Epidemiology and etiology of pediatric burns in Iran.

Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures.

Traumatic Brain Injury in Child Burn.

BACKGROUND: Burns are one of the most important health problems in communities. Traumatic injuries, especially Traumatic Brain Injury (TBI) associated with burns, may increase disability and mortality. In addition to preventing burns, any action for a better treatment approach and early detection of concomitant traumatic injuries can reduce complications, disability, and treatment costs. We aimed to investigate the outcome of children with burn injury with and without TBI. METHODS: In this cross-sectional study, 392 children with burn injuries treated at Motahari Hospital in Tehran, Iran from 2018-2019 were enrolled. Patient demographics, burn injury information and TBI-related information including head trauma and fracture were recorded in a checklist. Patients were divided into two groups of death (24 people) or discharge (368 people) in terms of outcome and the underlying variables were compared in the two groups. RESULTS: There was no significant difference between the mean age of patients and gender in the two groups. The difference in the length of hospital stay, inhalation injury and skull fracture in the two groups was not statistically significant. The mean burn severity based on Total Body Surface Area (TBSA) and the frequency of TBI in the deceased group was significantly higher (P=0.001). CONCLUSION: The severity of burns based on TBSA and TBI is associated with increased mortality among children with burn injuries. The results suggest the need to examine children with burn injuries for TBI using clinical examination or imaging.

Comparing the effect of two types of silver nano-crystalline dressings (acticoat and agcoat) in the treatment of full thickness burn wound.

BACKGROUND AND OBJECTIVES: This study was conducted to compare the effect of acticoat and agcoat dressing (2 types of silver nano-crystalline dressings) in the treatment of burn wounds. Infection is one of the most important causes of death in patients with major burn. Despite using different prevention methods, including prophylaxis antibiotics with broad-spectrum antibiotics, no method has been found to prevent this dangerous complication for burn patients. Topical silver sulfadiazine is one of the best topical antibiotics in infection control of burn wounds, and other forms of AG dressings are also useful. Their advantages are slow releasing, further-half-life, less frequent dressing change, and less pain during replacement. MATERIALS AND METHODS: In this study, 30 patients with infected full thickness burn wound were selected. The patients' age range was 18-85 years, with the mean age of 39.7-17.27. Every patient's wound was divided into 2 parts randomly, one part was dressed with agcoat and the other with acticoat. Sampling of the 2 parts was done before dressing and after the third and seventh day of dressing. RESULTS: The positive outcome of the first day culturing before silver dressing was 80% and 76.7% for agcoat and acticoat, respectively. However, on the third day, it decreased to 30% and 33.3%, respectively. On the seventh day, it further decreased to 20% in both groups, and the percentage of bacterial growth reduction was not significant. CONCLUSION: Based on the results of this study, silver agcoat dressing was as effective as acticoat dressing in preventing burn wound infection.

Herpes simplex virus infection in minor burn injury: a case report.

This is a relative rare case of 0.5% TBSA (total body surface area) burn wound infection caused by Herpes Simplex Virus (HSV). A 1-year-old male infant had deep second degree burn of the left fourth finger with 0.5% TBSA after exposure to a hot object. Blisters and vesicles surrounded by erythema were obvious in the examination of the burned area. The polymerase chain reaction (PCR) and gene sequencing analyses addressed contamination of the burn wound with HSV. Three days after the administration of antibiotics, the wound was relatively healed and finally, the patient was discharged in good general health, and no signs of relapse were observed in the 3-month follow-up. Although HSV infection is rarely reported in non-immunocompromised patients and TBSA burn injuries, due to the high prevalence of HSV infection and its mortality potential in the affected patients, HSV infection should be clinically suspected in the cases with delayed wound healing. In addition, since HSV infection is very contagious, and exposure to patients with HSV infection might be highly problematic for other patients hospitalized in burn wards; hence, proper facilities should be provided for the isolation care of the burn patients with HSV infection.

Epidemiologic analysis of central vein catheter infection in burn patients.

BACKGROUND AND OBJECTIVES: Currently, there are no well-defined guidelines or criteria for catheter-site care in burn patients, and there is little information about the epidemiology of central vein catheter (CVC) infection in such patients. This study aimed at addressing the epidemiological aspect of CVC infection in a sample of Iranian burn patients admitted to the largest referral burn center in Iran, Motahari Burn Center. MATERIALS AND METHODS: A total of 191 burn patients were eligible for the study. Catheter related blood stream infection (CRBSI) was diagnosed according to suspected line infection, sepsis or blood culture growing bacteria, which could not have been associated with another site. RESULTS: Of the 191 patients in this study, 45 males (23.68%) and 19 females (10%) had positive blood culture, confirming CV line infection. Patients who were burned by gas, gasoline ignition or burning Kerosene had the highest incidence of CV line infection. In contrast, patients burned by alcohol, pitch or thinner had the lower rate of CV line infection. Incidence of CV line infection was higher in patients with delay in presentation to the burn center (55.2%) when compared to those who presented without delay (22.8%). Pseudomonas aeruginosa was the most frequent colonizer of the wound culture (52.4%), the dominant strain of the first catheter tip culture (35%) and the dominant strain of the same day blood samples (53.8%). The mortality rate in patients diagnosed with CRBI was 21.9%. CONCLUSION: One of the important factors related to CV line infection is delay inpresentation to the burn center. The rate of CV line infection was 20.64 in catheter days.

