Electrical burns in adults.

INTRODUCTION: Electrical burns account for up to 10% of burns admissions worldwide and are a potentially serious mechanism of injury. The aim of this study is to describe the epidemiology, presentation, management and complications of electrical burn injuries in adults. MATERIAL AND METHODS: A retrospective study of all adult patients with electrical burns admitted to a tertiary burns centre. RESULTS: Eighty-two cases were identified. The mean age was 40 ± 2 years, 92.7% were males. The most common activities causing the injuries were work (39%) and do-it yourself activities (32%). A low voltage (< 1,000 W) power source was involved in 78% of cases. The mean total body surface area involved was 3 ± 0.3%. The head, hands, and other upper extremities were the body parts most frequently injured. The mean hospital stay was 2 ± 1days. CONCLUSION: Electrical injury was an infrequent but potentially serious cause of injury in adults. Minor injuries were successfully managed non-operatively. Electrical burns in adults are mainly low voltage burns contracted by manual workers resulting in a flesh burn. Although rare, the loss of digits, neurological sequelae, cardiac arrhythmias and renal failure remain serious complications in a significant number of cases.

Surgical training during the COVID-19 pandemic - a single institution's trainee survey.

BACKGROUND: Few studies have assessed the impact of COVID-19 on surgical training in low- and middle-income countries. The aim of this study was to survey the effect of the COVID-19 pandemic on postgraduate surgical training, research and registrar wellbeing in South Africa. METHODS: A cross-sectional study was conducted as an online survey from 5 October 2020 to 1 December 2020. The study population was registrars from all surgical disciplines at the Faculty of Medicine and Health Sciences of Stellenbosch University. The survey consisted of 26 multiple-choice and five open-ended qualitative questions on the impact of COVID-19 on physical and mental wellbeing, skills acquisition and postgraduate research. RESULTS: Of 98 surgical registrars, 35 (36%) responded. Twenty-three (65.7%) reported missed planned surgical rotations, 30 (85.7%) decreased surgical training time, and 22 (62.9%) reported a perceived decrease in training quality. Simulated skills training was only available to eight (22.9%) participants. Twenty-four (68.6%) experienced burnout and/or depression symptoms during the pandemic. Twenty-seven (77.1%) reported that postgraduate research was unaffected by the pandemic. CONCLUSION: During the COVID-19 pandemic, surgical trainees at this institution reported a decrease in the quality of surgical training and skills acquisition and a negative impact on their mental wellbeing.

Toxic Epidermal Necrolysis Syndrome: Management And Outcomes.

Toxic epidermal necrolysis syndrome (TENS) is a rare medical emergency associated with high morbidity and mortality. At present, there is no agreement regarding specific treatments for this disease. The aim of this study is to determine the outcome of patients with TENS using a treatment protocol that did not include the use of intravenous immunoglobulin or systemic steroids. This is a retrospective study of all patients diagnosed with TENS admitted to a tertiary burns centre from 2015-2017. Twelve cases were identified with a mean age of 46±8 years. Mean total body surface area affected was 51±9%. The SCORTEN index was 3.4±0.3 (range 2-5) and predicted 3 deaths in this cohort. Overall mortality was 25%. This study casts no doubt on the prognostic validity of SCORTEN. No specific TENS treatment has been unequivocally proven to be effective.

La nécrolyse épidermique toxique (NET) est une urgence médicale rare, grevée de fortes morbidité et mortalités. Aucun consensus ne se dégage actuellement concernant un traitement spécifique. Cette étude avait pour but d'évaluer l'évolution des patients souffrant d'une NET n'ayant reçu ni corticothérapie (CCT) ni immunoglobuline (Ig). Cette étude rétrospective concerne tous les patients (12) hospitalisés dans un CTB français pour NET entre 2015 et 2017. Ils étaient âgés en moyenne de 46 +/- 8 ans, atteints sur 51 +/- 9% de leur SCT. Le SCORTEN était de 3,4 +/- 0,3 (2 à 5) ce qui prédisait 3 morts ce qui a correspondu à la réalité et valide donc sa véracité. Aucun traitement spécifique n'a prouvé d'efficacité indubitable.

Inflammatory and coagulative pathophysiology for the management of burn patients with COVID-19: systematic review of the evidence.

The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19. As such, a COVID-19 positive patient sustaining burn injuries may have an amplified response to the burn insult due to their baseline hyperinflammatory and hypercoagulable states. Burn patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. The concurrent pathogenesis of COVID-19 and the inflammatory response in burn injury have serious implications on the management of burn patients.

