation diameters on the progressive combustion performance is studied through the dynamic vivacity method. With an increase in the length/outsider diameter, the slivering point occurs earlier and the slivering process lasts longer. Further, the burning progressivity of surface area can be improved. For propellants with same length/outside diameter ratio, with a decreasing of perforation diameter, the slivering point lags behind and the burning progressivity becomes greater. The slivering point corresponds to the instantaneous burning area, which is related to the form function and total burning process as well. However, the total burning progressivity of propellant is a very comprehensive result of propellant under multiple actions, including the mass fraction of burnt propellant, grain size and burning rate at different pressure regions. The correlation between them can boost a better understanding on the interaction between grain size, slivering burning process and burning progressivity.

Assault by burning in Jordan.

PubMed

Haddadin, W

2012-12-31

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

Assault by burning in Jordan

PubMed Central

Haddadin, W.

2012-01-01

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

Epidemiology and financial implications of self-inflicted burns.

PubMed

George, S; Javed, M; Hemington-Gorse, S; Wilson-Jones, N

2016-02-01

The cost of the treatment of burns is high especially in self-inflicted burns with prolonged treatment. We performed a retrospective review of the self-inflicted burns at our regional burns centre to determine the costs incurred in their management and to identify factors which could reduce the financial burden in the future. The data was collected retrospectively of all the inpatient and outpatient self-inflicted burns presenting to our regional burns centre in the year 2011. Twenty one patients (out of a total of 870 patients) presented with self-inflicted burns to our centre in 2011. Five (23.8%) were major burns with an average of 53.2% Total Body Surface Area (TBSA) and 16 (76.2%) were minor burns with an average of 0.5% TBSA. 11 (52.4%) patients had flame burns including 4 self-immolation burns. The mortality rate was 4.8% (n=1). Five (23.8%) patients underwent surgical treatment. Seven (33.3%) patients were treated in intensive care and with average stay of 46.85 days. Critical care and theatre attendances made up most of the costs with average ICU stay per patient calculated at £313,131/day. The total cost of all 21 patients was £1,581,856. Burns are preventable injuries, early detection and intervention in patients with propensity to self-inflict burns can possibly reduce the costs of treatment in the future. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Combat-related facial burns: analysis of strategic pitfalls.

PubMed

Johnson, Benjamin W; Madson, Andrew Q; Bong-Thakur, Sarah; Tucker, David; Hale, Robert G; Chan, Rodney K

2015-01-01

Burns constitute approximately 10% of all combat-related injuries to the head and neck region. We postulated that the combat environment presents unique challenges not commonly encountered among civilian injuries. The purpose of the present study was to determine the features commonly seen among combat facial burns that will result in therapeutic challenges and might contribute to undesired outcomes. The present study was a retrospective study performed using a query of the Burn Registry at the US Army Institute of Surgical Research Burn Center for all active duty facial burn admissions from October 2001 to February 2011. The demographic data, total body surface area of the burn, facial region body surface area involvement, and dates of injury, first operation, and first facial operation were tabulated and compared. A subset analysis of severe facial burns, defined by a greater than 7% facial region body surface area, was performed with a thorough medical record review to determine the presence of associated injuries. Of all the military burn injuries, 67.1% (n = 558) involved the face. Of these, 81.3% (n = 454) were combat related. The combat facial burns had a mean total body surface area of 21.4% and a mean facial region body surface area of 3.2%. The interval from the date of the injury to the first operative encounter was 6.6 ± 0.8 days and was 19.8 ± 2.0 days to the first facial operation. A subset analysis of the severe facial burns revealed that the first facial operation and the definitive coverage operation was performed at 13.45 ± 2.6 days and 31.9 ± 4.1 days after the injury, respectively. The mortality rate for this subset of patients was 32% (n = 10), with a high rate of associated inhalational injuries (61%, n = 19), limb amputations (29%, n = 9), and facial allograft usage (48%, n = 15) and a mean facial autograft thickness of 10.5/1,000th in. Combat-related facial burns present multiple challenges, which can contribute to suboptimal long-term outcomes. These challenges include prolonged transport to the burn center, delayed initial intervention and definitive coverage, and a lack of available high-quality color-matched donor skin. These gaps all highlight the need for novel anti-inflammatory and skin replacement strategies to more adequately address these unique combat-related obstacles. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

Utility of Gram stain for the microbiological analysis of burn wound surfaces.

PubMed

Elsayed, Sameer; Gregson, Daniel B; Lloyd, Tracie; Crichton, Marilyn; Church, Deirdre L

2003-11-01

Surface swab cultures have attracted attention as a potential alternative to biopsy histology or quantitative culture methods for microbiological burn wound monitoring. To our knowledge, the utility of adding a Gram-stained slide in this context has not been evaluated previously. To determine the degree of correlation of Gram stain with culture for the microbiological analysis of burn wound surfaces. Prospective laboratory analysis. Urban health region/centralized diagnostic microbiology laboratory. Burn patients hospitalized in any Calgary Health Region burn center from November 2000 to September 2001. Gram stain plus culture of burn wound surface swab specimens obtained during routine dressing changes or based on clinical signs of infection. Degree of correlation (complete, high, partial, none), including weighted kappa statistic (kappa(w)), of Gram stain with culture based on quantitative microscopy and degree of culture growth. A total of 375 specimens from 50 burn patients were evaluated. Of these, 239 were negative by culture and Gram stain, 7 were positive by Gram stain only, 89 were positive by culture only, and 40 were positive by both methods. The degree of complete, high, partial, and no correlation of Gram stain with culture was 70.9% (266/375), 1.1% (4/375), 2.4% (9/375), and 25.6% (96/375), respectively. The degree of correlation for all 375 specimens, as expressed by the weighted kappa statistic, was found to be fair (kappa(w) = 0.32).Conclusion.-The Gram stain is not suitable for the microbiological analysis of burn wound surfaces.

Report From the California Burn Registry—The Causes of Major Burns

PubMed Central

Bongard, Frederic S.; Ostrow, Louis B.; Sacks, Susan T.; McGuire, Andrew; Trunkey, Donald D.

1985-01-01

In its first four years of operation, the California Burn Registry recorded 3,332 cases of burns, of which 73.1% were in male and 26.9% were in female patients of all ages. The average total body surface area burned was 15.4±0.3%. Flame burns were the most common (31.4%). Other common sources included scalds (24.5%) and flammable liquids (12.9%). Several other causes were cited with less frequency. Burns taking place at home occurred more commonly than at all other locations combined. In all, 221 deaths (6.6%) were reported, most (66.1%) of which were due to flame burns. PMID:4013280

Prognostic factors in electrical burns: a review of 101 patients.

PubMed

Saracoglu, Ayten; Kuzucuoglu, Tamer; Yakupoglu, Sezer; Kilavuz, Oguzhan; Tuncay, Erhan; Ersoy, Burak; Demirhan, Recep

2014-06-01

Electrical burn wounds are among the most devastating of burns, with wide-ranging injuries. We aimed to document the factors affecting the mortality rate of patients presenting with electrical burn wounds to our regional burn centre. This retrospective study was conducted on 101 patients from January 2009 to June 2012. Factors were classified under 11 topics and evaluated according to their relationship with the mortality rate. The major causes of death in burn victims were multiple organ failure and infection. Twenty-six percent of the 101 patients died, all of whom were male. One (1.4%) of the patients who survived was female; 73 (98.6%) survivors were male. The mean age in the deceased group was statistically higher than that of the other patients (32.7 vs. 35.6 years; P < 0.05). All-cause mortality was 2.79 times higher for larger burns (> 25% total body surface area). The values for creatine kinase, creatine kinase-MB, total body surface area of burn, hospitalised period in the intensive care unit and intubation rate were significantly higher in the exitus group. Renal injury requiring haemofiltration was associated with an almost 12-fold increased risk for mortality. There was no statistically significant difference between patients regarding surgical interventions. Electrical injury remains a major cause of mortality and long-term disability among young people. Our data demonstrated several risk factors associated with increased mortality rate in patients with electrical burn wounds. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?

PubMed

Cheah, A K W; Kangkorn, T; Tan, E H; Loo, M L; Chong, S J

2018-01-01

Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation-Rule of Palm, Rule of Nines and the Lund and Browder chart. Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects' burn percentages. Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities ( p  < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.

An epidemiological analysis of paediatric burns in urban and rural areas in south central China.

PubMed

Zhou, Bo; Zhou, Xiao; Ouyang, Li-zhi; Huang, Xiao-yuan; Zhang, Pi-hong; Zhang, Ming-hua; Ren, Li-cheng; Liang, Peng-fei

2014-02-01

This study aims to analyse the epidemiology of paediatric burns in south central China, illustrate the differences between rural and urban areas, and discern prevention measures to reduce paediatric burns. Data were obtained from all paediatric patients admitted to Department of Burns unit of Xiangya Hospital during 2009-2012. A retrospective review was performed, including cause of burn, pre-hospital treatment, place of burn occurrence, anatomical areas involved, extent of burn, date of injury, number of operations, complications, length of hospital stay, hospitalisation cost and cure rate. A total of 278 hospitalised paediatric patients were admitted in this study. The majority (56.47%) were 1-3 years old. Rural patients accounted for 67.99% in total; the ratio of boys to girls was 2.05. Scalding with hot fluids was the most common cause of burns in children (62.59%), followed by flame (17.63), fireworks (9.71%), electricity (5.76%) and other factors such as contact and chemical (4.32%). The living room was the location with the highest frequency of burns in children (53.24%). Burns were more likely to happen in winter and the upper extremities were the most involved anatomic site (53.24%). Total burn surface area (TBSA) ranging from 0% to 9% accounted for 55.4% in total. Rural patients underwent more operations and had longer and costlier hospital stays than urban patients. Compared with treatment in urban areas, rural burn patients received less first-aid treatment, underwent more surgery, had more complications and longer and more costly hospital stays. This finding strongly suggests that it is necessary to make more efforts to prevent burns, especially in rural areas. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Hand burns surface area: A rule of thumb.

PubMed

Dargan, Dallan; Mandal, Anirban; Shokrollahi, Kayvan

2018-08-01

Rapid estimation of acute hand burns is important for communication, standardisation of assessment, rehabilitation and research. Use of an individual's own thumbprint area as a fraction of their total hand surface area was evaluated to assess potential utility in hand burn evaluation. Ten health professionals used an ink-covered dominant thumb pulp to cover the surfaces of their own non-dominant hand using the contralateral thumb. Thumbprints were assessed on the web spaces, sides of digits and dorsum and palm beyond the distal wrist crease. Hand surface area was estimated using the Banerjee and Sen method, and thumbprint ellipse area calculated to assess correlation. Mean estimated total hand surface area was 390.0cm 2 ±SD 51.5 (328.3-469.0), mean thumbprint ellipse area was 5.5cm 2 ±SD 1.3 (3.7-8.4), and mean estimated print number was 73.5±SD 11.0 (range 53.1-87.8, 95% CI 6.8). The mean observed number of thumbprints on one hand was 80.1±SD 5.9 (range 70.0-88.0, 95% CI 3.7), χ 2 =0.009. The combined mean of digital prints was 42, comprising a mean of two prints each on volar, dorsal, radial and ulnar digit surfaces, except volar middle and ring (3 prints each). Palmar prints were 15 (11-19), dorsal 15 (11-19), ulnar palm border 3, first web space 2, and second, third and fourth web spaces one each. Using the surface of the palm alone, excluding digits, as 0.5% of total body surface area, the area of one thumbprint was approximated as 1/30th of 1%. We have demonstrated how thumbprint area serves as a simple method for evaluating hand burn surface area. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

The burning issue of white phosphorus: a case report and review of the literature.

PubMed

Aviv, Uri; Kornhaber, Rachel; Harats, Moti; Haik, Josef

2017-01-01

Burns from white phosphorus are rare and remain a challenge for clinicians. White phosphorus burns are often associated with smaller surface areas and high morbidity rates. Classed as a chemical burn, white phosphorus is used for military purposes and within industry, for the manufacture of fireworks and agricultural products. In this report, we discuss the case of a 40 years old female who sustained 2% Total Body Surface Area partial to full thickness burns from white phosphorus. The burns were treated conservatively with mafenide acetate on the medial calf and dorsum of foot and Flaminal Forte was used for the palmar region. The patient was discharged 22 days after admission and followed up in the outpatient clinic. Despite the use of pressure garments, hypertrophic scarring began to develop on the dorsum of her right foot. During peacetime, white phosphorus possess a significant danger to civilians. Awareness of the unique nature of white phosphorus among military burn clinicians should be emphasized.

Long-term survival after burns in a Swedish population.

PubMed

Pompermaier, Laura; Steinvall, Ingrid; Fredrikson, Mats; Thorfinn, Johan; Sjöberg, Folke

2017-02-01

As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns. We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors. Age and a full-thickness burn were significantly associated with mortality after discharge (p<0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up. Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

A Model to Improve Detection of Nonaccidental Pediatric Burns.

PubMed

Nigro, Lauren C; Feldman, Michael J; Foster, Robin L; Pozez, Andrea L

2018-06-01

Pediatric burn patients warrant thorough evaluation because a sizeable proportion of pediatric burns are nonaccidental. A multidisciplinary method involving an internal child protection team (CPT) was developed and used to identify suspected nonaccidental pediatric burns in all pediatric burn patients 5 years of age or younger who were evaluated by the CPT and social workers at our institution over a 55-month period. We identified 343 cases for review that fit our age criteria, 6 of which we identified as cases of suspected abuse or neglect. On average, these patients were younger, suffered greater total body surface area burns (TBSA), and required a longer length of stay in the hospital than the total population. We have not had readmissions for repeat nonaccidental pediatric burn injuries in this group of patients since this model was implemented. Our multidisciplinary method might provide a more consistent and reliable method for identifying cases of suspected abuse. © 2018 American Medical Association. All Rights Reserved.

Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis.

PubMed

Levi, Benjamin; Jayakumar, Prakash; Giladi, Avi; Jupiter, Jesse B; Ring, David C; Kowalske, Karen; Gibran, Nicole S; Herndon, David; Schneider, Jeffrey C; Ryan, Colleen M

2015-11-01

Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30% total body surface area burn had 11.5 times higher odds of developing HO (p < 0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p < 0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p < 0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Risk factors for HO development include greater than 30% total body surface area burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. Prognostic study, level III.

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

PubMed

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

2014-02-01

To better characterize national genital burns (GBs) characteristics using a large burn registry. We hypothesized that mortality and morbidity will be higher in patients with GBs. The National Burn Repository, a large North American registry of hospitalized burn patients, was queried for patients with GB. Burn characteristics and mechanism, demographics, mortality, and surgical interventions were retrieved. Outcomes of interest were mortality, hospital-acquired infection (HAI), and surgical intervention on the genitalia. Adjusted odds ratios (aOR) for outcomes were determined with binomial logistic regression controlling for age, total burn surface area, race, length of stay, gender, and inhalation injury presence. GBs were present in 1245 cases of 71,895 burns (1.7%). Patients with GB had significantly greater average total burn surface area, length of stay, and mortality. In patients with GB, surgery of the genitalia was infrequent (10.4%), with the aOR of receiving surgery higher among men (aOR 2.7, P <.001) and those with third-degree burns (aOR 3.1, P <.002). Presence of a GB increased the odds of HAI (aOR 3.0, P <.0001) and urinary tract infections (aOR 3.4, P <.0001). GB was also an independent predictor of mortality (aOR 1.54) even after adjusting for the increased HAI risk. GBs are rare but associated with higher HAI rates and higher mortality after adjusting for well-established mortality risk factors. Although a cause and effect relationship cannot be established using these registry data, we believe this study suggests the need for special management considerations in GB cases to improve overall outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis.

PubMed

Eljaiek, Roberto; Heylbroeck, Christophe; Dubois, Marc-Jacques

2017-02-01

The objective was to systematically review the literature summarizing the effect on mortality of albumin compared to non-albumin solutions during the fluid resuscitation phase of burn injured patients. We searched MEDLINE, EMBASE and CENTRAL and the content of two leading journals in burn care, Burns and Journal of Burn Care and Research. Two reviewers independently selected randomized controlled trials comparing albumin vs. non-albumin solutions for the acute resuscitation of patients with >20% body surface area involvement. Reviewers abstracted data independently and assessed methodological quality of the included trials using predefined criteria. A random effects model was used to assess mortality. We identified 164 trials of which, 4 trials involving 140 patients met our inclusion criteria. Overall, the methodological quality of the included trials was fair. We did not find a significant benefit of albumin solutions as resuscitation fluid on mortality in burn patients (relative risk (RR) 1.6; 95% confidence interval (CI), 0.63-4.08). Total volume of fluid infusion during the phase of resuscitation was lower in patients receiving albumin containing solution -1.00ml/kg/%TBSA (total body surface area) (95% CI, -1.42 to -0.58). The pooled estimate demonstrated a neutral effect on mortality in burn patients resuscitated acutely with albumin solutions. Due to limited evidence and uncertainty, an adequately powered, high quality trial could be required to assess the impact of albumin solutions on mortality in burn patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Epidemiology of pediatric burns in southwest China from 2011 to 2015.

PubMed

Li, Haisheng; Wang, Song; Tan, Jianglin; Zhou, Junyi; Wu, Jun; Luo, Gaoxing

2017-09-01

Burns are a major form of injury in children worldwide. This study aimed to investigate the epidemiology, outcome, cost and risk factors of pediatric burns in southwest China. This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University from 2011 to 2015. Data, including demographic, injury-related, and clinical data and patient outcome, were collected from medical records. A total of 2478 children with burns (58.03% boys), accounting for 39.2% of total burn patients, were included. The average age of the burn patients was 2.86±2.86years, and most patients (85.55%) were under five years old. The incidence of burns peaked in January, February and May. Scald burns were the most frequent (79.06%), followed by flame burns (14.0%) and electrical burns (3.35%). Limbs were the most common burn sites (69.73%), and the average total body surface area (TBSA) was 11.57±11.61%. The percentage of children who underwent operations and the number of operations were significantly increased in cases of electrical burns, the older-age group, a larger TBSA and full-thickness burns. Six deaths were recorded, yielding a mortality of 0.24%. The median length of stay and cost were 14days and 9541 CNY, respectively, and the major risk factors for length of stay and cost were the TBSA, number of operations, full-thickness burns and outcome. In southwest China, among children under five years old, scald and flame burns should become the key prevention target, and future prevention strategies should be based on related risk factors. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

A review of burns patients admitted to the Burns Unit of Hospital Universiti Kebangsaan Malaysia.

PubMed

Chan, K Y; Hairol, O; Imtiaz, H; Zailani, M; Kumar, S; Somasundaram, S; Nasir-Zahari, M

2002-12-01

This is a retrospective review of 110 patients admitted to the Burns Units between October 1999 and November 2001. The aim was to determine the burns pattern of patients admitted to hospital UKM. There was an increasing trend for patients admitted. Female to male ratio was 1:2. Children consisted 34% of the total admission. Children had significant higher number of scald burns as compare to adult (p < 0.01). Domestic burns were consist of 75% overall admission. Mean percentage of TBSA (total body surface area) burns was 19%. Thirty percent of patients sustained more than 20% of TBSA. Sixty percent of patients had scald burns. Ninety percents of patients with second degree burns that were treated with biologic membrane dressing or split skin graft. Mean duration of hospital stay was 10 days. Over 70% of patients were discharged within 15 days. Overall mortality rate was 6.3%. The patients who died had significantly larger area of burns of more than 20% TBSA (p < 0.05) and a higher incidence of inhalation injury (p < 0.02). Hence, this study suggests a need for better preventive measures by the authority to prevent burns related accident and the expansion of the service provided by the Burns Unit.

In-Situ and Remotely-Sensed Observations of Biomass Burning Aerosols at Doi Ang Khang, Thailand During 7-SEAS BASELInE 2015

NASA Technical Reports Server (NTRS)

Sayer, Andrew M.; Hsu, N. Christina; Hsiao, Ta-Chih; Pantina, Peter; Kuo, Ferret; Ou-Yang, Chang-Feng; Holben, Brent N.; Janjai, Serm; Chantara, Somporn; Wang, Sheng-Hsiang;

The short-term effects of prescribed burning on biomass removal and the release of nitrogen and phosphorus in a treatment wetland.

PubMed

White, J R; Gardner, L M; Sees, M; Corstanje, R

2008-01-01

Nutrient removal by constructed wetlands can decline over time due to the accumulation of organic matter. A prescribed burn is one of many management strategies used to remove detritus in macrophyte-dominated systems. We quantified the short-term effects on effluent water quality and the amount of aboveground detritus removed from a prescribed burn event. Surface water outflow concentrations were approximately three times higher for P and 1.5 times higher for total Kjeldhal nitrogen (TKN) following the burn event when compared to the control. The length of time over which the fire effect was significant (P < 0.05), 3 d for TKN and up to 23 d for P fractions. Over time, the concentration of soluble reactive phosphorus (SRP) in the effluent decreased, but was compensated with increases in dissolved organic phosphorus (DOP) and particulate phosphorus (PP), such that net total P remained the same. Total aboveground biomass decreased by 68.5% as a result of the burn, however, much of the live vegetation was converted to standing dead material. These results demonstrate that a prescribed burn can significantly decrease the amount of senescent organic matter in a constructed wetland. However, short-term nutrient releases following the burn could increase effluent nutrient concentrations. Therefore, management strategies should include hydraulically isolating the burned area immediately following the burn event to prevent nutrient export.

Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients.

PubMed

Clemens, Michael S; Stewart, Ian J; Sosnov, Jonathan A; Howard, Jeffrey T; Belenkiy, Slava M; Sine, Christy R; Henderson, Jonathan L; Buel, Allison R; Batchinsky, Andriy I; Cancio, Leopoldo C; Chung, Kevin K

2016-10-01

To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients. Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation. A 16-bed burn ICU at tertiary military teaching hospital. Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011. None. A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality. Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.

Determination of burning area and port volume in complex burning regions of a solid rocket motor

NASA Technical Reports Server (NTRS)

Kingsbury, J. A.

1977-01-01

An analysis of the geometry of the burning in both star-cylindrical port interface regions and regions of partially inhibited slots is presented. Some characteristics parameters are defined and illustrated. Methods are proposed for calculating burning areas which functionally depend only on the total distance burned. According to this method, several points are defined where abrupt changes in geometry occur, and these are tracked throughout the burn. Equations are developed for computing port perimeter and port area at pre-established longitudinal positions. Some common formulas and some newly developed formulas are then used to compute burning surface area and port volume. Some specific results are presented for the solid rocket motor committed to the space shuttle project.

Burns caused by flambé foods.

PubMed

Peters, W; Knighton, J

1993-01-01

From 1978 to 1990, five patients were admitted to the hospital for treatment of burns that were sustained during the preparation of flambé foods in restaurants. Three patients were patrons, and two were waiters. The average body surface area involved was 14% (range 10% to 18%). The average area of full-thickness burn was 3% (0% to 10%). All patrons required long-term psychologic support and were involved with lengthy and expensive litigation proceedings. The two waiters lost a total of 5 months from work. Although these injuries are quite rare, it is hoped that they can be totally prevented by adherence to certain safety guidelines.

Predicting the proportion of full-thickness involvement for any given burn size based on burn resuscitation volumes.

PubMed

Liu, Nehemiah T; Salinas, José; Fenrich, Craig A; Serio-Melvin, Maria L; Kramer, George C; Driscoll, Ian R; Schreiber, Martin A; Cancio, Leopoldo C; Chung, Kevin K

2016-11-01

The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes. We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation. We defined the degree of FT involvement as FT Index (FTI; percentage of FT injury/percentage of total body surface area (TBSA) burned [%FT / %TBSA]) and compared variables on actual 24-hour fluid resuscitation volumes overall as well as for any given burn size. A total of 203 patients admitted to our burn center during the study period were included in the analysis. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean %TBSA was 41 ± 20 with a mean %FT of 18 ± 24. As %TBSA, %FT, and FTI increased, so did actual 24-hour fluid resuscitation volumes (mL/kg). However, increase in FTI did not result in increased volume indexed to burn size (mL/kg per %TBSA). This was true even when patients with inhalation injury were excluded. Further investigation revealed that as %TBSA increased, %FT increased nonlinearly (quadratic polynomial) (R = 0.994). Total burn size and FT burn size were both highly correlated with increased 24-hour fluid resuscitation volumes. However, FTI did not correlate with a corresponding increase in resuscitation volumes for any given burn size, even when patients with inhalation injury were excluded. Thus, there are insufficient data to presume that those who receive more volume at any given burn size are likely to be mostly full thickness or vice versa. This was influenced by a relatively low sample size at each 10%TBSA increment and larger burn sizes disproportionately having more FT burns. A more robust sample size may elucidate this relationship better. Therapeutic/care management study, level IV.

Perineal tap water burns in the elderly: at what cost?

PubMed

Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

2017-11-01

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

The epidemiology of pediatric burns undergoing intensive care in Burn Centre Brno, Czech Republic, 1997-2009.

PubMed

Lipový, B; Brychta, P; Gregorová, N; Jelínková, Z; Rihová, H; Suchánek, I; Kaloudová, Y; Mager, R; Krupicová, H; Martincová, A

2012-08-01

The aim of this study was to determine the basic epidemiological characteristics of severely burned children who were admitted to the intensive care unit (ICU), Department of Burns and Reconstructive Surgery Faculty Hospital Brno, Czech Republic in the years 1997-2009. We collected and evaluated epidemiological data such as age, sex, burn etiology, length of hospitalization, duration of the ICU stay, surgical or conservative therapeutic strategies, the use of mechanical ventilation and its duration, day and month of injury and the extent of burned area. In total 383 children (253 boys, 130 girls) aged 0-14 years, underwent intensive care for at least 48h. Male to female ratio was 1.95:1. The average range of burn area in the group was 16.43±12.86% TBSA (total body surface area). During the reporting period, 16 children were admitted with burns over 50% TBSA. 328 children suffered burns indoors, with 55 children being burned outdoors. Indoor/outdoor ratio was set at 5.96:1. The most frequent etiological agent was scalding (hot water, soup, coffee, oil, tea). The total number of scalded children in this group was 312 (81.46%). Mechanical ventilation was used in 96 cases (25.07% of all the admitted patients). The duration of mechanical ventilation in these patients was 8.03±5.67 days in average. The average length of stay in ICU was 10.71±10.92 days and total length of hospital stay was an average of 21.55±14.55 days. A total of 184 patients (48.04%) were treated surgically and therefore required necrectomy and skin grafting. The other 199 (51.96%) patients were treated conservatively. During the reporting period 3 children died (0.78%). In our report we identify basic epidemiological data defined in the aim of this study for burned children requiring intensive care. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Cultured allogenic keratinocytes for extensive burns: a retrospective study over 15 years.

PubMed

Auxenfans, Celine; Shipkov, Hristo; Bach, Christine; Catherine, Zulma; Lacroix, Pierre; Bertin-Maghit, Marc; Damour, Odile; Braye, Fabienne

2014-02-01

The aim was to review the use and indications of cultured allogenic keratinocytes (CAlloK) in extensive burns and their efficiency. This retrospective study comprised 15 years (1997-2012). all patients who received CAlloK. patients who died before complete healing. Evaluation criteria were clinical. Time and success of wound healing after CAlloK use were evaluated. The CAlloK were used for 2 indications - STSG donor sites and deep 2nd degree burns in extensively burned patients. A total of 70 patients were included with severity Baux score of 99.2 (from 51 to 144) and mean percentage of TBSA of 63.49% (from 21 to 96%). Fifty nine patients received CAlloK for STSG donor sites with a mean number of applications of 4 and mean surface of 3800 cm(2) per patient. Treated donor sites were re-harvested 2.5 times. The mean time of complete epithelialization was 7 days. In 11 patients, CAlloK were used for deep 2nd degree burns. The mean percentage of burned surface was 73.7%. The mean surface of CAlloK per patient was 2545 cm(2). Complete healing was achieved in 6.4 days. The CAlloK allow rapid healing of STSG donor-sites and deep 2nd second degree burns in extensively burned patients. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland

PubMed Central

Rohrer-Mirtschink, S.; Forster, N.; Giovanoli, P.; Guggenheim, M.

2015-01-01

Summary In Switzerland it is customary to light candles on Christmas trees and advent wreaths. This tradition leads to an increased risk of home fires. We reviewed the records of patients who sustained burn injuries from a lit Christmas tree or advent wreath during the Christmas holidays between January 1971 and January 2012. We treated 28 patients and observed 4 fatalities (mortality rate: 14%). 61% of the patients were male, 39% were female. The mean abbreviated burn severity index (ABSI) was 6.5 points in the group of the survivors and 10.8 points in the group of the non-survivors. The mean total body surface area burned (TBSA) for survivors was 18.9%, with 14.1% having full thickness burns; for the non-survivors the mean TBSA was 45.2%, with 38% having full thickness burns. The Mann-Whitney U-test showed a significant difference between the survivors and the fatalities concerning the mean total and full thickness burned body surface area (p value 0.009 and 0.012). More than sixty percent of the fires occurred in January and the most severe accidents were seen after January 4th. Despite Christmas decoration-associated fires being relatively uncommon, they tend to cause more serious injuries than regular household fires. We recommend that in countries where it is customary to set up flammable Christmas decorations, state-issued information pamphlets with instructions on fire safety conduct should be distributed. PMID:26668566

[Clinical and biological monitoring of nutritional status in severe burns].

PubMed

Bargues, L; Cottez-Gacia, S; Jault, P; Renard, C; Vest, P

2009-01-01

Burn patients are subject to hypermetabolism and catabolic states. Aim was to evaluate our current practice in nutrition. Twenty-one severely burned patients were prospectively included during three months period. Body weight was measured at least two times in a week during all stay in burn ICU. Biological markers of inflammation (C-reactive protein, CRP) and nutrition (prealbumin) were performed weekly. Protocol included early nasogastric feeding, tolerated gastric stasis less than 250 mL at four hours nasogastric aspirations, caloric target value of 40 Kcal/kg per day and measurement of total daily calorie intakes. Patient demographics showed a mean percent total body surface burn of 51.1+/-27 % (range 20-90), age of 38.7+/-13.1 years (range 18-67) and 57.3 % of smoke inhalation. All patients were ventilated and 19 patients survived. Length of stay was 75.7+/-47 days (range 22-184). Patients received only 58.9+/-10 % of calorie intakes recommended by French burn society. Loss of body mass was 15.2+/-9 kg (range 3-31) or 19.1+/-10 % of admission weight (range 5-37). Erosion of body mass was not correlated with burned surface (p=0.08), calorie intakes (p=0.26), smoke inhalation (p=0.46), lengths of stay (p=0.53), lengths of ventilation (p=0.08) or nutrition (p=0.12), days of antibiotic (p=0.72), number of dressing changes (p=0.6) or surgery (p=0.64). Biological parameters showed CRP decreasing and prealbumin improving values. New strategies of nutrition are necessary to improve outcome and reduce body mass loss in burns.

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

PubMed

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

2013-12-01

Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age--17% for 0-18 year olds, 24% for 19-60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0-18 years old, 79% in patients 19-60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed Central

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

2013-01-01

Background Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. Methods This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. Results A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age—17% for 0–18 year olds, 24% for 19–60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0–18 years old, 79% in patients 19–60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Discussion Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative. PMID:23768710

Predicting resource utilization of elderly burn patients in the baby boomer era.

PubMed

Richards, Winston T; Richards, Winston A; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W; Ang, Darwin N

2013-01-01

Census predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group. Using the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors. Using US Census Bureau data and burn incidence rates from this dataset, we estimated future resource use. Elderly patients were discharged to home less often and were discharged to short-term general hospitals, intermediate-care facilities, and skilled nursing facilities more often than the other age groups (P < .05). They also required home health care and intravenous medications significantly more often (P < .05). Their length of stay was longer, and total hospital charges were greater (P < .05) after adjusting for sex, race, Charleson comorbidity index, payer, total body surface area burned, and burn center treatment. Our data show an age-dependent increase in the use of posthospitalization resources, the length of stay, and the total charges for elderly burn patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Survival of Burns Involving 90% of the Total Body Surface Area After Treatment With Autologous Engineered Skin Substitutes

DTIC Science & Technology

2008-12-01

during acute hospitalization, and can result in long-term morbidity from scars . In this study, autologous ESS were compared with split-thickness...meshed skin autograft treatment of two pediatric patients with burns of 90% TBSA or greater, and evaluated qualitatively for formation of scar , and...populations ( Armour et al. 2007). Availability of ESS for treatment of extensive, deep burns may reduce time to wound closure, morbidity and

In-situ burning of oil in coastal marshes. 2. Oil spill cleanup efficiency as a function of oil type, marsh type, and water depth.

PubMed

Lin, Qianxin; Mendelssohn, Irving A; Carney, Kenneth; Miles, Scott M; Bryner, Nelson P; Walton, William D

2005-03-15

In-situ burning of spilled oil, which receives considerable attention in marine conditions, could be an effective way to cleanup wetland oil spills. An experimental in-situ burn was conducted to study the effects of oil type, marsh type, and water depth on oil chemistry and oil removal efficiency from the water surface and sediment. In-situ burning decreased the totaltargeted alkanes and total targeted polycyclic aromatic hydrocarbons (PAHs) in the burn residues as compared to the pre-burn diesel and crude oils. Removal was even more effective for short-chain alkanes and low ring-number PAHs. Removal efficiencies for alkanes and PAHs were >98% in terms of mass balance although concentrations of some long-chain alkanes and high ring-number PAHs increased in the burn residue as compared to the pre-burn oils. Thus, in-situ burning potentially prevents floating oil from drifting into and contaminating adjacent habitats and penetrating the sediment. In addition, in-situ burning significantly removed diesel oil that had penetrated the sediment for all water depths. Furthermore, in-situ burning at a water depth 2 cm below the soil surface significantly removed crude oil that had penetrated the sediment. As a result, in-situ burning may reduce the long-term impacts of oil on benthic organisms.

Epidemiology and outcome analysis of hand burns: A 5-year retrospective review of 378 cases in a burn center in Eastern China.

PubMed

Wang, Kang-an; Sun, Yu; Wu, Guo-sheng; Wang, Yi-ru; Xia, Zhao-fan

2015-11-01

Hands are frequent sites of burn but few related studies were reported in China. The aim of this study was to examine the impacts of gender, age, seasons, place, etiology, total body surface area (TBSA), depth, infection and comorbidities on prognosis following injury in a cohort of hand burn inpatients. This is a retrospective study of total 378 inpatients admitted to the burn center of Changhai hospital from January 2009 to December 2013. The present research showed the male inpatients were predominant and most of the inpatients aged from 20 to 49. Flame (37.04%) and electricity (25.40%) were the major causes of hand burns. Hand burns happened more commonly in work place (60.85%). The study preliminarily pointed out that male, flame and depth were the most significant factors impacting surgery. The main factors relevant to amputation were identified including the electrical burns and other etiology of burns. In addition, depth of hand burns was proved to have a higher impact on length of hospital stay (LOS) than other factors. The results of this study not only provide the necessary information of hand burns in Eastern China but also give the suggestions for the prevention of hand burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Experimental Investigation of Premixed Turbulent Hydrocarbon/Air Bunsen Flames

NASA Astrophysics Data System (ADS)

Tamadonfar, Parsa

Through the influence of turbulence, the front of a premixed turbulent flame is subjected to the motions of eddies that leads to an increase in the flame surface area, and the term flame wrinkling is commonly used to describe it. If it is assumed that the flame front would continue to burn locally unaffected by the stretch, then the total turbulent burning velocity is expected to increase proportionally to the increase in the flame surface area caused by wrinkling. When the turbulence intensity is high enough such that the stretch due to hydrodynamics and flame curvature would influence the local premixed laminar burning velocity, then the actual laminar burning velocity (that is, flamelet consumption velocity) should reflect the influence of stretch. To address this issue, obtaining the knowledge of instantaneous flame front structures, flame brush characteristics, and burning velocities of premixed turbulent flames is necessary. Two axisymmetric Bunsen-type burners were used to produce premixed turbulent flames, and three optical measurement techniques were utilized: Particle image velocimetry to measure the turbulence statistics; Rayleigh scattering method to measure the temperature fields of premixed turbulent flames, and Mie scattering method to visualize the flame front contours of premixed turbulent flames. Three hydrocarbons (methane, ethane, and propane) were used as the fuel in the experiments. The turbulence was generated using different perforated plates mounted upstream of the burner exit. A series of comprehensive parameters including the thermal flame front thickness, characteristic flame height, mean flame brush thickness, mean volume of the turbulent flame region, two-dimensional flame front curvature, local flame front angle, two-dimensional flame surface density, wrinkled flame surface area, turbulent burning velocity, mean flamelet consumption velocity, mean turbulent flame stretch factor, mean turbulent Markstein length and number, and mean fuel consumption rate were systematically evaluated from the experimental data. The normalized preheat zone and reaction zone thicknesses decreased with increasing non-dimensional turbulence intensity in ultra-lean premixed turbulent flames under a constant equivalence ratio of 0.6, whereas they increased with increasing equivalence ratios from 0.6 to 1.0 under a constant bulk flow velocity. The normalized preheat zone and reaction zone thicknesses showed no overall trend with increasing non-dimensional longitudinal integral length scale. The normalized preheat zone and reaction zone thicknesses decreased by increasing the Karlovitz number, suggesting that increasing the total stretch rate is the controlling mechanism in the reduction of flame front thickness for the experimental conditions studied in this thesis. In general, the leading edge and half-burning surface turbulent burning velocities were enhanced with increasing equivalence ratio from lean to stoichiometric mixtures, whereas they decreased with increasing equivalence ratio for rich mixtures. These velocities were enhanced with increasing total turbulence intensity. The leading edge and half-burning surface turbulent burning velocities for lean/stoichiometric mixtures were observed to be smaller than that for rich mixtures. The mean turbulent flame stretch factor displayed a dependence on the equivalence ratio and turbulence intensity. Results show that the mean turbulent flame stretch factors for lean/stoichiometric and rich mixtures were not equal when the unstrained premixed laminar burning velocity, non-dimensional bulk flow velocity, non-dimensional turbulence intensity, and non-dimensional longitudinal integral length scale were kept constant.

Preventable burns associated with the misuse of gasoline.

PubMed

Barillo, D J; Stetz, C K; Zak, A L; Shirani, K Z; Goodwin, C W

1998-08-01

Gasoline is intended for use as a motor fuel, but the universal availability of gasoline in the home encourages misuse as a solvent, insecticide, accelerant or cleaning solution. The careless or inappropriate use of gasoline may result in burn injury. We examined the circumstance of gasoline-related injury in a population admitted to one burn centre to determine the potential for burn prevention efforts. A retrospective review of all burn admissions to one centre for the years 1978 to 1996 demonstrated hat 1011 of 4339 acute admissions (23.3%) were gasoline-related. This group had an average total burn size of 29.8% total body surface (TBSA) and an average full thickness injury of 14.4% TBSA. There were 144 fatalities resulting from gasoline-associated burn injury. Where such determination could be made, the use of gasoline was judged to be inappropriate or unsafe in 687 of 788 cases (87.1%). Ninety of 144 fatalities (62.5%) were associated with inappropriate or unsafe use of gasoline. The careless or inappropriate use of gasoline poses significant risk of burn injury. The indoor use of gasoline, as well as use of gasoline for purposes other than as a motor fuel, should be strongly discouraged.

Experimental Constraints on Iron Mobilization into Biomass Burning Aerosols

NASA Astrophysics Data System (ADS)

Sherry, A. M.; Romaniello, S. J.; Herckes, P.; Anbar, A. D.

2017-12-01

Atmospheric deposition of iron (Fe) can limit marine primary productivity and, therefore, carbon dioxide uptake. Recent modeling studies suggest that biomass burning aerosols may contribute a significant amount of soluble Fe to the surface ocean. To address this hypothesis, we collected foliage samples from species representative of several biomes impacted by severe fire events. Existing studies of burn-induced trace element mobilization have often collected both entrained soil particles along with material from burning biomass, making it difficult to determine the actual source of aerosolized trace metals. In order to better constrain the importance of biomass vs. entrained soil as a source of trace metals in burn aerosols, we conducted burn experiments using soil-free foliage representative of a variety of fire-impacted ecosystems. The resulting burn aerosols were collected in two stages (PM > 2.5 μm and PM < 2.5 μm) on cellulose filters using a high-volume air sampler equipped an all-Teflon impactor. Unburned foliage and burn aerosols were analyzed for Fe and other trace metals using inductively coupled plasma mass spectrometry (ICP-MS). Our results show that 0.06-0.86 % of Fe in plant biomass is likely mobilized as atmospheric aerosols during biomass burning events, depending on the type of foliage. We used these results and estimates of annual global wildfire area to estimate the impact of biomass burning aerosols on total atmospheric Fe flux to the ocean. We estimate that biomass-derived Fe likely contributes 3% of the total soluble Fe flux from aerosols. Prior studies, which implicitly included both biomass and soil-derived Fe, concluded that biomass burning contributed as much as 7% of the total marine soluble Fe flux from aerosols. Together, these studies suggest that biomass and fire-entrained soil probably contribute equally to the total fire-derived Fe aerosol flux. Further study of solubility differences between plant- and soil-derived Fe is needed to improve estimates of the soluble Fe contribution from biomass burning to the marine soluble Fe flux.

Work-Related Burn Injuries Hospitalized in US Burn Centers: 2002 to 2011.

PubMed

Huang, Zhenna; Friedman, Lee S

2017-03-01

To develop a comprehensive definition to identify work-related burns in the National Burn Repository (NBR) based on multiple fields and describes injuries by occupation. The NBR, which is an inpatient dataset, was used to compare type and severity of burn injuries by occupation. Using the definition developed for this analysis, 22,969 burn injuries were identified as work-related. In contrast, the single work-related field intended to capture occupational injuries only captured 4696 cases. The highest numbers of burns were observed in construction/extraction, food preparation, and durable goods production occupations. Occupations with a mean total body surface area (TBSA) burned greater than 10% include transportation and material-moving, architecture and engineering, and arts/design/entertainment/sports/media occupations. The NBR dataset should be further utilized for occupational burn injury investigations and multiple fields should be considered for case ascertainment.

Burn care delivery in a sub-saharan african unit: A cost analysis study.

PubMed

Gallaher, Jared R; Mjuweni, Stephen; Cairns, Bruce A; Charles, Anthony G

2015-07-01

There are significant resource challenges to burn surgical care delivery in low and middle-income countries at baseline and only a few burn cost analysis studies from sub-Saharan Africa have been performed. This is a retrospective database analysis of prospectively collected data from all patients recorded in the burn registry between June 2011 and August 2014 located at the Kamuzu Central Hospital Burn Unit in Lilongwe, Malawi. We utilized activity-based costing, a bottom-up cost analysis methodology with cost allocation that allows determination of unit cost or cost per service. 905 patients were admitted to the burn unit during the study period. The calculated total monthly burn expenditure for all cost centers was $11,622.66. Per day, the total unit cost was $387.42 with a mean daily per-patient cost of $24.26 (SD ± $6.44). Consequently, the mean cost per in-patient admission was $559.85 (SD ± $736.17). The mean daily cost per 1% total burn surface per patient at our center is $2.65 (SD ± $3.01). This burn care cost analysis study helps quantify the relative contribution of differing cost centers that comprise burn care delivery and hospital costs in a sub-Saharan African setting. Accurate and relevant cost information on hospital services at the patient level is therefore fundamental for policy makers, payers, and hospitals. Our study has demonstrated that comprehensive burn care is possible at a cost much lower than found in other burn centers in low or middle-income countries and can be sustained with moderate funding. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases.

PubMed

Türegün, M; Sengezer, M; Selmanpakoglu, N; Celiköz, B; Nişanci, M

1997-01-01

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.

Control of burn wound sepsis in rats by methylene blue-mediated photodynamic treatment

NASA Astrophysics Data System (ADS)

Hasegawa, Hiroyuki; Sato, Shunichi; Kawauchi, Satoko; Saitoh, Daizoh; Shinomiya, Nariyoshi; Ashida, Hiroshi; Terakawa, Mitsuhiro

2012-02-01

Control of wound sepsis is an important challenge in traumatology. However, increase in the drug-resistant bacteria makes this challenge considerably difficult in recent years. In this study, we attempted to control burn wound sepsis in rats by photodynamic treatment, which has been reported to be effective against some drug-resistant bacteria. A 20% TBSA (total body surface area) full-thickness burn was made in rat dorsal skin, and five days after injury, a suspension of P. aeruginosa was applied to the wound surface. At 30 min after infection, a methylene blue (MB) solution was applied to the wound surface; 5 min afterwards, the wound was illuminated with a 665-nm light emitting diode (LED) array for 10 min. This treatment (application of MB and illumination) was repeated 3 times successively. The averaged light intensity on the wound surface was 3.3 mW/cm2, the corresponding total light dose being 5.9 J/cm2. One week after injury, the numbers of bacteria in the blood and liver were counted by colony forming assay. In the liver, the number of bacteria of the treated group was significantly lower than that of the sham control group without photodynamic treatment. In the blood, no bacteria were detected in the treated group, while a certain amount of bacteria was detected in the control group. These results demonstrate the efficacy of MB-mediated PDT with a red LED array to control burn wound sepsis.

Lawn mower-related burns.

PubMed

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

2000-01-01

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

Prescribed fire experiences on crop residue removal for biomass exploitations. Application to the maritime pine forests in the Mediterranean Basin.

PubMed

Molina, Juan Ramón; García, Juan Pedro; Fernández, Juan José; Rodríguez Y Silva, Francisco

2018-01-15

Socioeconomic changes, climate change, rural migration and fire exclusion have led to a high woody biomass accumulation increasing potential wildfire severity. Mechanical thinning and prescribed burning practices are commonly used to prevent large fires. The purpose of this study was to assess burning treatment effectiveness following mechanical thinning from biomass harvesting. Prescribed burning to reduce residue removal could help mitigate fire behavior, mainly in strategic management or critical focal points. Field samplings were conducted before and immediately after burnings on different environmental scenarios where fuel load was classified by categories. Prescribed fires reduced available fuel in all fuel categories, mainly in surface litter layer. Total fuel load reduction ranged from 59.07% to 86.18%. In this sense, fuel reduction effects were more pronounced when burns were conducted fewer than 10% on surface litter moisture. The difference in fuel consumption among scenarios was higher for most all woody fuel components and decomposition litter layer than for surface litter layer. Managers can use this information to design technical prescription to achieve the targets while decomposed litter retention maintaining the soil properties and biodiversity. Understanding the most effective "burn window" should help better plan prescribed burning, both in term of fire behavior and fuel consumption, without altering ecosystem properties. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2011-07-01

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

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

PubMed

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

2006-01-01

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

Periorbital burns – a 6 year review of management and outcome.

PubMed

Fitzgerald O'Connor, Edmund; Frew, Q; Din, A; Pleat, J; Ashraff, S; Ghazi-Nouri, S; El-Muttardi, N; Philp, B; Dziewulski, P

2015-05-01

Periorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. Patients admitted to a UK regional burns centre between January 2005 and January 2011 with periorbital burns were identified from the Patient Administration System (PAS), theatre logs and the International Burns Injury database (IBID). Multiple parameters were assessed using patient notes, ITU and hospital image databases. Over 6 years, 167 patients with facial burns requiring surgery were treated, including 103 patients with eyelid burns. The mean burn size was 33% total body surface area. The eyelid burn depth varied; 67% superficial partial thickness, 17% deep dermal and 16% full thickness. Two patients lost complete vision in one eye, one patient underwent amniotic membrane grafting. In total 16 patients required periorbital reconstruction to maintain eye closure, with 1.8 operations on average per patient. Acute surgery was required in 11 patients, whilst late intervention (>3 months) was needed in 5, 2 patients had both acute and delayed surgery. Of the 5 late intervention patients 4 were treated with full thickness skin grafts and 1 with a Z plasty. Average time for final reconstruction with delayed surgery was 4.5 months. The goal in management of periorbital burns is preservation of vision, prevention of future complications and restoration of an acceptable aesthetic outcome. Total visual loss is thankfully rare, but early ophthalmology intervention is vital given the evidence of corneal damage as a brief therapeutic window exists. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Spatial and temporal distribution of tropical biomass burning

NASA Astrophysics Data System (ADS)

Hao, Wei Min; Liu, Mei-Huey

1994-12-01

A database for the spatial and temporal distribution of the amount of biomass burned in tropical America, Africa, and Asia during the late 1970s is presented with a resolution of 5° latitude × 5° longitude. The sources of burning in each grid cell have been quantified. Savanna fires, shifting cultivation, deforestation, fuel wood use, and burning of agricultural residues contribute about 50, 24, 10, 11, and 5%, respectively, of total biomass burned in the tropics. Savanna fires dominate in tropical Africa, and forest fires dominate in tropical Asia. A similar amount of biomass is burned from forest and savanna fires in tropical America. The distribution of biomass burned monthly during the dry season has been derived for each grid cell using the seasonal cycles of surface ozone concentrations. Land use changes during the last decade could have a profound impact on the amount of biomass burned and the amount of trace gases and aerosol particles emitted.

Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care

PubMed Central

Olofsson, Pia; Fredrikson, Mats; Sjoberg, Folke

2017-01-01

Total duration of stay adjusted for percentage of the total body surface area burned (TBSA%) is a commonly used outcome measure in burn care. However, it has been criticised as it is affected by many factors, some of which are not strictly part of burn care. A division into operative stay and postoperative stay may improve this measure. The aim was to evaluate if operative stay can serve as a more standardised measure by: comparing the variation in operative stay/TBSA% with the variation in total stay/TBSA%, and to study different factors associated with operative stay and postoperative stay. Patients and methods Surgically managed burn patients admitted between 2010–14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay. Results Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, p<0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (p<0.001, R2 0.51). Conclusion Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure. PMID:28362844

Satisfaction With Appearance Scale-SWAP: Adaptation and validation for Brazilian burn victims.

PubMed

Caltran, Marina P; Freitas, Noélle O; Dantas, Rosana A S; Farina, Jayme Adriano; Rossi, Lidia A

2016-09-01

Methodological study that aimed to adapt the Satisfaction with Appearance Scale (SWAP) into Brazilian Portuguese language and to assess the validity, the reliability and the dimensionality of the adapted version in a sample of Brazilian burn victims. We carried out the adaptation process according to the international literature. Construct validity was assessed by correlating the adapted version of SWAP scores with depression (Beck Depression Index), self-esteem (Rosenberg Self-Esteem Scale), health-related quality of Life (Short Form Health Survey-36) and health status of burn victims (Burn Specific Health Scale-Revised), and with gender, total body surface area burned, and visibility of the scars. We tested dimensionality using Exploratory Factor Analysis (EFA) and the reliability by means of Cronbach's alpha. Participants were 106 adult burned patients. The correlations between the Brazilian version of the SWAP scores and the correlated construct measures varied from moderate to strong (r=.30-.77). The participants who perceived their burn sequelae was visible reported being more dissatisfied with their body image than the participants who answered that their scars would not be visible (p<.001). Cronbach's alpha for the adapted version was 0.88 and the item-total correlation varied from moderate to strong (r=.35-.73). The EFA resulted in three factors with a total explained variance percentage of 63.2%. The Brazilian version of the SWAP was valid and reliable for use with Brazilian burn victims. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Predictors of functional independence, quality of life, and return to work in patients with burn injuries in mainland China.

PubMed

Tang, Dan; Li-Tsang, Cecilia W P; Au, Ricky K C; Shen, Xia; Li, Kui-Cheng; Yi, Xian-Feng; Liao, Lin-Rong; Cao, Hai-Yan; Feng, Ya-Nan; Liu, Chuan-Shun

2016-01-01

Burn injury may be associated with long-term rehabilitation and disability, while research studies on the functional performance after injuries, quality of life (QOL), and abilities to return to work of burn patients are limited. These outcomes are related not just to the degree and nature of injuries, but also to the socio-economical background of the society. This study aimed to identify the factors which might affect burn patients' abilities to reintegrate back to the society based on a sample in mainland China. A retrospective study was conducted to collect data of demographic characteristics, medical data about burn injuries, physical and psychological status, and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital, timing of rehabilitation, and duration of rehabilitation intervention. Four hundred fifteen patients with burn injuries were recruited in the study. Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation, as well as the post-injury work status within 6 months after discharge. The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission, duration of treatment, timing of rehabilitation, payer source, and total body surface area burned. The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment. The significant predictors of work status within 6 months post-discharge included age, education, payer source, total body surface area burned, perceived QOL, and bodily pain at admission. The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries. Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation. Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.

[Transfusional requirements for escharectomy in burned children].

PubMed

Julia, Analía R; Basílico, Hugo; Magaldi, Gustavo; Demirdjian, Graciela

2010-02-01

Early excision has considerably improved outcome in extensive burns, but massive resections usually mean copious bleeding that must be conveniently corrected. The purpose of this study was to measure blood component use during escharectomies in children. All pediatric patients with acute burns excised at the Burn Unit of the Hospital Garrahan during one year were included. Volume of blood component used during and immediately after surgery was analyzed and related to percent excised, time post-burn, and the coexistence of infection and autograft at the time of excision. Ninety-four surgeries in 51 children aged 0-14 years with total burned body surface areas of 5-80% who underwent resections of 3-70% were studied. Total blood use (intra + post-operatively) was 2.07 ml/kg/%excised for red blood cells (60% during surgery) and 0.7 ml/kg/% excised for plasma. Only 12% of patients required platelet transfusion. There was no significant requirement variation with the existence of infection, grafting or time post-burn. Approximately 2 ml/kg/% excised of red blood cells (2/3 for surgery) and 1 ml/kg/% excised of plasma are needed for escharectomies in children. The need for platelets must be judged considering the individual patient.

Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

PubMed

Sebastian, Raul; Ghanem, Omar; Diroma, Frank; Milner, Stephen M; Gerold, Kevin B; Price, Leigh A

2015-05-01

Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

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

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

PubMed Central

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

2017-01-01

Objectives: To report the management of burn injuries that occured in the Syria civil war, which were referred to our burn center. Methods: Forty-three patients with burns, injured in the civil war in Syria and whom were referred to Dr. Lütfi Kırdar Kartal Educating and Training Hospital Burn Centre of İstanbul, Turkey between 2011-2015 were analyzed in a retrospective study. Results: Most of our patients were in major burn classification (93%; 40/43) and most of them had burns >15% total on body surface area. Most of them were admitted to our center late after first management at centers with improper conditions and in cultures of these patients unusual and resistant strains specific to the battlefield were produced. Conclusion: Immediate transfer of the patients from the scene of incidence to burn centers ensures early treatment, this factor may be effective on the outcome of these patients. PMID:28042637

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

PubMed

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

2017-01-01

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

Use of mineral oil Fleet enema for the removal of a large tar burn: a case report.

PubMed

Carta, Tricia; Gawaziuk, Justin; Liu, Song; Logsetty, Sarvesh

2015-03-01

Extensive hot tar burns are relatively uncommon. Management of these burns provides a significant clinical challenge especially with respect to tar removal involving a large total body surface area (TBSA), without causing further tissue injury. We report a case of an over 40-year old male construction worker who was removing a malfunctioning cap from broken valve. This resulted in tar spraying over the anterior surface of his body including legs, feet, chest, abdomen, arms, face and oral cavity (80% TBSA covered in tar resulting in a 50% TBSA burn injury). Initially, petrolatum-based, double antibiotic ointment was used to remove the tar, based on our previous experience with small tar burns. However, this was time-consuming and ineffective. The tar was easily removed with mineral oil without irritation. In order to meet the demand for quantity of mineral oil, the pharmacy suggested using mineral oil Fleet enema (C.B. Fleet Company, Inc., Lynchburg, Virginia, USA). The squeezable bottle and catheter tip facilitated administration of oil into the patient's construction boots and under clothing that was adhered to the patient's skin. Tar removal requires an effective, non-toxic and non-irritating agent. Mineral oil is such an agent. For patients that may present with a large surface area tar burn, using mineral oil Fleet enema is a viable option that facilitates application into difficult areas. Grant Support: The Firefighters' Burn Fund (Manitoba) supported this project. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Healthcare resource utilization and epidemiology of pediatric burn-associated hospitalizations, United States, 2000.

PubMed

Shields, Brenda J; Comstock, R Dawn; Fernandez, Soledad A; Xiang, Huiyun; Smith, Gary A

2007-01-01

The objective of this study was to describe the epidemiology and financial burden of burn-associated hospitalizations for children younger than 18 years in the United States. Retrospective data analysis of pediatric burn-associated hospitalizations was done using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000. An estimated 10,000 children younger than 18 years were hospitalized for burn-associated injuries in the United States in 2000. These children spent an estimated 66,200 days in the hospital with associated hospital charges equal to USD 211,772,700. Total charges and length of stay for pediatric burn-associated hospitalizations in the United States during 2000 were associated with degree of burn, percentage of total body surface area burned, child's age, region of the United States, hospital location, and hospital type. Children 2 years old or younger were more likely to be nonwhite, be hospitalized for burns, and burn their hands/wrists, compared with children 3 to 17 years of age. Male children in both age groups were more likely to be hospitalized for burns than female children. Children 2 years old or younger were more likely to be burned by hot liquids/vapors and contact with hot substances/objects, while children 3 to 17 years were more likely to be burned by fire/flames. This study is the first national study on healthcare resource utilization for pediatric burn-associated hospitalizations to utilize the KID database. Burns are a major source of pediatric morbidity and are associated with significant national healthcare resource utilization annually. Future burn prevention efforts should emphasize implementing passive injury prevention strategies, especially for young children who are nonwhite and live in low-income communities.

Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: a retrospective analysis.

PubMed

Cleland, Heather; Wasiak, Jason; Dobson, Hannah; Paul, Michelle; Pratt, George; Paul, Eldho; Herson, Marisa; Akbarzadeh, Shiva

2014-02-01

Cadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial. A review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays. During the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved. Cryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

A New Era in the Management of Burns Trauma in Kumasi, Ghana

PubMed Central

Agbenorku, P.; Akpaloo, J.; Yalley, D.; Appiah, A.

2010-01-01

Summary The aim of the study was to investigate the factors affecting the outcome of treatment of burns patients admitted to the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Information on patients admitted to the BICU from February 2001 to January 2006 was recorded. Parameters recorded included: admission record and demographics, causes of the injury, burned surface area, laboratory investigations, treatment regime, and record of discharge/death. The data were analysed with SPSS version 12.0 and Spearman's rank correlation. A total of 826 patients were recorded; males (n = 492, 60%) outnumbered females (n= 334, 40%). The mean age was 10.5 ± 5 yr, the majority (n = 441, 53%) in the range 0-10 yr. Flame burns (n = 587, 71%), scalds (n = 209, 25%), and chemicals (n = 19, 2%) were the three significant causes of burn injuries. The mean range of the total body surface area (TBSA) burned was 11-20%; 94% (n = 775) had up to 60% TBSA; 64% (n = 527) had only wound dressings for treatment; 21% (n = 174) had early excision with skin grafting, while 15% (n = 125) had delayed excision with skin grafting. The majority (n = 563, 68%) of the patients stayed for less than 10 days after admission. The mortality rate fell over the years, decreasing drastically between 2001 (20.4%) and 2002 (8.6%) and remaining at single digit level in 2003 (7.6%), 2004 (7.9%), and 2005 (7.4 %). The factors affecting the mortality trends were proper case management, increases in the number of professional medical personnel, and their greater dedication. PMID:21991199

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

PubMed

Oh, Hyunjin; Boo, Sunjoo

2017-09-01

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

[A 5-year interval report on study of burn metabolism and nutrition].

PubMed

Wang, S L

1992-12-01

This paper introduces the essential experiences concerning studies of burn metabolism and nutrition in our institute in the past five years. 1. Three new and practical animal models were developed for studying gastro-enteral nutrition in burns. 2. With indirect calorimetry, resting energy expenditure (REE) of 92 burn adult patients were measured and analyzed, and on the basis of which a new formula for calculating nutritional supplement in Chinese burn adults was proposed: kcal/day = 1,000 x M2 (body surface area) + 25 x % TBSA (total burn surface area). 3. Through experimental and clinical studies, it was found that antiouperoxide agents (such as SOD, CAT), tolbutamide, glutamine and Chinese herb decoction Sizunzituang all exhibited modulating effects on postburn metabolism and nutrition, e.g. decreasing catabolism, reducing negative nitrogen balance, stimulating secretion of insulin, enhancing tissue utilization of glucose, maintaining the mass of enteral mucosa and improving functions of viscerae. 4. A new less irritating, simple and easy-to-introduce nasal-enteral nutrition tube was devised, which could pass through the pylorus easily into the duodenum usually within 6hrs without using a stylet. It would be useful in the early postburn enteral nutrition supplementation.

Statewide ban on recreational fires resulted in a significant decrease in campfire-related summer burn center admissions.

PubMed

Hoang, David Manh; Reid, Dixie; Lentz, Christopher William

2013-01-01

Every summer, there is an increase in the number of burn injuries caused by accidents around campfires. Because of the prevalence of drought, high winds, and uncontrolled wild fires, a statewide ban on recreational fires was instituted in New Mexico from June to July 2011. We hypothesized that this legislation would have a significant impact on burn admissions caused by campfire-related injuries. A retrospective review of summer admissions to a state burn center was conducted to assess the effect of this ban on recreational fire injuries, and these data were compared with that of the previous summer when no ban was in effect. All burn admissions to a state burn center were reviewed from Memorial Day to Labor Day in 2010 and 2011. Data collected included cause, % TBSA, age, days of hospitalization, intensive care unit days, and total surface area grafted. Nonparametric statistical analysis was performed with Fisher exact test for dichotomous data and Mann-Whitney test for continuous data with significance at P < .05. There were 164 burn center admissions between Memorial Day and Labor Day in 2010 (n = 82) and 2011 (n = 82). Compared with all summer burn center admissions, patients injured by campfires were younger (18 vs 37 years; P = .002) with smaller total surface area burns (3.2 vs 6.2%; P = .41) and had shorter lengths of stay (10-11 vs 6-7 days; P = .62). There was more than a 3-fold decrease in burn admissions due to recreational fires during the study period (n = 14 [17%] in 2010 and 4 [5%] in 2011; P = .02). This resulted in a decrease in the number of patient-days from 91 in 2010 to 25 in 2011. Half of the camp fire admissions required skin grafts to definitively close the wounds (6/14 in 2010 and 2/4 in 2011). Recreational fire bans targeted at controlling wildfires during conditions favoring rapid spread were associated with a 3- to 4-fold decrease in campfire-related burn admissions. Compared with a summer when no fire ban was in effect, the number of patient-days decreased from 91 to 25.

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

PubMed

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

2012-05-01

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

Epidemiology and mortality of 162 major burns in Kuwait.

PubMed

Bang, R L; Ghoneim, I E

1996-09-01

The burns intensive care unit at IBN Sina Hospital reopened in July 1991, following the Iraqi occupation of Kuwait and the Gulf War. Epidemiology and mortality of 162 burn patients with 30 per cent and over total body surface area (TBSA) burns, treated from July 1991 to December 1994, is presented. There were 91 males and 71 females with a ratio of 1.3 to 1. The median age was 30 years (range 4 months to 93 years) and 44 per cent of the patients were 15-40 years of age. 124 (76.5 per cent) accidents occurred at home and the flame burn was the commonest involving 131 (80.9 per cent) patients. The median burn surface area was 45.5 per cent and the majority of them sustained deep burns. The hospital stay of the surviving patients ranged from 11 to 174 days (median 38 days), while the day of the death was from 1 to 134 days. Forty-six deaths represent an overall mortality rate of 28.4 per cent amongst our patients. All the patients whose Baux score was 130 and above died. Burn shock was responsible for 10 deaths, and out of them eight were not actively resuscitated due to high Baux score. Sixteen deaths occurred within 48 h postburn. Septicaemia and its related effects were responsible for the majority of the deaths.

Response of advance reproduction of oaks and associated species to repeated prescribed fires in upland oak-hickory forests, Missouri

Treesearch

Zhaofei Fan; Zhongqiu Ma; Daniel C. Dey; Scott D. Roberts

2012-01-01

The Chilton Creek prescribed burn project was initiated in 1996 by The Nature Conservancy (TNC) to restore native oak woodlands and test the effect of frequent, low intensity surface fires conducted in the dormant season (March-April) on upland oak-hickory forests in the Ozarks of Missouri. Burning treatments on five sites totaling 1000 ha were initiated in 1998. The...

Mite communities (Acari: Mesostigmata) in young and mature coniferous forests after surface wildfire.

PubMed

Kamczyc, Jacek; Urbanowski, Cezary; Pers-Kamczyc, Emilia

2017-06-01

Density, diversity and assemblage structure of Mesostigmata (cohorts Gamasina and Uropodina) were investigated in Scots pine forests differing in forest age (young: 9-40 years and mature: 83-101 years) in which wildfire occurred. This animal group belongs to the dominant acarine predators playing a crucial role in soil food webs and being important as biological control agents. In total, six forests (three within young and three within mature stands) were inspected in Puszcza Knyszyńska Forest Complex in May 2015. At each forest area, sampling was done from burned and adjacent control sites with steel cylinders for heat extraction of soil fauna. Data were analyzed statistically with nested ANOVA. We found a significant effect on mite density of both fire and forest age, with more mites in mature forests and control plots. In total, 36 mite taxa were identified. Mite diversity differed significantly between forest ages but not between burned versus control. Our study indicated that all studied forests are characterized by unique mite species and that the mite communities are dominated by different mite species depending on age forest and surface wildfire occurrence. Finally, canonical correspondence analysis ranked the mite assemblages from control mature, through burned young and burned mature, away from the control young.

Self-inflicted burns fatalities in Manipal, India.

PubMed

Mohanty, Manoj Kumar; Arun, M; Monteiro, Francis N P; Palimar, Vikram

2005-01-01

Death due to burns is an important public health problem. Suicide by burning is uncommon in the Western world compared with Asian countries. This study presents retrospective research carried out in the tertiary care teaching hospital of Kasturba Medical College, Manipal, Southern India, between January 1993 to December 2003 (11 years). Out of a total of 343 burns deaths during the above-mentioned period, 39 were victims of suicide. The majority of deaths (46.1%) occurred in the 21-30 years age group, with a preponderance of the female sex (79.5%). Most of the victims belonged to the Hindu religion and the incident occurred mostly during the daytime. In the overwhelming majority of cases, the incident occurred at home (97.4%). In all cases kerosene was the accelerant and flame was the causative agent. In more than fifty per cent of cases, the total body surface area (TBSA) involved was more than 80%. Dowry demands and harassment were the reasons for committng suicide in 12 cases. More stringent laws and empowering female independence, both mentally and economically, will reduce suicidal burns in young women.

Electrical burns: The trend and risk factors in the Ghanaian population.

PubMed

Agbenorku, P; Agbenorku, E; Akpaloo, J; Obeng, G; Agbley, D

2014-12-31

The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 - June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22-56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident.

Electrical burns: The trend and risk factors in the Ghanaian population

PubMed Central

Agbenorku, P.; Agbenorku, E.; Akpaloo, J.; Obeng, G.; Agbley, D.

2014-01-01

Summary The usefulness of electricity in daily life offers several advantages which cannot be underestimated. Electricity is needed by industries for manufacturing and also in homes for lighting, cooking, washing, etc. However, electricity can cause severe life-threatening complications. This study investigates the trend and mortality risk factors of electrical burn injuries at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Ghana. The Burns Registry at KATH BICU containing information on patients who were admitted for electrical burns was used. Data on the sex, age, occupation, cause of injury, Total Body Surface Area burned (TBSA) and outcome of admissions was obtained. GraphPad version 5 was used for the analysis. There were 13 (2.7%) electrical burns, suffered by 11 males (84.6%) and 2 females (15.4%) out of a total 487 BICU admissions over a 4-year period (July 1, 2009 – June 30, 2013); the mean age of the electrical burn victims was 37.8 years (range = 22–56); the TBSA ranged from 5.0% - 98.0%. Mortality risk factors identified were high voltage electrical burns, older age (P=0.0250) and TBSA>20% (P=0.048). Four cases (30.8%) were transferred to the Main Burns Ward (Ward D2C); 6 cases (46.1%) were discharged home; 3 patients (23.1%) died; all deaths were recorded in persons who had high voltage electrical burns. Electrical burns can be severe and can cause death. Even though the current study showed that a small population was affected by electrical burns, society has to be continually conscious of the detrimental effects of electrical energy and take the necessary precautions to minimize this type of accident. PMID:26336364

BurnCase 3D software validation study: Burn size measurement accuracy and inter-rater reliability.

PubMed

Parvizi, Daryousch; Giretzlehner, Michael; Wurzer, Paul; Klein, Limor Dinur; Shoham, Yaron; Bohanon, Fredrick J; Haller, Herbert L; Tuca, Alexandru; Branski, Ludwik K; Lumenta, David B; Herndon, David N; Kamolz, Lars-P

2016-03-01

The aim of this study was to compare the accuracy of burn size estimation using the computer-assisted software BurnCase 3D (RISC Software GmbH, Hagenberg, Austria) with that using a 2D scan, considered to be the actual burn size. Thirty artificial burn areas were pre planned and prepared on three mannequins (one child, one female, and one male). Five trained physicians (raters) were asked to assess the size of all wound areas using BurnCase 3D software. The results were then compared with the real wound areas, as determined by 2D planimetry imaging. To examine inter-rater reliability, we performed an intraclass correlation analysis with a 95% confidence interval. The mean wound area estimations of the five raters using BurnCase 3D were in total 20.7±0.9% for the child, 27.2±1.5% for the female and 16.5±0.1% for the male mannequin. Our analysis showed relative overestimations of 0.4%, 2.8% and 1.5% for the child, female and male mannequins respectively, compared to the 2D scan. The intraclass correlation between the single raters for mean percentage of the artificial burn areas was 98.6%. There was also a high intraclass correlation between the single raters and the 2D Scan visible. BurnCase 3D is a valid and reliable tool for the determination of total body surface area burned in standard models. Further clinical studies including different pediatric and overweight adult mannequins are warranted. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Gasoline immersion injury

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, L.A.; Cruse, C.W.

1981-01-01

Chemical burns and pulmonary complications are the most common problems encountered in the patient immersed in gasoline. Our patient demonstrated a 46-percent total-body-surface area, partial-thickness chemical burn. Although he did not develop bronchitis or pneumonitis, he did display persistent atelectasis, laryngeal edema, and subsequent upper airway obstruction. This had not previously been reported in gasoline inhalation injuries. Hydrocarbon hepatitis secondary to the vascular endothelial damage is apparently a reversible lesion with no reported long-term sequelae. Gasoline immersion injuries may be a series multisystem injury and require the burn surgeon to take a multisystem approach to its diagnosis and treatment.

How Much Global Burned Area Can Be Forecast on Seasonal Time Scales Using Sea Surface Temperatures?

NASA Technical Reports Server (NTRS)

Chen, Yang; Morton, Douglas C.; Andela, Niels; Giglio, Louis; Randerson, James T.

