Search

Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India. Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio. Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten. Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable. • We explored misclassification of injury intent using burn register data from India. • Injury intent was the most commonly missing variable in the data set (12.6%). • Patients with overwriting of intent predominantly included females and large burns. • Females with burns categorised as 'other' or with missing data may be misclassified. • These findings highlight opportunities to improve quality of surveillance data. [ABSTRACT FROM AUTHOR]

There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset. [ABSTRACT FROM AUTHOR]

Appropriate and timely first aid reduces morbidity in burns. This study aims to assess the knowledge of first aid in burns among healthcare workers (HCW) and nonhealthcare workers. (NHCW). A survey, distributed in both paper and Google survey formats, presented five sample cases with multiple-choice answers. Participants recorded the most suitable first aid management for each scenario. Correct answers were provided on completion. Out of the total 753 participants, only 89 (11.8%) got all five answers correct. 16% HCW and 6% NHCW could answer all 5 questions correctly (with a true HCW:NHCW ratio of 2.67:1). Providing care for individuals with burns substantially raised the probability of giving accurate responses (p = 0.0001). While attending the general First Aid Course did not affect the responses (p = 0.08), participation in the Burns First Aid Course demonstrated slightly improved results (p = 0.052). The scenario involving liquid petroleum gas leakage saw a high proportion of correct responses, likely influenced by media coverage. We find a clear need for adequate training in burns first aid due to low awareness among healthcare workers (HCW) and non-healthcare workers (NHCW). Factors such as participation in burn first aid courses and gaining firsthand experience in treating burns were found to be linked to improved knowledge of burns prevention and first aid. Utilizing various media channels could be a valuable strategy to reach a broader audience, especially in remote and inaccessible areas. • There is limited awareness of burns first aid and prevention among both healthcare and non-healthcare workers • Experience in treatment of burn injuries improves knowledge of burns first aid better than first aid training. • Efficient use of multimedia and technology enhances burns prevention and first aid knowledge, reaching remote areas. [ABSTRACT FROM AUTHOR]

Delivering specialised care for major burns requires a multidisciplinary health workforce. While health systems ‘hardware’ issues, such as shortages of the healthcare workforce and training gaps in burn care are widely acknowledged, there is limited evidence around the systems ‘software’ aspects, such as interest, power dynamics, and relationships that impact the healthcare workforce performance. This study explored challenges faced by the health workforce in burn care to identify issues affecting their performance. Qualitative in-depth interviews were conducted with a purposively selected sample (n = 31, 18 women and 13 men) of various cadres of the burn care health workforce in Uttar Pradesh, India. Inductive coding and thematic analysis identified three major themes. First, the dynamics within the multidisciplinary team where complex relations, power and normative hierarchy hampered performance. Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn injuries and multitasking. Third, dynamics between specialised burn units and broader health systems are narrated in challenges due to inadequate first response and delayed referral from primary care facilities. These findings indicate that burn care health workers in India face multiple challenges that need systemic intervention with a multipronged human resource for health framework. [ABSTRACT FROM AUTHOR]

Background: The profiling of medico-legal cases is imperative in order to avert preventable casualties in the future and to analyze the authentic crime rate within a specific region. Presently, road traffic accidents are the primary cause of casualties, resulting in numerous fatalities. Objective: The objective is to establish a comprehensive profile of deaths caused by either natural or unnatural factors, thereby enabling us to channel rigorous efforts towards mitigating their occurrence. Materials and Methods: A retrospective analysis was conducted on the mortality cases subjected to medico-legal postmortem examination at the Mortuary, Government Medical College, Kanpur, U.P., India, during the year 2022. Throughout this duration, a total of 2326 autopsy cases were conducted. Results: October had the highest number of autopsy cases. Males accounted for 63.23% of cases, with most falling in the 21-30 age group. Injury-related deaths were the largest proportion (47.36%), followed by natural deaths (19.93%), violent asphyxial deaths (10.48%), thermal injuries (9.89%), and poisoning (9.04%). Conclusion: The analysis reveals that road traffic accidents are the most common cause of death, potentially due to the increased frequency of transportation. Specifically, vehicular accidents resulting in head injuries were the leading cause of death. [ABSTRACT FROM AUTHOR]

