Comparison of the safety and efficacy for different regimens of pharmaco-prophylaxis among severely burned patients: a randomized controlled trial.

PURPOSE: Venous thromboembolism (VTE) is a common complication in critically ill patients, including severe burn cases. Burn patients respond differently to medications due to pharmacokinetic changes. This study aims to assess the feasibility and safety of different VTE pharmaco-prophylaxis in patients admitted to the ICU with severe burns. METHODS: A pilot, open-label randomized controlled trial was conducted on ICU patients with severe burns (BSA ≥ 20%). By using block randomization, patients were allocated to receive high-dose enoxaparin 30 mg q12hours (E30q12), standard-dose enoxaparin 40 mg q24hours (E40q24), or unfractionated heparin (UFH) 5000 Units q8hours. In this study, the primary outcomes assessed were the recruitment and consent rates, as well as bleeding or hematoma at both the donor and graft site. Additionally, secondary measures were evaluated to provide further insights. RESULTS: Twenty adult patients out of 114 screened were enrolled and received E30q12 (40%), E40q24 (30%), and UFH (30%). The recruitment rate was one patient per month with a 100% consent rate. Donor site bleeding occurred in one patient (16.7%) in the UFH group. On the other hand, graft site bleeding was only reported in one patient (12.5%) who received E30q12. Major bleeding happened in two patients, one in E30q12 and one in the UFH group. Five patients (25.0%) had minor bleeding; two patients (25.0%) received E30q12, two patients E40q24, and one patient UFH. RBC transfusion was needed in four patients, two on E30q12 and two on UFH. Only one patient had VTE, while four patients died in the hospital. CONCLUSION: The study observed a low recruitment rate but a high consent rate. Furthermore, there were no major safety concerns identified with any of the three pharmacologic prophylaxis regimens that were evaluated. TRIAL REGISTRATION NUMBER: NCT05237726.

Functional and patient-reported outcomes following single digit replantation: A systematic literature review.

OBJECTIVES: Finger amputations can involve different levels of injury complexity, and the success of a finger replantation is further shaped by a variety of factors, including patient characteristics, surgical technique, and postoperative rehabilitation. These variables may interact in complex ways and contribute to heterogeneity that makes it challenging to guide management for individual patients. As such, this systematic review seeks review the outcomes of isolated single digit replantation and compare patient reported outcomes following revision amputation to guide decision making. METHODS: The United States National Library of Medicine (PubMed/Medline), EMBASE and CINAHL were systematically searched to identify publications relevant to this systematic review. Related articles that were published from database inception to October 15, 2022 were extracted. The inclusion criteria consisted of English language clinical trials and observational studies reporting any functional or patient-reported outcome following single digit replantation. RESULTS: From the initial 1050 titles and abstracts that were eligible for screening, six studies representing 550 single digit replantations were included. There were 162 replanted thumbs (162/550), as reported in three studies, and 388 replanted fingers (388/550), as reported in all six studies. Overall, all six studies concluded that non-thumb single digit replantation can provide satisfactory outcomes. Five studies suggested that single digit replantation proximal to flexor zone II can have reasonable outcomes in select cases. Two of the comparative studies (Zhu et al. [1], Chung et al. [2]) showed a statistically significant increase in MHQ score in the non-thumb replant group in comparison to the revision amputation group (87.6 versus 84.6 respectively). CONCLUSION: When technically feasible, replantation is recommended, even in select index finger zone II amputations. Single digit replantation does not restore pre-injury hand function but does result in acceptable hand function when successful. Further study is needed to better inform risk-stratification of patients, and guide patient, and surgeon expectations for post-operative recovery. LEVEL OF EVIDENCE: III.

Heterotopic Ossification Complicating Traumatic Ulnar Nerve Palsy in a Child.

Heterotopic ossification (HO) refers to the process of forming bony tissues in extra-skeletal sites such as muscles and soft tissues. This pathological process most commonly commences following trauma, surgery, and fractures. Rarely, HO can compress nearby neurovascular structures. To the best of our knowledge, however, no previous reports exist of HO serving as second-hit to partially injured ulnar nerve in the pediatric population. We present a case of a 6-year-old girl with complete high ulnar nerve palsy caused by medial epicondylar fracture followed by development of HO around the elbow. The patient was initially managed conservatively. Four months after the first visit, she presented with complete ulnar nerve palsy that was not evident on the initial presentation. Based on further investigations, she was taken to OR for release of the cubital tunnel and anterior transposition of ulnar nerve. On further follow-up, the patient regained sensory and motor functions of the ulnar nerve with minimum sequalae. Post-traumatic ulnar nerve injury is well described in the literature as resulting from initial trauma or as an iatrogenic injury following fracture reduction and fixation. HO in the pediatric age group is considerably rare, occurring after trauma and burn injuries. Surgical timing of HO release remains controversial. No previous reports of HO complicating traumatic ulnar nerve palsy in pediatric patients exist. In the current case report, partial ulnar nerve injury was initially due to medial epicondylar fracture, but it had progressed to full blown ulnar palsy secondary to superimposed HO. Early HO takedown combined with decompression of ulnar nerve are crucial to ensure complete nerve recovery.