2016-01-01

Large-scale sea surface temperature (SST) patterns influence the interannual variability of burned area in many regions by means of climate controls on fuel continuity, amount, and moisture content. Some of the variability in burned area is predictable on seasonal timescales because fuel characteristics respond to the cumulative effects of climate prior to the onset of the fire season. Here we systematically evaluated the degree to which annual burned area from the Global Fire Emissions Database version 4 with small fires (GFED4s) can be predicted using SSTs from 14 different ocean regions. We found that about 48 of global burned area can be forecast with a correlation coefficient that is significant at a p < 0.01 level using a single ocean climate index (OCI) 3 or more months prior to the month of peak burning. Continental regions where burned area had a higher degree of predictability included equatorial Asia, where 92% of the burned area exceeded the correlation threshold, and Central America, where 86% of the burned area exceeded this threshold. Pacific Ocean indices describing the El Nino-Southern Oscillation were more important than indices from other ocean basins, accounting for about 1/3 of the total predictable global burned area. A model that combined two indices from different oceans considerably improved model performance, suggesting that fires in many regions respond to forcing from more than one ocean basin. Using OCI-burned area relationships and a clustering algorithm, we identified 12 hotspot regions in which fires had a consistent response to SST patterns. Annual burned area in these regions can be predicted with moderate confidence levels, suggesting operational forecasts may be possible with the aim of improving ecosystem management.

Operative management of acute pavement burns: a case series.

PubMed

Silver, A G; Zamboni, W A; Baynosa, R C

2014-11-01

Acute burns suffered from contact with environmentally heated roadways and walkways are a rare entity. The aim of this report is to assess the information gained from the treatment of a series of patients. A retrospective review of a consecutive series of cases, where operative treatment was necessary, that occurred during July 2010 in southern Arizona. Seven patients were included, with an average total body surface area burn of 10.2%. Direct fascial excision and tangential excision were carried out on three and four patients, respectively. Although tangential excision was carried out to normal endpoints, there was commonly a need for repetitive debridement. The total hospital costs were over $4,400,000 (£2,730,000). Burns suffered from contact with roadways/walkways are often deeper than suggested by their appearance. Direct fascial excision minimises the number of debridement sessions. We hypothesise that the failure to offload pressure on these wounds may be a causative factor in their observed deepening.

Vagus nerve stimulation blocks vascular permeability following burn injury in both local and distal sites

PubMed Central

Ortiz-Pomales, Yan T; Krzyzaniak, Michael; Coimbra, Raul; Baird, Andrew; Eliceiri, Brian P.

2012-01-01

Recent studies have shown that vagus nerve stimulation (VNS) can block the burn injury-induced systemic inflammatory response (SIRS). In this study we examined the potential for VNS to modulate vascular permeability (VP) in local sites (i.e. skin) and in secondary sites (i.e. lung) following burn injury. In a 30% total body surface area burn injury model, VP was measured using intravascular fluorescent dextran for quantification of the VP response in skin and lung. A peak in VP of the skin was observed 24 hours post-burn injury, that was blocked by VNS. Moreover, in the lung, VNS led to a reduction in burn-induced VP compared to sham-treated animals subjected to burn injury alone. The protective effects of VNS in this model were independent of the spleen, suggesting that the spleen was not a direct mediator of VNS. These studies identify a role for VNS in the regulation of VP in burns, with the translational potential of attenuating lung complications following burn injury. PMID:22694873

Myocardial Autophagy after Severe Burn in Rats

PubMed Central

Zhang, Qiong; Shi, Xiao-hua; Huang, Yue-sheng

2012-01-01

Background Autophagy plays a major role in myocardial ischemia and hypoxia injury. The present study investigated the effects of autophagy on cardiac dysfunction in rats after severe burn. Methods Protein expression of the autophagy markers LC3 and Beclin 1 were determined at 0, 1, 3, 6, and 12 h post-burn in Sprague Dawley rats subjected to 30% total body surface area 3rd degree burns. Autophagic, apoptotic, and oncotic cell death were evaluated in the myocardium at each time point by immunofluorescence. Changes of cardiac function were measured in a Langendorff model of isolated heart at 6 h post-burn, and the autophagic response was measured following activation by Rapamycin and inhibition by 3-methyladenine (3-MA). The angiotensin converting enzyme inhibitor enalaprilat, the angiotensin receptor I blocker losartan, and the reactive oxygen species inhibitor diphenylene iodonium (DPI) were also applied to the ex vivo heart model to examine the roles of these factors in post-burn cardiac function. Results Autophagic cell death was first observed in the myocardium at 3 h post-burn, occurring in 0.008 ± 0.001% of total cardiomyocytes, and continued to increase to a level of 0.022 ± 0.005% by 12 h post-burn. No autophagic cell death was observed in control hearts. Compared with apoptosis, autophagic cell death occurred earlier and in larger quantities. Rapamycin enhanced autophagy and decreased cardiac function in isolated hearts 6 h post-burn, while 3-MA exerted the opposite response. Enalaprilat, losartan, and DPI all inhibited autophagy and enhanced heart function. Conclusion Myocardial autophagy is enhanced in severe burns and autophagic cell death occurred early at 3 h post-burn, which may contribute to post-burn cardiac dysfunction. Angiotensin II and reactive oxygen species may play important roles in this process by regulating cell signaling transduction. PMID:22768082

Characterization of soil phosphorus in a fire-affected forest Cambisol by chemical extractions and (31)P-NMR spectroscopy analysis.

PubMed

Turrion, María-Belén; Lafuente, Francisco; Aroca, María-José; López, Olga; Mulas, Rafael; Ruipérez, Cesar

2010-07-15

This study was conducted to investigate the long-term effects of fire on soil phosphorus (P) and to determine the efficiency of different procedures in extracting soil P forms. Different P forms were determined: labile forms (Olsen-P, Bray-P, and P extracted by anion exchange membranes: AEM-P); moderately labile inorganic and organic P, obtained by NaOH-EDTA extraction after removing the AEM-P fraction; and total organic and inorganic soil P. (31)P-NMR spectroscopy was used to characterize the structure of alkali-soluble P forms (orthophosphate, monoester, pyrophosphate, and DNA). The studied area was a Pinus pinaster forest located at Arenas de San Pedro (southern Avila, Spain). The soils were Dystric Cambisols over granites. Soil samples were collected at 0-2 cm, 2-5 cm, and 10-15 cm depths, two years after a fire in the burned area and in an adjacent unburned forest area. Fire increased the total N, organic C, total P, and organic and inorganic P content in the surface soil layer. In burned soil, the P extracted by the sequential procedure (AEM and NaOH+EDTA) was about 95% of the total P. Bray extraction revealed a fire-induced increase in the sorption surfaces. Analysis by chemical methods overestimated the organic P fraction in the EDTA-NaOH extract in comparison with the determination by ignition procedure. This overestimation was more important in the burned than unburned soil samples, probably due to humification promoted by burning, which increased P sorption by soil particles. The fire-induced changes on the structure of alkali-soluble P were an increase in orthophosphate-P and a decrease in monoester-P and DNA-P. Copyright 2010 Elsevier B.V. All rights reserved.

A DNS study of the physical mechanisms associated with density ratio influence on turbulent burning velocity in premixed flames

NASA Astrophysics Data System (ADS)

Lipatnikov, Andrei N.; Chomiak, Jerzy; Sabelnikov, Vladimir A.; Nishiki, Shinnosuke; Hasegawa, Tatsuya

2018-01-01

Data obtained in 3D direct numerical simulations of statistically planar, 1D weakly turbulent flames characterised by different density ratios σ are analysed to study the influence of thermal expansion on flame surface area and burning rate. Results show that, on the one hand, the pressure gradient induced within a flame brush owing to heat release in flamelets significantly accelerates the unburned gas that deeply intrudes into the combustion products in the form of an unburned mixture finger, thus causing large-scale oscillations of the burning rate and flame brush thickness. Under the conditions of the present simulations, the contribution of this mechanism to the creation of the flame surface area is substantial and is increased by σ, thus implying an increase in the burning rate by σ. On the other hand, the total flame surface areas simulated at σ = 7.53 and 2.5 are approximately equal. The apparent inconsistency between these results implies the existence of another thermal expansion effect that reduces the influence of σ on the flame surface area and burning rate. Investigation of the issue shows that the flow acceleration by the combustion-induced pressure gradient not only creates the flame surface area by pushing the finger tip into the products, but also mitigates wrinkling of the flame surface (the side surface of the finger) by turbulent eddies. The latter effect is attributed to the high-speed (at σ = 7.53) axial flow of the unburned gas, which is induced by the axial pressure gradient within the flame brush (and the finger). This axial flow acceleration reduces the residence time of a turbulent eddy in an unburned zone of the flame brush (e.g. within the finger). Therefore, the capability of the eddy for wrinkling the flamelet surface (e.g. the side finger surface) is weakened owing to a shorter residence time.

Pavement temperature and burns: streets of fire.

PubMed

Harrington, W Z; Strohschein, B L; Reedy, D; Harrington, J E; Schiller, W R

1995-11-01

To measure pavement temperatures over a 24-hour period to determine when patients are at risk for burns and to report cases of pavement burns with predisposing factors. Descriptive study of pavement temperatures and retrospective case series of 23 patients with pavement burns admitted to the Maricopa Medical Center during the years 1986 to 1992. Twenty-three patients with pavement burns serious enough for them to be admitted to the burn center. We measured the temperatures of asphalt, cement, and other outdoor materials hourly for one 24-hour period using a thermocouple thermometer. Asphalt pavement was hot enough to cause burns from 9 AM to 7 PM during the summer months. It was hot enough to cause a second-degree burn within 35 seconds from 10 AM to 5 PM. The group of burned patients could be divided into three categories: incapacitated, restrained, and sensory deficient. All burns involved less than 13% of the total body surface area. During summer days in the desert, pavement is often hot enough to cause burns and does so with regularity in the southwestern United States. No one should be allowed to remain in contact with hot pavement, even transiently.

Comparison of traditional burn wound mapping with a computerized program.

PubMed

Williams, James F; King, Booker T; Aden, James K; Serio-Melvin, Maria; Chung, Kevin K; Fenrich, Craig A; Salinas, José; Renz, Evan M; Wolf, Steven E; Blackbourne, Lorne H; Cancio, Leopoldo C

2013-01-01

Accurate burn estimation affects the use of burn resuscitation formulas and treatment strategies, and thus can affect patient outcomes. The objective of this process-improvement project was to compare the accuracy of a computer-based burn mapping program, WoundFlow (WF), with the widely used hand-mapped Lund-Browder (LB) diagram. Manikins with various burn representations (from 1% to more than 60% TBSA) were used for comparison of the WF system and LB diagrams. Burns were depicted on the manikins using red vinyl adhesive. Healthcare providers responsible for mapping of burn patients were asked to perform burn mapping of the manikins. Providers were randomized to either an LB or a WF group. Differences in the total map area between groups were analyzed. Also, direct measurements of the burn representations were taken and compared with LB and WF results. The results of 100 samples, compared using Bland-Altman analysis, showed no difference between the two methods. WF was as accurate as LB mapping for all burn surface areas. WF may be additionally beneficial in that it can track daily progress until complete wound closure, and can automatically calculate burn size, thus decreasing the chances of mathematical errors.

Foot burns: epidemiology and management.

PubMed

Hemington-Gorse, S; Pellard, S; Wilson-Jones, N; Potokar, T

2007-12-01

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

Reliability and validity of the body image quality of life inventory: version for Brazilian burn victims.

PubMed

Assunção, Flávia Fernanda Oliveira; Dantas, Rosana Aparecida Spadoti; Ciol, Márcia Aparecida; Gonçalves, Natália; Farina, Jayme Adriano; Rossi, Lidia Aparecida

2013-06-01

The aims of this study were to adapt the Body Image Quality of Life Inventory (BIQLI) into Brazilian Portuguese (BP) and to assess the psychometric properties of the adapted version. Construct validity was assessed by correlating the BIQLI-BP scores with the Rosenberg's Self-Esteem Scale, with Burns Specific Health Scale-Revised (BSHS-R), and with gender, total body surface area burned, and visibility of the scars. Participants were 77 adult burn patients. Cronbach's alpha for the adapted version was .90 and moderate linear correlations were found between body image and self-esteem and between BIQLI-BP scores and two domains of the BSHS-R: affect and body image and interpersonal relationships. The BIQLI-BP showed acceptable levels of reliability and validity for Brazilian burn patients. Copyright © 2013 Wiley Periodicals, Inc.

Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling.

PubMed

Staruch, Robert M T; Beverly, A; Lewis, D; Wilson, Y; Martin, N

2017-02-01

While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement. A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24 h, and Herndon formula for the second 24 h, taking into consideration the effects of the amputation on residual burn size. This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

PubMed Central

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

2017-01-01

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

Economics of pediatric burns.

PubMed

Bass, Michael J; Phillips, Linda G

2008-07-01

Sustaining a burn injury sets in motion a cycle of pain, disfigurement, and a search for survival. In pediatric burns, the injury extends to the parents where fear, ignorance, and helplessness forever change their lives. Pediatric burn injuries are caused by fire, hot liquids, clothing irons, hair curlers, caustic substances like drain cleaner, the grounding of an electrical source, and exposure to radiation. Efficiency in the delivery of pediatric burn care is critical. Maximizing resource utilization means continual self-evaluation and economic analysis of therapeutic modalities. Griffiths et al found that most childhood burns are due to scalds, which can be treated for $1061 per percent burn. Paddock et al reduced the cost of treating superficial pediatric burns and reduced the length of stay in hospital using silver-impregnated gauze over traditional methods. Barrett et al found improved cosmesis of skin grafts using cultured epithelial autografts but at a substantially increased cost. Corpron et al showed that pediatric burn units that treat burns >10% total body surface area and operative treatment of pediatric burns regardless of size generate positive revenue. There is a paucity of evidentiary pediatric burn economic data. More research is needed to address areas of pediatric burn care inefficiency. Improving knowledge of cost in all health care endeavors will create competition and drive down expenditures.

A review of campfire burns in children: The QLD experience.

PubMed

Okon, O; Zhu, L; Kimble, R M; Stockton, K A

2018-03-27

Campfire burns in children are a significant health issue. It is imperative that the extent of the problem is examined and strategies discussed to inform future prevention campaigns. A retrospective review of data from the Queensland Paediatric Burns Registry for all children presenting with campfire burns between January 2013 and December 2014 (inclusive). Information collected included patient demographics, detail regarding mechanism of injury, first aid, Total Body Surface Area (TBSA), burn depth, and treatment. Seventy-five children with campfire burns were seen in our paediatric burns centre during this 2-year period. The median age of patients was 3 years (range 10 days-14 years). The hands and feet were the areas most commonly affected. Eleven percent of patients suffered flame burns, whilst 89% suffered contact burns from the hot coals or ashes. Of the latter group, approximately half experienced burns from campfires that had been extinguished for at least one night. Thirteen percent of patients underwent split thickness skin grafting. The incidence of burns was increased during school holiday months. We have previously demonstrated the effectiveness of targeted campaigns in reducing the incidence of campfire burns. A significant portion of patients sustained burns from incorrectly extinguished campfires. These injuries are likely to be preventable with ongoing public awareness campaigns. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

The effect of seasonality on burn incidence, severity and outcome in Central Malawi.

PubMed

Tyson, Anna F; Gallaher, Jared; Mjuweni, Stephen; Cairns, Bruce A; Charles, Anthony G

2017-08-01

In much of the world, burns are more common in cold months. However, few studies have described the seasonality of burns in sub-Saharan Africa. This study examines the effect of seasonality on the incidence and outcome of burns in central Malawi. A retrospective analysis was performed at Kamuzu Central Hospital and included all patients admitted from May 2011 to August 2014. Demographic data, burn mechanism, total body surface area (%TBSA), and mortality were analyzed. Seasons were categorized as Rainy (December-February), Lush (March-May), Cold (June-August) and Hot (September-November). A negative binomial regression was used to assess the effect of seasonality on burn incidence. This was performed using both the raw and deseasonalized data in order to evaluate for trends not attributable to random fluctuation. A total of 905 patients were included. Flame (38%) and Scald (59%) burns were the most common mechanism. More burns occurred during the cold season (41% vs 19-20% in the other seasons). Overall mortality was 19%. Only the cold season had a statistically significant increase in burn . The incidence rate ratios (IRR) for the hot, lush, and cold seasons were 0.94 (CI 0.6-1.32), 1.02 (CI 0.72-1.45) and 1.6 (CI 1.17-2.19), respectively, when compared to the rainy season. Burn severity and mortality did not differ between seasons. The results of this study demonstrate the year-round phenomenon of burns treated at our institution, and highlights the slight predominance of burns during the cold season. These data can be used to guide prevention strategies, with special attention to the implications of the increased burn incidence during the cold season. Though burn severity and mortality remain relatively unchanged between seasons, recognizing the seasonal variability in incidence of burns is critical for resource allocation in this low-income setting. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2017-01-01

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

[Thermal injuries in the OEAMTC air rescue service. Epidemiological characteristics of burns/scalds in children and adults].

PubMed

Selig, H F; Nagele, P; Lumenta, D B; Voelckel, W G; Trimmel, H; Hüpfl, M; Kamolz, L P

2014-04-01

Few data exist on the epidemiological characteristics of thermal injuries in prehospital emergency care, especially in the context of air rescue. Therefore, this study aimed to analyze the epidemiology of pediatric and adult thermal injuries in the helicopter emergency medical service (HEMS) run by the Austrian Automobile Motorcycle Touring Club (OEAMTC) air rescue service from an almost nationwide sample. All OEAMTC-HEMS rescue missions flown for thermal injuries in 2009 were retrospectively reviewed. Primary (n=88) and secondary missions (n=17) were collated and all primary missions were analyzed in detail. In total 71 out of 16,100 (0.4 %) primary HEMS rescue missions were for patients suffering from burns or scalds (children n=27, adults n=44). The proportion of major burns (burns covering >20 % of the total body surface area) was 40.7 % in children and 54.5 % in adults, 44 (62 %) burn/scald injuries were related to the head/neck, 37 (52.1 %) to the upper limbs and 10 (14.1 %) to the anogenital region. More than half of the victims (63.4%) suffered potentially life-threatening injury. In HEMS thermal injuries are infrequent but mostly life-threatening. Differences in epidemiological characteristics of pediatric and adult burns/scalds may have important operational, training and public health implications.

Factors predicting health status and recovery of hand function after hand burns in the second year after hospital discharge.

PubMed

Knight, Amber; Wasiak, Jason; Salway, Jacqueline; O'Brien, Lisa

2017-02-01

Hands are the most commonly burnt body part given humans' innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12-24 months after hand burn. The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes. The sample (n=41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient -56.6, confidence interval (95% CI) -76.70, -36.49) and female gender (-20.3; 95% CI -0.77, -40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (-5.35; 95% CI -1.83, -8.87) and work (-4.13; 95% CI -0.64, -7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (-38.84; 95% CI -58.04, -19.65) and female gender (-16.30; 95% CI -4.03, -28.57) were important predictors of poorer hand function. Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2018-02-01

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

Using a 3D tool to document and determine graft loss: A mini-review and case report.

PubMed

Benjamin, Nicole C; Wurzer, Paul; Voigt, Charles D; Benjamin, Debra A; Herndon, David N

2016-06-01

In severe burns, accurate determination of burn wound size and areas of debridement and graft loss is challenging. In this case report, we describe the use of 3D wound measurement software (BurnCase 3D, RISC Software GmbH, Hagenberg, Austria) in a 29-year-old patient with burns covering 92% of the total body surface area. BurnCase 3D was used to assess burn and monitor all surgical interventions. The software allowed us to calculate areas of graft loss and graft take throughout the acute hospitalization (until 90% of the wounds were covered with homografts). It also enabled preoperative planning for wound coverage and blood loss. Thus, BurnCase 3D appears to be a useful tool for accurate determination of burn wound areas and preoperative planning. However, whether the benefit of more efficient preoperative planning overcomes the disadvantage of the additional time needed to document the wound using the software needs to be evaluated further. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Body Composition Changes in Severely Burned Children During ICU Hospitalization.

PubMed

Cambiaso-Daniel, Janos; Malagaris, Ioannis; Rivas, Eric; Hundeshagen, Gabriel; Voigt, Charles D; Blears, Elizabeth; Mlcak, Ron P; Herndon, David N; Finnerty, Celeste C; Suman, Oscar E

2017-12-01

Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during ICU hospitalization. Retrospective chart review. Children's burn hospital. Twenty-four severely burned children admitted to our institution between 2000 and 2015. All patients underwent a dual-energy x-ray absorptiometry within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs. In the 24 patients, age was 10 ± 5 years, total body surface area burned was 59% ± 17%, time between dual-energy x-ray absorptiometries was 34 ± 21 days, and length of stay was 39 ± 24 days. We found a significant (p < 0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p < 0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p < 0.001) that was greater in the truncal region (p < 0.0001) and in the lower limbs (p < 0.05). ICU hospitalization is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.

Methylated spirit burns: an ongoing problem.

PubMed

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

2012-09-01

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

Bathroom scald burns in Queensland Children.

PubMed

Gole, Hobia; Kimble, Roy; Stockton, Kellie

2017-05-01

To evaluate the current characteristics of bathroom scald injuries in Queensland Children. Data was collected from patients who presented with a bathroom scald injury to the Stuart Pegg Paediatric Burns Centre at the Royal Children's Hospital and Lady Cilento Children's Hospital, Brisbane from January 2013 to December 2014. Bathroom scald burns represented 2.6% of total burns cases with an inpatient rate of 39%. The family home is the location of injury in 84% of cases and in 79% the patient was aged 2 years of age or younger. Total body surface area ranged from 0.5% to 20% with a median of 1.75% (IQR 0.63, 3.38%). In our study 8% of patients underwent grafting and 24% received follow up for scar management. Injuries occurred in rental properties in 47% of tempering valve survey respondents. The rate of installation of tempering valves was 23%. Bathroom scald burns continue to be over-represented in inpatient data. Tempering valves were not consistently installed after injury, this intervention would require further legislation to be an effective prevention strategy. This study provides important insights into paediatric bathroom scald injuries and will assist with the development of prevention strategies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Multiple remote sensing data sources to assess spatio-temporal patterns of fire incidence over Campos Amazônicos Savanna Vegetation Enclave (Brazilian Amazon).

PubMed

Alves, Daniel Borini; Pérez-Cabello, Fernando

2017-12-01

Fire activity plays an important role in the past, present and future of Earth system behavior. Monitoring and assessing spatial and temporal fire dynamics have a fundamental relevance in the understanding of ecological processes and the human impacts on different landscapes and multiple spatial scales. This work analyzes the spatio-temporal distribution of burned areas in one of the biggest savanna vegetation enclaves in the southern Brazilian Amazon, from 2000 to 2016, deriving information from multiple remote sensing data sources (Landsat and MODIS surface reflectance, TRMM pluviometry and Vegetation Continuous Field tree cover layers). A fire scars database with 30 m spatial resolution was generated using a Landsat time series. MODIS daily surface reflectance was used for accurate dating of the fire scars. TRMM pluviometry data were analyzed to dynamically establish time limits of the yearly dry season and burning periods. Burned area extent, frequency and recurrence were quantified comparing the results annually/seasonally. Additionally, Vegetation Continuous Field tree cover layers were used to analyze fire incidence over different types of tree cover domains. In the last seventeen years, 1.03millionha were burned within the study area, distributed across 1432 fire occurrences, highlighting 2005, 2010 and 2014 as the most affected years. Middle dry season fires represent 86.21% of the total burned areas and 32.05% of fire occurrences, affecting larger amount of higher density tree surfaces than other burning periods. The results provide new insights into the analysis of burned areas of the neotropical savannas, spatially and statistically reinforcing important aspects linked to the seasonality patterns of fire incidence in this landscape. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2017-06-15

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

Clinical and demographic features of burn injuries in karachi: a six-year experience at the burns centre, civil hospital, Karachi

PubMed Central

Ali, S.A.; Hamiz-ul-Fawwad, S.; Al-Ibran, E.; Ahmed, G.; Saleem, A.; Mustafa, D.; Hussain, M.

2016-01-01

Summary Burn injuries are a leading cause of morbidity and mortality, with 195,000 deaths annually. This study was conducted to identify the demographics of burn victims and the effect of different variables on the outcome of their injuries. 4016 patients admitted to the Burns Centre, Civil Hospital Karachi from January 2006 to December 2011 were retrospectively analyzed. Demographics, burn injury details and their outcome were recorded in a pre-designed questionnaire. Injuries were categorized as: fire, chemical, scald or electrical. To estimate total body surface area (TBSA) burned in adults, the rule of nines was used. For children and infants, the Lund-Browder chart was employed. SPSS v16.0 software was used for analysis. Frequencies and percentages of all variables, and the measure of central tendencies and dispersion for continuous variables were calculated. Cross tabs were used to assess mortality. Mean age was 28.13 years. More than half of the cases (n=2337, 58.2%) were aged between 16-30 years. Labourers, housewives and students were the most commonly affected groups. Burn injuries by flame/fire and electricity were most common. Most cases were accidental, followed by suicide attempts and homicides. Mean percentage of TBSA affected was 35.49%. Mean duration of hospital stay was 16.45 days. 50.6% of the expired cases were females. The mean age of expired patients was 30.07 while for patients who survived it was 27.01 years. The outcome of burn injuries is related to various demographic factors. Female gender, increasing age, burn injuries following suicide attempts and greater surface area involvement predict poor outcome. PMID:27857643

Generation and distribution of PAHs in the process of medical waste incineration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Ying, E-mail: echochen327@163.com; National Center of Solid Waste Management, Ministry of Environmental Protection, Beijing 100029; Zhao, Rongzhi

Highlights: ► PAHs generation and distribution features of medical waste incineration are studied. ► More PAHs were found in fly ash than that in bottom ash. ► The highest proportion of PAHs consisted of the seven most carcinogenic ones. ► Increase of free oxygen molecule and burning temperature promote PAHs degradation. ► There is a moderate positive correlation between total PCDD/Fs and total PAHs. - Abstract: After the deadly earthquake on May 12, 2008 in Wenchuan county of China, several different incineration approaches were used for medical waste disposal. This paper investigates the generation properties of polycyclic aromatic hydrocarbons (PAHs)more » during the incineration. Samples were collected from the bottom ash in an open burning slash site, surface soil at the open burning site, bottom ash from a simple incinerator, bottom ash generated from the municipal solid waste (MSW) incinerator used for medical waste disposal, and bottom ash and fly ash from an incinerator exclusively used for medical waste. The species of PAHs were analyzed, and the toxicity equivalency quantities (TEQs) of samples calculated. Analysis results indicate that the content of total PAHs in fly ash was 1.8 × 10{sup 3} times higher than that in bottom ash, and that the strongly carcinogenic PAHs with four or more rings accumulated sensitively in fly ash. The test results of samples gathered from open burning site demonstrate that Acenaphthylene (ACY), Acenaphthene (ACE), Fluorene (FLU), Phenanthrene (PHE), Anthracene (ANT) and other PAHs were inclined to migrate into surrounding environment along air and surface watershed corridors, while 4- to 6-ring PAHs accumulated more likely in soil. Being consistent with other studies, it has also been confirmed that increases in both free oxygen molecules and combustion temperatures could promote the decomposition of polycyclic PAHs. In addition, without the influence of combustion conditions, there is a positive correlation between total PCDD/Fs and total PAHs, although no such relationship has been found for TEQ.« less

Blood transfusions in severe burn patients: Epidemiology and predictive factors.

PubMed

Wu, Guosheng; Zhuang, Mingzhu; Fan, Xiaoming; Hong, Xudong; Wang, Kangan; Wang, He; Chen, Zhengli; Sun, Yu; Xia, Zhaofan

2016-12-01

Blood is a vital resource commonly used in burn patients; however, description of blood transfusions in severe burns is limited. The purpose of this study was to describe the epidemiology of blood transfusions and determine factors associated with increased transfusion quantity. This is a retrospective study of total 133 patients with >40% total body surface area (TBSA) burns admitted to the burn center of Changhai hospital from January 2008 to December 2013. The study characterized blood transfusions in severe burn patients. Univariate and Multivariate regression analyses were used to evaluate the association of clinical variables with blood transfusions. The overall transfusion rate was 97.7% (130 of 133). The median amount of total blood (RBC and plasma), RBC and plasma transfusions was 54 units (Interquartile range (IQR), 20-84), 19 units (IQR, 4-37.8) and 28.5 units (IQR, 14.8-51.8), respectively. The number of RBC transfusion in and outside operation room was 7 (0, 14) and 11 (2, 20) units, and the number of plasma was 6 (0.5, 12) and 21 (11.5, 39.3) units. A median of one unit of blood was transfused per TBSA and an average of 4 units per operation was given in the series. The consumption of plasma is higher than that of RBC. On multivariate regression analysis, age, full-thickness TBSA and number of operations were significant independent predictors associated with the number of RBC transfusion, and coagulopathy and ICU length showed a trend toward RBC consumption. Predictors for increased plasma transfusion were female, high full-thickness TBSA burn and more operations. Severe burn patients received an ample volume of blood transfusions. Fully understanding of predictors of blood transfusions will allow physicians to better optimize burn patients during hospitalization in an effort to use blood appropriately. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

A rare approach? Microsurgical breast reconstruction after severe burns

PubMed Central

Weitgasser, Laurenz; Bahsoun, Ali; Amr, Amro; Brandstetter, Michael; Knam, Friedrich; Schoeller, Thomas

2018-01-01

Breast deformity, in post-burn patients, is a common problem leading to lower self-esteem and reclusive behavior that impairs quality of life. The authors present the course of treatment of an 18-year-old immigrant girl who suffered second- to third-degree burns over approximately 20% of her total body surface area in her early childhood. The second- to third-degree burns were located on her right trunk and abdomen, as well as her right shoulder, neck, and right groin area. Since it was not offered in her home country, reconstructive surgery, including microsurgical breast reconstruction, was sought abroad. Due to the lack of available skin and soft tissue, a bilateral breast reconstruction with free transverse myocutaneous gracilis flaps was offered. This case illustrates one method of using microsurgery to address post-burn breast deformities in order to alleviate psychological suffering and improve quality of life. PMID:29506333

A mobile app for measuring the surface area of a burn in three dimensions: comparison to the Lund and Browder assessment.

PubMed

Goldberg, Harry; Klaff, Justin; Spjut, Aaron; Milner, Stephen

2014-01-01

The aim of this study was to compare the ease and accuracy of measuring the surface area of a severe burn through the use of a mobile software application (BurnMed) to the traditional method of assessment, the Lund and Browder chart. BurnMed calculates the surface area of a burn by enabling the user to first manipulate a three-dimensional model on a mobile device and then by touching the model at the locations representing the patient's injury. The surface area of the burn is calculated in real time. Using a cohort of 18 first-year medical students with no experience in burn care, the surface area of a simulated burn on a mannequin was made using BurnMed and compared to estimates derived from the Lund and Browder chart. At the completion of this study, students were asked to complete a questionnaire designed to assess the ease of use of BurnMed. Users were able to easily and accurately measure the surface area of a simulated burn using the BurnMed application. In addition, there was less variability in surface area measurements with the application compared to the results obtained using the Lund and Browder chart. Users also reported that BurnMed was easier to use than the Lund and Browder chart. A software application, BurnMed, has been developed for a mobile device that easily and accurately determines the surface area of a burn. This system uses a three-dimensional model that can be rotated, enlarged, and transposed by the health care provider to easily determine the extent of a burn. Results show that the variability of measurements using BurnMed is lower than the measurements obtained using the Lund and Browder chart. BurnMed is available at no charge in the Apple™ Store.

Return to work after specialised burn care: A two-year prospective follow-up study of the prevalence, predictors and related costs.

PubMed

Goei, H; Hop, M J; van der Vlies, C H; Nieuwenhuis, M K; Polinder, S; Middelkoop, E; van Baar, M E

2016-09-01

Burn injuries may cause long-term disability and work absence, and therefore result in high healthcare and productivity costs. Up to now, detailed information on return to work (RTW) and productivity costs after burns is lacking. The aim of this study was to accurately assess RTW after burn injuries, to identify predictors of absenteeism and to calculate healthcare and productivity costs from a societal perspective. A prospective cohort study was conducted in the burn centre of Rotterdam, the Netherlands, including all admitted working-age patients from 1 August 2011 to 31 July 2012. At 3, 12 and 24 months post-burn, patients were sent a questionnaire: including the Work and Medical Consumption questionnaire for the assessment of work absence and medical consumption and the EQ-5D-3L plus a cognitive dimension to assess post-burn and pre-burn quality of life (QOL). Cost analyses were from a societal perspective according the micro-costing method and the friction cost method was applied for the calculation of productivity loss. Univariate logistic regression was used to identify predictors of absenteeism at three months. A total of 104 patients were included in the study with a mean total body surface area (TBSA) burned of 8% (median 4%). 66 respondents were pre-employed, at 3 months 70% was back at work, at 12 months 92% and 8% had not returned to work at time of final follow-up at 24 months. Predictors of absenteeism at 3 months were: TBSA, length of stay, ICU-admission and surgery. Mean costs related to loss in productivity were €11.916 [95% CI 8.930-14.902] and accounted for 30% of total costs in pre-employed respondents in the first two years. This two-year follow-up study demonstrates that burn injuries cause substantial and prolonged productivity loss amongst burn survivors with mixed burn severity. This absenteeism contributes to already high societal costs of burn injuries. Predictors of absenteeism found in this study were primarily fixed patient and treatment related factors, future studies should focus on modifiable factors, in order to improve RTW outcomes. Also, more attention in the rehabilitation trajectory is needed to optimally support RTW in burn survivors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury.

PubMed

Palmieri, Tina L; Holmes, James H; Arnoldo, Brett; Peck, Michael; Potenza, Bruce; Cochran, Amalia; King, Booker T; Dominic, William; Cartotto, Robert; Bhavsar, Dhaval; Kemalyan, Nathan; Tredget, Edward; Stapelberg, Francois; Mozingo, David; Friedman, Bruce; Greenhalgh, David G; Taylor, Sandra L; Pollock, Brad H

2017-10-01

Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy. However, major burn injury is precluded from these studies. The optimal transfusion strategy in major burn injury is thus needed but remains unknown. This prospective randomized multicenter trial block randomized patients to a restrictive (hemoglobin 7-8 g/dL) or liberal (hemoglobin 10-11 g/dL) transfusion strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Eighteen burn centers enrolled 345 patients with 20% or more TBSA burn similar in age, TBSA burn, and inhalation injury. A total of 7054 units blood were transfused. The restrictive group received fewer blood transfusions: mean 20.3 ± 32.7 units, median = 8 (interquartile range: 3, 24) versus mean 31.8 ± 44.3 units, median = 16 (interquartile range: 7, 40) in the liberal group (P < 0.0001, Wilcoxon rank sum). BSI incidence, organ dysfunction, ventilator days, and time to wound healing (P > 0.05) were similar. In addition, there was no 30-day mortality difference: 9.5% restrictive versus 8.5% liberal (P = 0.892, χ test). A restrictive transfusion strategy halved blood product utilization. Although the restrictive strategy did not decrease BSI, mortality, or organ dysfunction in major burn injury, these outcomes were no worse than the liberal strategy (Clinicaltrials.gov identifier NCT01079247).

Clinical outcome of patients with self-inflicted burns.

PubMed

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

2017-06-01

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

INFLUENCE OF INHALATION INJURY ON ENERGY EXPENDITURE IN SEVERELY BURNED CHILDREN

PubMed Central

Przkora, Rene; Fram, Ricki Y.; Herndon, David N.; Suman, Oscar E.; Mlcak, Ronald P.

2014-01-01

Objective Determine the effect of inhalation injury on burn-induced hypermetabolism in children. Design Prospective study comparing hypermetabolism (i.e., resting energy expenditure and oxygen consumption) in burned children with and without inhalation injury during acute hospitalization. Setting Single pediatric burn center. Patients Eighty-six children (1–18 years) with ≥ 40% total body surface area burns were stratified to two groups: no inhalation injury and inhalation injury. Interventions None. Main Measurements and Results Inhalation injury was diagnosed based on bronchoscopic evaluation. At admission, PaO2:FiO2 ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patient with inhalation injury. No differences were detected in resting energy expenditure or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups. Conclusions Inhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by resting energy expenditure and oxygen consumption. PMID:24893760

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care.

PubMed

Wallis, Lee A; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

2016-01-01

Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden.

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care

PubMed Central

Wallis, Lee A.; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

2016-01-01

Background Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. Methods and Results The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. Conclusions In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden. PMID:26918631

Host defence peptides in human burns.

PubMed

Kaus, Aljoscha; Jacobsen, Frank; Sorkin, Michael; Rittig, Andrea; Voss, Bruno; Daigeler, Adrien; Sudhoff, Holger; Steinau, Hans-Ulrich; Steinstraesser, Lars

2008-02-01

The goal of this study was to analyse expression profiles of human epithelial host defence peptides in burned and unburned skin tissue, samples of which were obtained during debridements and snap-frozen in liquid nitrogen. Total RNA was isolated, and cDNA of epithelial host defence peptides and proteins (hCAP-18/LL-37, hBD1-hBD4, dermcidin, S100A7/psoriasin and RNAse7) was quantified by qRT-PCR. In situ hybridisation and immunohistochemical staining localised gene expression of hCAP-18/LL-37, hBD2 and hBD3 in histological sections. Most of the analysed host defence peptides and proteins showed higher mRNA levels in partial-thickness burns than in unburned tissue. In situ hybridisation revealed expression of hCAP-18/LL-37, hBD2 and hBD3 at the surface of burns that was independent of burn depth. However, the finding of higher host defence peptide gene expression rates does not correlate with the incidence of wound infection in burns. We hypothesise that the epithelial innate immune response in burns is complex.

Near-death experiences, posttraumatic growth, and life satisfaction among burn survivors.

PubMed

Royse, David; Badger, Karen

2017-03-01

Survivors of large burns may face positive and negative psychological after-effects from close-to-death injuries. This study is the first to examine their near-death experiences (NDEs) and posttraumatic growth (PTG) and life satisfaction afterwards. With an available sample of 92 burn survivors, half met the criteria for an NDE using an objective scale. Those who indicated religion was a source of strength and comfort had high scores on life satisfaction, PTG, and the NDE Scale. Individuals with larger burns reported greater PTG than those with smaller total body surface area burned (TBSA). There were no significant differences on life satisfaction, PTG, or NDEs when examined by gender or years since the burn injury. Elements of the NDE most frequently reported were: An altered sense of time, a sense of being out of the physical body, a feeling of peace, vivid sensations, and sense of being in an "other worldly" environment. Social workers and other health providers need to be comfortable helping burn survivors discuss any NDEs and process these through survivors' spirituality and religious belief systems as they recover.

Self-inflicted Burns: 10 year review and comparison to national guidelines.

PubMed

Caine, P L; Tan, A; Barnes, D; Dziewulski, P

2016-02-01

There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given. A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival. We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically. Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Do burns increase the severity of terror injuries?

PubMed

Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

2008-01-01

The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score compared with the other groups. In-hospital mortality rate for the burn/no-terror group was 3.4%. The burn/terror group had a mortality rate of 6.4% which was similar to the no-burn/terror group (6.6%). Terror-attack injuries with accompanying burns have a more complex presentation, are of higher severity, and are associated with increased length of hospital stay and a higher ICU admissions rate, compared with terror-attack injuries without burns and non terror-attack related burns. However, mortality rates in terror-attack injuries are not affected by burns.

Two-year hospital records of burns from a referral center in Western Iran: March 2010-March 2012.

PubMed

Ahmadijouybari, Touraj; Najafi, Farid; Moradinazar, Mehdi; Karami-matin, Behzad; Karami-matin, Reza; Ataie, Maria; Hatami, Masoumeh; Purghorbani, Samira; Amee, Vahid

2014-01-01

Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. Overall 13,248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6,519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive measures. © 2014 KUMS, All rights reserved.

Pediatric deep burns caused by hot incense ashes during 2014 Spring Festival in Fuyang city, China.

PubMed

Wang, Jian; Zhou, Bo; Tao, Ren Qin; Chen, Xu Lin

2016-01-01

The Chinese people in Fuyang city, a northwest city of Anhui Province, are accustomed to burning incense at home for blessing during the Spring Festival. Their children, especially toddlers, like playing around the burning incense and are at risk of burning by hot incense ashes. The purpose of this study was to describe the unique cause and clinical characteristics of pediatric deep burns caused by hot incense ashes during 2014 Spring Festival. Twelve consecutive children admitted to our Burn Center and Fuyang People's Hospital during 2014 Spring Festival, with burn injuries caused by hot incense ashes which were epidemiologically studied retrospectively. Data on age, gender, size, depth and site of burn, incidence by day, number of operation, hospital stay, and causes of burns were collected. All patients came from Fuyang city. Of the 12 patients, the average age was 2.17 years, with a range of 1-6. The boy-to-girl ratio was 2: 1. The mean total burn surface area (TBSA) was 5.83%, and 91.67% of the children sustained full-thickness burn. Hands were the most common parts of the body to be injured. Dry necrosis developed in 14 fingers of 3 patients. January 31, 2014, the first day of the Chinese New Year, was the time of highest incidence. Six patients (50%) required surgical intervention while the number of operations including escharectomy, excision, skin grafting, or amputation of necrotic fingers, per patient was 2. A total of 14 fingers were amputated of the necrotic parts. All children survived and mean length of hospital stay of the patients was 20 days. Hot incense ashes cause serious injuries to children in Fuyang city during the Spring Festival. Preventive programs should be directed towards high risk groups to reduce the incidence of this burn.

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

PubMed Central

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

2012-01-01

Summary Aim To determine the epidemiology and clinical presentation, and any contributing factors responsible for burns and outcome of care in Kuwait over the 5-yr period January 2006 to December 2010. Patients and methods. The study reviewed 1702 burn patients admitted over the study period to the Saud Al Babtain Burns, Plastic and Reconstructive Surgery Center, Kuwait. Patient characteristics, including age, sex, type of burn, nationality, total body surface area (TBSA) burn, hospital stay in days, and mortality were recorded. Results. Seventy-one per cent of the 1702 burn patients admitted were males; 540 were children. The majority of patients (64%) had less than 15% TBSA burns and only 14% had more than 50% TBSA burns. Flame burns were the most common cause of burn injuries (60%), followed by scalds (29%). Scalds were most common in children. The mortality rate was 5.75%. Flame burn was the leading cause of mortality. Lethal dose 50 (% TBSA at which a certain group has a 50% chance of survival) for adults (16-40 yr) and for the elderly (>65 yr) was 76.5% and 41.8% TBSA respectively. Conclusion. Burn injury is an important public health concern and is associated with high morbidity and mortality. Flame and scald burns are commonly a result of domestic and occupational accidents and they are preventable. Effective initial resuscitation, infection control, and adequate surgical treatment improve outcomes. PMID:23766750

Deep sole burns in several participants in a traditional festival of the firewalking ceremony in Kee-lung, Taiwan--clinical experiences and prevention strategies.

PubMed

Chang, Shun-Cheng; Hsu, Chih-Kang; Tzeng, Yuan-Sheng; Teng, Shou-Cheng; Fu, Ju-Peng; Dai, Niann-Tzyy; Chen, Shyi-Gen; Chen, Tim-Mo; Feng, Chun-Che

2012-11-01

Firewalking is a common Taoist cleansing ceremony in Taiwan, but burns associated with the practice have rarely been reported. We analyzed the patients with plantar burns from one firewalking ceremony. In one firewalking ceremony, 12 Taoist disciples suffered from contact burns to the soles of their feet while walking over burning coals. Eight of them had at least second-degree burns over areas larger than 1% of their total body surface areas (TBSAs). The age, sex, medical history, date of injury, time taken to traverse the fire pit, depth and TBSA of the burns, treatment, length of stay, and outcome were recorded and analyzed. Deep, disseminated second- to third-degree burns were noted and healing took as long as three weeks in some patients. Because disseminated hypertrophic scars form after burns, the soles involved regain much of their tensile strength while walking. The patients experienced only a few difficulties in their daily lives three months after injury. From our experience treating patients with deep disseminated second- to third-degree plantar burns caused by firewalking, we conclude that they should be treated conservatively, with secondary healing rather than a skin graft. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

The management of small area burns and unexpected illness after burn in children under five years of age - A costing study in the English healthcare setting.

PubMed

Kandiyali, R; Sarginson, J H; Hollén, L I; Spickett-Jones, F; Young, A E R

2018-02-01

The objective of this economic study was to evaluate the resource use and cost associated with the management of small area burns, including the additional costs associated with unexpected illness after burn in children of less than five years of age. This study was conducted as a secondary analysis of a multi-centre prospective observational cohort study investigating the physiological response to burns in children. 452 children were included in the economic analysis (median age=1.60years, 61.3% boys, median total burn surface area [TBSA]=1.00%) with a mean length of stay of 0.69 days. Of these children, 21.5% re-presented to medical care with an unexpected illness within fourteen days of injury. The cost of managing a burn of less than 10% TBSA in a child less than five years of age was £785. The additional cost associated with the management of illness after burn was £1381. A generalised linear regression model was used to determine the association between an unexpected illness after burn, presenting child characteristics and NHS cost. Our findings may be of value to those planning economic evaluations of novel technologies in burn care. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Burning HOT: revisiting guidelines associated with home oxygen therapy.

PubMed

Litt, Elizabeth J; Ziesche, Rolf; Happak, Wolfgang; Lumenta, David Benjamin

2012-01-01

Burn injuries secondary to home oxygen therapy (HOT) have become increasingly common in recent years, yet several guidelines for HOT and chronic obstructive pulmonary disease (COPD) neglect to stress the dangers of open flames. This retrospective review of burn injury admissions secondary to HOT to our burn centre from 2007 to 2012 aimed to establish the extent of this problem and to discuss the current literature and a selection of national guidelines. Out of six patients (five female, one male) with a median age of 72 (range 58-79), four were related to smoking, and two due to lighting candles. The mean total body surface area (TBSA) affected was 17% (range 2-60%). Five patients sustained facial burns, two suffered from inhalation injury (33.3%), and five required surgery (83.3%). Mean total length of stay was 20 days (range 8 to 33), and one patient died. Although mentioned in the majority, some guidelines fail to address the issue of smoking in light of the associated risk for injury, which in turn might have future implications in litigation related to iatrogenic injuries. Improved HOT guidelines will empower physicians to discourage smoking, and fully consider the risks versus benefits of home oxygen before prescription. With a view on impeding a rising trend of burns secondary to HOT, we suggest revision to national guidelines, where appropriate.

Smartphone applications in burns.

PubMed

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

2015-08-01

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

Facial burns from exploding microwaved foods: Case series and review.

PubMed

Bagirathan, Shenbana; Rao, Krishna; Al-Benna, Sammy; O'Boyle, Ciaran P

2016-03-01

Microwave ovens allow for quick and simple cooking. However, the importance of adequate food preparation, prior to microwave cooking, and the consequences of inadequate preparation are not well-known. The authors conducted a retrospective outcome analysis of all patients who sustained facial burns from microwaved foods and were treated at a UK regional burns unit over a six-year period. Patients were identified from clinical records. Eight patients presented following inadequate preparation of either tinned potatoes (n=4) or eggs (n=4). All patients sustained <2% total body surface area facial burns. Mean age was 41 years (range 21-68 years). Six cases (75%) had associated ocular injury. One received amniotic membrane grafts; this individual's vision remains poor twelve months after injury. Rapid dielectric heating of water within foods may produce high steam and vapour pressure gradients and cause explosive decompression [1,5,11]. Consumers may fail to recognise differential heating and simply cook foods for longer if they remain cool on the outer surface. Education on safe use and risks of microwave-cooked foods may help prevent these potentially serious injuries. Microwave ovens have become ubiquitous. The authors recognise the need for improved public awareness of safe microwave cooking. Burns resulting from microwave-cooked foods may have life-changing consequences. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Electrical burns in Kuwait: a review and analysis of 64 cases.

PubMed

Gang, R K; Bajec, J

1992-12-01

Sixty-four patients with electrical burns were admitted to the Department of Plastic Surgery, Ibn Sina Hospital, Kuwait during the past 6 years. There were 1202 admissions during this period, the incidence of electrical burns being 5.3 per cent. Sixty-nine per cent of the patients sustained injury from direct contact with live electrical wire, the remaining 31 per cent sustained flash burns. The incidence of low voltage injury was much higher as compared to high voltage. Forty-four per cent of these injuries were not work related. Less than 10 per cent of the body surface area was involved in about 80 per cent of the patients. A total of 65 operations was carried out in 39 patients. Twenty of these patients had repeated debridements until the wound was ready for coverage. All 64 patients survived.

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

PubMed

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

2012-05-01

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

Biogeochemical patterns of intermittent streams over space and time as surface flows decrease

NASA Astrophysics Data System (ADS)

MacNeille, R. B.; Lohse, K. A.; Godsey, S.; McCorkle, E. P.; Parsons, S.; Baxter, C.

2016-12-01

Climate change in the western United States is projected to lead to earlier snowmelt, increasing fire risk and potentially transitioning perennial streams to intermittent ones. Differences between perennial and intermittent streams, especially the temporal and spatial patterns of carbon and nutrient dynamics during periods of drying, are understudied. We examined spatial and temporal patterns in surface water biogeochemistry in southwest Idaho and hypothesized that as streams dry, carbon concentrations would increase due to evapoconcentration and/or increased in-stream production. Furthermore, we expected that biogeochemical patterns of streams would become increasingly spatially heterogeneous with drying. Finally, we expected that these patterns would vary in response to fire. To test these hypotheses, we collected water samples every 50 meters from two intermittent streams, one burned and one unburned, in April, May and June, 2016 to determine surface water biogeochemistry. Results showed average concentrations of dissolved inorganic carbon (DIC) and dissolved organic carbon (DOC) increased 3-fold from April to June in the burned site compared to the unburned site where concentrations remained relatively constant. Interestingly, average concentrations of total nitrogen (TN) dropped substantially for the burned site over these three months, but only decreased slightly for the unburned site over the same time period. We also assessed changes in spatial correlation between the burned and unburned site: carbon concentrations were less spatially correlated at the unburned site than at the burned site. Scatterplot matrices of DIC values indicated that at a lag distance of 300 m in April and June, the unburned site had r-values of 0.7416 and 0.5975, respectively, while the burned site had r-values of 0.9468 and 0.8783, respectively. These initial findings support our hypotheses that carbon concentrations and spatial heterogeneity increased over time.

Determinants of skeletal muscle protein turnover following severe burn trauma in children.

PubMed

Malagaris, Ioannis; Herndon, David N; Polychronopoulou, Efstathia; Rontoyanni, Victoria G; Andersen, Clark R; Suman, Oscar E; Porter, Craig; Sidossis, Labros S

2018-06-04

Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients. This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg. A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001). Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

[Enteral nutrition in burn patients].

PubMed

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

1992-01-01

Nutritional support plays an important role in the treatment of patients with burns. Due to the severe hypercatabolism that develops in these patients, oral support is insufficient in most cases, and this makes it essential to initiate artificial nutritional support (either enteral or parenteral). Enteral nutrition is more physiological than parenteral, and data exist which show that in patients with burns, enteral nutrition exercises a protective effect on the intestine and may even reduce the hypermetabolic response in these patients. The purpose of the study was to evaluate the effectiveness and tolerance of enteral nutritional support with a hypercaloric, hyperproteic diet with a high content of branched amino acids in the nutritional support of patients suffering from burns. The study included 12 patients (8 males and 4 females), admitted to the Burns Unit. Average age was 35 +/- 17 years (range: 21-85 years). The percentage of body surface affected by the burns was 10% in two cases, between 10-30% in three cases, between 30-50% in five cases and over 50% in two cases. Initiation of the enteral nutrition was between twenty-four hours and seven days after the burn. The patients were kept in the unit until they were discharged, and the average time spent in the unit was 31.5 days (range: 17-63 days). Total energetic requirements were calculated based on Harris-Benedict, with a variable aggression factor depending on the body surface burned, which varied from 2,000 and 4,000 cal day. Nitrogenous balance was determined on a daily basis, and plasmatic levels of total proteins, albumin and prealbumin on a weekly basis. There was a significant difference between the prealbumin values at the initiation and finalization of the enteral nutrition (9.6 +/- 2.24 mg/dl compared with 19.75 +/- 5.48 mg/dl; p < 0.001). The nitrogenous balance improved, changing from -5.4 in the second week to positive values by the fourth and fifth weeks of treatment. Tolerance to the enteral diet was very good, and only mild complications such as diarrhoea developed in two patients. Enteral nutrition is a suitable nutritional support method for patients with burns, which maintains the nitrogenous balance positive and improves the visceral protein parameters in these patients at an early stage, with very few complications.

The epidemiology of burns in young children from Mexico treated at a U.S. hospital.

PubMed

Patel, Dipen D; Rosenberg, Laura; Rosenberg, Marta; Leal, Jesus; Andersen, Clark R; Foncerrada, Guillermo; Lee, Jong O; Jimenez, Carlos J; Branski, Ludwik; Meyer, Walter J; Herndon, David N

2016-12-01

Young children are the most vulnerable for sustaining burns. At this pediatric burn hospital we have provided medical care to young children with severe burns from Mexico for many years. This study identified modifiable risk factors that could be used to assist in prevention of burns in this age group. A retrospective chart review was performed with children <5 years of age from Mexico who were injured from 2000 to 2013. The medical records of 447 acute patients were reviewed. There were 187 females and 260 males with large burns >20% total body surface area (TBSA) burned. Primary causes of burns were flame and scalds. Children with flame injuries were older (3.0±1.5 years of age) than those with scalds (2.6±1.2 years of age). Admissions attributed to flame burns were largely from explosions by propane tanks, gas line leaks, and house fires. Most admissions for scalds were predominantly from falling in large containers of hot water, food, or grease; and fewer were attributed to spills from hot liquids. Most cases reported to a social service agency were to find resources for families. Mortality rate for flame and scald burns was low. It is important take into account demographic, cultural, and socioeconomic variables when developing and implementing prevention programs. Burn prevention instruction for parents is crucial. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form

PubMed Central

2012-01-01

Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose. PMID:22583548

Muscle Contractile Properties in Severely Burned Rats

PubMed Central

Wu, Xiaowu; Wolf, Steven E.; Walters, Thomas J.

2010-01-01

Burn induces a sustained catabolic response which causes massive loss of muscle mass after injury. A better understanding of the dynamics of muscle wasting and its impact on muscle function is necessary for the development of effective treatments. Male Sprague-Dawley rats underwent either a 40% total body surface area (TBSA) scald burn or sham burn, and were further assigned to subgroups at four time points after injury (days 3, 7, 14 and 21). In situ isometric contractile properties were measured including twitch tension (Pt), tetanic tension (Po) and fatigue properties. Body weight decreased in burn and sham groups through day 3, however, body weight in the sham groups recovered and increased over time compared to burned groups, which progressively decreased until day 21 after injury. Significant differences in muscle wet weight and protein weight were found between sham and burn. Significant differences in muscle contractile properties were found at day 14 with lower absolute Po as well as specific Po in burned rats compared to sham. After burn, the muscle twitch tension was significantly higher than the sham at day 21. No significant difference in fatigue properties was found between the groups. This study demonstrates dynamics of muscle atrophy and muscle contractile properties after severe burn; this understanding will aid in the development of approaches designed to reduce the rate and extent of burn induced muscle loss and function. PMID:20381255

The accuracy of burn diagnosis codes in health administrative data: A validation study.

PubMed

Mason, Stephanie A; Nathens, Avery B; Byrne, James P; Fowler, Rob; Gonzalez, Alejandro; Karanicolas, Paul J; Moineddin, Rahim; Jeschke, Marc G

2017-03-01

Health administrative databases may provide rich sources of data for the study of outcomes following burn. We aimed to determine the accuracy of International Classification of Diseases diagnoses codes for burn in a population-based administrative database. Data from a regional burn center's clinical registry of patients admitted between 2006-2013 were linked to administrative databases. Burn total body surface area (TBSA), depth, mechanism, and inhalation injury were compared between the registry and administrative records. The sensitivity, specificity, and positive and negative predictive values were determined, and coding agreement was assessed with the kappa statistic. 1215 burn center patients were linked to administrative records. TBSA codes were highly sensitive and specific for ≥10 and ≥20% TBSA (89/93% sensitive and 95/97% specific), with excellent agreement (κ, 0.85/κ, 0.88). Codes were weakly sensitive (68%) in identifying ≥10% TBSA full-thickness burn, though highly specific (86%) with moderate agreement (κ, 0.46). Codes for inhalation injury had limited sensitivity (43%) but high specificity (99%) with moderate agreement (κ, 0.54). Burn mechanism had excellent coding agreement (κ, 0.84). Administrative data diagnosis codes accurately identify burn by burn size and mechanism, while identification of inhalation injury or full-thickness burns is less sensitive but highly specific. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

The effect of family characteristics on the recovery of burn injuries in children.

PubMed

Sheridan, Robert L; Lee, Austin F; Kazis, Lewis E; Liang, Matthew H; Li, Nien-Chen; Hinson, Michelle I; Bauk, Helena; Meyer, Walter J; Stubbs, Teresa K; Palmieri, Tina L; Tompkins, Ronald G

2012-09-01

Interactions between family members and characteristics of family life and function may affect a child's recovery from burn injury. We prospectively examined the relationship between family characteristics and physical and psychosocial recovery from burns. The families of 399 burned children aged 5 years to 18 years admitted to one of four Shriners Hospitals for Children for management of acute burns completed the Family Environment Scale within 7 days of admission and then the American Burn Association/Shriners Hospitals for Children Burn Outcome Questionnaire (BOQ) at baseline, 3, 6, 12, 18, 24, 36, and 48 months. Generalized estimating equations with random effects for the time since burn were used to track recovery of the BOQ patient-centered domains associated with baseline family characteristics during the course of the study. The children had a mean age of 11 years and burn size of 32% total body surface area burned. Higher Family Environment Scale scores in cohesion, independence, organization, and active recreational orientation were associated with significantly better rates of recovery in multiple BOQ domains of health-related quality of life. Higher scores in conflict and achievement orientation predicted statistically significant impaired recovery. Higher expressiveness predicted greater difficulty with school reentry. Family characteristics affect the recovery of children after serious burns. Some of these may be amenable to focused anticipatory family interventions to help optimize outcomes. In particular, those characteristics that impair school reentry should be targeted.

Full and Partial Thickness Burns from Spontaneous Combustion of E-Cigarette Lithium-Ion Batteries with Review of Literature.

PubMed

Treitl, Daniela; Solomon, Rachele; Davare, Dafney L; Sanchez, Rafael; Kiffin, Chauniqua

2017-07-01

In recent years, the use of electronic cigarettes (e-cigarettes) has increased worldwide. Most electronic nicotine delivery systems use rechargeable lithium-ion batteries, which are relatively safe, but in rare cases these batteries can spontaneously combust, leading to serious full and partial thickness burn injuries. Explosions from lithium-ion batteries can cause a flash fire and accelerant-related burn injuries. A retrospective chart review was conducted of 3 patients with lithium-ion battery burns seen at our Level I community-based trauma center. Clinical presentation, management, and outcome are presented. All 3 patients sustained burn injuries (total body surface area range 5-13%) from the spontaneous combustion of lithium-ion batteries used for e-cigarettes. All patients were treated with debridement and local wound care. All fully recovered without sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians can expect to treat burn cases due to spontaneous lithium-ion battery combustion as e-cigarette use continues to increase. The cases presented here are intended to bring attention to lithium-ion battery-related burns, prepare physicians for the clinical presentation of this burn mechanism, and facilitate patient education to minimize burn risk. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of mortality prediction models in burns ICU patients in Pinderfields Hospital over 3 years.

PubMed

Douglas, Helen E; Ratcliffe, Andrew; Sandhu, Rajdeep; Anwar, Umair

2015-02-01

Many different burns mortality prediction models exist; however most agree that important factors that can be weighted include the age of the patient, the total percentage of body surface area burned and the presence or absence of smoke inhalation. A retrospective review of all burns primarily admitted to Pinderfields Burns ICU under joint care of burns surgeons and intensivists for the past 3 years was completed. Predicted mortality was calculated using the revised Baux score (2010), the Belgian Outcome in Burn Injury score (2009) and the Boston group score by Ryan et al. (1998). Additionally 28 of the 48 patients had APACHE II scores recorded on admission and the predicted and actual mortality of this group were compared. The Belgian score had the highest sensitivity and negative predictive value (72%/85%); followed by the Boston score (66%/78%) and then the revised Baux score (53%/70%). APACHE II scores had higher sensitivity (81%) and NPV (92%) than any of the burns scores. In our group of burns ICU patients the Belgian model was the most sensitive and specific predictor of mortality. In our subgroup of patients with APACHE II data, this score more accurately predicted survival and mortality. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Unplanned readmission after hospital discharge in burn patients in Iran.

PubMed

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

2018-02-21

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

Effect of biomass open burning on particulate matter and polycyclic aromatic hydrocarbon concentration levels and PAH dry deposition in ambient air.

PubMed

Chiu, Jui C; Shen, Yun H; Li, Hsing W; Chang, Shun S; Wang, Lin C; Chang-Chien, Guo P

2011-01-01

The objectives of the present study were to investigate particulate matter (PM) and polycyclic aromatic hydrocarbon (PAH) concentrations in ambient air during rice straw open burning and non-open burning periods. In the ambient air of a rice field, the mean PM concentration during and after an open burning event were 1828 and 102 μg m⁻³, respectively, which demonstrates that during a rice field open burning event, the PM concentration in the ambient air of rice field is over 17 times higher than that of the non-open burning period. During an open burning event, the mean total PAH and total toxic equivalence (BaP(eq)) concentrations in the ambient air of a rice field were 7206 ng m⁻³ and 10.3 ng m⁻³, respectively, whereas after the open burning event, they were 376 ng m⁻³ and 1.50 ng m⁻³, respectively. Open burning thus increases total PAH and total BaP(eq) concentrations by 19-fold and 6.8-fold, respectively. During a rice straw open burning event, in the ambient air of a rice field, the mean dry deposition fluxes of total PAHs and total BaP(eq) were 1222 μg m⁻² day⁻¹ and 4.80 μg m⁻² day⁻¹, respectively, which are approximately 60- and 3-fold higher than those during the non-open burning period, respectively. During the non-open burning period, particle-bound PAHs contributed 79.2-84.2% of total dry deposition fluxes (gas + particle) of total PAHs. However, an open burning event increases the contribution to total PAH dry deposition by particle-bound PAHs by up to 85.9-95.5%. The results show that due to the increased amount of PM in the ambient air resulting from rice straw open burning, particle-bound PAHs contributed more to dry deposition fluxes of total PAHs than they do during non-open burning periods. The results show that biomass (rice straw) open burning is an important PAH emission source that significantly increases both PM and PAH concentration levels and PAH dry deposition in ambient air.

The flaming gypsy skirt injury.

PubMed

Leong, S C L; Emecheta, I E; James, M I

2007-01-01

On review of admissions over a 12-month period, we noted a significant number of women presenting with gypsy skirt burns. We describe all six cases to highlight the unique distribution of the wounds and the circumstances in which the accidents occurred. Four skirts were ignited by open fire heaters: two skirts ignited whilst the women were standing nearby, distracted with a telephone conversation; one brushed over the flame as she was walking past the heater; other whilst dancing in the lounge. One skirt was ignited by decorative candles placed on the floor during a social gathering. Another skirt was set alight by cigarette ember, whilst smoking in the toilet. Percentage surface area burned, estimated according to the rule of nines, showed that gypsy skirt burns were significant ranging from 7 to 14% total body surface area (TBSA) and averaging 9% TBSA. Two patients required allogenic split-skin grafts. Common sense care with proximity to naked flame is all that is needed to prevent this injury.

Wind erosion from a sagebrush steppe burned by wildfire: measurements of PM10 and total horizontal sediment flux

USGS Publications Warehouse

Wagenbrenner, Natalie S.; Germino, Matthew J.; Lamb, Brian K.; Robichaud, Peter R.; Foltz, Randy B.

2013-01-01

above the soil surface, had a maximum PM10 vertical flux of 100 mg m-2 s-1, and generated a large dust plume that was visible in satellite imagery. The peak PM10 concentration measured on-site at a height of 2 m in the downwind portion of the burned area was 690 mg m-3. Our results indicate that wildfire can convert a relatively stable landscape into one that is a major dust source.

Spatially-varied erosion modeling using WEPP for timber harvested and burned hillslopes

Treesearch

Peter R. Robichaud; T. M. Monroe

1997-01-01

Spatially-varied hydrologic surface conditions exist on steep hillslopes after timber harvest operation and site preparation burning treatments. Site preparation burning creates low- and high-severity burn surface conditions or disturbances. In this study, a hillslope was divided into multiple combinations of surface conditions to determine how their spatial...

Inability to determine tissue health is main indication of allograft use in intermediate extent burns.

PubMed

Fletcher, John L; Cancio, Leopoldo C; Sinha, Indranil; Leung, Kai P; Renz, Evan M; Chan, Rodney K

2015-12-01

Cutaneous allograft is commonly used in the early coverage of excised burns when autograft is unavailable. However, allograft is also applied in intermediate-extent burns (25-50%), during cases in which it is possible to autograft. In this population, there is a paucity of data on the indications for allograft use. This study explores the indications for allograft usage in moderate size burns. Under an IRB-approved protocol, patients admitted to our burn unit between March 2003 and December 2010 were identified through a review of the burn registry. Data on allograft use, total burn surface area, operation performed, operative intent, number of operations, intensive care unit length of stay, and overall length of stay were collected and analyzed. Data are presented as means±standard deviations, except where noted. In the study period, 146 patients received allograft during their acute hospitalization. Twenty-five percent of allograft recipients sustained intermediate-extent burns. Patients with intermediate-extent burns received allograft later in their hospitalization than those with large-extent (50-75% TBSA) burns (6.8 days vs. 3.4 days, p=0.01). Allografted patients with intermediate-extent burns underwent more operations (10.8 vs. 6.1, p=0.002) and had longer hospitalizations (78.3 days vs. 40.9 days, p<0.001) than non-allografted patients, when controlled for TBSA. Clinical rationale for placement of allograft in this population included autograft failure, uncertain depth of excision, lack of autograft donor site, and wound complexity. When uncertain depth of excision was the indication, allograft was universally applied onto the face. In half of allografted intermediate-extent burn patients the inability to identify a viable recipient bed was the ultimate reason for allograft use. Unlike large body surface area burns, allograft skin use in intermediate-extent injury occurs later in the hospitalization and is driven by the inability to determine wound bed suitability for autograft application. Allograft application can be utilized to test recipient site viability in cases of autograft failure or uncertain depth of excision. Published by Elsevier Ltd.

[Predictive factors of mortality of the burnt persons: study on 221 adults hospitalized between 2004 and 2009].

PubMed

Elkafssaoui, S; Hami, H; Mrabet, M; Bouaiti, E; Tourabi, K; Quyou, A; Soulaymani, A; Ihrai, H

2014-06-01

The objective of the present study is the evaluation of the predictive factors of mortality to a troop of Moroccan grown-up serious burnt persons. Variables analyzed in the study are: the age, the sex, the localization of the burn, the degree of burn, indicates Total Body Surface Area (TBSA), indicate Unit of Standard Burn (UBS) and the indication of leases, sepsis and the medical histories (tobacco, diabetes). Factors associated significantly to a mortality raised at the burned patients were the female genital organ, the localization of the burn at the level of the head, the sepsis, one TBSA greater or equal to 20%, an UBS greater or equal to 200 and an indication of leases greater or equal to 75. Other factors such as the age, the degree of burn and the histories did not show a significant difference. An evaluation and a good knowledge of factors associated to a high risk of death allow an adequate coverage of this category of patients. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Civilian blast-related burn injuries

PubMed Central

Patel, J.N.; Tan, A.; Dziewulski, P.

2016-01-01

Summary There is limited English literature describing the experience of a civilian hospital managing blast-related burn injuries. As the largest regional burn unit, we reviewed our cases with the aim of identifying means to improve current management. A 6-year retrospective analysis of all patients coded as sustaining blast-related burns was conducted through the unit’s burns database. Medical case notes were reviewed for information on burn demographics, management and outcomes. 42 patients were identified. Male to female ratio was 37:5. Age range was 12-84 years, (mean=33 years). Total body surface area (%TBSA) burn ranged from 0.25% to 60%, (median=1%). The most common burn injury was flame (31/42, 73.8%). Gas explosions were the most common mechanism of injury (19 cases; 45.2%). 7/42 cases (16.7%) had full ATLS management pre-transfer to the burns unit. The Injury Severity Score (ISS) ranged from 0-43 (median=2). 17/42 (40.4%) patients required admission. 37/36 (88.1%) patients were managed conservatively of which 1 patient later required surgery due to deeper burns. 5/42 (11.9%) patients required surgical management at presentation and these were noted to be burns with >15% TBSA requiring resuscitation. One case required emergency escharotomies and finger amputations. All patients survived their burn injuries. Blast-related burn injuries are generally uncommon in the civilian setting. Following proper assessment, most of these cases can be deemed as minor injuries and managed conservatively. Improvement in burns management education and training at local emergency departments would provide efficient patient care and avoid unnecessary referrals to a burns unit. PMID:27857651

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

PubMed

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

2016-02-01

Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment. 15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre. death or length of stay <10 days, age <16 years. demographic variables, burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, carbohydrate and insulin delivery/24h, arterial blood glucose and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven. 229 patients, aged 45 ± 20 years (mean ± SD), burned 32 ± 20% TBSA were analyzed. SAPSII was 35 ± 13. TBSA, Ryan and ABSI remained stable. Inhalation injury increased. A total of 28,690 blood glucose samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme hypoglycemia in period 4). Severe hyperglycemia persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and glucose deliveries decreased in periods 3 and 4 (p<0.0001). Infectious complications increased during the last 2 periods (p=0.01). A standardized ICU glucose control protocol improved the glycemic control in adult burn patients, reducing glucose variability. Moderate glycemic control in burns was safe specifically related to hypoglycemia, reducing the incidence of hypoglycaemic events compared to the period before. Hyperglycemia persisted at a lower level. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Does voltage predict return to work and neuropsychiatric sequelae following electrical burn injury?

