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At least 1,351 records · Page 75Linked to original sources
PubMed2006

Epidemiological and clinical profile of burn victims Hospital Universitario San Vicente de Paúl, Medellín, 1994-2004.

OBJECTIVES: To describe the clinical and epidemiological profile of the patients in the Burn Unit of the Hospital Universitario San Vicente de Paúl (HUSVP) de Medellín, Colombia, from 1994-2004. METHODS: Retrospective descriptive study of all pediatric and adult burn patients. The following were recorded: age, gender, cause, extent and severity of the burns, time in the hospital, operations, complications and death rate. Statistica 6.0 (Stafsoft Inc.) was used. RESULTS: Two thousand three hundred and nineteen patients were admitted, 66.8% were males and 62.9% were less than 15 years old. Burns caused by scalding were the most frequent (45.9%) followed by flames (38.5%) The average burn area was 26.9%. Average hospital stay was 26.9 days. In 2004, 40.4% of the patients required surgery; 13.4% of the patients had complications. 7.4% of the patients died, with an average burn area of 62%; burns caused by flames accounted for 63% of the deaths. CONCLUSIONS: There is a continuing improvement in hospital stay, survives burn sizes, with figures comparable to others without access to a tissue bank or skin cultivation.

Adult↗
PubMed2006

Burns in Turkish children and adolescents: nine years of experience.

AIM: The aim of this study was to describe information about burns that occur in children and adolescents in Turkey. PATIENTS AND METHODS: The subjects were 362 patients whom were younger than 18 years who were treated at 3 burn centers in 2 different regions of Turkey between 1997 and 2005. The data collected for each case were age, gender, place of residence, cause and extent of burn, body sites affected, environment in which the injury occurred, interval from injury to arrival at a burn center, hospitalization status (inpatient versus outpatient), surgical treatment, and mortality. RESULTS: The 362 patients comprised 35.5% of all 1021 burn victims admitted during the study period. There were 183 boys and 179 girls (ratio 1:0.98) and the mean total body surface area burned was 17.7+/-16.5%. The highest proportion of patients were in the 1-6 years age group. Non-bath (not immersed) hot water scalding (216 cases, 59.7%) was the leading burn cause. The most common environment in which burn injury occurred was the home. The trunk was the body site most frequently affected (62.7%). 241 (66.6%) subjects lived in urban environments and 121 (33.4%) lived in rural areas. 171 patients (47.2%) were taken directly to the burn units, whereas the others (52.8%) were referred from other medical centers. 124 (34.3%) subjects were treated as outpatients and 238 (65.7%) were hospitalized. The overall mortality rate was 8.6% (31 deaths). Of the 238 inpatients, 92 (38.7%) were treated with daily dressings only, 128 (53.8%) required debridement, and 75 (31.5%) needed both debridement and grafting. CONCLUSION: Every country needs a nationwide public education system that is aimed at preventing burns and ensuring that burn victims receive proper first aid and age-appropriate, specialized burn care.

Adolescent↗
PubMed2006

Microbiological safety and clinical efficacy of radiation sterilized amniotic membranes for treatment of second-degree burns.

Amniotic membranes collected from the placentae of screened donors were processed and sterilized by gamma irradiation at 25 kGy. The sterility assurance level (SAL) of gamma irradiated amniotic membranes and clinical efficacy in second-degree burn wound healing were evaluated. Processed air-dried amniotic tissue from 159 batches of processing was checked for the bioburden level before sterilization. About 39% of the tissues had bioburden in the range of 10(1)-10(2)/100 cm(2) and 54.8% in the range of 10(2)-10(3)/100 cm(2). Based on the bioburden of the processed tissue prior to sterilization and the D(10) value of 2.3 kGy for the radiation resistant reference strain Bacillus pumilus, the sterility assurance level of the amniotic membranes irradiated at 25 kGy is found to be 10(-7) to 10(-11). The burn wound healing rate was compared between the radiation sterilized amniotic membranes and glycerol preserved amniotic membranes. Fifty patients with partial-thickness burns (up to 70% TBSA) were selected for the study. The scalds constituted 82% (41 patients) whereas flame burns accounted for 18% (9 patients). Various aspects like ease of application, patient comfort, development of fluid under the membrane, bacterial culture of drained fluid, rate of epithelialization, development of hypertrophic scars, keloids, unstable scars and restriction of joint movements were recorded with the application of gamma irradiated and glycerol preserved membranes. Radiation sterilized amniotic membranes had advantage over the glycerolized membranes with respect to the ease of application. Five patients with glycerol preserved membranes and four with gamma irradiated membranes developed fluid. The bacteriology of fluid showed Pseudomonas aeruginosa in four cases, Staphylococcus aureus in two cases, Escherichia coli in two cases and Acinetobacter in one case. The application of radiation sterilized amniotic membranes on the burn wound favoured epithelialization. In all the patients, membranes dessicated and separated in 10-14 days time leaving behind an epithelialized surface.