India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems. • The first study from a low-and middle-income country exploring patients' journeys and 'three delays' in burns care. • Findings suggest long delays in reaching an appropriate health facility and receiving adequate care. • The absence referral linkage between facilities and high treatement cost, are identified are critical barriers to timely care. • We propose a modified 'three-delays' framework to analyse factors causing delays in accessing burn care. [ABSTRACT FROM AUTHOR]

Background: Burns constitute a major cause of deaths, both suicidal & accidental in the world & our country. As per the National crime record bureau of India, burns one among the common method of suicide and the rate of fatal suicidal burns was 2.6% in 2021. In Tamil Nadu, the rate of suicide is 11.5%, and also, being the second highest among the other states.(1) This study is undertaken with the aim to study sociodemographic profile of burns case brought to autopsy at tertiary medical college, along with the pattern & outcome. Methods: A cross sectional study was done in a total of 53 cases of burns brought for medicolegal autopsy during the study period. Data including age, gender, socioeconomic status, manner of burns, % of burns, duration of survival were all collected based on pre structured proforma & further was analysed using standard statistical method. Results and Conclusion: Burns incidence is seen in mostly age group 31-40, with majority of them being females (62.27%).suicidal burns are more common (73.59%), with >75%(66.03% ) burns being more. About 35.8% survived for 1-7 days prior to succumbing death. Enhancing a better mental& physical environment should be the priority. Early & effective treatment can be useful in reducing the mortality due to burns. [ABSTRACT FROM AUTHOR]

Background: The pattern of injuries is unique to the mode of the accident as well as to the causative agent. The objective of the present study was to describe the pattern of injury among victims of a fatal accident and draw a medicolegal conclusion from the pattern of injury. Methods: A total of 145 dead bodies brought for autopsy at the two selected post-mortemcentres were included in the present study. The socio-demographic data like age, sex, religion, occupation as well as the circumstances leading to the death of the individual were gathered from documents and detailed interview of the friends/relatives/eyewitnesses etc. Among study participants, burns were the single largest category of accidents closely followed by road traffic accidents. The brain was the most common internal organ injured and the skull was the most common major bone fractured among the victims. One-fourth of all study participants were dead before being brought to hospital and onethird of all study participants survived for more than 48 hours after the incident. Conclusion: Septicaemic shock and craniocerebral injury were the most common cause of death among study participants. [ABSTRACT FROM AUTHOR]

In India, incidence of burn injuries is quite high due to widespread illiteracy, old customs like dowry and use of kerosene for lighting and cooking; poverty, overcrowding and unemployment, other social & emotional factors, lack of safety measures at industrial setup & lack of adequate healthcare services. Although, mortality in cases of burns has been reduced considerably by modern advance healthcare services, yet death due to burns is not an uncommon event. The study was carried out with the aim to study the various demographic parameters related to deaths due to burns such as age, sex, occupation, socio-economic status, marital status, locality and source of fire. It was a 1.6 years prospective study of cases of burns autopsied at the mortuary of Gandhi medical college, Bhopal. The relevant information was obtained from inquest papers, history provided by relatives of the deceased and postmortem examination. On data analysis, it was found that incidence of burns was found to be higher higher in females (55.0%) as compared to males (45.0%). young adults between the age group of 21-30 years have been the major victims of burns (41.00%). In both sexes, majority of the burn cases were married (74%). Most of the burn cases belonged to middle class, were housewives (51 %). and from rural areas (75 %). Hence, steps need be taken by Govt., NGOs and medical professionals to reduce the mortality due to burns. [ABSTRACT FROM AUTHOR]

Death due to burns is a major public health problem worldwide. Most cases occur in middle and low-income countries. In India, deaths due to burns are commoner in women than in men. Fire is easily available weapon for suicide and homicide and it can also cause accidental deaths. Death due to burns in newly married female is a common incident in our country and major fraction of such deaths happen as a result of dowry harassment or killing for not giving dowry. Our study aimed to identify some of the epidemiological factors in deaths due to burns in newly married females in and around Pondicherry. Out of 48 cases during the study period, 24 victims were in the age group of 22-25 years and 26 women died within 3 years of marriage. The majority of the cases occurred in less educated and homemaker wives and were living in a joint family. Major reasons or motive behind deaths were dowry harassment and torture, and quarrel with husband or inlaws. The most common manner of such deaths was suicidal followed by accidental. [ABSTRACT FROM AUTHOR]

