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Introduction: Burn victims are reported to have more possibility of bone loss in acute phase of injury partly due to sympathetic dysfunction and catecholamine increase beside other hypermetabolic responses. These patients are also prone to autonomic neuropathy and sympathetic skin response (SSR) impairment. We aim to investigate the correlation between SSR in the acute phase and bone mineral density (BMD) parameters in electrical burn patients and determine whether the SSR parameter in initial weeks of the event is a good predictor of bone loss in long term., Materials and Methods: Sixty two individuals exposed to low voltage(<1000 V) electrical current were invited to a cohort study. The SSR was recorded from their four limbs in 2-5 weeks after injury. Then, dual X-ray absorptiometry (DXA) was done to measure their BMD, T-score and Z -score, 9-12 months later. The correlation between SSR parameters in acute phase and DXA indexes was evaluated using Spearman test. A Roc curve was charted to point out a cut-off value for SSR amplitude and latency in respect to T-score to predict the subsequent bone loss., Result: All the patients were male with a mean age of 34.09 years. Biphasic SSR parameters showed a significant correlation with lumbar BMD in a confidence interval of 99.9%. SSR amplitude threshold of 293.75 μV and latency of 2.15 s had a 100% sensitivity and 94% and 83% specificity respectively for predicting the bone loss (T-score<-1) in long term. The area under Roc curve was 0.94 and 0.99 in terms of SSR amplitude and latency., Conclusion: SSR recorded in the first few weeks after electrical injury is a good predictor of bone loss in long term, so we recommend this test as a guide for screening the patients at risk for osteoporosis in electrical burn and formulating the preventive measurements., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Often discovered late during the clinical course of burns, bone loss is widely accepted by clinicians as a de facto consequence of burn. Literature on this bone loss is limited and contradictory in details. More insight into the prevalence and magnitude of bone loss may facilitate its prevention. To this end, over a period of two years, we gathered a test group of 34 male patients with at least six-month-old thermal burns and a control group of 50 male members of similar age and geographical background as our test group. All members with any history of metabolic or endocrine disease or ICU admission were excluded from both groups. Using dual energy X-ray absorptiometry (DXA), we measured bone mineral density (BMD), Z-score and T-score in lumbar vertebra, femoral neck, and total femur and compared the results between the two groups. T-test of density scores against total body surface area of burns was performed. We found that the average T-scores, Z-scores and BMDs in the test group were significantly smaller than the averages in the control group (P<0.001); and in the test and the control group, 25.7% and 0% of subjects respectively, had osteoporotic lumbar T-scores. Total femur and femoral neck T-scores exhibited a significant similar pattern with smaller differences across the two groups. The density scores also showed a significant reverse relationship to the total body surface area (TBSA) of burn (P<0.003). Our results indicate that thermal burn victims have lower bone density and higher prevalence of osteoporosis than their healthy counterparts and that this difference is significant enough to justify screening in these patients which requires further longitudinal studies to institute., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: Several studies have shown the importance of the sympathetic nervous system in bone metabolism. There is an evidence of sympathetic skin response (SSR) impairment in electrical burn patients up to 2 years after their injuries. The acute phase of burn is accompanied by increased bone resorption. Whether the prolonged dysfunction of sympathetic nervous system may result in bone metabolism derangement even after the acute phase of electrical burn is the inspiring question for this study. And we tried to find correlation between SSR abnormality and areal bone mineral density (BMD) in electrical burn patients 6 months or more after the incidents., Methods and Materials: 42 electrical burn patients (≥6 months prior to study) who did not have a known joint or bone disease, history of neuropathy (central or peripheral), diabetes mellitus or consumption of any drug affecting the autonomic nervous system or evidence of neuropathy in nerve conduction study were recruited. We also gathered a control group of 50 healthy subjects (without electrical burn or the exclusion criteria). They went under dual energy X-ray absorptiometry and SSR study. Data were analyzed statistically with SPSS 16.0 making use of independent t-test and Pearson correlation coefficient. P<0.05 was considered significant statistically., Results: Areal BMD was significantly lower in electrical burn patients than control group (P<0.001). SSR latency was significantly prolonged and its amplitude was significantly reduced in burn patients compared to control group (P<0.001). In burn patients there was an inverse correlation of areal BMD of lumbar vertebrae, left femur neck and total femur with SSR latency and a direct correlation of areal BMD with SSR amplitude. In control group there was just direct correlation of areal BMD of lumbar vertebrae and left femur neck with SSR amplitude., Conclusion: Electrical burn patients are at risk of reduced areal BMD long after their injuries. Sympathetic derangement and impaired SSR are correlated with reduction in areal BMD in these patients., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Background: Sensory, motor, and autonomic neuropathy has been reported after electrical injury. Besides subclinical involvement of the sympathetic nervous system during the 1st year post injury, late clinical manifestations of this involvement have been reported sporadically. This study was designed to investigate how the clinical and electrodiagnostic manifestations of sympathetic involvement would change with time in electricity victims., Methods and Materials: Sixty electrically burnt patients were followed for 22 months with sympathetic skin response (SSR) and autonomic system derangement symptom surveillance., Results: Thirty-one patients reported autonomic derangement symptoms during the 2nd year post injury. SSR latency prolongation showed direct negative correlation with time; but SSR amplitude was decreased in all cases irrespective of the time laps. Symptomatic patients showed significantly lower SSR amplitudes compared to asymptomatic ones. This was true for the pre-symptom SSR test results too., Conclusion: SSR amplitude can be used as a predictive test for the symptoms of autonomic derangement to occur post electrical injury., (Copyright © 2013. Published by Elsevier Ltd.)

Background: Electrical burn has been reported to be highly associated with peripheral neuropathy. This study was designed to evaluate the sympathetic skin response (SSR) of electrical burn patients to determine whether the sympathetic nervous system is involved in these patients., Materials and Methods: The sympathetic skin response of 28 patients, suffering from electrical burn injury (divided into two groups of high voltage and low voltage exposure) was compared with that of 28 matched subjects, who had never experienced electrical burn. Bilateral palmar and plantar latency and amplitude of SSR were recorded in response to Median and Tibial nerve electrical stimulation., Results: SSR in all recording sites of the electrical burn patients compared showed significantly more prolonged latencies and reduced amplitudes, with their counterparts in the control group with no significant difference between the high voltage and low voltage electrical burns. There was no significant difference in SSR latency, between the entry and exit sites of the electrical current. The SSR amplitude however, showed more reduction in right hand than the left one, in whom the electrical current had entered the body from the right hand. The time lapse between the electrical burn and the SSR study was shown to play no role in the results., Discussion: Increased SSR latency in electrical burn injury may be a sign of autonomic nervous system involvement, through systemic responses to electrical burn., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)