Does 'Prison Napalm' work? Measuring the cooling temperature of sugar solution burns in a porcine model.

Non-accidental scalds sustained with sugar solution are potentially devastating and often associated with assaults within prisons where they are commonly known as 'Napalm' attacks. However, little is known about the mechanism behind such injuries. Proposed explanations have included a higher initial temperature, increased viscosity compared to water and lower emissivity, although these have yet to be demonstrated in any experimental model. We therefore set out to measure the post-exposure cooling temperature of the dermis after exposure to different concentrations of boiled sugar solution in a dead porcine model. Dead pork belly tissue was pre-heated to human body temperature (36.3-38.4 °C). Five solutions with different concentrations of sugar (0, 250, 500, 1000 and 2000 g/L) were heated to boiling point using standard commercially available kettles and then poured directly onto the tissue. Intradermal temperatures of the dermis were measured at one-minute intervals for a duration of 10 min. At one-minute after exposure, average intradermal porcine temperatures were 46.7 °C, 47.9 °C, 48.9 °C, 50.8 °C and 51.7 °C respectively for increasing concentrations of sugar solution. The rate of cooling was similar in all solutions with an average loss of 1.5 °C per minute. Using a generalised mixed model accounting for concentration and time period, it was identified that increasing sugar concentration resulted in statistically higher temperatures of burn (p = 0.006). Our report finds that higher concentrations of boiled sugar solution caused a higher initial temperature of burn but did not influence cooling rates. This suggests that 'Prison Napalm' attacks will indeed cause more severe burns than those utilising plain water, but not for all the widely believed reasons. We therefore recommend that access to kettles in prison cells should be limited, but where such access is deemed a right, consideration should be given to temperature restricted devices, as is the case in other countries.

Keeping New Delhi metallo-ß-lactamase-1 at the door.

New Delhi metallo-ß-lactamase-1 is a recently described gene that codes for carbapenem resistance. Inherently transferable between Gram-negative bacteria on a plasmid that also confers extended antibiotic resistance, it represents a potentially serious problem for susceptible patients, such as burn victims, and is spreading globally at a rapid rate. The authors present a case of a septic burn patient returning from India, whose microbiological cultures grew bacteria expressing New Delhi metallo-ß-lactamase-1. His TBSA was 14%. His length of stay as an inpatient was 95 days. This is the first case report of this resistance strain from a U.K. burns unit. Isolation, barrier nursing and the use of hydrogen peroxide vapor decontamination proved effective in limiting transmission and spread. The authors are of the opinion that their experience has implications for the management of similar cases in the future.

Pediatric superficial scald burns--reassessment of our follow-up protocol.

The most common pediatric burn injury is a superficial scald. The current follow-up protocol for such burns includes review of the patient at 2 weeks postinjury and then 2 months later. The authors decided to review the protocol to assess the need for this second follow-up. A retrospective study reviewed the case notes of patients younger than 16 years at the time of their injury presenting with a scald over 5% TBSA. The progress of healing and scar development up to 5 years follow-up was assessed. This study showed that scalds healing within 2 weeks following injury rarely became hypertrophic. A prospective study was performed over a 10-month period. All children who suffered a superficial partial-thickness scald injury were included. At the 2-week appointment, the need for further follow-up was predicted. The accuracy of this prediction was assessed 2 months later. This study showed that an experienced member of the burns team could reliably predict at 2-week appointment those children who could be safely discharged with no subsequent need for scar management. This study suggests that it will be safe to modify the follow-up protocol, reducing the number of clinic attendances.

Homoeopathic treatment of burn scars - clinical enquiry

After observing the flattening in one patient's hypertrophic scar after treatment with the homoeopathic medicine Graphites, we decided to look at the effect of Graphites on hypertrophic burn scars. 5 patients with scarring subsequent to burns were treated with 2 different dilutions of potentized Graphites for 3 months. Of the 4 patients who completed the treatment 3 described a subjective improvement in itch, one patient with an open wound of 5 month's duration saw this heal after the first dose of Graphites. 2 patients chose to continue Graphites 6c at the final follow-up. All patient's scars improved both on patient and independent assessor scoring over the treatment period, but is was not possible to determine to what extent this was due to the treatment. Further study is required before undertaking a more formal trial