Self-Immolation refers to the act of burning oneself, and is considered a fatal method of suicide. The study aimed to explore the lived experiences of women Self-Immolation Attempt Survivors (SIAS) during their social engagements in the Indian context. The study explored both women SIAS' feelings, attitudes, and behaviours, and those of others during social engagement. The study used semi-structured interview method to collect data from seven women SIAS in the long-term rehabilitation phase of recovery. All the women SIAS lived in Karnataka, a Southern State of India when self-immolation occurred, and stayed there even after the hospitalization for burns recovery. Data was collected in the language of Kannada, the native language of Karnataka. Interviews were audio-recorded with consent from women SIAS. Interviews were first transcribed in Kannada, and later translated to English. The data was subjected to interpretative phenomenological analysis. The accounts of seven women Self-Immolation Attempt Survivors (SIAS) clustered around the following six super-ordinate themes with several sub-ordinate themes: Self-Isolation; Unpleasant feelings experienced by SIAS due to others' behaviour; Prejudice and discrimination towards SIAS; Unhelpful behaviours of others towards SIAS; Healthy coping mechanisms adopted by SIAS; Social acceptance of SIAS. Implications of the study are discussed as well. [ABSTRACT FROM AUTHOR]

Aim: To examine the characteristics of acid attack survivors who were aged ≤16 years at the time of the assault. Methods: Case files from the Chhanv and the Laxmi Foundations in India were accessioned for cases of acid attacks involving children and adolescents (≤16 years). Details of the age, sex, reason for the attack, injuries sustained and possible outcomes were recorded. Results: Ten cases were identified that involved eight girls (aged 3-16 years) and two boys (12 and 14 years). The head and neck were the primary targets in all cases. The primary reasons for the attacks involving adolescent girls were punishment for refusing sexual advances from older males and family violence/child abuse. The two male victims were assaulted as part of property dispute and gang violence. Penalties varied greatly with prison sentences (when handed down) ranging from <1 year to 10 years. Conclusion: The number of cases of paediatric acid attacks appear small, with motivations for the attacks including responses to spurned sexual advances, domestic violence/child abuse, criminal gang activities and ostensibly at random. Nongovernment organisations are vital in the rehabilitation of victims. It is of concern that dissemination on social networks and publicity through the media may lead to an increase in number of cases., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia., Methods: We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised., Results: 1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment., Conclusion: The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons., Competing Interests: Declarations of interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Death of a bride by immolation either self or by the in-laws and their family members is a well-known phenomenon since many centuries in India. Even though our country is developing in all respects, but still we are unable to prevent these deaths due to various reasons. In this study, we have made an attempt to highlight the statistics of fatal thermal deaths in married women in one year with relation to Incidence, Age, element of dowry and cause of death. Results showed that Incidence of thermal deaths in married females was 75.2% with maximum victims in the 18-22 years age group. Further it was noted that 39% of these victims were due to alleged dowry harassment and the cause of death in majority being septic shock. [ABSTRACT FROM AUTHOR]

Superstitious beliefs have been frequently encountered in our day-to-day practices among patients and caretakers. Though this is a common phenomenon, there is a paucity of data pertaining to these beliefs due to various reasons. Many of these beliefs are deep engraved into the culture and mindsets of the population. This is an observational study performed in Tertiary burn care center in India during period October 1, 2018 to January 31, 2019. Data from 100 patient units were collected through a set of questionnaires given to each of patient and their caregivers/family members and responses were collected and analyzed. In the food category of superstitions, there was a thought that white colored foods had to be avoided to avoid pus discharge and wound healing in 60% of the response; eating pomegranate or drinking the juice of pomegranate improves the hemoglobin in 80% of the response. Wearing various colored strings in various parts of the body seemed to be a dominant practice in 85% of the responses, wearing the hair with origin from human, donkeys, horses, and various animals was practiced in 45% of people and wearing peacock feathers was seen in 40% of patients. About 95% of the patients thought adversely to the idea of bathing or even contact of the water with the wounds. This study is an attempt to analyze the different parameters of superstition, misconception, and magical beliefs. [ABSTRACT FROM AUTHOR]