Adult↗
PubMed2004

Desmosomes and disease: pemphigus and bullous impetigo.

Desmosomal cadherins are the pathophysiologic targets of autoimmune or toxin-mediated disruption in the human diseases pemphigus and bullous impetigo (including its generalized form, called staphylococcal scalded skin syndrome). Experiments exploiting the production of both pathogenic and nonpathogenic antidesmoglein antibodies in pemphigus patients' sera have afforded data that make an invaluable contribution towards identifying the functional domains of the desmogleins involved in intercellular adhesion. Conformational epitopes of antidesmoglein autoantibodies in pemphigus patients' sera and the specific cleavage site of desmoglein 1 by exfoliative toxin have been identified, implicating the N-terminal extracellular domains of the desmogleins as critical regions for controlling intercellular adhesion. Furthermore, the development of active autoimmune mouse models for pemphigus allows in vivo characterization of the disease and its pathogenesis. These studies offer new insight into the potential mechanisms of acantholysis in pemphigus and staphylococcal-associated blistering disease, with implications for the role of desmogleins in desmosomal structure and function.

Acantholysis↗
PubMedDate not supplied

Life-threatening eruptions due to infectious agents.

Some infectious diseases may cause rapidly fatal eruptions that need to be diagnosed and treated in an early phase for patient survival. The main life-threatening eruptions of infectious etiology include Rocky Mountain spotted fever, meningococcemia, toxic shock syndrome, streptococcal toxic shock syndrome, and staphylococcal scalded skin syndrome.

Bacteremia↗
PubMed2005

The impact of burn injury and ethanol on the cytokine network of the mouse hypothalamus: reproductive implications.

Nearly 50% of the patients admitted to hospitals for burn injuries have detectable levels of alcohol (EtOH) in their circulation. In fact, EtOH is often a causal factor in their injury. It is well known that EtOH as well as burn injury disrupt function of the hypothalamic-pituitary-gonadal (HPG) axis. The cellular mechanisms by which EtOH and/or burn impacts on the HPG are not entirely understood. In the studies reported here, we tested the hypothesis that these injuries mediated their effects by local hypothalamic inflammation. Young adult male mice were subjected to either a 15% total body surface area, full thickness scald, to EtOH, or to both and compared to appropriate controls. They were sacrificed 48 h later. EtOH and burn, as well as the combined injury, consistently and impressively reduced serum testosterone, while increasing hypothalamic concentrations of all three of the pro-inflammatory cytokines, TNFalpha, IL-1beta, and IL-6. In general, the increases induced by burn were greater than those caused by EtOH and the effect of the combined insult was not additive. Hypothalamic concentrations of LHRH were also increased. The data are consistent with the idea that EtOH and/or burn, as models of critical illness, medicate their hypothalamic suppressive effects via increase in pro-inflammatory cytokines.

Animals↗
PubMed2005

Aging, traumatic injury, and estrogen treatment.

Aged subjects are more likely than young to have a poor prognosis after traumatic injury. Regardless of the type of injury, from scald wound to bone fracture, aged have slower recoveries and suffer more complications than their younger counterparts. This age-dependent phenomenon may be influenced by the hyper-inflammatory state observed in the aged referred to as 'inflamm-aging.' Having elevated levels of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha), in the circulation prior to injury may predispose the aged population to produce even higher concentrations of these factors after injury. Marked overproduction of pro-inflammatory cytokines leads to immunosuppression. Since many trauma victims do not die of their primary injuries, but rather succumb following infections and/or other complications at later time points, the functional status of the immune system is of paramount importance. Evidence suggests that at physiological levels, estrogen is beneficial to the immune system. This is due, in part, to the hormone's ability to boost immunity and to attenuate aberrant production of pro-inflammatory cytokines, thus serving as a systemic anti-inflammatory agent. In this short review, an examination of the effects of estrogen on inflammatory and immune responses that are critical to survival and recovery following traumatic injury will be discussed.

