Intentional and non-intentional burn related deaths: a comparative study of socio-demographic profile

Our Experience and Clinical Findings in Perineal Burns: Implications for Patient Prognosis-A 3 Year Retrospective Study

Background and Objectives: Burn injury represents a very important public health problem that affects all age groups. Of all burns, of particular interest is that of the perineum. Despite the importance of the subject, unfortunately, the medical literature on this anatomical region is sparse. With this study we aim to analyze the characteristics of burns affecting the perineal area, the physiopathologic implications of this injury, the influence of patient prognosis, possible complications and therapeutic guidelines. Materials and Methods: This study is formed by a retrospective analysis of cases that were admitted over a period spanning 3 years with a total of 258 burned patients. After inclusion criteria, we selected 49 patients who had perineal burns and compared this group to a non-perineal burns lot of 198 patients (11 were excluded). We studied their characteristics and the demographical aspects that we deemed most important to their condition: age, sex, burn percentage of total body surface area (TBSA), the percentage of third-degree lesions, comorbidities, and associated infections, inhalation injuries and we calculated the significant scores such as the Abbreviated Burn Severity Index score (ABSI). Results: The patients in our study mostly had severe extensive burns (64.9% mean TBSA) which were also underlined by the mean ABSI of 10.88 ± 2.46 thus having a poor prognosis considering their age, the percentage of burned area, the presence of third-degree burns and inhalation injuries. In our study, perineal burns were usually associated with burns of adjacent regions abdominal wall burns comprising 51% and thigh burns comprising 97.9% of the associated injuries. This relationship both explains their presence in mostly severe cases with higher TBSA and also underlines the issues that derive from the burns of the perineum and their several complications which lead to an unbalance of the patients. The treatment of perineal burns still remains much debated in the literature when considering their indications and can become rather complex in the sequelae setting. Conclusions: The issue of burns remains one of the most important subjects in plastic surgery. Being a region hard to treat but with a big influence on patient evolution and survival chances prevention remains a key factor.

Burns and fires in South Africa's informal settlements: Have approved kerosene stoves improved safety?

This study is a follow-on to an intervention project that implemented South African Bureau of Standards approved kerosene stoves and safety education in 150 households of a Johannesburg informal settlement. An investigation conducted 12 months later established that 43 stoves had operational defects, yet 23 households continued using the faulty appliances. This study focuses on (1) the psychological and behavioural factors associated with continued use of faulty stoves by the 23 households, and (2), the specific technical failures of these stoves. The study involved one-on-one recall interviews with the households using defective stoves (N=21) and laboratory-based stove tests for seven of the affected appliances. The results indicate that the stoves had defects in critical safety features such as flame control and the self-extinguishing mechanism. Four stove malfunctions of minor burn affect were reported in the study. Continued use of the damaged stoves was significantly associated with the time from receipt of the stove to detection of first failure: stoves that failed later on were more significantly likely to remain in use as compared to those that failed sooner. The findings point to the need for strengthening enforcement of appliance standards, public education on kerosene stove use, and structural change for the energy-poor.

Trends in trauma-related mortality among adolescents: A 6 year snapshot from a teaching hospital's post mortem data

INTRODUCTION

The aim is to explore the trends in trauma mortality in children aged 0-18 years can help to co-ordinate resources toward research and programs to reduce the burden.

METHODS

This is a retrospective study carried out on adolescents ≤18 years of age autopsied according to the attorney request at Forensic Medicine & Toxicology department of King George's Medical University, Lucknow, India in the period from January 1st, 2009 to December 31st, 2014.

RESULTS

There were 9160 deaths from all causes in children ≤18 years old, 7747 of which were due to trauma related causes, with a female predominance of 1.3:1. The age distribution revealed that 65.8% of deaths occurred in the 10-18 age group. Road traffic accidents (RTA) was the most prevalent cause (3635 deaths - 46.92%), followed by asphyxia (1128 deaths - 14.56%) and sexual assault (649 deaths - 8.37%). Asphyxia/suffocation was the major cause of injury with 31.96% of deaths within group <1 year; asphyxia (28.66%) and transport-related injuries (32.27%) were more predominant in the 1-4 age group; transport-related deaths were frequent in the 5-9 age group (45.14%), 10-14 age group (55.68%) and in the group 15-18 age group (51.69%). Regarding times of death, 61% occurred at the scene, 5.6% during pre-hospital care, 26.2% occurred at the hospital within the first 24 h after admission, and the remaining 7.6% of deaths occurred after 24 h after admission to the hospital. When we analyzed the deaths according to the intent, homicides occurred in 16% of cases. Unintentional injuries occurred in 69% of deaths and self-inflicted injuries were identified in 15% cases.

CONCLUSIONS

Findings show that there was a predominance of deaths in children and adolescents males, between 15 and 18 years old, mainly from road traffic accidents. This study highlights the burden of trauma caused mortalities in children, which requires instant action.

Severity of burn and its related factors: A study from the developing country Pakistan

BACKGROUND

Burns are leading cause of fatal injuries and major cause of morbidity and mortality in developing countries. The major obstacle in controlling severity is factors related to burn. This study determines frequency of burns and the factors related to it in Karachi, Pakistan.

METHODS

A cross-sectional study was conducted and 384 hospitalized adult patients with burns were consecutively interviewed during August 2013 to February 2014. Information was collected on socio-demographic profile, intent of burn, severity of burn, health hazards, physical and psychological characteristics. TBSA burn of >15% was considered as higher severity of burn.

RESULTS

Higher severity of burns was found in 76.3% patients. Multivariate analysis showed that higher severity of burns were significantly associated with age less than 25 years (OR 2.7, 95% CI 1.5-4.9), never had been to school (OR 3.1, 95% CI 1.7-5.9) and intentional burn (OR 20.6, 95% CI 5.0-84.9).

CONCLUSION

Majority of patients had higher severity of burn. The intent of injury was intentional, age less than 25 years and no schooling were found significantly associated with higher severity of burns.

Time-dependent Degradation Pattern of Cardiac Troponin T in Cases of Death by Burn

OBJECTIVE

Death due to burn occurs frequently. This study investigated time-dependent alterations in cardiac troponin T (cTnT) associated with fatal burns.

METHODS

Cardiac tissue samples were collected from 10 medico-legal autopsies after informed consent from the relatives and post-mortem degradation by incubation of the cardiac tissue was studied at room temperature for different time periods. The cases included in this study were the subjects of burns without any prior history of disease who died in the hospital and their exact time of death was known. An efficient extraction protocol to analyse the banding pattern of cTnT in post-mortem tissue was developed.

RESULTS

The data show a distinct time-dependent profile corresponding to the degradation of cTnT by proteases found in cardiac muscle. Both post-mortem interval and cardiac tissue of burned corpses had a statistically significant effect where the greatest amount of protein breakdown was observed within the first 41.20 hours, after which intact protein slowly disappears. The average molecular weight of all fragments showed intact cTnT to be rapidly degraded into smaller fragments.

CONCLUSION

In cases of burns, such knowledge will assist in knowing if there were previous scars that might have mimicked a burn and also help to properly evaluate the real cause of death.