PubMed

Chudasama, Shruti; Goverman, Jeremy; Donaldson, Jeffrey H; van Aalst, John; Cairns, Bruce A; Hultman, Charles Scott

2010-05-01

Voltage has historically guided the acute management and long-term prognosis of physical morbidity in electrical injury patients; however, few large studies exist that include neuropsychiatric morbidity in final outcome analysis. This review compares high (>1000 V) to low (<1000 V) voltage injuries, focusing on return to work and neuropsychiatric sequelae following electrical burn injury. Patients with electrical injuries admitted to the University of North Carolina Jaycee Burn Center between 2000 and 2005 were prospectively entered into a trauma database, then retrospectively reviewed. Patients were divided into 4 cohorts: high voltage (>1000 V), low voltage (<1000 V), flash arc, and lightning. Demographics, hospital course, and follow-up were recorded to determine physical and neuropsychiatric morbidity. Differences among cohorts were tested for statistical significance. Over 5 years, 2548 patients were admitted to the burn center, including 115 patients with electrical injuries. There were 110 males and 5 females, with a mean age of 35 years (range, 0.75-65 years). The cause of the electrical injury was high voltage in 60 cases, low voltage in 25 cases, flash arc in 29 cases and lightning in 1 case. The mean total body surface area burn was 8% (range, 0%-52%). The etiology was work-related electrical injury in 85 patients. Mean follow-up period was 352 days with 13 (11%) patients lost to follow-up. Patients with high voltage injuries had significantly larger total body surface area burn, longer ICU stays, longer hospitalizations, and significantly higher rates of fasciotomy, amputation, nerve decompression and outpatient reconstruction, with 4 cases of renal failure and 2 deaths. In spite of these differences, high and low voltage groups experienced similar rates of neuropsychiatric sequelae, limited return to work and delays in return to work. Final impairment ratings for the high and low voltage groups were 17.5% and 5.3%, respectively. Electrical injuries often incur severe morbidity despite relatively small burn size and/or low voltage. When comparing high and low voltage injuries, similarities in endpoints such as neuropsychiatric sequelae, the need for late reconstruction, and failure to return to work challenge previous notions that voltage predicts outcome.

Cardowan coal mine explosion: experience of a mass burns incident.

PubMed Central

Allister, C; Hamilton, G M

1983-01-01

A coal mine explosion 1700 feet (516 m) underground and two miles (3.2 km) from the pit head resulted in 40 casualties. Two hours elapsed between the explosion and the arrival of patients at hospital. Six patients suffered mechanical injuries, only one of which was life threatening. Thirty six suffered burns; in 18 over 15% of the total body surface area was affected. Nineteen patients had a mild respiratory upset requiring oxygen treatment. The average length of inpatient stay in those admitted was 24 days. Early assessment and treatment in the accident and emergency department was relatively simple because of the large proportion of burn injuries. Lack of communication between site and hospital made administration of the disaster difficult. PMID:6409324

Long-term scar quality after hydrosurgical versus conventional debridement of deep dermal burns (HyCon trial): study protocol for a randomized controlled trial.

PubMed

Legemate, Catherine M; Goei, Harold; Middelkoop, Esther; Oen, Irma M M H; Nijhuis, Tim H J; Kwa, Kelly A A; van Zuijlen, Paul P M; Beerthuizen, Gerard I J M; Nieuwenhuis, Marianne K; van Baar, Margriet E; van der Vlies, Cornelis H

2018-04-19

Deep dermal burns require tangential excision of non-viable tissue and skin grafting to improve wound healing and burn-scar quality. Tangential excision is conventionally performed with a knife, but during the last decade hydrosurgery has become popular as a new tool for tangential excision. Hydrosurgery is generally thought to be a more precise and controlled manner of burn debridement leading to preservation of viable tissue and, therefore, better scar quality. Although scar quality is considered to be one of the most important outcomes in burn surgery today, no randomized controlled study has compared the effect of these two common treatment modalities with scar quality as a primary outcome. The aim of this study is, therefore, to compare long-term scar quality after hydrosurgical versus conventional tangential excision in deep dermal burns. A multicenter, randomized, intra-patient, controlled trial will be conducted in the Dutch burn centers of Rotterdam, Beverwijk, and Groningen. All patients with deep dermal burns that require excision and grafting are eligible. Exclusion criteria are: a burn wound < 50 cm 2 , total body surface area (TBSA) burned > 30%, full-thickness burns, chemical or electrical burns, infected wounds (clinical symptoms in combination with positive wound swabs), insufficient knowledge of the Dutch or English language, patients that are unlikely to comply with requirements of the study protocol and follow-up, and patients who are (temporarily) incompetent because of sedation and/or intubation. A total of 137 patients will be included. Comparable wound areas A and B will be appointed, randomized and either excised conventionally with a knife or with the hydrosurgery system. The primary outcome is scar quality measured by the observer score of the Patient and Observer Scar Assessment Scale (POSAS); a subjective scar-assessment instrument, consisting of two separate six-item scales (observer and patient) that are both scored on a 10-point rating scale. This study will contribute to the optimal surgical treatment of patients with deep dermal burn wounds. Dutch Trial Register, NTR6232 . Registered on 23 January 2017.

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

PubMed

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

2007-09-30

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.

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. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

The effect of lower body burns on physical function.

PubMed

Benjamin, Nicole C; Andersen, Clark R; Herndon, David N; Suman, Oscar E

2015-12-01

To attenuate burn-induced catabolism, patients are often enrolled in a resistance exercise program as part of their physical rehabilitation. This study assessed how lower body burn locations affected strength and cardiopulmonary function. Children enrolled in an exercise study between 2003 and 2013, were 7-18 years of age, and burned ≥30% of their total body surface area were included. Analysis of variance was used to model the relationship of lower body strength (PTW) and cardiopulmonary function (VO2peak) due to burns which traverse the subject's lower body joints. There was a significant relationship between PTW and burns at the hip and toe joints, showing a 26 N m/kg (p=0.010) and 33 N m/kg (p=0.013) decrease in peak torque, respectively. Burns at the hip joint corresponded to a significant decrease in VO2peak by 4.9 ml kg(-1) min(-1) (p=0.010) in peak cardiopulmonary function. Physical function and performance are detrimentally affected by burns that traverse specific lower body joints. The most significant relationship on exercise performance was that of hip joint burns as it affected both strength and cardiopulmonary measurements. Ultimately, burns at hip and toe joints need to be considered when interpreting exercise test results involving the lower body. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Examining the Correlation between Objective Injury Parameters, Personality Traits, and Adjustment Measures among Burn Victims

PubMed Central

Weissman, Oren; Domniz, Noam; Petashnick, Yoel R.; Gilboa, Dalia; Raviv, Tal; Barzilai, Liran; Farber, Nimrod; Harats, Moti; Winkler, Eyal; Haik, Josef

2015-01-01

Background: Burn victims experience immense physical and mental hardship during their process of rehabilitation and regaining functionality. We examined different objective burn-related factors as well as psychological ones, in the form of personality traits that may affect the rehabilitation process and its outcome. Objective: To assess the influence and correlation of specific personality traits and objective injury-related parameters on the adjustment of burn victims post-injury. Methods: Sixty-two male patients admitted to our burn unit due to burn injuries were compared with 36 healthy male individuals by use of questionnaires to assess each group’s psychological adjustment parameters. Multivariate and hierarchical regression analysis was conducted to identify differences between the groups. Results: A significant negative correlation was found between the objective burn injury severity (e.g., total body surface area and burn depth) and the adjustment of burn victims (p < 0.05, p < 0.001, Table 3). Moreover, patients more severely injured tend to be more neurotic (p < 0.001), and less extroverted and agreeable (p < 0.01, Table 4). Conclusion: Extroverted burn victims tend to adjust better to their post-injury life while the neurotic patients tend to have difficulties adjusting. This finding may suggest new tools for early identification of maladjustment-prone patients and therefore provide them with better psychological support in a more dedicated manner. PMID:25874193

The Effect of Lower Body Burns on Physical Function

PubMed Central

Benjamin, Nicole C.; Andersen, Clark R.; Herndon, David N.; Suman, Oscar E.

2015-01-01

Objective To attenuate burn-induced catabolism, patients are often enrolled in a resistance exercise program as part of their physical rehabilitation. This study assessed how lower body burn locations affected strength and cardiopulmonary function. Methods Children enrolled in an exercise study between 2003 and 2013, were 7–18 years of age, and burned ≥ 30% of their total body surface area were included. Analysis of variance was used to model the relationship of lower body strength (PTW) and cardiopulmonary function (VO2peak) due to burns which traverse the subject’s lower body joints. Results There was a significant relationship between PTW and burns at the hip and toe joints, showing a 26 Newton·meters/kilogram (p=0.010) and 33 Newton·meters/kilogram (p=0.013) decrease in peak torque, respectively. Burns at the hip joint corresponded to a significant decrease in VO2peak by 4.9 mL·kg−1·min−1 (p=0.010) in peak cardiopulmonary function. Conclusion Physical function and performance are detrimentally affected by burns that traverse specific lower body joints. The most significant relationship on exercise performance was that of hip joint burns as it affected both strength and cardiopulmonary measurements. Ultimately, burns at hip and toe joints need to be considered when interpreting exercise test results involving the lower body. PMID:26421695

Hot surface temperatures of domestic appliances.

PubMed

Bassett, Malcolm; Arild, Anne-Helene

2002-09-01

Domestic appliances are burning people. In the European Union, accidents requiring hospital treatment due to burns from hot objects account for between 0 and 1% of all such accidents. Young children are particularly at risk. These reported accidents requiring hospital treatment are also likely to be a small proportion of the total number of burns from hot objects. There is a lack of hard evidence about the level of accidents, typical consumer expectation and use, and on the state of the art of appliances. Results of technical laboratory tests carried out on products are used to demonstrate the state of the art and also show how consumer expectations could be changing. Results of a survey into accidents, based on a written questionnaire following telephone contact, provide information on non-hospital cases. Results of tests on products show that there are significant differences in the temperatures of touchable surfaces, even in products of the same type. Typically, these differences are due to variations in design and/or materials of construction. Some products are hot enough to burn skin. Accident research indicates that non-hospital medical practices are treating burn injuries, which are therefore not being included into the current accident statistics. For products with the same function, some types of design or materials of construction are safer, with lower surface temperatures. Many product standards have no or unnecessarily high limits on surface temperatures. Many standards do not address the realities of who is using their products, for what purpose or where they are located. Some standards use unreasonable general limitations and exclusions that allow products with higher surface temperatures than they should have. Many standards rely on the experience factor for avoiding injury that is no longer valid, with the increased availability of safer products of the same type. A major field of work ahead is to carry out more surveys and in-depth studies of non-fatal accidents and injuries.

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

PubMed

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

2016-03-01

This study evaluated the impact of a newly implemented protocol for superficial to mid-dermal partial thickness burns which involves early surgery and rapid coverage with biosynthetic dressing in a specialized national burns center in Singapore. Consecutive patients with 5% or greater total body surface area (TBSA) superficial to mid-dermal partial thickness burns injury admitted to the Burns Centre at the Singapore General Hospital between August and December 2014 for surgery within 48 hours of injury were prospectively recruited into the study to form the protocol group. Comparable historical cases from the year 2013 retrieved from the burns center audit database were used to form the historical control group. Demographics (age, sex), type and depth of burns, %TBSA burnt, number of operative sessions, and length of stay were recorded for each patient of both cohorts. Thirty-nine burns patients managed under the new protocol were compared with historical control (n = 39) comparable in age and extensiveness of burns. A significantly shorter length of stay (P < 0.05) per TBSA burns was observed in the new protocol group (0.74 day/%TBSA) versus historical control (1.55 day/%TBSA). Fewer operative sessions were needed under the new protocol for burns 10% or greater TBSA burns (P < 0.05). The authors report their promising experience with a newly implemented protocol for surgically managed burns patients which involves early surgery and appropriate use of biosynthetic dressing on superficial to mid-dermal partial thickness burns. Clinically, shorter lengths of stay, fewer operative sessions, and decreased need for skin grafting of burns patient were observed.

Impaired Respiratory Function and Heightened Pulmonary Inflammation in Episodic Binge Ethanol Intoxication and Burn Injury

PubMed Central

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

2015-01-01

Clinical data indicate that cutaneous burn injuries covering greater than ten percent total body surface area are associated with significant morbidity and mortality, where 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 three-fold, and doubles length of hospital admittance, compared to non-intoxicated burn patients. The most common drinking pattern in the United States is binge drinking, where one rapidly consumes alcoholic beverages (4 for women, 5 for men) in 2 hours and an estimated 38 million Americans binge drink, often several times per month. Experimental data demonstrate 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 affects 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. Overall, our study identifies plethysmography as a useful tool for characterizing respiratory function in a murine burn model and for future identification of therapeutic compounds capable of restoring pulmonary functionality. PMID:26364264

Recreational-outdoor burns: the impact and severity--a retrospective review of 107 patients.

PubMed

Phillips, B J; Kassir, A; Anderson, B; Schiller, W R

1998-09-01

Campfires, bonfires and barbecues play a prominent role in outdoor activities and serve a variety of decorative and functional purposes. Given all of it's various forms, uses and benefits, the outdoor fire can turn dangerous in a matter of seconds: a stumble or fall (the child running that trips) leads to direct contact with the flames and subsequent burn injury. With it's everyday occurrence, we were surprised to find a paucity of information regarding this type of burn in the literature, including the NBIE analysis. A retrospective review of 107 patients admitted to the Maricopa Medical Bum Center, from 1987 to 1996, was conducted. Each chart was analyzed for the patient demographics, mechanism of injury, percent total body surface area burned, operative versus non-operative treatment and overall outcome. An average burn injury involved 5.7% TBSA, with a wide range from 1 to 47%. The majority of our population involved either small children or intoxicated adults and a total of 50 patients required 92 operations. Severe morbidity, including 4 amputations and 2 mortalities, were seen. The average hospital stay was 14.3 days, ranging from 1 to 52 days. Recreational outdoor burns were extremely common injuries leading to loss of functional employment and prolonged physical therapy requirements. Small children and intoxicated adults comprised the majority of our study population. The impact and severity of such outdoor fires could be greatly affected by appropriate attention to prevention.

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

PubMed

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

2017-03-31

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

Comparison of combat and non-combat burns from ongoing U.S. military operations.

PubMed

Kauvar, David S; Cancio, Leopoldo C; Wolf, Steven E; Wade, Charles E; Holcomb, John B

2006-05-15

Military burns result from either combat or non-combat causes. We compared these etiologies from patients involved in ongoing conflicts to evaluate their impact and provide prevention recommendations. All military patients with significant burns treated at the United States Army Institute of Surgical Research from April 2003 to May 2005 were reviewed. Injuries were categorized as having resulted from combat or non-combat causes. Demographics, burn severity and pattern, mortality, and early outcomes were compared. There were 273 burn patients seen with 63% injured in combat. A high early rate of non-combat injuries was noted. Feedback on non-combat burn prevention was provided to the combat theater, and the incidence of non-combat burns decreased. Mean age and time from injury to admission did not differ. The majority of combat injuries resulted from explosive device detonation. Waste burning, ammunition handling, and gasoline caused most non-combat injuries. Combat casualties had more associated and inhalation injuries and greater full-thickness burn size; total body surface area burned was equivalent. The hands and the face were the most frequently burned body areas. Mortality was 5% in combat and 2% in non-combat patients. The majority of survivors in both groups returned to military duty. The disparity in full-thickness burn size and incidence of inhalation and associated injuries resulted from differing mechanisms of injury, with explosions and penetrating trauma more common in combat wounds. Despite the severity of combat burns, mortality was low and outcomes generally good. Non-combat burns are preventable and have decreased in incidence.

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

PubMed

Hashmi, Madiha; Kamal, Rehana

2013-05-01

In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU). This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented. A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR =32-7). 32% victims were children <14 years and only 7% were >50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36-33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%. Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death. Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality. Burn hazard awareness, prevention and educational programmes targeted at the vulnerable population, i.e. women and young children at home and men at their work place is the single most cost-effective way of reducing the incidence of burns in developing countries. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

The protective effects of sildenafil in acute lung injury in a rat model of severe scald burn: A biochemical and histopathological study.

PubMed

Gokakin, Ali Kagan; Deveci, Koksal; Kurt, Atilla; Karakus, Boran Cihat; Duger, Cevdet; Tuzcu, Mehmet; Topcu, Omer

2013-09-01

Severe burn induces biochemical mediators such as reactive oxygen species that leads to lipid peroxidation which may have a key role in formation of acute lung injury (ALI). Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil preserves alveolar growth, angiogenesis, reduces inflammation and airway reactivity. The purpose of the present study was to evaluate the effects of different dosages of sildenafil in ALI due to severe scald burn in rats. Twenty-four rats were subjected to 30% total body surface area severe scald injury and were randomly divided into three equal groups as follow: control, 10 and 20mg/kg sildenafil groups. Levels of malondialdehyde (MDA), activities of glutathione peroxidase (Gpx), catalase (Cat), total oxidative stress (TOS), and total antioxidative capacity (TAC) were measured in both tissues and serums. Oxidative stress index (OSI) was calculated. A semi-quantitative scoring system was used for the evaluation of histopatological findings. Sildenafil increased Gpx, Cat, TAC and decreased MDA, TOS and OSI. Sildenafil decreased inflammation scores in lungs. Our results reveal that sildenafil is protective against scald burn related ALI by decreasing oxidative stress and inflammation and the dosage of 10mg/kg could be apparently better than 20mg/kg. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Electricity and fishing - a dangerous mix.

PubMed

Fodor, Lucian; Bota, Ioan O; Abbas, Yusuf; Fodor, Marius; Ciuce, Constantin

2011-05-01

The advent of fishing rods made of carbon fiber and graphite rods has greatly increased the risks of electrical injuries associated with fishing. The braided fishing lines and metal hooks put the fishermen at risk for electrical injuries. We review our burn center's experience with electrical injuries related to fishing activities during the last four years. We retrospectively collected data on patients with electrical burns related to fishing activities between January 2006, when our burns unit was established, and December 2009. Eight patients with electrical burns were admitted during this period of time, five who sustained the injury while fishing, due to contact of the fishing rod with overhead high-voltage cables and three who were injured during illegal fishing, using electricity to stun the fish. The total burn surface area ranged from 0.5% to 70%. Three of the patients sustained fourth degree burns, while the rest had second and third degree burns. One patient underwent scapulohumeral disarticulation and an above-knee amputation. Two patients had fingers and toes amputated. Latissimus dorsi and anterolateral thigh flaps were used to cover the defects in two cases. Local flaps were employed in other two cases to cover the tissue defects. Two patients died. Fishing-related burns and illegal fishing can lead to serious injuries and death. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

Anthropogenic disturbance of element cycles at the Earth's surface.

PubMed

Sen, Indra S; Peucker-Ehrenbrink, Bernhard

2012-08-21

The extent to which humans are modifying Earth's surface chemistry can be quantified by comparing total anthropogenic element fluxes with their natural counterparts (Klee and Graedel, 2004). We quantify anthropogenic mass transfer of 77 elements from mining, fossil fuel burning, biomass burning, construction activities, and human apportionment of terrestrial net primary productivity, and compare it to natural mass transfer from terrestrial and marine net primary productivity, riverine dissolved and suspended matter fluxes to the ocean, soil erosion, eolian dust, sea-salt spray, cosmic dust, volcanic emissions, and for helium, hydrodynamic escape from the Earth's atmosphere. We introduce an approach to correct for losses during industrial processing of elements belonging to geochemically coherent groups, and explicitly incorporate uncertainties of element mass fluxes through Monte Carlo simulations. We find that at the Earth's surface anthropogenic fluxes of iridium, osmium, helium, gold, ruthenium, antimony, platinum, palladium, rhenium, rhodium and chromium currently exceed natural fluxes. For these elements mining is the major factor of anthropogenic influence, whereas petroleum burning strongly influences the surficial cycle of rhenium. Our assessment indicates that if anthropogenic contributions to soil erosion and eolian dust are considered, anthropogenic fluxes of up to 62 elements surpass their corresponding natural fluxes.

Data Filtering of Western Hemisphere GOES Wildfire ABBA Products

NASA Astrophysics Data System (ADS)

Theisen, M.; Prins, E.; Schmidt, C.; Reid, J. S.; Hunter, J.; Westphal, D.

2002-05-01

The Fire Locating and Modeling of Burning Emissions (FLAMBE') project was developed to model biomass burning emissions, transport, and radiative effects in real time. The model relies on data from the Geostationary Operational Environment Satellites (GOES-8, GOES-10), that is generated by the Wildfire Automated Biomass Burning Algorithm (WF ABBA). In an attempt to develop the most accurate modeling system the data set needs to be filtered to distinguish the true fire pixels from false alarms. False alarms occur due to reflection of solar radiation off of standing water, surface structure variances, and heat anomalies. The Reoccurring Fire Filtering algorithm (ReFF) was developed to address such false alarms by filtering data dependent on reoccurrence, location in relation to region and satellite, as well as heat intensity. WF ABBA data for the year 2000 during the peak of the burning season were analyzed using ReFF. The analysis resulted in a 45% decrease in North America and only a 15% decrease in South America, respectively, in total fire pixel occurrence. The lower percentage decrease in South America is a result of fires burning for longer periods of time, less surface variance, as well as an increase in heat intensity of fires for that region. Also fires are so prevalent in the region that multiple fires may coexist in the same 4-kilometer pixel.

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

PubMed Central

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

2016-01-01

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

Inflammatory response in multiple organs in a mouse model of acute alcohol intoxication and burn injury*

PubMed Central

Li, Xiaoling; Akhtar, Suhail; Kovacs, Elizabeth J.; Gamelli, Richard L.; Choudhry, Mashkoor A.

2011-01-01

The present study characterized the inflammatory response following burn injury and determined whether ethanol (EtOH) intoxication at the time of burn injury influences this response. To accomplish this, male mice were gavaged with EtOH (2.9 g/Kg) 4 hours prior to 12–15% total body surface area sham or burn injury. Mice were sacrificed on day one after injury; blood, small intestine, lung and liver were collected to measure IL-6, IL-10, IL-18 and MCP-1 levels. In addition, neutrophil infiltration, MPO activity and edema formation were also measured in the small intestine, lung and liver. There was no difference in the inflammatory markers in the small intestine, lung and liver in mice receiving either sham or burn injury alone except IL-6 which was increased in all 4 tissue compartments following burn injury alone. However, as compared to EtOH or burn injury alone, EtOH combined with burn injury resulted in a significant increase in cytokines, neutrophil infiltration, MPO activity and edema in the small intestine, liver and lung tissue. Furthermore, a significant increase in IL-6 and MCP-1 was observed in circulation following EtOH and burn injury compared to either EtOH intoxication or burn injury alone, no other cytokines were detected in circulation. These findings suggest that acute EtOH intoxication exacerbates the inflammatory response following burn injury. PMID:21593683

Alcohol potentiates post burn remote organ damage through shifts in fluid compartments mediated by bradykinin

PubMed Central

Chen, Michael M.; O’Halloran, Eileen B.; Ippolito, Jill A.; Choudhry, Mashkoor A.; Kovacs, Elizabeth J.

2014-01-01

Of the 450,000 burn patients each year, 50% have a positive blood alcohol content and this predisposes them to worsened clinical outcomes. Despite high prevalence and established consequences, the mechanisms responsible for alcohol-mediated complications of post burn remote organ damage are currently unknown. To this end, mice received a single dose of alcohol (1.12 g/kg) or water by oral gavage and were subjected to a 15% total body surface area burn. Animals with a burn alone lost ~5% of their body weight in 24 hours whereas intoxicated and burned mice lost only 1% body weight (p<0.05) despite a 17% increase in hematocrit (p<0.05) and a 57% increase in serum creatinine (p<0.05) over burn injury alone. This retention of water weight despite increased dehydration suggests that intoxication at the time of a burn causes a shift in fluid compartments that may exacerbate end organ ischemia and damage as evidenced by a 3-fold increase in intestinal bacterial translocation (p<0.05), a 30% increase (p<0.05) in liver weight to body weight ratio, and an increase in alveolar wall thickness over a burn alone. Furthermore, administration of the bradykinin antagonist HOE140 30 minutes after intoxication and burn restored fluid balance and alleviated end organ damage. These findings suggest that alcohol potentiates post burn remote organ damage through shifts in fluid compartments mediated by bradykinin. PMID:25243425

Contributions of Severe Burn and Disuse to Bone Structure and Strength in Rats

PubMed Central

Baer, L.A.; Wu, X.; Tou, J. C.; Johnson, E.; Wolf, S.E.; Wade, C.E.

2012-01-01

Burn and disuse results in metabolic and bone changes associated with substantial and sustained bone loss. Such loss can lead to an increased fracture incidence and osteopenia. We studied the independent effects of burn and disuse on bone morphology, composition and strength, and microstructure of the bone alterations 14 days after injury. Sprague-Dawley rats were randomized into four groups: Sham/Ambulatory (SA), Burn/Ambulatory (BA), Sham/Hindlimb Unloaded (SH) and Burn/Hindlimb Unloaded (BH). Burn groups received a 40% total body surface area full-thickness scald burn. Disuse by hindlimb unloading was initiated immediately following injury. Bone turnover was determined in plasma and urine. Femur biomechanical parameters were measured by three-point bending tests and bone microarchitecture was determined by microcomputed tomography (uCT). On day 14, a significant reduction in body mass was observed as a result of burn, disuse and a combination of both. In terms of bone health, disuse alone and in combination affected femur weight, length and bone mineral content. Bending failure energy, an index of femur strength, was significantly reduced in all groups and maximum bending stress was lower when burn and disuse were combined. Osteocalcin was reduced in BA compared to the other groups, indicating influence of burn. The reductions observed in femur weight, BMC, biomechanical parameters and indices of bone formation are primarily responses to the combination of burn and disuse. These results offer insight into bone degradation following severe injury and disuse. PMID:23142361

Near Surface Vapor Bubble Layers in Buoyant Low Stretch Burning of Polymethylmethacrylate

NASA Technical Reports Server (NTRS)

Olson, Sandra L.; Tien, J. S.

1999-01-01

Large-scale buoyant low stretch stagnation point diffusion flames over solid fuel (polymethylmethacrylate) were studied for a range of aerodynamic stretch rates of 2-12/ sec which are of the same order as spacecraft ventilation-induced stretch in a microgravity environment. An extensive layer of polymer material above the glass transition temperature is observed. Unique phenomena associated with this extensive glass layer included substantial swelling of the burning surface, in-depth bubble formation, and migration and/or elongation of the bubbles normal to the hot surface. The bubble layer acted to insulate the polymer surface by reducing the effective conductivity of the solid. The reduced in-depth conduction stabilized the flame for longer than expected from theory neglecting the bubble layer. While buoyancy acts to move the bubbles deeper into the molten polymer, thermocapillary forces and surface regression both act to bring the bubbles to the burning surface. Bubble layers may thus be very important in low gravity (low stretch) burning of materials. As bubbles reached the burning surface, monomer fuel vapors jetted from the surface, enhancing burning by entraining ambient air flow. Popping of these bubbles at the surface can expel burning droplets of the molten material, which may increase the fire propagation hazards at low stretch rates.

Preliminary evidence of early bone resorption in a sheep model of acute burn injury: an observational study.

PubMed

Klein, Gordon L; Xie, Yixia; Qin, Yi-Xian; Lin, Liangjun; Hu, Minyi; Enkhbaatar, Perenlei; Bonewald, Lynda F

2014-03-01

Treatment with bisphosphonates within the first 10 days of severe burn injury completely prevents bone loss. We therefore postulated that bone resorption occurs early post burn and is the primary explanation for acute bone loss in these patients. Our objective was to assess bone for histological and biomechanical evidence of early resorption post burn. We designed a randomized controlled study utilizing a sheep model of burn injury. Three sheep received a 40 % total body surface area burn under isoflurane anesthesia, and three other sheep received cotton-smoke inhalation and served as control. Burned sheep were killed 5 days post procedure and controls were killed 2 days post procedure. Backscatter scanning electron microscopy was performed on iliac crests obtained immediately postmortem along with quantitative histomorphometry and compression testing to determine bone strength (Young's modulus). Blood ionized Ca was also determined in the first 24 h post procedure as was urinary CTx. Three of three sheep killed at 5 days had evidence of scalloping of the bone surface, an effect of bone resorption, whereas none of the three sheep killed at 2 days post procedure had scalloping. One of the three burned sheep killed at 5 days showed quantitative doubling of the eroded surface and halving of the bone volume compared to sham controls. Mean values of Young's modulus were approximately one third lower in the burned sheep killed at 5 days compared to controls, p = 0.08 by unpaired t test, suggesting weaker bone. These data suggest early post-burn bone resorption. Urine CTx normalized to creatinine did not differ between groups at 24 h post procedure because the large amounts of fluids received by the burned sheep may have diluted urine creatinine and CTx and because the urine volume produced by the burned sheep was threefold that of the controls. We calculated 24 h urinary CTx excretion, and with this calculation CTx excretion/24 h in the burned sheep was nearly twice that of the controls. Moreover, whole blood ionized Ca measured at 3- to 6-h intervals over the first 24 h in both burn and control sheep showed a 6 % reduction versus baseline in the burned sheep with <1 % reduction in the control animals. This sheep model was previously used to demonstrate upregulation of the parathyroid calcium-sensing receptor within the timeframe of the present study. Because both early bone resorption, supported by this study, and calcium-sensing receptor upregulation, consistent with the observed reduction in blood ionized Ca, are mediated by proinflammatory cytokines that are present as part of the post-burn systemic inflammatory response, we may postulate that post-burn upregulation of the parathyroid calcium-sensing receptor may be an adaptive response to clear the blood of excess calcium liberated by cytokine-mediated bone resorption.

Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries.

PubMed

Pawlik, Marie-Christin; Kemp, Alison; Maguire, Sabine; Nuttall, Diane; Feldman, Kenneth W; Lindberg, Daniel M

2016-05-01

Intentional burns represent a serious form of physical abuse that must be identified to protect children from further harm. This study is a retrospectively planned secondary analysis of the Examining Siblings To Recognize Abuse (ExSTRA) network data. Our objective was to describe the characteristics of burns injuries in children referred to Child Abuse Pediatricians (CAPs) in relation to the perceived likelihood of abuse. We furthermore compare the extent of diagnostic investigations undertaken in children referred to CAPs for burn injuries with those referred for other reasons. Within this dataset, 7% (215/2890) of children had burns. Children with burns were older than children with other injuries (median age 20 months vs. 10 months). Physical abuse was perceived as likely in 40.9% (88) and unlikely in 59.1% (127). Scalds accounted for 52.6% (113) and contact burns for 27.6% (60). Several characteristics of the history and burn injury were associated with a significantly higher perceived likelihood of abuse, including children with reported inflicted injury, absent or inadequate explanation, hot water as agent, immersion scald, a bilateral/symmetric burn pattern, total body surface area ≥10%, full thickness burns, and co-existent injuries. The rates of diagnostic testing were significantly lower in children with burns than other injuries, yet the yield of skeletal survey and hepatic transaminases testing were comparable between the two groups. This would imply that children referred to CAPs for burns warrant the same level of comprehensive investigations as those referred for other reasons. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

PubMed

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

2015-09-01

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

Fluid resuscitation for major burn patients with the TMMU protocol.

PubMed

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

2009-12-01

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

Global estimation of CO emissions using three sets of satellite data for burned area

NASA Astrophysics Data System (ADS)

Jain, Atul K.

Using three sets of satellite data for burned areas together with the tree cover imagery and a biogeochemical component of the Integrated Science Assessment Model (ISAM) the global emissions of CO and associated uncertainties are estimated for the year 2000. The available fuel load (AFL) is calculated using the ISAM biogeochemical model, which accounts for the aboveground and surface fuel removed by land clearing for croplands and pasturelands, as well as the influence on fuel load of various ecosystem processes (such as stomatal conductance, evapotranspiration, plant photosynthesis and respiration, litter production, and soil organic carbon decomposition) and important feedback mechanisms (such as climate and fertilization feedback mechanism). The ISAM estimated global total AFL in the year 2000 was about 687 Pg AFL. All forest ecosystems account for about 90% of the global total AFL. The estimated global CO emissions based on three global burned area satellite data sets (GLOBSCAR, GBA, and Global Fire Emissions Database version 2 (GFEDv2)) for the year 2000 ranges between 320 and 390 Tg CO. Emissions from open fires are highest in tropical Africa, primarily due to forest cutting and burning. The estimated overall uncertainty in global CO emission is about ±65%, with the highest uncertainty occurring in North Africa and Middle East region (±99%). The results of this study suggest that the uncertainties in the calculated emissions stem primarily from the area burned data.

Preliminary results in single-step wound closure procedure of full-thickness facial burns in children by using the collagen-elastin matrix and review of pediatric facial burns.

PubMed

Demircan, Mehmet; Cicek, Tugrul; Yetis, Muhammed Ikbal

2015-09-01

Management of full-thickness facial burns remains one of the greatest challenges. Controversy exists among surgeons regarding the use of early excision for facial burns. Unfortunately, delayed excision of deeper burns often results in more scarring and subsequent reconstruction becomes more difficult. A collagen-elastin matrix is used to improve the quality of the reconstructed skin, to reduce scarring and to prevent wound contraction. It serves as a foundation for split thickness skin graft and enhances short and long-term results. We report the usage of a collagen-elastin matrix during single-step wound closure technique of severe full-thickness facial burns in 15 children with large burned body surface area, and also we review the literature about pediatric facial burns. There were 15 pediatric patients with severe facial burns, 8 girls and 7 boys ranging in age from 10 months to 12 years, mean age 7 years and 6 months old. The facial burn surface area (FBSA) among the patients includes seven patients with 100%, five with 75%, and three with 50%. The average total body surface area (TBSA) for the patients was 72%, ranging between 50 and 90%. 5 of the patients' admissions were late, more than four days after burns while the rest of the patients were admitted within the first four days (acute admission time). The burns were caused by flame in eight of the patients, bomb blast in four, and scalding in three. All patients were treated by the simultaneous application of the collagen-elastin matrix and an unmeshed split thickness skin graft at Turgut Özal Medical Center, Pediatric Burn Center, Malatya, Turkey. After the treatment only two patients needed a second operation for revision of the grafts. All grafts transplanted to the face survived. The average Vancouver scar scales (VSS) were 2.55±1.42, ranging between one and six, in the first 10 of 15 patients at the end of 6 months postoperatively. VSS measurements of the last 5 patients were not taken since the 6 months postoperative period was not over. In regard to early results, graft quality was close to normal skin in terms of vascularity, elasticity, pliability, texture and color. Esthetic and functional results have been encouraging. This study shows us that the collagen-elastin matrix as a dermal substitute is a useful adjunct, which may result in quick healing with satisfying esthetic and functional results. It also may enhance short and long-term results in after burn facial wound closure in children. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2017-03-01

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

Development and evaluation of a novel smart device-based application for burn assessment and management.

PubMed

Godwin, Zachary; Tan, James; Bockhold, Jennifer; Ma, Jason; Tran, Nam K

2015-06-01

We have developed a novel software application that provides a simple and interactive Lund-Browder diagram for automatic calculation of total body surface area (TBSA) burned, fluid formula recommendations, and serial wound photography on a smart device platform. The software was developed for the iPad (Apple, Cupertino, CA) smart device platforms. Ten burns ranging from 5 to 95% TBSA were computer generated on a patient care simulator using Adobe Photoshop CS6 (Adobe, San Jose, CA). Burn clinicians calculated the TBSA first using a paper-based Lund-Browder diagram. Following a one-week "washout period", the same clinicians calculated TBSA using the smart device application. Simulated burns were presented in a random fashion and clinicians were timed. Percent TBSA burned calculated by Peregrine vs. the paper-based Lund-Browder were similar (29.53 [25.57] vs. 28.99 [25.01], p=0.22, n=7). On average, Peregrine allowed users to calculate burn size significantly faster than the paper form (58.18 [31.46] vs. 90.22 [60.60]s, p<0.001, n=7). The smart device application also provided 5 megapixel photography capabilities, and acute burn resuscitation fluid calculator. We developed an innovative smart device application that enables accurate and rapid burn size assessment to be cost-effective and widely accessible. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

A 10-year experience with major burns from a non-burn intensive care unit.

PubMed

Ibarra Estrada, Miguel Ángel; Chávez Peña, Quetzalcóatl; García Guardado, Dante Ismael; López Pulgarín, José Arnulfo; Aguirre Avalos, Guadalupe; Corona Jiménez, Federico

2014-09-01

The aim of this study was to review clinical data and outcomes of patients with burns in a Mexican non-burn intensive care unit (ICU). We did a retrospective analysis of our single-centre database of burn patients admitted to the ICU in the Hospital Civil Fray Antonio Alcalde (University Hospital). The sample was divided for analysis into two groups according to the outcome 'death' or 'discharge' from ICU. Overall mortality was 58.2%, without a decreasing trend in mortality rates through the years. We identified the presence of third-degree burns (odds ratio (OR) 1.5, p=0.003), and >49% total burned surface area (TBSA; OR 3.3, p≤0.001) was associated with mortality. Mean age was higher in deceased patients (38.2 years vs. 31.3 years, p=0.003) as was the TBSA (62.8% vs. 36.4%, p≤0.001). At multivariate analysis, inhalation injury was not associated with increased mortality, but it was with more mechanical ventilation days. Early surgical debridement/cleansing was performed in most patients; however, the mean of the procedures was 1.7 per patient in both groups. We identified significant factors associated with mortality. These variables and prognosis from non-burn ICUs differ broadly compared with burn intensive care units (BICUs); thus, more structured, multidisciplinary and specialised treatment strategies are still needed. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Risk factors for peri-traumatic distress and appearance concerns in burn-injured inpatients identified by a screening tool

PubMed Central

Oaie, Ecaterina; Piepenstock, Emma; Williams, Lisa

2018-01-01

Introduction: Psychosocial screening of burn-injured patients is a National Burn Care Guideline and is increasingly used to identify individuals most in need of support. It can also generate data that can inform our understanding of patient reported concerns following a burn injury. Method: As part of routine care, 461 patients admitted to a burns unit were screened soon after admission using a psychosocial screen designed by the service. The questionnaire included items on pre-existing social support, coping, emotional and psychological difficulties, as well as current trauma symptoms and current level of concern about changed appearance following the burn. Results: Overall, patients reported low levels of appearance concerns (mean 3.7/10) and trauma symptoms (18% reporting flashbacks) in the initial days following a burn injury. In those who did report concerns, there were some significant associations with demographic and other variables. Patients who experienced flashbacks were younger and had a larger total body surface area (TBSA) burn. Higher levels of appearance concern were associated with younger women, larger TBSA and facial burns. However, the relationships found were weak and frequently confounded by other factors. Conclusion: Overall, the findings indicate that initial trauma symptoms and appearance concerns are not inevitable in this group and there is no substitute for screening in identifying who is most at risk. PMID:29873338

ER stress and subsequent activated calpain play a pivotal role in skeletal muscle wasting after severe burn injury

PubMed Central

Shen, Chuanan; Li, Dawei; Wang, Xiaoteng

2017-01-01

Severe burns are typically followed by hypermetabolism characterized by significant muscle wasting, which causes considerable morbidity and mortality. The aim of the present study was to explore the underlying mechanisms of skeletal muscle damage/wasting post-burn. Rats were randomized to the sham, sham+4-phenylbutyrate (4-PBA, a pharmacological chaperone promoting endoplasmic reticulum (ER) folding/trafficking, commonly considered as an inhibitor of ER), burn (30% total body surface area), and burn+4-PBA groups; and sacrificed at 1, 4, 7, 14 days after the burn injury. Tibial anterior muscle was harvested for transmission electron microscopy, calcium imaging, gene expression and protein analysis of ER stress / ubiquitin-proteasome system / autophagy, and calpain activity measurement. The results showed that ER stress markers were increased in the burn group compared with the sham group, especially at post-burn days 4 and 7, which might consequently elevate cytoplasmic calcium concentration, promote calpain production as well as activation, and cause skeletal muscle damage/wasting of TA muscle after severe burn injury. Interestingly, treatment with 4-PBA prevented burn-induced ER swelling and altered protein expression of ER stress markers and calcium release, attenuating calpain activation and skeletal muscle damage/wasting after severe burn injury. Atrogin-1 and LC3-II/LC3-I ratio were also increased in the burn group compared with the sham group, while MuRF-1 remained unchanged; 4-PBA decreased atrogin-1 in the burn group. Taken together, these findings suggested that severe burn injury induces ER stress, which in turns causes calpain activation. ER stress and subsequent activated calpain play a critical role in skeletal muscle damage/wasting in burned rats. PMID:29028830

Experience and outcomes of micrografting for major paediatric burns.

PubMed

Rode, H; Martinez, R; Potgieter, D; Adams, S; Rogers, A D

2017-08-01

The deficit of donor sites in major burns over 50% of the total body surface area has necessitated the application of methods besides traditional meshed autografting to achieve definitive skin cover. The Meek micrografting technique was introduced at this hospital in 2011, especially in the absence of a reliable source of deceased donor allograft skin. The purpose of this study was to evaluate this strategy with reference to its technical execution, efficacy and indications in the context of major paediatric burn surgery. A cohort study was performed of all paediatric patients with major burn who underwent Meek micrografting at a dedicated paediatric burn centre in a developing country over a five year period. Demographics, details of their burns, operative management and clinical course and outcomes were collected from patient records and operative notes and analysed. Thirty-five patients were managed using the micrografting technique during the study period. The mean patient age was 4.1 years (range 3 months-11 years) and their mean total body surface area (TBSA) burn was 49.7% (range 15-86%). Eleven patients sustained inhalation injuries and five developed a re-feeding syndrome on account of delayed referral. The mean abbreviated burn severity index (ABSI) was 8.5 (range 2-13). The hospital length of stay in the 27 survivors was a mean of 75.5 days, equating to 1.4 days per percentage burn. Eight patients died during the course of treatment, with a mean TBSA burn of 67.75% (range 38-86%). Graft take one month after surgery was documented to be more than 90% in 24 patients, of whom 3 subsequently died. Eleven patients had less than 90% graft take at this time, of whom 5 died. There is a considerable 'learning curve' associated with this technique. In order to achieve success one must ensure a completely viable, non-infected bed, obtained by tangential or fascial excision, followed by allografting as temporary coverage and to 'test the wound bed' for definitive coverage. Infection resulted in the majority of autograft loss in this series, and in addition to risk factors like burn size and inhalation injury, accounted for many of the deaths in this series. Meek micrografting offers high expansion ratios, thereby facilitating durable wound cover in the presence of limited donor sites. It is unlikely that a lethal dose, 50% (LD 50 ) of almost 70% TBSA would have been possible in this context without the regular application of this technique. This study advocates for the widespread availability of Meek micrografting and deceased donor allograft skin in developing countries. Copyright © 2017. Published by Elsevier Ltd.

Use of porcine acellular dermal matrix following early dermabrasion reduces length of stay in extensive deep dermal burns.

PubMed

Guo, Zhi-Qian; Qiu, Le; Gao, You; Li, Jin-Hu; Zhang, Xin-He; Yang, Xin-Lei; Peszel, April; Chen, Xu-Lin

2016-05-01

Extensive deep partial-thickness burns still seriously challenge the surgeon's abilities. This study aimed to assess the impact of early dermabrasion combined with porcine acellular dermal matrix (ADM) in extensive deep dermal burns. From September 2009 to September 2013, a total of 60 adult patients sustained greater than 50% total body surface area (TBSA) burn by hot water or gas explosion were divided into three groups based on dermabrasion: group A (early dermabrasion and porcine ADM), group B (early dermabrasion and nano-silver dressings), and group C (conservative group). The wound healing time and length of hospital stay were analyzed. Scar assessment was performed at 3 and 12 months after the injury with a modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA). No significant difference was found in mean burn size, burn depth, age, male-to-female ratio, or incidence of inhalation injury between the patients in the three groups (p>0.05). Compared with groups B and C, the patients that received early dermabrasion combined with porcine ADM had a shorter wound healing time (p<0.01). The burn patients treated with early dermabrasion and porcine ADM coverage had a mean length of hospital stay of 28.3 days (±7.2), which was significantly shorter than that of groups B and C (p<0.05-0.01). The mVSS-TBSA of patients in group A was significantly improved in comparison with groups B and C at 3 and 12 months after the injury. There was no significant difference in the mortality rate between the three groups (p>0.05). Early dermabrasion combined with porcine ADM coverage facilitates wound healing, reduces the length of hospital stay, and improves esthetic and functional results in extensive deep dermal burns with burn size over 50% TBSA. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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

Porcine Burn Shock - Development of a Reliable Model and Response to Sodium, Water, and Plasma Loads Administered for Resuscitation

DTIC Science & Technology

1973-06-01

nm.ddt. inital, Diet n*Mf) Thomas L. Wachtel, M.D. G. R. McCahan, Jr., D.V.M. 0 REPORT CATS 70. TOTAL No. Or PAGE Nb O. or mrs June 1973 - w 78 0. CON...observations of caloric uptake of pigskin, rise in temperature at the dermis-fat interface as a function of both time and skin surface temperature and an...of Iso-, Hypo - and Hypertonic Sodium Solutions in the Treatment of Burn Shock in Mice," Surgery, 57: 698-704, May 1965. 24. Rosenthal, S. M

Pediatric scalds: do cooking-related burns have a higher injury burden?

PubMed

Bachier, Marielena; Hammond, Sarah E; Williams, Regan; Jancelewicz, Timothy; Feliz, Alexander

2015-11-01

Pediatric scald burns result in frequent emergency room visits and hospitalizations. We investigated whether cooking-related burns produce greater morbidity requiring more extensive care than noncooking burns. We performed a 6-y review at our free-standing children's hospital. Children aged <18 y admitted for accidental scald burns were included. Demographics, injury pattern, treatment, and outcome (contractures and/or limited mobility and nonhealing and/or infected wounds) data were analyzed comparing cooking versus noncooking burns. The Mann-Whitney U test, a chi-square test, and the negative binomial were used to compare continuous, categorical, and count data between groups. Bivariate analysis was performed to identify risk factors among patients with adverse outcomes. We identified 308 patients; 262 (85%) cooking and 46 (15%) noncooking burns. Most patients were African-American males, with public insurance, and a median age of 2 y. Cooking burns preferentially occurred over the head, neck, and upper body; noncooking burns were distributed over the lower body (P < 0.02). Median total body surface area was equal for both groups (P > 0.11). In subgroup analysis, semisolid and grease burns resulted in increased rates of wound contractures and/or limited mobility when compared with noncooking burns (P = 0.05 and P = 0.008, respectively). Patients with complications were more likely to have third degree burns and required more consults, longer hospitalization, and more surgical debridements and clinic visits. Most accidental scald burns occurred in young children during food preparation. Greater long-term morbidity was found in patients with semisolid and grease burns. This subset of children has a higher injury burden and requires extensive care in the acute and long-term setting. Copyright © 2015 Elsevier Inc. All rights reserved.

Epidemiology of burns undergoing hospitalization to the National Burns Unit in the Sultanate of Oman: a 25-year review.

PubMed

Al-Shaqsi, Sultan; Al-Kashmiri, Ammar; Al-Bulushi, Taimoor

2013-12-01

The aim of this study was to describe the epidemiology of burns admitted to the National Burns Unit (NBU) in the Sultanate of Oman between 1987 and 2011. This is a retrospective review of burn patients admitted to Oman's National Burns Unit (NBU) between 1987 and 2011. The data extracted from the national burn registry. The study describes the admission rate by gender and age groups, occupation, causes of burns, time-to-admission, length of stay and in-hospital mortality of burns between 1987 and 2011. During a 25-year from 1987 to 2011, there were 3531 burn patients admitted to the National Burns Unit in Oman. The average admission rate to NBU is 7.02 per 100,000 persons per year. On average, males were more likely to be admitted to the NBU than females during the study period (P value < 0.04). Patients aged 1-10 years old constituted 46.6% of caseload during the study period. Flames and scalds caused 88.4% of burns. About half of all patients admitted to the NBU have burns to more than 11% of total body surface area (TBSA). The average stay in hospital was estimated to be 15.3 days per patient. The average in-hospital mortality rate was estimated to be 8.2% per year (range 1.9-22%). Burns are significant public health issue in the Sultanate of Oman. Children are disproportionately over-represented in this study. Prevention programmes are urgently needed to address this "silent and costly epidemic." Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Soil Dynamics Following Fire in Juncus and Spartina Marshes

NASA Technical Reports Server (NTRS)

Schmalzer, Paul A.; Hinkle, C. Ross

1992-01-01

We examined soil changes in the O-5 and 5-15 cm layers for one year after a fire in burned Juncus roemerianus and Spartina bakeri marshes and an unburned Juncus marsh. Each marsh was sampled (N = 25) preburn, immediately postburn, and 1, 3, 6, 9, and 12 months postburn. All marshes were flooded at the time of the fire; water levels declined below the surface by 6 months but reflooded at 12 months after the fire. Soil samples were analyzed for pH, conductivity, organic matter, exchangeable Ca, Mg, and K, available PO4-P, total Kjeldahl nitrogen (TKN), exchangeable NO3-N, NO2-N, and NH4-N. Changes due to burning were most pronounced in the surface (0-5 cm) layer. Soil pH increased 0.16-0.28 units immediately postburn but returned to preburn levels in 1 month. Organic matter increased by 1 month and remained elevated through 9 months after the fire. Calcium, Mg, K, and PO4-P all increased by 1 month after burning, and the increases persisted for 6 to 12 months. Conductivity increased in association with these cations. Burning released ions from organic matter as indicated by the increase in pH, conductivity, Ca, Mg, K, and PO4-P. NH4-N in burned marshes was elevated 6 months and NO3-N 12 months after burning. TKN showed seasonal variations but no clear fire-related changes. Nitrogen species were affected by the seasonally varying water levels as well as fire; these changes differed from those observed in many upland systems.

Inhibition of Na+/H+ exchanger 1 by cariporide reduces burn-induced intestinal barrier breakdown.

PubMed

Yang, Xuekang; Chen, Ji; Bai, Hua; Tao, Ke; Zhou, Qin; Hou, Hongyi; Hu, Dahai

2013-12-01

Severe burns initiate an inflammatory cascade within the gut, which leads to intestinal mucosal injury. Although Na(+)/H(+) exchanger 1 (NHE1) is recognised as a pivotal player in several inflammatory processes, its role in burn-induced intestinal injury is relatively unknown. We hypothesised that NHE1 might be involved in the increased intestinal permeability and barrier breakdown after severe burns. Thus, we here investigate whether the inhibition of NHE1 has a protective effect on burn-induced intestinal injury. Mice were subjected to a 30% total body surface area (TBSA) full-thickness steam burn. Cariporide was used to assess the function of NHE1 in mice with burn-induced intestinal injury by fluorescence spectrophotometry, Western blotting and enzyme linked immunosorbent assay (ELISA). We found that severe burn increased intestinal permeability, associated with the up-regulation of NHE1 and raised inflammatory cytokine levels. Mice treated with the NHE1 inhibitor cariporide had significantly attenuated burn-induced intestinal permeability and a reduced inflammatory response. NHE1 inhibition also reduced nuclear factor-κB (NF-κB) activation and attenuated p38 mitogen-activated protein kinase (MAPK) phosphorylation. Our study suggests that NHE1 plays an important role in burn-induced intestinal permeability through the regulation of the inflammatory response. Inhibition of NHE1 may be adopted as a potential therapeutic strategy for attenuating intestinal barrier breakdown. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Myosin Light Chain Kinase Mediates Intestinal Barrier Disruption following Burn Injury

PubMed Central

Chen, Chuanli; Wang, Pei; Su, Qin; Wang, Shiliang; Wang, Fengjun

2012-01-01

Background Severe burn injury results in the loss of intestinal barrier function, however, the underlying mechanism remains unclear. Myosin light chain (MLC) phosphorylation mediated by MLC kinase (MLCK) is critical to the pathophysiological regulation of intestinal barrier function. We hypothesized that the MLCK-dependent MLC phosphorylation mediates the regulation of intestinal barrier function following burn injury, and that MLCK inhibition attenuates the burn-induced intestinal barrier disfunction. Methodology/Principal Findings Male balb/c mice were assigned randomly to either sham burn (control) or 30% total body surface area (TBSA) full thickness burn without or with intraperitoneal injection of ML-9 (2 mg/kg), an MLCK inhibitor. In vivo intestinal permeability to fluorescein isothiocyanate (FITC)-dextran was measured. Intestinal mucosa injury was assessed histologically. Tight junction proteins ZO-1, occludin and claudin-1 was analyzed by immunofluorescent assay. Expression of MLCK and phosphorylated MLC in ileal mucosa was assessed by Western blot. Intestinal permeability was increased significantly after burn injury, which was accompanied by mucosa injury, tight junction protein alterations, and increase of both MLCK and MLC phosphorylation. Treatment with ML-9 attenuated the burn-caused increase of intestinal permeability, mucosa injury, tight junction protein alterations, and decreased MLC phosphorylation, but not MLCK expression. Conclusions/Significance The MLCK-dependent MLC phosphorylation mediates intestinal epithelial barrier dysfunction after severe burn injury. It is suggested that MLCK-dependent MLC phosphorylation may be a critical target for the therapeutic treatment of intestinal epithelial barrier disruption after severe burn injury. PMID:22529961

Superficial Burn Wound Healing with Intermittent Negative Pressure Wound Therapy Under Limited Access and Conventional Dressings

PubMed Central

Honnegowda, Thittamaranahalli Muguregowda; Padmanabha Udupa, Echalasara Govindarama; Rao, Pragna; Kumar, Pramod; Singh, Rekha

2016-01-01

BACKGROUND Thermal injury is associated with several biochemical and histopathological alteration in tissue. Analysis of these objective parameters in research and clinical field are common to determine healing rate of burn wound. Negative pressure wound therapy has been achieved wide success in treating chronic wounds. This study determines superficial burn wound healing with intermittent negative pressure wound therapy under limited access and conventional dressings METHODS A total 50 patients were randomised into two equal groups: limited access and conventional dressing groups. Selective biochemical parameters such as hydroxyproline, hexosamine, total protein, and antioxidants, malondialdhyde (MDA), wound surface pH, matrix metalloproteinase-2 (MMP-2), and nitric oxide (NO) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing under intermittent negative pressure. RESULTS Patients treated with limited access have shown significant increase in the mean hydroxyproline, hexosamine, total protein, reduced glutathione (GSH), glutathione peroxidase (GPx), and decrease in MDA, MMP-2, wound surface pH, and NO. Histopathologic study showed that there was a significant difference after 10 days of treatment between limited access vs conventional dressing group, Median (Q1, Q3)=3 (2, 4.25) vs 2 (1.75, 4). CONCLUSION Limited access was shown to exert its beneficial effects on wound healing by increasing ground substance, antioxidants and reducing MMP-2 activity, MDA, NO and providing optimal pH, decreasing necrotic tissue, amount of inflammatory infiltrate, increasing ECM deposition and angiogenesis. PMID:27853690

Life expectancy in elderly patients following burns injury.

PubMed

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

2018-05-18

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

Enhancing the clinical utility of the burn specific health scale-brief: not just for major burns.

PubMed

Finlay, V; Phillips, M; Wood, F; Hendrie, D; Allison, G T; Edgar, D

2014-03-01

Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p<0.001, p<0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p<0.001). The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Development of Erosive Burning Models for CFD Predictions of Solid Rocket Motor Internal Environments

NASA Technical Reports Server (NTRS)

Wang, Qun-Zhen

2003-01-01

Four erosive burning models, equations (11) to (14). are developed in this work by using a power law relationship to correlate (1) the erosive burning ratio and the local velocity gradient at propellant surfaces; (2) the erosive burning ratio and the velocity gradient divided by centerline velocity; (3) the erosive burning difference and the local velocity gradient at propellant surfaces; and (4) the erosive burning difference and the velocity gradient divided by centerline velocity. These models depend on the local velocity gradient at the propellant surface (or the velocity gradient divided by centerline velocity) only and, unlike other empirical models, are independent of the motor size. It was argued that, since the erosive burning is a local phenomenon occurring near the surface of the solid propellant, the erosive burning ratio should be independent of the bore diameter if it is correlated with some local flow parameters such as the velocity gradient at the propellant surface. This seems to be true considering the good results obtained by applying these models, which are developed from the small size 5 inch CP tandem motor testing, to CFD simulations of much bigger motors.

From Cholera to Burns: A Role for Oral Rehydration Therapy

PubMed Central

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

2011-01-01

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

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

PubMed

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

2018-06-27

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

Fire-related injuries with inpatient care in Finland: a 10-year nationwide study.

PubMed

Haikonen, Kari; Lillsunde, Pirjo M; Lunetta, Philippe; Lounamaa, Anne; Vuola, Jyrki

2013-06-01

The aim of this study was to examine fire-related injuries leading to inpatient care in Finland. The Finnish National Hospital Discharge Register (2000-2009) and a sample of 222 patients from the Helsinki Burn Centre who sustained flame burns was used. During the 10-years study period, the incidence of fire-related injuries with inpatient care was approximately 5.6 per 100000 persons-years (n=295; males 74%, females 26%). Approximately three quarters involved burns and the remaining cases were mostly combustion gas poisonings. Burns declined from 5.4 in 2000 to 4.0 per 100000 person-years in 2009. The decline was accounted for by young people primarily. Socio-economic features and smoking habits differ between the injured and general population. House fire victims were mainly middle aged and older, while injures involving flammable substances, campfires, etc., were mostly associated with young people. House fires caused the worst damage in terms of Total Body Surface Area burned and inhalation burns. Significantly more people die on the scene of the incident than during the hospital care. Targeting preventive measures in particular at older people and those with a tendency for alcohol abuse and smoking could potentially reduce the burden of the most severe flame burns. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Photoacoustic diagnosis of edema in rat burned skin

NASA Astrophysics Data System (ADS)

Yoshida, Ken; Sato, Shunichi; Hatanaka, Kosuke; Saitoh, Daizoh; Ashida, Hiroshi; Sakamoto, Toshihisa; Obara, Minoru

2010-02-01

Diagnosis of edema, abnormal accumulation of water in tissue, is important for managing various traumatic injuries and diseases. However, there is no established method for real-time, noninvasive monitoring of edema. In severe extensive burn injuries, edema develops both topically and systemically due to the increased permeability of blood vessels. In this study, we examined photoacoustic (PA) monitoring of edema formed in rat burn models. Deep dermal burn with a 20% total body surface area was made in the dorsal skin of rats. Burn and its adjacent nonburn tissues were irradiated with 6-ns light pulses at 1430 nm, which is one of the absorption peak wavelengths of water in the near infrared. The PA signal amplitude increased until 12 - 24 hr postburn, and thereafter it gradually decreased to its initial level; the latter phase (after 24 hr postburn) coincided with a diuretic phase in the rats. There was a significant correlation between the PA signal amplitudes and water contents in the tissue measured by wet/dry weight method. These findings demonstrate the validity of PA measurement for real-time, noninvasive monitoring of edema.

Ten-year epidemiology of chemical burns in western Zhejiang Province, China.

PubMed

Ye, Chunjiang; Wang, Xingang; Zhang, Yuanhai; Ni, Liangfang; Jiang, Ruiming; Liu, Liping; Han, Chunmao

2016-05-01

Chemical burns occur frequently in western Zhejiang Province. This study documents the epidemiology of chemical burns in the region using burn data from a local specialized hospital. Results from this analysis will assist in the planning of prevention strategies for high-risk occupations and groups. A 10-year retrospective analysis was conducted for all patients with chemical burns admitted to the Department of Burn and Plastic Surgery from January 2004 to December 2013. Information obtained for each patient included demographics (gender, age, occupation and education), location of the burn, cause of the burn, and categories of chemicals. Data regarding the season of admittance, prehospital treatment, wound site/size (area, region, and depth), accompanying injuries, operations, length of hospital stay and mortality were also assessed. A total of 690 patients (619 males, 71 females; average age: 30.6±12.4 years) were admitted to the department for chemical burns. Over the 10-year period, the incidence of chemical burns showed an increasing tendency. Chemical burns occurred most frequently in patients aged 20-59 years (94.79%). Most of the chemical burns were work-related, primarily in private enterprises (47.97%) and state-owned enterprises (24.93%). Operations (68.99%) and machine problems (17.26%) were the main causes of chemical burns in the workplace. With regard to burns caused by chemicals, most were caused by acids (72.01%), with hydrofluoric acid and sulphuric acid causing 51.45%. Most chemical burns occurred in the summer and autumn seasons (61.02%). The burn size was <10% of the total body surface area (TBSA) for 445 patients (64.49%), while only 26 patients (3.76%) had burns covering >40% TBSA. The most common burn sites were the upper extremities (31.57%), lower extremities (19.86%), and head and neck (28.83%). Most patients (581 (84.20%)) received water washing treatment on site immediately after exposure. The most common accompanying injuries included inhalation injury, ocular burns and digestive tract injury. The average hospital stay was 17.0±23.1 days (range 1-333 days). Surgery was performed in 146 patients (21.16%), and the overall mortality rate was 0.58%. Chemical burns are preventable. The high morbidity of chemical burns in western Zhejiang Province is related to the industrial structure of the area. Governmental management in the fields of production, transportation, and utilization of chemicals could be improved. Workplaces have the responsibility to provide safe work environments and equipment, as well as occupational education and safety training for high-risk work groups. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Amniotic membrane traps and induces apoptosis of inflammatory cells in ocular surface chemical burn

PubMed Central

Liu, Ting; Zhai, Hualei; Xu, Yuanyuan; Dong, Yanling; Sun, Yajie; Zang, Xinjie

2012-01-01

Purpose Severe chemical burns can cause necrosis of ocular surface tissues following the infiltration of inflammatory cells. It has been shown that amniotic membrane transplantation (AMT) is an effective treatment for severe chemical burns, but the phenotypes of cells that infiltrate the amniotic membrane and the clinical significance of these cellular infiltrations have not previously been reported. The present work studies the inflammation cell traps and apoptosis inducing roles of the amniotic membrane after AMT in patients with acute chemical burns. Methods A total of 30 patients with acute alkaline burns were classified as having either moderate or severe burns. In all participants, AMT was performed within one week of his/her injury. After 7–9 days, the transplanted amniotic membranes were removed. Histopathological and immunohistochemical techniques were used for the examination and detection of infiltrating cells, and tests for the expression of CD (cluster of differentiation)15, CD68, CD3, CD20, CD57, CD31, CD147, and CD95 (Fas) were performed. A TUNEL (TdT-mediated dUTP nick end labeling) assay was used to confirm apoptosis of the infiltrating cells. Three patients with herpes simplex-induced keratitis who had undergone AMT to treat persistent epithelium defects were used as a control group. Amniotic membrane before transplantation was used as another control. Results After amniotic membrane transplantation, the number of infiltrating cells in patients with severe burns was significantly higher than in patients with moderate burns or in control patients (p<0.05). Among the severe burns patients, CD15 and CD68 were widely expressed in the infiltrating cells, and CD3, CD20, and CD57 were only found in a small number of cells. Occasionally, CD31-positive cells were found in the amniotic membranes. More cells that were CD147, Fas, and TUNEL positive were found in patients with severe burns than in patients with moderate burns or in control patients. Conclusions Neutrophils and macrophages were the main cells that had infiltrated into the amniotic membrane during the acute phase of healing from a chemical burns. AMT can trap different inflammatory cells and induce apoptosis of inflammatory cells in acute ocular chemical burns. PMID:22876141

Hierarchical decomposition of burn body diagram based on cutaneous functional units and its utility.

PubMed

Richard, Reg; Jones, John A; Parshley, Philip

2015-01-01

A burn body diagram (BBD) is a common feature used in the delivery of burn care for estimating the TBSA burn as well as calculating fluid resuscitation and nutritional requirements, wound healing, and rehabilitation intervention. However, little change has occurred for over seven decades in the configuration of the BBD. The purpose of this project was to develop a computerized model using hierarchical decomposition (HD) to more precisely determine the percentage burn within a BBD based on cutaneous functional units (CFUs). HD is a process by which a system is degraded into smaller parts that are more precise in their use. CFUs were previously identified fields of the skin involved in the range of motion. A standard Lund/Browder (LB) BBD template was used as the starting point to apply the CFU segments. LB body divisions were parceled down into smaller body area divisions through a HD process based on the CFU concept. A numerical pattern schema was used to label the various segments in a cephalo/caudal, anterior/posterior, medial/lateral manner. Hand/fingers were divided based on anatomical landmarks and known cutaneokinematic function. The face was considered using aesthetic units. Computer code was written to apply the numeric hierarchical schema to CFUs and applied within the context of the surface area graphic evaluation BBD program. Each segmented CFU was coded to express 100% of itself. The CFU/HD method refined the standard LB diagram from 13 body segments and 33 subdivisions into 182 isolated CFUs. Associated CFUs were reconstituted into 219 various surface area combinations totaling 401 possible surface segments. The CFU/HD schema of the body surface mapping is applicable to measuring and calculating percent wound healing in a more precise manner. It eliminates subjective assessment of the percentage wound healing and the need for additional devices such as planimetry. The development of CFU/HD body mapping schema has rendered a technologically advanced system to depict body burns. The process has led to a more precise estimation of the segmented body areas while preserving the overall TBSA information. Clinical application to date has demonstrated its worthwhile utility.

In situ burning of oil in coastal marshes. 1. Vegetation recovery and soil temperature as a function of water depth, oil type, and marsh type.

PubMed

Lin, Qianxin; Mendelssohn, Irving A; Bryner, Nelson P; Walton, William D

2005-03-15

In-situ burning of oiled wetlands potentially provides a cleanup technique that is generally consistent with present wetland management procedures. The effects of water depth (+10, +2, and -2 cm), oil type (crude and diesel), and oil penetration of sediment before the burn on the relationship between vegetation recovery and soil temperature for three coastal marsh types were investigated. The water depth over the soil surface during in-situ burning was a key factor controlling marsh plant recovery. Both the 10- and 2-cm water depths were sufficient to protect marsh vegetation from burning impacts, with surface soil temperatures of <35 and 48 degrees C, respectively. Plant survival rate and growth responses at these water depth burns were not significantly different from the unburned control. In contrast, a water table 2 cm below the soil surface during the burn resulted in high soil temperatures, with 90-200 degrees C at 0-0.5 cm soil depth and 55-75 degrees C at 1-2 cm soil depth. The 2-cm soil exposure to fire significantly impeded the post-burn recovery of Spartina alterniflora and Sagittaria lancifolia but did not detrimentally affect the recovery of Spartina patens and Distichlis spicata. Oil type (crude vs diesel) and oil applied to the marsh soil surface (0.5 L x m(-2)) before the burn did not significantly affect plant recovery. Thus, recovery is species-specific when no surface water exists. Even water at the soil surface will most likely protect wetland plants from burning impact.

The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition.

PubMed

Cartotto, Robert; Li, Zeyu; Hanna, Steven; Spano, Stefania; Wood, Donna; Chung, Karen; Camacho, Fernando

2016-11-01

The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian burns. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients. Retrospective study of burn patients mechanically ventilated for ≥48h at an American Burn Association-verified burn center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3). We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p=0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p=0.001], but had no significant difference in the incidence of inhalation injury (p=0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p=0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p=0.001), a reduction in ventilator-free days/1st 30 days in all subjects (p=0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p=0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death. ARDS is common among mechanically ventilated civilian burn patients, and develops early after burn. The extent of full thickness burn predicted development of moderate to severe ARDS. Increasing severity of ARDS based upon the Berlin definition was associated with a significantly greater duration of mechanical ventilation and a trend toward higher mortality. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds.

PubMed

Aramwit, Pornanong; Palapinyo, Sirinoot; Srichana, Teerapol; Chottanapund, Suthat; Muangman, Pornprom

2013-09-01

The aim of this study was to evaluate the effect of silk sericin, a protein from silkworm cocoon, on scratch wound healing in vitro. For applicable result in clinical use, we also study the efficacy of sericin added to a standard antimicrobial cream, silver zinc sulfadiazine, for open wound care in the treatment of second-degree burn wounds. In vitro scratch assays show that sericin at concentration 100 μg/mL can promote the migration of fibroblast L929 cells similar to epidermal growth factor (positive control) at 100 μg/mL. After 1 day of treatment, the length of scratch in wounds treated with sericin was significantly shorter than the length of negative control wounds (culture medium without sericin). For clinical study, a total of 29 patients with 65 burn wounds which covered no less than 15 % of total body surface area were randomly assigned to either control (wounds treated with silver zinc sulfadiazine cream) or treatment (wounds treated with silver zinc sulfadiazine with added sericin cream) group in this randomized, double-blind, standard-controlled study. The results showed that the average time to reach 70 % re-epithelialization of the burned surface and complete healing in the treatment group was significantly shorter, approximately 5-7 days, than in the control group. Regarding time for complete healing, control wounds took approximately 29.28 ± 9.27 days, while wounds treated with silver zinc sulfadiazine with added sericin cream took approximately 22.42 ± 6.33 days, (p = 0.001). No infection or severe reaction was found in any wounds. This is the first clinical study to show that silk sericin is safe and beneficial for burn wound treatment when it is added to silver sulfadiazine cream.

Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey.

PubMed

Stewart, Barclay T; Lafta, Riyadh; Esa Al Shatari, Sahar A; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2016-02-01

Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Burns in Baghdad from 2003–2014: results of a randomized household cluster survey

PubMed Central

Stewart, Barclay T; Lafta, Riyadh; Shatari, Sahar A Esa Al; Cherewick, Megan; Burnham, Gilbert; Hagopian, Amy; Galway, Lindsay P; Kushner, Adam L

2015-01-01

Purpose Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Results Nine-hundred households, totaling 5,148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2,340 serious burn injures (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burn injuries generally increased post-invasion to 8,780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn injury than children aged less than 13 years (aOR 2.42; 95%CI 1.08 – 5.44). Nineteen burns (35%) involved ≥20% body surface area. Death (16% of burn injuries), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn injury. Conclusion Civilian burn injury in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn injury. Ongoing conflict will directly and indirectly generate more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance. PMID:26526376

Split thickness skin graft meshing ratio indications and common practices.

PubMed

Pripotnev, Stahs; Papp, Anthony

2017-12-01

Split thickness skin grafting is a commonly used technique in burn surgery for resurfacing wounds that are unlikely to heal without scarring. Meshing and expanding skin grafts allow for reconstruction of larger wounds with smaller donor sites. A retrospective chart review was performed of 210 patients with burns equal to or greater than 20% total body surface area admitted to Vancouver General Hospital between 1998 and 2014. Charts were reviewed to collect data on patient and burn demographics. A survey was sent to Canadian plastic surgeons registered with the CSPS to collect data on common practices in burn surgery nationwide. The patients that received 3:1 or higher meshed grafts were all flame burns, had a significantly higher average TBSA (51.89%±14.87 vs 29.13%±9.48, p=0.001), and a significantly higher full thickness burn TBSA (25.76%±21.97 vs 6.20%±9.04, p=0.001). We found no significant differences in gender, age, or burn location between the less than 2:1 and 3:1 or greater meshing ratio groups. The survey of plastic surgeons performing burn surgery in Canada revealed that 60% of responders had experience with skin grafts using meshing ratios of 3:1 or higher. Of these surgeons, 100% felt that burn size and 36% felt that burn location would influence their decision to use a 3:1 or higher meshing ratio. A larger burn size is the major influencing factor for the use of higher skin graft meshing ratios by Canadian burn surgeons. Furthermore, burn location determines the choice of donor and recipient sites in these cases. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Long-Term Social Reintegration Outcomes for Burn Survivors With and Without Peer Support Attendance: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

PubMed

Grieve, Brian; Shapiro, Gabriel D; Wibbenmeyer, Lucy; Acton, Amy; Lee, Austin; Marino, Molly; Jette, Alan; Schneider, Jeffrey C; Kazis, Lewis E; Ryan, Colleen M

2017-10-31

To examine differences in long-term social reintegration outcomes for burn survivors with and without peer support attendance. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area (TBSA) or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Burn support group attendance was reported by 330 (55%) of 596 respondents who responded to this item. Attendees had larger burn size (43.4%±23.6% vs 36.8%±23.4% TBSA burned, P<.01) and were more likely to be >10 years from injury (50% vs 42.5%, P<.01). Survivors who attended at least 1 support group scored significantly higher on 3 of the scales: Social Interactions (P=.01), Social Activities (P=.04), and Work and Employment (P=.05). In adjusted analyses, peer support attendance was associated with increased scores on the Social Interactions scale, increasing scores by 17% of an SD (95% confidence interval, 1%-33%; P=.04). Burn survivors who reported peer support attendance had better social interaction scores than those who did not. This is the first reported association between peer support group attendance and improvements in community reintegration in burn survivors. This cross-sectional study prompts further exploration into the potential benefits of peer support groups on burn recovery with future intervention studies. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A Soft Casting Technique for Managing Pediatric Hand and Foot Burns.

