Aetiology of adult burns treated from 2000 to 2012 in a Swiss University Hospital.

BACKGROUND: Burns in Switzerland are frequent and lead to high economic and social costs. However, little is known about the aetiology of burns suffered by patients seeking treatment in hospital emergency departments. This knowledge could be used to develop preventive measures. METHODS: This retrospective analysis included all patients (≥16 years old) with acute thermal injuries of known cause admitted to the adult emergency department in Bern University Hospital (Switzerland, not a specialised burns unit) between 2000 and 2012. Clinical and sociodemographic data were extracted from medical records, i.e. the environment in which the burn occurred, as well as details of burn severity and aetiology. RESULTS: Seven hundred and one (701) patients with a mean age of 35.0±14.5 years (56% men) were included in the analysis. The winter season and the days around Christmas, turn of the year and Swiss National Day were identified as times with high risk of burns. Household (45%) and workplace (31%) were the most common locations/settings in which the burns occurred. Approximately every second burn was caused by scald, every fourth by flame and every seventh by hot objects. The analysis identified cooking, tar and electricity in workplace accidents, barbecues and the use of gasoline as aetiological factors in burns in leisure time, together with water in domestic thermal injuries. Burns occurred predominantly on non-protected skin on the hand and arms. The most severe burns were seen in electrical and flame burns. Men suffered more severe burns than women in all settings except psychopathology. CONCLUSIONS: The data suggest that the incidence and severity of burns in Switzerland could be reduced by preventive strategies and public campaigns, including education on fire protection systems, raising awareness about the times and locations where the risks of burns are greater, further improvement in workplace safety, particularly with cooking facilities and electrical equipment, and the development of innovative safety devices (i.e. machines, protective gloves). These findings have to be interpreted carefully, as this study includes only adult patients who presented in our ED and, in most cases, the burns covered less than 20% of the body surface.

Use of a miniaturized test system for determining acute toxicity of toxicity identification evaluation fractions.

A miniaturized test system was developed and used to determine the acute toxicity of effluent fractions separated by HPLC to Daphnia magna and Pimephales promelas. The miniaturized test system consists of exposing test organisms in 1 ml of test solution using 48-well microtiter plates for the test vessels. Several factors were investigated to determine the acceptability of this test system. These factors included organism biomass to test solution ratio, toxicity of the microtiter plates to the organisms, dissolved oxygen in the test solution, partitioning of the test chemicals to the walls of the test vessels, and dilution of the test solution when the organisms are transferred. Toxicity of four reference chemicals to D. magna and P. promelas was also determined using the miniaturized test systems. It was concluded that the test system could be miniaturized and still provide results comparable to those obtained when standard U.S. EPA test procedures were used. The major benefit of using the miniaturized test system is that less solution is required for conducting a toxicity test. This becomes important when only a small amount of test solution is available, as might occur during a toxicity identification evaluation, after an effluent has been fractionated by HPLC. Other benefits include less space required to conduct a test, less time necessary to prepare test solutions, and a reduced volume of waste for disposal.

Concurrent use of foscarnet and ciprofloxacin may increase the propensity for seizures.

OBJECTIVE: To report a possible interaction between foscarnet and ciprofloxacin in two patients with AIDS, cytomegalovirus (CMV) retinitis, and disseminated Mycobacterium avium complex (MAC) infection and to review the available literature related to foscarnet-associated seizures. DATA SOURCE: Case report information was obtained from Medical Service Daily Rounds during the patients' hospitalization and from the patients' medical records. Computerized (MEDLINE) and manual (Index Medicus) search methods were used to obtain English-language literature published between 1980 and 1993. DATA SYNTHESIS: Foscarnet is a synthetic antiviral agent with activity against herpesviruses and HIV. The incidence of seizures with foscarnet infusion is high, ranging from 13 to 15 percent. Predisposing factors such as renal impairment, electrolyte and metabolic abnormalities, and underlying neurologic disorders have been associated with seizures during foscarnet therapy. We describe two patients with AIDS who developed generalized tonic-clonic seizures while receiving foscarnet and ciprofloxacin for the treatment of CMV retinitis and disseminated MAC infection, respectively. Neither of the patients had any of the aforementioned risk factors for foscarnet-associated seizures. CONCLUSIONS: Concurrent administration of ciprofloxacin, a known epileptogenic agent, and foscarnet may predispose patients to the development of seizures.