Perception of Cosmetic Procedures among Saudis during COVID-19 Pandemic.

BACKGROUND: A novel coronavirus disease (COVID-19) was first reported in December 2019 in Wuhan, China. The fast spread of the virus has led to a significant reduction in the numbers of elective procedures especially cosmetic interventions. Although many measures have been carried out to offload the health care system, it is unclear whether these changes had an effect on general population perception toward undergoing cosmetic procedures. The aim of this study was to assess the perception of Saudis toward undergoing a cosmetic surgery during the COVID-19 pandemic. METHOD: An online survey consisting of two parts was used, with a series of questions about cosmetic procedures, in general, and cosmetic procedures during the COVID-19 pandemic, in particular. The survey included Saudis (age 18 to 60 years) with access to social media. RESULTS: A total of 563 respondents participated in this survey. The vast majority were women (86.9%) and were between 18 and 24 years old (38.7%). Some 27.4% considered a cosmetic procedure during the COVID-19 pandemic; however, only 11.9% underwent any. In the majority of the participants (86%), the pandemic did not change their minds about having a cosmetic procedure. About 49.7% agreed that fear of contracting the virus would be a factor for not undergoing a cosmetic procedure during the pandemic. CONCLUSIONS: Clear differences in the engagement and perception of cosmetic procedures during the COVID-19 pandemic exist among Saudis. More studies are needed to explore the effects of pandemics on aesthetic practice and to find ways to perform elective procedures in a safe way.

Fast growing myopericytoma of the hand: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Myopericytoma (MPC) is a rare benign soft tissue neoplasm that arises from perivascular smooth muscle-like myoid cells that share features of both glomus and smooth muscle cells. It usually slow growing solitary tumor that might mimic aggressive sarcoma. CASE PRESENTATION: 45 years old male, with unremarkable medical history, presented with fast growing mass on the left 1st webspace that was noticed 6 months prior to presentation. Investigations with US and MRI showed highly vascular solid mass that was worrisome for malignant lesion. Surgical excision was done and histopathology confirmed the diagnosis of myopericytoma. CLINICAL DISCUSSION: MPC is a rare perivascular neoplasm that's reported mainly in the extremities with lower limbs are most affected sites. Usually it presents as solid painless slowly growing mass. However, Multiple papers reported different rare presentations like multiple, painful and some with malignant transformation. CONCLUSION: MPC is a benign tumor that might mimic aggressive sarcoma. Such cases should be approached with high suspicion and proper investigation and management should be followed promptly.

Intra-medullary, at fracture site introduction of K-wires for metacarpal fracture fixation (in-site technique). A new fixation technique and a case series.

PURPOSE: Metacarpal bone fractures represent one-fifth of upper extremity fractures. The most commonly affected bone was the fifth metacarpal also known as boxer's fracture with a range 9.7-50%. Different techniques have been described for fracture fixation with K-wires being the most described technique. In this paper, we present a new technique utilizing k-wires to reduce and fix metacarpal fractures in an easy less traumatic way aiming to optimize the clinical outcomes in regards of range of motion and stiffness. METHODOLOGY: Retrospective chart review including all the patients that were managed with the new technique. RESULTS: 24 fractures were fixed with the new technique without violating the MCP joint with different fingers involvement and different presenting deformity. At the end of the splinting time, 80% of the cases had full ROM at the time of splint removal. The remaining 20% had some stiffness that improved with further physiotherapy. CONCLUSION: This approach is easy to teach, fast with good clinical outcomes. However, a larger sample size study comparing this technique to the existing treatment options is needed. TYPE OF STUDY: Case Series and literature review, Level IV.

Emotional Intelligence and Burnout in Plastic Surgery Residents: Is There a Relationship?

BACKGROUND: The specific role of emotional intelligence (EI) in the field of plastic surgery has not been investigated. We aim to investigate the relationship between EI and the individual components of burnout among plastic surgery residents in Saudi Arabia. METHODS: In this cross-sectional study, all plastic surgery residents (n = 37) in Riyadh, Saudi Arabia, were invited to participate in a questionnaire based study in March 2018. The survey contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey), validated measure of EI (Trait Emotional Intelligence Questionnaire-Short Form), and evaluated residents' demographics, professional and personal risk factors, and career satisfaction. RESULTS: The overall rate of high burnout was 37.9%, with 72.4% residents reporting high level of emotional exhaustion (EE), 41% reporting high depersonalization (DP) and 41% reporting low sense of personal accomplishment (PA). EI has shown to have a significant negative relationship with EE (95% confidence interval CI, -9.061 to -1.374; P = 0.010), DP (95% CI, -5.747 to -1.974; P < 0.001), and a significant positive correlation with PA (95% CI, 1.398-5.439; P = 0.002). Significant risk factors for burnout included dissatisfaction with plastic surgery as a career choice, dissatisfaction with income, and dissatisfaction with the role in the operating room (P < 0.05). CONCLUSIONS: We found a positive correlation between higher levels of EI and sense of personal achievement, whereas a negative correlation was observed between higher level of EI and EE and DP among the residents in this study. Plastic surgery residents who are satisfied with their salary have lower EE and DP. Residents who are satisfied with their role in the operating room have a better sense of PA.