PubMed

Choi, Young Mee; Nederveld, Cindy; Campbell, Kristen; Moulton, Steven

2018-04-04

Hand and foot burns in children are difficult to dress. The authors have developed a soft casting technique to manage burns to these areas. The aim of this study is to report the outcomes using weekly dressing changes with a soft casting technique to manage pediatric hand and foot burns in the outpatient setting. A retrospective chart review was performed on children with burns to the hands or feet, who underwent dressing changes with a soft casting technique at the Children's Hospital Colorado Burn Center. Soft casting was performed by placing antibiotic ointment-impregnated nonadherent gauze over the burn wound(s), wrapping the extremity using rolled gauze, applying soft cast pad, plaster, soft cast tape, and an elastic bandage. This was changed weekly. Two hundred ninety-eight children with hand burns had a mean age of 16.8 ± 2 months. Two hundred forty-eight children had partial thickness burn injuries (83%), 50 had full thickness burn injuries (17%), and the mean total body surface area (TBSA) was 1 ± 2.4%. The mean time to heal was 10.1 ± 1.7 days for all subjects. Sixty-six children with foot burns were identified with a mean age of 24 ± 2.6 months. Forty-six children had partial thickness injuries (70%), 20 had full thickness burn injuries (30%), and the mean TBSA was 2.3 ± 2.9%. The mean time to heal was 14.1 ± 2.2 days for all subjects. Weekly dressing changes using a soft casting technique are effective for the outpatient management of pediatric hand and foot burns. This method avoids costly inpatient hospital care, reduces the number of painful dressing changes, and allows children to heal in their own environment.

Exhaust system-related burns affecting children: a UK perspective and literature review

PubMed Central

Vermaak, P.V.; Deall, C.E.; McArdle, C.; Burge, T.

2016-01-01

Summary Burns caused by exhaust systems in children may be associated with considerable morbidity. Current epidemiological data varies, but no data are available for the UK population. We aim to identify the pattern of exhaust-related burns affecting children who presented to a regional centre for paediatric burn care in the UK. Patients who sustained burns related to exhaust mechanisms between May 2005 and August 2012 were identified via the departmental database. Data collected included patient demographics, burn injury information, management and outcomes. Thirty-nine patients sustained 43 burns from contact with exhaust mechanisms, and the majority were less than 5 years of age. 77% of the patients were male. Burns affected critical areas such as the hands and feet in 26% of cases. Most burns involved a total body surface area of ≤1% and were partial thickness in depth. Thirty-three percent of patients required operative intervention. Time to heal was less than 3 weeks in 69% of cases and 3 patients healed with hypertrophic scarring. The majority of burns were small in size and partial thickness in depth. Most were treated conservatively and healed with low complication rates. More than 1 in 5 injuries involved critical burn areas, highlighting the potential for considerable morbidity. The age profile in our study contrasted with other results worldwide. Our study highlights the need for vigilant supervision of children around motorcycles. We recommend the wearing of protective long trousers when riding motorcycles and the fitting of external shields to motorcycle exhaust pipes. PMID:28149228

Impact of Work-Related Burn Injury on Social Reintegration Outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

PubMed

Schneider, Jeffrey C; Shie, Vivian L; Espinoza, Leda F; Shapiro, Gabriel D; Lee, Austin; Acton, Amy; Marino, Molly; Jette, Alan; Kazis, Lewis E; Ryan, Colleen M

2017-11-26

To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Older participants, those who were married, and men were more likely to be burned at work (P<.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P=.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P<.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work. Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Parecoxib Reduces Systemic Inflammation and Acute Lung Injury in Burned Animals with Delayed Fluid Resuscitation

PubMed Central

Chong, Si Jack; Wu, Jian; Lu, Jia; Moochhala, Shabbir M.

2014-01-01

Burn injuries result in the release of proinflammatory mediators causing both local and systemic inflammation. Multiple organ dysfunctions secondary to systemic inflammation after severe burn contribute to adverse outcome, with the lungs being the first organ to fail. In this study, we evaluate the anti-inflammatory effects of Parecoxib, a parenteral COX-2 inhibitor, in a delayed fluid resuscitation burned rat model. Anaesthetized Sprague Dawley rats were inflicted with 45% total body surface area full-thickness scald burns and subsequently subjected to delayed resuscitation with Hartmann's solution. Parecoxib (0.1, 1.0, and 10 mg/kg) was delivered intramuscularly 20 min after injury followed by 12 h interval and the rats were sacrificed at 6 h, 24 h, and 48 h. Burn rats developed elevated blood cytokines, transaminase, creatinine, and increased lung MPO levels. Animals treated with 1 mg/kg Parecoxib showed significantly reduced plasma level of CINC-1, IL-6, PGEM, and lung MPO. Treatment of 1 mg/kg Parecoxib is shown to mitigate systemic and lung inflammation without significantly affecting other organs. At present, no specific therapeutic agent is available to attenuate the systemic inflammatory response secondary to burn injury. The results suggest that Parecoxib may have the potential to be used both as an analgesic and ameliorate the effects of lung injury following burn. PMID:24579056

Method and apparatus to measure the depth of skin burns

DOEpatents

Dickey, Fred M.; Holswade, Scott C.

2002-01-01

A new device for measuring the depth of surface tissue burns based on the rate at which the skin temperature responds to a sudden differential temperature stimulus. This technique can be performed without physical contact with the burned tissue. In one implementation, time-dependent surface temperature data is taken from subsequent frames of a video signal from an infrared-sensitive video camera. When a thermal transient is created, e.g., by turning off a heat lamp directed at the skin surface, the following time-dependent surface temperature data can be used to determine the skin burn depth. Imaging and non-imaging versions of this device can be implemented, thereby enabling laboratory-quality skin burn depth imagers for hospitals as well as hand-held skin burn depth sensors the size of a small pocket flashlight for field use and triage.

The association between hypothermia, prehospital cooling, and mortality in burn victims.

PubMed

Singer, Adam J; Taira, Breena R; Thode, Henry C; McCormack, Jane E; Shapiro, Mark; Aydin, Ani; Lee, Christopher

2010-04-01

Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35 degrees C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. There were 1,215 burn patients from 1994 to 2007. Mean age (+/-standard deviation [+/-SD]) was 29 (+/-24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6 degrees C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia.

Incidence and Clinical Outcome of Hypophosphatemia in Pediatric Burn Patients.

PubMed

Leite, Heitor Pons; Pinheiro Nogueira, Larissa Araújo; Teodosio, Ariane Helena Calassa

The objective of this study is to investigate the factors associated with serum phosphate concentrations in severely burned children and whether hypophosphatemia is associated with outcome. Seventy-eight children with a total body surface area of 24% (6.0-68.5) were retrospectively analyzed for serum phosphate concentrations during the first 10 days of stay in the intensive care unit (ICU). The method of generalized estimating equations was used to evaluate the effect of the exposure variables for serum phosphate concentrations during the study period. Outcome variables were the probability of ICU discharge at 30 days and time on mechanical ventilation. Potential explanatory variables for clinical outcome were hypophosphatemia (serum phosphate <3.8 mg/dL for children <2 years and <3.5 mg/dL for older children), age, sex, percent total body surface area burn, inhalation injury, and severe sepsis and/or septic shock. Competing-risk analysis was applied to calculate the probability of ICU discharge at 30 days, and death was assumed as the competing event. The rate of hypophosphatemia was 79.5%. Serum phosphate concentrations were associated with C-reactive protein (coefficient: -0.63; 95% confidence interval [CI]: -0.96 to -0.30; P = .001). Hypophosphatemia was independently associated with a 68% decrease in the probability of ICU discharge at 30 days (subhazard ratio: -0.32; 95% CI: 0.20, 0.53; P = .001) and an increase of 2.9 days in mechanical ventilation (coefficient: 2.91; 95% CI: 1.16, 4.66; P = .001). Serum phosphate concentrations in pediatric burn patients are associated with the magnitude of inflammatory response. Hypophosphatemia is associated with decreased probability of ICU discharge and increased time on mechanical ventilation.

Water chemistry of surface waters affected by the Fourmile Canyon wildfire, Colorado, 2010-2011

USGS Publications Warehouse

McCleskey, R. Blaine; Writer, Jeffrey H.; Murphy, Sheila F.

2012-01-01

In September 2010, the Fourmile Canyon fire burned about 23 percent of the Fourmile Creek watershed in Boulder County, Colo. Water-quality sampling of Fourmile Creek began within a month after the wildfire to assess its effects on surface-water chemistry. Water samples were collected from five sites along Fourmile Creek (above, within, and below the burned area) monthly during base flow, twice weekly during snowmelt runoff, and at higher frequencies during storm events. Stream discharge was also monitored. Water-quality samples were collected less frequently from an additional 6 sites on Fourmile Creek, from 11 tributaries or other inputs, and from 3 sites along Boulder Creek. The pH, electrical conductivity, temperature, specific ultraviolet absorbance, total suspended solids, and concentrations (dissolved and total) of major cations (calcium, magnesium, sodium, and potassium), anions (chloride, sulfate, alkalinity, fluoride, and bromide), nutrients (nitrate, ammonium, and phosphorus), trace metals (aluminum, arsenic, boron, barium, beryllium, cadmium, cobalt, chromium, copper, iron, mercury, lithium, manganese, molybdenum, nickel, lead, rubidium, antimony, selenium, strontium, vanadium, and zinc), and dissolved organic carbon are here reported for 436 samples collected during 2010 and 2011.

Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital.

PubMed

Mathews, Alexandra L; Cheng, Ming-Huei; Muller, John-Michael; Lin, Miffy Chia-Yu; Chang, Kate W C; Chung, Kevin C

2017-01-01

Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital

PubMed Central

Mathews, Alexandra L.; Cheng, Ming-Huei; Muller, John-Michael; Lin, Miffy Chia-Yu; Chang, Kate W.C.; Chung, Kevin C.

2016-01-01

Introduction Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. Methods A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA) ≥ 50 (n=20), and those with %TBSA <50 (n=28) were analyzed. Results The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965 ± 34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478 ± 23,518 per patient. Conclusions In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA ≥ 50 will contribute the majority of inpatient expenses. PMID:27553390

Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

PubMed

Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

2015-01-01

Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

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

PubMed Central

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

2015-01-01

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

Impaired zinc and copper status in children with burn injuries: need to reassess nutritional requirements.

PubMed

Voruganti, V Saroja; Klein, Gordon L; Lu, Hong-Xing; Thomas, Suchmor; Freeland-Graves, Jeanne H; Herndon, David N

2005-09-01

Major burns are associated with impaired Zn and Cu status. These micronutrients are essential for bone matrix formation, linear growth, and wound healing. This study evaluated the status of Zn and Cu in burned children and assessed adequacy of supplementation. Six children, mean total body surface area (TBSA), 54+/-9% (S.D.), were recruited. Nutrient intakes, plasma, wound exudate, and 24h urine samples were collected and analyzed for Zn and Cu. Bone mineral content was assessed by dual energy X-ray absorptiometry. Dietary Zn and Cu were three times the dietary reference, and mean plasma concentrations of Zn and Cu were low at admission and discharge. Urinary Zn was elevated at admission, whereas Cu was elevated at both times. Wound Zn and Cu concentrations exceeded plasma concentrations, suggesting that inflammatory wound exudate was a primary route of loss. We demonstrate that burn injury in children results in low plasma levels of Zn and Cu that are inadequately compensated during hospitalization.

Calcium and ER stress mediate hepatic apoptosis after burn injury

PubMed Central

Gauglitz, Gerd G.; Song, Juquan; Kulp, Gabriela A.; Finnerty, Celeste C.; Cox, Robert A.; Barral, José M.; Herndon, David N.; Boehning, Darren

2009-01-01

Abstract A hallmark of the disease state following severe burn injury is decreased liver function, which results in gross metabolic derangements that compromise patient survival. The underlying mechanisms leading to hepatocyte dysfunction after burn are essentially unknown. The aim of the present study was to determine the underlying mechanisms leading to hepatocyte dysfunction and apoptosis after burn. Rats were randomized to either control (no burn) or burn (60% total body surface area burn) and sacrificed at various time‐points. Liver was either perfused to isolate primary rat hepatocytes, which were used for in vitro calcium imaging, or liver was harvested and processed for immunohistology, transmission electron microscopy, mitochondrial isolation, mass spectroscopy or Western blotting to determine the hepatic response to burn injury in vivo. We found that thermal injury leads to severely depleted endoplasmic reticulum (ER) calcium stores and consequent elevated cytosolic calcium concentrations in primary hepatocytes in vitro. Burn‐induced ER calcium depletion caused depressed hepatocyte responsiveness to signalling molecules that regulate hepatic homeostasis, such as vasopressin and the purinergic agonist ATP. In vivo, thermal injury resulted in activation of the ER stress response and major alterations in mitochondrial structure and function – effects which may be mediated by increased calcium release by inositol 1,4,5‐trisphosphate receptors. Our results reveal that thermal injury leads to dramatic hepatic disturbances in calcium homeostasis and resultant ER stress leading to mitochondrial abnormalities contributing to hepatic dysfunction and apoptosis after burn injury. PMID:20141609

Comparison Between Civilian Burns and Combat Burns From Operation Iraqi Freedom and Operation Enduring Freedom

PubMed Central

Wolf, Steven E.; Kauvar, David S.; Wade, Charles E.; Cancio, Leopoldo C.; Renz, Evan P.; Horvath, Edward E.; White, Christopher E.; Park, Myung S.; Wanek, Sandra; Albrecht, Michael A.; Blackbourne, Lorne H.; Barillo, David J.; Holcomb, John B.

2006-01-01

Objective: To assess outcome differences between locally burned civilians and military personnel burned in a distant combat zone treated in the same facility. Summary Background Data: The United States Army Institute of Surgical Research (USAISR) Burn Center serves as a referral center for civilians and is the sole center for significant burns in military personnel. We made the hypothesis that outcomes for military personnel burned in the current conflict in Iraq and Afghanistan would be poorer because of delays to definitive treatment, other associated injury, and distance of evacuation. Methods: We reviewed the civilian and military records of patients treated at the USAISR from the outset of hostilities in Iraq in April 2003 to May 2005. Demographics, injury data, mortality, and clinical outcomes were compared. Results: We cared for 751 patients during this time period, 273 of whom were military (36%). Military injuries occurred in a younger population (41 ± 19 vs. 26 ± 7 years for civilian and military respectively, P < 0.0001) with a longer time from injury to burn center arrival (1 ± 5 days vs. 6 ± 5, P < 0.0001), a higher Injury Severity Score (ISS 5 ± 8 vs. 9 ± 11, P < 0.0001), and a higher incidence of inhalation injury (8% vs. 13%, P = 0.024). Total burn size did not differ. Mortality was 7.1% in the civilian and 3.8% in the military group (P = 0.076). When civilians outside the age range of the military cohort were excluded, civilian mortality was 5.0%, which did not differ from the military group (P = 0.57). Total body surface area (TBSA) burned, age ≥40 years, presence of inhalation injury, and ventilator days were found to be important predictors of mortality by stepwise regression, and were used in a final predictive model with the area under receiver operator characteristic curve of 0.97 for both populations considered together. No significant effect of either group was identified during development. Conclusions: Mortality does not differ between civilians evacuated locally and military personnel injured in distant austere environments treated at the same center. PMID:16772782

Time-dependent morphological and biochemical changes following cutaneous thermal burn injury and their modulation by copper nicotinate complex: an animal model.

PubMed

Nassar, Muammar A Y; Eldien, Heba M Saad; Tawab, Hanem S Abdel; Saleem, Tahia H; Omar, Hossam M; Nassar, Ahmed Y; Hussein, Mahmoud Rezk Abdelwahed

2012-10-01

Thermal tissue injury is partly mediated by reactive oxygen metabolites. Oxygen free radicals are contributory to local tissue damage following thermal injury and accordingly an interventional therapy using antioxidants may be beneficial. Copper nicotinate complex can scavenge reactive oxygen species (i.e., has antioxidant activity). To examine time-related morphological and biochemical changes following skin thermal injury and their modulation by copper nicotinate complex. An animal model composed of 80 albino rats was established. Ten rats (nonburn group) served as a control group. Seventy rats (burn group) were anesthetized, given a 10% total body surface area, full-thickness burn. Ten rats (from the postburn group) were sacrificed after 24 h (without treatment, i.e., untreated-burn group). The remaining rats were divided into three subgroups (20 rats, each) and were treated topically either with soft paraffin, moist exposed burn ointment (MEBO, a standard therapeutic treatment for burns), or copper nicotinate complex. Five animals from each subgroup were sacrificed every week over a period of 4 weeks. The morphological and biochemical changes were evaluated and compared among the different groups. High levels of the plasma and skin nitiric oxide (marker of oxidative stress) were observed in the untreated-burn group. These levels were significantly low following the application of copper nicotinate complex. Low levels of plasma and skin superoxide dismutase (marker of oxidative stress) and plasma ceruloplasmin were observed in the untreated-burn group. These levels were significantly high following copper nicotinate complex treatment. The total and differential leukocyte counts were low following the onset of the thermal injury. They gradually returned to normal levels over a 4-week period following the application of MEBO or copper nicotinate complex. Compared to untreated-burn group, postburn-healing changes (resolution of the inflammatory reaction, reepithelization of the epidermis, angiogenesis, deposition of collagen fibers, and recovery of the subcellualr organelles) were significantly accelerated following the application of either MEBO or copper nicotinate complex. Application of copper nicotinate complex was associated with improved healing of the thermal burns of the skin. The underlying molecular changes underlying these effects await further investigations.

Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom.

PubMed

Wolf, Steven E; Kauvar, David S; Wade, Charles E; Cancio, Leopoldo C; Renz, Evan P; Horvath, Edward E; White, Christopher E; Park, Myung S; Wanek, Sandra; Albrecht, Michael A; Blackbourne, Lorne H; Barillo, David J; Holcomb, John B

2006-06-01

To assess outcome differences between locally burned civilians and military personnel burned in a distant combat zone treated in the same facility. The United States Army Institute of Surgical Research (USAISR) Burn Center serves as a referral center for civilians and is the sole center for significant burns in military personnel. We made the hypothesis that outcomes for military personnel burned in the current conflict in Iraq and Afghanistan would be poorer because of delays to definitive treatment, other associated injury, and distance of evacuation. We reviewed the civilian and military records of patients treated at the USAISR from the outset of hostilities in Iraq in April 2003 to May 2005. Demographics, injury data, mortality, and clinical outcomes were compared. : We cared for 751 patients during this time period, 273 of whom were military (36%). Military injuries occurred in a younger population (41 +/- 19 vs. 26 +/- 7 years for civilian and military respectively, P < 0.0001) with a longer time from injury to burn center arrival (1 +/- 5 days vs. 6 +/- 5, P < 0.0001), a higher Injury Severity Score (ISS 5 +/- 8 vs. 9 +/- 11, P < 0.0001), and a higher incidence of inhalation injury (8% vs. 13%, P = 0.024). Total burn size did not differ. Mortality was 7.1% in the civilian and 3.8% in the military group (P = 0.076). When civilians outside the age range of the military cohort were excluded, civilian mortality was 5.0%, which did not differ from the military group (P = 0.57). Total body surface area (TBSA) burned, age > or =40 years, presence of inhalation injury, and ventilator days were found to be important predictors of mortality by stepwise regression, and were used in a final predictive model with the area under receiver operator characteristic curve of 0.97 for both populations considered together. No significant effect of either group was identified during development. Mortality does not differ between civilians evacuated locally and military personnel injured in distant austere environments treated at the same center.

Interactive home telehealth and burns: A pilot study.

PubMed

Hickey, Sean; Gomez, Jason; Meller, Benjamin; Schneider, Jeffery C; Cheney, Meredith; Nejad, Shamim; Schulz, John; Goverman, Jeremy

2017-09-01

The objective of this study is to review our experience incorporating Interactive Home Telehealth (IHT) visits into follow-up burn care. A retrospective review of all burn patients participating in IHT encounters over the course of 15 months was performed. Connections were established through secure video conferencing and call-routing software. Patients connected with a personal computer or tablet and providers connected with a desktop computer with a high-definition web camera. In some cases, high-definition digital images were emailed to the provider prior to the virtual consultation. For each patient, the following was collected: (1) patient and injury demographics (diagnosis, prognosis, and clinical management), (2) total number of encounters, (3) service for each encounter (burn, psychiatry, and rehabilitation), (4) length of visit, including travel distance and time saved and, (5) complications, including re-admissions and connectivity issues. 52 virtual encounters were performed with 31 patients during the first year of the pilot project from March 2015 to June 2016. Mean age of the participant was 44 years (range 18-83 years). Mean total burn surface area of the participant was 12% (range 1-80%). Average roundtrip travel distance saved was 188 miles (range 4-822 miles). Average round trip travel time saved was 201min (range 20-564min). There were no unplanned re-admissions and no complications. Five connectivity issues were reported, none of which prevented completion of the visit. Interactive Home Telehealth is a safe and feasible modality for delivering follow-up care to burn patients. Burn care providers benefit from the potential to improve outpatient clinic utilization. Patients benefit from improved access to multiple members of their specialized burn care team, as well as cost-reductions for patient travel expenses. Future studies are needed to ensure patient and provider satisfaction and to further validate the significance, cost-effectiveness and safety. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Enhanced biogenic emissions of nitric oxide and nitrous oxide following surface biomass burning

NASA Technical Reports Server (NTRS)

Anderson, Iris C.; Levine, Joel S.; Poth, Mark A.; Riggan, Philip J.

1988-01-01

Recent measurements indicate significantly enhanced biogenic soil emissions of both nitric oxide (NO) and nitrous oxide (N2O) following surface burning. These enhanced fluxes persisted for at least six months following the burn. Simultaneous measurements indicate enhanced levels of exchangeable ammonium in the soil following the burn. Biomass burning is known to be an instantaneous source of NO and N2O resulting from high-temperature combustion. Now it is found that biomass burning also results in significantly enhanced biogenic emissions of these gases, which persist for months following the burn.

Biological markers of stress in pediatric acute burn injury.

PubMed

Brown, Nadia J; Kimble, Roy M; Rodger, Sylvia; Ware, Robert S; McWhinney, Brett C; Ungerer, Jacobus P J; Cuttle, Leila

2014-08-01

Burns and their associated wound care procedures evoke significant stress and anxiety, particularly for children. Little is known about the body's physiological stress reactions throughout the stages of re-epithelialization following an acute burn injury. Previously, serum and urinary cortisol have been used to measure stress in burn patients, however these measures are not suitable for a pediatric burn outpatient setting. To assess the sensitivity of salivary cortisol and sAA in detecting stress during acute burn wound care procedures and to investigate the body's physiological stress reactions throughout burn re-epithelialization. Seventy-seven participants aged four to thirteen years who presented with an acute burn injury to the burn center at the Royal Children's Hospital, Brisbane, Australia, were recruited between August 2011 and August 2012. Both biomarkers were responsive to the stress of burn wound care procedures. sAA levels were on average 50.2 U/ml higher (p<0.001) at 10 min post-dressing removal compared to baseline levels. Salivary cortisol levels showed a blunted effect with average levels at ten minutes post dressing removal decreasing by 0.54 nmol/L (p<0.001) compared to baseline levels. sAA levels were associated with pain (p=0.021), no medication (p=0.047) and Child Trauma Screening Questionnaire scores at three months post re-epithelialization (p=0.008). Similarly, salivary cortisol was associated with no medication (p<0.001), pain scores (p=0.045) and total body surface area of the burn (p=0.010). Factors which support the use of sAA over salivary cortisol to assess stress during morning acute burn wound care procedures include; sensitivity, morning clinic times relative to cortisol's diurnal peaks, and relative cost. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Adult survivors' lived experience of burns and post-burn health: A qualitative analysis.

PubMed

Abrams, Thereasa E; Ogletree, Roberta J; Ratnapradipa, Dhitinut; Neumeister, Michael W

2016-02-01

The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study explores the experiences and perceptions early (ages 18-35) and midlife (ages 36-64) adults providing insight for how participants perceived their burns in relationship to their post-burn health. Participants were interviewed using semi-structured interview questions framed around seven domains of health. Interview recordings were transcribed verbatim then coded line by line, identifying dominant categories related to health. Categories were analyzed identifying shared themes among the study sample. Participants were Caucasian, seven males and one female. Mean age at time of interviews was 54.38 and 42.38 at time of burns. Mean time since burns occurred was 9.38 years with a minimum of (20%) total body surface area (TBSA) burns. Qualitative content analysis rendered three emergent health-related categories and associated themes that represented shared meanings within the participant sample. The category of "Physical Health" reflected the theme physical limitations, pain and sensitivity to temperature. Within the category of "Intellectual Health" were themes of insight, goal setting and self-efficacy, optimism and humor and within "Emotional Health" were the themes empathy and gratitude. By exploring subjective experiences and perceptions of health shared through dialog with experienced burned persons, there are opportunities to develop a more complete picture of how holistic health may be affected by major burns that in turn could support future long-term rehabilitative trajectories of early and midlife adult burn patients. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Terror-inflicted thermal injury: A retrospective analysis of burns in the Israeli-Palestinian conflict between the years 1997 and 2003.

PubMed

Haik, Josef; Tessone, Ariel; Givon, Adi; Liran, Alon; Winkler, Eyal; Mendes, David; Goldan, Oren; Bar-Meir, Eran; Regev, Eli; Orenstein, Arie; Peleg, Kobi

2006-12-01

Terror attacks have changed in the past decade, with a growing tendency toward explosives and suicide bombings, which led to a rise in the incidence of thermal injuries among victims. The Israeli-Palestinian conflict of October 2000 marked a turning point when an organized terror campaign commenced. This article presents data of terror-associated burns from the Israeli National Trauma Registry (ITR) during the years 1997 to September 2000 and October 2000 to 2003. We analyzed demographic and clinical characteristics of 219 terror-related burn patients and 6,546 other burn patients admitted to hospitals in Israel between 1997 and 2003. Data were obtained from the ITR. Burns contributed about 9% of all terror related trauma and about 5% of all other trauma (p < 0.0001). These percentages have not changed significantly before and after October 2000. Terror-related burns afflict Jewish males more than predicted by their percentage in the population, whereas other burns afflict non-Jewish males more than predicted. Adults and young adults (15-59 years) are the predominant group in terror-related burns (80%), whereas children younger than 15 years are the predominant group in other burns (50%). Large burns (20% to 89% total body surface area) are more common in terror casualties, with greater mortality (6.4% in terror-related versus 3.4% in others; p = 0.0258). Although the incidence of burns has risen because of an organized campaign, this change was noticeable in other trauma forms as well in similar proportions. Terror-related burns afflict a targeted population, and generally take on a more severe course with greater mortality rates, thus requiring appropriate medical treatment.

Alternatively Activated Macrophages Drive Browning of White Adipose Tissue in Burns.

PubMed

Abdullahi, Abdikarim; Auger, Christopher; Stanojcic, Mile; Patsouris, David; Parousis, Alexandra; Epelman, Slava; Jeschke, Marc G

2017-08-16

The aim of this study was to uncover the mediators and mechanistic events that facilitate the browning of white adipose tissue (WAT) in response to burns. In hypermetabolic patients (eg, burns, cancer), the browning of WAT has presented substantial clinical challenges related to cachexia, atherosclerosis, and poor clinical outcomes. Browning of the adipose tissue has recently been found to induce and sustain hypermetabolism. Although browning appears central in trauma-, burn-, or cancer-induced hypermetabolic catabolism, the mediators are essentially unknown. WAT and blood samples were collected from patients admitted to the Ross Tilley Burn Centre at Sunnybrook Hospital. Wild type, CCR2 KO, and interleukin (IL)-6 KO male mice were purchased from Jax laboratories and subjected to a 30% total body surface area burn injury. WAT and serum collected were analyzed for browning markers, macrophages, and metabolic state via histology, gene expression, and mitochondrial respiration. In the present study, we show that burn-induced browning is associated with an increased macrophage infiltration, with a greater type 2 macrophage profile in the fat of burn patients. Similar to our clinical findings in burn patients, both an increase in macrophage recruitment and a type 2 macrophage profile were also observed in post burn mice. Genetic loss of the chemokine CCR2 responsible for macrophage migration to the adipose impairs burn-induced browning. Mechanistically, we show that macrophages recruited to burn-stressed subcutaneous WAT (sWAT) undergo alternative activation to induce tyrosine hydroxylase expression and catecholamine production mediated by IL-6, factors required for browning of sWAT. Together, our findings uncover macrophages as the key instigators and missing link in trauma-induced browning.

[New developments in skin replacement materials].

PubMed

Przybilski, M; Deb, R; Erdmann, D; Germann, G

2004-06-01

Current treatment strategies in intensive care medicine permit survival of patients with burns of more than 80% of the total body surface area (TBSA). Major burns result in extensive skin defects. Thus, burn victims often suffer from scar contractures, altered thermoregulation, and unsatisfactory cosmetic results. In addition to the well-established cultivated epithelial autografts, a number of new composite grafts have been developed in the field of tissue engineering. The combination of synthetic and allogenic matrix structures together with an allogenic or autologous epithelium allows the possibility of mimicking skin structure. The aim is to achieve improved wound healing by regeneration of dermal tissue instead of scarring. This article provides an overview of the currently available products which have already been introduced into clinical routine as well as describing advantages and disadvantages of the individual products and their indications.

Response of a local hospital to a burn disaster: Contributory factors leading to zero mortality outcomes.

PubMed

Yeong, Eng-Kean; O'Boyle, Ciaran P; Huang, Hui-Fu; Tai, Hao-Chih; Hsu, Yen-Chun; Chuang, Shu-Yang; Wu, Yu-Feng; Chang, Che-Wei; Liu, Tom J; Lai, Hong-Shiee

2018-05-09

To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan. Female predominance (mean age: 21.7 years) and lower extremity circumferential flame burns were the characteristics of the burn injury. The mean Baux score was 70±18. The mean burn area was 42% of the total body surface area (TBSA). A total of 79% patients arrived at the hospital within 24h of sustaining injuries. Intensive care unit (ICU) admission criteria were modified to accommodate patients with 40% TBSA of burns, facilities were expanded from 4 ICU beds to 18 beds, and new staff was recruited. A total of 36% patients (n=12/33, 62±13 TBSA of burns) required fluid resuscitation. The mean volume of Lactate Ringer administered in the first 24h of burns was 3.34±2.18ml/kg/%TBSA, while the mean volume of fresh frozen plasma administered was 0.60±0.63ml/kg/h. Forty-two percent patients were intubated on the day of admission, and 71% of the intubated patients had inhalation injuries that were confirmed by diagnostic bronchoscopy. The mean intubation period was 17±9 days. The incidence of pulmonary edema was 58% (n=7/12), possibly due to sub-optimal monitoring. Of these, 57% (n=4/7) patients progressed to adult respiratory distress syndrome, but were successfully treated with early strict fluid restriction, systemic antibiotics, ventilation support, and bronchial lavage. A total of 94% patients received grafting. The mean grafted area was 4432.3±3891cm 2 . Tube feeding was provided to patients with burns >40% TBSA. All patients tolerated gastric tube feeding without conversion to duodenal switch. On admission, all patients received prophylactic antibiotics. Septic shock was noted in 12 patients, but no mortality occurred. The mean hospital stay was 1.5 days per percent burn. This article highlights the value of precise triage, traffic control, and effective resource allocation in treating a BMCI. Effective supporting systems for facility expansion, staff recruitment, medical supplies and clear-cut treatment strategies for severely burned patients are contributory factors leading to zero mortalities in our series, in addition to young age and minimal inhalation injuries. The need for reevaluation of the safety of cornstarch powder in festival activities is clear. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

Influence of rice straw burning on the levels of polycyclic aromatic hydrocarbons in agricultural county of Taiwan.

PubMed

Lai, Chia-Hsiang; Chen, Kang-Shin; Wang, Hsin-Kai

2009-01-01

Atmospheric particulate and polycyclic aromatic hydrocarbons (PAHs) size distribution were measured at Jhu-Shan (a rural site) and Sin-Gang (a town site) in central Taiwan during the rice straw burning and non-burning periods. The concentrations of total PAHs accounting for a roughly 58% (34%) increment in the concentrations of total PAHs due to rice-straw burning. Combustion-related PAHs during burning periods were 1.54-2.57 times higher than those during non-burning periods. The mass median diameter (MMD) of 0.88-1.21 microm in the particulate phase suggested that rice-straw burning generated the increase in coarse particle number. Chemical mass balance (CMB) receptor model analyses showed that the primary pollution sources at the two sites were similar. However, rice-straw burning emission was specifically identified as a significant source of PAH during burning periods at the two sites. Open burning of rice straws was estimated to contribute approximately 6.3%-24.6% to total atmospheric PAHs at the two sites.

Effects of Mesalamine Treatment on Gut Barrier Integrity Following Burn Injury

PubMed Central

Cannon, Abigail R.; Akhtar, Suhail; Hammer, Adam M.; Morris, Niya L.; Javorski, Mike J.; Li, Xiaoling; Kennedy, Richard H.; Gamelli, Richard L.; Choudhry, Mashkoor A.

2016-01-01

Gut barrier disruption is often implicated in pathogenesis associated with burn and other traumatic injuries. In this study, we examined whether therapeutic intervention with mesalamine (5-ASA), a common anti-inflammatory treatment for patients with inflammatory bowel disease, reduces intestinal inflammation and maintains normal barrier integrity after burn injury. Male C57BL/6 mice were administered an ~20% total body surface area dorsal scald burn and resuscitated with either 1mL normal saline or 100mg/kg of 5-ASA dissolved in saline. We examined intestinal transit and permeability along with levels of small intestine epithelial cell pro-inflammatory cytokines and tight junction protein expression one day after burn injury in the presence or absence of 5-ASA. A significant decrease in intestinal transit was observed one day after burn injury, which accompanied a significant increase in gut permeability. We found a substantial increase in the levels of IL-6 (by ~1.5 fold) and IL-18 (by ~2.5 fold) in small intestine epithelial cells one day after injury. Furthermore, burn injury decreases expression of the tight junction proteins claudin-4, claudin-8, and occludin. Treatment with 5-ASA after burn injury prevented the burn induced increase in permeability, partially restored normal intestinal transit, normalized levels of the pro-inflammatory cytokines IL-6 and IL-18, and restored tight junction protein expression of claudin-4 and occludin to that of sham levels. Together these findings suggest that 5-ASA can potentially be used as treatment to decrease intestinal inflammation and normalize intestinal function after burn injury. PMID:27388883

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

PubMed

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

2016-06-30

Specific burn outcome prediction scores such as the Abbreviated Burn Severity Index (ABSI), Ryan, Belgian Outcome of Burn Injury (BOBI) and revised Baux scores have been extensively studied. Validation studies of the critical care score SAPS II (Simplified Acute Physiology Score) have included burns patients but not addressed them as a cohort. The study aimed at comparing their performance in a Swiss burns intensive care unit (ICU) and to observe whether they were affected by a standardized definition of inhalation injury. We conducted a retrospective cohort study, including all consecutive ICU burn admissions (n=492) between 1996 and 2013: 5 epochs were defined by protocol changes. As required for SAPS II calculation, stays <24h were excluded. Data were collected on age, gender, total body surface area burned (TBSA) and inhalation injury (systematic standardized diagnosis since 2006). Study epochs were compared (χ2 test, ANOVA). Score performance was assessed by receiver operating characteristic curve analysis. SAPS II performed well (AUC 0.89), particularly in burns <40% TBSA (AUC 0.93). Revised Baux and ABSI scores were not affected by the standardized diagnosis of inhalation injury and showed the best performance (AUC 0.92 and 0.91 respectively). In contrast, the accuracy of the BOBI and Ryan scores was lower (AUC 0.84 and 0.81) and reduced after 2006. The excellent predictive performance of the classic scores (revised Baux score and ABSI) was confirmed. SAPS II was nearly as accurate, particularly in burns <40% TBSA. Ryan and BOBI scores were least accurate, as they heavily weight inhalation injury.

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

PubMed Central

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

2016-01-01

Summary Specific burn outcome prediction scores such as the Abbreviated Burn Severity Index (ABSI), Ryan, Belgian Outcome of Burn Injury (BOBI) and revised Baux scores have been extensively studied. Validation studies of the critical care score SAPS II (Simplified Acute Physiology Score) have included burns patients but not addressed them as a cohort. The study aimed at comparing their performance in a Swiss burns intensive care unit (ICU) and to observe whether they were affected by a standardized definition of inhalation injury. We conducted a retrospective cohort study, including all consecutive ICU burn admissions (n=492) between 1996 and 2013: 5 epochs were defined by protocol changes. As required for SAPS II calculation, stays <24h were excluded. Data were collected on age, gender, total body surface area burned (TBSA) and inhalation injury (systematic standardized diagnosis since 2006). Study epochs were compared (χ2 test, ANOVA). Score performance was assessed by receiver operating characteristic curve analysis. SAPS II performed well (AUC 0.89), particularly in burns <40% TBSA (AUC 0.93). Revised Baux and ABSI scores were not affected by the standardized diagnosis of inhalation injury and showed the best performance (AUC 0.92 and 0.91 respectively). In contrast, the accuracy of the BOBI and Ryan scores was lower (AUC 0.84 and 0.81) and reduced after 2006. The excellent predictive performance of the classic scores (revised Baux score and ABSI) was confirmed. SAPS II was nearly as accurate, particularly in burns <40% TBSA. Ryan and BOBI scores were least accurate, as they heavily weight inhalation injury. PMID:28149234

Cultured Skin Substitutes Reduce Donor Skin Harvesting for Closure of Excised, Full-Thickness Burns

PubMed Central

Boyce, Steven T.; Kagan, Richard J.; Yakuboff, Kevin P.; Meyer, Nicholas A.; Rieman, Mary T.; Greenhalgh, David G.; Warden, Glenn D.

2002-01-01

Objective Comparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. Summary Background Data Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been shown to close full-thickness skin wounds in preclinical and clinical studies with acceptable functional and cosmetic results. Methods Qualitative outcome was compared between CSS and AG in 45 patients on an ordinal scale (0, worst; 10, best) with primary analyses at postoperative day 28 and after about 1 year for erythema, pigmentation, pliability, raised scar, epithelial blistering, and surface texture. In the latest 12 of the 45 patients, tracings were performed of donor skin biopsies and wounds treated with CSS at postoperative days 14 and 28 to calculate percentage engraftment, the ratio of closed wound:donor skin areas, and the percentage of total body surface area closed with CSS. Results Measures of qualitative outcome of CSS or AG were not different statistically at 1 year after grafting. Engraftment at postoperative day 14 exceeded 75% in the 12 patients evaluated. The ratio of closed wound:donor skin areas for CSS at postoperative day 28 was significantly greater than for conventional 4:1 meshed autografts. The percentage of total body surface area closed with CSS at postoperative day 28 was significantly less than with AG. Conclusions The requirement for harvesting of donor skin for CSS was less than for conventional skin autografts. These results suggest that acute-phase recovery of patients with extensive burns is facilitated and that complications are reduced by the use of CSS together with conventional skin grafting. PMID:11807368

Cultured skin substitutes reduce donor skin harvesting for closure of excised, full-thickness burns.

PubMed

Boyce, Steven T; Kagan, Richard J; Yakuboff, Kevin P; Meyer, Nicholas A; Rieman, Mary T; Greenhalgh, David G; Warden, Glenn D

2002-02-01

Comparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been shown to close full-thickness skin wounds in preclinical and clinical studies with acceptable functional and cosmetic results. Qualitative outcome was compared between CSS and AG in 45 patients on an ordinal scale (0, worst; 10, best) with primary analyses at postoperative day 28 and after about 1 year for erythema, pigmentation, pliability, raised scar, epithelial blistering, and surface texture. In the latest 12 of the 45 patients, tracings were performed of donor skin biopsies and wounds treated with CSS at postoperative days 14 and 28 to calculate percentage engraftment, the ratio of closed wound:donor skin areas, and the percentage of total body surface area closed with CSS. Measures of qualitative outcome of CSS or AG were not different statistically at 1 year after grafting. Engraftment at postoperative day 14 exceeded 75% in the 12 patients evaluated. The ratio of closed wound:donor skin areas for CSS at postoperative day 28 was significantly greater than for conventional 4:1 meshed autografts. The percentage of total body surface area closed with CSS at postoperative day 28 was significantly less than with AG. The requirement for harvesting of donor skin for CSS was less than for conventional skin autografts. These results suggest that acute-phase recovery of patients with extensive burns is facilitated and that complications are reduced by the use of CSS together with conventional skin grafting.

Work-related burn injuries in Ontario, Canada: a follow-up 10-year retrospective study

PubMed Central

Clouatre, Elsa; Gomez, Manuel; Banfield, Joanne; Jeschke, Marc G

2013-01-01

Work-related burn injuries contribute to a quarter of all burn injuries in USA. In 2009, the provincial Workplace Safety and Insurance Board reported 64,824 work-related injuries that resulted in time-lost, 1188 injuries (2%) were a result of burns. There have been two previous studies performed at a regional burn centre (1984-1990 and 1998-2000) looking at incidence and characteristics of work-related burns. There was no significant change between these two groups. The purpose of this study was to identify the recent pattern of work-related burns from 2001 to 2010 and to compare it to the previous studies. During the study period, 1427 patients were admitted for an acute injury to the regional burn centre. Of these, 330 were due to a work-related incident (23%). The mean age of patients was 40.5±11.9 years, 95% were male. The mean total body surface area burn was 11.9±16.2%. The most common mechanism of burn injury was flame (32.7%) followed by electrical (27%) and scald (19.7%), inhalation injury was present in 4.8% of patients and the mortality was 1.8%. Our study has shown that there has been a significant decrease in the incidence in work-related burns treated at the regional burn centre (23.1%, vs. 28.2% vs. 30.2% p<0.01), flame burns have now become the leading cause of injury, there was a significant reduction in inhalation injury (4.8% vs. 23% vs. 14.8%, p<0.00001), and mortality overtime (1.8%, vs. 4% vs. 6.7% p=0.02). These findings strongly suggests a change in the cause of work-related burns, improvement in burn care, and that prevention strategies may have been more effective. PMID:23352030

Burns, inflammation, and intestinal injury: protective effects of an anti-inflammatory resuscitation strategy.

PubMed

Costantini, Todd W; Peterson, Carrie Y; Kroll, Lauren; Loomis, William H; Putnam, James G; Wolf, Paul; Eliceiri, Brian P; Baird, Andrew; Bansal, Vishal; Coimbra, Raul

2009-12-01

Intestinal barrier breakdown after severe burn can lead to intestinal inflammation, which may act as the source of the systemic inflammatory response. In vitro intestinal cell studies have shown that mitogen-activated protein kinase (MAPK) signaling is an important modulator of intestinal inflammation. We have previously observed that pentoxifylline (PTX) attenuates burn-induced intestinal permeability and tight junction breakdown. We hypothesized that PTX would limit intestinal barrier breakdown and attenuate inflammatory signaling via the MAPK pathway. Male balb/c mice underwent 30% total body surface area full-thickness steam burn. Immediately after burn, animals received an intraperitoneal injection of PTX (12.5 mg/kg) in normal saline or normal saline alone. In vivo intestinal permeability to 4 kDa fluorescein isothiocyanate-dextran was measured. Intestinal extracts were obtained to measure interleukin-6 by enzyme-linked immunosorbent assay, and phosphorylated p38 MAPK, p38 MAPK, phosphorylated extracellular signal-related kinase (1/2) (ERK (1/2)), and ERK (1/2) by immunoblotting. Acute lung injury was assessed by histology at 24 hours after burn. Administration of PTX immediately after injury attenuated burn-induced intestinal permeability. PTX also decreased the burn-induced phosphorylation of p38 MAPK and decreased phosphorylation of ERK (1/2) at 2 hours and 24 hours after injury. Animals given PTX had decreased intestinal interleukin-6 levels. A single dose of PTX also decreased histologic lung injury at 24 hours after burn. PTX attenuates burn-induced intestinal permeability and subsequent intestinal inflammation. Use of PTX after burn was also associated with decreased acute lung injury. Because of its compelling anti-inflammatory effects, PTX may be an ideal candidate for use as an immunomodulatory adjunct to resuscitation fluid.

Selective decontamination of the digestive tract ameliorates severe burn-induced insulin resistance in rats.

PubMed

Li, Jun; Zhu, Liang; Xu, Ming; Han, Juntao; Bai, Xiaozhi; Yang, Xuekang; Zhu, Huayu; Xu, Jie; Zhang, Xing; Gong, Yangfan; Hu, Dahai; Gao, Feng

2015-08-01

Severe burns often initiate the prevalence of hyperglycemia and insulin resistance, significantly contributing to adverse clinical outcomes. However, there are limited treatment options. This study was designed to investigate the role and the underlying mechanisms of oral antibiotics to selectively decontaminate the digestive tract (SDD) on burn-induced insulin resistance. Rats were subjected to 40% of total body surface area full-thickness burn or sham operation with or without SDD treatment. Translocation of FITC-labeled LPS was measured at 4h after burn. Furthermore, the effect of SDD on post-burn quantity of gram-negative bacteria in gut was investigated. Serum or muscle LPS and proinflammatory cytokines were measured. Intraperitoneal glucose tolerance test and insulin tolerance test were used to determine the status of systemic insulin resistance. Furthermore, intracellular insulin signaling (IRS-1 and Akt) and proinflammatory related kinases (JNK and IKKβ) were assessed by western blot. Burn increased the translocation of LPS from gut 4h after injury. SDD treatment effectively inhibited post-burn overgrowth of gram-negative enteric bacilli in gut. In addition, severe burns caused significant increases in the LPS and proinflammatory cytokines levels, activation of proinflammatory related kinases, and systemic insulin resistance as well. But SDD treatment could significantly attenuate burn-induced insulin resistance and improve the whole-body responsiveness to insulin, which was associated with the inhibition of gut-derived LPS, cytokines, proinflammatory related kinases JNK and IKKβ, as well as activation of IRS-1 and Akt. SDD appeared to have an effect on proinflammatory signaling cascades and further reduced severe burn-induced insulin resistance. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors' social participation.

PubMed

Kazis, Lewis E; Marino, Molly; Ni, Pengsheng; Soley Bori, Marina; Amaya, Flor; Dore, Emily; Ryan, Colleen M; Schneider, Jeff C; Shie, Vivian; Acton, Amy; Jette, Alan M

2017-10-01

Measuring the impact burn injuries have on social participation is integral to understanding and improving survivors' quality of life, yet there are no existing instruments that comprehensively measure the social participation of burn survivors. This project aimed to develop the Life Impact Burn Recovery Evaluation Profile (LIBRE), a patient-reported multidimensional assessment for understanding the social participation after burn injuries. 192 questions representing multiple social participation areas were administered to a convenience sample of 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via Computerized Adaptive Testing (CAT) or fixed short forms. The study sample included 54.7% women with a mean age of 44.6 (SD 15.9) years. The average time since burn injury was 15.4 years (0-74 years) and the average total body surface area burned was 40% (1-97%). The CFA indicated acceptable fit statistics (CFI range 0.913-0.977, TLI range 0.904-0.974, RMSEA range 0.06-0.096). The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15% for all scales. The LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.

Pediatric burns mortality risk factors in a developing country’s tertiary burns intensive care unit

PubMed Central

Agbenorku, Pius; Agbenorku, Manolo; Fiifi-Yankson, Papa Kwesi

2013-01-01

Aim: This study aimed at identifying risk factors related to pediatric burns mortality in a middle income country such as Ghana. Methods: The data for the three years retrospective study (May 2009 – April 2012) was obtained from the pediatric burn admissions records and patients’ folders of the Reconstructive Plastic Surgery & Burns Unit (RPSBU), Komfo Anokye Teaching Hospital (KATH), Ghana. Data retrieved included: Demographic features, Total Burned Surface Area (TBSA) incurred; Aetiology of burns; Duration of the admission; Outcome of admission; Part of the body affected and Cost incurred. Ethical approval for this study was obtained from the KNUST-SMS/KATH Committee on Human Research, Publications and Ethics. Data analyses were performed with SPSS 17.0 version. Results: Information on 197 patients was completely retrieved for the study. Burns mortality rate for the study was identified to be 21.3% (N=42). The mean age of the 42 dead patients was 3.7±0.3 years, ranging from 0-13 years, while, males (54.8%, N= 23) outnumbered females (45.2%, N=19). The TBSA burned interquartile range was 48%. In terms of etiology of burns Scald (73.8%, N=31) was the commonest cause of injury. Mortality risk factors identified were Age <6 years (P=0.028); Scald especially hot water and soup (P=0.016); TBSA >36% (P=0.028) and Inhalation injury (P=0.040). Conclusion: Age, scald, TBSA and Inhalation Injury were identified as pediatric burns mortality risk factors in a developing country such as Ghana’s RPSBU. These identified factors will serve as a guideline for plastic surgeons and other health professionals practicing in countries such as Ghana. PMID:23875121

Severe Burn-Induced Intestinal Epithelial Barrier Dysfunction Is Associated With Endoplasmic Reticulum Stress and Autophagy in Mice

PubMed Central

Huang, Yalan; Feng, Yanhai; Wang, Yu; Wang, Pei; Wang, Fengjun; Ren, Hui

2018-01-01

The disruption of intestinal barrier plays a vital role in the pathophysiological changes after severe burn injury, however, the underlying mechanisms are poorly understood. Severe burn causes the disruption of intestinal tight junction (TJ) barrier. Previous studies have shown that endoplasmic reticulum (ER) stress and autophagy are closely associated with the impairment of intestinal mucosa. Thus, we hypothesize that ER stress and autophagy are likely involved in burn injury-induced intestinal epithelial barrier dysfunction. Mice received a 30% total body surface area (TBSA) full-thickness burn, and were sacrificed at 0, 1, 2, 6, 12 and 24 h postburn. The results showed that intestinal permeability was increased significantly after burn injury, accompanied by the damage of mucosa and the alteration of TJ proteins. Severe burn induced ER stress, as indicated by increased intraluminal chaperone binding protein (BIP), CCAAT/enhancer-binding protein homologous protein (CHOP) and inositol-requiring enzyme 1(IRE1)/X-box binding protein 1 splicing (XBP1). Autophagy was activated after burn injury, as evidenced by the increase of autophagy related protein 5 (ATG5), Beclin 1 and LC3II/LC3I ratio and the decrease of p62. Besides, the number of autophagosomes was also increased after burn injury. The levels of p-PI3K(Ser191), p-PI3K(Ser262), p-AKT(Ser473), and p-mTOR were decreased postburn, suggesting that autophagy-related PI3K/AKT/mTOR pathway is involved in the intestinal epithelial barrier dysfunction following severe burn. In summary, severe burn injury induces the ER stress and autophagy in intestinal epithelia, leading to the disruption of intestinal barrier. PMID:29740349

Risk Factors for the Development of Heterotopic Ossification in Seriously Burned Adults: A NIDRR Burn Model System Database Analysis

PubMed Central

Levi, Benjamin; Jayakumar, Prakash; Giladi, Avi; Jupiter, Jesse B.; Ring, David C.; Kowalske, Karen; Gibran, Nicole S.; Herndon, David; Schneider, Jeffrey C.; Ryan, Colleen M.

2015-01-01

Purpose Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study we utilize a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. Methods Data from 6 high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. Results Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. Controlling for age and sex in a multivariate model, patients with >30% total body surface area (TBSA) burn had 11.5x higher odds of developing HO (p<0.001), and those with arm burns that required skin grafting had 96.4x higher odds of developing HO (p=0.04). For each additional time a patient went to the operating room, odds of HO increased 30% (OR 1.32, p<0.001), and each additional ventilator day increase odds 3.5% (OR 1.035, p<0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Conclusion Risk factors for HO development include >30% TBSA burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. PMID:26496115

Contribution of Brown Carbon to Direct Radiative Forcing over the Indo-Gangetic Plain.

PubMed

Shamjad, P M; Tripathi, S N; Pathak, Ravi; Hallquist, M; Arola, Antti; Bergin, M H

2015-09-01

The Indo-Gangetic Plain is a region of known high aerosol loading with substantial amounts of carbonaceous aerosols from a variety of sources, often dominated by biomass burning. Although black carbon has been shown to play an important role in the absorption of solar energy and hence direct radiative forcing (DRF), little is known regarding the influence of light absorbing brown carbon (BrC) on the radiative balance in the region. With this in mind, a study was conducted for a one month period during the winter-spring season of 2013 in Kanpur, India that measured aerosol chemical and physical properties that were used to estimate the sources of carbonaceous aerosols, as well as parameters necessary to estimate direct forcing by aerosols and the contribution of BrC absorption to the atmospheric energy balance. Positive matrix factorization analyses, based on aerosol mass spectrometer measurements, resolved organic carbon into four factors including low-volatile oxygenated organic aerosols, semivolatile oxygenated organic aerosols, biomass burning, and hydrocarbon like organic aerosols. Three-wavelength absorption and scattering coefficient measurements from a Photo Acoustic Soot Spectrometer were used to estimate aerosol optical properties and estimate the relative contribution of BrC to atmospheric absorption. Mean ± standard deviation values of short-wave cloud free clear sky DRF exerted by total aerosols at the top of atmosphere, surface and within the atmospheric column are -6.1 ± 3.2, -31.6 ± 11, and 25.5 ± 10.2 W/m(2), respectively. During days dominated by biomass burning the absorption of solar energy by aerosols within the atmosphere increased by ∼35%, accompanied by a 25% increase in negative surface DRF. DRF at the top of atmosphere during biomass burning days decreased in negative magnitude by several W/m(2) due to enhanced atmospheric absorption by biomass aerosols, including BrC. The contribution of BrC to atmospheric absorption is estimated to range from on average 2.6 W/m(2) for typical ambient conditions to 3.6 W/m(2) during biomass burning days. This suggests that BrC accounts for 10-15% of the total aerosol absorption in the atmosphere, indicating that BrC likely plays an important role in surface and boundary temperature as well as climate.

Impact of managed moorland burning on peat nutrient and base cation status

NASA Astrophysics Data System (ADS)

Palmer, Sheila; Gilpin, Martin; Wearing, Catherine; Johnston, Kerrylyn; Holden, Joseph; Brown, Lee

2013-04-01

Controlled 'patch' burning of moorland vegetation has been used for decades in the UK to stimulate growth of heather (Calluna vulgaris) for game bird habitat and livestock grazing. Typically small patches (300-900 m2) are burned in rotations of 8-25 years. However, our understanding of the short-to-medium term environmental impacts of the practice on these sensitive upland areas has so far been limited by a lack of scientific data. In particular the effect of burning on concentrations of base cations and acid-base status of these highly organic soils has implications both for ecosystem nutrient status and for buffering of acidic waters. As part of the EMBER project peat chemistry data were collected in ten upland blanket peat catchments in the UK. Five catchments were subject to a history of prescribed rotational patch burning. The other five catchments acted as controls which were not subject to burning, nor confounded by other detrimental activities such as drainage or forestry. Soil solution chemistry was also monitored at two intensively studied sites (one regularly burned and one control). Fifty-centimetre soil cores, sectioned into 5-cm intervals, were collected from triplicate patches of four burn ages at each burned site, and from twelve locations at similar hillslope positions at each control site. At the two intensively monitored sites, soil solution chemistry was monitored at four depths in each patch. Across all sites, burned plots had significantly smaller cation exchange capacities, lower concentrations of exchangeable base cations and increased concentrations of exchangeable H+ and Al3+ in near-surface soil. C/N ratios were also lower in burned compared to unburned surface soils. There was no consistent trend between burn age and peat chemistry across all burned sites, possibly reflecting local controls on post-burn recovery rates or external influences on burn management decisions. At the intensively monitored site, plots burned less than two years prior to sampling had significantly smaller exchange capacities and lower concentrations of soil base cations in surface soils relative to plots burned 15-25 years previously. In contrast, surface soil solutions in recently burned plots were enriched in base cations relative to older plots and relative to the control site, possibly due to enhanced leaching at bare soil surfaces. The results offer evidence for an impact of burning on peat nutrient and acid-base status, but suggest that soils recover given time with no further burning.

A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns.

PubMed

Gravante, G; Di Fede, M C; Araco, A; Grimaldi, M; De Angelis, B; Arpino, A; Cervelli, V; Montone, A

2007-12-01

Our purpose was to directly compare results obtained with the ReCell system and the classic skin grafting for epidermal replacement in deep partial thickness burns. We recruited all patients with deep partial thickness burns admitted at the Burn Centre of S. Eugenio Hospital in Rome over 2 years. Enrollment was conducted with a controlled strategy--sampling chart--that allowed homogeneous groups (ReCell and skin grafting) for age, gender, type of burns and total burn surface area (TBSA). We evaluated as primary endpoints of the study the (i) time for complete epithelization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epithelization (color, joint contractures). Secondary endpoints were the assessment of infections, inflammations or any adverse effects of the ReCell procedure, particular medications assumed, postoperative pain. Eighty-two patients were analyzed in two homogeneous groups. All of them received adequate epidermal replacement, but skin grafting was faster than ReCell (p<0.05). On the contrary, ReCell biopsy areas and postoperative pain were smaller than classic grafting (p<0.05). The aesthetic and functional outcomes were similar between procedures. ReCell is a feasible, simple and safe technique. It gives similar results to skin grafting but, harvesting minor areas, can open possible future applications in the management of large-burns patients.

CE: Original Research: The Lived Experience of Social Media by Young Adult Burn Survivors.

PubMed

Giordano, Marie S

2016-08-01

: Young adult burn survivors who were burned before they reached young adulthood (before the age of 18) face particular challenges in meeting their needs for socialization. Social media are widely used by adolescents and young adults, and permit socialization without face-to-face communication. This qualitative, phenomenological study was conducted in order to explore and describe the lived experience of social media by young adult burn survivors. Five women and four men between the ages of 20 and 25 years were interviewed; before the age of 18 years, each had sustained burns over more than 25% of their total body surface area. Van Manen's phenomenological methodology provided the study framework. Five essential themes emerged: identity, connectivity, social support, making meaning, and privacy. The participants used social media as a way to express their identity while safeguarding their privacy, and as a way to make meaning out of their traumatic experiences. Connecting with others facilitated a flow of social support and information, which was motivating and encouraging. The findings indicate that the use of social media by young adult burn survivors may be warranted as a way to further their healing processes. The knowledge gained from this study may also be useful in facilitating the development of nursing interventions aimed at preparing young adult burn survivors for reentry into society.

Prediction of Maximal Aerobic Capacity in Severely Burned Children

PubMed Central

Porro, Laura; Rivero, Haidy G.; Gonzalez, Dante; Tan, Alai; Herndon, David N.; Suman, Oscar E.

2011-01-01

Introduction Maximal oxygen uptake (VO2 peak) is an indicator of cardiorespiratory fitness, but requires expensive equipment and a relatively high technical skill level. Purpose The aim of this study is to provide a formula for estimating VO2 peak in burned children, using information obtained without expensive equipment. Methods Children, with ≥40% total surface area burned (TBSA), underwent a modified Bruce treadmill test to asses VO2 peak at 6 months after injury. We recorded gender, age, %TBSA, %3rd degree burn, height, weight, treadmill time, maximal speed, maximal grade, and peak heart rate, and applied McHenry’s select algorithm to extract important independent variables and Robust multiple regression to establish prediction equations. Results 42 children; 7 to 17 years old were tested. Robust multiple regression model provided the equation: VO2=10.33 – 0.62 *Age (years) + 1.88 * Treadmill Time (min) + 2.3 (gender; Females = 0, Males = 1). The correlation between measured and estimated VO2 peak was R=0.80. We then validated the equation with a group of 33 burned children, which yielded a correlation between measured and estimated VO2 peak of R=0.79. Conclusions Using only a treadmill and easily gathered information, VO2 peak can be estimated in children with burns. PMID:21316155

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

Alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.

PubMed

Chen, Michael M; O'Halloran, Eileen B; Ippolito, Jill A; Choudhry, Mashkoor A; Kovacs, Elizabeth J

2015-01-01

Of the 450,000 burn patients each year, 50% have a positive blood alcohol content, and this predisposes them to worsened clinical outcomes. Despite high prevalence and established consequences, the mechanisms responsible for alcohol-mediated complications of postburn remote organ damage are currently unknown. To this end, mice received a single dose of alcohol (1.12 g/kg) or water by oral gavage and were subjected to a 15% total body surface area burn. Animals with a burn alone lost ∼5% of their body weight in 24 h, whereas intoxicated and burned mice lost only 1% body weight (P < 0.05) despite a 17% increase in hematocrit (P < 0.05) and a 57% increase in serum creatinine (P < 0.05) over burn injury alone. This retention of water weight despite increased dehydration suggests that intoxication at the time of a burn causes a shift in fluid compartments that may exacerbate end-organ ischemia and damage as evidenced by a 3-fold increase in intestinal bacterial translocation (P < 0.05), a 30% increase (P < 0.05) in liver weight-to-body weight ratio, and an increase in alveolar wall thickness over a burn alone. Furthermore, administration of the bradykinin antagonist HOE140 30 min after intoxication and burn restored fluid balance and alleviated end-organ damage. These findings suggest that alcohol potentiates postburn remote organ damage through shifts in fluid compartments mediated by bradykinin.

Comparison of clinical outcomes in diabetic and non-diabetic burns patients in a national burns referral centre in southeast Asia: A 3-year retrospective review.

PubMed

Low, Zhao-Kai; Ng, Wai-Yee; Fook-Chong, Stephanie; Tan, Bien-Keem; Chong, Si-Jack; Hwee, Jolie; Tay, Sook-Muay

2017-03-01

Diabetic burns patients may be at risk of worse clinical outcomes. This study aims to further investigate the impact of diabetes mellitus on clinical outcomes in burns patients in Singapore. A 3-year retrospective review was performed at the Singapore General Hospital Burns Centre (2011-2013). Pure inhalational burns were excluded. Diabetic (N=53) and non-diabetic (N=533) patients were compared, and the impact of diabetes on clinical outcomes, adjusting for confounders, was investigated using multivariate logistic regression. The diabetic group had a significantly higher incidence of wound infection and severe renal impairment, as well as a longer length of stay, higher number of operations and higher rate of unplanned readmission. ICU admission was significantly associated with hyperglycaemia (OR 5.44 [2.61-11.35], p<0.001) and a higher total body surface area of burn (OR per 1% TBSA 1.07 [1.05-1.09], p<0.001). Unplanned readmission was significantly associated with wound infection (OR 4.29 [1.70-10.83], p=0.002), and mortality associated with a higher TBSA (OR per 1% TBSA 1.1 [1.07-1.14], p<0.001). After adjusting for confounders, diabetes mellitus was not significantly associated with unplanned readmission or mortality. Diabetic burns patients have an increased risk of worse clinical outcomes, including wound infections, renal impairment and longer length of stay. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Temperature profile of graphite surface burning in a stream of oxygen

NASA Technical Reports Server (NTRS)

Kisch, D.

1978-01-01

Using methods for the objective measurement of the spectrum line reversal temperature in burning gases, the temperature profile at a graphite surface burning in a stream of oxygen was measured. From the behavior of the reversal temperature, it follows that particles in long-lived, high-energy states are present in the burning gas, and these bring about an overexcitation of the atomic species emitting the reversal line. Qualitative measurements show that a temperature maximum occurs at the expected distance of 1-2 mm from the graphite surface.

Estimating severity of burn in children: Pediatric Risk of Mortality (PRISM) score versus Abbreviated Burn Severity Index (ABSI).

PubMed

Berndtson, Allison E; Sen, Soman; Greenhalgh, David G; Palmieri, Tina L

2013-09-01

The purpose of our study is to validate the Pediatric Risk of Mortality (PRISM) score and compare the accuracy of PRISM predicted outcomes to the Abbreviated Burn Severity Index (ABSI). We hypothesized that the PRISM score is more accurate in predicting mortality and hospital length of stay than the ABSI in children with severe burns. All children <18 years of age admitted to a regional pediatric burn center between January 1, 2008 and July 1, 2010 were reviewed. Those with a Total Body Surface Area (TBSA) burn ≥20% who were admitted within 7 days of injury were selected for our study. Measured parameters included: demographics, burn characteristics, PRISM and ABSI scores at admission, and outcomes (mortality, hospital length of stay (LOS), ventilator days and cause of death). A total of 83 patients met criteria and had complete data sets. The mean age (±SEM) was 8.0±0.6 years, mean % TBSA burn 49.9±2.1%, 62.7% were male, and 45.8% had inhalation injury. Hospital LOS was 74.4±7.9 days, with 31.5±4.9 ventilator days. Mean PRISM score ranged from 14.2 to 16.0, with ABSI scores 7.9 to 8.5. Actual overall mortality was 18.1% compared to a PRISM predicted mortality of 19.8±2.5% (p<0.001, r=0.570). ABSI predicted mortality varied from 10 to 20% for a score of 7.9 to 30-50% for a score of 8.5. Logistic regression showed that both PRISM (p<0.001) and ABSI (p<0.001) mortality predictions accurately estimated actual mortality, which remained true in a combined model. ABSI was predictive of hospital LOS (p<0.001) and ventilator days (p<0.001) while PRISM was not (p=0.326 and p=0.863). Both PRISM and ABSI scores are predictive of mortality in severely burned children. Only ABSI correlates with hospital length of stay and ventilator days, and thus may also be more useful in predicting ICU resource utilization. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

The effect of smoking status on burn inhalation injury mortality.

PubMed

Knowlin, Laquanda; Stanford, Lindsay; Cairns, Bruce; Charles, Anthony

2017-05-01

Three factors that effect burn mortality are age, total body surface of burn (TBSA), and inhalation injury. Of the three, inhalation injury is the strongest predictor of mortality thus its inclusion in the revised Baux score (age+TBSA+17* (inhalation injury, 1=yes, 0=no)). However, the weighted contribution of specific comorbidities such as smoker status on mortality has traditionally not been accounted for nor studied in this subset of burn patients. We therefore sought to examine the impact of current tobacco and/or marijuana smoking in patients with inhalation injury. A retrospective analysis of patients admitted to a regional burn center from 2002 to 2012. Independent variables analyzed included basic demographics, burn mechanism, presence of inhalation injury, TBSA, pre-existing comorbidities, and smoker status. Bivariate analysis was performed and logistic regression modeling using significant variables was utilized to estimate odds of mortality. There were a total of 7640 patients over the study period. 7% (n=580) of the burn cohort with inhalation injury were included in this study. In-hospital burn mortality for inhalation injury patients was 23%. Current smokers (20%) included cigarette smokers and marijuana users, 19% and 3%, respectively. Preexisting respiratory disease (17%) was present in 36% of smokers compared to 13% of non-smokers (p<0.001). Smokers had significantly lower mortality rate (9%) compared to non-smokers (26%, p<0.01). The logistic regression model for mortality outcomes identified statistically four significant variables: age, TBSA, ethnicity, and smoker status (OR=0.41, 95% CI=0.18-0.93). Presence of comorbidities, including preexisting respiratory disease, was not significant. In the sub group of burn patients with inhalation injury, the odds of mortality significantly decreased in pre-existing smokers after adjusting for significant covariates. We postulate that an immune tolerance mechanism that modulates and diminishes the pro-inflammatory response confers a survival advantage in smokers after exposure to acute smoke inhalation injury. Future prospective studies in human and/or animal models are needed to confirm these findings. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: a prospective study of admissions and outpatients.

PubMed

Othman, Nasih; Kendrick, Denise; Al-Windi, Ahmad

2015-03-01

While it is globally observed that young children are at a higher risk of burn injuries, little is known about childhood burns in Iraqi Kurdistan. This study was undertaken to describe the epidemiology of burns amongst pre-school children in this region. A prospective study was undertaken from November 2007 to November 2008 involving all children aged 0-5 years attending the burns centre in Sulaimaniyah province for a new burn injury whether treated as an outpatient or admitted to hospital. 1,122 children attended the burns centre of whom 944 (84%) were interviewed (male 53%, female 47%). Mean age was 1.9 years with children aged 1 year comprising 32% and those aged 2 years comprising 21% of the sample. The incidence of burns was 1044/100,000 person-years (1030 in females and 1057 in males). Mechanisms of injury included scalds (80%), contact burns (12%) flames (6%) and other mechanisms (2%). Almost 97% of burns occurred at home including 43% in the kitchen. Winter was the commonest season (36%) followed by autumn (24%). There were 3 peak times of injury during the day corresponding to meal times. The majority of burns were caused by hot water (44%) and tea (20%) and the most common equipment/products responsible were tea utensils (41%). There were 237 admissions with an admission rate of 95 per 100,000 person-years. Scald injuries accounted for most admissions (84%). Median total body surface area affected by the burn or scald (TBSA) was 11% and median hospital stay was 7 days. In-hospital mortality was 8%. Mortality rate was 4% when TBSA was ≤25%, and 100% when TBSA was over 50%. Burn incidence is high in young children especially those aged 1-2 years. Preventive interventions targeted at families with young children & focusing on home safety measures could be effective in reducing childhood burns. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Global biomass burning - Atmospheric, climatic, and biospheric implications

NASA Technical Reports Server (NTRS)

Levine, Joel S.

1991-01-01

On a global scale, the total biomass consumed by annual burning is about 8680 million tons of dry material; the estimated total biomass consumed by the burning of savanna grasslands, at 3690 million tons/year, exceeds all other biomass burning (BMB) components. These components encompass agricultural wastes burning, forest burning, and fuel wood burning. BMB is not restricted to the tropics, and is largely anthropogenic. Satellite measurements indicate significantly increased tropospheric concentrations of CO and ozone associated with BMB. BMB significantly enhances the microbial production and emission of NO(x) from soils, and of methane from wetlands.

Assessment of the relation between prealbumin serum level and healing of skin-grafted burn wounds.

