Risk Factors for Infection and Mortality in Burned Children: Where are we going?

Clove (Syzygium aromaticum) (Figure 1) is a plant-derived spice that has been traditionally used for centuries as food preservative and as medicinal plants [1].

The anti-inflammatory, antioxidant and bactericide activities of clove are mainly due to its major components, which is the eugenol with a concentration rate ranging from to (77-95%) [2,3].

Clove is generally safe when taken in foods in lower concentrations [4], however, it is not recommended as a topical application on skin due to insufficiency of safety and toxicity data [5]; it was found to be highly cytotoxic for human fibroblasts and endothelial cells [6] leading to allergic skin reactions (burning, hives, itching, irritation, rash…), ulcer formation and/or tissue necrosis [7].

Background: Burn wounds caused by airbags deployment are infrequent, and with the increasing use of these safety feature in cars the documentation and sharing of the information related to these injuries is important to help improve the design of airbags and give the treating clinicians some background knowledge when treating injuries of similar nature.

Case presentation: This is a case report of lady who sustained a chemical burn injury to her finger following the deployment of airbags when she had a frontal car collision. The pH of the wound has helped to establish the pathophysiology of the wound.

Conclusion: Thorough history and examination help to detect minor injuries which can be overlooked otherwise. Airbags are associated with both friction and chemical burns, and pH of the burn wound helped in differentiating between them, and decides on first aid and appropriate management and follow ups.

Burns are a common global cause of injury; however iatrogenic burns are rare and preventable mode of injury. We report two cases who sustained superficial partial thickness burns from ECG monitoring leads during Magnetic Resonance Imaging (MRI). The two patients have sustained 0.2% and <1% superficial partial thickness burn of their Total Body Surface Area (TBSA) respectively. Common features included a relatively long duration of spine MR scanning (90 and 30 minutes) and high Body Mass Index (BMI). Both patients made uneventful recovery and were discharged within 24 hours of admission. It is still uncertain whether injuries were thermal or electrically-induced, however several mechanisms have been implied. These include electromagnetic inductionheating, the antenna effect and current induction through a closed loop. In this report, we discuss the proposed mechanisms of injury and highlight the fundamental need for staff education, and preparing national guidelines and safety checklists to prevent similar injuries in the future.

Burns are major health hazards which are associated with high mortality and morbidity rates. Burns management in developing countries is a major challenge due to inadequate access to burn care facility along with poorly equipped health care system. Although we are faced with a high burden of burns in our country, appropriate research on burns is still inadequate. We present our data of burns patients from a single center tertiary care hospital in south India.

Aim: To analyze various demographic characteristics, clinical and microbiological profile along with outcome of all burns patients admitted to our hospital.

Methods: This study was a retrospective analysis of burns patients admitted to the Critical Care Unit of Apollo Speciality Hospital, Vanagaram and a tertiary care facility in Chennai over a period of 3 years. Data such as age, gender, co-morbidities, type and degree of burns, percentage of burns and length of stay, mortality rate and infection rate were analyzed.

Results: There were a total of 94 burns patients included in the study. Amongst these, 61 patients (65%) were males and 33 patients (35%) were females. A majority of our burns population, 72% (n=68), belonged to age group from 21-50 years with a mean age of 40.50 years (SD±17.18).Mean total body surface area involved among burns was 48.56 (SD±21.08). Thermal burns were the commonest type of burns seen in 70%patients (n=66). These included flame burns in 49% patients (n=46) and scald burns in21% patients (n=20).Patients who presented to us within 6 hours post burns were 46% (n=43). Around 60% (n=56) patients had a hospital stay duration of ≤ 2 weeks. Infection rate among our patients was 62.8% and a mortality rate of 37% (n=35) was observed.

Conclusion: We highlight key demographic, clinical and microbiological data of all burns patients from a single center tertiary hospital in south India. This knowledge should help develop better strategies for management and prevention of mortality due to burns.

Background: Loss of skin as the first line of defence suppress immune system, extend hospital stay and makes burn patients more vulnerable to acquire healthcare associated infections. Such infections become the reason for mortality and morbidity in burn patients. Therefore, continuous monitoring of the pattern of nosocomial infection and drug resistance is necessary for assuring patient safety and healthcare quality improvement.