Burn-induced neuroepithelial changes as a delayed cause of mortality in major burns: a case report and literature review.

BACKGROUND: Mortality in major burns is caused mainly by multisystem organ failure. Brain lesions in burn patients are rare and predominantly traumatic in nature. Here, we present an unusual case of burn-induced glioma causing rapid neurological deterioration and death. CASE PRESENTATION: A 33-year-old male, with 85% total body surface area (TBSA) flame burns, presented initially with inhalation injury and acute compartment syndrome with no other associated injuries. Based on the initial assessment, the patient's cognitive status was not affected, with a Glasgow coma scale (GCS) on admission of 15/15 and normal brain computed tomography (CT) images. The patient was resuscitated and immediately admitted to the burns unit where he underwent multiple sessions of debridement and skin grafting. The patient's neurological status deteriorated dramatically, and brain magnetic resonance imaging (MRI) confirmed the presence of a heterogenous mass, highly suggestive of a high-grade glioma, that was not present during the initial assessment. Unfortunately, the patient died shortly afterwards as a result of cardiac asystole. CONCLUSIONS: Multiple studies have demonstrated a connection between chronic inflammatory processes and gliomagenesis. The case presented here supports the notion that high-grade gliomas can progress rapidly in immunocompromised patients, thus further reducing survival rates. Therefore, patients with inflammatory conditions combined with neurological symptoms/signs should be investigated thoroughly to evaluate the presence and extent of such pathology. Newly developed radiological modalities can help in early detection and timely management of the condition.

Current knowledge of burn injury first aid practices and applied traditional remedies: a nationwide survey.

BACKGROUND: Burn first aid awareness has been shown to reduce morbidity and mortality. We present a report on the knowledge and practices of the Saudi population with regard to burn first aid and the application of traditional remedies. METHODS: An internet-based survey was conducted to assess the public's knowledge on first aid practices and home remedies applied for burn injuries among Saudi adults. RESULTS: A total of 2758 individuals responded to the survey. There were 1178 (42.7 %) respondents who had previously received burn first aid information. One thousand five hundred fifty respondents had a history of burn exposure in which burn injury first aid was applied as follows: 1118 (72.1 %) removed clothing and accessories from the injured area; water was applied by 990 (63.9 %); among those who applied water, 877 (88.6 %) applied cold water; and only 57 (5.8 %) did so for more than 15 min. Wrapping the burn area was performed by 526 (33.9 %), and 985 (63.5 %) sought medical assistance. When it comes to traditional remedies, 2134 (77.4 %) knew of and/or implemented these remedies as first aid or to treat burns. Honey and toothpaste were the commonest among these remedies with 1491 (69.9 %) and 1147 (53.7 %), respectively. This was associated with female gender (r = 0.87, P < 0.001), younger age group (19-25 years) (r = 0.077, P < 0.001), from central region (r = 0.012, P < 0.001), and university graduate (r = 0.05, P = 0.002). Nearly half of those who knew of traditional remedies did not have previous knowledge of burn first aid. CONCLUSIONS: Proper burn first aid is a simple, cheap, and accessible means of managing burns initially. Although the majority of the respondents were university graduates (51.1 %), knowledge and implementation of burn first aid was very poor. Major healthcare agencies should review and promote a consistent guideline for burn first aid in an effort to tackle and minimize the effect of this grave injury.

What determines the selection of undergraduate medical students to the specialty of their future careers?

BACKGROUND: It is important to understand the factors that influence the undergraduate medical students' specialties choice for the post-graduation. OBJECTIVES: To identify the number of undergraduate medical students who decided their post-graduate specialty career, factors that may influence their decision to select a particular specialty, and their career specialties preference. METHODS: A self-administered questionnaire was used to achieve the objectives. RESULTS: Less than half of the students (40.2%) showed a future specialty preference. Senior students and having background about specialties were the significant factors for career choices. General Surgery (27.4%), ENT-Ophthalmology (24.6%) and Internal Medicine (22%) were preferred specialties. Male students preferred General Surgery (15.7%), Internal Medicine (15%), ENT-Ophthalmology (12%) and Orthopedics (9.1%). Female students showed interest in ENT-Ophthalmology (12.1%), Surgery (11.7%), Pediatrics (10.8%) and Dermatology (8.2%). The least popular specialties were Community Medicine, (6.6%), Anesthesia, (6%) and Forensic Medicine (4.6%). Obstetrics and Gynecology (Ob/Gyne) was a less popular branch even in female students. CONCLUSIONS: General Surgery, ENT-Ophthalmology and Internal Medicine were the most preferred specialties, while Community Medicine, Forensic and Ob/Gyne, even for female students were least selected specialties. Proper information and counseling should be offered to students about the challenges and opportunities to select their future careers.