Accidents↗
PubMed2007

Aging and estrogen: modulation of inflammatory responses after injury.

Aged subjects have a poor prognosis after traumatic injury and, regardless of the type of injury, they have slower recoveries and suffer more complications than their younger counterparts. The age-dependent responses may be influenced by the hyper-inflammatory state observed in the aged prior to injury, including elevated levels of interleukin-6 (IL-6). Physiological levels of estrogen are beneficial to the immune system, due, in part, to the hormone's ability to attenuate aberrant production of pro-inflammatory cytokines. Using two independent injury models, we have found increased mortality and elevated serum levels of IL-6 in aged mice, when compared to young animals (p<0.05). In parallel studies, groups of aged mice given estrogen (17beta-estradiol) prior to scald burn, had significantly improved survival (p<0.05) and lowered serum IL-6 (p<0.05). Multiple cellular mechanisms may be involved in mediating the beneficial effects of estrogen on inflammatory and immune responses in aged individuals who sustain an injury. These mechanisms are discussed herein.

Aged↗
PubMed2005

Xanthomonas albilineans HtpG is required for biosynthesis of the antibiotic and phytotoxin albicidin.

Xanthomonas albilineans, the causal agent of leaf scald disease of sugarcane, produces a highly potent polyketide-peptide antibiotic and phytotoxin called albicidin. Previous studies established the involvement of a large cluster of genes in the biosynthesis of this toxin. We report here the sub-cloning and sequencing of an additional gene outside of the main cluster and essential for albicidin biosynthesis. This gene encodes a 634-amino-acid protein that shows high identity with the Escherichia coli heat shock protein HtpG. Complementation studies of X. albilineans Tox- mutants confirmed the requirement of htpG for albicidin biosynthesis and revealed functional interchangeability between E. coli and X. albilineans htpG genes. HtpG was co-localised with albicidin in the cellular membrane, i.e., the cellular fraction where the toxin is most probably biosynthesised. Here we show the requirement of an HtpG protein for the biosynthesis of a polyketide-peptide antibiotic.

Bacterial Proteins↗
PubMed2006

Application of enterobacterial repetitive intergenic consensus-polymerase chain reaction to trace the fate of generic Escherichia coli within a high capacity pork slaughter line.

The dissemination of enteric contaminants (generic Escherichia coli and Salmonella) associated with pork carcasses and contact surfaces within a high capacity (6,000 carcasses per day) pork slaughter line was evaluated. Sponge samples were taken periodically from the holding area floor and carcasses at different points in the line throughout an 8.75 h production period. E. coli levels within the holding area were high (ca. 6 log cfu 100 cm(-2)) during the initial phase of processing and did not significantly increase throughout the activity period. In the course of dehairing carcasses, the levels of E. coli were significantly (p<0.05) reduced by scalding but increased during the scraping process. A combination of polishing and triple singeing reduced E. coli populations and the bacterium was only recovered sporadically on eviscerated carcasses. The E. coli populations associated with the slaughter line had a low diversity considering the large number of carcasses processed. In Visit I, the 665 E. coli isolates typed using ERIC-PCR could be grouped into 41 genotypes. In Visit II, 141 genotypes were identified among the 855 E. coli isolates tested. This would suggest that contamination on incoming pigs was of only minor significance compared to that present within the slaughterhouse environment. The holding area was shown to act as a reservoir for endemic E. coli genotypes that could be systematically transferred throughout the dressing line on carcasses. Indeed, the majority of genotypes could be re-isolated throughout the 8.75-h processing period. E. coli isolated from carcasses within the evisceration area could be traced to up-stream operations. The holding area and scraper operation were found to be the most important sites of cross-contamination. Fourteen genotypes recovered (primarily within the holding area) on Visit I were re-isolated on Visit II. Despite the presence of endemic E. coli populations, Salmonella was recovered from only two sites (holding area floor and a carcass within the cooler) on a single occasion. The two Salmonella recovered were genetically distinct (similarity index=22%) suggesting that they originated from different sources and were not part of an endemic population. The study has further illustrated the utility of molecular typing of generic E. coli isolates to establish the dynamics of enteric contamination within pork slaughter lines. However, the extent to which the distribution of E. coli can be extrapolated to that of Salmonella remains uncertain.