Blood pressure alterations in burn patients with septic shock under hydro-cortisone treatment.

BACKGROUND AND OBJECTIVES: Hydrocortisone is widely used in septic shock cases resistant to fluid and vasopressor therapy. It may result in increased blood pressure and survival. However the efficacy is no established among patients with severe burn and septic shock. Accordingly it was assessed in this study. MATERIALS AND METHODS: The patients older than 14 years of age with resistant septic shock were enrolled during one-year period. The hydrocortisone was prescribed 100 mg three times per day and the alterations in systolic and diastolic blood pressures were recorded. RESULTS: Twenty-nine patients were enrolled including 19 men and 10 women. The mean age was 37 ± 19 years and the mean burn surface area was 60 ± 20. Fourteen patients had positive blood culture. The most common isolated microorganism were Pseudomonas aeuroginosa in 34.6%(10 cases), and then Acinetobacter in 13.8%(4 cases). The infection was from wound in 79% and the remaining 21% had pneumonia. Twenty-one patients had good response to hydrocortisone and the increase in systolic and diastolic blood pressures was significant; but the mortality rate was similar. CONCLUSION: Treatment with hydrocortisone would result in increase in systolic and diastolic blood pressure in burn patients with resistant septic shock.

Effects of silicone gel on burn scars.

AIM: To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis. METHODS: A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale. RESULTS: The median age of participants was 22 years (1.5-60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score. CONCLUSION: Silicone gel is an effective treatment for hypertrophic burn scars.

Burn injuries during pregnancy in Iran.

OBJECTIVE: To report on maternal and fetal outcome in 53 pregnant women seen at a referral burn center. METHODS: Possible links between outcome and maternal age, level of education, marital status, percentage of total body surface area (TBSA) burned, inhalation injury, source and intentionality of the burn, and trimester of pregnancy at the time of the burn were assessed. RESULTS: Of 5,497 women, 53 (1.3%) were pregnant at the time of admission. Maternal and fetal deaths occurred at significantly higher rates in cases of inhalation injury (P=0.001). The mean percentage of TBSA burned was significantly higher in cases of maternal or fetal death (P<0.001 for both), and when the burn has a suicidal intent (P=0.006). The maternal and fetal mortality rates were also higher when the burn was suicidal (P=0.001 and P=0.005). CONCLUSION: Inhalation injury, suicidal burn injury, and percentage of TBSA burned were correlated with a higher maternal and fetal mortality.

Evaluation of a methodology for a collaborative multiple source surveillance network for autism spectrum disorders--Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002.

PROBLEM: Autism spectrum disorders (ASDs) encompass a spectrum of conditions, including autistic disorder; pervasive developmental disorders, not otherwise specified (PDD-NOS); and Asperger disorder. Impairments associated with ASDs can range from mild to severe. In 2000, in response to increasing public heath concern regarding ASDs, CDC established the Autism and Developmental Disabilities Monitoring (ADDM) Network. The primary objective of this ongoing surveillance system is to track the prevalence and characteristics of ASDs in the United States. ADDM data are useful to understand the prevalence of ASDs and have implications for improved identification, health and education service planning, and intervention for children with ASDs. Because complete, valid, timely, and representative prevalence estimates are essential to inform public health responses to ASDs, evaluating the effectiveness and efficiency of the ADDM methodology is needed to determine how well these methods meet the network's objective. REPORTING PERIOD: 2002. DESCRIPTION OF SYSTEM: The ADDM Network is a multiple-source, population-based, active system for monitoring ASDs and other developmental disabilities. In 2002, data were collected from 14 collaborative sites. This report describes an evaluation conducted using guidelines established by CDC for evaluating public health surveillance systems and is based on examination of the following characteristics of the ADDM Network surveillance system: simplicity, flexibility, data quality, acceptability, representativeness, sensitivity, predictive value positive (PVP), timeliness, stability, data confidentiality and security, and sources of variability. RESULTS AND INTERPRETATION: Using multiple sources for case ascertainment strengthens the system's representativeness, sensitivity, and flexibility, and the clinician review process aims to bolster PVP. Sensitivity and PVP are difficult to measure, but the ADDM methodology provides the best possible estimate currently available of prevalence of ASDs without conducting complete population screening and diagnostic clinical case confirmation. Although the system is dependent on the quality and availability of information in evaluation records, extensive quality control and data cleaning protocols and missing records assessments ensure the most accurate reflection of the records reviewed. Maintaining timeliness remains a challenge with this complex methodology, and continuous effort is needed to improve timeliness and simplicity without sacrificing data quality. The most difficult influences to assess are the effects of changes in diagnostic and treatment practices, service provision, and community awareness. Information sharing through education and outreach with site-specific stakeholders is the best mechanism for understanding the current climate in the community with respect to changes in service provision and public policy related to ASDs, which can affect prevalence estimates. PUBLIC HEALTH ACTIONS: These evaluation results and descriptions can be used to help interpret the ADDM Network 2002 surveillance year data and can serve as a model for other public health surveillance systems, especially those designed to monitor the prevalence of complex disorders.