PubMed

Moghazy, A M; Adly, O A; Abbas, A H; Moati, T A; Ali, O S; Mohamed, B A

2010-06-01

Nutritional status is an important factor in graft healing. Prealbumin (transthyretin) is a better nutritional marker than the widely used albumin serum level. Prealbumin serum levels were estimated in an endeavour to correlate them to graft healing and to serve as a predictor of graft healing in burn wounds. Fifty burned patients undergoing graft in the Suez Canal University Hospital Burn Unit were subjected to this cross-sectional study. Prealbumin levels were assessed on preoperative day and on the fourth postoperative day. Graft healing was considered complete when the take was 90% or more of the grafted area. The most significantly correlated factor to graft healing was serum prealbumin. Serum albumin levels were not in significant correlation with graft healing or prealbumin levels. In addition, serum prealbumin levels were significantly higher in the younger age group and significantly lower in patients with chronic diseases. Serum prealbumin level is a sensitive tool in predicting graft take in burned patients when all local conditions are favourable and optimised. Nevertheless, it seems less sensitive in the prediction of graft healing in small raw areas less than 5% of total body surface area (TBSA). (c) 2009 Elsevier Ltd and ISBI. All rights reserved.

Sequels, complications and management of a chemical burn associated with cement splash.

PubMed

Lim, Gerald C S; Yeh, Lung-Kun; Lin, Hsin-Chiung; Hwang, Chao-Ming

2006-01-01

We present a case of successful superficial keratectomy and amniotic membrane grafting to re-establish ocular surface from denuded stroma and significant limbal ischemia caused by a cement splash. We fully documented a case report about the sequels, complications and management strategies of a chemical burn to the eyes associated with a cement splash. Slit lamp examination, visual acuity test as well as all common cultures and stains were performed to measure the outcome. Visual acuity significantly improved from 0.2 to best-corrected visual acuity 0.7 at the 5-month postoperative visit. The cornea regained its clarity. Total re-epithelialization of the injured area was observed. It is of primary importance to remove all the debris from a cement splash at the first available opportunity. Superficial keratectomy and amniotic membrane grafting may be the best methods for the re-epithelialization and reconstruction of the ocular surface.

Thermal investigation of an electrical high-current arc with porous gas-cooled anode

NASA Technical Reports Server (NTRS)

Eckert, E. R. G.; Schoeck, P. A.; Winter, E. R. F.

1984-01-01

The following guantities were measured on a high-intensity electric arc with tungsten cathode and transpiration-cooled graphite anode burning in argon: electric current and voltage, cooling gas flow rate (argon), surface temperature of the anode and of the anode holder, and temperature profile in three cross-sections of the arc are column. The last mentioned values were obtained from spectroscopic photographs. From the measured quantities, the following values were calculated: the heat flux into the anode surface, the heat loss of the anode by radiation and conduction, and the heat which was regeneratively transported by the cooling gas back into the arc space. Heat balances for the anode were also obtained. The anode losses (which are approximately 80% of the total arc power for free burning arcs) were reduced by transpiration cooling to 20%. The physical processes of the energy transfer from the arc to the anode are discussed qualitatively.

Enhanced biogenic emissions of nitric oxide and nitrous oxide following surface biomass burning

Treesearch

Iris C. Anderson; Joel S. Levine; Mark A. Poth; Philip J. Riggan

1988-01-01

Recent measurements indicate significantly enhanced biogenic soil emissions of both nitric oxide (NO) and nitrous oxide (N2O) following surface burning. These enhanced fluxes persisted for at least 6 months following the burn. Simultaneous measurements indicate enhanced levels of...

30 CFR 816.87 - Coal mine waste: Burning and burned waste utilization.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Coal mine waste: Burning and burned waste...-SURFACE MINING ACTIVITIES § 816.87 Coal mine waste: Burning and burned waste utilization. (a) Coal mine... extinguishing operations. (b) No burning or burned coal mine waste shall be removed from a permitted disposal...

30 CFR 816.87 - Coal mine waste: Burning and burned waste utilization.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Coal mine waste: Burning and burned waste...-SURFACE MINING ACTIVITIES § 816.87 Coal mine waste: Burning and burned waste utilization. (a) Coal mine... extinguishing operations. (b) No burning or burned coal mine waste shall be removed from a permitted disposal...

30 CFR 816.87 - Coal mine waste: Burning and burned waste utilization.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal mine waste: Burning and burned waste...-SURFACE MINING ACTIVITIES § 816.87 Coal mine waste: Burning and burned waste utilization. (a) Coal mine... extinguishing operations. (b) No burning or burned coal mine waste shall be removed from a permitted disposal...

30 CFR 816.87 - Coal mine waste: Burning and burned waste utilization.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Coal mine waste: Burning and burned waste...-SURFACE MINING ACTIVITIES § 816.87 Coal mine waste: Burning and burned waste utilization. (a) Coal mine... extinguishing operations. (b) No burning or burned coal mine waste shall be removed from a permitted disposal...

30 CFR 816.87 - Coal mine waste: Burning and burned waste utilization.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Coal mine waste: Burning and burned waste...-SURFACE MINING ACTIVITIES § 816.87 Coal mine waste: Burning and burned waste utilization. (a) Coal mine... extinguishing operations. (b) No burning or burned coal mine waste shall be removed from a permitted disposal...

A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center.

PubMed

Gaylord, Kathryn M; Holcomb, John B; Zolezzi, Maria E

2009-04-01

Posttraumatic stress disorder (PTSD) has been identified in 12% to 20% of noninjured veterans and in 32% of combat casualties. Eight percent of the US general population experience PTSD symptoms, whereas 25.5% of civilians with major burns have PTSD. Known predictors of physical outcomes of patients with burn are age, total body surface area (TBSA) burned, and Injury Severity Score (ISS). The United States Army Institute of Surgical Research Burn Center provides burn care for combat casualties and civilians. We hypothesized that we would find no difference in PTSD incidence between these two populations and that age, TBSA, and ISS are associated with PTSD. We retrospectively examined the clinical records of 1,792 patients admitted between October 2003 and May 2008. Records were stratified by PTSD, age, TBSA, and ISS. PTSD scores were compared. Descriptive analyses were used. Four hundred ninety-nine patients (372 military [74.5%]; 127 civilians [25.5%]) were assessed for PTSD using PTSD checklist military and civilian versions. PTSD was defined as >or=44 on the PTSD checklist instruments. We found no significant difference in PTSD between combat casualties and civilians (25% vs. 17.32%, p = 0.761). TBSA and ISS were significantly associated with PTSD; however, no association between age and PTSD was found. The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury.

[Deep alkali burns: Evaluation of a two-step surgical strategy].

PubMed

Devinck, F; Deveaux, C; Bennis, Y; Deken-Delannoy, V; Jeanne, M; Martinot-Duquennoy, V; Guerreschi, P; Pasquesoone, L

2018-04-10

Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision. Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P<0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P=0.059). Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice.

PubMed

Cambiaso-Daniel, Janos; Parry, Ingrid; Rivas, Eric; Kemp-Offenberg, Jennifer; Sen, Soman; Rizzo, Julie A; Serghiou, Michael A; Kowalske, Karen; Wolf, Steven E; Herndon, David N; Suman, Oscar E

2018-03-22

Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with >30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivor's ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor.

Polycyclic aromatic hydrocarbons in ambient air, surface soil and wheat grain near a large steel-smelting manufacturer in northern China.

PubMed

Liu, Weijian; Wang, Yilong; Chen, Yuanchen; Tao, Shu; Liu, Wenxin

2017-07-01

The total concentrations and component profiles of polycyclic aromatic hydrocarbons (PAHs) in ambient air, surface soil and wheat grain collected from wheat fields near a large steel-smelting manufacturer in Northern China were determined. Based on the specific isomeric ratios of paired species in ambient air, principle component analysis and multivariate linear regression, the main emission source of local PAHs was identified as a mixture of industrial and domestic coal combustion, biomass burning and traffic exhaust. The total organic carbon (TOC) fraction was considerably correlated with the total and individual PAH concentrations in surface soil. The total concentrations of PAHs in wheat grain were relatively low, with dominant low molecular weight constituents, and the compositional profile was more similar to that in ambient air than in topsoil. Combined with more significant results from partial correlation and linear regression models, the contribution from air PAHs to grain PAHs may be greater than that from soil PAHs. Copyright © 2016. Published by Elsevier B.V.

Early Hg mobility in cultivated tropical soils one year after slash-and-burn of the primary forest, in the Brazilian Amazon.

PubMed

Béliveau, Annie; Lucotte, Marc; Davidson, Robert; Lopes, Luis Otávio do Canto; Paquet, Serge

2009-07-15

In the Brazilian Amazon, forest conversion to agricultural lands (slash-and-burn cultivation) contributes to soil mercury (Hg) release and to aquatic ecosystem contamination. Recent studies have shown that soil Hg loss occurs rapidly after deforestation, suggesting that Hg mobility could be related to the massive cation input resulting from biomass burning. The objective of this research was to determine the effects of the first year of slash-and-burn agriculture on soil Hg levels at the regional scale of the Tapajós River, in the state of Pará, Brazilian Amazon. A total of 429 soil samples were collected in 26 farms of five riparian communities of the Tapajós basin. In September 2004, soil samples were collected from primary forest sites planned for slash-and-burn cultivation. In August 2005, one year after the initial burning, a second campaign was held and the exact same sites were re-sampled. Our results showed that total Hg levels in soils did not change significantly during the first year following slash-and-burn, suggesting no immediate release of soil Hg at that point in time. However, an early Hg mobility was detected near the surface (0-5 cm), reflected by a significant shift in Hg distribution in soil fractions. Indeed, a transfer of Hg from fine to coarser soil particles was observed, indicating that chemical bonds between Hg and fine particles could have been altered. A correspondence analysis (CA) showed that this process could be linked to a chemical competition caused by cation enrichment. The regional dimension of the study highlighted the prevailing importance of soil types in Hg dynamics, as shown by differentiated soil responses following deforestation according to soil texture. Confirming an early Hg mobility and indicating an eventual Hg release out of the soil, our results reinforce the call for the development of more sustainable agricultural practices in the Amazon.

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

PubMed

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

2015-03-01

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

Effects of prescribed fire for pasture management on soil organic matter and biological properties: A 1-year study case in the Central Pyrenees.

PubMed

Girona-García, Antonio; Badía-Villas, David; Martí-Dalmau, Clara; Ortiz-Perpiñá, Oriol; Mora, Juan Luis; Armas-Herrera, Cecilia M

2018-03-15

Prescribed burning has been readopted in the last decade in the Central Pyrenees to stop the regression of subalpine grasslands in favour of shrublands, dominated among others by Echinospartum horridum (Vahl) Rothm. Nevertheless, the effect of this practice on soil properties is uncertain. The aim of this work was to analyse the effects of these burnings on topsoil organic matter and biological properties. Soil sampling was carried out in an autumnal prescribed fire in Buisán (NE-Spain, November 2015). Topsoil was sampled at 0-1cm, 1-2cm and 2-3cm depth in triplicate just before (U), ~1h (B0), 6months (B6) and 12months (B12) after burning. We analysed soil total organic C (TOC), total nitrogen (TN), microbial biomass C (C mic ), soil respiration (SR) and β-D-glucosidase activity. A maximum temperature of 438°C was recorded at soil surface while at 1cm depth only 31°C were reached. Burning significantly decreased TOC (-52%), TN (-44%), C mic (-57%), SR (-72%) and β-D-glucosidase (-66%) at 0-1cm depth while SR was also reduced (-45%) at 1-2cm depth. In B6 and B12, no significant changes in these properties were observed as compared to B0. It can be concluded that the impact of prescribed burning has been significant and sustained over time, although limited to the first two topsoil centimetres. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2018-04-10

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

Two-Year Gender Differences in Satisfaction With Appearance After Burn Injury and Prediction of Five-Year Depression: A Latent Growth Curve Approach.

PubMed

Al Ghriwati, Nour; Sutter, Megan; Pierce, Bradford S; Perrin, Paul B; Wiechman, Shelley A; Schneider, Jeffrey C

2017-11-01

To use latent growth curve and longitudinal structural equation modeling to examine the 2-year trajectory of satisfaction with appearance in adults with burn injury, and that trajectory's effect on depression 5 years after burn injury. Data were collected at discharge after burn injury hospitalization and at 6 months, 1 year, 2 years, and 5 years postdischarge. The Burn Model Systems (BMS) program consisted of a data center and 5 participating burn centers. The sample consisted of adults (N=720) who were hospitalized for a burn injury, enrolled in the BMS database, and completed measures at least once throughout the 5-year study duration. Not applicable. Satisfaction With Appearance Scale and Patient Health Questionnaire-9 (depression). Women with burn injury reported higher levels of dissatisfaction with their appearance in comparison to their male counterparts over the 2 years after discharge. Individuals with a larger total body surface area (TBSA) affected by a burn also reported greater body dissatisfaction across the postdischarge 2-year period. Results did not support significant gender or TBSA differences in the rate of change of body dissatisfaction trajectories across these 2 years. Individuals with greater body dissatisfaction at 6 months postdischarge tended to have higher depressive symptoms at 5 years. Six month postdischarge, body dissatisfaction scores also mediated the effects of gender and TBSA on depressive symptoms 5 years later. It is recommended that individuals with heightened body image dissatisfaction after a burn, particularly women and those with larger TBSA, participate in evidence-based psychosocial interventions to improve long-term adjustment. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Revised Baux Score and updated Charlson comorbidity index are independently associated with mortality in burns intensive care patients.

PubMed

Heng, Jacob S; Clancy, Olivia; Atkins, Joanne; Leon-Villapalos, Jorge; Williams, Andrew J; Keays, Richard; Hayes, Michelle; Takata, Masao; Jones, Isabel; Vizcaychipi, Marcela P

2015-11-01

The purpose of the current study was to utilise established scoring systems to analyse the association of (i) burn injury severity, (ii) comorbid status and (iii) associated systemic physiological disturbance with inpatient mortality in patients with severe burn injuries admitted to intensive care. Case notes of all patients with acute thermal injuries affecting ≥15% total body surface area (TBSA) admitted to the Burns Intensive Care Unit (BICU) at Chelsea and Westminster Hospital during a 10-year period were retrospectively reviewed. Revised Baux Score, Belgian Outcome in Burn Injury (BOBI) Score, Abbreviated Burn Severity Index (ABSI), APACHE II Score, Sequential Organ Failure Assessment (SOFA) Score and Updated Charlson Comorbidity Index (CCI) were computed for each patient and analysed for association with inpatient mortality. Ninety mechanically ventilated patients (median age 45.7 years, median % TBSA burned 36.5%) were included. 72 patients had full thickness burns and 35 patients had inhalational injuries. Forty-four patients died in hospital while 46 survived to discharge. In a multivariate logistic regression model, only the Revised Baux Score (p<0.001) and updated CCI (p=0.014) were independently associated with mortality. This gave a ROC curve with area under the curve of 0.920. On multivariate cox regression survival analysis, only the Revised Baux Score (p<0.001) and the updated CCI (p=0.004) were independently associated with shorter time to death. Our data suggest that the Revised Baux Score and the updated CCI are independently associated with inpatient mortality in patients admitted to intensive care with burn injuries affecting ≥15% TBSA. This emphasises the importance of comorbidities in the prognosis of patients with severe burn injuries. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2018-05-01

Infection with multidrug-resistant (MDR) Gram-negative organisms leads to poorer outcomes in the critically ill burn patient. The aim of this study was to identify the risk factors for MDR Gram-negative pathogen infection in critically ill burn patients admitted to a major tertiary referral intensive care unit (ICU) in Australia. A retrospective case-control study of all adult burn patients admitted over a 7-year period was conducted. Twenty-one cases that cultured an MDR Gram-negative organism were matched with 21 controls of similar age, gender, burn size and ICU stay. Multivariable conditional logistic regression was used to individually assess risk factors after adjusting for Acute Burn Severity Index. Adjusted odds ratios (ORs) were reported. P-values < 0.25 were considered as potentially important risk factors. Factors increasing the risk of MDR Gram-negative infection included superficial partial thickness burn size (OR: 1.08; 95% confidence interval (CI): 1.01-1.16; P-value: 0.034), prior meropenem exposure (OR: 10.39; 95% CI: 0.96-112.00; P-value: 0.054), Gram-negative colonization on admission (OR: 9.23; 95% CI: 0.65-130.15; P-value: 0.10) and escharotomy (OR: 2.66; 95% CI: 0.52-13.65; P-value: 0.24). For cases, mean age was 41 (SD: 13) years, mean total body surface area burned was 47% (SD: 18) and mean days in ICU until MDR specimen collection was 17 (SD: 10) days. Prior meropenem exposure, Gram-negative colonization on admission, escharotomy and superficial partial thickness burn size may be potentially important factors for increasing the risk of MDR Gram-negative infection in the critically ill burn patient. © 2017 Royal Australasian College of Surgeons.

β-Adrenergic blockade does not impair the skin blood flow sensitivity to local heating in burned and nonburned skin under neutral and hot environments in children.

PubMed

Rivas, Eric; McEntire, Serina J; Herndon, David N; Mlcak, Ronald P; Suman, Oscar E

2017-05-01

We tested the hypothesis that propranolol, a drug given to burn patients to reduce hypermetabolism/cardiac stress, may inhibit heat dissipation by changing the sensitivity of skin blood flow (SkBF) to local heating under neutral and hot conditions. In a randomized double-blind study, a placebo was given to eight burned children, while propranolol was given to 13 burned children with similar characteristics (mean±SD: 11.9±3 years, 147±20 cm, 45±23 kg, 56±12% Total body surface area burned). Nonburned children (n=13, 11.4±3 years, 152±15 cm, 52±13 kg) served as healthy controls. A progressive local heating protocol characterized SkBF responses in burned and unburned skin and nonburned control skin under the two environmental conditions (23 and 34°C) via laser Doppler flowmetry. Resting SkBF was greater in burned and unburned skin compared to the nonburned control (main effect: skin, P<.0001; 57±32 burned; 38±36 unburned vs 9±8 control %SkBF max ). No difference was found for maximal SkBF capacity to local heating between groups. Additionally, dose-response curves for the sensitivity of SkBF to local heating were not different among burned or unburned skin, and nonburned control skin (EC 50 , P>.05) under either condition. Therapeutic propranolol does not negatively affect SkBF under neutral or hot environmental conditions and further compromise temperature regulation in burned children. © 2017 John Wiley & Sons Ltd.

Mapping surface soil moisture with L-band radiometric measurements

NASA Technical Reports Server (NTRS)

Wang, James R.; Shiue, James C.; Schmugge, Thomas J.; Engman, Edwin T.

1989-01-01

A NASA C-130 airborne remote sensing aircraft was used to obtain four-beam pushbroom microwave radiometric measurements over two small Kansas tall-grass prairie region watersheds, during a dry-down period after heavy rainfall in May and June, 1987. While one of the watersheds had been burned 2 months before these measurements, the other had not been burned for over a year. Surface soil-moisture data were collected at the time of the aircraft measurements and correlated with the corresponding radiometric measurements, establishing a relationship for surface soil-moisture mapping. Radiometric sensitivity to soil moisture variation is higher in the burned than in the unburned watershed; surface soil moisture loss is also faster in the burned watershed.

Condensed-Phase Processes during Solid Propellant Combustion. 3. Preliminary Depth-Profiling Studies on XM39, JA2, M9, M30, and HMX2

DTIC Science & Technology

1994-01-01

are listed in Schroeder et al. (1992). Wilmot et al. (1981) and Sharma et al. (1991) describe the chemical analysis of the burned surface of nitrate...below the surface (spectrum(b)) and are totally absent from the spectrum(c) of the region 40-80 pm below the surface CF (spectrum(d)). This suggests...Proving Ground, MD, May 1992. (AD-A250 799) Sharma, J., G. B. Wilmot , A. A. Campolattaro, and F. Santiago. "XPS Study of Condensed Phase Combustion in

Characterization of phenolic compounds in Pinus laricio needles and their responses to prescribed burnings.

PubMed

Cannac, Magali; Pasqualini, Vanina; Greff, Stéphane; Fernandez, Catherine; Ferrat, Lila

2007-07-30

Fire is a dominant ecological factor in Mediterranean-type ecosystems. Management strategies include prescribed (controlled) burning, which has been used in the management of several species, such as Pinus nigra ssp laricio var. Corsicana, a pine endemic to Corsica of great ecological and economic importance. The effects of prescribed burning on Pinus laricio have been little studied. The first aim of this study was to characterize total and simple phenolic compounds in Pinus laricio. The second aim was to understand: i) the short term (one to three months) and medium term (three years) effects of prescribed burning, and ii) the effects of periodic prescribed burning on the production of phenolic compounds in Pinus laricio. The first result of this study is the presence of total and simple phenolic compounds in the needles of Pinus laricio. 3-Vanillyl propanol is the major compound. After a prescribed burning, the synthesis of total phenolic compounds increases in Pinus laricio for a period of three months. Total phenolic compounds could be used as bioindicators for the short-term response of Pinus laricio needles to prescribed burning. Simple phenolic compounds do not seem to be good indicators of the impact of prescribed burning because prescribed burnings are low in intensity.

Characterization of Emissions and Residues from Simulations of the Deepwater Horizon Surface Oil Burns

EPA Science Inventory

The surface oil burns conducted by the U.S. Coast Guard from April to July 2010 during the Deepwater Horizon disaster in the Gulf of Mexico were simulated by small scale burns to characterize the pollutants, determine emission factors, and gather particulate matter for subsequent...

OX62+OX6+OX35+ rat dendritic cells are unable to prime CD4+ T cells for an effective immune response following acute burn injury.

PubMed

Fazal, Nadeem

2013-01-01

Co-stimulatory molecules expressed on Dendritic Cells (DCs) function to coordinate an efficient immune response by T cells in the peripheral lymph nodes. We hypothesized that CD4+ T cell-mediated immune suppression following burn injury may be related to dysfunctional DCs residing in gut associated lymphoid tissues (GALT), such as Mesenteric Lymph Nodes (MLN). Therefore, we studied co-stimulatory molecules expressed on burn rat MLN DCs as an index of functional DCs that would mount an effective normal CD4+ T cell immune response. In a rat model of 30% Total Body Surface Area (TBSA) scald burn, OX62+OX6+OX35+ DCs and CD4+ T cells were isolated from MLN of day 3 post-burn and sham control rats. DCs were tested for their expression of co-stimulatory molecules, and prime CD4+ T cell (DC:CD4+T cell co-culture assays) to determine an effector immune response such as CD4+ T cell proliferation. The surface receptor expressions of MLN DCs co-stimulatory molecules, i.e., MHC-II, CD40, CD80 (B7-1), and CD86 (B7-2) were determined by Flow cytometry (quantitatively) and confocal microscopy (qualitatively). Tritiated thymidine and CFDA-SE determined CD4+ T cell proliferation following co-incubation with DCs. Cytokine milieu of MLN (IL-12 and IL-10) was assessed by mRNA determination by RT-PCR. The results showed down-regulated expressions of co-stimulatory markers (CD80, CD86, CD40 and MHC-II) of MLN DCs obtained from burn-injured rats, as well as lack of ability of these burn-induced DCs to stimulate CD4+ T cell proliferation in co-culture assays, as compared to the sham rats. Moreover, anti-CD40 stimulation of affected burn MLN DCs did not reverse this alteration. Furthermore, a marked up-regulation of mRNA IL-10 and down-regulation of mRNA IL-12 in burn MLN as compared to sham animals was also observed. To surmise, the data indicated that dysfunctional OX62+OX6+OX35+ rat MLN DCs may contribute to CD4+ T-cell-mediated immune suppression observed following acute burn injury.

OX62+OX6+OX35+ rat dendritic cells are unable to prime CD4+ T cells for an effective immune response following acute burn injury☆

PubMed Central

Fazal, Nadeem

2013-01-01

Co-stimulatory molecules expressed on Dendritic Cells (DCs) function to coordinate an efficient immune response by T cells in the peripheral lymph nodes. We hypothesized that CD4+ T cell-mediated immune suppression following burn injury may be related to dysfunctional DCs residing in gut associated lymphoid tissues (GALT), such as Mesenteric Lymph Nodes (MLN). Therefore, we studied co-stimulatory molecules expressed on burn rat MLN DCs as an index of functional DCs that would mount an effective normal CD4+ T cell immune response. In a rat model of 30% Total Body Surface Area (TBSA) scald burn, OX62+OX6+OX35+ DCs and CD4+ T cells were isolated from MLN of day 3 post-burn and sham control rats. DCs were tested for their expression of co-stimulatory molecules, and prime CD4+ T cell (DC:CD4+T cell co-culture assays) to determine an effector immune response such as CD4+ T cell proliferation. The surface receptor expressions of MLN DCs co-stimulatory molecules, i.e., MHC-II, CD40, CD80 (B7-1), and CD86 (B7-2) were determined by Flow cytometry (quantitatively) and confocal microscopy (qualitatively). Tritiated thymidine and CFDA-SE determined CD4+ T cell proliferation following co-incubation with DCs. Cytokine milieu of MLN (IL-12 and IL-10) was assessed by mRNA determination by RT-PCR. The results showed down-regulated expressions of co-stimulatory markers (CD80, CD86, CD40 and MHC-II) of MLN DCs obtained from burn-injured rats, as well as lack of ability of these burn-induced DCs to stimulate CD4+ T cell proliferation in co-culture assays, as compared to the sham rats. Moreover, anti-CD40 stimulation of affected burn MLN DCs did not reverse this alteration. Furthermore, a marked up-regulation of mRNA IL-10 and down-regulation of mRNA IL-12 in burn MLN as compared to sham animals was also observed. To surmise, the data indicated that dysfunctional OX62+OX6+OX35+ rat MLN DCs may contribute to CD4+ T-cell-mediated immune suppression observed following acute burn injury. PMID:24600560

Linking Satellite-Derived Fire Counts to Satellite-Derived Weather Data in Fire Prediction Models to Forecast Extreme Fires in Siberia

NASA Astrophysics Data System (ADS)

Westberg, David; Soja, Amber; Stackhouse, Paul, Jr.

2010-05-01

Fire is the dominant disturbance that precipitates ecosystem change in boreal regions, and fire is largely under the control of weather and climate. Boreal systems contain the largest pool of terrestrial carbon, and Russia holds 2/3 of the global boreal forests. Fire frequency, fire severity, area burned and fire season length are predicted to increase in boreal regions under climate change scenarios. Meteorological parameters influence fire danger and fire is a catalyst for ecosystem change. Therefore to predict fire weather and ecosystem change, we must understand the factors that influence fire regimes and at what scale these are viable. Our data consists of NASA Langley Research Center (LaRC)-derived fire weather indices (FWI) and National Climatic Data Center (NCDC) surface station-derived FWI on a domain from 50°N-80°N latitude and 70°E-170°W longitude and the fire season from April through October for the years of 1999, 2002, and 2004. Both of these are calculated using the Canadian Forest Service (CFS) FWI, which is based on local noon surface-level air temperature, relative humidity, wind speed, and daily (noon-noon) rainfall. The large-scale (1°) LaRC product uses NASA Goddard Earth Observing System version 4 (GEOS-4) reanalysis and NASA Global Precipitation Climatology Project (GEOS-4/GPCP) data to calculate FWI. CFS Natural Resources Canada uses Geographic Information Systems (GIS) to interpolate NCDC station data and calculate FWI. We compare the LaRC GEOS- 4/GPCP FWI and CFS NCDC FWI based on their fraction of 1° grid boxes that contain satellite-derived fire counts and area burned to the domain total number of 1° grid boxes with a common FWI category (very low to extreme). These are separated by International Geosphere-Biosphere Programme (IGBP) 1°x1° resolution vegetation types to determine and compare fire regimes in each FWI/ecosystem class and to estimate the fraction of each of the 18 IGBP ecosystems burned, which are dependent on the FWI. On days with fire counts, the domain total of 1°x1° grid boxes with and without daily fire counts and area burned are totaled. The fraction of 1° grid boxes with fire counts and area burned to the total number of 1° grid boxes having common FWI category and vegetation type are accumulated, and a daily mean for the burning season is calculated. The mean fire counts and mean area burned plots appear to be well related. The ultimate goal of this research is to assess the viability of large-scale (1°) data to be used to assess fire weather danger and fire regimes, so these data can be confidently used to predict future fire regimes using large-scale fire weather data. Specifically, we related large-scale fire weather, area burned, and the amount of fire-induced ecosystem change. Both the LaRC and CFS FWI showed gradual linear increase in fraction of grid boxes with fire counts and area burned with increasing FWI category, with an exponential increase in the higher FWI categories in some cases, for the majority of the vegetation types. Our analysis shows a direct correlation between increased fire activity and increased FWI, independent of time or the severity of the fire season. During normal and extreme fire seasons, we noticed the fraction of fire counts and area burned per 1° grid box increased with increasing FWI rating. Given this analysis, we are confident large-scale weather and climate data, in this case from the GEOS-4 reanalysis and the GPCP data sets, can be used to accurately assess future fire potential. This increases confidence in the ability of large-scale IPCC weather and climate scenarios to predict future fire regimes in boreal regions.

Fire effects on soil organic matter content, composition, and nutrients in boreal interior Alaska

USGS Publications Warehouse

Neff, J.C.; Harden, J.W.; Gleixner, G.

2005-01-01

Boreal ecosystems contain a substantial fraction of the earth's soil carbon stores and are prone to frequent and severe wildfires. In this study, we examine changes in element and organic matter stocks due to a 1999 wildfire in Alaska. One year after the wildfire, burned soils contained between 1071 and 1420 g/m2 less carbon than unburned soils. Burned soils had lower nitrogen than unburned soils, higher calcium, and nearly unchanged potassium, magnesium, and phosphorus stocks. Burned surface soils tended to have higher concentrations of noncombustible elements such as calcium, potassium, magnesium, and phosphorus compared with unburned soils. Combustion losses of carbon were mostly limited to surface dead moss and fibric horizons, with no change in the underlying mineral horizons. Burning caused significant changes in soil organic matter structure, with a 12% higher ratio of carbon to combustible organic matter in surface burned horizons compared with unburned horizons. Pyrolysis gas chromatography - mass spectroscopy also shows preferential volatilization of polysaccharide-derived organic matter and enrichment of lignin-and lipid-derived compounds in surface soils. The chemistry of deeper soil layers in burned and unburned sites was similar, suggesting that immediate fire impacts were restricted to the surface soil horizon. ?? 2005 NRC.

Stream structure at low flow: biogeochemical patterns in intermittent streams over space and time

NASA Astrophysics Data System (ADS)

MacNeille, R. B.; Lohse, K. A.; Godsey, S.; McCorkle, E. P.; Parsons, S.; Baxter, C.

2017-12-01

Climate change in the western United States is projected to lead to earlier snowmelt, increasing fire risk and potentially transitioning perennial streams to intermittent ones. Differences between perennial and intermittent streams, especially the temporal and spatial patterns of carbon and nutrient dynamics during periods of drying, are understudied. We examined spatial and temporal patterns in surface water biogeochemistry during a dry (2016) and a wet (2017) water year in southwest Idaho. We hypothesized that as streams dry, carbon concentrations would increase due to evapoconcentration and/or increased in-stream production, and that the heterogeneity of constituents within each stream would increase. We expected these patterns to differ in a high water year compared to a low water year due to algae scour. Finally, we expected that the spatial heterogeneity of biogeochemistry would decrease with time following fire. To test these hypotheses, in 2016 we collected surface water samples at 50 meter intervals from two intermittent headwater streams over 2,500 meter reaches in April, May, and June. One stream is burned and one remains unburned. In 2017, we collected surface water at the 50, 25 and 10 meter intervals from each stream once during low flow. 2016 results showed average concentrations of dissolved inorganic carbon (DIC) and dissolved organic carbon (DOC) increased 3-fold from April to June in the burned site compared to the unburned site. Interestingly, average concentrations of total nitrogen (TN) dropped substantially for the burned site over these three months, but only decreased slightly for the unburned site over the same time period. Between wet and dry water years, we observed a decrease in the spatial heterogeneity as measured by the standard deviation (SD) in conductivity at 50 meter intervals; the burned stream had a SD of 23.08 in 2016 and 11.40 in 2017 whereas the unburned stream had similar SDs. We conclude that the burned stream experienced more inter and intra-annual surface water change in chemistry patterns than did the unburned stream.

Inhalation injury in a burn unit: a retrospective review of prognostic factors

PubMed Central

Monteiro, D.; Silva, I.; Egipto, P.; Magalhães, A.; Filipe, R.; Silva, A.; Rodrigues, A.; Costa, J.

2017-01-01

Summary Inhalation injury (InI) is known to seriously affect the prognosis of burn patients, as it is strongly associated with high morbidity and mortality. Despite major advances in the treatment of burn patients in the past years, advances in the treatment of smoke InI have been somewhat limited; mortality reduction mostly results from improvements in critical care. It is difficult to separate the contribution of InI from other mechanisms that also affect respiratory tract and lungs. The aim of this study was to compare patients with and without InI and to identify prognostic factors among patients with smoke InI. Patients with InI displayed higher total body surface area (TBSA) burned, higher incidence of pneumonia and acute respiratory distress syndrome (ARDS), a higher rate of positive blood cultures and a significantly higher death rate. We could conclude that older age, higher TBSA, ARDS and pneumonia were independent predictive factors for mortality in our global study population. Older age and higher TBSA were the only independent factors found to be predictive of mortality in patients with InI. PMID:29021724

Inhalation injury in a burn unit: a retrospective review of prognostic factors.

PubMed

Monteiro, D; Silva, I; Egipto, P; Magalhães, A; Filipe, R; Silva, A; Rodrigues, A; Costa, J

2017-06-30

Inhalation injury (InI) is known to seriously affect the prognosis of burn patients, as it is strongly associated with high morbidity and mortality. Despite major advances in the treatment of burn patients in the past years, advances in the treatment of smoke InI have been somewhat limited; mortality reduction mostly results from improvements in critical care. It is difficult to separate the contribution of InI from other mechanisms that also affect respiratory tract and lungs. The aim of this study was to compare patients with and without InI and to identify prognostic factors among patients with smoke InI. Patients with InI displayed higher total body surface area (TBSA) burned, higher incidence of pneumonia and acute respiratory distress syndrome (ARDS), a higher rate of positive blood cultures and a significantly higher death rate. We could conclude that older age, higher TBSA, ARDS and pneumonia were independent predictive factors for mortality in our global study population. Older age and higher TBSA were the only independent factors found to be predictive of mortality in patients with InI.

Experimental Proteus mirabilis Burn Surface Infection

DTIC Science & Technology

1982-02-01

Reprinted from the Achie of Surgery ECTE February 1982, Volume 117 Copyright 19 2. American Medical Association MAY 2 8 1982 V0A Experimental Proteus ... mirabilis Burn Surface Infection Albert T. McManus, PhD; Charles G. McLeod, Jr, DVM; Arthur D. Mason, Jr, MD * We established a human burn Isolate of... Proteus mirabills as have examined human burn isolates from the genera an experimental pathogen. Infliction of a nonfatal scald injury Enterobacter

To everything there is a season: impact of seasonal change on admissions, acuity of injury, length of stay, throughput, and charges at an accredited, regional burn center.

PubMed

Hultman, C Scott; Tong, Winnie T; Surrusco, Matthew; Roden, Katherine S; Kiser, Michelle; Cairns, Bruce A

2012-07-01

Although previous studies have investigated the impact of weather and temporal factors on incidence of trauma admissions, there is a paucity of data describing the effect of seasonal change on burn injury. The purpose of this study was to examine the impact of the changing seasons on admissions to and resource utilization at an accredited burn center, with the goal of optimizing patient throughput and matching supply with demand. We performed a retrospective review of all burn admissions to an accredited, regional burn center, from Summer 2009 through Spring 2010. Patients were segregated into the seasonal cohorts of Summer, Fall, Winter, and Spring, based on admission date. Patient demographics included age, gender, mechanism of injury, and total body surface area (TBSA) injured. Main outcome measures included length of intensive care unit (ICU) stay, length of stay (LOS), and hospital charges, which served as a proxy for resource utilization (nursing, wound, and critical care; access to operating room (OR); inpatient rehabilitation). Groups were compared by T tests, with statistical significance assigned to P values <0.05. Seven hundred thirty patients were admitted to the burn center during this annual period, with a mean age of 31.6 years and a TBSA of 8.9%. Although Spring had the greatest the number of admissions at 219 (30%), patients from Summer and Winter had the largest burns, longest length of ICU and hospital stays, and highest hospital charges (P < 0.05). Furthermore, variability of these parameters, as measured by standard deviation, was greatest during Summer and Winter, serving to reduce throughput via uneven demand on resources. Highest throughput occurred during the Spring, which had the highest admission-to-LOS ratio. No differences were observed in age, gender, and incidence of electrical injuries, across the 4 seasons. Summer and winter were the peak seasons of resource utilization at our burn center, in terms of length and variability of ICU and hospital stays, as well as total hospital charges. Such seasonal change may be related to acuity of burn injury but not number of burn admissions. To improve operational efficiency and maximize patient throughput, resource allocation should be structured to anticipate seasonal changes, so that supply of services matches demand.

Toxic shock syndrome in paediatric thermal injuries: A case series and systematic literature review.

PubMed

Gutzler, Linda; Schiestl, Clemens; Meuli, Martin; Oliveira, Carol

2018-02-01

Toxic shock syndrome (TSS) is a rare, but potentially life-threatening complication of thermal injuries in children. The study objective was to systematically review the literature on paediatric TSS after burns or scalds, and describe our experience with this condition in Switzerland. All tertiary paediatric healthcare centres managing burns and scalds in Switzerland were inquired. A systematic literature review was performed using EMBASE (1947-2016), MEDLINE (1946-2016), Web of Science (1900-2016) and Google Scholar in October 2016. Data on patient characteristics, symptoms, laboratory parameters, management and outcome were extracted from paper and electronic patient charts. Descriptive statistics were performed. The literature review revealed 25 articles describing 59 cases observed in 10 countries (UK, USA, Hungary, Austria, Sweden, Denmark, Israel, Japan, Spain, Switzerland) from 1985 to 2016. The patient age ranged from 8 months to 8 years at the time point of TSS-diagnosis. The injured total body surface area ranged from <1% to 41%. Forty-one patients suffered from scalds, 6 from burns and in 12 cases the type of injury was not specified. The TSS-diagnosis was made 1-7days after thermal injury. Nineteen children underwent admission to the Intensive Care Unit. Six children died from TSS. In Switzerland, we identified 11 consecutive cases between 07/2001 and 06/2011 (median age 15 months, range 9 months-14 years; 9 male, 2 female; 3 burns, 8 scalds; 7% median total body surface area (TBSA), range 2-30%). Diagnosis of TSS was made on day 5 after injury in median (range 3-34 days). Eight of eleven patients received intensive care. Survivors (10/11) suffered no long-term sequelae besides scars. One 13-month old boy died 3days after a 7%-TBSA scald. Toxic shock syndrome is an important complication of paediatric burns in Switzerland and several other countries world-wide. Diagnosis and management remain challenging. Awareness among treating clinicians is crucial for a favourable outcome. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Prescribed burning and mastication effects on surface fuels in southern pine beetle-killed loblolly pine plantations

Treesearch

Aaron D. Stottlemyer; Thomas A. Waldrop; G. Geoff Wang

2015-01-01

Surface fuels were characterized in loblolly pine (Pinus taeda L.) plantations severely impacted by southern pine beetle (Dendroctonus frontalis Ehrh.) (SPB) outbreaks in the upper South Carolina Piedmont. Prescribed burning and mastication were then tested as fuel reduction treatments in these areas. Prescribed burning reduced...

Deficiency of Mannose-Binding Lectin Greatly Increases Susceptibility to Postburn Infection with Pseudomonas aeruginosa1

PubMed Central

Møller-Kristensen, Mette; Eddie Ip, W. K.; Shi, Lei; Gowda, Lakshmi D.; Hamblin, Michael R.; Thiel, Steffen; Jensenius, Jens Chr.; Ezekowitz, R. Alan B.; Takahashi, Kazue

2011-01-01

Burn injury disrupts the mechanical and biological barrier that the skin presents against infection by symbionts like the Pseudomonas aeruginosa, a Gram-negative bacteria. A combination of local factors, antimicrobial peptides, and resident effector cells form the initial response to mechanical injury of the skin. This activity is followed by an inflammatory response that includes influx of phagocytes and serum factors, such as complement and mannose-binding lectin (MBL), which is a broad-spectrum pattern recognition molecule that plays a key role in innate immunity. A growing consensus from studies in humans and mice suggests that lack of MBL together with other comorbid factors predisposes the host to infection. In this study we examined whether MBL deficiency increases the risk of P. aeruginosa infection in a burned host. We found that both wild-type and MBL null mice were resistant to a 5% total body surface area burn alone or s.c. infection with P. aeruginosa alone. However, when mice were burned then inoculated s.c. with P. aeruginosa at the burn site, all MBL null mice died by 42 h from septicemia, whereas only one-third of wild-type mice succumbed (p = 0.0005). This result indicates that MBL plays a key role in containing and preventing a systemic spread of P. aeruginosa infection following burn injury and suggests that MBL deficiency in humans maybe a premorbid variable in the predisposition to infection in burn victims. PMID:16424207

Ecosystem Carbon Emissions from 2015 Forest Fires in Interior Alaska

NASA Technical Reports Server (NTRS)

Potter, Christopher S.

2018-01-01

In the summer of 2015, hundreds of wildfires burned across the state of Alaska, and consumed more than 1.6 million ha of boreal forest and wetlands in the Yukon-Koyukuk region. Mapping of 113 large wildfires using Landsat satellite images from before and after 2015 indicated that nearly 60% of this area was burned at moderate-to-high severity levels. Field measurements near the town of Tanana on the Yukon River were carried out in July of 2017 in both unburned and 2015 burned forested areas (nearly adjacent to one-another) to visually verify locations of different Landsat burn severity classes (low, moderate, or high). Results: Field measurements indicated that the loss of surface organic layers in boreal ecosystem fires is a major factor determining post-fire soil temperature changes, depth of thawing, and carbon losses from the mineral topsoil layer. Measurements in forest sites showed that soil temperature profiles to 30 cm depth at burned forest sites increased by an average of 8o - 10o C compared to unburned forest sites. Sampling and laboratory analysis indicated a 65% reduction in soil carbon content and a 58% reduction in soil nitrogen content in severely burned sample sites compared to soil mineral samples from nearby unburned spruce forests. Conclusions: Combined with nearly unprecedented forest areas severely burned in the Interior region of Alaska in 2015, total ecosystem fire emission of carbon to the atmosphere exceeded most previous estimates for the state.

An alteration of the gut-liver axis drives pulmonary inflammation after intoxication and burn injury in mice

PubMed Central

Chen, Michael M.; Zahs, Anita; Brown, Mary M.; Ramirez, Luis; Turner, Jerrold R.; Choudhry, Mashkoor A.

2014-01-01

Approximately half of all adult burn patients are intoxicated at the time of their injury and have worse clinical outcomes than those without prior alcohol exposure. This study tested the hypothesis that intoxication alters the gut-liver axis, leading to increased pulmonary inflammation mediated by burn-induced IL-6 in the liver. C57BL/6 mice were given 1.2 g/kg ethanol 30 min prior to a 15% total body surface area burn. To restore gut barrier function, the specific myosin light chain kinase inhibitor membrane-permeant inhibitor of kinase (PIK), which we have demonstrated to reduce bacterial translocation from the gut, was administered 30 min after injury. Limiting bacterial translocation with PIK attenuated hepatic damage as measured by a 47% reduction in serum alanine aminotransferase (P < 0.05), as well as a 33% reduction in hepatic IL-6 mRNA expression (P < 0.05), compared with intoxicated and burn-injured mice without PIK. This mitigation of hepatic damage was associated with a 49% decline in pulmonary neutrophil infiltration (P < 0.05) and decreased alveolar wall thickening compared with matched controls. These results were reproduced by prophylactic reduction of the bacterial load in the intestines with oral antibiotics before intoxication and burn injury. Overall, these data suggest that the gut-liver axis is deranged when intoxication precedes burn injury and that limiting bacterial translocation in this setting attenuates hepatic damage and pulmonary inflammation. PMID:25104501

Sodium Butyrate Protects against Severe Burn-Induced Remote Acute Lung Injury in Rats

PubMed Central

Liu, Sheng; Guo, Feng; Sun, Li; Wang, Yong-Jie; Sun, Ye-Xiang; Chen, Xu-Lin

2013-01-01

High-mobility group box 1 protein (HMGB1), a ubiquitous nuclear protein, drives proinflammatory responses when released extracellularly. It plays a key role as a distal mediator in the development of acute lung injury (ALI). Sodium butyrate, an inhibitor of histone deacetylase, has been demonstrated to inhibit HMGB1 expression. This study investigates the effect of sodium butyrate on burn-induced lung injury. Sprague–Dawley rats were divided into three groups: 1) sham group, sham burn treatment; 2) burn group, third-degree burns over 30% total body surface area (TBSA) with lactated Ringer’s solution for resuscitation; 3) burn plus sodium butyrate group, third-degree burns over 30% TBSA with lactated Ringer’s solution containing sodium butyrate for resuscitation. The burned animals were sacrificed at 12, 24, and 48 h after burn injury. Lung injury was assessed in terms of histologic changes and wet weight to dry weight (W/D) ratio. Tumor necrosis factor (TNF)-α and interleukin (IL)-8 protein concentrations in bronchoalveolar lavage fluid (BALF) and serum were measured by enzyme-linked immunosorbent assay, and HMGB1 expression in the lung was determined by Western blot analysis. Pulmonary myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration were measured to reflect neutrophil infiltration and oxidative stress in the lung, respectively. As a result, sodium butyrate significantly inhibited the HMGB1 expressions in the lungs, reduced the lung W/D ratio, and improved the pulmonary histologic changes induced by burn trauma. Furthermore, sodium butyrate administration decreased the TNF-α and IL-8 concentrations in BALF and serum, suppressed MPO activity, and reduced the MDA content in the lungs after severe burn. These results suggest that sodium butyrate attenuates inflammatory responses, neutrophil infiltration, and oxidative stress in the lungs, and protects against remote ALI induced by severe burn, which is associated with inhibiting HMGB1 expression. PMID:23874764

An Outcomes Study on the Effects of the Singapore General Hospital Burns Protocol.

PubMed

Liang, Weihao; Kok, Yee Onn; Tan, Bien Keem; Chong, Si Jack

2018-01-01

The Singapore General Hospital Burns Protocol was implemented in May 2014 to standardize treatment for all burns patients, incorporate new techniques and materials, and streamline the processes and workflow of burns management. This study aims to analyze the effects of the Burns Protocol 2 years after its implementation. Using a REDCap electronic database, all burns patients admitted from May 2013 to April 2016 were included in the study. The historical preimplementation control group composed of patients admitted from May 2013 to April 2014 (n = 96). The postimplementation prospective study cohort consisted of patients admitted from May 2014 to April 2016 (n = 243). Details of the patients collected included age, sex, comorbidities, total body surface area (TBSA) burns, time until surgery, number of surgeries, number of positive tissue and blood cultures, and length of hospital stay. There was no statistically significant difference in the demographics of both groups. The study group had a statistically significant shorter time to surgery compared with the control group (20.8 vs 38.1, P < 0.0001). The study group also averaged fewer surgeries performed (1.96 vs 2.29, P = 0.285), which, after accounting for the extent of burns, was statistically significant (number of surgeries/TBSA, 0.324 vs 0.506; P = 0.0499). The study group also had significantly shorter length of stay (12.5 vs 16.8, P = 0.0273), a shorter length of stay/TBSA burns (0.874 vs 1.342, P = 0.0101), and fewer positive tissue cultures (0.6 vs 1.3, P = 0.0003). The study group also trended toward fewer positive blood culture results (0.09 vs 0.35, P = 0.0593), although the difference was just shy of statistical significance. The new Singapore General Hospital Burns Protocol had revolutionized Singapore burns care by introducing a streamlined, multidisciplinary burns management, resulting in improved patient outcomes, lowered health care costs, and improved system resource use.

The epidemiology of geriatric burns in Iran: A national burn registry-based study.

PubMed

Emami, Seyed-Abolhassan; Motevalian, Seyed Abbas; Momeni, Mahnoush; Karimi, Hamid

2016-08-01

Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs. We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3-59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (p<0.02). Burn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (p<0.001). Among the patients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about $7450. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Biomass burning aerosols and the low-visibility events in Southeast Asia

DOE PAGES

Lee, Hsiang-He; Bar-Or, Rotem Z.; Wang, Chien

2017-01-23

Fires including peatland burning in Southeast Asia have become a major concern to the general public as well as governments in the region. This is because aerosols emitted from such fires can cause persistent haze events under certain weather conditions in downwind locations, degrading visibility and causing human health issues. In order to improve our understanding of the spatiotemporal coverage and influence of biomass burning aerosols in Southeast Asia, we have used surface visibility and particulate matter concentration observations, supplemented by decade-long (2003 to 2014) simulations using the Weather Research and Forecasting (WRF) model with a fire aerosol module, driven bymore » high-resolution biomass burning emission inventories. We find that in the past decade, fire aerosols are responsible for nearly all events with very low visibility (< 7 km). Fire aerosols alone are also responsible for a substantial fraction of low-visibility events (visibility  < 10 km) in the major metropolitan areas of Southeast Asia: up to 39 % in Bangkok, 36 % in Kuala Lumpur, and 34 % in Singapore. Biomass burning in mainland Southeast Asia accounts for the largest contribution to total fire-produced PM 2.5 in Bangkok (99 %), while biomass burning in Sumatra is a major contributor to fire-produced PM 2.5 in Kuala Lumpur (50 %) and Singapore (41 %). To examine the general situation across the region, we have further defined and derived a new integrated metric for 50 cities of the Association of Southeast Asian Nations (ASEAN): the haze exposure day (HED), which measures the annual exposure days of these cities to low visibility (< 10 km) caused by particulate matter pollution. It is shown that HEDs have increased steadily in the past decade across cities with both high and low populations. Fire events alone are found to be responsible for up to about half of the total HEDs. Our results suggest that in order to improve the overall air quality in Southeast Asia, mitigation policies targeting both biomass burning and fossil fuel burning sources need to be implemented.« less

Biomass burning aerosols and the low-visibility events in Southeast Asia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Hsiang-He; Bar-Or, Rotem Z.; Wang, Chien

Fires including peatland burning in Southeast Asia have become a major concern to the general public as well as governments in the region. This is because aerosols emitted from such fires can cause persistent haze events under certain weather conditions in downwind locations, degrading visibility and causing human health issues. In order to improve our understanding of the spatiotemporal coverage and influence of biomass burning aerosols in Southeast Asia, we have used surface visibility and particulate matter concentration observations, supplemented by decade-long (2003 to 2014) simulations using the Weather Research and Forecasting (WRF) model with a fire aerosol module, driven bymore » high-resolution biomass burning emission inventories. We find that in the past decade, fire aerosols are responsible for nearly all events with very low visibility (< 7 km). Fire aerosols alone are also responsible for a substantial fraction of low-visibility events (visibility  < 10 km) in the major metropolitan areas of Southeast Asia: up to 39 % in Bangkok, 36 % in Kuala Lumpur, and 34 % in Singapore. Biomass burning in mainland Southeast Asia accounts for the largest contribution to total fire-produced PM 2.5 in Bangkok (99 %), while biomass burning in Sumatra is a major contributor to fire-produced PM 2.5 in Kuala Lumpur (50 %) and Singapore (41 %). To examine the general situation across the region, we have further defined and derived a new integrated metric for 50 cities of the Association of Southeast Asian Nations (ASEAN): the haze exposure day (HED), which measures the annual exposure days of these cities to low visibility (< 10 km) caused by particulate matter pollution. It is shown that HEDs have increased steadily in the past decade across cities with both high and low populations. Fire events alone are found to be responsible for up to about half of the total HEDs. Our results suggest that in order to improve the overall air quality in Southeast Asia, mitigation policies targeting both biomass burning and fossil fuel burning sources need to be implemented.« less

Effects of glutamine treatment on myocardial damage and cardiac function in rats after severe burn injury.

PubMed

Yan, Hong; Zhang, Yong; Lv, Shang-jun; Wang, Lin; Liang, Guang-ping; Wan, Qian-xue; Peng, Xi

2012-01-01

Treatment with glutamine has been shown to reduce myocardial damage associated with ischemia/reperfusion injury. However, the cardioprotective effect of glutamine specifically after burn injury remains unclear. The present study explores the ability of glutamine to protect against myocardial damage in rats that have been severely burned. Seventy-two Wistar rats were randomly divided into three groups: normal controls (C), burned controls (B) and a glutamine-treated group (G). Groups B and G were subjected to full thickness burns comprising 30% of total body surface area. Group G was administered 1.5 g/ (kg•d) glutamine and group B was given the same dose of alanine via intragastric administration for 3 days. Levels of serum creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST) and blood lactic acid were measured, as well as myocardial ATP and glutathione (GSH) contents. Cardiac function indices and histopathological changes were analyzed at 12, 24, 48 and 72 post-burn hours. In both burned groups, levels of serum CK, LDH, AST and blood lactic acid increased significantly, while myocardial ATP and GSH contents decreased. Compared with group B, CK, LDH, and AST levels were lower and blood lactic acid, myocardial ATP and GSH levels were higher in group G. Moreover, cardiac contractile function inhibition and myocardial histopathological damage were significantly reduced in group G compared to B. Taken together, these results show that glutamine supplementation protects myocardial structure and function after burn injury by improving energy metabolism and by promoted the synthesis of ATP and GSH in cardiac myocytes.

Predictive Factors of Mortality in Burn Patients

PubMed Central

Fazeli, Shahram; Karami-Matin, Reza; Kakaei, Neda; Pourghorban, Samira; Safari-Faramani, Roya; Safari-Faramani, Bahare

2014-01-01

Background: Burn injuries impose a considerable burden on healthcare systems in Iran. It is among the top ten causes of mortality and a main cause of disability. Objectives: This study aimed to examine factors influencing mortality in burn patients admitted to the main educational tertiary referral hospital in Kermanshah. Patients and Methods: All patients admitted to the Imam Khomeini Hospital (from March 2011 to March 2012), due to thermal burn injuries were included in the study. We applied multiple logistic regressions to identify risk and protective factors of mortality. Also we calculated lethal area fifty percent (LA50), as an aggregate index for hospital quality. Results: During the study period, 540 burn patients were admitted. Male to female ratio was 1.12:1. Twenty three percent of the patients were less than 15 years-old. Median of age was 25 years (Inter Quartile Range, 16 - 37). Overall, probability of death was 25.8%. Lethal area fifty percent (LA50) was 50.82 (CI 95%: 47.76 - 54.48). In the final model, after adjustment of sex, age, total body surface area (TBSA), cause of burn and it’s severity, female gender (P < 0.05), age ≥ 60 years (in comparison with age less than 15 years, P < 0.05) and larger burn size (P < 0.0001) were identified as the main risk factors of death in these patients. Conclusions: Findings showed that the main risk factors of death were female gender, burn size and old age. Directing more attention to these vulnerable patients is required to reduce mortality and improve patient survival. PMID:24719826

Effects of glycyl-glutamine dipeptide supplementation on myocardial damage and cardiac function in rats after severe burn injury

PubMed Central

Zhang, Yong; Yan, Hong; Lv, Shang-Gun; Wang, Lin; Liang, Guang-Ping; Wan, Qian-Xue; Peng, Xi

2013-01-01

Glutamine decreases myocardial damage in ischemia/reperfusion injury. However, the cardioprotective effect of glutamine after burn injury remains unclear. Present study was to explore the protective effect of glycyl-glutamine dipeptide on myocardial damage in severe burn rats. Seventy-two Wistar rats were randomly divided into three groups: normal control (C), burned control (B) and glycyl-glutamine dipeptide-treated (GG) groups. B and GG groups were inflicted with 30% total body surface area of full thickness burn. The GG group was given 1.5 g/kg glycyl-glutamine dipeptide per day and the B group was given the same dose of alanine via intraperitoneal injection for 3 days. The serum CK, LDH, AST, and, blood lactic acid levels, as well as the myocardium ATP and GSH contents, were measured. The indices of cardiac contractile function and histopathological change were analyzed at 12, 24, 48, and 72 post-burn hours (PBH). The serum CK, LDH, AST and blood lactic acid levels increased, and the myocardium ATP and GSH content decreased in both burned groups. Compared with B group, the CK, LDH, AST and blood lactic acid levels reduced, myocardium ATP and GSH content increased in GG group. Moreover, the inhibition of cardiac contractile function and myocardial histopathological damage were reduced significantly in GG group. We conclude that myocardial histological structure and function were damaged significantly after burn injury, glycyl-glutamine dipeptide supplementation is beneficial to myocardial preservation by improving cardiocyte energy metabolism, increasing ATP and glutathione synthesis. PMID:23638213

Effects of glutamine treatment on myocardial damage and cardiac function in rats after severe burn injury

PubMed Central

Yan, Hong; Zhang, Yong; Lv, Shang-jun; Wang, Lin; Liang, Guang-ping; Wan, Qian-xue; Peng, Xi

2012-01-01

Treatment with glutamine has been shown to reduce myocardial damage associated with ischemia/reperfusion injury. However, the cardioprotective effect of glutamine specifically after burn injury remains unclear. The present study explores the ability of glutamine to protect against myocardial damage in rats that have been severely burned. Seventy-two Wistar rats were randomly divided into three groups: normal controls (C), burned controls (B) and a glutamine-treated group (G). Groups B and G were subjected to full thickness burns comprising 30% of total body surface area. Group G was administered 1.5 g/ (kg•d) glutamine and group B was given the same dose of alanine via intragastric administration for 3 days. Levels of serum creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST) and blood lactic acid were measured, as well as myocardial ATP and glutathione (GSH) contents. Cardiac function indices and histopathological changes were analyzed at 12, 24, 48 and 72 post-burn hours. In both burned groups, levels of serum CK, LDH, AST and blood lactic acid increased significantly, while myocardial ATP and GSH contents decreased. Compared with group B, CK, LDH, and AST levels were lower and blood lactic acid, myocardial ATP and GSH levels were higher in group G. Moreover, cardiac contractile function inhibition and myocardial histopathological damage were significantly reduced in group G compared to B. Taken together, these results show that glutamine supplementation protects myocardial structure and function after burn injury by improving energy metabolism and by promotedthe synthesis of ATP and GSH in cardiac myocytes. PMID:22977661

Renal Replacement Therapy in Severe Burns: A Multicenter Observational Study.

PubMed

Chung, Kevin K; Coates, Elsa C; Hickerson, William L; Arnold-Ross, Angela L; Caruso, Daniel M; Albrecht, Marlene; Arnoldo, Brett D; Howard, Christina; Johnson, Laura S; McLawhorn, Melissa M; Friedman, Bruce; Sprague, Amy M; Mosier, Michael J; Conrad, Peggie F; Smith, David J; Karlnoski, Rachel A; Aden, James K; Mann-Salinas, Elizabeth A; Wolf, Steven E

2018-06-20

Acute kidney injury (AKI) after severe burns is historically associated with a high mortality. Over the past two decades, various modes of renal replacement therapy (RRT) have been utilized in this population. The purpose of this multicenter study was to evaluate demographic, treatment and outcomes data among severe burn patients treated with RRT collectively at various burn centers around the United States. After institutional review board approval, a multicenter observational study was conducted. All adult patients 18 or older, admitted with severe burns who were placed on RRT for acute indications but not randomized into a concurrently enrolling interventional trial were included. Across 8 participating burn centers, 171 subjects were enrolled during a 4 year period. Complete data was available in 170 subjects with a mean age of 51±17, percent total body surface area (TBSA) burn of 38±26% and Injury Severity Score of 27±21. 80% of subjects were male and 34% were diagnosed with smoke inhalation injury. The preferred mode of therapy was continuous venovenous hemofiltration at a mean delivered dose of 37±19 (mL/kg/hr) and a treatment duration of 13±24 days. Overall, in hospital mortality was 50%. Among survivors, 21% required RRT upon discharge from the hospital while 9% continued to require RRT 6 months after discharge. This is the first multi-center cohort of burn patients who underwent RRT reported to date. Overall mortality is comparable to other critically ill populations who undergo RRT. Most patients who survive to discharge eventually recover renal function.

Better Protection of Glass-Fronted Stoves Is Needed in Sweden Because of the Increase in the Number of Contact Burns Among Small Children.

PubMed

Zötterman, Johan; Steinvall, Ingrid; Elmasry, Moustafa

2018-06-13

The impression among the attending physicians at their Burn Centre is that the number of contact burns caused by glass-fronted stoves is increasing, particularly in the youngest group of patients. It is an interesting subgroup, as these injuries are preventable. The authors' aim of this study was to find out whether the incidence of burns after contact with glass-fronted stoves has increased.The authors included all patients aged between 0 and 3.9 years who presented to the National Burn Centre during the period 2008-2015 with contact burn injuries caused by glass-fronted stoves. The change in incidence over time was calculated from national records and analyzed with simple linear regression.Fifty-six patients were included, of whom 20 were treated during the past 2 years of the study. Thirty-seven of the 56 were boys (66%), median (10-90 percentiles) age was 1.1 (0.7-2.5) years, percentage total body surface area burned was 0.6% (0.1-2.0), 12 were admitted for overnight stay in hospital, and seven needed operations. The incidence was 0.34/100 000 children-years during the first 2 years, and it was three times as high during the past 2 years. The increase in incidence was 0.24/100 000 children-years by each 2-year period (P = .02).The authors' results indicate that contact burns among children caused by glass-fronted stoves are increasing in Sweden. The authors propose that there should be a plan for their prevention put in place.

Children with burn injuries-assessment of trauma, neglect, violence and abuse

PubMed Central

Toon, Michael H.; Maybauer, Dirk M.; Arceneaux, Lisa L.; Fraser, John F.; Meyer, Walter; Runge, Antoinette; Maybauer, Marc O.

2011-01-01

Abstract: Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists. PMID:21498973

The burning issues of motor vehicle radiator scald injuries revisited – a fresh review and changing prevention strategies

PubMed Central

Patel, J.N.; Tan, A.; Frew, Q.; Dziewulski, P.

2016-01-01

Summary A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced. PMID:28289357

The burning issues of motor vehicle radiator scald injuries revisited - a fresh review and changing prevention strategies.

PubMed

Patel, J N; Tan, A; Frew, Q; Dziewulski, P

2016-12-31

A preventable subgroup of burn injuries is scalds sustained from motor vehicle radiators. This study was to determine changes in trends in epidemiology of such injuries and to discuss whether current and other prevention efforts proposed previously require reinforcement. We conducted a retrospective study (February 2007-August 2015) of all motor vehicle-related burn referrals to our regional burns service. 68 cases of motor vehicle radiator burns were identified. Male to female ratio was 65:3. Mean age was 35.1 (range = 9-71). Most cases occurred in the summer months (22/68 = 32.4%). 65 cases (95.6%) involved car radiators. 66% of injuries resulted from actively removing the pressure cap of an overheated radiator in the motor vehicle. Mean total burn surface area (%TBSA) was 2.1% (range = 0.5- 11%). The depths of burn injuries were mostly superficial partial thickness. Face, chest and upper limbs were the most common sites of injury. Mean healing time was 14.2 days (range = 4-60). Following the introduction of safety measures by vehicle manufacturers, motor vehicle radiator burns in this era are mostly minor injuries and can be potentially managed conservatively as an outpatient. This contrasts with findings from previous studies over a decade ago of larger, more significant injuries requiring admission and surgery. Whilst manufacturers have installed safety measures into the design of radiator caps, our findings suggest that re-educating the public to allow a period of cooling prior to opening caps should be reinforced.

Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury population.

PubMed

Slocum, Chloe S; Goldstein, Richard; DiVita, Margaret A; Mix, Jacqueline; Niewczyk, Paulette; Gerrard, Paul; Sheridan, Robert; Kowalske, Karen J; Zafonte, Ross; Ryan, Colleen M; Schneider, Jeffrey C

2015-05-01

Burn patients exhibit comorbidities that influence outcomes. This study examines whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population. Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision, codes were used to assess three comorbidity measures (Charlson Comorbidity Index, Elixhauser Comorbidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers). The number of subjects and unique comorbidity codes (>1% of frequency) captured by each comorbidity measure was calculated. The study included 5347 patients with a median total body surface area burn decile of 20%-29%, mean age of 51.6 yrs, and mean number of comorbidities of 7.6. There were 2809 unique International Classification of Diseases, 9th Revision, comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67%, 27%, and 58% of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1%. Of these, 67% were not captured in all three comorbidity measures. Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.

Preparation of grout for stabilization of abandoned in-situ oil shale retorts

DOEpatents

Mallon, Richard G.

1982-01-01

A process for the preparation of grout from burned shale by treating the burned shale in steam at approximately 700.degree. C. to maximize the production of the materials alite and larnite. Oil shale removed to the surface during the preparation of an in-situ retort is first retorted on the surface and then the carbon is burned off, leaving burned shale. The burned shale is treated in steam at approximately 700.degree. C. for about 70 minutes. The treated shale is then ground and mixed with water to produce a grout which is pumped into an abandoned, processed in-situ retort, flowing into the void spaces and then bonding up to form a rigid, solidified mass which prevents surface subsidence and leaching of the spent shale by ground water.

[Effects of low-dose insulin on oxidation-reduction in rat organs after major burns].

PubMed

Wang, Wei; Jiang, Hong-mei; Li, Wei-ren; Zuo, Lu; Tao, Lei; Yu, Xiang

2013-11-12

To explore the effects of low-dose insulin on oxidation-reduction of heart and kidney in rats immediately after severe burns. Twenty four male Sprague-Dawley (SD) rats were randomly divided into 3 groups of sham burn, burn and treatment (n = 8 each). The sham burn group was placed into 37 °C warm water for 15 seconds to simulate burn process and received no fluid replacement. The burn and treatment groups were immersed into (95 ± 0.5) °C hot water for 15 seconds to make a rat model of 30% total burn surface area, III degree burn injury and immediately received an intraperitoneal injection of physiological saline (40 ml/kg). At the same time, a subcutaneous injection of insulin (1.0 U×kg(-1)×d(-1)) was given in the treatment group and a subcutaneous injection of same-volume physiological saline in the burn group. The rats were sacrificed after 24 post-scald hours (PSH). Abdominal aortic blood was collected for an analysis of blood glucose. The oxidation and antioxidation parameters of heart and kidney, such as malondialdehyde (MDA), xanthine oxidase (XO), myeloperoxidase (MPO), total superoxide dismutase (T-SOD), superoxide dismutase 1, 2 (SOD1, 2), catalase (CAT) and glutathione peroxidase (GPx), were detected by spectrophotometry. Compared with the sham burn group, MDA content, XO and MPO activities of heart and kidney were significantly higher in the burn group (all P < 0.05); in the treatment group, MDA content and XO activity of heart were significantly lower than the burn group ((0.85 ± 0.07) vs (1.11 ± 0.07) nmol/mg, (69.72 ± 1.94) vs (77.21 ± 2.10) U/g) while the MPO activities of heart and kidney were significantly lower (all P < 0.05).compared with the sham burn group, the activities of T-SOD, CAT, GPx of heart and kidney were significantly lower in the burn group, SOD1 activity of kidney was significantly lower, but SOD2 activity of kidney was significantly higher while SOD2 activity of heart was significantly lower (all P < 0.05); Compared with the burn group, the activities of T-SOD and SOD1 of heart in the treatment group were significantly higher ((83.5 ± 2.5) vs (79.6 ± 3.2), (62.8 ± 2.3) vs (58.8 ± 3.0) U/mg), CAT and GPx activity of heart and kidney were significantly higher (all P < 0.05). Compared with the sham burn group, blood glucose in the burn and treatment group were significantly higher ((7.81 ± 0.30), (7.19 ± 0.22) vs (6.30 ± 0.24) mmol/L) and blood glucose in the treatment group was significantly lower than the burn group((7.81 ± 0.30) mmol/L)(all P < 0.05). During an early stage, a low-dose insulin may intervene in heart tissue lipid peroxidation of severely burned rats. And differences exist in the effects of oxidation-reduction between heart and kidney.

Carbon loading of alveolar macrophages in adults and children exposed to biomass smoke particles.

PubMed

Kulkarni, Neeta S; Prudon, Benjamin; Panditi, Sri L; Abebe, Yekoye; Grigg, Jonathan

2005-06-01

Exposure to carbonaceous particles from biomass burning is associated with increased respiratory morbidity in both women and children in the developing world. However, the amount of carbon reaching lower airway cells has not been determined in these populations. Alveolar macrophages (AM) remove inhaled particulate matter (PM), and are implicated in the pathogenesis of PM-induced lung disease. In this study, we aimed to compare AM carbon loading in women and children exposed to biomass PM in Gondar, Ethiopia, with individuals exposed to fossil-fuel PM in the developed world (Leicester, UK). To achieve these aims, we sampled AM from Ethiopian mothers and children, and from UK adults and children using induced sputum (IS). AM were imaged under light microscopy, and the total two-dimensional surface area of carbon within each AM determined by image analysis. AM containing carbon were detected in all subjects. The total surface area of carbon per AM was higher in Ethiopian women (n=10) compared with UK adults (n=10, median 9.19 vs. 0.71 microm2/AM, p=0.0002). Similarly, the total surface area of carbon per AM was higher in Ethiopian children (n=10) compared with UK children (n=10, 3.32 vs. 0.44 microm2/AM, p=0.0002). However, loading in Ethiopian children was lower than paired maternal levels (3.32 vs. 9.19 microm2/AM, p=0.011). We conclude that analysis of AM obtained by induced sputum is a practical way of quantifying natural exposure of the lower airway to carbonaceous particles from the burning of biomass fuels.

Repeated wildfires alter forest recovery of mixed-conifer ecosystems.

PubMed

Stevens-Rumann, Camille; Morgan, Penelope

2016-09-01

Most models project warmer and drier climates that will contribute to larger and more frequent wildfires. However, it remains unknown how repeated wildfires alter post-fire successional patterns and forest structure. Here, we test the hypothesis that the number of wildfires, as well as the order and severity of wildfire events interact to alter forest structure and vegetation recovery and implications for vegetation management. In 2014, we examined forest structure, composition, and tree regeneration in stands that burned 1-18 yr before a subsequent 2007 wildfire. Three important findings emerged: (1) Repeatedly burned forests had 15% less woody surface fuels and 31% lower tree seedling densities compared with forests that only experienced one recent wildfire. These repeatedly burned areas are recovering differently than sites burned once, which may lead to alternative ecosystem structure. (2) Order of burn severity (high followed by low severity compared with low followed by high severity) did influence forest characteristics. When low burn severity followed high, forests had 60% lower canopy closure and total basal area with 92% fewer tree seedlings than when high burn severity followed low. (3) Time between fires had no effect on most variables measured following the second fire except large woody fuels, canopy closure and tree seedling density. We conclude that repeatedly burned areas meet many vegetation management objectives of reduced fuel loads and moderate tree seedling densities. These differences in forest structure, composition, and tree regeneration have implications not only for the trajectories of these forests, but may reduce fire intensity and burn severity of subsequent wildfires and may be used in conjunction with future fire suppression tactics. © 2016 by the Ecological Society of America.