Abattoirs↗
PubMed2006

The effects on the microbiological condition of product of carcass dressing, cooling, and portioning processes at a poultry packing plant.

The log mean numbers of aerobes, coliforms, Escherichia coli and presumptive staphylococci plus listerias on chicken carcasses and carcass portions at various stages of processing at a poultry packing plant were estimated from the numbers of those bacteria recovered from groups of 25 randomly selected product units. The fractions of listerias in the presumptive staphylococci plus listerias groups of organisms were also estimated. Samples were obtained from carcasses by excising a strip of skin measuring approximately 5 x 2 cm(2) from a randomly selected site on each selected carcass, or by rinsing each selected carcass portion. The log mean numbers of aerobes, coliforms, E. coli and presumptive staphylococci plus listerias on carcasses after scalding at 58 degrees C and plucking were about 4.4, 2.5, 2.2 and 1.4 log cfu/cm(2), respectively. The numbers of bacteria on eviscerated carcasses were similar. After the series of operations for removing the crop, lungs, kidneys and neck, the numbers of aerobes were about 1 log unit less than on eviscerated carcasses, but the numbers of the other bacteria were not substantially reduced. After cooling in water, the numbers of coliforms and E. coli were about 1 log unit less and the numbers of presumptive staphylococci plus listerias were about 0.5 log unit less than the numbers on dressed carcasses, but the numbers of aerobes were not reduced. The numbers of aerobes were 1 log unit more on boneless breasts, and 0.5 log units more on skin-on thighs and breasts that had been tumbled with brine than on cooled carcasses; and presumptive staphylococci plus listerias were 0.5 log unit more on thighs than on cooled carcasses. Otherwise the numbers of bacteria on the product were not substantially affected by processing. Listerias were <20% of the presumptive staphylococci plus listerias group of organisms recovered from product at each point in the process except after breasts were tumbled with brine, when >40% of the organisms were listerias.

Animals↗
PubMed2005

beta-glucan protects against burn-induced oxidative organ damage in rats.

Thermal injury may lead to systemic inflammatory response, and multiple organ failure. Generation of reactive oxygen radicals and lipid peroxidation play important roles in burn-induced remote organ injury. In the present study, we investigated the putative protective effect of local or systemic beta-glucan treatment on burn-induced remote organ injury. Wistar albino rats were exposed to 90 degrees C bath for 10 s to induce thermal trauma. beta-glucan (3.75 mg/rat locally or 50 mg/kg orally) or saline was administered immediately after the trauma and were repeated twice daily in 48 h groups. Rats were decapitated either 6 or 48 h after burn injury and the skin, lung, liver, ileum and kidney tissues were taken for the measurement of malondialdehyde (MDA)--an index of lipid peroxidation--and glutathione (GSH)--a key antioxidant--levels. Neutrophil infiltration was evaluated by the measurement of tissue myeloperoxidase (MPO) activity, while the tumor necrosis factor-alpha (TNF-alpha) levels were measured in serum samples. Skin tissues were also examined microscopically. Severe skin scald injury (30% of total body surface area) caused significant decreases in GSH levels of the liver and intestinal tissues (p<0.01-<0.001), while MDA levels were significantly (p<0.01-p<0.001) increased at post-burn 6 and 48 h. Both local and systemic beta-glucan treatments significantly reversed (p<0.01-p<0.001) the elevations in MDA levels, while reduced GSH levels were reversed back to control levels (p<0.01-p<0.001); and the raised MPO levels were significantly decreased (p<0.05-p<0.001). The results indicate that both systemic and local administration of beta-glucan were effective against burn-induced oxidative tissue damage in the rat. beta-glucans, besides their immunomodulatory effects, have additional antioxidant properties. Therefore, beta-glucans merit consideration as therapeutic agents in the treatment of burn injuries.

Animals↗
PubMed2005

The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus.

