Effect of early grafting on improvement of lethal area index (la50) in burn patients: a 7-year investigation in a burn referral centre in the North of Iran.

Burning is a major health challenge in all societies. In this descriptive cross-sectional study, health information about hospitalized burn patients was extracted from the hospital information system from April 2009 to February 2015. Logistic regression method was used to identify risk factors and mortality predictors. Lethal area index (LA50) was investigated to evaluate the quality of annual hospital medical care. A total of 7725 patient medical files were examined. Mean age of the patients was 32.3±22.5 years old. The most common cause of burning accidents was hot liquids. Mean percentage of total body surface area was 15.8±17.9%. The most and the least common affected areas were upper parts and posterior thorax, respectively. Total calculated LA50 was 56.22 (CI95% = 50.09-62.20). This index was 43.89%, 46.43%, 52.29%, 52.29%, 57.00%, 62.08% and 67.53% annually from 2009 to 2015, respectively. There was a statistically significant difference with regards to mortality rate in the different age groups, higher-degree burns, burn location and burn causes. Analysis of mortality predictors in a model adjusted by age and sex showed that old age (p<0.0001), inhalational injuries (p<0.0001) and burn percentage (P<0.0001) were the three mortality predictors in the multiple logistic regression model. The relationship between early grafting and decreased mortality and increased LA50 was nearly significant in statistical analyses. Burn patient survival rate and annual LA50 had an increasing trend in this hospital. Early grafting surgery seemed to be effective on this trend and decreased mortality risk to a large extent.

La brûlure est dans toutes les sociétés un défi majeur de santé publique. Dans cette étude descriptive transversale, les informations concernant les brûlés hospitalisés ont été extraites du système informatique de l'hôpital entre Avril 2009 et Février 2015. La méthode de régression logistique a été utilisée pour identifier les facteurs de risque et les indicateurs de mortalité. L'index de surface létale (LA 50) fut utilisé pour évaluer annuellement la qualité des soins médicaux à l'hôpital. Un total de 7725 dossiers médicaux de patients a été colligé. L'âge moyen des patients était de 32,3 + ou - 22,5 années. La cause la plus fréquente des accidents de brûlures était les liquides chauds. Le pourcentage moyen de surface corporelle brûlée était entre 15,8 + ou - 17,9 %. Les zones les plus fréquentes, ainsi que les moins étaient respectivement les régions supérieures et les régions postérieures du thorax. Les chiffres de surface létale étaient de 56,22 (CI95% = 50.09 - 62.20). Cet index était 43.89 %, 46.43 %, 52.29 %, 52.29 %, 57.00 %, 62.08 % et 67.53 % par an entre 2009 et 2015. Il y avait une différence statistiquement significative en ce qui concerne le taux de mortalité et les différents groupes selon l'âge, la profondeur des brûlures, leur localisation et leur cause. L'analyse des indicateurs de mortalité dans un modèle adapté en fonction de l'âge et du sexe montre que l'âge (p <0.0001), les lésions par inhalation (p < 0.0001) et le pourcentage de brûlures (P <0.0001) sont les trois indicateurs de mortalité dans les multiples modèles de régression logistique. Le lien entre greffe précoce, diminution de la mortalité, et accroissement de l'index LA 50 était assez significatif dans les analyses statistiques. Le taux de survie des brûlés et le LA 50 annuel avaient tendance à augmenter dans cet hôpital. La greffe précoce semble être effective sur cette évolution et diminue le risque mortel dans une large mesure.

Immunotherapy with Mycobacterium vaccae and peripheral blood flow in long-treated leprosy patients, a randomised, placebo-controlled trial.

OBJECTIVE: to evaluate immunotherapy as a means of improving peripheral blood flow in chronic leprosy patients. DESIGN: this was a double-blind, randomised, placebo-controlled, clinical trial. MATERIALS: heat-killed Mycobacterium vaccae 1mg plus 0.02 microg Tuberculin protein per 0.1 ml dose in borate buffer, with saline as placebo. Those studied were 92 long-treated residents of a leprosy centre in Iran, 10 of their healthy children and 10 staff members. Evaluation employed the Perimed PF2, Laser-Doppler Flowmeter, a platinum skin thermistor, and a thermal sensibility tester. METHODS: single intradermal injections of test or placebo were given to 103 patients 18 months before the blinded evaluation. Fingerpulp blood flux was measured in controlled conditions and vasomotor reflexes and skin sensation to touch, pain and heat were evaluated in 45 and 47 patients in the placebo and M. vaccae groups, respectively, and in 20 healthy control persons. RESULTS: Laser-Doppler flux, skin temperature, vasomotor reflexes and sensation were impaired in leprosy patients. Immunotherapy improved (p < 0.05) Laser-Doppler flux, skin temperature and temperature sensation. CONCLUSIONS: immunotherapy, given 18 months earlier, significantly improved blood flow and temperature sensation, in fully-treated, chronic, leprosy patients. The same principles might be employed in other conditions of reduced peripheral blood flow.

Circulation and sensation at the fingertips of claw hands.