Background: Burn injuries in adults can be complicated due to various underlying factors. Of all the co-morbidities complicating wound healing and prognosis of the patient post burn injury, diabetes mellitus is the most common in India. We therefore aimed to explore the epidemiology, interventions, complications, and outcomes in diabetic patients with burn injury. Aim: To analyze demographic characteristics, clinical and microbiological profile and outcome of diabetic burns patients in comparison with nondiabetic burns patients. Materials and methods: This study was a retrospective analysis of diabetic and nondiabetic burns patients admitted to Apollo speciality clinics, Vanagaram, a tertiary care facility in Chennai over a period of 3 years. Data such as age, gender, type and degree of burns, percentage of burns and length of stay, mortality rate, infection rate, type of infections, surgical procedures, and medical complications were analyzed in comparison with nondiabetic burns patients. Results: Among ninety-four burns patients admitted to our hospital over a period of 3 years, 18 patients (19%) were diabetics and 76 patients (81%) were nondiabetics. Mean age of diabetics was 58.2 years (SD-17.1) and nondiabetics was 36.3 years (SD-16.4). Surgical intervention with split skin graft was performed in 50% of diabetics and 48.7% of nondiabetics. Average length of stay of diabetics was 12.6 days and nondiabetics was 16.2 days (p value: 0.334). Diabetic patients with burns were noted to have higher rate of infection (67% vs 61.8%, p value: 0.803) and mortality (44% vs 35.5%, p value: 0.482). Conclusion: The clinical course is different between diabetic and nondiabetic patients with burns injury. Although length of stay and surgical interventions were not significantly different, diabetes as a comorbidity appears to increase the risk of infections and mortality in patients with burns. [ABSTRACT FROM AUTHOR]

Introduction: Burn injuries sustained by the Indian women while cooking food in the kitchen or working place comprise a unique entity in the Accidental burn epidemiology. Burn deaths in females are a major public health problem in our country. Materials and Methods : Present study based on autopsy for the period of 2 year to evaluate epidemiological aspects of burn injury in the mortuary & Hospital situated in the metropolitan city of India. Results: 55.05% victims belonged to lower middle class, Hindu (69.19%). Housewives (84.34%), Married (86.87 %) females, educated middle school (26.77%), belonged to Suburban area (55.05%). Age group 21-25 yrs was more common affected (31.31%), married since more than 7 yrs (41.41%), victims survived for period of more than 7 days (32.83%). Accidental burns were most commonly by stove blast (74.75%) & victims sustained 51-75% TBSA burns (45.96 %), died from Septicemia (80.50%) Conclusion: Most common married, housevies, belonged to young age were victims of Accidental burn injury. Considering the morbidity and mortality owing to burns, government and other social organizations need to put special efforts for the prevention and education programs against burn injuries. [ABSTRACT FROM AUTHOR]

Objective: There is a high rate of death due to burns and wound infections in India. Innovators and manufacturers of wound and burn dressings need to keep themselves abreast of the most current rules governing medical devices. The concept of advanced dressings is emerging in India. However, local manufacturing is hindered by an absence of clear regulatory guidelines. The lack of advanced wound and burn dressings on the market critically affects patient survival rates, while imports from other countries make dressings unaffordable and beyond the reach of most patients. This article presents the details of an approval procedure for advanced dressings and provides manufacturers, innovators and investors with a better understanding of the classification rules, import, export and marketing approval processes. We also discus the reasons for high levels of imports and costs, as well as suggestions on how to address this. Method: A critical analysis was conducted of 54 research and review articles, including regulatory guidelines to control the marketing of wound and burn care dressings recommended by international regulatory agencies. Conclusion: India is highly dependent on imports of advanced dressings. Due to lack of clear, quality regulatory guidelines, innovators and manufacturers are facing issues while showcasing their product in the Indian market. Thus development of clear quality regulatory guidelines is crucial. Therefore, this article may guide and encourage manufacturers to develop advanced dressings in India [ABSTRACT FROM AUTHOR]

Fire, one of the pure elements forming the world and one of the elements to provide life energy to all living beings, sometimes turns deadly. In Forensic Medicine departments, one of the most common cases for post mortem examinations is Burns case. But it becomes difficult many a times to comment on the manner of death in cases with a brief survival period. So, the currentretrospective study was undertaken at Mortuary complex of GMERS Medical college, Dharpur-Patan, Gujarat during the period from 1st Jan 2016 to 31stDec 2017. [ABSTRACT FROM AUTHOR]