BACKGROUND: The Nikolskiy sign is a well-known mechanical symptom that can be helpful in the diagnosis of pemphigus. The reports about associations with other than pemphigus cause confusion concerning the diagnostic importance of the Nikolskiy sign in pemphigus. OBJECTIVE: Our purpose was to examine the significance and usefulness of the Nikolskiy sign on the clinical diagnosis of pemphigus by determination of its sensitivity and specificity. METHODS: Presence of the Nikolskiy sign with the modifications of "direct" and "marginal" on 123 consecutive patients with various cutaneous diseases presenting as intact blisters and/or erosions was sought. RESULTS: A positive Nikolskiy sign was demonstrated in 24 (19.5%) of the 123 patients. Of the positive 24 patients, 18 had pemphigus, 4 had bullous pemphigoid, 1 had linear IgA dermatosis, and 1 had staphylococcal scalded skin syndrome. The sensitivity of "direct" Nikolskiy sign (38%) was less than that of the "marginal" form (69%), but the specificity of "direct" Nikolskiy sign (100%) was higher than that of the "marginal" form (94%) in the diagnosis of pemphigus. LIMITATIONS: This study was primarily concerned with the diagnostic importance of the Nikolskiy sign in pemphigus. We did not focus on its prognostic value in pemphigus. The small size of the group of patients with pemphigus, which is related to low annual incidence of pemphigus in our region, is another limitation of this study. CONCLUSIONS: The Nikolskiy sign offers a moderately sensitive but highly specific tool for the diagnosis of pemphigus.

Adult↗
PubMed2006

Fatal burns in Manipal area: a 10 year study.

The purpose of this study was to record and evaluate the causes and the magnitude of the fatal burn injuries retrospectively. An analysis of autopsy records revealed 19.4% cases of burn injuries amongst the total autopsies done over 10years period (1993-2002) in the mortuary of the department of Forensic Medicine of Kasturba medical College, Manipal. The majority of deaths (78.5%) occurred between 11 and 40years of age group with preponderance of females (74.8%). The flame burns were seen in 94.1% of the victims followed by scalds and electrical burns in 2.8% and 2.5% cases, respectively. The majority of burn incidents were accidental (75.8%) in nature followed by suicidal (11.5%) and homicidal (3.1%) deaths. The percentage of burn (TBSA) over 40% were observed in most of the cases (92.5%). The majority of deaths occurred within a week (69.87%) and most the victims died because of septicemia (50.9%).

Accidents↗
PubMed2006

Staphylococcal cutaneous infections: invasion, evasion and aggression.

Staphylococcal infections cause a variety of cutaneous and systemic infections, including impetigo, furuncle, subcutaneous abscess, staphylococcal scalded skin syndrome (SSSS), toxic shock syndrome (TSS) and neonatal toxic shock syndrome-like exanthematous disease (NTED), in association with microbial virulence factors. The virulence factors produced by Staphylococcus aureus have a wide array of biological properties, including disruption of the epithelial barrier, inhibition of opsonization by antibody and complement, interference with neutrophil chemotaxis, cytolysis of neutrophils, and inactivation of antimicrobial peptides. Exfoliative toxins (ETs) induce the 'acantholytic' infection of S. aureus due to the disruption of cell-to-cell cohesion, which allows the pathogenic organisms to spread within the epithelium. Furthermore, S. aureus expresses exotoxins with biological properties of superantigens that induce T-cell activation with subsequent anergy and immunosuppression. Of the S. aureus leukotoxins, Panton-Valentine leukocidin (PVL) is involved in the development of multiple furuncles with more intense erythema, particularly in healthy young adults. TSS is an acute life-threatening illness caused by TSS toxin-1 (TSST-1) and is usually classified into two categories; menstrual TSS, originally described in association with tampon use, and nonmenstrual TSS with a variety of clinical settings. NTED is a neonatal disease induced by TSST-1 although clinical symptoms are much milder than those of TSS. In TSS and NTED, the expansion of TSST-1-reactive Vbeta2-positive T cells is observed. The production of pathogenic S. aureus exotoxins and biofilm formation is regulated by the accessory gene regulator (agr) locus in the quorum-sensing signaling pathway. There is no doubt that targeting the quorum-sensing signaling pathway or anti-toxin therapy is a promising therapeutic approach supportive of primary antibiotic therapy.