L'infection par COVID- 19 peut entraîner une réponse explosive du système immunitaire avec sécrétion/activation de cytokines, chémokines, complément et protéines de l'inflammation. Cette réponse inflammatoire rend le patient à risque de phénomènes thrombo- emboliques, de lésions respiratoire pouvant conduire à un SDRA et de défaillance multiviscérale. Cette cascade est proche de celle observée en cas de brûlure étendue si bien que les patients brûlés- COVID19 pourraient avoir une réponse immunitaire encore plus intense et n'avoir plus aucune « réserve de défense ¼ quand il faudra les opérer. La concomitance brûlure- COVID19 peut ainsi avoir des implications majeures quant à la prise en charge de la brûlure.

Availability Of Covid-19 Information From National And International Burn Society Websites.

National and international burn society websites are an important source of information for patients and burn care professionals. The current COVID-19 pandemic represents an unprecedented global health crisis. The aim of this study was to assess the information available on national and international burns society websites on the current pandemic of COVID-19. National and international burns society websites were assessed with regard to COVID-19 information. Five percent of nations had a burn care society website. Forty percent of these national society websites mentioned COVID-19. None provided their state's guidelines, nor advised to provide only urgent or emergent care. None recommended following WHO guidelines. One-third (33%) of the international societies documented the decision to postpone its congress and provided links to two articles describing burn care during the COVID-19 pandemic. The availability of COVID-19 clinical guidelines and information on national and international burn care society websites is lacking. Burn care society websites must develop relevant COVID-19 information to support burn care professionals on the frontline of care.

Les sites des sociétés savantes brûlologiques sont une source importante d'information pour le grand public et les professionnels. La pandémie actuelle à COVID- 19 est une crise sanitaire sans précédent. Le but de cette étude était d'évaluer les informations concernant cette épidémie disponibles sur les sites des sociétés savantes, tant nationales qu'internationales. Seuls 5% des pays ont des sites émanant des sociétés savantes brûlologiques, 40% de ces sites dispensant des informations sur la pandémie. Aucun ne relayait les recommandations de leur état, pas plus qu'il ne conseillait de ne pratiquer que des soins urgents ni de suivre les recommandations de l'OMS. Le tiers des sociétés y a fait apparaître la décision de repousser leur congrès, le tiers aussi insérant un lien vers 2 articles décrivant la prise en charge des brûlés en période pandémique. Les informations concernant la pandémie COVID-19 manquent donc sur les sites des sociétés savantes brûlologiques. Elles doivent les afficher, afin d'aider les professionnels dans la prise en charge des brûlés pendant cette période.

Protective Measures For Burn Care Professionals During The Coronavirus Disease 2019 Pandemic: Systematic Review.

The emergence of a novel human ß coronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has developed into a global pandemic and public health emergency. The management of patients with burns must be adapted to this context. The aim of this systematic review is to identify the optimal protection measures during the COVID-19 pandemic and provide guidance of protective measures for burn surgeons. A systematic search of PubMed was performed for articles about COVID-19. "Burn units", "burns", "COVID-19", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" and "telemedicine" were reviewed during the entire diagnosis and management process of burn patients. Eight articles were included, and five articles emphasized that burn care professionals should pay attention to prevent cross-infection. Only three articles reported in detail how burn care professionals should be protected during surgery in the operating room. These experiences and strategies can help burn care professionals work safely and effectively, and prevent both nosocomial infections and burn care professional infections during the global pandemic of COVID-19.

La survenue de la pandémie COVID19 a entraîné une urgence pour les services de santé, et nécessité une adaptation des soins aux brûlés. Le but de cette revue est d'identifier les mesures de protection optimales dans ce contexte afin de publier un guide pour les chirurgiens brûlologues (sic!!!, NDRLF). Une recherche PubMed a été effectuée avec les termes "COVID19", "burn units", "burns", "health personnel", "protective devices", "severe acute respiratory syndrome coronavirus 2", "surgeons" et "telemedicine". Huit articles ont été parmi lesquels 5 insistaient sur le fait que les professionnels de santé devaient faire attention aux contaminations croisées. Seuls trois détaillaient les mesures per opératoires. Ces stratégies et expériences peuvent aider les professionnels de la brûlologie à travailler efficacement et sans risque de contamination (personnelle et aux patients) aussi bien par COVID que par d'autres pathogènes.

Burns from ECG leads in an MRI scanner: Case series and discussion of mechanisms.

Iatrogenic burns are rare and preventable. The authors present two cases of burns from ECG leads, sustained during magnetic resonance imaging (MRI). Common features included a long duration spinal MR scan (120 and 60 minutes) and high patient body mass index (BMI >30). Both patients were discharged within 24 hours of admission, but required a period of outpatient burn care. The causation of these injuries remains unclear but there are several possible mechanisms including: electromagnetic induction heating, antenna effects and closed-loop current induction. The authors provide a description of the injuries, discuss possible mechanisms that may lead to burn injury in the MRI environment and suggest ways to reduce the risks of such injuries.