Burn-induced increase in atrogin-1 and MuRF-1 in skeletal muscle is glucocorticoid independent but downregulated by IGF-I.

PubMed

Lang, Charles H; Huber, Danuta; Frost, Robert A

2007-01-01

The present study determined whether thermal injury increases the expression of the ubiquitin (Ub) E3 ligases referred to as muscle ring finger (MuRF)-1 and muscle atrophy F-box (MAFbx; aka atrogin-1), which are muscle specific and responsible for the increased protein breakdown observed in other catabolic conditions. After 48 h of burn injury (40% total body surface area full-thickness scald burn) gastrocnemius weight was reduced, and this change was associated with an increased mRNA abundance for atrogin-1 and MuRF-1 (3.1- to 8-fold, respectively). Similarly, burn increased polyUb mRNA content in the gastrocnemius twofold. In contrast, there was no burn-induced atrophy of the soleus and no significant change in atrogin-1, MuRF-1, or polyUb mRNA. Burns also did not alter E3 ligase expression in heart. Four hours after administration of the anabolic agent insulin-like growth factor (IGF)-I to burned rats, the mRNA content of atrogin-1 and polyUb in gastrocnemius had returned to control values and the elevation in MuRF-1 was reduced 50%. In contrast, leucine did not alter E3 ligase expression. In a separate study, in vivo administration of the proteasome inhibitor Velcade prevented burn-induced loss of muscle mass determined at 48 h. Finally, administration of the glucocorticoid receptor antagonist RU-486 did not prevent burn-induced atrophy of the gastrocnemius or the associated elevation in atrogin-1, MuRF-1, or polyUb. In summary, the acute muscle wasting accompanying thermal injury is associated with a glucocorticoid-independent increase in the expression of several Ub E3 ligases that can be downregulated by IGF-I.

Predictive Value of IL-8 for Sepsis and Severe Infections after Burn Injury - A Clinical Study

PubMed Central

Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Cox, Robert A; Song, Juquan; Jeschke, Marc G

2014-01-01

The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring post-burn inflammation is of paramount importance but so far there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As IL-8 is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict post-burn sepsis, infections, and mortality other outcomes post-burn. Plasma cytokines, acute phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days post injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure (MOF), and mortality were recorded. A cut-off level for IL-8 was determined using receiver operating characteristic (ROC) analysis. Statistical significance is set at (p<0.05). ROC analysis identified a cut-off level of 234 pg/ml for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cut off and stratified into high (H) (n=133) and low (L) (n=335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area (TBSA) burned and incidence of MOF (p<0.001). In the H group IL-8 levels were able to predict sepsis (p<0.002). In the H group, elevated IL-8 was associated with increased inflammatory and acute phase responses compared to the L group (p<0.05). High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients. PMID:25514427

Extra-large negative pressure wound therapy dressings for burns - Initial experience with technique, fluid management, and outcomes.

PubMed

Fischer, Sebastian; Wall, Jennifer; Pomahac, Bohdan; Riviello, Robert; Halvorson, Eric G

2016-03-01

The use of negative-pressure-wound-therapy (NPWT) is associated with improved outcomes in smaller burns. We report our experience using extra-large (XL) NPWT dressings to treat ≥15% total body surface area (TBSA) burned and describe our technique and early outcomes. We also provide NPWT exudate volume for predictive fluid resuscitation in these critically ill patients. We retrospectively reviewed patients treated with XL-NPWT from 2012 to 2014. Following excision/grafting, graft and donor sites were sealed with a layered NPWT dressing. We documented wound size, dressing size, NPWT outputs, graft take, wound infections, and length of stay (LOS). Mean NPWT exudate volume per %TBSA per day was calculated. Twelve burn patients (mean TBSA burned 30%, range 15-60%) were treated with XL-NPWT (dressing TBSA burned and skin graft donor sites range 17-44%). Average graft take was 97%. No wound infections occurred. Two patients had burns ≥50% TBSA and their LOS was reduced compared to ABA averages. XL-NPWT outputs peaked at day 1 after grafting followed by a steady decline until dressings were removed. Average XL-NPWT dressing output during the first 5 days was 101±66mL/%BSA covered per day. 2 patients developed acute kidney injury. The use of XL-NPWT to treat extensive burns is feasible with attention to application technique. NPWT dressings appear to improve graft take, and to decrease risk of infection, LOS, and pain and anxiety associated with wound care. Measured fluid losses can improve patient care in future applications of NPWT to large burn wounds. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2018-01-01

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale "hostile behaviour" and sensitivity to change of the PSQ should be further evaluated.

Impacts of Wildfires on Mercury Contamination in Canada

NASA Astrophysics Data System (ADS)

Dastoor, A.; Fraser, A.; Ryjkov, A.

2017-12-01

Wildfires frequency has increased in past four decades in Canada, and is expected to increase in future as a result of climate change. Biomass Burning Mercury Emissions (BBMEs) are known to be significant; however, the impact of biomass burning on Mercury (Hg) burden in Canada has not been previously quantified. We investigated the spatio-temporal variability of BBME in Canada, and used Environment and Climate Change Canada's air quality and mercury model, GEM-MACH-Hg, to quantify the impacts of BBME on spatio-temporal variability of air concentrations and deposition fluxes of Hg in Canada. We optimized the biomass burning Emission Factors (EFs) for gaseous elemental mercury (GEM) using observations, GEM-MACH-Hg and an inversion technique for five vegetation types represented in North American fires to constrain the BBME impacts of Hg. We used three BBME scenarios (i.e., two scenarios where mercury is emitted only as GEM using literature or optimized EFs, and a third scenario where mercury is emitted as GEM using literature EFs and particle bound mercury (PBM) emitted using a GEM/PBM ratio from lab measurements) in Canada to conduct three sets of model simulations for 2010-2015. The three BBME scenarios represent the range of possible values for the impacts of BBME in Canada on mercury concentration and deposition. We found total BBME and its spatial distribution to be highly variable from year to year, and total atmospheric BBME averaged for 2010-2015 in Canada to be between 6 - 14 tonnes, which is 3 - 7 times the mercury emission from anthropogenic sources in Canada during the biomass burning season (i.e., from May to September). We found that while BBME have a small impact on surface air concentrations of GEM and total Hg deposition averaged over individual provinces/territories, these impacts for individual ecosystems can be as high as 95% during the burning season. We found that northern Alberta and Saskatchewan, central British Columbia, and the area around Great Slave Lake in the Northwest Territories are at greater risk of mercury contamination from biomass burning. We analysed the uncertainties in BBME, and found that reducing uncertainty in the speciation of Hg in BBME would provide the largest benefit to constraining the mercury contamination from biomass burning source to Canadian ecosystems.

Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients

PubMed Central

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

2018-01-01

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale—BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach’s alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale “hostile behaviour” and sensitivity to change of the PSQ should be further evaluated. PMID:29381711

Emissions of volatile organic compounds from maize residue open burning in the northern region of Thailand

NASA Astrophysics Data System (ADS)

Sirithian, Duanpen; Thepanondh, Sarawut; Sattler, Melanie L.; Laowagul, Wanna

2018-03-01

Emission factors for speciated volatile organic compounds (VOCs) from maize residue burning were determined in this study based on chamber experiments. Thirty-six VOC species were identified by Gas Chromatography/Mass Spectrometer (GC/MS). They were classified into six groups, including alkanes, alkenes, oxygenated VOCs, halogenated VOCs, aromatics and other. The emission factor for total VOCs was estimated as about 148 mg kg-1 dry mass burned. About 68.4% of the compounds were aromatics. Field samplings of maize residues were conducted to acquire the information of fuel characteristics including fuel loading, fraction of maize residues that were actually burned as well as proximate and elemental analysis of maize residues. The emission factors were then applied to estimate speciated VOC emissions from maize residue open burning at the provincial level in the upper-northern region of Thailand for the year 2014. Total burned area of maize covered an area of about 500,000 ha which was about 4.7% of the total area of upper-northern region of the country. It was found that total VOC emissions released during the burning season (January-April) was about 79.4 tons. Ethylbenzene, m,p-xylene, 1,2,4-trimethylbenzene, acetaldehyde and o-xylene were the major contributors, accounting for more than 65% of total speciated VOC emissions.

Two-year follow-up of outcomes related to scarring and distress in children with severe burns.

PubMed

Wurzer, Paul; Forbes, Abigail A; Hundeshagen, Gabriel; Andersen, Clark R; Epperson, Kathryn M; Meyer, Walter J; Kamolz, Lars P; Branski, Ludwik K; Suman, Oscar E; Herndon, David N; Finnerty, Celeste C

2017-08-01

We assessed the perception of scarring and distress by pediatric burn survivors with burns covering more than one-third of total body surface area (TBSA) for up to 2 years post-burn. Children with severe burns were admitted to our hospital between 2004 and 2012, and consented to this IRB-approved-study. Subjects completed at least one Scars Problems and/or Distress questionnaire between discharge and 24 months post burn. Outcomes were modeled with generalized estimating equations or using mixed linear models. Significance was accepted at p < 0.01. Responses of 167 children with a mean age of 7 ± 5 years and burns covering an average 54 ± 14% of TBSA were analyzed. Significant improvements over the 2-year period were seen in reduction of pain, itching, sleeping disturbance, tightness, range of motion, and strength (p < 0.01). There was a significantly increased persistent desire to hide the scarred body areas over time (p < 0.01). The perception of mouth scarring, inability to portray accurate facial expressions, and skin coloration did not improve over the follow-up period. According to self-assessment questionnaires, severely burned children exhibit significant improvements in their overall perception of scarring and distress. However, these patients remain self-conscious with respect to their body image even 2 years after burn injury. Implications for Rehabilitation According to self-assessment questionnaires, severely burned children perceive significant improvements in scarring and distress during the first 2 years post burn. Significant improvements were seen in reduction of pain, itching, sleeping disturbances, tightness, range of motion, and strength (p < 0.01). Burn care providers should improve the treatment of burns surrounding the mouth that with result in scarring, and develop strategies to prevent skin discoloration. Careful evaluation of pain and sleeping disorders during the first year post burn are warranted to improve the patient rehabilitation. Overall, significantly more female patients expressed a persistent desire to hide their scarred body areas. The rehabilitation team should provide access to wigs or other aids to pediatric burn survivors to address these needs.

[Influences of high-voltage electrical burns on microcirculation perfusion on serosal surface of small intestine of rats and the interventional effects of pentoxifylline].

PubMed

Zhang, Q F; Xu, S J; Liang, L M; Feng, J K; Xu, Y F; Tu, L L

2017-03-20

Objective: To investigate influences of high-voltage electrical burns on microcirculation perfusion on serosal surface of small intestine of rats and the interventional effects of pentoxifylline (PTX). Methods: Totally 180 SD rats were divided into sham injury group, simple electrical burn group, and treatment group according to the random number table, with 60 rats in each group. The electrical current was applied to the outside proximal part of left forelimb of rats and exited from the outside proximal part of right hind limb of rats. Rats in simple electrical burn group and treatment group were inflicted with high-voltage electrical burn wounds of 1cm×1cm at current entrances and exits, with the voltage regulator and experimental transformer. Rats in sham injury group were sham injured through connecting the same equipments without electricity. At 2 min post injury, rats in sham injury group and simple electrical burn group were intraperitoneally injected with 2 mL normal saline, and rats in treatment group were injected with 2 mL PTX injection (50 mg/mL). At 15 min before injury and 5 min, 1 h, 2 h, 4 h, and 8 h post injury, 10 rats in each group were selected to collect blood of heart respectively. Serum were separated from the blood to determine the level of soluble vascular cell adhesion molecule-1(sVCAM-1) with enzyme-linked immunosorbent assay method. The number of adhesional leukocyte in mesenteric venule of rats was determined with Bradford variable projection microscope system. The microcirculation perfusion on serosal surface of small intestine of rats was detected with laser Doppler perfusion imager. Data were processed with analysis of variance of factorial design and LSD test. Results: (1) At 5 min, 1 h, 2 h, 4 h, 8 h post injury, the serum content of sVCAM-1 in rats of simple electrical burn group were (8 502±1 158), (11 793±3 310), (9 960±2 146), (9 708±1 429), (7 292±1 386) ng/mL respectively, higher than that in sham injury group and treatment group [ (1 897±946), (1 882±940), (1 882±938), (1 888±946), (1 884±942) ng/mL, and (6 840±1 558), (6 742±2 465), (5 625±2 593), (2 373±1 463), (5 187±2 797) ng/mL, respectively, with P values below 0.001]. The serum content of sVCAM-1 in rats of sham injury group and treatment group at all time points post injury, except 4 h post injury of treatment group, was higher than that of the same group at 15 min before injury (with P values below 0.001). (2) At all time points post injury, the number of adhesional leukocyte in mesenteric venule of rats in simple electrical burn group was higher than that in sham injury group and treatment group (with P values below 0.001). The number of adhesional leukocyte in mesenteric venule of rats in simple electrical burn group and treatment group at all time points post injury was higher than that of the same group at 15 min before injury (with P values below 0.001). (3) At all time points post injury, the microcirculation perfusion on serosal surface of small intestine of rats in simple electrical burn group was lower than that in sham injury group and treatment group (with P values below 0.001). The microcirculation perfusion on serosal surface of small intestine of rats in simple electrical burn group and treatment group at all time points post injury was lower than that of the same group at 15 min before injury (with P values below 0.001). Conclusions: High-voltage electrical burns can increase the serum content of sVCAM-1, the number of adhesional leukocyte in mesenteric venule, and reduce microcirculation perfusion on serosal surface of small intestine of rats. PTX can inhibit secretion of serum sVCAM-1, reduce the number of adhensional leukocyte in mesenteric venule to alleviate microcirculation disturbance caused by high-voltage electrical burns.

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

A modified surgical technique in the management of eyelid burns: a case series

PubMed Central

2011-01-01

Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid. PMID:21843322

Ecological impacts of wheat seeding after a Sierra Nevada wildfire

USGS Publications Warehouse

Keeley, Jon E.

2004-01-01

The Highway Fire burned 1680 ha of mixed ponderosa pine–oak–chaparral in the newly created Giant Sequoia National Monument and the adjacent Sequoia National Forest of Fresno County, California in August 2001. The USDA Forest Service Burned Area Emergency Rehabilitation (BAER) program recommended that portions of the burned forest be seeded with a non-persistent variety of wheat at a density of 157 kg ha–1 (140 lb/ac). The present study compared the vascular plant diversity and cover in seeded and unseeded parts of this burn to evaluate the ecological impact of seeding an alien grass. In the first post-fire growing season, the natural regeneration of unseeded control sites averaged ~55% ground surface covered. Wheat seeding enhanced the ground cover, averaging 95% ground surface cover. Wheat was the dominant species on the seeded sites, comprising 67% of the total cover. Dominance–diversity curves were markedly affected by the seeding and indicated a disruption in the natural ecological structure of these communities. On seeded sites, wheat dominated and all other species were poorly represented whereas, on unseeded control sites, there was a more equitable distribution of species. Correlated with the wheat cover was a significant decrease in species richness at all scales examined. Total species richness was reduced from 152 species across all unseeded sites to 104 species on all seeded sites. Average species richness, at scales from 1 to 1000 m2, was 30–40% lower on seeded sites. Species most strongly inhibited were post-fire endemics whose lifecycle is restricted to immediate post-fire environments. Seeded sites had fewer alien species than unseeded sites; however, this may not have any lasting effect since other studies show the primary alien threat is not in the first post-fire year. Seeding was also associated with an order of magnitude drop in Pinus ponderosa seedling recruitment and, coupled with the massive thatch still remaining on the site, it is likely that recruitment will be inhibited in subsequent years.

[The advantages in using cyanoacrylate glue over skin staples as a method of skin graft fixation in the pediatric burns population].

PubMed

Curings, P; Vincent, P-L; Viard, R; Gir, P; Comparin, J-P; Voulliaume, D

2017-11-23

Local postoperative care and burn wound management can present with a certain degree of difficulty in the pediatric population. While the use of skin staples as a method of skin graft fixation is a well-known, rapid and simple method, their removal can be painful and may necessitate some sedation or even general anesthesia. We studied in this article the advantages and economic value of using the cyanoacrylate glue as a fixation method for skin grafts. A comparative study was carried out from 2012 to 2016. Hundred and eighteen infants with burns up to 5% of total body surface area were included in the study. Seventy-two infants had split thickness skin grafts fixed with skin staples. Forty-six infants had split thickness skin grafts fixed with cyanoacrylate glue. We compared the quality of graft, the sedation used during the first postoperative dressing, the length of hospital stay, the amount of glue used and the presence of complications. There is a difference between the two groups studied in terms of age and total burn surface area. The rate of graft take was 100% in both groups. The first postoperative dressing was carried out without the use of powerful analgesia in the cyanoacrylate group, while it was necessary to use general anesthesia in 64% of the skin staples group. The average length of stay in hospital after skin grafting was 4.9 days for the cyanoacrylate glue versus 6.5 days in the skin staples group. No complications were noted in the 2 groups. The use of cyanoacrylate glue allows rapid fixation of skin grafts and avoid general anesthesia for postoperative cares. Subsequently the length of hospital stay is reduced within 25%. The medico-economic value of glue protocol is highly significant compared to skin staples, while having similar good results and without significant problems. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Global and Regional Decreases in Tropospheric Oxidants from Photochemical Effects of Aerosols

NASA Technical Reports Server (NTRS)

Martin, Randall V.; Jacob, Daniel J.; Yantosca, Robert M.; Chin, Mian; Ginoux, Paul

2003-01-01

We evaluate the sensitivity of tropospheric OH, O3, and O3 precursors to photochemical effects of aerosols not usually included in global models: (1) aerosol scattering and absorption of ultraviolet radiation and (2) reactive uptake of HO', NO2, and NO3. Our approach is to couple a global 3-D model of tropospheric chemistry (GEOS- CHEM) with aerosol fields from a global 3-D aerosol model (GOCART). Reactive uptake by aerosols is computed using reaction probabilities from a recent review (gamma(sub HO2) = 0.2, gamma(sub NO2) = 10(exp -4), gamma(sub NO3) = l0(exp -3). Aerosols decrease the O3 - O((sup 1)D) photolysis frequency by 5-20% at the surface throughout the Northern Hemisphere (largely due to mineral dust) and by a factor of 2 in biomass burning regions (largely due to black carbon). Aerosol uptake of HO2 accounts for 10-40% of total HOx radical ((triple bonds)OH + peroxy) loss in the boundary layer over polluted continental regions (largely due to sulfate and organic carbon) and for more than 70% over tropical biomass burning regions (largely due to organic carbon). Uptake of NO2 and NO3 accounts for 10-20% of total HNO3 production over biomass burning regions and less elsewhere. Annual mean OH concentrations decrease by 9% globally and by 5-35% in the boundary layer over the Northern Hemisphere. Simulated CO increases by 5- 15 ppbv in the remote Northern Hemisphere, improving agreement with observations. Simulated boundary layer O3 decreases by 15- 45 ppbv over India during the biomass burning season in March and by 5-9 ppbv over northern Europe in August, again improving comparison with observations. We find that particulate matter controls would increase surface O3 over Europe and other industrial regions.

High regression rate hybrid rocket fuel grains with helical port structures

NASA Astrophysics Data System (ADS)

Walker, Sean D.

Hybrid rockets are popular in the aerospace industry due to their storage safety, simplicity, and controllability during rocket motor burn. However, they produce fuel regression rates typically 25% lower than solid fuel motors of the same thrust level. These lowered regression rates produce unacceptably high oxidizer-to-fuel (O/F) ratios that produce a potential for motor instability, nozzle erosion, and reduced motor duty cycles. To achieve O/F ratios that produce acceptable combustion characteristics, traditional cylindrical fuel ports are fabricated with very long length-to-diameter ratios to increase the total burning area. These high aspect ratios produce further reduced fuel regression rate and thrust levels, poor volumetric efficiency, and a potential for lateral structural loading issues during high thrust burns. In place of traditional cylindrical fuel ports, it is proposed that by researching the effects of centrifugal flow patterns introduced by embedded helical fuel port structures, a significant increase in fuel regression rates can be observed. The benefits of increasing volumetric efficiencies by lengthening the internal flow path will also be observed. The mechanisms of this increased fuel regression rate are driven by enhancing surface skin friction and reducing the effect of boundary layer "blowing" to enhance convective heat transfer to the fuel surface. Preliminary results using additive manufacturing to fabricate hybrid rocket fuel grains from acrylonitrile-butadiene-styrene (ABS) with embedded helical fuel port structures have been obtained, with burn-rate amplifications up to 3.0x than that of cylindrical fuel ports.

Fuel reduction and coarse woody debris dynamics with early season and late season prescribed fire in a Sierra Nevada mixed conifer forest

USGS Publications Warehouse

Knapp, E.E.; Keeley, J.E.; Ballenger, E.A.; Brennan, T.J.

2005-01-01

Fire exclusion has led to an unnatural accumulation and greater spatial continuity of organic material on the ground in many forests. This material serves both as potential fuel for forest fires and habitat for a large array of forest species. Managers must balance fuel reduction to reduce wildfire hazard with fuel retention targets to maintain other forest functions. This study reports fuel consumption and changes to coarse woody debris attributes with prescribed burns ignited under different fuel moisture conditions. Replicated early season burn, late season burn, and unburned control plots were established in old-growth mixed conifer forest in Sequoia National Park that had not experienced fire for more than 120 years. Early season burns were ignited during June 2002 when fuels were relatively moist, and late season burns were ignited during September/October 2001 when fuels were dry. Fuel loading and coarse woody debris abundance, cover, volume, and mass were evaluated prior to and after the burns. While both types of burns reduced fuel loading, early season burns consumed significantly less of the total dead and down organic matter than late season burns (67% versus 88%). This difference in fuel consumption between burning treatments was significant for most all woody fuel components evaluated, plus the litter and duff layers. Many logs were not entirely consumed - therefore the number of logs was not significantly changed by fire - but burning did reduce log length, cover, volume, and mass. Log cover, volume, and mass were reduced to a lesser extent by early season burns than late season burns, as a result of higher wood moisture levels. Early season burns also spread over less of the ground surface within the burn perimeter (73%) than late season burns (88%), and were significantly patchier. Organic material remaining after a fire can dam sediments and reduce erosion, while unburned patches may help mitigate the impact of fire on fire-sensitive species by creating refugia from which these species can recolonize burned areas. Early season burns may be an effective means of moderating potential ecosystem damage when treating heavy and/or continuous fuels resulting from long periods of fire exclusion, if burning during this season is not detrimental to other forest functions. ?? 2005 Elsevier B.V. All rights reserved.

Quantifying spatial variability of depth of peat burn in wetlands in relation to antecedent characteristics using field data, multi-temporal and multi-spectral LiDAR

NASA Astrophysics Data System (ADS)

Chasmer, L.; Flade, L.; Virk, R.; Montgomery, J. S.; Hopkinson, C.; Thompson, D. K.; Petrone, R. M.; Devito, K.

2017-12-01

Landscape changes in the hydrological characteristics of wetlands in some parts of the Boreal region of Canada are occurring as a result of climate-induced feedbacks and anthropogenic disturbance. Wetlands are largely resilient to wildfire, however, natural, climatic and anthropogenic disturbances can change surface water regimes and predispose wetlands to greater depth of peat burn. Over broad areas, peat loss contributes to significant pollution emissions, which can affect community health. In this study, we a) quantify depth of peat burn and relationships to antecedent conditions (species type, topography, surficial geology) within three classified wetlands found in the Boreal Plains ecoregion of western Canada; and b) examine the impacts of wildfire on post-fire ground surface energy balance to determine how peat loss might affect local hydro-climatology and surface water feedbacks. High-resolution optical imagery, pre- and post-burn multi-spectral Light Detection And Ranging (LiDAR), airborne thermal infrared imagery, and field validation data products are integrated to identify multiple complex interactions within the study wetlands. LiDAR-derived depth of peat burn is within 1 cm (average) compared with measured (RMSE = 9 cm over the control surface), demonstrating the utility of LiDAR with high point return density. Depth of burn also correlates strongly with variations in Normalised Burn Ratio (NBR) determined for ground surfaces only. Antecedent conditions including topographic position, soil moisture, soil type and wetland species also have complex interactions with depth of peat loss within wetlands observed in other studies. However, while field measurements are important for validation and understanding eco-hydrological processes, results from remote sensing are spatially continuous. Temporal LiDAR data illustrate the full range of variability in depth of burn and wetland characteristics following fire. Finally, measurements of instantaneous surface temperature indicate that the temperatures of burned wetlands are significantly warmer by up to 10oC compared to non-burned wetlands, altering locally variable sensible vs. latent energy exchanges and implications for further post-fire evaporative losses.

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 ...

Insulin sensitivity is related to fat oxidation and protein kinase C activity in children with acute burn injury

PubMed Central

Cree, Melanie G.; Zwetsloot, Jennifer J.; Herndon, David N.; Newcomer, Bradley R.; Fram, Ricki Y.; Angel, Carlos; Green, Justin M.; Dohm, Gerald L.; Sun, Dayoung; Aarsland, Asle; Wolfe, Robert R.

2014-01-01

Objective Impaired fatty acid oxidation occurs with type 2 diabetes and is associated with accumulations of intracellular lipids, which may increase diacylglycerol, stimulate protein kinase C activity and inactivate insulin signaling. Glucose and fat metabolism are altered in burn patients, but have never been related to intracellular lipids or insulin signaling. Methods Thirty children sustaining >40% total body surface area burns were studied acutely with glucose and palmitate tracer infusions and a hyper-insulinemic euglycemic clamp. Muscle triglyceride, diacylglycerol, fatty acyl CoA and insulin signaling were measured. Liver and muscle triglyceride levels were measured with magnetic resonance spectroscopy. Muscle samples from healthy children were controls for diacylglycerol concentrations. Results Insulin sensitivity was reduced and correlated with whole body palmitate β-oxidation (P=0.004). Muscle insulin signaling was not stimulated by hyper-insulinemia. Tissue triglyceride concentrations and activated protein kinase C-β were elevated, whereas the concentration of diacylglycerol was similar to the controls. Free fatty acid profiles of muscle triglyceride did not match diacylglycerol. Conclusions Insulin resistance following burn injury is accompanied by decreased insulin signaling and increased protein kinase C-β activation. The best metabolic predictor of insulin resistance in burned patients was palmitate oxidation. PMID:18535477

How important is biomass burning in Canada to mercury contamination?

NASA Astrophysics Data System (ADS)

Fraser, Annemarie; Dastoor, Ashu; Ryjkov, Andrei

2018-05-01

Wildfire frequency has increased in past four decades in Canada and is expected to increase in future as a result of climate change (Wotton et al., 2010). Mercury (Hg) emissions from biomass burning are known to be significant; however, the impact of biomass burning on air concentration and deposition fluxes in Canada has not been previously quantified. We use estimates of burned biomass from FINN (Fire INventory from NCAR) and vegetation-specific emission factors (EFs) of mercury to investigate the spatiotemporal variability of Hg emissions in Canada. We use Environment and Climate Change Canada's GEM-MACH-Hg (Global Environmental Multi-scale, Modelling Air quality and Chemistry model, mercury version) to quantify the impact of biomass burning in Canada on spatiotemporal variability of air concentrations and deposition fluxes of mercury in Canada. We use North American gaseous elemental mercury (GEM) observations (2010-2015), GEM-MACH-Hg, and an inversion technique to optimize the EFs for GEM for five vegetation types represented in North American fires to constrain the biomass burning impacts of mercury. The inversion results suggest that EFs representing more vegetation types - specifically peatland - are required. This is currently limited by the sparseness of measurements of Hg from biomass burning plumes. More measurements of Hg concentration in the air, specifically downwind of fires, would improve the inversions. We use three biomass burning Hg emissions scenarios in Canada to conduct three sets of model simulations for 2010-2015: two scenarios where Hg is emitted only as GEM using literature or optimized EFs and a third scenario where Hg is emitted as GEM using literature EFs and particle bound mercury (PBM) emitted using the average GEM/PBM ratio from lab measurements. The three biomass burning emission scenarios represent a range of possible values for the impacts of Hg emissions from biomass burning in Canada on Hg concentration and deposition. We find total biomass burning Hg emissions to be highly variable from year to year and estimate average 2010-2015 total atmospheric biomass burning emissions of Hg in Canada to be between 6 and 14 t during the biomass burning season (i.e. from May to September), which is 3-7 times the mercury emission from anthropogenic sources in Canada for this period. On average, 65 % of the emissions occur in the provinces west of Ontario. We find that while emissions from biomass burning have a small impact on surface air concentrations of GEM averaged over individual provinces/territories, the impact at individual sites can be as high as 95 % during burning events. We estimate average annual mercury deposition from biomass burning in Canada to be between 0.3 and 2.8 t, compared to 0.14 t of mercury deposition from anthropogenic sources during the biomass burning season in Canada. Compared to the biomass burning emissions, the relative impact of fires on mercury deposition is shifted eastward, with on average 54 % percent of the deposition occurring in provinces west of Ontario. While the relative contribution of Canadian biomass burning to the total mercury deposition over each province/territory is no more than 9 % between 2010 and 2015, the local contribution in some locations (including areas downwind of biomass burning) can be as high as 80 % (e.g. northwest of Great Slave Lake in 2014) from May to September. We find that northern Alberta and Saskatchewan, central British Columbia, and the area around Great Slave Lake in the Northwest Territories are at greater risk of mercury contamination from biomass burning. GEM is considered to be the dominant mercury species emitted from biomass burning; however, there remains an uncertainty in the speciation of mercury released from biomass burning. We find that the impact of biomass burning emissions on mercury deposition is significantly affected by the uncertainty in speciation of emitted mercury because PBM is more readily deposited closer to the emission sources than GEM; an addition of ˜ 18 % percent of mercury emission from biomass burning in the form of PBM in the model increases the 6-year average deposition by ˜ 4 times.

Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients.

PubMed

Murray, Clinton K; Hoffmaster, Roselle M; Schmit, David R; Hospenthal, Duane R; Ward, John A; Cancio, Leopoldo C; Wolf, Steven E

2007-07-01

To investigate whether specific values of or changes in temperature, white blood cell count, or neutrophil percentage were predictive of bloodstream infection in burn patients. Retrospective review of electronic records. Intensive care center at the US Army Institute of Surgical Research Burn Center. Burn patients with blood cultures obtained from 2001 to 2004. Temperature recorded at the time blood cultures were obtained; highest temperature in each 6-hour interval during the 24 hours prior to this; white blood cell count and neutrophil percentage at the time of obtaining the blood culture and during the 24 hours preceding the blood culture; demographic data; and total body surface area burned. A total of 1063 blood cultures were obtained from 223 patients. Seventy-three people had 140 blood cultures from which microorganisms were recovered. Organisms that were recovered from blood cultures included 80 that were gram negative, 54 that were gram positive, 3 that were mixed gram positive/gram negative, and 3 yeasts. Although white blood cell count and neutrophil percentage at the time of the culture were statistically different between patients with and patients without bloodstream infection, receiver operating characteristic curve analysis revealed these values to be poor discriminators (receiver operating characteristic curve area = 0.624). Temperature or alterations in temperature in the preceding 24-hour period did not predict presence, absence, or type of bloodstream infection. Temperature, white blood cell count, neutrophil percentage, or changes in these values were not clinically reliable in predicting bloodstream infection. Further work is needed to identify alternative clinical parameters, which should prompt blood culture evaluations in this population.

Use and efficacy of a nutrition protocol for patients with burns in intensive care.

PubMed

Lown, D

1991-01-01

The University of Michigan Burn Center uses a protocol to standardize the assessment, initiation, and monitoring of nutritional support for patients with burns of greater than 30% total body surface area (TBSA). Six patients with 20% to 80% TBSA burns were followed for 3 weeks to determine the effect of the protocol on the assessment, initiation, monitoring, and adequacy of nutritional support. The protocol calls for resting energy expenditure (REE) measurement within 24 hours of injury, to be repeated 3 times per week, for assessment of caloric requirements. Patients experienced an average delay before first REE measurement of 3 days after burn injury because measurements were unavailable on weekends and surgical days. REE measurements were used to determine caloric requirements and to tailor nutritional support to fluctuating metabolic needs. In four of the six patients a Dobhoff feeding tube (Biosearch Medical Products, Inc., Somerville, N.J.) was placed in the small bowel and enteral nutrition was initiated within 24 hours of admission, as outlined in the protocol. Two patients received concurrent parenteral nutrition because of difficulty in placing the Dobhoff feeding tube when fluoroscopy was not available. The three patients receiving nutrition solely through enteral feeding had achieved 100% of their caloric requirements by day 2, 4, and greater than 7 days after injury, respectively. Overall, the six patients received enterally an average of 75% of their caloric requirements. The major reason for inadequate enteral support was interruption of tube feedings because of tube dislodgment or multiple surgical procedures. The protocol used weekly measurements of total iron-binding capacity and prealbumin level s parameters of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole body protein kinetics measured with a non-invasive method in severely burned children

PubMed Central

Børsheim, Elisabet; Chinkes, David L.; McEntire, Serina J.; Rodriguez, Nancy R.; Herndon, David N.; Suman, Oscar E.

2010-01-01

Persistent and extensive skeletal muscle catabolism is characteristic of severe burns. Whole body protein metabolism, an important component of this process, has not been measured in burned children during the long-term convalescent period. The aim of this study was to measure whole body protein turnover in burned children at discharge (95% healed) and in healthy controls by a non-invasive stable isotope method. Nine burned children (7 boys, 2 girls; 54 ± 14 (SD)% total body area burned; 13 ± 4 yrs; 45 ± 20 kg; 154 ± 14 cm) and 12 healthy children (8 boys, 4 girls; 12 ± 3 yrs; 54 ± 16 kg;150 ± 22 cm) were studied. A single oral dose of 15N-alanine (16 mg/kg) was given, and thereafter urine was collected for 34 hours. Whole body protein flux was calculated from labeling of urinary urea nitrogen. Then, protein synthesis was calculated as protein flux minus excretion, and protein breakdown as flux minus intake. At discharge, total protein turnover was 4.53 ± 0.65 (SE) g kg bodyweight−1 day−1 in the burned children compared to 3.20 ± 0.22 g kg−1 day−1 in controls (P = 0.02). Expressed relative to lean body mass (LBM), the rates were 6.12 ± 0.94 vs. 4.60 ± 0.36 g kg LBM−1 day−1 in burn vs. healthy (P = 0.06). Total protein synthesis was also elevated in burned vs. healthy children, and a tendency for elevated protein breakdown was observed. Conclusion: Total protein turnover is elevated in burned children at discharge compared to age-matched controls, possibly reflecting the continued stress response to severe burn. The oral 15N-alanine bolus method is a convenient, non-invasive, and no-risk method for measurement of total body protein turnover. PMID:20392565

Burns to the genitalia, perineum, and buttocks increase the risk of death among U.S. service members sustaining combat-related burns in Iraq and Afghanistan.

PubMed

Clemens, Michael S; Janak, Judson C; Rizzo, Julie A; Graybill, John C; Buehner, Michelle F; Hudak, Steven J; Thompson, Charles K; Chung, Kevin K

2017-08-01

Among service members injured in Iraq and Afghanistan, to determine the risk of mortality associated with combat-related burns to the genitalia, perineum, and buttocks. The prospectively maintained burn registry from the United States Army Institute of Surgical Research was retrospectively reviewed to identify all service members with combat-related burns sustained in Iraq and Afghanistan from March 2003 to October 2013. The two primary risk factors of interest were (1) any burn to the genitals, perineum, and/or buttocks (PB) and (2) burns involving the entire perineal, genital, and buttock region (complete PB). Cox proportional hazard models were used to estimate the risk of mortality for both primary risk factors, and adjusted for severe non-burn-related trauma, percent of burn over total body surface area (TBSA), inhalational injury, time to urinary tract infection, and time to bacteremia. A post-hoc analysis was performed to explore the potential effect modification of TBSA burned on the relationship between PB and mortality. Among the 902 U.S. service members with combat-related burns sustained during the study period, 226 (25.0%) had involvement of the genitalia, perineum, and/or buttocks. Complete PB was associated with a crude risk of mortality (HR: 5.3; 2.9-9.7), but not an adjusted risk (HR=1.8; 0.8-4.0). However, TBSA burned was identified as a potential negative effect modifier. Among patients with burns <60% TBSA, sustaining a complete PB conferred an adjusted risk of death (HR=2.7; 1.1-6.8). Further, patients with a perineal burn had a five-fold increased incidence of bacteremia. In adjusted models, each event of bacteremia increased the risk of mortality by 92% (HR 1.92; 1.39-2.65). Perineal burns were associated with a two-fold increased incidence of severe non-burn related trauma that also doubled mortality risk in adjusted models (HR 2.29; 1.23-4.27). Among those with relatively survivable combat-related burns (<60% TBSA), genital/perineal/buttock involvement increases the risk of death. Bacteremia may account for part of this increased risk, but does not fully explain the independent risk associated with perineal burns. Published by Elsevier Ltd.

Simulating high spatial resolution high severity burned area in Sierra Nevada forests for California Spotted Owl habitat climate change risk assessment and management.

NASA Astrophysics Data System (ADS)

Keyser, A.; Westerling, A. L.; Jones, G.; Peery, M. Z.

2017-12-01

Sierra Nevada forests have experienced an increase in very large fires with significant areas of high burn severity, such as the Rim (2013) and King (2014) fires, that have impacted habitat of endangered species such as the California spotted owl. In order to support land manager forest management planning and risk assessment activities, we used historical wildfire histories from the Monitoring Trends in Burn Severity project and gridded hydroclimate and land surface characteristics data to develope statistical models to simulate the frequency, location and extent of high severity burned area in Sierra Nevada forest wildfires as functions of climate and land surface characteristics. We define high severity here as BA90 area: the area comprising patches with ninety percent or more basal area killed within a larger fire. We developed a system of statistical models to characterize the probability of large fire occurrence, the probability of significant BA90 area present given a large fire, and the total extent of BA90 area in a fire on a 1/16 degree lat/lon grid over the Sierra Nevada. Repeated draws from binomial and generalized pareto distributions using these probabilities generated a library of simulated histories of high severity fire for a range of near (50 yr) future climate and fuels management scenarios. Fuels management scenarios were provided by USFS Region 5. Simulated BA90 area was then downscaled to 30 m resolution using a statistical model we developed using Random Forest techniques to estimate the probability of adjacent 30m pixels burning with ninety percent basal kill as a function of fire size and vegetation and topographic features. The result is a library of simulated high resolution maps of BA90 burned areas for a range of climate and fuels management scenarios with which we estimated conditional probabilities of owl nesting sites being impacted by high severity wildfire.

Upon admission coagulation and platelet function in patients with thermal and electrical injuries.

PubMed

Wade, Charles E; Baer, Lisa A; Cardenas, Jessica C; Folkerson, Lindley E; Nutall-Aurora, Kisha; Cotton, Bryan A; Matijevic, Nena; Holcomb, John B; Cross, James M; Huzar, Todd

2016-12-01

There has been increased focus on hemostatic potential and function in the initial assessment of the patient with traumatic injuries, that not been extensively studied in patients with burns. We proposed to determine the hemostatic potential of patients with burns upon admission to the emergency department and contrasted their condition with that of healthy controls and patients with other traumatic injuries. In addition we assessed differences due to thermal versus electrical injury and evaluated the effect of burn size. This is a patient based prospective observational study conducted with delayed consented. Subjects at the highest level of trauma activation upon admission to the ED had a blood sample collected for research purposes and were subsequently consented. Hemostatic potential was measured by rapid thromelastography (r-TEG ® ), thrombin generation by calibrated automated thrombogram (CAT) and platelet function by Multiplate ® using five activators. Burn subjects were compared to subjects with other traumatic injuries and controls. Within the burn subjects additional analysis compared mechanism (thermal vs. electrical) and burn size. Values are medians (IQR). Two hundred and eighty two trauma patients (with burns n=40, 14%) and 27 controls were enrolled. Upon admission, compared to controls, subjects with burns or trauma were hyper-coagulable based on r-TEG and CAT, with increased rates of clot formation and thrombin generation. There were no differences in burns compared to other traumatic injuries. The presence of hyper-coagulation did not appear to be related to the type of burn or the percentage of total body surface area involved. Employing previous defined cut points for R-TEG driven therapeutic interventions burn patients had similar rates of hyper- and hypo-coagulation noted in patients with traumatic injuries. Upon admission patients with burns are in a hyper-coagulable state similar to that of other trauma patients. Employing demonstrated cut points of hemostatic potential in trauma patients associated with increased risk of poor outcomes demonstrated the incidence in burn patients to be similar, suggesting that these values could be used in the early assessment of the patient with burns to guide treatment interventions. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Preparation of grout for stabilization of abandoned in-situ oil shale retorts. [Patent application

DOEpatents

Mallon, R.G.

1979-12-07

A process is described for the preparation of grout from burned shale by treating the burned shale in steam at approximately 700/sup 0/C to maximize the production of the materials alite and larnite. Oil shale removed to the surface during the preparation of an in-situ retort is first retorted on the surface and then the carbon is burned off, leaving burned shale. The burned shale is treated in steam at approximately 700/sup 0/C for about 70 minutes. The treated shale is then ground and mixed with water to produce a grout which is pumped into an abandoned, processed in-situ retort, flowing into the void spaces and then bonding up to form a rigid, solidified mass which prevents surface subsidence and leaching of the spent shale by ground water.

Characterization of porosity via secondary reactions. Final technical report, 1 September 1991--30 November 1995

DOE Office of Scientific and Technical Information (OSTI.GOV)

Calo, J.M.; Zhang, L.; Hall, P.J.

1997-09-01

A new approach to the study of porosity and porosity development in coal chars during gasification was investigated. This approach involves the establishment of the relationships between the amount and type of surface complexes evolved during post-activation temperature programmed desorption (TPD), and the porosity, as measured by gas adsorption and small angle neutron scattering (SANS) techniques. With this new method, the total surface area and micropore volume can be determined by the interpretation of post-activation TPD spectra. The primary conclusion of this work is that it is possible to predict total surface area and micropore volume from TPD spectra. Frommore » the extended random pore model, additional information about the micropore surface area, the nonmicroporous surface area, and the mean micropore size development as a function of reaction time (or burn-off) can also be predicted. Therefore, combining the TPD technique and the extended random pore model provides a new method for the characterization of char porosity.« less

[Analysis of projects received and funded in fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China during 2010-2013].

PubMed

Xiong, Kun; Wang, Linlin; Chen, Xulin; Cao, Yongqian; Xiang, Chuan; Xue, Lixiang; Yan, Zhangcai

2014-01-01

To summarized the projects received and funded in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China (NSFC) during 2010-2013, put forward the thinking and perspective of this future trend in these fields. The number of the funded project and total funding in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from NSFC during 2010-2013 had been statistical analyzed, in the meantime, the overview situation of various branches in basic research and further preliminary analysis the research frontier and hot issues have been analyzed. (1) The number of funded project were 581 in H15 of NSFC during 2010-2013, total funding reached to 277.13 million RMB, including 117 projects in H1511 (emergency and intensive care medicine/trauma/burns/plastic surgery and other science issue), 96 projects in H1507 (wound healing and scar), 88 projects in H1502 (multi-organ failure), 71 projects in H1505 (burn), 61 projects in H1504 (trauma). (2) The top 10 working unit for project funding in the field of emergency and intensive care medicine/trauma/burns/plastic surgery present as Third Military Medical University (70), Shanghai Jiao tong University (69), Second Military Medical University (40), Chinese PLA General Hospital (36), Forth Military Medical University (35), Zhejiang University (22), Sun Yat-Sen University (18), Southern Medical University (14), China Medical University (11), Capital Medical University (11) respectively, the number of funded project positive correlated with funding. (3) The funded research field in H15 covered almost all important organs and system injury or repair research, our scientists reached a fairly high level in some research field, for example, sepsis, trauma, repair, et al. "Sepsis" was funded 112 projects in H15 for 4 years, the growth rate became rapid and stable comparing to shock, burns and cardiopulmonary resuscitation funded projects' number. "Emergency and intensive care medicine/trauma/burns" research fields related to heart, lung, bone/cartilage/muscle, stomach/intestinal/liver, brain/spinal cord/peripheral nerve and other tissues/organs. The number of funded projects in plastic surgery related research fields in angioma and flap related projects were down below to 3 projects, but the number of funded project in wounds, scar repair related research field were more than other fields relatively. (4) In frontier and research hot issue, the funded rate represent as 23.8%, 21.4%, 19.0% and 23.9% in stem cell related research fields in 4 years respectively. The funded rate average to 20.9% in epigenetic related research fields for four years, the funded rate achieved to break through "zero" in autophagy related research fields, the total rate raised to 32.6% from 2011 to 2013. The funded number and funding were raised rapidly in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from NSFC. The application for each proposal should be focus on concise or upgrade the scientific issues to improve the quality. The depth or systematic in content and interdisciplinary research fields (e.g. immunology) should be paid attention to. Sepsis, trauma and burns will be the main stream direction in future in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery. The fields of wound healing and scar, surface organ defects, damage, repair and regeneration, surface tissue/organ transplantation and reconstruction, craniofacial deformities and correction are important develop directions in future work.

Phosphorus release from ash and remaining tissues of two wetland species after a prescribed fire.

PubMed

Liu, G D; Gu, B; Miao, S L; Li, Y C; Migliaccio, K W; Qian, Y

2010-01-01

Dead plant tissues and ash from a prescribed fire play an important role in nutrient balance and cycling in the Florida Everglades ecosystem. The objective of this study was to assess the dynamic changes in total phosphorus release (TPr) from ash or tissues of either cattail (Typha domingensis Pers.) or sawgrass (Cladium jamaicense Crantz) to water. Natural-dead (senesced-dead) and burning-dead (standing-dead due to a prescribed fire) cattail and sawgrass were collected from highly (H) and moderately (M) impacted zones in the Florida Everglades. This experiment was conducted by incubation and water-extraction of the materials in plastic bottles for 65 d at room temperature (24 +/- 1 degrees C). Results showed that 63 to 88%, 17 to 48%, 9 to 20%, and 13 to 28% of total P (TPp) were released as TPr from cattail and sawgrass ash, cattail tissues from the H zone, cattail tissues, and sawgrass tissues from the M zone, respectively. TPp means total P of plant tissues, whereas TPr is total P release from the tissues or ash. Most of the TPr was released within 24 h after burning. The quick release of TPr observed in this experiment may help explain the P surge in the surface water immediately following a fire in the marsh. These findings suggest that prescribed burning accelerates P release from cattail and sawgrass. They also imply that it is very important to keep the water stagnant in the first 24 h to maximize the benefits of a prescribed fire in the Everglades.

Landsat-Based Detection and Severity Analysis of Burned Sugarcane Plots in Tarlac, Philippines Using Differenced Normalized Burn Ratio (dNBR)

NASA Astrophysics Data System (ADS)

Baloloy, A. B.; Blanco, A. C.; Gana, B. S.; Sta. Ana, R. C.; Olalia, L. C.

2016-09-01

The Philippines has a booming sugarcane industry contributing about PHP 70 billion annually to the local economy through raw sugar, molasses and bioethanol production (SRA, 2012). Sugarcane planters adapt different farm practices in cultivating sugarcane, one of which is cane burning to eliminate unwanted plant material and facilitate easier harvest. Information on burned sugarcane extent is significant in yield estimation models to calculate total sugar lost during harvest. Pre-harvest burning can lessen sucrose by 2.7% - 5% of the potential yield (Gomez, et al 2006; Hiranyavasit, 2016). This study employs a method for detecting burn sugarcane area and determining burn severity through Differenced Normalized Burn Ratio (dNBR) using Landsat 8 Images acquired during the late milling season in Tarlac, Philippines. Total burned area was computed per burn severity based on pre-fire and post-fire images. Results show that 75.38% of the total sugarcane fields in Tarlac were burned with post-fire regrowth; 16.61% were recently burned; and only 8.01% were unburned. The monthly dNBR for February to March generated the largest area with low severity burn (1,436 ha) and high severity burn (31.14 ha) due to pre-harvest burning. Post-fire regrowth is highest in April to May when previously burned areas were already replanted with sugarcane. The maximum dNBR of the entire late milling season (February to May) recorded larger extent of areas with high and low post-fire regrowth compared to areas with low, moderate and high burn severity. Normalized Difference Vegetation Index (NDVI) was used to analyse vegetation dynamics between the burn severity classes. Significant positive correlation, rho = 0.99, was observed between dNBR and dNDVI at 5% level (p = 0.004). An accuracy of 89.03% was calculated for the Landsat-derived NBR validated using actual mill data for crop year 2015-2016.

Scalding in Turkish children: comparison of burns caused by hot water and hot milk.

PubMed

Tarim, Akin; Nursal, Tarik Zafer; Basaran, Ozgür; Yildirim, Sedat; Türk, Emin; Moray, Gökhan; Haberal, Mehmet

2006-06-01

Our aim in this study was to compare the clinical differences and etiologic risk factors for hot water and hot milk scald burns in Turkish children. The retrospective study examined the cases of 140 children aged 0.1-7 years who had scald burns treated in three burn units of a Turkish hospital network between March 2000 and December 2004. The patients were categorized in two groups: hot water burns or hot milk burns. Ninety-five (67.9%) patients had hot water burns and 45 (47.1%) had hot milk burns. The proportion of patients with hot milk burns who lived in rural areas was significantly higher than the corresponding proportion for the hot water cases (75.6% versus 52.6%, respectively; p<0.01). In 20 (44%) of the hot milk cases, the burn was caused by milk being boiled in large pots outdoors for cheese production. The other 25 hot milk cases were caused by milk being boiled in the kitchen. The mean (+/-S.D.) percentage total body surface area burned in the hot milk cases was higher than that in the hot water cases (33.6+/-2.24% versus 21.42+/-1.43%, respectively; p<0.001), and the corresponding mean percentages of TBSA with full-thickness burns were 9.2+/-2.52% versus 3.13+/-0.83%, respectively; (p=0.083). The mean percentages of TBSA with second-degree burns showed the same trend (29.0+/-12.39% versus 18.8+/-1.47%, respectively; p<0.001) higher percentage of the children with hot milk burns required antibiotics (78% versus 52.8%, respectively; p<0.006). Seven (7.4%) of the hot water burn patients and 15 (33.3%) of the hot milk burn patients died during the study period (p=0.025; overall mortality rate 15.7%). Children scalded with hot milk tend to have more extensive burns, and thus have higher mortality, than those scalded with hot water. To create effective programs for preventing scald injuries in Turkey and elsewhere, it is essential to consider ethnic and cultural issues based on these characteristics. Simple precautions should be explained and methods of using liquids such as hot milk should be researched in different geographic locations in order to formulate good prevention strategies.

Mass Burns Disaster in Abule-egba, Lagos, Nigeria from a Petroleum Pipeline Explosion Fire

PubMed Central

Fadeyibi, I.O.; Omosebi, D.T.; Jewo, P.I.; Ademiluyi, S.A.

2009-01-01

Summary The aim of this paper is to review the basic principles of triage in mass burns disasters and discuss the experience of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, in the December 2006 disaster at Abule-Egba, Lagos, Nigeria. It is hoped that the experience gained will help in the planning for and management of similar disasters in the developing countries with limited facilities. Burn injury has been described as the severest form of trauma and its management is very challenging as it is often accompanied by numerous pathophysiological changes. Successful management requires expert management by well-trained personnel in equipped and dedicated centres. In mass disasters the total number of victims may exceed the capability of the facility and its staff and a system for sorting out the patients and caring for those that will benefit from the facilities available needs to be developed. Other patients will either be sent to other medical facilities for further treatment or discharged after initial care for future follow-up. Documented experiences in the management of mass burns disasters from petroleum pipeline explosions from developing countries are rare. However, petroleum pipeline explosions, especially in the Lagos area of Nigeria, are relatively common. These cases have been associated with a variety of factors. The resulting morbidity and mortality have been high. LASUTH has a dedicated burns centre, which has received and managed many burn patients. Triage is the medical process of screening patients according to their need of treatment and the resources available. The aims and objectives of triage are discussed, its various levels described, and the final goals elaborated. All the burn victims involved in the 2006 disaster were studied, together with the triage carried out at different levels and the consequent sorting of the patients. Standard burns management was carried out. A total of 385 patients sustained burns of various degrees from the fire resulting from the explosion. On site, emergency department (ED) and intra-hospital triage were carried out. Ninety patients were brought to the LASUTH ED. Of these, 51 patients (56.67%) received first-aid treatment and were either discharged for out-patient follow-up or referred to secondary health care facilities. Twenty-eight (31.11%) out of the remaining 39 patients with burns in more than 70% total body surface area (TBSA) were categorized as unsalvageable and 11 (12.22%) with less than 70% TBSA as salvageable. All the patients in the unsalvageable group died (i.e. 100% mortality), while one patient died in the salvageable group (mortality rate, 9.09%). The mortality rate for the ruptured petroleum product pipeline incident was 84.16%; the fatality rate for all patients seen at LASUTH was 32.22%. The need for caution in the handling of petroleum products is discussed and the effectiveness of the triage system used is highlighted. In conclusion, burns from flammable petroleum products can be very dangerous and proper triage should therefore be carried out, with salvageable patients being managed by experts in dedicated burns centres. PMID:21991163

Theoretical Analysis on Marangoni-driven Cavity Formation in Ice during In Situ Burning of Oil Spills in Ice-infested Waters

NASA Astrophysics Data System (ADS)

Farmahini Farahani, H.; Jomaas, G.; Rangwala, A. S.

2017-12-01

In situ burning, intentional burning of discharged oil on the water surface, is a promising response method to oil spill accidents in the Arctic. However, burning of the oil adjacent to ice bodies creates a lateral cavity in the ice. As a result of the cavity formation the removal efficiency which is a key success criterion for in situ burning operation will decrease. The formation of lateral cavities are noticed recently and only a few experimental studies have addressed them. These experiments have shown lateral cavities with a length of <12 cm for 5 minutes burning of crude oil in laboratory. Our previous findings indicate the existence of a direct relation between the burning rate of the oil and penetration length in the ice. In addition, on the surface of the oil and near the ice the anchoring of the flame on the oil surface creates a severe horizontal temperature gradient which in turn generates a Marangoni flow from hot to cold regions. This is found to be the dominant heat transfer mechanism that is providing the heat for the ice to melt. Here, we introduce an order of magnitude analysis on the governing equations of the ice melting problem to estimate the penetration length of a burning oil near ice. This correlation incorporates the flame heat feedback with the surface flow driven by Marangoni convection. The melting energy continuity is also included in the analysis to complete the energy transfer cycle that leads to melting of the ice. The comparison between this correlation and the existing experimental data shows a very good agreement. Therefore, this correlation can be used to estimate the penetration length for burning of an actual spill and can be applied towards improved guidelines of burning adjacent to ice bodies, so as to enhance the chances for successful implantation of in situ burning.

The Baux score is dead. Long live the Baux score: a 27-year retrospective cohort study of mortality at a regional burns service.

PubMed

Roberts, Geoffrey; Lloyd, Mark; Parker, Mike; Martin, Rebecca; Philp, Bruce; Shelley, Odhran; Dziewulski, Peter

2012-01-01

To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008. Patient and burn-specific information and mortality were collated from written admission ledgers and the hospital coding department for 11,109 patients. The data set was divided into age cohorts (0-14, 15-44, 45-64, and >65 years) and time cohorts (1982-1991, 1992-2000, and 2000-2008). Lethal area 50 (LA50) was calculated by logistic regression and probit analysis. Mortality was related to the Baux score (age + total % burned surface area) by logistic regression. In the time period 2000 to 2008, the LA50 values with approximate 95% confidence intervals (CIs) were 100% (CI, 85.5-100%) in the 0 to 14 cohort (LA10, 78.3%; CI, 64.1-92.5%), 76.4% (CI, 69.1-83.8%) in the 15 to 44 cohort, 58.6% (CI, 50.8-66.5%) in the 45 to 64 cohort, and 30.8% (CI, 24.7-36.9%) in the >65 cohort. The point of futility (the Baux Score at which predicted mortality is 100%) was 160 and the Baux50 (the Baux score at which predicted mortality is 50%) was 109.6 (CI, 105.9-113.4) in the 2000 to 2008 cohort. Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage.

PubMed

Hu, Quan; Chai, Jiake; Hu, Sen; Fan, Jun; Wang, Hong-Wei; Ma, Li; Duan, Hong-Jie; Liu, Lingying; Yang, Hongming; Li, Bai-Ling; Wang, Yi-He

2015-12-01

The purposes of this study were to establish an animal model for burn-blast combined injury research and elaborate cardiopulmonary system changes in the early shock stage. In this study, royal demolition explosive or RDX (hexagon, ring trimethylene nitramine) was used as an explosive source, and the injury conditions of the canine test subjects at various distances to the explosion (30, 50, and 70 cm) were observed by gross anatomy and pathology to determine a larger animal model of moderate blast injury. The canines were then subjected to a 35 % total body surface area (TBSA) full-thickness flame injury using napalm, which completed the development of a burn-blast combined injury model. Based on this model, the hemodynamic changes and arterial blood gas analysis after the burn-blast combined injury were measured to identify the cardiopulmonary system characteristics. In this research, RDX explosion and flame injury were used to develop a severe burn-blast injury animal model that was stable, close to reality, and easily controllable. The hemodynamic and arterial blood gas changes in the canine subjects after burn-blast injury changed distinctly from the burn and blast injuries. Blood pressure and cardiac output fluctuated, and the preload was significantly reduced, whereas the afterload significantly increased. Meanwhile, the oxygen saturation (SO2) decreased markedly with carbon dioxide partial pressure (PCO2), and lactic acid (Lac) rose, and oxygen partial pressure (PO2) reduced. These changes suggested that immediate clinical treatment is important during burn-blast injury both to stabilize cardiac function and supply blood volume and to reduce the vascular permeability, thereby preventing acute pneumonedema or other complications.

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

PubMed Central

Fatemi, Mohammad Javad; Salehi, Hamid; Akbari, Hossein; Alinejad, Faranak; Saberi, Mohsen; Mousavi, Seyed Jaber; Soltani, Majid; Taghavi, Shahrzad; Payandan, Hossein

2013-01-01

Background: Burn injuries are one of the main causes of mortality and morbidity throughout the world and burn patients have higher chances for infection due to their decreased immune resistance. Levamisole, as an immunomodulation agent, stimulates the immune response against infection. Materials and Methods: This randomized clinical trial was conducted in Motahari Burn Center, Tehran, Iran. Patients who had second- or third-degree burn with involvement of more than 50% of total body surface area (TBSA) were studied. The levamisole group received levamisole tablet, 100 mg per day. Meantime, both the levamisole and control groups received the standard therapy of the Burn Center, based on a standard protocol. Then, the outcome of the patients was evaluated. Results: 237 patients entered the study. After excluding 42 patients with inhalation injury, electrical and chemical burns, and the patients who died in the first 72 h, 195 patients remained in the study, including 110 patients in the control group and 85 in the treatment group. The mean age of all patients (between 13 to 64 years) was 33.29 ± 11.39 years (Mean ± SD), and it was 33.86 ± 11.45 years in the control group and 32.57 ± 11.32 years in the treatment group. The mean percentage of TBSA burn was 64.50 ± 14.34 and 68.58 ± 14.55 for the levamisole and control groups, respectively, with the range of 50-100% and 50-95% TBSA. The mortality rate was 68 (61.8%) patients in the control group and 50 (58.8%) patients in the treatment group (P = 0.8). Conclusion: According to this study, there was no significant relationship between improvement of mortality and levamisole consumption. PMID:24381625

A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience

PubMed Central

Nessler, Michał B.; Drukala, Justyna; Bartoszewicz, Marzenna; Mądry, Ryszard

2014-01-01

Introduction The local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons. Aim This paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique. Material and methods For this study, 20 children aged between 4 and 12 years with 55–65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group). Results In the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal – 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC – 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001). Conclusions This study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children. PMID:25097488

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karlstad, M.D.; DeMichele, S.J.; Istfan, N.

The effects of burn and first-pass splanchnic leucine extraction (FPE) on protein kinetics and energy expenditure were assessed by measuring O/sub 2/ consumption, CO/sub 2/ production, nitrogen balance, leucine kinetics, and tissue fractional protein synthetic rates (FSR-%/day) in enterally fed rats. Anesthetized male rats (200 g) were scalded on their dorsum with boiling water (25-30% body surface area) and enterally fed isovolemic diets that provided 60 kcal/day and 2.4 g of amino acids/day for 3 days. Controls were not burned. An intravenous or intragastric infusion of L-(1-/sup 14/C)leucine was used to assess protein kinetics on day 3. FPE was takenmore » as the ratio of intragastric to intravenous plasma leucine specific activity. There was a 69% reduction in cumulative nitrogen balance (P less than 0.001) and a 17-19% increase in leucine oxidation (P less than 0.05) and total energy expenditure (P less than 0.01) in burned rats. A 15% decrease in plasma leucine clearance (P less than 0.05) was accompanied by a 20% increase in plasma (leucine) (P less than 0.01) in burned rats. Burn decreased rectus muscle FSR from 5.0 +/- 0.4 to 3.5 +/- 0.5 (P less than 0.05) and increased liver FSR from 19.0 +/- 0.5 to 39.2 +/- 3.4 (P less than 0.01). First pass extraction of dietary leucine by the splanchnic bed was 8% in controls and 26% in burned rats. Leucine kinetics corrected for FPE showed increased protein degradation with burn that was not evident without FPE correction. This hypermetabolic burn model can be useful in the design of enteral diets that optimize rates of protein synthesis and degradation.« less

Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury.

PubMed

Arshad, Sira N; Gaskell, Sarah L; Baker, Charlotte; Ellis, Nicola; Potts, Jennie; Coucill, Theresa; Ryan, Lynn; Smith, Jan; Nixon, Anna; Greaves, Kate; Monk, Rebecca; Shelmerdine, Teresa; Leach, Alison; Shah, Mamta

2015-06-01

Returning to school can be a major step for burn-injured children, their family, and staff and pupils at the receiving school. Previous literature has recognised the difficulties children may face after a significant injury and factors that may influence a successful reintegration. A regional paediatric burns service recognised that some patients were experiencing difficulties in returning to school. A baseline audit confirmed this and suggested factors that hindered or facilitated this process, initiating the development of a school reintegration programme (SRP). Since the programme's development in 2009, it has been audited annually. The aim of this paper was to evaluate the impact of the SRP by presenting data from the 2009 to 2011 audits. For the baseline audit, the burn care team gathered information from clinical records (age, gender, total body surface area burned (TBSA), skin grafting and length of stay) and telephone interviews with parents and teachers of the school returners. For the re-audits, the same information was gathered from clinical records and feedback questionnaires. Since its introduction, the mean length of time from discharge to return to school has dropped annually for those that opted into the programme, when compared to the baseline by 62.3% (53 days to 20 days). Thematic analysis highlights positive responses to the programme from all involved. Increased awareness and feeling supported were amongst the main themes to emerge. Returning to school after a significant burn injury can be challenging for all involved, but we hypothesise that outreach interventions in schools by burns services can have a positive impact on the time it takes children to successfully reintegrate. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial.

PubMed

Gee Kee, Emma; Kimble, Roy M; Cuttle, Leila; Stockton, Kellie

2013-11-25

In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤ 10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Australian New Zealand Clinical Trials Registry ACTRN12613000105741.

Accelerated Burn Wound Closure in Mice with a New Formula Based on Traditional Medicine

PubMed Central

Mehrabani, Mehrnaz; Seyyedkazemi, Seyyed Mohsen; Nematollahi, Mohammad Hadi; Jafari, Elham; Mehrabani, Mitra; Mehdipour, Mohammad; Sheikhshoaee, Zahra; Mandegary, Ali

2016-01-01

Background A combination of the oils of sesame, hemp, wild pistachio, and walnut has been used for treatment of skin disorders, including wound burns, in some parts of Kerman, Iran. Evaluation of this remedy in the form of a pharmaceutical formulation in animal models can pave the way for its future application in wound burn healing in humans. Objectives This experimental study investigated the healing potential of a new formula (NF) based on folk medicine from Iran for the treatment of third degree burns in mice. The formula was a combination of the oils of four plants: sesame (Sesamum indicum L.), wild pistachio (Pistacia atlantica Desf.), hemp (Cannabis sativa L.), and walnut (Juglans regia L.) Methods Twenty-four mice were selected based on simple random sampling. Twenty-five percent of the total body surface area was burned by exposure to boiling water, according to the Walker-Mason method. NF and silver sulfadiazine (the positive control) were applied topically twice a day for 21 days. The burned area in the negative control group was left untreated. Epithelialization time and the percent of wound contraction were measured during the treatment period. The process of wound repairing was evaluated using histological (H and E and trichrome staining) and immunohistological (anti-pancytokeratin) methods. Results When compared to the controls, NF significantly improved wound contraction after day 10. Epithelialization time in the NF group was significantly faster than in the other groups (20 vs. 25.5 days) (P < 0.001). Histopathological and immunohistochemical findings confirmed the efficacy of the NF. Conclusions A new therapeutic remedy was introduced for the treatment of burn wounds. Further clinical and molecular studies are suggested to determine the exact mechanism(s) involved in the burn wound healing effect of NF. PMID:28191338

Colored corn starch dust explosion-related ocular injuries at a Taiwan water park: A preliminary report from a single medical center

PubMed Central

Liao, Yi-Lin; Yeh, Lung-Kun; Tsai, Yueh-Ju; Chen, Shin-Yi

2016-01-01

Purpose: To elucidate the manifestations of ocular injuries in the colored corn starch dust explosion at a Taiwan water park. Methods: This is a retrospective, non-comparative, consecutive-interventional case series. Fifty explosion-injury patients on 27 June 2015 treated at Chang-Gung Memorial Hospital, Linkou, were included. Thorough ophthalmic examinations were based on emergent triage and consecutive ophthalmological consultations. Multiple ocular and systemic parameters were assessed. Results: Of the 100 eyes in the 50 cases reviewed, 22 cases were male and 28 cases were female. The mean age was 22.08 ± 4.64 years, and the mean burn total body surface area (TBSA) of patients was 45.92 ± 20.30%. Of the 50 patients, 20 had Grade 1 ocular burns, and the others were without ocular involvement. Two of the 20 cases that presented Grade 1 ocular burns died within 1 month due to other systemic complications. The most common ocular manifestations among those with ocular injuries included periocular swelling (75%), followed by conjunctival chemosis (65%), conjunctival hyperemia (50%), singed eyelashes (20%), cornea epithelial defects (10%), and punctate keratopathy (5%). It is worth mentioning that one patient developed herpes simplex keratitis due to stress 3 weeks after being burned. Half of the 50 patients had facial burns. Specifically, the patients with a greater TBSA presented more significant ocular-burn manifestations than those patients with lower TBSA. Conclusion: Prompt ophthalmologic consultations are particularly necessary for mass burn-casualty patients with facial burns, inhalation injuries, and greater TBSA. The inspection and control of all ignition sources and the manipulation of dust with low concentrations and in an open space are crucial factors to prevent future dust explosions. PMID:29018726

Propranolol and Oxandrolone Therapy Accelerated Muscle Recovery in Burned Children.

PubMed

Chao, Tony; Porter, Craig; Herndon, David N; Siopi, Aikaterina; Ideker, Henry; Mlcak, Ronald P; Sidossis, Labros S; Suman, Oscar E

2018-03-01

Severe burns result in prolonged hypermetabolism and skeletal muscle catabolism. Rehabilitative exercise training (RET) programs improved muscle mass and strength in severely burned children. The combination of RET with β-blockade or testosterone analogs showed improved exercise-induced benefits on body composition and muscle function. However, the effect of RET combined with multiple drug therapy on muscle mass, strength, cardiorespiratory fitness, and protein turnover are unknown. In this placebo-controlled randomized trial, we hypothesize that RET combined with oxandrolone and propranolol (Oxprop) will improve muscle mass and function and protein turnover in severely burned children compared with burned children undergoing the same RET with a placebo. We studied 42 severely burned children (7-17 yr) with severe burns over 30% of the total body surface area. Patients were randomized to placebo (22 control) or to Oxprop (20) and began drug administration within 96 h of admission. All patients began RET at hospital discharge as part of their standardized care. Muscle strength (N·m), power (W), V˙O2peak, body composition, and protein fractional synthetic rate and fractional breakdown rate were measured pre-RET (PRE) and post-RET (POST). Muscle strength and power, lean body mass, and V˙O2peak increased with RET in both groups (P < 0.01). The increase in strength and power was significantly greater in Oxprop versus control (P < 0.01), and strength and power was greater in Oxprop over control POST (P < 0.05). Fractional synthetic rate was significantly higher in Oxprop than control POST (P < 0.01), resulting in improved protein net balance POST (P < 0.05). Rehabilitative exercise training improves body composition, muscle function, and cardiorespiratory fitness in children recovering from severe burns. Oxprop therapy augments RET-mediated improvements in muscle strength, power, and protein turnover.

Flame retardant emission from e-waste recycling operation in northern Vietnam: environmental occurrence of emerging organophosphorus esters used as alternatives for PBDEs.

PubMed

Matsukami, Hidenori; Tue, Nguyen Minh; Suzuki, Go; Someya, Masayuki; Tuyen, Le Huu; Viet, Pham Hung; Takahashi, Shin; Tanabe, Shinsuke; Takigami, Hidetaka

2015-05-01

Three oligomeric organophosphorus flame retardants (o-PFRs), eight monomeric PFRs (m-PFRs), tetrabromobisphenol A (TBBPA), and polybrominated diphenyl ethers (PBDEs) were identified and quantified in surface soils and river sediments around the e-waste recycling area in Bui Dau, northern Vietnam. Around the e-waste recycling workshops, 1,3-phenylene bis(diphenyl phosphate) (PBDPP), bisphenol A bis(diphenyl phosphate) (BPA-BDPP), triphenyl phosphate (TPHP), TBBPA, and PBDEs were dominant among the investigated flame retardants (FRs). The respective concentrations of PBDPP, BPA-BDPP, TPHP, TBBPA and the total PBDEs were 6.6-14000 ng/g-dry, <2-1500 ng/g-dry, 11-3300 ng/g-dry, <5-2900 ng/g-dry, and 67-9200 ng/g-dry in surface soils, and 4.4-78 ng/g-dry, <2-20 ng/g-dry, 7.3-38 ng/g-dry, 6.0-44 ng/g-dry and 100-350 ng/g-dry in river sediments. Near the open burning site of e-waste, tris(methylphenyl) phosphate (TMPP), (2-ethylhexyl)diphenyl phosphate (EHDPP), TPHP, and the total PBDEs were abundantly with respective concentrations of <2-190 ng/g-dry, <2-69 ng/g-dry, <3-51 ng/g-dry and 1.7-67 ng/g-dry in surface soils. Open storage and burning of e-waste have been determined to be important factors contributing to the emissions of FRs. The environmental occurrence of emerging FRs, especially o-PFRs, indicates that the alternation of FRs addition in electronic products is shifting in response to domestic and international regulations of PBDEs. The emissions of alternatives from open storage and burning of e-waste might become greater than those of PBDEs in the following years. The presence and environmental effects of alternatives should be regarded as a risk factor along with e-waste recycling. Copyright © 2015 Elsevier B.V. All rights reserved.