Biofilms↗
PubMed2003

Staphylococcal species in the oral cavity from patients in a regional burns unit.

The aim of this study was to perform a quantitative and qualitative analysis of oral carriage of staphylococci in a range of oral specimens from patients admitted to a regional burns unit. The study recruited 28 patients and reasons for admittance were: burns (46%), skin grafting (39%), lacerations (7%), scalding (4%) and necrotizing fasciitis (4%). No patient had smoke inhalation injuries or trauma to the oro-pharynx. There were five patients from whom methicillin-sensitive S. aureus (MRSA) could be detected in oral specimens. For three patients only the wound and oral specimens were positive for MRSA. In one patient only the oral specimens were positive for MRSA. There were five patients from whom methicillin-sensitive S. aureus (MRSA) could be detected in the oral specimens. In one patient only the oral specimens were positive for MSSA. Staphylococci could be recovered from the dental plaque, denture and toothbrush specimens with a mean count of 1.1 x 10(4)cfu/mL (range 20-5.3 x 10(4)), 5.4 x 10(3) (range 40-2.1 x 10(4)) and 264 cfu/mL (range 20-500), respectively. Both MSSA and MRSA could be recovered from these specimen types. In one patient only the toothbrush was positive for MRSA and all other oral specimens were negative. This study suggests that staphylococci are not infrequent colonizers of the oral cavity, and that this site may serve as a potential reservoir for transmission to other body sites.

Adolescent↗
PubMed2004

Sialochemical and gustatory analysis in patients with oral sensory complaints.

UNLABELLED: Our objective was to perform concomitant taste and salivary analyses in subjects with oral sensory complaints (OSC), including burning mouth syndrome (BMS), idiopathic taste aberrations, and xerostomia without established etiology, to attempt to find a possible explanation for the mechanism underlying those complaints. BMS is a disorder characterized by a painful burning or scalding sensation in clinically normal and healthy oral mucosa. Taste and salivary analyses were performed on 163 subjects with OSC who complained of BMS, taste aberration, or xerostomia, alone or in combination. These subjects were compared with 84 healthy, age- and sex-matched control subjects. The salivary and taste analyses were found to be helpful in distinguishing control subjects from complaining subjects. The most striking result found was the great similarity of both salivary and taste analyses in the BMS, taste aberration, and xerostomia groups, which were significantly different from the results obtained in the control group. An oral neuropathy or neurologic transduction interruption induced by salivary compositional alterations is suggested as the possible etiology for the complaints. This report might add an important objective diagnostic tool to the clinician treating such patients. PERSPECTIVE: The merit of the current study stems from the fact that it suggests for the first time a salivary-related local neuropathic mechanism for oral sensorial complaints. This may be of paramount importance, both with respect to the biological background of these complaints and to the possible therapeutic modalities that might be offered to suffering patients.

Adolescent↗
PubMed2005

Incidence rates and risk factors for injury events in high school students in Lijin County, China.

PROBLEM: Most investigations of injuries among Chinese populations are focused on urban or better developed areas, fewer on rural or poor areas. METHODS: From September 21 to 27, 2002, an epidemiological investigation of eight kinds of injury-related events was carried out among 1,944 students in 39 classes randomly sampled from middle schools in Lijin County, a rural area. The eight kinds of events were: (a) traffic accidents, (b) poisoning, (c) fall, (d) burn or scald, (e) blunt or sharp tools contact, (f) electrical contact, (g) animal or insect bites, and (h) non-fatal drowning. RESULTS: The total incidence rate of eight kinds of injuries in the previous year was 21.1%. The incidence rate among boys was 24.2%, while that among girls was 17.4%, which was significant (chi-square=13.4, P<0.05). The incidence rate among junior high school students was 23.1%, while that among senior high school students was 15.5%, which was also significant (chi-square=13.2, P<0.05). A case-control study of 410 students with at least one of eight kinds of injury events indicated that students' gender and their mothers' health status were related to their injuries. CONCLUSION: The injury incidence rate in a rural area was less than other results in urban or developed areas. Students' gender and mothers' health status were important factors associated with the occurrence of injury. IMPACT ON INDUSTRY: In order to improve the surroundings of the growing population of adolescents, some preventive measures should be put forward, especially to the high-risk students of injury.

Adolescent↗