Upper Extremity Burns in the Developing World

Sasor, Sarah E.; Chung, Kevin C.

doi:10.1016/j.hcl.2019.07.010

Cited by 22 publications

(7 citation statements)

References 59 publications

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“…The risk factors for mortality in our patients were: TBSA burned >37% (over this value, mortality risk increases 30 times), burn depth (the grater the depth of the burn, the greater the mortality risk), presence of inhalation injury (12.729 times higher risk of negative outcome), requirement of orotracheal intubation or tracheostomy, ABSI score > 9 points (72 times higher mortality risk), burns affecting arms (8.426 times higher risk), and increased level of creatinkinase and leukocytes at admission. Reports show that, in almost 80% of severe burn cases, the arms are affected, especially due to protective reflexes, and, as observed in this study, there was an increased percentage of patients with third-degree burns and extended TBSA% burned [ 55 ]. Interestingly, an LOS of ≤14 days was associated with a 7.181 higher risk of mortality, translating the severity of cases cared for in our burn unit.…”

Section: Discussionsupporting

confidence: 67%

Emergency Care for Burn Patients—A Single-Center Report

Niculae

Peride

Ţigliş

et al. 2023

JPM

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Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit. Design. We performed a retrospective observational study of 2021. Patients. All patients admitted to our six-bed intensive care unit (ICU) were included. Interventions. The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. Results. There were 93 burned patients included in our study that were divided into two groups: alive patients’ group (63.4%) and deceased patients’ group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. Conclusion. A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients’ outcomes.

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Section: Discussionsupporting

confidence: 67%

Emergency Care for Burn Patients—A Single-Center Report

Niculae

Peride

Ţigliş

et al. 2023

JPM

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“…Similar reports from Nigeria, Kenya and Uganda have shown that work-related injuries and traffic injuries are common and most often affect the upper extremity [13][14][15]. Poorly equipped facilities for acute treatment of burn injuries and residual problems and disability after non-treated burns are specific problems in LMICs, with a risk for specifically affecting children, where the number of cases may be related to an increased use of open fire in food cooking as well as inappropriately protected electrical equipment and cables [16,17].…”

Section: Hand Surgery In a Global Perspectivementioning

confidence: 99%

Global Rehabilitation – Addressing the Need for Early, Safe, Continuous and Widespread Rehabilitation in Low- and Middle-Income Countries

Brogren¹,

Vikström²,

Johansson³

et al. 2021

CMR

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Background: Scaling-up surgical care is one of the most important goals in improving global health and long-term development, where specific attention is directed towards diagnosis and treatment of traumatic injuries, as well as to certain conditions, with varying frequencies between continents and countries. Successful outcome after surgery depends also on safe, efficient and widespread rehabilitation, including both short-and long-term engagement of physiotherapists and occupational therapists. However, relatively little attention has been paid to rehabilitation after trauma and surgery for injuries and various conditions in a global perspective. In fact, the access to rehabilitation in low-and middle-income countries (LMIC) is believed to be enormous. Objective: Through a shared project between two University Hospitals in Zimbabwe and Sweden, our objective was to create an academic partnership with the goal of improving rehabilitation after hand injuries in Zimbabwe. Results: Except geographical, political and patient-related factors, we found that prolonged or inadequate immobilisation after hand injuries and poor teamwork between surgeons and therapists were important factors that complicated the patient care. We give examples on how educational programs in rehabilitation could be organized with focus on creating a close alliance between surgeons and therapists. Conclusion: Creating academic partnerships between universities and hospitals can be of mutual benefit and may be a model for spreading knowledge and strengthen health care systems. Collaboration between therapists and surgeons can be strengthened through integrated courses adapted to existing local circumstances, exchange programs and on-line education, which can be organized between specific departments in different countries. We launch the concept of Global Rehabilitation and give examples of how teaching posttraumatic and postoperative management of hand surgical injuries and common conditions could be structured.

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“…Burn injuries, as one of the common clinical critical illnesses worldwide caused by thermal aggressions, have caused high morbidity and mortality rates, especially in low and middle-income countries ( 1 ). Burns affect the integrity of the skin, which acts as the protective organ that prevents the body from experiencing microbial invasion; extensive burn injuries are highly prone to inflicting deep damages, such as severe infections, complications, and sepsis, to the body ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Bruton's Tyrosine Kinase Protects Against Burn Sepsis-Induced Intestinal Injury

Jia¹,

Yu²,

Niu³

et al. 2022

Front. Med.

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This study aimed to investigate the role and molecular mechanisms of Bruton's tyrosine kinase (BTK), a member of the Tec family in burn sepsis-induced intestinal injury. Eighty C57BL/6 mice were randomly divided into four groups: the sham group, the burn group, the burn + sepsis group, and the burn + sepsis + LFM-A13 (a selective BTK inhibitor) group. The dynamic expression profiles of BTK and p-BTK in the intestine were measured by Western blot analysis. Intestinal histopathological changes and cellular apoptosis were determined. Inflammatory cytokines in serum and intestinal tissue were examined through enzyme-linked immunosorbent assay. Myeloperoxidase (MPO) activity was determined via a colorimetric assay. Intestinal p-BTK expression in the burn+sepsis group was significantly increased compared with that in the sham and burn groups. In the burn + sepsis group, the p-BTK expression level increased over time, peaked at 12, and then decreased at 24 h. LFM-A13 administration significantly inhibited p-BTK expression in the intestine. In contrast to the sham and burn groups, the burn + sepsis group exhibited obvious histopathological changes, which gradually aggravated over time. LFM-A13 also reduced the histopathological changes and cellular apoptosis in intestinal tissues, inhibited the inflammatory cytokines IL-4, IL-6, and TNF-α in serum and intestinal tissues, and significantly inhibited the increase in intestinal MPO activity induced by burn sepsis. BTK activation is one important aspect of the signaling event that may mediate the release of the anti-inflammatory cytokine IL-4 and the pro-inflammatory cytokines IL-6 and TNF-α; oxidative stress; and intestinal cell apoptosis. Thus, it contributes to burn sepsis-induced intestinal injury.

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Upper Extremity Burns in the Developing World

Cited by 22 publications

References 59 publications

Emergency Care for Burn Patients—A Single-Center Report

Emergency Care for Burn Patients—A Single-Center Report

Global Rehabilitation – Addressing the Need for Early, Safe, Continuous and Widespread Rehabilitation in Low- and Middle-Income Countries

Inhibition of Bruton's Tyrosine Kinase Protects Against Burn Sepsis-Induced Intestinal Injury

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