Les brûlures iatrogènes sont rares et évitables. Nous présentons deux cas de brûlures subies au cours de l'imagerie par résonance magnétique (IRM). Dans les deux cas, il s'agissait d'une analyse de longue durée de la moelle (120 et 60 minutes) et des patients avec un indice de masse corporelle élevé (IMC> 30). Les deux patients ont recu leur congé de l'hopital dans les 24 heures suivant l'admission, mais ils ont eu besoin d'une période de soins ambulatoires. La causalité de ces blessures reste imprécise mais plusieurs mécanismes sont possibles, y compris : le chauffage par induction électromagnétique, les effets de l'antenne et l'induction de courant à boucle fermée. Nous donnons une description des blessures, discutons des mécanismes possibles qui peuvent conduire à des brûlures dans l'environnement IRM et proposons des moyens pour réduire les risques de telles blessures.

Extravasation injuries in adults.

Insertion of an intravascular catheter is one of the most common invasive procedures in hospitals worldwide. These intravascular lines are crucial in resuscitation, allow vital medication to be administered, and can be used to monitor the patients' real-time vital parameters. There is, however, growing recognition of potential risks to life and limb associated with their use. Medical literature is now replete with isolated case reports of complications succinctly described by Garden and Laussen (2004) as "An unending supply of "unusual" complications from central venous catheters." This paper reviews complications of venous and arterial catheters and discusses treatment approaches and methods to prevent complications, based on current evidence and endeavours to provide information and guidance that will enable practitioners to prevent, recognise, and successfully treat extravasation injuries in adults.

Characteristics and differences in necrotizing fasciitis and gas forming myonecrosis: a series of 36 patients.

BACKGROUND AND AIMS: Necrotizing fasciitis (NF) and gas forming myonecrosis (GFM), both being subtypes of necrotizing soft tissue infection (NSTI), are life threatening conditions sharing certain similarities. Despite the necessity of early and radical surgical debridement in necrotizing infections, the distinction between these entities is of clinical relevance since gas forming myonecrosis in a number of cases results from an underlying abdominal cause and the focus of infection can be missed. This study was to evaluate the incidence and risk factors as well as the mortality rate in patients with NSTI and GFM. MATERIAL AND METHODS: All patients with NSTI treated in the authors' hospital between January 2005 and Decem-ber 2009 were enrolled in the study. Medical records, histological slides, microbiological and laboratory parameters as well as Computerized Tomography (CT) and magnetic resonance imaging (MRI) scans were reviewed for all patients. Differences between NF and GFM regarding hospital stay, number of surgical interventions and pre-existing comorbidities as well as mortality rate were analyzed. The laboratory risk factor for necrotizing fasciitis (LRINEC) score was calculated in all patients on admission. RESULTS AND CONCLUSIONS: Thirty patients (17 female, 13 male) with necrotizing fasciitis with a mean age of 55 years (SD 15.5) were included in the study. There was no statistically significant difference between survivors and deceased patients comparing the LRINEC score (n.s.). Patients with necrotizing fasciitis secondarily involving the trunk had a significantly higher mortality rate (OR 11.2; 95% CI=1.7-72.3). In the majority of cases (12 cases), minor skin lesions were identified as the site of origin. Amongst all necrotizing soft tissue infections six patients (female n=3; male n=3) with a mean age of 61.5 years (SD 12.2) with non-clostridial gas forming myonecrosis were identified. Three patients had a history of malignancy and in three patients the infection was secondary to major surgery. The mean LRINEC score was 8.5 (SD 1). Three patients (50%) died due to GFM. Early diagnosis and appropriate intervention is critical to provide accurate treatment decisions. Eradicating the differing primary sources of infection in GFM and NF will have a positive impact on outcome.

Survival of rat functional dental pulp cells in vascularized tissue engineering chambers.

Regenerative endodontics aims to preserve, repair or regenerate the dental pulp tissue. Dental pulp stem cells, have a potential use in dental tissue generation. However, specific requirements to drive the dental tissue generation are still obscured. We established an in vivo model for studying the survival of dental pulp cells (DPC) and their potential to generate dental pulp tissue. DPC were mixed with collagen scaffold with or without slow release bone morphogenic protein 4 (BMP-4) and fibroblast growth factor 2 (FGF2). The cell suspension was transplanted into a vascularized tissue engineering chamber in the rat groin. Tissue constructs were harvested after 2, 4, 6, and 8 weeks and processed for histomorphological and immunohistochemical analysis. After 2 weeks newly formed tissue with new blood vessel formation were observed inside the chamber. DPC were found around dentin, particularly around the vascular pedicle and also close to the gelatin microspheres. Cell survival, was confirmed up to 8 weeks after transplantation. Dentin Sialophosphoprotein (DSPP) positive matrix production was detected in the chamber, indicating functionality of dental pulp progenitor cells. This study demonstrates the potential of our tissue engineering model to study rat dental pulp cells and their behavior in dental pulp regeneration, for future development of an alternative treatment using these techniques.