Aim: To describe the microbial profile of infections among burn patients admitted to Bahrain Defence Force Military Hospital.

Method: This is a retrospective cohort study involving 295burn patients. Wound swab method was used to isolate the microorganisms first on admission and then on suspicion of infection. The overall percentage of wound culture positive cases was 11.8% and the wound infection percentage was 5% of the total number of patients admitted to the unitA total of 126 swabs was performed from the burn wounds.

Results: Gram+ bacteria S.aureus was predominant in initial cultures. It was however, succeeded by Gram- bacteria, Pseudomonas, from third culture onwards. Fungal infection with Candida was most prevalent (n=21,16.7%). With TBSA >30% polymicrobial growth was observed which tend to increase with increase length of hospitalization. A greater proportion of patients (42.9%, n=15) had acquired healthcare associated infections and was negatively associated with increased length of hospitalization(r=-0.418, p=0.012).

Conclusion: 5% of the total patient population was categorized as health care associated infection cases. Gram negative bacteria, Pseudomonas were the prevalent microorganism isolated from wound infection of the burn patients.

Large burns are extensive soft tissue injuries with severe deep skin damage associated with high mortality [1-2]. This type of lesions can also lead to mental distress and chronic ilness but specially to scars, contractures, limitation of motion and bad quality of life [3-5]. Treatment of large burns as well as chronic nonhealing wounds have always been difficult medical problems and many different methods have been used to treat such injuries [6-7]. Current wound treatments are ineffective in many cases, so alternative novel types of therapy are needed and should urgently be understood and correctly explored. Abnormal damaged body environments can promote wound healing and tissue regeneration by local biochemical “alarm signals”, but usually these innate mechanisms are not enough to reach complete restoration of normal skin, specially in an acceptable time [8-12].When these impairments in wound healing arise, it is also often followed by an increased susceptibility to infection, further complications, failure of other organs and death [13-14]. In these circumstances, time management should be a crucial fundamental issue to be considered. In the near future we will not only ask for better novel therapeutic approaches but also for those that could lead to complete skin healing, restoration of function and acceptable aesthetics in the shortest period of time [ 15-16]. The development of tissue engineering and living skin substitutes started more than 40 years ago with the in vitro culture of keratinocytes as established by Howard Green in 1975 [17-18]. His outstanding discoveries led to the possibility of replacing the epidermis of extensively burned patients by using cultured keratinocytes autografts [19].

Since Eikenella corrodens is part of the normal oral flora, it can be isolated from fist fight and human-bite injuries. Suspicion of the clinician, collection of adequate specimen, and proper culture technique will improve its isolation in the laboratories. Here we report a case of wound infection due to Eikenella corrodens in a 27-year-old female patient after biting herself during examination at the emergency ward.

Aim: Describe the complications and management of a rare case of burn injury by phenolic acid.

Methods: A 45-year-old truck driver sustained a 35% total body surface area (TBSA) burn from an accidental phenolic acid injury. After initial treatment and decontamination with a polyethylene glycol solution, he arrived at the hospital intubated and on vasopressor support. No other traumatic injuries were found. Local assessment revealed a 35% TBSA burn of partial and full thickness on the perineal region, legs, right arm, and a small area of the abdomen. His Revised Baux score was 97. During his recovery, the patient developed hepatic insufficiency followed by renal failure, which required dialysis. A few days later, a total body CT scan revealed multiple ischemic cerebral areas. After 12 days from admission and episodes of bronchial bleeding, the patient died due to a multiorgan failure. A skin biopsy and toxicological analysis for phenol levels were performed during his hospital stay.

Results: In addition to the clinical case analysis, a review of the medical literature regarding cases of death following phenol burns, a histological analysis of the biopsy tissue collected and an analysis of the blood levels of phenol and its derivative o-cresol were conducted.

Conclusions: This case report illustrates the lethality of phenol chemical burns and emphasizes the critical role of multidisciplinary management in addressing multi-organ complications