Preventing Scars after Injury with Partial Irreversible Electroporation

PubMed Central

Golberg, Alexander; Villiger, Martin; Khan, Saiqa; Quinn, Kyle P.; Lo, William C. Y.; Bouma, Brett E.; Mihm, Martin C.; Austen, William G.; Yarmush, Martin L.

2017-01-01

Preventing the formation of hypertrophic scars, especially those that are a result of major trauma or burns, would have enormous impact in the fields of regenerative and trauma medicine. In this report, we introduce a non-invasive method to prevent scarring based on non-thermal partial irreversible electroporation. Contact burn injuries in rats were treated with varying treatment parameters to optimize the treatment protocol. Scar surface area and structural properties of the scar were assessed with histology and non-invasive, longitudinal imaging with polarization-sensitive optical coherence tomography. We found that partial irreversible electroporation using 200 pulses of 250 V and 70 μs duration, delivered at 3 Hz every 20 days during a total of five therapy sessions after the initial burn injury resulted in a 57.9% reduction of the scar area in comparison with untreated scars and structural features approaching those of normal skin. Noteworthy, unlike humans, rats do not develop hypertrophic scars. Therefore, the use of a rat animal model is the limiting factor of this work. PMID:27393126

Suicidal burns in Samarkand burn centers and their consequences.

PubMed

Shakirov, B M; Ahmedov, Y M; Hakimov, E A; Tagaev, K R; Karabaev, B H

2013-12-31

Suicide is a global public health problem, particularly in Asia where few countries with large populations have high suicide rates accounting for the majority of the world's suicides. During a 14-year period, 76 individuals, aged 17 to 66 years, committed suicide from 1995 to 2008 and were included in this report. Data was collected on each patient including, age, sex, place of injury, patient occupation, accommodation, psychiatric illness, suicidal motives, flammable substances used, place of burn, season of the year, and total body surface area (TBSA) burnt. Most suicidal cases (55 out of 76) had a history of depressive episodes and emotional unstable disorders, and 18 of them had a known history of psychiatric illness. In 5 cases alcohol intoxication was present at the moment of suicide, and 3 patients had chronic alcohol dependence together with basic psychiatric disease. It is also evident from this study that the causes of suicide in females are mainly socio-economical and psychological.

Burns (Part 2). Tops and flops using cultured epithelial autografts in children.

PubMed

Meuli, M; Raghunath, M

1997-09-01

The goal of this article is to review the status of cultured epithelial autografts in clinical practice with particular focus on the pediatric subset of patients. The current indications include massive deep burns (>60 - 70% total body surface area), resurfacing-type postburn scar revisions, and skin defect coverage following excision of large skin lesions like giant nevi. Although this method can be lifesaving for massively burned patients, and although excellent functional and cosmetic results may be obtained under ideal circumstances, formidable problems continue to exist. Take is inconsistent, cultured grafts are extremely susceptible to infection, and skin breakdown during the first months post grafting may occur due to mechanical instability of the regenerating skin. It may take one more decade of concerted research, jointly performed by clinicians and tissue culture technology experts in order to fabricate more skin-like grafts which are robust, reliable, and less expensive. Then, "cultured skin" will conquer the world and benefit countless patients.

Suicidal burns in Samarkand burn centers and their consequences

PubMed Central

Shakirov, B.M.; Ahmedov, Y.M.; Hakimov, E.A.; Tagaev, K.R.; Karabaev, B.H.

2013-01-01

Summary Suicide is a global public health problem, particularly in Asia where few countries with large populations have high suicide rates accounting for the majority of the world’s suicides. During a 14-year period, 76 individuals, aged 17 to 66 years, committed suicide from 1995 to 2008 and were included in this report. Data was collected on each patient including, age, sex, place of injury, patient occupation, accommodation, psychiatric illness, suicidal motives, flammable substances used, place of burn, season of the year, and total body surface area (TBSA) burnt. Most suicidal cases (55 out of 76) had a history of depressive episodes and emotional unstable disorders, and 18 of them had a known history of psychiatric illness. In 5 cases alcohol intoxication was present at the moment of suicide, and 3 patients had chronic alcohol dependence together with basic psychiatric disease. It is also evident from this study that the causes of suicide in females are mainly socio-economical and psychological. PMID:24799853

Burns inflicted by self or by others--an 11 year snapshot.

PubMed

Malic, C C; Karoo, R O S; Austin, O; Phipps, A

2007-02-01

In the United Kingdom, the incidence of assault by burning and of self inflicted burns increased significantly over the last decade. This has major implications both for service providers and society as a whole. Our aim was to investigate the differences in patients' characteristics, management and outcome following a burn sustained by either an assault or self immolation. Acute admissions to a tertiary Burn Centre were retrospectively reviewed over an 11 year period (1994-2005). Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of the patients were collected. Over an 11 year period, 1745 patients were admitted to the tertiary Burn Centre. Of this total, 41 patients (mean age 29 years+/-16) sustained burns following an assault, a further 86 patients (mean age of 37 years+/-12) had self inflicted burn injuries; males were preponderant in both groups. In this series, a history of alcohol or substance abuse was present in 25% of both cohorts, 63% of the patients with self inflicted injuries having a previously diagnosed psychiatric disorder. Petrol, accelerants and other flammable liquids were the main agents chosen to inflict injury in both the assault and self inflicted groups. The burn depth and surface area distribution was greater in the self inflicted group compared to those assaulted (29% versus 21%). A difference was also noted in the pattern of distribution of burns between the two groups, as well as between genders although this difference was not significant. Two-thirds (67.4%) of the self immolated patients and 56% of the assaulted group required surgery. The length of hospital stay was similar for both groups, averaging 20 days. The crude mortality for the self inflicted group was 29%, whereas in the assaulted patients, the overall mortality was 4.9%. Although the incidence of burns caused either by assault or attempted suicide is low, the affected patients require a multidisciplinary approach. Their management requires significant medical, psychological occupational and social support. Increased awareness and education of those vulnerable individuals maybe of benefit to help prevent self inflicted injuries by burning.

A review of community management of paediatric burns.

PubMed

Cox, S G; Martinez, R; Glick, A; Numanoglu, A; Rode, H

2015-12-01

This study was a component of a broader review to evaluate burn care in South Africa. A prospective audit of 353 children with thermal injuries admitted to the Red Cross War Memorial Children's Hospital in Cape Town was performed during 2012/2013. The audit was based to assess the adherence of initial burn management to the provincial policy guidelines on the clinical management of the burn wound. The community management of each patient prior to admission to a burns centre was assessed for the following: basic demographics, emergency home management, wound cover, analgesia and transport to medical facilities. Their ages ranged from 1 month to 14 years. The average total body surface area [TBSA] was 15% [1-86%]. Most of the injuries were due to hot water accidents [78.5%] followed by flame burns (9%), direct contact and electricity burns. Two hundred and twenty five children [63%] received first aid measures at home, including cooling with water [166] ice [30] and a cooling agent. No cooling was instituted in 130 and 65% of the patient's wounds were cooled for 10 min or less. Eighty percent proceeded to the referral centre or burns unit without their wounds being covered; with only 19 patients having any medical type of dressing available at home. Two hundred and ninety five children [83.6%] received pain medication prior to admission at the burns unit. Of the 316 patients not directly attending the burns unit, 137 received i.v. fluids of which 95 had burns greater than 10% TBSA. None of the patients were in shock on admission and all i.v. lines were functioning. Forty-four children with burns greater than 10% did not receive i.v. fluids. The audit identified six factors that were inadequately addressed during the pre-admission period: first aid, cooling of the wound, early covering of the wound, resuscitation, pain management and transfer. If these could be readdressed, basic burn care would be substantially improved in the study area. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Randomized Controlled Trial of Polyhexanide/Betaine Gel Versus Silver Sulfadiazine for Partial-Thickness Burn Treatment.

PubMed

Wattanaploy, Saruta; Chinaroonchai, Kusuma; Namviriyachote, Nantaporn; Muangman, Pornprom

2017-03-01

Silver sulfadiazine is commonly used in the treatment of partial-thickness burns, but it sometimes forms pseudo-eschar and delays wound healing. Polyhexanide/betaine gel, a new wound cleansing and moisturizing product, has some advantages in removing biofilm and promotes wound healing. This study was designed to compare clinical efficacy of polyhexanide/betaine gel with silver sulfadiazine in partial-thickness burn treatment. From September 2013 to May 2015, 46 adult patients with partial-thickness burn ≥10% total body surface area that were admitted to the Burn Unit of Siriraj Hospital within 48 hours after injury were randomly allocated into 2 groups. One group was treated with polyhexanide/betaine gel, and the other group was treated with silver sulfadiazine. Both groups received daily dressing changes and the same standard care given to patients with burns in this center. Healing times in the polyhexanide/betaine gel group and silver sulfadiazine group were 17.8 ± 2.2 days and 18.8 ± 2.1 days, respectively ( P value .13). There were no significant differences in healing times, infection rates, bacterial colonization rates, and treatment cost in both groups. The pain score of the polyhexanide/betaine gel group was significantly less than the silver sulfadiazine group at 4 to 9 days after treatment ( P < .001). The satisfactory assessment result of the polyhexanide/betaine gel group was better than that in the silver sulfadiazine group. These data indicate the need for adequately designed studies to elicit the full potential of polyhexanide gel as a wound dressing for partial-thickness burn wounds.

An analysis of surgical and anaesthetic factors affecting skin graft viability in patients admitted to a Burns Intensive Care Unit.

PubMed

Isitt, Catherine E; McCloskey, Kayleigh A; Caballo, Alvaro; Sharma, Pranev; Williams, Andrew; Leon-Villapalos, Jorge; Vizcaychipi, Marcela P

2016-01-01

Skin graft failure is a recognised complication in the treatment of major burns. Little research to date has analysed the impact of the complex physiological management of burns patients on the success of skin grafting. We analysed surgical and anaesthetic variables to identify factors contributing to graft failure. Inclusion criteria were admission to our Burns Intensive Care Unit (BICU) between January 2009 and October 2013 with a major burn. After exclusion for death before hospital discharge or prior skin graft at a different hospital, 35 patients remained and were divided into those with successful autografts (n=16) and those with a failed autograft (n=19). For the purposes of this study, we defined poor autograft viability as requiring at least one additional skin graft to the same site. Logistic regression of variables was performed using SPSS (Version 22.0 IBMTM). Age, Sex, %Total Burn Surface Area or Belgian Outcome Burns Injury score did not significantly differ between groups. No differences were found in any surgical factor at logistic regression (graft site, harvest site, infection etc.). When all operations were analysed, the use of colloids was found to be significantly associated with graft failure (p=0.035, CI 95%) and this remained significant when only split thickness skin grafts (STSGs) and debridement operations were included (p=0.034, CI 95%). No differences were found in crystalloid use, intraoperative temperature, pre-operative haemoglobin and blood products or vasopressor use. This analysis highlights an independent association between colloids and graft failure which has not been previously documented.

Localization of burn mark under an abnormal topography on MOSFET chip surface using liquid crystal and emission microscopy tools.

PubMed

Lau, C K; Sim, K S; Tso, C P

2011-01-01

This article focuses on the localization of burn mark in MOSFET and the scanning electron microscope (SEM) inspection on the defect location. When a suspect abnormal topography is shown on the die surface, further methods to pin-point the defect location is necessary. Fault localization analysis becomes important because an abnormal spot on the chip surface may and may not have a defect underneath it. The chip surface topography can change due to the catastrophic damage occurred at layers under the chip surface, but it could also be due to inconsistency during metal deposition in the wafer fabrication process. Two localization techniques, liquid crystal thermography and emission microscopy, were performed to confirm that the abnormal topography spot is the actual defect location. The tiny burn mark was surfaced by performing a surface decoration at the defect location using hot hydrochloric acid. SEM imaging, which has the high magnification and three-dimensional capabilities, was used to capture the images of the burn mark. Copyright © 2011 Wiley Periodicals, Inc.

Landscape Patterns of Burn Severity in the Soberanes Fire of 2016

NASA Technical Reports Server (NTRS)

Potter, Christopher

2016-01-01

The Soberanes Fire started on July 22, 2016 in Monterey County on the California Central Coast from an illegal campfire. This fire burned for 10 weeks at a record cost of more than $208 million for protection and control. A progressive analysis of the normalized burn ratio from the Landsat satellite showed that the final high burn severity (HBS) area for the Soberanes Fire comprised 22 percent of the total area burned, whereas final moderate burn severity (MBS) area comprised about 10 percent of the total area burned of approximately 53,470 ha (132,130 acres). The resulting landscape pattern of burn severity classes from the 2016 Soberanes Fire revealed that the majority of HBS area was located in the elevation zone between 500 and 1000 m, in the slope zone between 15 percent and 30 percent, or on south-facing aspects.

Influence of early childhood burns on school performance: an Australian population study.

PubMed

Azzam, Nadin; Oei, Ju-Lee; Adams, Susan; Bajuk, Barbara; Hilder, Lisa; Mohamed, Abdel-Latif; Wright, Ian M R; Holland, Andrew J A

2018-05-01

To determine the influence of burn injuries on childhood performance in national standardised curriculum-based school tests. Birth and health records of 977 children who were hospitalised with a burn injury between 2000 and 2006 in the state of New South Wales, Australia, were linked to performance scores in the National Assessment Program: Literacy and Numeracy test, a compulsory nationwide curriculum-based test (CBT) and compared with children who were not hospitalised for burns and who were matched for birth year, gender, gestation and socioeconomic status. Test scores in years 3 (ages 8-9), 5 (ages 10-11) and 7 (ages 13-14) in numeracy, writing, reading, spelling, grammar and punctuation. Mean age at first burn injury was 28 months (median: 20, range: 0-140). Children with burns were significantly more likely to have younger mothers (28.5 vs 29.6 years) (P<0.001), be indigenous (OR 2.5 (95% CI 2.1 to 3.1)) (P<0.001) and have siblings (OR 1.2 (95% CI 1.1 to 1.4)) (P<0.001). They were also less likely to meet national minimum standards in most domains of testing until year 5, even after adjustment for parental education levels, parental smoking, maternal age and indigenous status. Each 10% increase in total body surface area burnt was associated with a decrease in year 5 scores by 37.0% in numeracy and 71.9% in writing. Most childhood burn injuries occur before the start of formal schooling. Children who are hospitalised for burns perform more poorly in CBT even after accounting for family and socioeconomic disadvantage. Rehabilitation of children with burn injuries must address school performance to decrease any long-term negative societal impact of burns. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns: study protocol for a randomized controlled trial.

PubMed

Rashaan, Zjir M; Krijnen, Pieta; van den Akker-van Marle, M Elske; van Baar, Margriet E; Vloemans, Adrianus F P; Dokter, Jan; Tempelman, Fenike R H; van der Vlies, Cees H; Breederveld, Roelf S

2016-03-05

Partial thickness burns are painful, difficult to manage and can have a negative effect on quality of life through scarring, permanent disfigurement and loss of function. The aim of burn treatment in partial thickness burns is to save lives, stimulate wound healing by creating an optimumly moist wound environment, to have debriding and analgesic effects, protect the wound from infection and be convenient for the patient and caregivers. However, there is no consensus on the optimal treatment of partial thickness wounds. Flaminal® and Flamazine® are two standard treatment options that provide the above mentioned properties in burn treatment. Nevertheless, no randomized controlled study has yet compared these two common treatment modalities in partial thickness burns. Thus, the aim of this study is to evaluate the clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns. In this two-arm open multi-center randomized controlled trial, 90 patients will be randomized between Flaminal® and Flamazine® and followed for 12 months. The study population will consist of competent or temporarily non-competent (because of sedation and/or intubation) patients, 18 years of age or older, with acute partial thickness burns and a total body surface area (TBSA) of less than 30 %. The main study outcome is time to complete re-epithelialization (greater than 95 %). Secondary outcome measures include need for grafting, wound colonization/infection, number of dressing changes, pain and anxiety, scar formation, health-related quality of life (HRQoL), and costs. This study will contribute to the optimal treatment of patients with partial thickness burn wounds and will provide evidence on the (cost-)effectiveness and quality of life of Flaminal® versus Flamazine® in the treatment of partial thickness burns. Netherlands Trial Register NTR4486 , registered on 2 April 2014.

Anxiety, depression and PTSD-related symptoms in spouses and close relatives of burn survivors: When the supporter needs to be supported.

PubMed

Bond, Suzie; Gourlay, Catherine; Desjardins, Alexandra; Bodson-Clermont, Paule; Boucher, Marie-Ève

2017-05-01

The aim of the study was to assess the prevalence of anxiety, depression and PTSD-related symptoms reported by spouses and close relatives of adult burn survivors. Potential associations between these symptoms and variables such as the severity of the burn were also explored. Participants were spouses (n=31) and close relatives (n=25) of hospitalized patients with acute burns. Anxiety and depression symptoms were assessed by the Hospital Distress Anxiety and Depression Scale and PTSD-related symptoms by the Modified PTSD Symptom Scale at both admission to and discharge from the burn unit. At admission, 77% of spouses and 56% of close relatives of burn patients reported anxiety, depression or PTSD-related symptoms in the clinical range. While spouses had higher scores than close relatives on symptom measures, significant differences were only established for anxiety symptoms (p<.02). A significant effect was found for gender, with women reporting more anxiety (p=.01) and depression (p=.02) symptoms than men. Results also showed a main effect for time, with anxiety (p<.0001), depression (p<.0001) and PTSD-related (p<.0001) symptoms being higher at admission than at discharge. Variables associated with the index patient, such as total body surface area burned, length of stay, number of ventilated days, facial burns, or level of care at admission, were not associated with outcome measures. Spouses and close relatives of burn survivors showed high levels of psychological distress in the first few days following admission, and more than a quarter still reported symptoms in the clinical range at discharge. Our analysis points to the need to offer psychological support and guidance to family members so that they can in turn provide effective support to the burn survivor. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.

PubMed

Boyce, Steven T; Simpson, Peggy S; Rieman, Mary T; Warner, Petra M; Yakuboff, Kevin P; Bailey, J Kevin; Nelson, Judith K; Fowler, Laura A; Kagan, Richard J

Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository, correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7 ± 9.7 for ESS compared with a maximum of 4.0 ± 0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the National Burn Repository (P < .05). Engraftment was 83.5 ± 2.0% for ESS and 96.5 ± 0.9% for AG. Percentage TBSA closed was 29.9 ± 3.3% for ESS, and 47.0 ± 2.0% for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R value of 0.65 (P < .001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.

Evaluation of long term health-related quality of life in extensive burns: a 12-year experience in a burn center.

PubMed

Xie, Bing; Xiao, Shi-chu; Zhu, Shi-hui; Xia, Zhao-fan

2012-05-01

We sought to evaluate the long term health-related quality of life (HRQOL) in patients survived severely extensive burn and identify their clinical predicting factors correlated with HRQOL. A cross-sectional study was conducted in 20 patients survived more than 2 years with extensive burn involving ≥70% total body surface area (TBSA) between 1997 and 2009 in a burn center in Shanghai. Short Form-36 Medical Outcomes Survey (SF-36), Brief Version of Burn Specific Health Scale (BSHS-B) and Michigan Hand Outcome Questionnaire (MHQ) were used for the present evaluation. SF-36 scores were compared with a healthy Chinese population, and linear correlation analysis was performed to screen the clinical relating factors predicting physical and mental component summary (PCS and MCS) scores from SF-36. HRQOL scores from SF-36 were significantly lower in the domains of physical functioning, role limitations due to physical problems, pain, social functioning and role limitations due to emotional problems compared with population norms. Multiple linear regression analysis demonstrated that only return to work (RTW) predicted improved PCS. While age at injury, facial burns, skin grafting and length of hospital stay were correlated with MCS. Work, body image and heat sensitivity obtained the lowest BSHS-B scores in all 9 domains. Improvements of HRQOL could still be seen in BSHS-B scores in domains of simple abilities, hand function, work and affect even after a quite long interval between burns and testing. Hand function of extensive burn patients obtained relatively poor MHQ scores, especially in those without RTW. Patients with extensive burns have a poorer quality of life compared with that of general population. Relatively poor physical and psychological problems still exist even after a long period. Meanwhile, a trend of gradual improvements was noted. This information will aid clinicians in decision-making of comprehensive systematic regimens for long term rehabilitation and psychosocial treatment. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Direct Mouse Trauma/Burn Model of Heterotopic Ossification

PubMed Central

Peterson, Jonathan R.; Agarwal, Shailesh; Brownley, R. Cameron; Loder, Shawn J.; Ranganathan, Kavitha; Cederna, Paul S.; Mishina, Yuji; Wang, Stewart C.; Levi, Benjamin

2015-01-01

Heterotopic ossification (HO) is the formation of bone outside of the skeleton which forms following major trauma, burn injuries, and orthopaedic surgical procedures. The majority of animal models used to study HO rely on the application of exogenous substances, such as bone morphogenetic protein (BMP), exogenous cell constructs, or genetic mutations in BMP signaling. While these models are useful they do not accurately reproduce the inflammatory states that cause the majority of cases of HO. Here we describe a burn/tenotomy model in mice that reliably produces focused HO. This protocol involves creating a 30% total body surface area partial thickness contact burn on the dorsal skin as well as division of the Achilles tendon at its midpoint. Relying solely on traumatic injury to induce HO at a predictable location allows for time-course study of endochondral heterotopic bone formation from intrinsic physiologic processes and environment only. This method could prove instrumental in understanding the inflammatory and osteogenic pathways involved in trauma-induced HO. Furthermore, because HO develops in a predictable location and time-course in this model, it allows for research to improve early imaging strategies and treatment modalities to prevent HO formation. PMID:26274052

Predictive role of arterial carboxyhemoglobin concentrations in ovine burn and smoke inhalation-induced lung injury.

PubMed

Lange, Matthias; Cox, Robert A; Enkhbaatar, Perenlei; Whorton, Elbert B; Nakano, Yoshimitsu; Hamahata, Atsumori; Jonkam, Collette; Esechie, Aimalohi; von Borzyskowski, Sanna; Traber, Lillian D; Traber, Daniel L

2011-05-01

Inhalation injury frequently occurs in burn patients and contributes to the morbidity and mortality of these injuries. Arterial carboxyhemoglobin has been proposed as an indicator of the severity of inhalation injury; however, the interrelation between arterial carboxyhemoglobin and histological alterations has not yet been investigated. Chronically instrumented sheep were subjected to a third degree burn of 40% of the total body surface area and inhalation of 48 breaths of cotton smoke. Carboxyhemoglobin was measured immediately after injury and correlated to clinical parameters of pulmonary function as well as histopathology scores from lung tissue harvested 24 hours after the injury. The injury was associated with a significant decline in pulmonary oxygenation and increases in pulmonary shunting, lung lymph flow, wet/dry weight ratio, congestion score, edema score, inflammation score, and airway obstruction scores. Carboxyhemoglobin was negatively correlated to pulmonary oxygenation and positively correlated to pulmonary shunting, lung lymph flow, and lung wet/dry weight ratio. No significant correlations could be detected between carboxyhemoglobin and histopathology scores and airway obstruction scores. Arterial carboxyhemoglobin in sheep with combined burn and inhalation injury are correlated with the degree of pulmonary failure and edema formation, but not with certain histological alterations including airway obstruction scores.

Characterization of post-fire surface cover, soils, and burn severity at the Cerro Grande Fire, New Mexico, using hyperspectral and multispectral remote sensing

USGS Publications Warehouse

Kokaly, R.F.; Rockwell, B.W.; Haire, S.L.; King, T.V.V.

2007-01-01

Forest fires leave behind a changed ecosystem with a patchwork of surface cover that includes ash, charred organic matter, soils and soil minerals, and dead, damaged, and living vegetation. The distributions of these materials affect post-fire processes of erosion, nutrient cycling, and vegetation regrowth. We analyzed high spatial resolution (2.4??m pixel size) Airborne Visible and Infrared Imaging Spectrometer (AVIRIS) data collected over the Cerro Grande fire, to map post-fire surface cover into 10 classes, including ash, soil minerals, scorched conifer trees, and green vegetation. The Cerro Grande fire occurred near Los Alamos, New Mexico, in May 2000. The AVIRIS data were collected September 3, 2000. The surface cover map revealed complex patterns of ash, iron oxide minerals, and clay minerals in areas of complete combustion. Scorched conifer trees, which retained dry needles heated by the fire but not fully combusted by the flames, were found to cover much of the post-fire landscape. These scorched trees were found in narrow zones at the edges of completely burned areas. A surface cover map was also made using Landsat Enhanced Thematic Mapper plus (ETM+) data, collected September 5, 2000, and a maximum likelihood, supervised classification. When compared to AVIRIS, the Landsat classification grossly overestimated cover by dry conifer and ash classes and severely underestimated soil and green vegetation cover. In a comparison of AVIRIS surface cover to the Burned Area Emergency Rehabilitation (BAER) map of burn severity, the BAER high burn severity areas did not capture the variable patterns of post-fire surface cover by ash, soil, and scorched conifer trees seen in the AVIRIS map. The BAER map, derived from air photos, also did not capture the distribution of scorched trees that were observed in the AVIRIS map. Similarly, the moderate severity class of Landsat-derived burn severity maps generated from the differenced Normalized Burn Ratio (dNBR) calculation had low agreement with the AVIRIS classes of scorched conifer trees. Burn severity and surface cover images were found to contain complementary information, with the dNBR map presenting an image of degree of change caused by fire and the AVIRIS-derived map showing specific surface cover resulting from fire.

A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT.

PubMed

Rosenberg, Lior; Krieger, Yuval; Bogdanov-Berezovski, Alex; Silberstein, Eldad; Shoham, Yaron; Singer, Adam J

2014-05-01

Excisional debridement followed by autografting is the standard of care (SOC) for deep burns, but is associated with serious potential complications. Conservative, non-surgical and current enzymatic debridement methods are inefficiently slow. We determined whether a non-surgical option of rapid enzymatic debridement with the debriding enzyme NexoBrid™ (NXB) would reduce need for surgery while achieving similar esthetic and functional outcomes as SOC. We conducted a multi-center, open-label, randomized, controlled clinical trial including patients aged 4-55 years with deep partial and full thickness burns covering 5-30% of their total body surface area (TBSA). Patients were randomly assigned to burn debridement with NXB (applied for 4h) or SOC, which included surgical excisional or non-surgical debridement. NXB significantly reduced the time from injury to complete débridement (2.2 vs. 8.7 days, P<0.0001), need for surgery (24.5% vs. 70.0%, P<0.0001), the area of burns excised (13.1% vs. 56.7%, P<0.0001) and the need for autografting (17.9% vs. 34.1%, P=0.01). Scar quality and quality of life scores were similar in both study groups as were the rates of adverse events. Enzymatic débridement with NXB resulted in reduced need for and extent of surgery compared with SOC while achieving comparable long-term results in patients with deep burns. Clinical Trials.gov NCT00324311. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

[Entering the Dawn of a New Life: A Discussion of Life for Survivors of the Formosa Fun Coast Water Park Explosion].

PubMed

Wen, Hui-Min

2016-02-01

A dust explosion at the Formosa Fun Coast water park in Taiwan caused nearly 500 burn injury cases. One hundred of these cases involved burns over more than 20% of the total body surface area. This tragedy inundated hospitals across northern Taiwan with an unprecedented number of burn patients. Significant manpower and medical resources were targeted on related resuscitation and treatment efforts, with support and assistance provided by agencies and organizations nationwide. Most of the burn patients were young people in their teens and twenties, whose severe burns posed the greatest threat and challenge to their lives so far. Furthermore, their experience presented major psychosocial and physical health challenges. Patients received an array of clinical treatments such as debridement, skin grafting, dressing, and rehabilitation. Debilitating pain, skin damage, changes to body image, physical disabilities, helplessness, sadness, and anxiety have not only deeply affected the patients physically and psychologically but also created significant life stresses for their family members / companions, which requires counseling in order to facilitate emotional healing. Although burn patients gradually recover as they pass through the acute, recovery, and rehabilitation phases, they will face the challenges of lifelong rehabilitation after discharge. I hope that these young victims will take courage and be brave and strong in dealing with the difficulties and challenges of daily life and will embrace the future with hope as they enter the dawn of their new life.

[Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery].

PubMed

Carneiro, João Miguel Gonçalves Valadares de Morais; Alves, Joana; Conde, Patrícia; Xambre, Fátima; Almeida, Emanuel; Marques, Céline; Luís, Mariana; Godinho, Ana Maria Mano Garção; Fernandez-Llimos, Fernando

Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM ® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10g.dL -1 and the other blood products by routine coagulation and ROTEM ® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Prehospital burn management in a combat zone.

PubMed

Lairet, Kimberly F; Lairet, Julio R; King, Booker T; Renz, Evan M; Blackbourne, Lorne H

2012-01-01

The purpose of this article is to provide a descriptive study of the management of burns in the prehospital setting of a combat zone. A retrospective chart review was performed of U.S. casualties with >20% total-body-surface-area thermal burns, transported from the site of injury to Ibn Sina Combat Support Hospital (CSH) between January 1, 2006, and August 30, 2009. Ibn Sina CSH received 225 burn casualties between January 2006 and August 2009. Of these, 48 met the inclusion criteria. The mean Injury Severity Score was 31.7 (range 4 to 75). Prehospital vascular access was obtained in 24 casualties (50%), and 20 of the casualties received fluid resuscitation. Out of the 48 casualties enrolled, 28 (58.3%) did not receive prehospital fluid resuscitation. Of the casualties who received fluid resuscitation, nearly all received volumes in excess of the guidelines established by the American Burn Association and those recommended by the Committee for Tactical Combat Casualty Care. With regard to pain management in the prehospital setting, 13 casualties (27.1%) received pain medication. With regard to the prehospital fluid resuscitation of primary thermal injury in the combat zone, two extremes were noted. The first group did not receive any fluid resuscitation; the second group was resuscitated with fluid volumes higher than those expected if established guidelines were utilized. Pain management was not uniformly provided to major burn casualties, even in several with vascular access. These observations support improved education of prehospital personnel serving in a combat zone.

The investigation of critical burning of fuel droplets

NASA Technical Reports Server (NTRS)

Allison, C. B.; Canada, G. S.; Faeth, G. M.

1973-01-01

The combustion and evaporation of liquid fuels at high pressures were investigated. Particular emphasis was placed on conditions where the liquid surface approaches the thermodynamic critical point during combustion. The influence of transient effects on a burning liquid fuel was also investigated through both analysis and measurements of the response of liquid monopropellant combustion to imposed pressure oscillations. Work was divided into four phases (1) Droplet combustion at high pressures, which consider both measurement and analysis of the porous sphere burning rate of liquids in a natural convection environment at elevated pressure. (2) High pressure droplet burning in combustion gases, which involved steady burning and evaporation of liquids from porous spheres in a high pressure environment that simulates actual combustion chamber conditions. (3) Liquid strand combustion, which considered the burning rate, the state of the liquid surface and the liquid phase temperature distribution of a burning liquid monopropellant column over a range of pressures. (4) Oscillatory combustion, which was a theoretical and experimental investigation of the response of a burning liquid monopropellant to pressure oscillations.

Measurement of Solid Rocket Propellant Burning Rate Using X-ray Imaging

NASA Astrophysics Data System (ADS)

Denny, Matthew D.

The burning rate of solid propellants can be difficult to measure for unusual burning surface geometries, but X-ray imaging can be used to measure burning rate. The objectives of this work were to measure the baseline burning rate of an electrically-controlled solid propellant (ESP) formulation with real-time X-ray radiography and to determine the uncertainty of the measurements. Two edge detection algorithms were written to track the burning surface in X-ray videos. The edge detection algorithms were informed by intensity profiles of simulated 2-D X-ray images. With a 95% confidence level, the burning rates measured by the Projected-Slope Intersection algorithm in the two combustion experiments conducted were 0.0839 in/s +/-2.86% at an average pressure of 407 psi +/-3.6% and 0.0882 in/s +/-3.04% at 410 psi +/-3.9%. The uncertainty percentages were based on the statistics of a Monte Carlo analysis on burning rate.

A review of the peri-operative management of paediatric burns: Identifying adverse events.

PubMed

Rode, H; Brink, C; Bester, K; Coleman, M P; Baisey, T; Martinez, R

2016-11-02

Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission, according to burn admission criteria, about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small, residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures. To review the peri-operative management and standard of surgical care of burnt children. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified. There were 257 males and 301 females in this study, with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%, with an average of 23.5%. Inhalational injury was present in 11.3%, pneumonia in 13.1%, wound sepsis in 20.8%, and septicaemia in 9.7%, and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0°C. Core temperatures recorded at the start, halfway through and at completion of surgery were 36.9°C, 36.8°C and 36.5°C, respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL, respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

Estimates of global biomass burning emissions for reactive greenhouse gases (CO, NMHCs, and NOx) and CO2

NASA Astrophysics Data System (ADS)

Jain, Atul K.; Tao, Zhining; Yang, Xiaojuan; Gillespie, Conor

2006-03-01

Open fire biomass burning and domestic biofuel burning (e.g., cooking, heating, and charcoal making) algorithms have been incorporated into a terrestrial ecosystem model to estimate CO2 and key reactive GHGs (CO, NOx, and NMHCs) emissions for the year 2000. The emissions are calculated over the globe at a 0.5° × 0.5° spatial resolution using tree density imagery, and two separate sets of data each for global area burned and land clearing for croplands, along with biofuel consumption rate data. The estimated global and annual total dry matter (DM) burned due to open fire biomass burning ranges between 5221 and 7346 Tg DM/yr, whereas the resultant emissions ranges are 6564-9093 Tg CO2/yr, 438-568 Tg CO/yr, 11-16 Tg NOx/yr (as NO), and 29-40 Tg NMHCs/yr. The results indicate that land use changes for cropland is one of the major sources of biomass burning, which amounts to 25-27% (CO2), 25 -28% (CO), 20-23% (NO), and 28-30% (NMHCs) of the total open fire biomass burning emissions of these gases. Estimated DM burned associated with domestic biofuel burning is 3,114 Tg DM/yr, and resultant emissions are 4825 Tg CO2/yr, 243 Tg CO/yr, 3 Tg NOx/yr, and 23 Tg NMHCs/yr. Total emissions from biomass burning are highest in tropical regions (Asia, America, and Africa), where we identify important contributions from primary forest cutting for croplands and domestic biofuel burning.

Tanning bed burns reported on Twitter: over 15,000 in 2013.

PubMed

Seidenberg, Andrew B; Pagoto, Sherry L; Vickey, Theodore A; Linos, Eleni; Wehner, Mackenzie R; Costa, Renata Dalla; Geller, Alan C

2016-06-01

Few surveillance tools exist for monitoring tanning bed injuries. Twitter data were examined to identify and describe reports of tanning bed-caused burns. Tweets sent in 2013 containing keywords for tanning bed use and burning were content analyzed to determine whether a burn caused by a tanning bed was described, and additional data on tanning behavior and burn characteristics were extracted. After content assessment, 15,178 (64 %) tweets were found to describe a tanning bed-caused burn. Sites most reportedly burnt were buttocks (n = 3117), face/head (n = 1020), and chest/breast (n = 546). Alarmingly, 200 burns to the eyes/eyelids were mentioned. A total of 456 tweets described burning >1 time from a tanning bed. A total of 211 tweets mentioned falling asleep inside the tanning bed. In 2013, over 15,000 tweets reported tanning bed-caused burns. Twitter data provides unique insight into tanning behaviors and injuries not captured through traditional public health surveillance.

Energy balance studies and plasma catecholamine values for patients with healed burns.

PubMed

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

1991-01-01

We report heat balance studies and plasma catecholamine values for 49 children and young adults with healed burn wounds (age range 0.6 to 31 years and burn range 1% to 82% body surface area burned; mean 41%). All measurements were made during the week of discharge. Heat production for patients with healed burns was not significantly different from predicted normal values. However, compartmented heat loss demonstrated a persistent increment in evaporative heat loss that was secondary to continued elevation of cutaneous water vapor loss immediately after wound closure. A reciprocal decrement in dry heat loss was demonstrated (as a result of a cooler average surface temperature, 0.84 degree C cooler than the average integrated skin temperature of five normal volunteers who were studied in our unit under similar environmental conditions). Mean values for plasma catecholamines were in the normal range: epinephrine = 56 +/- 37 pg/ml, norepinephrine = 385 +/- 220 pg/ml, and dopamine = 34 +/- 29 pg/ml. In conclusion, patients with freshly healed burn wounds have normal rates of heat production; however, there is a residual increment in transcutaneous water vapor loss, which produces surface cooling and decreased average surface temperature, which in turn lowers dry heat loss by an approximately equivalent amount.

Puerarin attenuates severe burn-induced acute myocardial injury in rats.

PubMed

Liu, Sheng; Ren, Hong-Bo; Chen, Xu-Lin; Wang, Fei; Wang, Ren-Su; Zhou, Bo; Wang, Chao; Sun, Ye-Xiang; Wang, Yong-Jie

2015-12-01

Puerarin, the main isoflavone glycoside extracted from the root of Pueraria lobata, is widely prescribed for patients with cardiovascular disorders in China. This study investigates the effect of puerarin on severe burn-induced acute myocardial injury in rats and its underlying mechanisms. Healthy adult Wistar rats were divided into three groups: (1) sham group, sham burn treatment; (2) burn group, third-degree burns over 30% of the total body surface area (TBSA) with lactated Ringer's solution for resuscitation; and (3) burn plus puerarin group, third-degree burns over 30% of TBSA with lactated Ringer's solution containing puerarin for resuscitation. The burned animals were sacrificed at 1, 3, 6, 12, and 24 h after burn injury. Myocardial injury was evaluated by analyzing serum creatine kinase MB fraction (CK-MB) activity and cardiac troponin T (cTNT) level. Changes in cardiomyocyte ultrastructure were also determined using a transmission electron microscope. Tumor necrosis factor (TNF)-α concentration in serum was measured by radioimmunoassay. Cardiac myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration were measured to determine neutrophil infiltration and oxidative stress in the heart, respectively. The expression of p38 mitogen-activated protein (MAP) kinase in the heart was determined by Western blot analysis. After the 30% TBSA full-thickness burn injury, serum CK-MB activities and cTnT levels increased markedly, both of which were significantly decreased by the puerarin treatment. The level of serum TNF-α concentration in burn group at each time-point was obviously higher than those in sham group (1.09±0.09 ng/ml), and it reached the peak value at 12 h post burn. Burn trauma also resulted in worsen ultrastructural condition, elevated MPO activity and MDA content in heart tissue, and a significant activation of cardiac p38 MAP kinase. Administration of puerarin improved the ultrastructural changes in cardiomyocytes, decreased TNF-α concentration in serum as well as suppressed cardiac MPO activity and reduced MDA content, and abolished the activation of p38 MAP kinase in heart tissue after severe burn. These results suggest that puerarin attenuates inflammatory responses, reduces neutrophil infiltration and oxidative stress in the heart, and protects against acute myocardial injury induced by severe burn. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Biomass Burning Data and Information

Atmospheric Science Data Center

2015-04-21

Biomass Burning Data and Information This data set represents ... geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ... models of the atmosphere. Project Title:  Biomass Burning Discipline:  Tropospheric Composition ...

Understanding Changes in Modeled Land Surface Characteristics Prior to Lightning-Initiated Holdover Fire Breakout

NASA Technical Reports Server (NTRS)

Schultz, Christopher J.; Case, Jonathan L.; Hain, Christopher R.; White, Kristopher; Wachter, J. Brent; Nauslar, Nicholas; MacNamara, Brittany

2018-01-01

Lightning initiated wildfires are only 16% of the total number of wildfires within the United States, but account for 56% of the acreage burned. One of the challenges with lightning-initiated wildfires is their ability to "holdover" which means smolder for up to 2+ weeks before breaking out into a full fledged fire. This work helps characterize the percentage of holdover events due to lightning, and helps quantify changes in the land surface characteristics to help understand trends in soil moisture and vegetation stress that potentially contribute to the fire breaking out into a full wildfire.

30 CFR 57.6903 - Burning explosive material.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Burning explosive material. 57.6903 Section 57... General Requirements-Surface and Underground § 57.6903 Burning explosive material. If explosive material is suspected of burning at the blast site, persons shall be evacuated from the endangered area and...

30 CFR 57.6903 - Burning explosive material.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Burning explosive material. 57.6903 Section 57... General Requirements-Surface and Underground § 57.6903 Burning explosive material. If explosive material is suspected of burning at the blast site, persons shall be evacuated from the endangered area and...

30 CFR 57.6903 - Burning explosive material.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Burning explosive material. 57.6903 Section 57... General Requirements-Surface and Underground § 57.6903 Burning explosive material. If explosive material is suspected of burning at the blast site, persons shall be evacuated from the endangered area and...

30 CFR 57.6903 - Burning explosive material.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Burning explosive material. 57.6903 Section 57... General Requirements-Surface and Underground § 57.6903 Burning explosive material. If explosive material is suspected of burning at the blast site, persons shall be evacuated from the endangered area and...

30 CFR 57.6903 - Burning explosive material.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Burning explosive material. 57.6903 Section 57... General Requirements-Surface and Underground § 57.6903 Burning explosive material. If explosive material is suspected of burning at the blast site, persons shall be evacuated from the endangered area and...

Application of X-ray television image system to observation in solid rocket motor

NASA Astrophysics Data System (ADS)

Fujiwara, T.; Ito, K.; Tanemura, T.; Shimizu, M.; Godai, T.

The X-ray television image system is used to observe the solid propellant burning surface during rocket motor operation as well as to inspect defects in solid rocket motors in a real time manner. This system can test 200 mm diameter dummy propellant rocket motors with under 2 percent discriminative capacity. Viewing of a 50 mm diameter internal-burning rocket motor, propellant burning surface time transition and propellant burning process of the surroundings of artificial defects were satisfactorily observed. The system was demonstrated to be effective for nondestructive testing and combustion research of solid rocket motors.

Investigation of critical burning of fuel droplets

NASA Technical Reports Server (NTRS)

Allison, C. B.; Canada, G. S.

1972-01-01

Fuel droplets were simulated by porous spheres having diameters in the range 0.63 to 1.9 cm and combustion tests were conducted at pressures up to 78 atm in a quiescent cold air environment. Measurements were made of the burning rate and liquid surface temperature during steady combustion. A high pressure flat flame burner apparatus is under development in order to allow testing of high pressure droplet burning in a combustion gas environment. Work was continued on the high pressure strand combustion characteristics of liquid fuels, with the major emphasis on hydrazine. Data was obtained on the burning rate and liquid surface temperatures at pressures in the range 7 to 500 psia. The response of a burning liquid monopropellant to imposed pressure oscillations is being investigated.

Fluidized combustion of coal. [to limit SO2 and NOx emissions

NASA Technical Reports Server (NTRS)

Pope, M.

1978-01-01

A combustion technology that permits the burning of low quality coal, and other fuels, while maintaining stack emissions within State and Federal EPA limits is discussed. Low quality fuels can be burned directly in fluidized beds while taking advantage of low furnace temperatures and chemical activity within the bed to limit SO2 and NOx emissions. The excellent heat transfer characteristics of the fluidized beds also result in a reduction of total heat transfer surface requirements. Tests on beds operating at pressures of one to ten atmospheres, at temperatures as high as 1600 F, and with gas velocities in the vicinity of four to twelve feet per second, have proven the concept. The progress that has been made in the development of fluidized bed combustion technology and work currently underway are discussed.

Experimental Methodology for Estimation of Local Heat Fluxes and Burning Rates in Steady Laminar Boundary Layer Diffusion Flames.

PubMed

Singh, Ajay V; Gollner, Michael J

2016-06-01

Modeling the realistic burning behavior of condensed-phase fuels has remained out of reach, in part because of an inability to resolve the complex interactions occurring at the interface between gas-phase flames and condensed-phase fuels. The current research provides a technique to explore the dynamic relationship between a combustible condensed fuel surface and gas-phase flames in laminar boundary layers. Experiments have previously been conducted in both forced and free convective environments over both solid and liquid fuels. A unique methodology, based on the Reynolds Analogy, was used to estimate local mass burning rates and flame heat fluxes for these laminar boundary layer diffusion flames utilizing local temperature gradients at the fuel surface. Local mass burning rates and convective and radiative heat feedback from the flames were measured in both the pyrolysis and plume regions by using temperature gradients mapped near the wall by a two-axis traverse system. These experiments are time-consuming and can be challenging to design as the condensed fuel surface burns steadily for only a limited period of time following ignition. The temperature profiles near the fuel surface need to be mapped during steady burning of a condensed fuel surface at a very high spatial resolution in order to capture reasonable estimates of local temperature gradients. Careful corrections for radiative heat losses from the thermocouples are also essential for accurate measurements. For these reasons, the whole experimental setup needs to be automated with a computer-controlled traverse mechanism, eliminating most errors due to positioning of a micro-thermocouple. An outline of steps to reproducibly capture near-wall temperature gradients and use them to assess local burning rates and heat fluxes is provided.

Experimental Methodology for Estimation of Local Heat Fluxes and Burning Rates in Steady Laminar Boundary Layer Diffusion Flames

PubMed Central

Singh, Ajay V.; Gollner, Michael J.

2016-01-01

Modeling the realistic burning behavior of condensed-phase fuels has remained out of reach, in part because of an inability to resolve the complex interactions occurring at the interface between gas-phase flames and condensed-phase fuels. The current research provides a technique to explore the dynamic relationship between a combustible condensed fuel surface and gas-phase flames in laminar boundary layers. Experiments have previously been conducted in both forced and free convective environments over both solid and liquid fuels. A unique methodology, based on the Reynolds Analogy, was used to estimate local mass burning rates and flame heat fluxes for these laminar boundary layer diffusion flames utilizing local temperature gradients at the fuel surface. Local mass burning rates and convective and radiative heat feedback from the flames were measured in both the pyrolysis and plume regions by using temperature gradients mapped near the wall by a two-axis traverse system. These experiments are time-consuming and can be challenging to design as the condensed fuel surface burns steadily for only a limited period of time following ignition. The temperature profiles near the fuel surface need to be mapped during steady burning of a condensed fuel surface at a very high spatial resolution in order to capture reasonable estimates of local temperature gradients. Careful corrections for radiative heat losses from the thermocouples are also essential for accurate measurements. For these reasons, the whole experimental setup needs to be automated with a computer-controlled traverse mechanism, eliminating most errors due to positioning of a micro-thermocouple. An outline of steps to reproducibly capture near-wall temperature gradients and use them to assess local burning rates and heat fluxes is provided. PMID:27285827

Fire environment effects on particulate matter emission factors in southeastern U.S. pine-grasslands

NASA Astrophysics Data System (ADS)

Robertson, Kevin M.; Hsieh, Yuch P.; Bugna, Glynnis C.

2014-12-01

Particulate matter (PM) emission factors (EFPM), which predict particulate emissions per biomass consumed, have a strong influence on event-based and regional PM emission estimates and inventories. PM < 2.5 μm aerodynamic diameter (PM2.5), regulated for its impacts to human health and visibility, is of special concern. Although wildland fires vary widely in their fuel conditions, meteorology, and fire behavior which might influence combustion reactions, the EFPM2.5 component of emission estimates is typically a constant for the region or general fuel type being assessed. The goal of this study was to use structural equation modeling (SEM) to identify and measure effects of fire environment variables on EFPM2.5 in U.S. pine-grasslands, which contribute disproportionately to total U.S. PM2.5 emissions. A hypothetical model was developed from past literature and tested using 41 prescribed burns in northern Florida and southern Georgia, USA with varying years since previous fire, season of burn, and fire direction of spread. Measurements focused on EFPM2.5 from flaming combustion, although a subset of data considered MCE and smoldering combustion. The final SEM after adjustment showed EFPM2.5 to be higher in burns conducted at higher ambient temperatures, corresponding to later dates during the period from winter to summer and increases in live herbaceous vegetation and ambient humidity, but not total fine fuel moisture content. Percentage of fine fuel composed of pine needles had the strongest positive effect on EFPM2.5, suggesting that pine timber stand volume may significantly influence PM2.5 emissions. Also, percentage of fine fuel composed of grass showed a negative effect on EFPM2.5, consistent with past studies. Results of the study suggest that timber thinning and frequent prescribed fire minimize EFPM2.5 and total PM2.5 emissions on a per burn basis, and that further development of PM emission models should consider adjusting EFPM2.5 as a function of common land use variables, including pine timber stocking, surface vegetation composition, fire frequency, and season of burn.

Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population.

PubMed

Waltzman, Joshua T; Bell, Derek E

2014-01-01

The vacuum-assisted closure device (VAC) is associated with improved wound healing outcomes. Its use as a bolster device to secure a split-thickness skin graft has been previously demonstrated; however, there is little published evidence demonstrating its benefits specifically in the burn population. With use of the VAC becoming more commonplace, its effect on skin graft take and overall time to healing in burn patients deserves further investigation. Retrospective review of burn registry database at a high-volume level I trauma center and regional burn center during a 16-month period was performed. Patients who had a third-degree burn injury requiring a split-thickness skin graft and who received a VAC bolster were included. Data points included age, sex, burn mechanism, burn location, grafted area in square centimeters, need for repeat grafting, percent graft take, and time to complete reepithelialization. Sixty-seven patients were included in the study with a total of 88 skin graft sites secured with a VAC. Age ranged from <1 year to 84 years (average 41 years). The average grafted area was 367 ± 545 cm. The three most common were the leg, thigh, and arm (28, 15, and 12%, respectively). Average percent graft take was 99.5 ± 1.5%. Notably, no patients returned to the operating room for repeat grafting. The average time to complete reepithelialization was 16 ± 7 days. The VAC is a highly reliable and reproducible method to bolster a split-thickness skin graft in the burn population. The observed rate of zero returns to the operating room for repeat grafting was especially encouraging. Its ability to conform to contours of the body and cover large surface areas makes it especially useful in securing a graft. This method of bolstering results in decreased repeat grafting and minimal graft loss, thus decreasing morbidity compared with conventional bolster dressings.

[Epidemiological changes in burned children. A 10-year follow-up].

PubMed

Rojas Goldsack, María de Los Ángeles; Saavedra Opazo, Rolando; Vicencio Pezo, Paulina; Solís Flores, Fresia

2016-01-01

The aim of the study was to compare the incidence and epidemiological characteristics of burns suffered by children in a district of Santiago of Chile over a period of ten years. An analytical study was conducted by checking through the medical files of children under 15 years of age from Pudahuel district who were admitted with burns to the Santiago Aid to Burned Children Corporation (COANIQUEM) during 2011. A comparison was made with the results obtained in a similar study performed in the same district in 2001. In 2011, 440 children were admitted, with an incidence rate of 700/100,000 <15 years old (95% CI: 635-765), a decrease of 25% compared to 2001(Incidence rate of 933/100,000; 95% CI: 856-1010). There were 52% males, 64.5% under 5 years old of age, 88% burned at home, or at other houses where they are been taking care of. There was a significant change in the causative agent, and included, increasing by their relative importance; hot objects (27.1%). The mechanism that mostly increased in occurrence were contact with stoves or heaters, and also emerge that caused by hair iron, and motorcycle exhaust. The most common location was the hand, increasing by 30.8%, and 66.4% showed an extension of the burn of <1% total body surface area (2001, 61%). A significant decline of 54% of deep burns was observed, and 23.2% were admitted to rehabilitation, a similar proportion to 2001. The rate of hospitalization and/or skin graft decreased from 104/100,000 to 62/100,000<15 years old (95% CI: 43-82). Burns incidence has decreased. Hot objects are now the main causal agent. The decrease in the rate of hospitalization and/or graft indicates a lower severity of burns. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Randomized, Paired-site Comparison of Autologous Engineered Skin Substitutes and Split-thickness Skin Graft for Closure of Extensive, Full-thickness Burns

PubMed Central

Boyce, Steven T.; Simpson, Peggy S.; Rieman, Mary T.; Warner, Petra M.; Yakuboff, Kevin P.; Bailey, J. Kevin; Nelson, Judith K.; Fowler, Laura A.; Kagan, Richard J.

2016-01-01

Objectives Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. Methods ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository (NBR), correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. Results One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7±9.7 for ESS compared with a maximum of 4.0±0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the NBR (p<0.05). Engraftment was 83.5±2.0% for ESS and 96.5±0.9 for AG. Percentage TBSA closed was 29.9±3.3% for ESS, and 47.0±2.0 for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R2 value of 0.65 (p<0.001). Conclusions These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA. PMID:27404165

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

PubMed

Kilyewala, C; Alenyo, R; Ssentongo, R

2017-07-06

Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) <2 kg/m 2 (p = 0.021), % total burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count <4000 or >12,000/μL (p = 0.05). Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

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

PubMed

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

2017-08-01

To compare patient and burn characteristics between patients who had a pre-existing psychiatric diagnosis and patients who did not in a Burn Unit at an academic hospital. Psychosocial issues are common in patients recovering from a burn; however, little is known regarding hospital course and discharge outcomes in patients with a pre-existing psychiatric diagnosis presenting with a burn. Baseline medical comorbidities of burn patients have been shown to be a significant risk for in-hospital mortality. A retrospective chart review of 479 consecutive patients admitted to the Burn Unit of an academic hospital in Halifax, Nova Scotia between March 2nd 1995 and June 1st 2013 was performed. Extensive data regarding patient and burn characteristics and outcomes was collected. Patients with and without pre-existing psychiatric diagnoses at the time of hospital admission were compared. Sixty-three (13%) patients had a psychiatric diagnosis, with the most common being depression (52%). Forty-percent (n=25/63) of these patients had multiple pre-existing psychiatric diagnoses. Patients with a psychiatric diagnosis had a greater total-body-surface-area (TBSA)% covered by a third-degree burn (p=0.001), and were more likely to have an inhalation injury (p<0.001). These patients were also significantly more likely to experience 6 of the 10 most prevalent in-hospital complications and had a higher mortality rate (p=0.02). They were less likely to be discharged home (p=0.001), and more likely to go to a home hospital (p=0.04) or rehabilitation facility (p=0.03). Psychiatric diagnosis was associated with significantly more placement issues (e.g. rehab bed unavailability, homeless) upon discharge from the Burn Unit (p=0.01). The risk of death in burn patients with pre-existing psychiatric disorders was about three times the risk of death in patients with no psychiatric disorders when adjusting for other potential confounders (95% CI, 1.13-9.10; p-value 0.03). Presence of a pre-existing psychiatric disorder in the burn patient was associated with worse outcomes and was a significant predictor of death. Psychiatric diagnoses should be identified early in burn treatment and efforts should be made to ensure a comprehensive approach to inpatient support and patient discharge to reduce unfavorable burn outcomes and placement issues. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Effect of evaporative surface cooling on thermographic assessment of burn depth

NASA Technical Reports Server (NTRS)

Anselmo, V. J.; Zawacki, B. E.

1977-01-01

Differences in surface temperature between evaporating and nonevaporating, partial- and full-thickness burn injuries were studied in 20 male, white guinea pigs. Evaporative cooling can disguise the temperature differential of the partial-thickness injury and lead to a false full-thickness diagnosis. A full-thickness burn with blister intact may retain enough heat to result in a false partial-thickness diagnosis. By the fourth postburn day, formation of a dry eschar may allow a surface temperature measurement without the complication of differential evaporation. For earlier use of thermographic information, evaporation effects must be accounted for or eliminated.

Estimating the usage of allograft in the treatment of major burns.

PubMed

Horner, C W M; Atkins, J; Simpson, L; Philp, B; Shelley, O; Dziewulski, P

2011-06-01

To assess the amount of allograft used in the past treatment of major burns and calculate a figure to guide estimation of the quantity of allograft required to treat future patients and aid resource planning. A retrospective observational study. Records of 143 patients treated with major burns at a regional centre, from January 2004 to November 2008 were accessed with biometric data and quantity of allograft used being recorded. This data was used to calculate an allograft index (cm² allograft used/burn surface area (cm²)) (AI) for each patient. 112 of the 143 patients had complete sets of data, of the 112, 89 patients survived the initial stay in hospital. For all data average AI=1.077 ± 0.090. AI varied according to burn % area with burns < 40% requiring 0.490 cm² allo/cm²burn, increasing in a logarithmic fashion (R²=0.995) for burn areas > 40%. The ability to estimate deceased donor skin requirements based on % body surface area affected is important in the care planning for patients with major burns. Our findings of 0.5 cm² allograft/cm² burn for injuries less than 40% TBSA, increasing to 1.82 cm² allograft/cm² burn for injuries up to 80% TBSA can be used for planning purposes for individual services and for burn disaster planning. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations.

PubMed

Santos, João V; Oliveira, Andreia; Costa-Pereira, Altamiro; Amarante, José; Freitas, Alberto

2016-06-01

There is a lack of recent and nation-wide epidemiological studies of burns in Europe, mainly in southern Europe. There are no recent studies describing the clinical and economic burden of burns in this European area. Hence, this research aimed to describe the clinical and economic burden of burn hospitalisations in Portugal. A retrospective observational study was performed and the Portuguese hospitalisation database of public hospitals was used; all inpatients, discharged between 2000 and 2013, with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx) were taken into account. Furthermore, admissions to hospitals with and without burn centres were compared. A total of 26,447 burn hospitalisations were registered (mean of 1889burn admissions/year). The total hospitalisation rate was of 18.9hospitalisations/100,000inhabitants/year, and there was a higher incidence of male patients. Burn hospitalisations and hospitalisation rates are significantly decreasing - mostly in 0-14-year-old patients - and children below the age of 5 years represented a fifth of all admissions. Besides the important morbidity, the in-hospital mortality rate was of 4.4%. With a total annual charge of almost 13million Euros, the average cost per burn admission is increasing, and reached 8032Euros in 2013. Additionally, more than half of the patients admitted to hospitals without burn centres were not transferred to hospitals with burn centres, not following the European Burns Association transferral criteria. As the largest southern European nation-wide epidemiological study of burn patients, this research highlights that burn admissions, as well as hospitalisation rates, are decreasing significantly. This was particularly obvious among the youngest patients despite the fact that the numbers still remain very high. Moreover, the in-hospital mortality rate is still excessively high and the burn transferral criteria are not being followed. Thus, it is important to improve preventive measures, reach out to and educate providers about the burn transferral criteria, and develop specific health care strategies for children with these injuries. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Procalcitonin for the early diagnosis of sepsis in burn patients: A retrospective study.

PubMed

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

2017-11-01

The gold standard for sepsis diagnosis in burn patient still relies on microbiological cultures, which take 48-72h to provide results, delaying the start of antimicrobial therapy. Thus, biomarkers allowing an earlier sepsis diagnosis in burn patients are needed. This retrospective observational study included 150 burn patients with total burned surface area ≥15%. Clinical diagnosis of sepsis among these patients was done according to the American Burn Association criteria. Biomarker (procalcitonin, white blood cells and platelet countings, prothrombinemia, D-dimers, C-reactive protein, blood lactate and temperature) values were available for 48 patients without sepsis (2767 timepoints) and 102 patients with sepsis (652 timepoints). Quantitative variables were compared with Mann-Whitney tests and qualitative variables were compared with Pearson chi-square test. Effect size was measured by the probability of superiority. Receiver operating characteristic (ROC) curves evaluate capacity for sepsis diagnosis. Sensitivity, specificity, positive and negative predictive values were calculated for some cut-off values, including the best cut-off defined by the maximum of Youden index. Statistically significant differences between the groups of septic and non-septic patients, with medium to large effect size, were detected for all the biomarkers considered, except temperature. PCT was the biomarker with the largest AUC and effect size (AUC=0.71). Analysis of the PCT ROC curve showed that 0.5ng/mL cut-off presented highest sensitivity and lowest specificity, whereas 1.5ng/mL cut-off was associated with lowest sensitivity and highest specificity. Procalcitonin showed to be the best of the biomarkers studied for an early diagnosis of sepsis. Its use should be considered in antimicrobial stewardship programs in Burn Units. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2018-04-01

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

Application of the cultured epidermal autograft "JACE(®") for treatment of severe burns: Results of a 6-year multicenter surveillance in Japan.

PubMed

Matsumura, Hajime; Matsushima, Asako; Ueyama, Masashi; Kumagai, Norio

2016-06-01

In the 1970s, Green et al. developed a method that involved culturing keratinocyte sheets and used for treatment of burns. Since then, the take rate of cultured epidermal autograft (CEA) onto fascia, granulation tissue, or allografts has been extensively reported, while that on an artificial dermis in a large case series is not. Moreover, the contribution of CEA to patient survival has not been analyzed in a multicenter study. We conducted a 6-year multicenter surveillance on the application of the CEA "JACE(®") for treatment of burns >30% total body surface area (TBSA) across 118 Japanese hospitals. This surveillance included 216 patients and 718 graft sites for efficacy analysis. The CEA take rate at 4 weeks after grafting was evaluated, and safety was monitored until 52 weeks. In addition, the survival curve obtained in this study and the data obtained from the Tokyo Burn Unit Association (TBUA) were compared. The mean CEA take rates at week 4 were 66% (sites) and 68% (patients), and the rate on the artificial dermis was 65% for 226 sites. CEA application combined with wide split-thickness auto or patch autograft increased the CEA take rate. On comparison with the data obtained from the TBUA, which included data on individuals with burns of the same severity, CEA application was found to contribute to patient survival until 7 weeks after burn. We reported the take rate of CEA based on a 6-year multicenter surveillance. From our results, we found that the application of CEA is a useful treatment for the patients with extensive burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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

PubMed

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

2017-06-01

Despite major advances in therapeutic strategies for the management of patients with severe burns, significant morbidity and mortality is observed. Hyperbaric oxygen therapy (HBOT) increases the supply of oxygen to burn areas. The aim of this study was to determine whether HBOT is effective in the treatment of major thermal burns. On June 27, 2015 in New Taipei, Taiwan, a mass casualty disaster occurred as fire erupted over a large crowd, injuring 499 people. Fifty-three victims (20 women and 33 men) were admitted to Tri-Service General Hospital. Thirty-eight patients underwent adjunctive HBOT (HBOT group), and 15 patients received routine burn therapy (control group). Serum procalcitonin (PCT) level, a sepsis biomarker, was measured until it reached normal levels (<0.5μg/L). The records of all patients from June 2015 to March 2016 were analyzed retrospectively. Outcome measures that were compared between the groups included the use of tracheostomy and hemodialysis, total body surface area (TBSA) and the number of skin graft operations, length of hospital stay, infection status, and mortality. The mean age of the patients was 22.4 years, and the mean TBSA was 43%. All the patients survived and were discharged without requiring limb amputation or being permanently disabled. Patient characteristics did not differ significantly between the groups. PCT levels returned to normal significantly faster (p=0.007) in the HBOT group. Multidisciplinary burn care combined with adjunctive HBOT improves sepsis control compared with standard treatment without HBOT. Prospective studies are required to define the role of HBOT in extensive burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Whole blood neutrophil gelatinase-associated lipocalin predicts acute kidney injury in burn patients.

PubMed

Sen, Soman; Godwin, Zack R; Palmieri, Tina; Greenhalgh, David; Steele, Amanda N; Tran, Nam K

2015-06-15

Early detection of acute kidney injury (AKI) in severely burn-injured patients can help alter treatment to prevent progression to acute failure and reduce the need for renal replacement therapy. We hypothesized that whole blood neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely burn-injured patients who develop AKI during acute resuscitation. We performed a prospective observation study of adult burn patients with a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO) were collected for 48 h after admission. Our primary goal was to correlate the risk of AKI in the first week after burn injury with serial NGAL levels in the first 48 h after admission. Our secondary goal was to determine if NGAL was an earlier independent predictor of AKI compared with Cr and UO. We enrolled 30 adult (age ≥ 18 y) burn patients with the mean ± standard deviation age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI within the first 7 d after burn injury. There were no differences in age, TBSA, fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI patients. NGAL was significantly increased as early as 4 h after injury (182.67 ± 83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio, 1.02) and remained predictive of AKI for the period of more than the first 24 h after admission. UO and Cr were not predictive of AKI in the first 24 h after admission. Whole blood NGAL is markedly increased in burn patients who develop AKI in the first week after injury. In addition, NGAL is an early independent predictor of AKI during acute resuscitation for severe burn injury. UO and Cr are not predictive of AKI during this time period. Copyright © 2015 Elsevier Inc. All rights reserved.

Dementia: A risk factor for burns in the elderly.

PubMed

Harvey, Lara; Mitchell, Rebecca; Brodaty, Henry; Draper, Brian; Close, Jacqueline

2016-03-01

Older people are disproportionately at risk of burn and have a high risk of dementia; however the impact of dementia on risk of burn is unknown. Linked hospitalisation and death records for individuals aged 65 years and older admitted to a NSW hospital for a burn over the ten year period 2003-2012 were analysed. Demographic and burn characteristics and health outcomes were compared for people with and without dementia. Incidence rates were calculated per 100,000 population and negative binomial regression was used to examine temporal trends. Of the 1535 older people hospitalised for a burn, 11.0% had a record of dementia. The age-standardised incidence rate for people with dementia was 22.7 per 100,000, and for people without dementia was 14.2 per 100,000 population, an incident rate ratio (IRR) of 1.6 (95%CI 1.3-2.0, p<0.0001). There was no significant change in rates over time. People with dementia were more likely to be admitted with burns to the trunk and have greater than 20% total body surface area (TBSA) burn. Mean length of stay (LOS) was more than double (24 vs 12 days) and 30-day mortality three times higher (15.4% vs 5.1%) for people with dementia. Adjusting for differences in age, sex, TBSA, inhalation injury, comorbidities and complications eliminated the increased mortality but not the difference in LOS. People with dementia were more likely to have been burnt by hot tap water (RR 2.3; 95%CI 1.8-2.8, p<0.0001) and ignition of clothing/nightwear (RR 2.6; 95% CI 1.2-5.4, p=0.0149) and to have sustained the burn in residential aged care (20.0%). Burns in people with dementia are significant injuries, which have not decreased over the past ten years despite prevention efforts to reduce burns in older people. Targeted prevention education in the home and residential aged care facilities is warranted. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Small Molecular Weight Soybean Protein-Derived Peptides Nutriment Attenuates Rat Burn Injury-Induced Muscle Atrophy by Modulation of Ubiquitin-Proteasome System and Autophagy Signaling Pathway.

PubMed

Zhao, Fen; Yu, Yonghui; Liu, Wei; Zhang, Jian; Liu, Xinqi; Liu, Lingying; Yin, Huinan

2018-03-21

This article describes results of the effect of dietary supplementation with small molecular weight soybean protein-derived peptides on major rat burn injury-induced muscle atrophy. As protein nutrients have been previously implicated to play an important role in improving burn injury outcomes, optimized more readily absorbed small molecular weight soybean protein-derived peptides were evaluated. Thus, the quantity, sodium dodecyl sulfate polyacrylamide-gel electrophoresis patterns, molecular weight distribution, and composition of amino acids of the prepared peptides were analyzed, and a major full-thickness 30% total body surface area burn-injury rat model was utilized to assess the impact of supplementation with soybean protein-derived peptides on initial systemic inflammatory responses as measured by interferon-gamma (IFN-γ), chemokine (C-C motif) ligand 2 (CCL2, also known as MCP-1), chemokine (C-C motif) ligand 7 (CCL7, also known as MCP-3), and generation of muscle atrophy as measured by tibialis anterior muscle (TAM) weight relative to total body weight. Induction of burn injury-induced muscle atrophy ubiquitin-proteasome system (UPS) signaling pathways in effected muscle tissues was determined by Western blot protein expression measurements of E3 ubiquitin-protein ligase TRIM-63 (TRIM63, also known as MuRF1) and F-box only protein 32 (FBXO32, also known as atrogin-1 or MAFbx). In addition, induction of burn injury-induced autophagy signaling pathways associated with muscle atrophy in effected muscle tissues was assessed by immunohistochemical analysis as measured by microtubule-associated proteins 1 light chain 3 (MAP1LC3, or commonly abbreviated as LC3) and beclin-1 (BECN1) expression, as well as relative induction of cytoplasmic-liberated form of MAP1LC3 (LC3-I) and phagophore and autophagosome membrane-bound form of MAP1LC3 (LC3-II), and BECN1 protein expression by Western blot analysis. Nutrient supplementation with small molecular weight soybean protein-derived peptides resulted a significant reduction in burn injury-induced inflammatory markers, muscle atrophy, induction of TRIM63 and FBXO32 muscle atrophy signaling pathways, and induction of autophagy signaling pathways LC3 and BECN1 associated with muscle atrophy. These results implicated that small molecular weight soybean-derived peptides dietary supplementation could be used as an adjunct therapy in burn injury management to reduce the development or severity of muscle atrophy for improved burn patient outcomes.

[Advances in the research of application of artificial intelligence in burn field].

PubMed

Li, H H; Bao, Z X; Liu, X B; Zhu, S H

2018-04-20

Artificial intelligence has been able to automatically learn and judge large-scale data to some extent. Based on database of a large amount of burn data and in-depth learning, artificial intelligence can assist burn surgeons to evaluate burn surface, diagnose burn depth, guide fluid supply during shock stage, and predict prognosis, with high accuracy. With the development of technology, artificial intelligence can provide more accurate information for burn surgeons to make clinical diagnosis and treatment strategies.

Reliable scar scoring system to assess photographs of burn patients.

PubMed

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

2015-12-01

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

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

PubMed

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

2016-03-31

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

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

Biomass smoke from southern Africa can significantly enhance the brightness of stratocumulus over the southeastern Atlantic Ocean

NASA Astrophysics Data System (ADS)

Lu, Zheng; Liu, Xiaohong; Zhang, Zhibo; Zhao, Chun; Meyer, Kerry; Rajapakshe, Chamara; Wu, Chenglai; Yang, Zhifeng; Penner, Joyce E.

2018-03-01

Marine stratocumulus clouds cover nearly one-quarter of the ocean surface and thus play an extremely important role in determining the global radiative balance. The semipermanent marine stratocumulus deck over the southeastern Atlantic Ocean is of particular interest, because of its interactions with seasonal biomass burning aerosols that are emitted in southern Africa. Understanding the impacts of biomass burning aerosols on stratocumulus clouds and the implications for regional and global radiative balance is still very limited. Previous studies have focused on assessing the magnitude of the warming caused by solar scattering and absorption by biomass burning aerosols over stratocumulus (the direct radiative effect) or cloud adjustments to the direct radiative effect (the semidirect effect). Here, using a nested modeling approach in conjunction with observations from multiple satellites, we demonstrate that cloud condensation nuclei activated from biomass burning aerosols entrained into the stratocumulus (the microphysical effect) can play a dominant role in determining the total radiative forcing at the top of the atmosphere, compared with their direct and semidirect radiative effects. Biomass burning aerosols over the region and period with heavy loadings can cause a substantial cooling (daily mean ‑8.05 W m‑2), primarily as a result of clouds brightening by reducing the cloud droplet size (the Twomey effect) and secondarily through modulating the diurnal cycle of cloud liquid water path and coverage (the cloud lifetime effect). Our results highlight the importance of realistically representing the interactions of stratocumulus with biomass burning aerosols in global climate models in this region.