Measurements of skin blood flow (by laser Doppler flowmetry) and temperature were made under environmental conditions promoting peripheral vasodilatation at the fingertips of a disfigured 'clawed' hand in 12 leprosy patients long-resident at Baba Baghi Leprosy Hospital, Tabriz, Iran. Sensory function was assessed by measuring the responses to light touch, pain and temperature of each finger, and peripheral autonomic function was gauged by estimating palmer sweating and by measuring skin vasomotor reflexes in response to inspiratory gasp. In 2 patients all measured fingers had laser Dopper flux (LDFlux) values and skin temperatures lower than the 95% confidence limits for the mean of 20 healthy controls, i.e. were impaired; in 2 patients all fingers had normal values for LDFlux and temperature; and in 8 patients there was a combination of impairment with most fingers normal for these parameters but with the small finger most commonly impaired. There were 10 (67%) fingers with impaired LDFlux and temperature values who had significant sensory impairment, whereas only 5 (18%) of the fingers with normal LDFlux values and temperatures had a similar sensory deficit. Overall, the fingers with the most impaired sensation had significantly (P < 0.05) lower LDFlux and temperature values than those with no sensory deficit. Microcirculatory impairment was not related to disordered skin vasometer reflexes or dysfunction of sweating. We concluded that the relationship between motor (skeletal muscle) nerve paralysis and any subsequent sensory neuropathy and/or microcirculatory impairment is more complex than might be expected from previous understanding of the disease.

Percutaneous absorption and skin decontamination of PCBs: in vitro studies with human skin and in vivo studies in the rhesus monkey.

Knowledge of the entry of polychlorinated biphenyls through the skin into the body and subsequent disposition aids estimation of potential for human health hazard. [14C]Aroclor 1242 and [14C]Aroclor 1254 were separately administered intravenously and topically to rhesus monkeys. Following iv administration, 30-d excretion was 39.4 +/- 5.9% urine and 16.1 +/- 0.8% feces (total 55.5 +/- 5.1%) for Aroclor 1242, and 7.0 +/- 2.2% urine and 19.7 +/- 5.8% feces (total 26.7 +/- 7.5%) for Aroclor 1254. Mineral oil and trichlorobenzene are common PCB cosolvents in transformers. Skin absorption of Aroclor 1242 was 20.4 +/- 8.5% formulated in mineral oil and 18.0 +/- 3.8% in trichlorobenzene (p greater than .05). Absorption of Aroclor 1254 was 20.8 +/- 8.3% in mineral oil and 14.6 +/- 3.6% in trichlorobenzene (p greater than .05). PCBs are thus absorbed through skin, and excretion from the body is slow. Vehicle (trichlorobenzene or mineral oil) did not affect percutaneous absorption. In vitro skin absorption in human cadaver skin did not correlate with in vivo findings. This was due to lack of PCB partition from skin into the water receptor fluid, even with addition of 6% Oleth 20 (Volpo 20) solubilizer. Skin decontamination of PCBs showed soap and water to be as effective as or better than the solvent ethanol, mineral oil, and trichlorobenzene in removing PCBs from skin. There is a dynamic time lapse for PCBs between initial skin contact and skin absorption (irreversible removal). Thus initially most PCBs could be removed from skin, but this ability decreased with time to the point where at 24 h only about 25% of the initial PCB skin dose could be recovered with skin washing.

In vitro percutaneous absorption and stratum corneum binding of alachlor: effect of formulation dilution with water.

The effect of vehicle dilution on the percutaneous absorption of alachlor, 2-chloro-2',6'-diethyl-N-(methoxymethyl)acetanilide, through excised human skin was determined using flowthrough design glass penetration cells and 14C radiotracer methodology. Three dilutions of alachlor (in the solubilizing commercial formulation) with distilled water were utilized: 1:20, 1:40, and 1:80 (v/v); corresponding to concentrations of 23.0, 11.8, and 5.98 mg alachlor per milliliter, respectively. Skin from the penetration studies and human powdered stratum corneum from the binding studies demonstrated a high capacity for alachlor. A soap and water (1:1, v/v) solution effectively decontaminated powdered stratum corneum. Using plasma as the receptor solution, penetration ranged from 0.5 to 4% of the applied dose for an 8-hr exposure period. Lag times of 1.2 to 1.8 hr were observed. Increasing dilution resulted in significant enhancement (p less than 0.01) in the rate and extent of alachlor penetration. Although the biological significance of this observation is unclear, this phenomenon might be explored in future studies because of its ramifications for human toxicity and for decontamination opportunities.

Methodology to measure the transient effect of occlusion on skin penetration and stratum corneum hydration in vivo.

The effect of short duration occlusion on skin penetration and stratum corneum water content was studied in vivo in eight human subjects. Percutaneous absorption of hexyl nicotinate was monitored non-invasively by laser Doppler velocimetry (LDV) following each of three randomly assigned pre-treatments: untreated control, 30 min occlusion with a polypropylene chamber and 30 min occlusion followed by exposure to ambient conditions for 1 h. Stratum corneum water content after the same pre-treatments was measured with the dielectric probe technique. The local vasodilatory effect of the nicotinic acid ester was quantified using LDV by the onset of increased blood flow, the time of maximal increase in response, the magnitude of the peak response and the area under the response-time curve. Each of these parameters was significantly different, immediately following occlusion, from the untreated control values. However, if the occluded site was exposed for 1 h prior to hexyl nicotinate application these parameters did not differ significantly from the controls. Stratum corneum water content (expressed as a percentage of a maximal value) showed the same behaviour: the pre-treatment control value was 31.8 +/- 4.8%; after 30 min occlusion, this had risen to 46.9 +/- 6.2%; 1 h later, the reading had returned to 32.1 +/- 6.2%. There was a significant correlation between stratum corneum water content and area under the LDV response-time curve. It appears, therefore, that this method may be useful for quantifying the relationship between increased stratum corneum hydration and enhanced percutaneous absorption in vivo in man.