Electrical burns and complications: Data of a tertiary burn center intensive care unit.

BACKGROUND: To review the records of electrical burn patients hospitalized in our burn intensive care unit (ICU) and to report the complications together with our treatment results. METHODS: Demographic data, burn mechanism, presentation, percentage of burn total body surface area (TBSA), abbreviated burn severity index (ABSI) scores, complications and treatment approaches of electrical burn patients admitted to our burn ICU between September 2017 and August 2018 were evaluated retrospectively in this study. RESULTS: Electrical burn injury patients consisted of 17.9% of the patients who were hospitalized in burn ICU (n=139). All patients were male, and the median age was 27.0 years. Twenty-three patients (92%) were burned with high voltage electricity. The median percentage of burn TBSA score was 20.0. Eight patients had an accompanying head, a vertebra or extremity injuries. Sixteen patients (64%) were injured at work. Sixteen patients (64%) recovered with complications. ICU stay and total hospital stay were significantly higher in the group that healed with complications (p=0.005 and p=0.001, respectively). However, no significant differences were detected in burn TBSA and ABSI scores. TBSA and ABSI scores were correlated with ICU and total hospital stay. CONCLUSION: The proportion of our electrical burn patients is higher than reported in the literature. Burn TBSA and ABSI scores seem unrelated to prognosis. As the majority of patients are burned with high-voltage electricity at work, these injuries can be reduced by following occupational safety principles. Because of the high rate of complications in electrical burns, an experienced health team in well-equipped centers should treat patients in accordance with updated guidelines.

Response of GNSS-R on Dynamic Vegetated Terrain Conditions.

Global navigation satellite system reflectometry (GNSS-R) has the potential to offer a cost-effective solution for global land observations. In this study, we aim to understand GNSS-R sensitivity to changing land geophysical parameters. For this objective, we performed simulations of a ground-based receiver using a recently developed coherent bistatic vegetation scattering model (SCoBi-Veg) to detect GNSS-R signatures under varying soil moisture (SM), vegetation water content (VWC), and surface roughness during a full corn growing season. We modeled different corn growth stages by using in situ measurement data. We analyzed the simulated reflectivity and received power values based on the aforementioned variable input parameters. This study demonstrates that specular reflections dominate the diffusely scattered contribution in case of moderate roughness, regardless of the corn field row structure or the polarization. Significant correlations between VWC and cross-polarized reflectivity values are also shown. Furthermore, the study quantifies the effects of SM and surface roughness on GNSS-R deliverables.

Objective clinical pain analysis using serum cyclooxygenase-2 and inducible nitric oxide synthase in American patients.

BACKGROUND: Pain is a multidimensional condition of multiple origins. Determining both intensity and underlying cause are critical for effective management. Utilization of painkillers does not follow any guidelines relying on biomarkers, which effectively eliminates objective treatment. The aim of this study was to evaluate the use of serum cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) as pain biomarkers. This work could significantly advance the diagnosis and treatment of pain. METHODS: We assessed the potential utility of serum COX-2 and iNOS as objective measures of pain in a sample of American patients. Pain was scaled between level 0-5 in accordance with the level reported by the patients. Blood samples were collected from 102 patients in the emergency room. Sandwich ELISA was used to determine the COX-2 and iNOS levels in the blood serum while statistical analysis was performed using Pearson product-moment correlation coefficients, Regression and Receiver Operating Characteristics (ROC) analyses. The biomarker results were also compared with self-reports of pain by the patients using conventional pain ratings and patients were asked to report the cause of the pain. Pain levels were clustered into four groups as 0 [self-reported 0], 1 [self-reported as 1], 2 [self-reported as 2 and 3] and 3 [self-reported as 4 and 5]. Co-expression of COX-2 and iNOS could significantly alter pain development and its sensitization. Therefore, iNOS dependent COX-2 levels were employed as categorized level. RESULTS: Self-reported pain levels did not show a correlation with the serum level of COX-2 and iNOS. The lack of correlation is attributed to multiple reasons including patients' intake of painkillers prior to participation, painkiller intake habit, chronic diseases, and subjectivity of self-reported pain. Increased serum COX-2 levels were reported in relation to the subtypes of these health issues. Further, 83% of the patients who reported pain also showed the presence of COX-2 in serum, while only 53% of the patients showed the presence of iNOS in serum. Moderate relation was found between the clustered pain level and categorized COX-2 and iNOS- levels. CONCLUSIONS: The findings support the requirement of further studies to use COX-2 and iNOS as prognostic biomarkers for objective quantification of pain at the clinical level.

The prognostic value of cystatin C compared with trauma scores in multiple blunt trauma: a prospective cohort study.

BACKGROUND: Many scoring systems have been developed to predict the prognosis of the traumatized patients in Emergency Departments, and the necessary calculations make complex scoring systems difficult to use as a part of the initial trauma patient assessment, and they also have limited accuracy. STUDY OBJECTIVE: This study compares the accuracy of cystatin C with trauma scoring systems in predicting the mortality of trauma patients. METHODS: Serum cystatin C levels were measured upon arrival in consecutive adult multiple blunt trauma patients during a 12-month period. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Scale (GCS) Score, and cystatin C. Trauma scores and cystatin C were used in Cox regression models to predict trauma patients' risk of death. RESULTS: During the study period, 153 patients were enrolled and 18 died. There were negative correlations between cystatin C levels and the GCS (r = -0.666, p < 0.001) as well as the RTS (r = -0.229, p = 0.004). A moderate correlation was found between the ISS and the cystatin C level (r = 0.492, p < 0.001). In Cox regression models, every increase in units of cystatin C levels and ISS (the cut-off levels were 0.93 mg/L and ≥ 16, respectively) results in a 4.22- and 1.068-fold increase in mortality, respectively. CONCLUSION: Cystatin C may represent an important severity-of-illness indicator, easily available to clinicians during the initial assessment of trauma victims on admission.

Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction.

OBJECTIVE: Our objective was to study the accuracy of emergency medicine [(EM) bedside ultrasonography (BUS)] and radiology residents performed ultrasonography (RUS) in patients with suspected mechanical small bowel obstruction (SBO). METHODS: After a 6-h training program, from January to June 2009, four EM residents used BUS to prospectively evaluate the patients presenting to the emergency department with suspected SBO. Then, patients underwent RUS. Outcome was determined by surgical findings if they were operated upon or self-reported the condition upon telephone follow-up at 1-month. BUS and RUS results were compared with chi2 testing. RESULTS: Of the 174 enrolled patients, 90 patients were BUS-positive. Of these, surgical findings agreed with the BUS findings in 84 patients. In 78 cases, BUS was negative, and 76 of these patients had benign clinical courses. Six patients were excluded from the study. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for BUS were 97.7, 92.7, 93.3, 97.4, and 13.4%, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for RUS were 88.4, 100, 100, and 89.1%, respectively. The diagnostic accuracy of BUS and RUS were not statistically different from each other (kappa=0.81). The presence of dilated small bowel loops (>25 mm in jejunum or >15 mm in ileum) was the most sensitive (94%) and specific (94%) sonographic finding for SBO. CONCLUSION: Abdominal sonography for the diagnosis of SBO is a new application of BUS in the emergency department. EM residents can diagnose SBO using BUS with a high-degree of accuracy, comparable with that of radiology residents.