In vitro and in vivo assessment of lactic acid-modified chitosan scaffolds for potential treatment of full-thickness burns.

PubMed

Velasquillo, Cristina; Silva-Bermudez, Phaedra; Vázquez, Nadia; Martínez, Alan; Espadín, Andres; García-López, Julieta; Medina-Vega, Antonio; Lecona, Hugo; Pichardo-Baena, Raúl; Ibarra, Clemente; Shirai, Keiko

2017-10-01

Autologous skin transplantation is today's "gold standard" treatment for full-thickness burns. However, when > 30% of total body surface area is damaged, there is an important shortage of autologous donor sites for skin grafting; then, treatment alternatives become crucial. Such alternatives can be based on polymeric scaffolds capable of functioning as protective covers and cells/factors carriers. Chitosan (CTS) is a natural-derived polymer with relevant biological-related properties but poor mechanical performance. Improved mechanical properties can be achieved through lactic acid grafting (LA-g); nevertheless, LA-g affects the biological response towards the CTS-based materials. In this work, CTS-LA scaffolds with different LA-g percentages were synthesized and evaluated to determine appropriate LA-g degrees for full-thickness burns treatment. In vitro results indicated that the higher the LA-g percentage, the lower the capability of the scaffolds to sustain fibroblasts culture. Scaffolds with LA-g around 28% (CTS-LA28) sustained cell culture and allowed normal cell functionality. Further evaluation of CTS-LA28 as acellular and cellular grafts in a full-thickness burn mouse model showed that at 28 days post-burn, macroscopic characteristic of the reparation tissue were closer to healthy skin when cellular grafts were used for treatment; histological evaluation also showed that dermis cellularity and collagenous fibers structure were similar to those in healthy skin when cellular grafts were used for burns treatment. © 2017 Wiley Periodicals Inc. J Biomed Mater Res Part A: 105A: 2875-2891, 2017. © 2017 Wiley Periodicals, Inc.

Source Estimation of Wintertime Soot Particles for an Urban Site Varanasi (25.30 N, 83.00 E) in Central Indo-Gangetic Plain Region

NASA Astrophysics Data System (ADS)

Singh, A. K.; Srivastava, M. K.; Dumka, U. C.; Singh, R. K.; Singh, R. S.; Tiwari, S.; Mehrotra, B. J.; Srivastava, A. K.

2017-12-01

Black carbon particles (BC: also called Soot) are formed by incomplete combustion of hydrocarbon based fuels (fossil fuel: coal, diesel, petrol, etc.) as well as due to burning of biomass and bio-fuels (wood, shrubs, dry leaves, etc.). Soot particles are warming agent to the atmosphere that gained wide attention in recent years due to their direct and indirect impacts on local, regional as well as global climate. The climatic effects due to soot are not well understood as indicated by large uncertainties in their climate forcing estimation, particularly in South and East Asian region, possibly due to unavailability of adequate database and information about the source. Measurement of wintertime BC mass concentrations for urban site in central IGP, `Varanasi' (25.30 N, 83.00 E), using a seven wavelength Aethalometer is reported in this work. Delta-C (=BC370 - BC880), which is an indicator of biomass/bio-fuels or residential coal burning is used to understand the source. Aethalometer based source apportionment model "Aethalometer model" was used to apportion the fossil fuel/traffic and wood/biomass burning mass concentration to the total BC mass. The preliminary results for representative month (January-2015) show that daily-average BC mass ranged from 4.47 to 20.70 μg m-3 (Average: 9.45 ± 4.15 μg m-3). The daily Absorption Ångström Exponent (AAE) and the ratio of BCff/BC and BCff/BCwb varied between 1.09 - 1.32, 0.67 - 0.92 and 2 - 40, respectively, due to the changes in BC emissions rates. The total BC, BC from fossil fuel (BCff) and BC from wood/biomass burning (BCwb) behaved in the remarkable diurnal pattern, behaving opposite to the mixing layer heights (MLHs). During daytime, MLHs are higher due to surface based solar warming and causes more volume of atmosphere for the BC dispersion. This phenomenon causes the surface measurement of lower BC mass during the daytime. The data is, however, still being processed for multi-year wintertime observations and the detailed discussions will be shown during the presentation.

Impact of Biomass Burning Aerosols on the Biosphere over Amazonia

NASA Astrophysics Data System (ADS)

Malavelle, F.; Haywood, J.; Mercado, L.; Folberth, G.; Bellouin, N.

2014-12-01

Biomass burning (BB) smoke from deforestation and the burning of agricultural waste emit a complex cocktail of aerosol particles and gases. BB emissions show a regional hotspot over South America on the edges of Amazonia. These major perturbations and impacts on surface temperature, surface fluxes, chemistry, radiation, rainfall, may have significant consequent impacts on the Amazon rainforest, the largest and most productive carbon store on the planet. There is therefore potential for very significant interaction and interplay between aerosols, clouds, radiation and the biosphere in the region. Terrestrial carbon production (i.e. photosynthesis) is intimately tied to the supply of photosynthetically active radiation (PAR - i.e. wavelengths between 300-690 nm). PAR in sufficient intensity and duration is critical for plant growth. However, if a decrease in total radiation is accompanied by an increase in the component of diffuse radiation, plant productivity may increase due to higher light use efficiency per unit of PAR and less photosynthetic saturation. This effect, sometimes referred as diffuse light fertilization effect, could have increased the global land carbon sink by approximately one quarter during the global dimming period and is expected to be a least as important locally. By directly interacting with radiation, BB aerosols significantly reduce the total amount of PAR available to plant canopies. In addition, BB aerosols also play a centre role in cloud formation because they provide the necessary cloud condensation nuclei, hence indirectly altering the water cycle and the components and quantity of PAR. In this presentation, we use the recent observations from the South American Biomass Burning Analysis (SAMBBA) to explore the impact of radiation changes on the carbon cycle in the Amazon region caused by BB emissions. A parameterisation of the impact of diffuse and direct radiation upon photosynthesis rates and net primary productivity in the biosphere has been implemented within a fully coupled Earth System Model, namely the UK Met Office Hadley Centre HadGEM2-ES model. We present results from ten-year experiments (2000-2010) designed to investigate the sensitivity of the terrestrial biosphere to the burden and absorbing nature of Amazonian BB aerosols.

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

PubMed

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care and reduced health care costs, while maintaining quality of care and patient satisfaction. This program has improved inpatient burn rehabilitation by maximizing time spent in therapy and avoiding unnecessary patient travel to offsite appointments.

Global Burned Area and Biomass Burning Emissions from Small Fires

NASA Technical Reports Server (NTRS)

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

2012-01-01

In several biomes, including croplands, wooded savannas, and tropical forests, many small fires occur each year that are well below the detection limit of the current generation of global burned area products derived from moderate resolution surface reflectance imagery. Although these fires often generate thermal anomalies that can be detected by satellites, their contributions to burned area and carbon fluxes have not been systematically quantified across different regions and continents. Here we developed a preliminary method for combining 1-km thermal anomalies (active fires) and 500 m burned area observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) to estimate the influence of these fires. In our approach, we calculated the number of active fires inside and outside of 500 m burn scars derived from reflectance data. We estimated small fire burned area by computing the difference normalized burn ratio (dNBR) for these two sets of active fires and then combining these observations with other information. In a final step, we used the Global Fire Emissions Database version 3 (GFED3) biogeochemical model to estimate the impact of these fires on biomass burning emissions. We found that the spatial distribution of active fires and 500 m burned areas were in close agreement in ecosystems that experience large fires, including savannas across southern Africa and Australia and boreal forests in North America and Eurasia. In other areas, however, we observed many active fires outside of burned area perimeters. Fire radiative power was lower for this class of active fires. Small fires substantially increased burned area in several continental-scale regions, including Equatorial Asia (157%), Central America (143%), and Southeast Asia (90%) during 2001-2010. Globally, accounting for small fires increased total burned area by approximately by 35%, from 345 Mha/yr to 464 Mha/yr. A formal quantification of uncertainties was not possible, but sensitivity analyses of key model parameters caused estimates of global burned area increases from small fires to vary between 24% and 54%. Biomass burning carbon emissions increased by 35% at a global scale when small fires were included in GFED3, from 1.9 Pg C/yr to 2.5 Pg C/yr. The contribution of tropical forest fires to year-to-year variability in carbon fluxes increased because small fires amplified emissions from Central America, South America and Southeast Asia-regions where drought stress and burned area varied considerably from year to year in response to El Nino-Southern Oscillation and other climate modes.

Minimally invasive burn care: a review of seven clinical studies of rapid and selective debridement using a bromelain-based debriding enzyme (Nexobrid®)

PubMed Central

Rosenberg, L.; Shoham, Y.; Krieger, Y.; Rubin, G.; Sander, F.; Koller, J.; David, K.; Egosi, D.; Ahuja, R.; Singer, A.J.

2015-01-01

Summary Current surgical and non-surgical eschar removal-debridement techniques are invasive or ineffective. A bromelainbased rapid and selective enzymatic debriding agent was developed to overcome these disadvantages and compared with the standard of care (SOC). The safety and efficacy of a novel Debriding Gel Dressing (DGD) was determined in patients with deep partial and full thickness burns covering up to 67% total body surface area (TBSA). This review summarizes data from seven studies, four of which were randomized clinical trials that included a SOC or control vehicle. DGD eschar debridement efficacy was >90% in all studies, comparable to the SOC and significantly greater than the control vehicle. The total area excised was less in patients treated with DGD compared with the control vehicle (22.9% vs. 73.2%, P<0.001) or the surgical/non-surgical SOC (50.5%, P=0.006). The incidence of surgical debridement in patients treated with DGD was lower than the SOC (40/163 [24.5%] vs. 119/170 [70.0%], P0.001). Less autografting was used in all studies. Long-term scar quality and function were similar in DGD- and SOCtreated. DGD is a safe and effective method of burn debridement that offers an alternative to surgical and non-surgical SOC. PMID:27777547

Surface composition changes in massive star evolution with mass loss

NASA Technical Reports Server (NTRS)

Noels, A.; Gabriel, M.; Vreux, J.-M.; Conti, P. S.

1980-01-01

A series of evolutionary models of 40-100 solar mass objects undergoing mass loss are constructed with the explicit inclusion of the surface composition of H, He, C, N, O elements. Mass loss rates similar to those observed in Of stars, 4 to 7 x 10 to the -6th solar masses/yr, result in an appearance at the surface of equilibrium CNO products, i.e. enhanced nitrogen and diminished carbon, while that star is still burning hydrogen in the core. This result obtains because the initial convection core is a relatively large fraction of the total mass and rather modest loss exposes levels of anomalous composition. It is suggested that these objects might reasonably be identified as those luminous late type WN stars still containing surface hydrogen.

Forward-looking infrared imaging predicts ultimate burn depth in a porcine vertical injury progression model.

PubMed

Miccio, Joseph; Parikh, Shruti; Marinaro, Xavier; Prasad, Atulya; McClain, Steven; Singer, Adam J; Clark, Richard A F

2016-03-01

Current methods of assessing burn depth are limited and are primarily based on visual assessments by burn surgeons. This technique has been shown to have only 60% accuracy and a more accurate, simple, noninvasive method is needed to determine burn wound depth. Forward-looking infrared (FLIR) thermography is both noninvasive and user-friendly with the potential to rapidly assess burn depth. The purpose of this paper is to determine if early changes in burn temperature (first 3 days) can be a predictor of burn depth as assessed by vertical scarring 28 days after injury. While under general anesthesia, 20 burns were created on the backs of two female Yorkshire swine using a 2.5cm×2.5cm×7.5cm, 150g aluminum bar, for a total of 40 burns. FLIR imaging was performed at both early (1, 2 and 3 days) and late (7, 10, 14, 17, 21, 24 and 28 days) time points. Burns were imaged from a height of 12 inches from the skin surface. FLIR ExaminIR(©) software was used to examine the infrared thermographs. One hundred temperature points from burn edge to edge across the center of the burn were collected for each burn at all time points and were exported as a comma-separated values (CSV) file. The CSV file was processed and analyzed using a MATLAB program. The temperature profiles through the center of the burns generated parabola-like curves. The lowest temperature (temperature minimum) and a line midway between the temperature minimum and ambient skin temperature at the burn edges was defined and the area of the curve calculated (the "temperature half-area"). Half-area values 2 days after burn had higher correlations with scar depth than did the minimum temperatures. However, burns that became warmer from 1 day to 2 days after injury had a lower scar depth then burns that became cooler and this trend was best predicted by temperature minima. When data were analyzed as a diagnostic test for sensitivity and specificity using >3mm scarring, i.e. a full-thickness burn, as a clinically relevant criterion standard, temperature minima at 2 days after burn was found to be the most sensitive and specific test. FLIR imaging is a fast and simple tool that has been shown to predict burn wound outcome in a porcine vertical injury progression model. Data showed that more severe burn wounds get cooler between 1 and 2 days after burn. We found four analytic methods of FLIR images that were predictive of burn progression at 1 and 2 days after burn; however, temperature minima 2 days after burn appeared to be the best predictive test for injury progression to a full-thickness burn. Although these results must be validated in clinical studies, FLIR imaging has the potential to aid clinicians in assessing burn severity and thereby assisting in burn wound management. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Insulin protects against hepatic damage postburn.

PubMed

Jeschke, Marc G; Kraft, Robert; Song, Juquan; Gauglitz, Gerd G; Cox, Robert A; Brooks, Natasha C; Finnerty, Celeste C; Kulp, Gabriela A; Herndon, David N; Boehning, Darren

2011-01-01

Burn injury causes hepatic dysfunction associated with endoplasmic reticulum (ER) stress and induction of the unfolded protein response (UPR). ER stress/UPR leads to hepatic apoptosis and activation of the Jun-N-terminal kinase (JNK) signaling pathway, leading to vast metabolic alterations. Insulin has been shown to attenuate hepatic damage and to improve liver function. We therefore hypothesized that insulin administration exerts its effects by attenuating postburn hepatic ER stress and subsequent apoptosis. Male Sprague Dawley rats received a 60% total body surface area (TBSA) burn injury. Animals were randomized to receive saline (controls) or insulin (2.5 IU/kg q. 24 h) and euthanized at 24 and 48 h postburn. Burn injury induced dramatic changes in liver structure and function, including induction of the ER stress response, mitochondrial dysfunction, hepatocyte apoptosis, and up-regulation of inflammatory mediators. Insulin decreased hepatocyte caspase-3 activation and apoptosis significantly at 24 and 48 h postburn. Furthermore, insulin administration decreased ER stress significantly and reversed structural and functional changes in hepatocyte mitochondria. Finally, insulin attenuated the expression of inflammatory mediators IL-6, MCP-1, and CINC-1. Insulin alleviates burn-induced ER stress, hepatocyte apoptosis, mitochondrial abnormalities, and inflammation leading to improved hepatic structure and function significantly. These results support the use of insulin therapy after traumatic injury to improve patient outcomes.

Insulin Protects against Hepatic Damage Postburn

PubMed Central

Jeschke, Marc G; Kraft, Robert; Song, Juquan; Gauglitz, Gerd G; Cox, Robert A; Brooks, Natasha C; Finnerty, Celeste C; Kulp, Gabriela A; Herndon, David N; Boehning, Darren

2011-01-01

Burn injury causes hepatic dysfunction associated with endoplasmic reticulum (ER) stress and induction of the unfolded protein response (UPR). ER stress/UPR leads to hepatic apoptosis and activation of the Jun-N-terminal kinase (JNK) signaling pathway, leading to vast metabolic alterations. Insulin has been shown to attenuate hepatic damage and to improve liver function. We therefore hypothesized that insulin administration exerts its effects by attenuating postburn hepatic ER stress and subsequent apoptosis. Male Sprague Dawley rats received a 60% total body surface area (TBSA) burn injury. Animals were randomized to receive saline (controls) or insulin (2.5 IU/kg q. 24 h) and euthanized at 24 and 48 h postburn. Burn injury induced dramatic changes in liver structure and function, including induction of the ER stress response, mitochondrial dysfunction, hepatocyte apoptosis, and up-regulation of inflammatory mediators. Insulin decreased hepatocyte caspase-3 activation and apoptosis significantly at 24 and 48 h postburn. Furthermore, insulin administration decreased ER stress significantly and reversed structural and functional changes in hepatocyte mitochondria. Finally, insulin attenuated the expression of inflammatory mediators IL-6, MCP-1, and CINC-1. Insulin alleviates burn-induced ER stress, hepatocyte apoptosis, mitochondrial abnormalities, and inflammation leading to improved hepatic structure and function significantly. These results support the use of insulin therapy after traumatic injury to improve patient outcomes. PMID:21267509

Assessment of amniotic and polyurethane membrane dressings in the treatment of burns.

PubMed

Adly, O A; Moghazy, A M; Abbas, A H; Ellabban, A M; Ali, O S; Mohamed, B A

2010-08-01

As allograft and xenografts are not available in Islamic countries, amniotic membrane seems to be an effective alternative in the management of deep burns. Its proven bioactivities and modest price suggest that it might be superior to synthetic dressings. Forty-six patients were enrolled in this randomized, controlled clinical trial conducted in the Burn Unit at Suez Canal University Hospital, Ismailia, Egypt. All age groups and both gender were included in the study. Only patients with less than 50% total body surface area burned were included, thus minimizing the dropouts in both groups. All were either second or third degree. These patients were randomly assigned either to group I: amniotic membrane (Biomembrane) dressing, or group II: polyurethane membrane (Tegaderm) dressing. Those in group I demonstrated a significantly lower rate of infection and required less frequent dressing changes than those in group II. They also sustained less electrolyte and albumin loss. The rate of healing in the amniotic membrane group was significantly faster than in the polyurethane group. Furthermore, pain was significantly less when Biomembrane was used. Based on these findings, we recommend the use of lyophilized gamma-irradiated amniotic membrane as an effective alternative for allograft and xenografts in Islamic countries and the Jewish population.

Fuel loads, fire regimes, and post-fire fuel dynamics in Florida Keys pine forests

USGS Publications Warehouse

Sah, J.P.; Ross, M.S.; Snyder, J.R.; Koptur, S.; Cooley, H.C.

2006-01-01

In forests, the effects of different life forms on fire behavior may vary depending on their contributions to total fuel loads. We examined the distribution of fuel components before fire, their effects on fire behavior, and the effects of fire on subsequent fuel recovery in pine forests within the National Key Deer Refuge in the Florida Keys. We conducted a burning experiment in six blocks, within each of which we assigned 1-ha plots to three treatments: control, summer, and winter burn. Owing to logistical constraints, we burned only 11 plots, three in winter and eight in summer, over a 4-year period from 1998 to 2001. We used path analysis to model the effects of fuel type and char height, an indicator of fire intensity, on fuel consumption. Fire intensity increased with surface fuel loads, but was negatively related to the quantity of hardwood shrub fuels, probably because these fuels are associated with a moist microenvironment within hardwood patches, and therefore tend to resist fire. Winter fires were milder than summer fires, and were less effective at inhibiting shrub encroachment. A mixed seasonal approach is suggested for fire management, with burns applied opportunistically under a range of winter and summer conditions, but more frequently than that prevalent in the recent past. ?? IAWF 2006.

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

PubMed Central

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

2014-01-01

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

Experimental and Numerical Characterization of Polymer Nanocomposites for Solid Rocket Motor Internal Insulation

DTIC Science & Technology

2006-09-30

Nanophase, Thermoplastic Elastomer, EPDM Rubber , Surface Modified MMT Clay, Carbon Nanofibers 16. SECURITY CLASSIFICATION OF: a. REPORT u b. ABSTRACT U...diene rubber ( EPDM ) is the baseline insulation material for solid rocket motor cases. A novel class of insulation materials was developed by the Air...Figure 1. Upon analysis of the control sample, it was observed that the EPDM rubber was totally burned forming a small amount of char, which was easily

Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

PubMed

Boucher, Bradley A; Hudson, Joanna Q; Hill, David M; Swanson, Joseph M; Wood, G Christopher; Laizure, S Casey; Arnold-Ross, Angela; Hu, Zhe-Yi; Hickerson, William L

2016-12-01

High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. Prospective clinical pharmacokinetic study. Ten adult patients with burns receiving I/C for a documented infection and requiring high-dose CVVH were studied. Blood and effluent samples for analysis of I/C concentrations were collected for up to 6 hours after the I/C infusion for calculation of I/C total CL (CL T otal ), CL by CVVH (CL HF ), half-life during CVVH, volume of distribution at steady state (Vd ss ), and the percentage of drug eliminated by CVVH. In this patient sample, the mean age was 50 ± 17 years, total body surface area burns was 23 ± 27%, and 80% were male. Nine patients were treated with high-dose CVVH for acute kidney injury and one patient for sepsis. The mean delivered CVVH dose was 52 ± 14 ml/kg/hour (range 32-74 ml/kg/hr). The imipenem CL HF was 3.27 ± 0.48 L/hour, which accounted for 23 ± 4% of the CL T otal (14.74 ± 4.75 L/hr). Cilastatin CL HF was 1.98 ± 0.56 L/hour, which accounted for 45 ± 19% of the CL T otal (5.16 + 2.44 L/hr). The imipenem and cilastatin half-lives were 1.77 ± 0.38 hours and 4.21 ± 2.31 hours, respectively. Imipenem and cilastatin Vd ss were 35.1 ± 10.3 and 32.8 ± 13.8 L, respectively. Efficient removal of I/C by high-dose CVVH, a high overall clearance, and a high volume of distribution in burn intensive care unit patients undergoing this CRRT method warrant aggressive dosing to treat serious infections effectively depending on the infection site and/or pathogen. © 2016 Pharmacotherapy Publications, Inc.

Factors Affecting Source-Water Quality after Disturbance of Forests by Wildfire

NASA Astrophysics Data System (ADS)

Murphy, S. F.; Martin, D. A.; McCleskey, R. B.; Writer, J. H.

2015-12-01

Forests yield high-quality water supplies to communities throughout the world, in part because forest cover reduces flooding and the consequent transport of suspended and dissolved constituents to surface water. Disturbance by wildfire reduces or eliminates forest cover, leaving watersheds susceptible to increased surface runoff during storms and reduced ability to retain contaminants. We assessed water-quality response to hydrologic events for three years after a wildfire in the Fourmile Creek Watershed, near Boulder, Colorado, and found that hydrologic and geochemical responses downstream of a burned area were primarily driven by small, brief convective storms that had relatively high, but not unusual, rainfall intensity. Total suspended sediment, dissolved organic carbon, nitrate, and manganese concentrations were 10-156 times higher downstream of a burned area compared to upstream, and water quality was sufficiently impaired to pose water-treatment concerns. The response in both concentration and yield of water-quality constituents differed depending on source availability and dominant watershed processes controlling the constituent. For example, while all constituent concentrations were highest during storm events, annual sediment yields downstream of the burned area were controlled by storm events and subsequent mobilization, whereas dissolved organic carbon yields were more dependent on spring runoff from upstream areas. The watershed response was affected by a legacy of historical disturbance: the watershed had been recovering from extensive disturbance by mining, railroad and road development, logging, and fires in the late 19th and early 20th centuries, and we observed extensive erosion of mine waste in response to these summer storms. Therefore, both storm characteristics and historical disturbance in a burned watershed must be considered when evaluating the role of wildfire on water quality.

Efficacy of enzymatic debridement of deeply burned hands.

PubMed

Krieger, Yuval; Bogdanov-Berezovsky, Alexander; Gurfinkel, Reuven; Silberstein, Eldad; Sagi, Amiram; Rosenberg, Lior

2012-02-01

The burned hand is a common and difficult to care-for entity in the field of burns. Due to the anatomy of the hand (important and delicate structures crowded in a small limited space without sub-dermal soft tissue), surgical debridement of the burned tissue is technically difficult and may cause considerable complications and, therefore, should be performed judiciously. Selective enzymatic debridement of the burn wound can preserve the spontaneous epithelialisation potential and reduce the added injury to the traumatised tissue added by a surgical debridement. The aim of the study was to assess the implication of a selective enzymatic compound (Debrase(®) - Ds) in the special field of deep hand burns, by comparing the actual burn area that required surgical coverage after enzymatic debridement to the burn area clinically judged to require skin grafting prior to debridement. This was a retrospective data collection and analysis from 154 complete files of prospective, open-label study in 275 hospitalised, Ds-treated burn patients. A total of 69 hand burns diagnosed as 'deep' was analysed; 36% of the wounds required surgical intervention after enzymatic debridement; 28.6% of the total burned area estimated initially as deep was covered by skin graft (statistically significant p<0.001). Debridement of deep-hand burns with a selective enzymatic agent decreased the perceived full-thickness wound area and skin-graft use. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

Quantifying the air quality-CO2 tradeoff potential for airports

NASA Astrophysics Data System (ADS)

Ashok, Akshay; Dedoussi, Irene C.; Yim, Steve H. L.; Balakrishnan, Hamsa; Barrett, Steven R. H.

2014-12-01

Aircraft movements on the airport surface are responsible for CO2 emissions that contribute to climate change and other emissions that affect air quality and human health. While the potential for optimizing aircraft surface movements to minimize CO2 emissions has been assessed, the implications of CO2 emissions minimization for air quality have not been quantified. In this paper, we identify conditions in which there is a tradeoff between CO2 emissions and population exposure to O3 and secondary PM2.5 - i.e. where decreasing fuel burn (which is directly proportional to CO2 emissions) results in increased exposure. Fuel burn and emissions are estimated as a function of thrust setting for five common gas turbine engines at 34 US airports. Regional air quality impacts, which are dominated by ozone and secondary PM2.5, are computed as a function of airport location and time using the adjoint of the GEOS-Chem chemistry-transport model. Tradeoffs between CO2 emissions and population exposure to PM2.5 and O3 occur between 2-18% and 5-60% of the year, respectively, depending on airport location, engine type, and thrust setting. The total duration of tradeoff conditions is 5-12 times longer at maximum thrust operations (typical for takeoff) relative to 4% thrust operations (typical for taxiing). Per kilogram of additional fuel burn at constant thrust setting during tradeoff conditions, reductions in population exposure to PM2.5 and O3 are 6-13% and 32-1060% of the annual average (positive) population exposure per kilogram fuel burn, where the ranges encompass the medians over the 34 airports. For fuel burn increases due to thrust increases (i.e. for constant operating time), reductions in both PM2.5 and O3 exposure are 1.5-6.4 times larger in magnitude than those due to increasing fuel burn at constant thrust (i.e. increasing operating time). Airports with relatively high population exposure reduction potentials - which occur due to a combination of high duration and magnitude of tradeoff conditions - are identified. Our results are the first to quantify the extent of the tradeoff between CO2 emissions and air quality impacts at airports. This raises the possibility of reducing the air quality impacts of airports beyond minimizing fuel burn and/or optimizing for minimum net environmental impact.

Characterization of the Particulate Emissions from the BP Deepwater Horizon Surface Oil Burns

EPA Science Inventory

Opportunistic particle samples were gathered from the sail of a tethered aerostat during at-sea plume sampling of the purposely-burned surface oil during the BP Deepwater Horizon disaster in the Gulf of Mexico. Particles were analyzed for polycyclic aromatic hydrocarbons (PAHs),...

Role of autophagy and its molecular mechanisms in mice intestinal tract after severe burn.

PubMed

Zhang, Duan Y; Qiu, Wei; Jin, PeiS; Wang, Peng; Sun, Yong

2017-10-01

Severe burn can lead to hypoxia/ischemia of intestinal mucosa. Autophagy is the process of intracellular degradation, which is essential for cell survival under stresses, such as hypoxia/ischemia and nutrient deprivation. The present study was designed to investigate whether there were changes in intestinal autophagy after severe burn in mice and further to explore the effect and molecular mechanisms of autophagy on intestinal injury. This study includes three experiments. Kunming species mice were subjected to 30% total body surface area third-degree burn. First, we determined protein of LC3 (light chain 3), beclin-1, and cleaved-caspase3 by Western blotting and immunohistochemical (paraffin) staining to investigate whether there were changes in intestinal autophagy after severe burn in mice. Then, changes of the status of enteric damage postburn were measured by observing intestinal mucosa morphology under a magnifier, hematoxylin and eosin staining, enzyme-linked immunosorbent assay, Western blotting under the condition that the intestinal autophagy was respectively activated by rapamycin and inhibited by 3-methyladenine. Finally, protein of the AMP-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway, LC3-II and beclin-1 were assayed, and mice were treated with compound C before burn. The protein of LC3 and beclin-1 were observed at 1 hour postburn and increased to peak-point at 24 hours, reaching the normal level at 96 hours. The cleaved caspase-3 expression increased at 1 hour postburn, but the peak point occurred at 12 hours and had dropped to normal level at 72 hours. In addition, rapamycin enhanced intestinal autophagy and alleviated burn-induced gut damage, while 3-methyladenine showed the against behavior. The AMPK/mTOR pathway which was inhibited decreased the expression of phosphorylated AMPK, LC3-II, and beclin-1, increasing the expression of phosphorylated mTOR. Intestinal autophagy is activated and response to intestinal apoptosis after serious burn, which alleviated burn-induced intestinal injury. The AMPK/mTOR pathway may involve in the activation of burn-induced autophagy. Therapeutic/care management, levels of evidence are not applicable to some studies, such as in vitro work, animal models, cadaver studies.

Improved survival following thermal injury in adult patients treated at a regional burn center.

PubMed

Gomez, Manuel; Cartotto, Robert; Knighton, Judy; Smith, Karen; Fish, Joel S

2008-01-01

Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of advanced critical care trained nurses, and an increased number of dedicated full-time fellowship-trained burn surgeons. The purpose of this study was to determine the composite effect of these modifications on burn patients' survival. A retrospective hospital chart review was conducted among adult burn patients admitted during a 10-year period (1996-2005). Patients were stratified in two time periods: PAST (1996-1998) and RECENT (1999-2005). RECENT patients were selected by matching age, gender, total body surface area burn, full thickness burn, and presence of inhalation injury with PAST patients. All values are mean +/- SD. Student's t-test and chi2 analysis were performed accordingly with a P < .05 considered significant. Of 1569 acute burn patients admitted between 1996 and 2005, 96 (6%) were excluded because they received comfort measures only. Of the remaining 1473 patients, 684 patients (PAST = 342, RECENT = 342) were selected by the matching criteria. More RECENT patients required mechanical ventilation (25% vs 17%, P = .011), with a trend toward more prolonged duration (9 vs 11.5 days, P = .175), more escharotomies (9.6% vs 5.6%, P = .036), more operations (1.1 vs 0.8, P = .003), and more temporary allograft skin (10% vs 2%, P < .001) than did PAST patients. RECENT patients had lower mortality than did PAST patients (2.3% vs 5.6%, P = .048), specifically patients aged 60 or older (5.4% vs 25.5%, P = .004), patients with TBSA lower than 20% (1% vs 3.9%, P = .031), patients on mechanical ventilation (9.3% vs 27.6%, P = .006), and patients who had surgery (2.6% vs 7.3%, P = .032). The significant decrease in burn patient's mortality was likely due to the composite effects of improvements in clinical care between the two time periods.

Acute Kidney Injury: It's not just the 'big' burns.

PubMed

Kimmel, L A; Wilson, S; Walker, R G; Singer, Y; Cleland, H

2018-02-01

Acute Kidney Injury (AKI) complicates the management of at least 25% of patients with severe burns and is associated with long term complications. Most research focuses on the patients with more severe burns, and whether the same factors are associated with the development of AKI in patients with burns between 10 and 19% total body surface area (TBSA) is unknown. The aims of this study were to examine the incidence of, and factors associated with, the development of AKI in patients with %TBSA≥10, as well as the relationship with hospital metrics such as length of stay (LOS). Retrospective medical record review of consecutive burns patients admitted to The Alfred Hospital, the major adult burns centre in Victoria, Australia. Demographic and injury details were recorded. Factors associated with AKI were determined using multiple logistic regression. Between 2010 and June 2014, 300 patients were admitted with burn injury and data on 267 patients was available for analysis. Median age was 54.5 years with 78% being male. Median %TBSA was 15 (IQR 12, 20). The AKI incidence, as measured by the RIFLE criteria, was 22.5%, including 15% (27/184) in patients with %TBSA 10-19. Factors associated with AKI included increasing age and %TBSA (OR 1.05 p<0.001) as well as increased surgeries (p<0.041) and a cardiac comorbidity (p<0.01). All patients with renal comorbidity developed AKI. In the %TBSA 10-19 cohort, only increasing age (OR 1.05 p<0.001) was associated with AKI. After accounting for confounding factors, the probability of discharge from hospital in Non-AKI group was greater than for the AKI patients at all time points (P<0.001). This is the first study to show an association between patients with %TBSA 10-19 and AKI. Given the association between AKI and complications, prospective research is needed to further understand AKI in burns with the aim of risk reduction. Copyright © 2017 Elsevier Ltd. All rights reserved.

Radioactivity in smoke particulates from prescribed burns at the Savannah River Site and at selected southeastern United States forests.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Commodore, Adwoa, A.; Jannik, G. Timothy; Eddy, Teresa, P.

In this study we compare airborne radionuclide concentrations during prescribed burns at the Savannah River Site (SRS) and a sample of forests in the Southeastern United States. The spatial trends of airborne radionuclide concentrations from prescribed burn areas at SRS are also characterized. Total suspended particulate (TSP) samples were taken at three settings (subsequently termed burn sample populations): during prescribed burns at SRS (n = 34), on nonburn days at SRS (n = 12) and during prescribed burns at five offsite locations in the Southeastern United States (n = 2 per location). Mass concentrations of TSP were calculated and alpha,more » beta and gamma spectroscopy was performed to determine radionuclide activity concentrations. Spatial correlation in radionuclide concentration was assessed and ordinary kriging was used to create continuous surface maps across our study area. Median activity concentrations of natural radionuclides including {sup 40}K, thorium and uranium isotopes (n = 34) were higher in samples from SRS prescribed fires (p < 0.02) compared to offsite locations (n = 10) and nonburn days (n = 12). Median gross beta activity was also higher at SRS (p < 0.0001). Median concentrations of anthropogenic radionuclides did not significantly differ among burn sample populations except for {sup 238}Pu (p = 0.0022) and {sup 239,240}Pu (p = 0.014) with median concentrations of 8.41 x 10{sup -4} and 6.72 x 10{sup -5} pCi m{sup -3} at SRS compared to 1.55 x 10{sup -4} and -7.07 x 10{sup -6} pCi m{sup -3} (nonburn days) and 1.46 x 10{sup -4} and 2.78 x 10{sup -6} pCi m{sup 3} (offsite burns) respectively. Results from our spatial analysis found that only {sup 40}K demonstrated significant spatial correlation (X{sup 2} = 15.48, p = 0.0004) and spatial trends do not appear to directly link areas with higher activity concentrations with SRS facilities.« less

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.

PubMed

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources.

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial

PubMed Central

2013-01-01

Background In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Methods/Design Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. Discussion The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000105741 PMID:24274190

Treatment of burning mouth syndrome with a low-level energy diode laser.

PubMed

Yang, Hui-Wen; Huang, Yu-Feng

2011-02-01

To test the therapeutic efficacy of low-level energy diode laser on burning mouth syndrome. Burning mouth syndrome is characterized by burning and painful sensations in the mouth, especially the tongue, in the absence of significant mucosal abnormalities. Although burning mouth syndrome is relatively common, little is known regarding its etiology and pathophysiology. As a result, no treatment is effective in all patients. Low-level energy diode laser therapy has been used in a variety of chronic and acute pain conditions, including neck, back and myofascial pain, degenerative osteoarthritis, and headache. A total of 17 patients who had been diagnosed with burning mouth syndrome were treated with an 800-nm wavelength diode laser. A straight handpiece was used with an end of 1-cm diameter with the fiber end standing 4 cm away from the end of handpiece. When the laser was applied, the handpiece directly contacted or was immediately above the symptomatic lingual surface. The output used was 3 W, 50 msec intermittent pulsing, and a frequency of 10 Hz, which was equivalent to an average power of 1.5 W/cm(2) (3 W × 0.05 msec × 10 Hz = 1.5 W/cm(2)). Depending on the involved area, laser was applied to a 1-cm(2) area for 70 sec until all involved area was covered. Overall pain and discomfort were analyzed with a 10-cm visual analogue scale. All patients received diode laser therapy between one and seven times. The average pain score before the treatment was 6.7 (ranging from 2.9 to 9.8). The results showed an average reduction in pain of 47.6% (ranging from 9.3% to 91.8%). The burning sensation remained unchanged for up to 12 months. Low-level energy diode laser may be an effective treatment for burning mouth syndrome.

Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia

PubMed Central

Chim, Harvey; Yew, Woon Si; Song, Colin

2007-01-01

Introduction Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. Methods The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. Results Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. Conclusion The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources. PMID:17274813

A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns.

PubMed

Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith Chengetayi

2017-10-23

Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. PROSPERO CDR42016048370 .

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

PubMed

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

2016-05-12

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

Seasonal Fluctuation in Moisture Content of Pine Foliage

Treesearch

Von J. Johnson

1966-01-01

Green or living fuels, particularly pine crowns, are commonly consumed by forest fires burning hot, windy weather. In some cases the pine crown fire has been known to burn ahead of surface-burning fire for some distance before dropping to the ground.

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

PubMed

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

2005-05-01

As an abundant amino acid in the human body, glutamine has many important metabolic roles that may protect or promote tissue integrity and enhance the immune system. A relative deficiency of glutamine in such patients could compromise recovery and result in prolonged illness and an increase in late mortality. The purpose of this clinical study is to observe the effects of enteral supplement with glutamine granules on protein metabolism in severely burned patients. Forty-eight severe burn patients (total burn surface area 30-75%, full thickness burn area 20-58%) who met the requirements of the protocol joined this double-blind randomized controlled clinical trial. Patients were randomly divided into two groups: burn control group (B group, 23 patients) and glutamine treated group (Gln group, 25 patients). There was isonitrogenous and isocaloric intake in both groups, glutamine and B group patents were supplemented with glutamine granules or placebo (glycine) at 0.5 g/kg per day for 14 days with oral feeding or tube feeding, respectively. The level of plasma glutamine, plasma protein content, urine nitrogen and urine 3-methylhistidine (3-MTH) excretion were determined, wound healing rate of the burned area and hospital stay were recorded. The results showed that there were significant reductions in plasma glutamine level and abnormal protein metabolism. After supplement with glutamine granules for 14 days, the plasma glutamine concentration was significantly higher than that in B group (607.86+/-147.25 micromol/L versus 447.63+/-132.38 micromol/L, P<0.01) and the plasma prealbumin and transferrin in Gln group were remarkably higher than those in B group (P<0.01), but the concentration of total protein and albumin were not significantly changed compared with B group (P>0.05). On the other hand, the amount of urine nitrogen and 3-MTH excreted in Gln group were significantly lower than that in B group. In addition, wound healing was faster and hospital stay days were shorter in Gln group than B group (46.59+/-12.98 days versus 55.68+/-17.36 days, P<0.05). These indicated that supplement glutamine granules with oral feeding or tube feeding could abate the degree of glutamine depletion, promote protein synthesis, inhibit protein decompose, improve wound healing and reduce hospital stay.

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

PubMed

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

2017-02-14

Objective: To investigate and evaluate the epidemiological characteristics of patients under 14 with large area burns in China. Methods: Data of pediatric patients aged 0-14yr with ≥30% total body surface area (TBSA) burned admitted into 106 burn centers in the mainland of China in 2014 were retrieved. The children were divided into three age groups: 0-3, 4-6 and 7-14 years according to the age. Information of age, gender, time of burn injury, causes of burns, admission time, prehospital emergency care of burn wound, burn area, inhalation injuries, the case fatality rate and length of hospital stay were collected for analysis. Results: Of the 486 cases included, 285 (58.6%) were boys and 201 (41.4%) were girls. The mean age of the children was (3.4±2.8) years. Children under 3 years old accounted for 67.5% of all the cases. 271 of the burn injuries (55.8%) occurred from April through August. Scalds and flames were the main causes of burns, which were the causes of 394 cases (81.1%) and 71 cases (14.6%), respectively. The burn injuries resulted from scalds and flames accounted for 89.6% and 7.3%, 70.8% and 21.9%, 51.6% and 41.9% in the age group of 0-3, 4-6 and 7-14 years respectively. The distribution of burn etiology in different age groups differed significantly (χ(2)=21.239, 59.442, 7.333, all P <0.01). Most of the patients (57.8%) were admitted within 2 hours after injury. However, when it came to the pre-hospital emergency management of burn wound, 164 patients (33.7%) did not use any drug or wound dressing, whereas the wound area of 236 patients (48.6%) were treated improperly with toothpaste, soy sauce, eggs or other non-standard disposal. The mean TBSA area of the patients was (42.1±14.5)%, while 288 (59.3%) of the patients suffered full thickness burns with mean TBSA of (24.5±17.9)%. The case fatality rate (CFR) was 4.1%, and the CFR of patients complicated with inhalation injury was significantly higher than those without ( P <0.01). The average length of stay for pediatric burn patients was (52.3±40.2) days. Conclusions: Children under 3 years old are important target population of severe burns. Scald is the most common type of burns, while the proportion of flames increases as age goes up. Most patients are likely to get clinical treatment in time, however, the pre-hospital emergency burn care is not satisfying at present.

Characterizing hand-piled fuels

Treesearch

Clinton S. Wright; Paige C. Eagle; Cameron S. Balog

2010-01-01

Land managers throughout the West pile and burn surface fuels to mitigate fire hazard in dry forests. Whereas piling was historically conducted with heavy machinery following commercial harvesting operations, land managers are increasingly prescribing the use of hand piling and burning to treat surface fuels created by thinning and brush cutting. An estimate of the...

Characterization of the Particulate Emissions from the BP Deepwell Horizon Spill Surface Oil Burns

EPA Science Inventory

A particle sample gathered from the plume of the purposely-burned surface oil during the BP Deepwater Horizon disaster in the Gulf of Mexico was analyzed for polycyclic aromatic hydrocarbons (PAHs), organic acids, organic carbon (OC), elemental carbon (EC), metals, and chloro-org...

A thirty year, fine-scale, characterization of area burned in Canadian forests shows evidence of regionally increasing trends in the last decade

PubMed Central

2018-01-01

Fire as a dominant disturbance has profound implications on the terrestrial carbon cycle. We present the first ever multi-decadal, spatially-explicit, 30 meter assessment of fire regimes across the forested ecoregions of Canada at an annual time-step. From 1985 to 2015, 51 Mha burned, impacting over 6.5% of forested ecosystems. Mean annual area burned was 1,651,818 ha and varied markedly (σ = 1,116,119), with 25% of the total area burned occurring in three years: 1989, 1995, and 2015. Boreal forest types contained 98% of the total area burned, with the conifer-dominated Boreal Shield containing one-third of all burned area. While results confirm no significant national trend in burned area for the period of 1985 to 2015, a significant national increasing trend (α = 0.05) of 11% per year was evident for the past decade (2006 to 2015). Regionally, a significant increasing trend in total burned area from 1985 to 2015 was observed in the Montane Cordillera (2.4% increase per year), while the Taiga Plains and Taiga Shield West displayed significant increasing trends from 2006 to 2015 (26.1% and 12.7% increases per year, respectively). The Atlantic Maritime, which had the lowest burned area of all ecozones (0.01% burned per year), was the only ecozone to display a significant negative trend (2.4% decrease per year) from 1985 to 2015. Given the century-long fire return intervals in many of these ecozones, and large annual variability in burned area, short-term trends need to be interpreted with caution. Additional interpretive cautions are related to year used for trend initiation and the nature and extents of spatial regionalizations used for summarizing findings. The results of our analysis provide a baseline for monitoring future national and regional trends in burned area and offer spatially and temporally detailed insights to inform science, policy, and management. PMID:29787562

A thirty year, fine-scale, characterization of area burned in Canadian forests shows evidence of regionally increasing trends in the last decade.

PubMed

Coops, Nicholas C; Hermosilla, Txomin; Wulder, Michael A; White, Joanne C; Bolton, Douglas K

2018-01-01

Fire as a dominant disturbance has profound implications on the terrestrial carbon cycle. We present the first ever multi-decadal, spatially-explicit, 30 meter assessment of fire regimes across the forested ecoregions of Canada at an annual time-step. From 1985 to 2015, 51 Mha burned, impacting over 6.5% of forested ecosystems. Mean annual area burned was 1,651,818 ha and varied markedly (σ = 1,116,119), with 25% of the total area burned occurring in three years: 1989, 1995, and 2015. Boreal forest types contained 98% of the total area burned, with the conifer-dominated Boreal Shield containing one-third of all burned area. While results confirm no significant national trend in burned area for the period of 1985 to 2015, a significant national increasing trend (α = 0.05) of 11% per year was evident for the past decade (2006 to 2015). Regionally, a significant increasing trend in total burned area from 1985 to 2015 was observed in the Montane Cordillera (2.4% increase per year), while the Taiga Plains and Taiga Shield West displayed significant increasing trends from 2006 to 2015 (26.1% and 12.7% increases per year, respectively). The Atlantic Maritime, which had the lowest burned area of all ecozones (0.01% burned per year), was the only ecozone to display a significant negative trend (2.4% decrease per year) from 1985 to 2015. Given the century-long fire return intervals in many of these ecozones, and large annual variability in burned area, short-term trends need to be interpreted with caution. Additional interpretive cautions are related to year used for trend initiation and the nature and extents of spatial regionalizations used for summarizing findings. The results of our analysis provide a baseline for monitoring future national and regional trends in burned area and offer spatially and temporally detailed insights to inform science, policy, and management.

Emissions of fine particulate nitrated phenols from the burning of five common types of biomass.

PubMed

Wang, Xinfeng; Gu, Rongrong; Wang, Liwei; Xu, Wenxue; Zhang, Yating; Chen, Bing; Li, Weijun; Xue, Likun; Chen, Jianmin; Wang, Wenxing

2017-11-01

Nitrated phenols are among the major constituents of brown carbon and affect both climates and ecosystems. However, emissions from biomass burning, which comprise one of the most important primary sources of atmospheric nitrated phenols, are not well understood. In this study, the concentrations and proportions of 10 nitrated phenols, including nitrophenols, nitrocatechols, nitrosalicylic acids, and dinitrophenol, in fine particles from biomass smoke were determined under three different burning conditions (flaming, weakly flaming, and smoldering) with five common types of biomass (leaves, branches, corncob, corn stalk, and wheat straw). The total abundances of fine nitrated phenols produced by biomass burning ranged from 2.0 to 99.5 μg m -3 . The compositions of nitrated phenols varied with biomass types and burning conditions. 4-nitrocatechol and methyl nitrocatechols were generally most abundant, accounting for up to 88-95% of total nitrated phenols in flaming burning condition. The emission ratios of nitrated phenols to PM 2.5 increased with the completeness of combustion and ranged from 7 to 45 ppmm and from 239 to 1081 ppmm for smoldering and flaming burning, respectively. The ratios of fine nitrated phenols to organic matter in biomass burning aerosols were comparable to or lower than those in ambient aerosols affected by biomass burning, indicating that secondary formation contributed to ambient levels of fine nitrated phenols. The emission factors of fine nitrated phenols from flaming biomass burning were estimated based on the measured mass fractions and the PM 2.5 emission factors from literature and were approximately 0.75-11.1 mg kg -1 . According to calculations based on corn and wheat production in 31 Chinese provinces in 2013, the total estimated emission of fine nitrated phenols from the burning of corncobs, corn stalks, and wheat straw was 670 t. This work highlights the apparent emission of methyl nitrocatechols from biomass burning and provides basic data for modeling studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

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 provide insight with respect to the higher morbidity rate in adults. Furthermore, the dramatic discrepancies observed in plasma cytokine detection between children and adults suggest that these two patient populations may benefit from different therapeutic interventions to achieve attenuation of the post-burn inflammatory response. PMID:18548133

DOE Office of Scientific and Technical Information (OSTI.GOV)

Streets, D. G.; Yarber, K. F.; Woo, J.-H.

Estimates of biomass burning in Asia are developed to facilitate the modeling of Asian and global air quality. A survey of national, regional, and international publications on biomass burning is conducted to yield consensus estimates of 'typical' (i.e., non-year-specific) estimates of open burning (excluding biofuels). We conclude that 730 Tg of biomass are burned in a typical year from both anthropogenic and natural causes. Forest burning comprises 45% of the total, the burning of crop residues in the field comprises 34%, and 20% comes from the burning of grassland and savanna. China contributes 25% of the total, India 18%, Indonesiamore » 13%, and Myanmar 8%. Regionally, forest burning in Southeast Asia dominates. National, annual totals are converted to daily and monthly estimates at 1{sup o} x 1{sup o} spatial resolution using distributions based on AVHRR fire counts for 1999--2000. Several adjustment schemes are applied to correct for the deficiencies of AVHRR data, including the use of moving averages, normalization, TOMS Aerosol Index, and masks for dust, clouds, landcover, and other fire sources. Good agreement between the national estimates of biomass burning and adjusted fire counts is obtained (R{sup 2} = 0.71--0.78). Biomass burning amounts are converted to atmospheric emissions, yielding the following estimates: 0.37 Tg of SO{sub 2}, 2.8 Tg of NO{sub x}, 1100 Tg of CO{sub 2}, 67 Tg of CO, 3.1 Tg of CH{sub 4}, 12 Tg of NMVOC, 0.45 Tg of BC, 3.3 Tg of OC, and 0.92 Tg of NH{sub 3}. Uncertainties in the emission estimates, measured as 95% confidence intervals, range from a low of {+-}65% for CO{sub 2} emissions in Japan to a high of {+-}700% for BC emissions in India.« less

[Fluid management and cause of death during shock period in patients with severe burns or burns complicated by inhalation injury].

PubMed

Zhang, Ming-liang; Li, Chi; Ma, Chun-xu

2003-11-01

To explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury. One hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed. The fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA.kg) including colloid fluid 0.5 ml/(%TBSA.kg), crystalloid fluid 1 ml/(%TBSA.kg)and water 0.7 ml/(%TBSA.kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA.kg) including colloid fluid 0.4 ml/(%TBSA.kg), crystalloid fluid 0.7 ml/(%TBSA.kg) and water 0.7 ml/(%TBSA.kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period. Many fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.

Novel burn device for rapid, reproducible burn wound generation.

PubMed

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

2016-03-01

Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200±5°C) and pressed into the skin for 40s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40s at a constant pressure and at pressures of 1 or 3lbs with a constant contact time of 40s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Novel burn device for rapid, reproducible burn wound generation

PubMed Central

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

2016-01-01

Introduction Scarring following full thickness burns leads to significant reductions in range of motion and quality of life for burn patients. To effectively study scar development and the efficacy of anti-scarring treatments in a large animal model (female red Duroc pigs), reproducible, uniform, full-thickness, burn wounds are needed to reduce variability in observed results that occur with burn depth. Prior studies have proposed that initial temperature of the burner, contact time with skin, thermal capacity of burner material, and the amount of pressure applied to the skin need to be strictly controlled to ensure reproducibility. The purpose of this study was to develop a new burner that enables temperature and pressure to be digitally controlled and monitored in real-time throughout burn wound creation and compare it to a standard burn device. Methods A custom burn device was manufactured with an electrically heated burn stylus and a temperature control feedback loop via an electronic microstat. Pressure monitoring was controlled by incorporation of a digital scale into the device, which measured downward force. The standard device was comprised of a heat resistant handle with a long rod connected to the burn stylus, which was heated using a hot plate. To quantify skin surface temperature and internal stylus temperature as a function of contact time, the burners were heated to the target temperature (200 ± 5 °C) and pressed into the skin for 40 s to create the thermal injuries. Time to reach target temperature and elapsed time between burns were recorded. In addition, each unit was evaluated for reproducibility within and across three independent users by generating burn wounds at contact times spanning from 5 to 40 s at a constant pressure and at pressures of 1 or 3 lbs with a constant contact time of 40 s. Biopsies were collected for histological analysis and burn depth quantification using digital image analysis (ImageJ). Results The custom burn device maintained both its internal temperature and the skin surface temperature near target temperature throughout contact time. In contrast, the standard burner required more than 20 s of contact time to raise the skin surface temperature to target due to its quickly decreasing internal temperature. The custom burner was able to create four consecutive burns in less than half the time of the standard burner. Average burn depth scaled positively with time and pressure in both burn units. However, the distribution of burn depth within each time-pressure combination in the custom device was significantly smaller than with the standard device and independent of user. Conclusions The custom burn device's ability to continually heat the burn stylus and actively control pressure and temperature allowed for more rapid and reproducible burn wounds. Burns of tailored and repeatable depths, independent of user, provide a platform for the study of anti-scar and other wound healing therapies without the added variable of non-uniform starting injury. PMID:26803369

Effects of open burning of rice straw on concentrations of atmospheric polycyclic aromatic hydrocarbons in central Taiwan.

PubMed

Chen, Kang-Shin; Wang, Hsin-Kai; Peng, Yen-Ping; Wang, Wen-Cheng; Chen, Chia-Hsiu; Lai, Chia-Hsiang

2008-10-01

The sizes and concentrations of 21 atmospheric polycyclic aromatic hydrocarbons (PAHs) were measured at Jhu-Shan (a rural site) and Sin-Gang (a town site) in central Taiwan in October and December 2005. Air samples were collected using semi-volatile sampling trains (PS-1 sampler) over 16 days for rice-straw burning and nonburning periods. These samples were then analyzed using a gas chromatograph with a flame-ionization detector (GC/FID). Particle-size distributions in the particulate phase show a bimode, peaking at 0.32-0.56 microm and 3.2-5.6 microm at the two sites during the nonburning period. During the burning period, peaks also appeared at 0.32-0.56 microm and 3.2-5.6 microm at Jhu-Shan, with the accumulation mode (particle size between 0.1 and 3.2 microm) accounting for approximately 74.1% of total particle mass. The peaks at 0.18-0.32 microm and 1.8-3.2 microm at Shin-Gang had an accumulation mode accounting for approximately 70.1% of total particle mass. The mass median diameter (MMD) of 3.99-4.35 microm in the particulate phase suggested that rice-straw burning generated increased numbers of coarse particles. The concentrations of total PAHs (sum of 21 gases + particles) at the Jhu-Shan site (Sin-Gang site) were 522.9 +/- 111.4 ng/ml (572.0 +/- 91.0 ng/ml) and 330.1 +/- 17.0 ng/ml (or 427.5 +/- 108.0 ng/ml) during burning and nonburning periods, respectively, accounting for a roughly 58% (or 34%) increase in the concentrations of total PAHs due to rice-straw burning. On average, low-weight PAHs (about 87.0%) represent the largest proportion of total PAHs, followed by medium-weight PAHs (7.1%), and high-weight PAHs (5.9%). Combustion-related PAHs during burning periods were 1.54-2.57 times higher than those during nonburning periods. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at the two sites are similar and include vehicle exhaust, coal/wood combustion, incense burning, and incineration emissions. Open burning of rice straw was estimated to contribute approximately 5.0-33.5% to the total atmospheric PAHs at the two sites.

Relationship of surface fuels to fire radiative energy as estimated from airborne lidar and thermal infrared imaging

NASA Astrophysics Data System (ADS)

Hudak, A. T.; Dickinson, M. B.; Kremens, R.; Loudermilk, L.; O'Brien, J.; Satterberg, K.; Strand, E. K.; Ottmar, R. D.

2013-12-01

Longleaf pine stand structure and function are dependent on frequent fires, so fire managers maintain healthy longleaf pine ecosystems by frequently burning surface fuels with prescribed fires. Eglin Air Force Base (AFB) in the Florida panhandle boasts the largest remnant of longleaf pine forest, providing a productive setting for fire scientists to make multi-scale measurements of fuels, fire behavior, and fire effects in collaboration with Eglin AFB fire managers. Data considered in this analysis were collected in five prescribed burn units: two forested units burned in 2011 and a forested unit and two grassland units burned in 2012. Our objective was to demonstrate the linear relationship between biomass and fire energy that has been shown in the laboratory, but using two independent remotely sensed airborne datasets collected at the unit level: 1) airborne lidar flown over the burn units immediately prior to the burns, and 2) thermal infrared image time series flown over the burn units at 2-3 minute intervals. Airborne lidar point cloud data were reduced to 3 m raster metrics of surface vegetation height and cover, which were in turn used to map surface fuel loads at 3 m resolution. Plot-based measures of prefire surface fuels were used for calibration/validation. Preliminary results based on 2011 data indicate airborne lidar can explain ~30% of variation in surface fuel loads. Multi-temporal thermal infrared imagery (WASP) collected at 3 m resolution were calibrated to units of fire radiative power (FRP), using simultaneous FRP measures from ground-based radiometers, and then temporally integrated to estimate fire radiative energy (FRE) release at the unit level. Prior to AGU, FRP and FRE will be compared to estimates of the same variables derived from ground-based FLIR thermal infrared imaging cameras, each deployed with a nadir view from a tripod, at three sites per burn unit. A preliminary proof-of-concept, comparing FRE derived from a tripod-based FLIR (3.2 MW), to another FLIR deployed with an oblique view from atop a 36 m boom lift (2.1 MW), demonstrated reasonable agreement. Unit-level estimates of FRE will also be compared to estimates of surface fuel consumption (~5 Mg/ha) that were summarized at the unit level from pre- and post-fire clip plots of surface fuel biomass. At AGU, we will also compare predictions of surface fuel loads to estimates of energy release, as mapped at 3 m resolution from these independent remotely sensed data sources. These results will serve to demonstrate our ability to remotely measure and relate fuel loads to fire behavior at a landscape level.

Large forest fires in Canada, 1959-1997

NASA Astrophysics Data System (ADS)

Stocks, B. J.; Mason, J. A.; Todd, J. B.; Bosch, E. M.; Wotton, B. M.; Amiro, B. D.; Flannigan, M. D.; Hirsch, K. G.; Logan, K. A.; Martell, D. L.; Skinner, W. R.

2002-01-01

A Large Fire Database (LFDB), which includes information on fire location, start date, final size, cause, and suppression action, has been developed for all fires larger than 200 ha in area for Canada for the 1959-1997 period. The LFDB represents only 3.1% of the total number of Canadian fires during this period, the remaining 96.9% of fires being suppressed while <200 ha in size, yet accounts for ˜97% of the total area burned, allowing a spatial and temporal analysis of recent Canadian landscape-scale fire impacts. On average ˜2 million ha burned annually in these large fires, although more than 7 million ha burned in some years. Ecozones in the boreal and taiga regions experienced the greatest areas burned, with an average of 0.7% of the forested land burning annually. Lightning fires predominate in northern Canada, accounting for 80% of the total LFDB area burned. Large fires, although small in number, contribute substantially to area burned, most particularly in the boreal and taiga regions. The Canadian fire season runs from late April through August, with most of the area burned occurring in June and July due primarily to lightning fire activity in northern Canada. Close to 50% of the area burned in Canada is the result of fires that are not actioned due to their remote location, low values-at-risk, and efforts to accommodate the natural role of fire in these ecosystems. The LFDB is updated annually and is being expanded back in time to permit a more thorough analysis of long-term trends in Canadian fire activity.

Large forest fires in Canada, 1959-1997

NASA Astrophysics Data System (ADS)

Stocks, B. J.; Mason, J. A.; Todd, J. B.; Bosch, E. M.; Wotton, B. M.; Amiro, B. D.; Flannigan, M. D.; Hirsch, K. G.; Logan, K. A.; Martell, D. L.; Skinner, W. R.

2003-01-01

A Large Fire Database (LFDB), which includes information on fire location, start date, final size, cause, and suppression action, has been developed for all fires larger than 200 ha in area for Canada for the 1959-1997 period. The LFDB represents only 3.1% of the total number of Canadian fires during this period, the remaining 96.9% of fires being suppressed while <200 ha in size, yet accounts for ~97% of the total area burned, allowing a spatial and temporal analysis of recent Canadian landscape-scale fire impacts. On average ~2 million ha burned annually in these large fires, although more than 7 million ha burned in some years. Ecozones in the boreal and taiga regions experienced the greatest areas burned, with an average of 0.7% of the forested land burning annually. Lightning fires predominate in northern Canada, accounting for 80% of the total LFDB area burned. Large fires, although small in number, contribute substantially to area burned, most particularly in the boreal and taiga regions. The Canadian fire season runs from late April through August, with most of the area burned occurring in June and July due primarily to lightning fire activity in northern Canada. Close to 50% of the area burned in Canada is the result of fires that are not actioned due to their remote location, low values-at-risk, and efforts to accommodate the natural role of fire in these ecosystems. The LFDB is updated annually and is being expanded back in time to permit a more thorough analysis of long-term trends in Canadian fire activity.

Characterization of polychlorinated dibenzo-p-dioxin/dibenzofuran emissions from joss paper burned in a furnace with air pollution control devices.

PubMed

Hu, Ming-Tsan; Chen, Shui-Jen; Huang, Kuo-Lin; Lin, Yuan-Chung; Chang-Chien, Guo-Ping; Tsai, Jen-Hsiung

2009-05-01

Burning joss paper, a common practice in temples in some Asian countries, can release toxic pollutants. This study investigated polychlorinated dibenzo-p-dioxin/dibenzofuran (PCDD/F) emissions and profiles from burning joss paper in a temple furnace connected to two wet scrubbers. The mean total PCDD/F content and corresponding toxic equivalent quantity (TEQ) in joss paper were 193 ng kg(-1) and 0.645 ng I-TEQ kg(-1), respectively, whereas those in bottom ash from burned joss paper were 18.5 ng kg(-1) and 1.92 ng I-TEQ kg(-1), respectively. The wet scrubbers decreased individual PCDD/F emissions by 26.7-71.0% and those of total PCDD/Fs and I-TEQ by 47.2% and 66.0%, respectively. The total PCDD/F TEQ emission factors before and after the wet scrubbers were 8.14 and 3.42 microg I-TEQ ton-feedstock(-1), respectively. The estimated total PCDD/F and corresponding TEQ emissions were 5.29 g year(-1) and 0.462 g I-TEQ year(-1), respectively, in Taiwan. Burning joss paper in temple furnaces is a significant source of PCDD/F emissions.

An LNG release, transport, and fate model system for marine spills.

PubMed

Spaulding, Malcolm L; Swanson, J Craig; Jayko, Kathy; Whittier, Nicole

2007-02-20

LNGMAP, a fully integrated, geographic information based modular system, has been developed to predict the fate and transport of marine spills of LNG. The model is organized as a discrete set of linked algorithms that represent the processes (time dependent release rate, spreading, transport on the water surface, evaporation from the water surface, transport and dispersion in the atmosphere, and, if ignited, burning and associated radiated heat fields) affecting LNG once it is released into the environment. A particle-based approach is employed in which discrete masses of LNG released from the source are modeled as individual masses of LNG or spillets. The model is designed to predict the gas mass balance as a function of time and to display the spatial and temporal evolution of the gas (and radiated energy field). LNGMAP has been validated by comparisons to predictions of models developed by ABS Consulting and Sandia for time dependent point releases from a draining tank, with and without burning. Simulations were in excellent agreement with those performed by ABS Consulting and consistent with Sandia's steady state results. To illustrate the model predictive capability for realistic emergency scenarios, simulations were performed for a tanker entering Block Island Sound. Three hypothetical cases were studied: the first assumes the vessel continues on course after the spill starts, the second that the vessel stops as soon as practical after the release begins (3 min), and the third that the vessel grounds at the closest site practical. The model shows that the areas of the surface pool and the incident thermal radiation field (with burning) are minimized and dispersed vapor cloud area (without burning) maximized if the vessel continues on course. For this case the surface pool area, with burning, is substantially smaller than for the without burning case because of the higher mass loss rate from the surface pool due to burning. Since the vessel speed substantially exceeds the spill spreading rate, both the thermal radiation fields and surface pool trail the vessel. The relative directions and speeds of the wind and vessel movement govern the orientation of the dispersed plume. If the vessel stops, the areas of the surface pool and incident radiation field (with burning) are maximized and the dispersed cloud area (without burning) minimized. The longer the delay in stopping the vessel, the smaller the peak values are for the pool area and the size of the thermal radiation field. Once the vessel stops, the spill pool is adjacent to the vessel and moving down current. The thermal radiation field is oriented similarly. These results may be particularly useful in contingency planning for underway vessels.

[Epidemiological investigation on 2 133 hospitalized patients with electrical burns].

PubMed

Jiang, M J; Li, Z; Xie, W G

2017-12-20

Objective: To analyze the epidemiological characteristics of the hospitalized patients with electrical burns in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as Institute of Burns of Wuhan Third Hospital), so as to provide reference for the prevention and treatment of electrical burns. Methods: Medical records of all hospitalized burn patients in Institute of Burns of Wuhan Third Hospital from January 2004 to December 2016 were collected. Genders, ages, social categories, seasons of injury, total burn areas, depths of wounds, electrical voltages of injury, sites of wound, treatment methods, amputation rates, lengths of hospital stay, operation costs, hospitalization costs, and treatment outcomes of the electrical burn patients were collected. Treatment methods, lengths of hospital stay, operation costs, and hospitalization costs of the thermal burn patients were collected and compared with those of the electrical burn patients. Electrical voltages of injury, amputation rates, operation costs, hospitalization costs, and treatment outcomes were compared and analyzed between the electrical contact burn patients and the electrical arc burn patients. Data were processed with Chi-square test and Wilcoxon rank-sum test. Results: During the 13 years, 23 534 burn patients were admitted to Institute of Burns of Wuhan Third Hospital, among whom 2 133 (9.1%) were with electrical burns, without obvious variation in admission number of electrical burn patients every year. There were 1 418 patients (66.5%) with electrical contact burns and 715 patients (33.5%) with electrical arc burns. The ratio of male to female was 11.2∶1.0 among the electrical burn patients with known genders. The proportions of three age groups of more than 20 years old and less than or equal to 30 years old, more than 30 years old and less than or equal to 40 years old, and more than 40 years old and less than or equal to 50 years old were relatively higher, which were 18.3% (391/2 133), 22.1% (471/2 133), and 24.6% (525/2 133), respectively. The first three social category groups in proportions were workers, peasants, and preschool children, which were 57.9% (1 235/2 133), 14.6% (311/2 133), and 6.0% (128/2 133), respectively. Among the electrical burn patients with known seasons of injury, most cases were injured in summer (659 cases, accounting for 34.1%), obviously more than the proportions in autumn (537 cases, accounting for 27.8%), spring (455 cases, accounting for 23.5%), and winter (283 cases, accounting for 14.6%), with χ (2) values from 8.414 to 149.573, P values below 0.01. The group of patients with total burn areas less than 10% total body surface area (TBSA) occupied the highest proportion (1 603 cases, accounting for 75.15%), among whom 229 (10.74%) were with scattered small wounds which were less than 1% TBSA. The percentage of electrical contact burn patients with deep wounds was 79.1% (1 122/1 418), which was obviously higher than 2.5% (18/715) of the electrical arc burn patients ( χ (2)=381.741, P <0.001). Among the patients with known electrical voltages of injury, patients injured by high voltage among the electrical contact burn patients accounted for 78.4% (469/598), which was obviously higher than 8.7% (11/127) of the electrical arc burn patients ( χ (2)=227.893, P <0.001). The most common wound site of the electrical burn patients was upper limbs (1 650 cases, accounting for 63.2%), followed by lower limbs (382 cases, accounting for 14.6%), head and neck (292 cases, accounting for 11.2%), trunk (247 cases, accounting for 9.5%), and hip and perineum (40 cases, accounting for 1.5%). The operation rate of electrical burn patients was 32.4% (691/2 133), obviously higher than 19.1% (3 860/20 209)of the thermal burn patients during the same period ( χ (2)=210.255, P <0.001). Wounds of 116 electrical contact burn patients were repaired with free flap by vascular anastomosis, of which 9 (7.8%) failed. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were (28±29) d, (9 534±16 935) and (44 258±93 012) Yuan, respectively, obviously longer or higher than those of the thermal burn patients during the same period [(17±19) d, (2 990±8 916) and (23 291±88 340) Yuan, respectively, with Z values from -21.323 to -10.996, P values below 0.001]. The amputation rate and the death rate of electrical burn patients were 3.8% (82/2 133) and 0.8% (16/2 133) respectively. Compared with those of electrical arc burn patients, the amputation rate and the operation cost of electrical contact burn patients were obviously higher ( χ (2)=36.970, Z =-11.351, P values below 0.001), and the length of hospital stay of electrical contact burn patients was obviously longer ( Z =-5.181, P <0.001). There were no significant differences in hospitalization cost and treatment outcome between the electrical contact burn patients and the electrical arc burn patients ( Z =-1.461, χ (2)=1.673, P values above 0.05). Conclusions: The number and the proportion of hospitalized electrical burn patients in Institute of Burns of Wuhan Third Hospital were relatively high, indicating a hard task of prevention for electrical burns in Wuhan area. Working-age workers and farmers, and preschool children were the key groups in prevention from electrical burns. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were obviously higher than those of thermal burn patients. The amputation rate and the operation cost of electrical contact burn patients were obviously higher than those of electrical arc burn patients, but there were no obvious differences in hospitalization cost or treatment outcome between them. Actively using tissue flaps including free flap to repair of wounds may be helpful to reduce the amputation rate, improve the results, and shorten the time of treatment.

Scheduled Civil Aircraft Emission Inventories for 1999: Database Development and Analysis

NASA Technical Reports Server (NTRS)

Sutkus, Donald J., Jr.; Baughcum, Steven L.; DuBois, Douglas P.

2001-01-01

This report describes the development of a three-dimensional database of aircraft fuel burn and emissions (NO(x), CO, and hydrocarbons) for the scheduled commercial aircraft fleet for each month of 1999. Global totals of emissions and fuel burn for 1999 are compared to global totals from 1992 and 2015 databases. 1999 fuel burn, departure and distance totals for selected airlines are compared to data reported on DOT Form 41 to evaluate the accuracy of the calculations. DOT Form T-100 data were used to determine typical payloads for freighter aircraft and this information was used to model freighter aircraft more accurately by using more realistic payloads. Differences in the calculation methodology used to create the 1999 fuel burn and emissions database from the methodology used in previous work are described and evaluated.

Production of Landsat ETM+ reference imagery of burned areas within Southern African savannahs: comparison of methods and application to MODIS

Treesearch

A. M. S. Smith; N. A. Drake; M. J. Wooster; A. T. Hudak; Z. A. Holden; C. J. Gibbons

2007-01-01

Accurate production of regional burned area maps are necessary to reduce uncertainty in emission estimates from African savannah fires. Numerous methods have been developed that map burned and unburned surfaces. These methods are typically applied to coarse spatial resolution (1 km) data to produce regional estimates of the area burned, while higher spatial resolution...