Background: The National Crime Records Bureau of India reported a decline in suicide rate from 2010 through 2014. We conducted this study to know whether our hospital data reflects the national data and to know the age and gender specific differences in selecting methods of suicide. Methods: We conducted a retrospective analysis of autopsied cases in Department of Forensic Medicine in a tertiary care hospital in central Kerala, India. Data on age, gender, cause of death of autopsied cases with alleged history of deliberate self-harm (DSH) were noted. Results: Mean age of study population was 43.4±24.4. There were 59.3% males and 40.7% females, but young females outnumbered young males. Majority of cases were hanging (n=1325), followed by poisoning (n=1169), burns (n=809), drowning (n=626) and others (n=401). Hanging and poisoning were the common methods chosen by males while burns and poisoning were the common methods by females. The number of DSH cases was 1,040, 866, 771, 837 and 826 in each year from 2010 to 2014, respectively. Number of poisoning cases was declining steadily from 350 to 163 while non-poisoning suicide was not showing any steady changes (690, 578, 514, 657, and 663). Pesticides were the most common agent recorded in the autopsy sheet while corrosives, plant toxins, cyanide, toxic alcohol and drug overdose were less common. Quinalfos, chlorpyrifos and carbofuran were the commonly identified pesticides on chemical analysis. Conclusion: There is a decrease trend in the number of suicides over the 5 years from 2010 through 2014 with a decrease in suicide due to poisoning. Though there is minimal increase in suicide due to hanging, it did not affect the total number of suicides. [ABSTRACT FROM AUTHOR]

Aim: To assess the quality of life of major burn patients in a tertiary care teaching hospital.Materials and Method: A prospective approach was taken to identify patients who visited the department of plastic surgery for follow up from October 2017 to March 2018 after obtaining institutional ethical clearance. Details regarding social demographics, nature of the injury and the cause of injury were recorded in addition to administration of the questionnaire WHOQOL-BREF to assess the quality of life. Quality of life has four domains for assessment of physical, psychological, social and environmental aspects of burn survivors. Results: A total of 100 patients with burn injuries were identified (63 males, 37 females; mean age = 35.14 years). Nature of injury and cause of injury has no statistical significance over the quality of life. Quality of life was neither poor nor good among majority of 2nd-degree burn patients. [ABSTRACT FROM AUTHOR]

Every burn injury recorded in vital Statistics represents a catastrophic injury: catastrophic in the overwhelming insult to the patients, catastrophic in its psychological aspects and catastrophic in cost and suffering to the family involved. A severe burn is the most devastating injury a person can sustain and yet hope to survive. It is a common catastrophe today as burn injury cases are one of the common emergencies admitted in any hospital. As the etiological factors of the burn injuries vary considerably in different communities, careful analysis of the epidemiological features in every community is needed before a sound prevention programme can be planned and implemented. The present study was carried out in the department of Forensic medicine and Toxicology of PGIMS and General Hospital Rohtak, Haryana and total 448 cases were collected for this study purpose. Female victims were most commonly affected as compared to male victims. The majority of deaths 232 (51.8%) occurred in the age group of 20-39 years followed by 119 (26.5%) in the age group of 40-59 years. Married females were most common victim compared to unmarried female victim. The majority of burn deaths were accidental (85.3%) in nature followed by suicidal (8.1%) and homicidal deaths (6.6%) [ABSTRACT FROM AUTHOR]

Fire has been known to mankind for about 400,000 years. Although the use of fire was known to ancient man, it is probably the potential fury of an unharnessed fire that made man bow before it. Burn injuries occur universally and have plagued mankind ever since antiquity till the present day. Burn injuries are the commonest cause of unnatural death in India and constitute a major cause of death and morbidity in the world and in this country too. Burns always have posed a threat to the sensitive human body. The present study is from the data collected of 48 burn cases which were autopsied at mortuary, Department of Forensic Medicine and Toxicology SNMC Bagalkot. It was observed that majority of the victims were in the age group of 21-30 years, with female to male ratio of 5:1. Most of the victims were married and the majority were housewives, belonging to rural area and of class-I socioeconomic strata. Most of the burns took place in the kitchen, mostly due to kerosene stove burst. Body surface area involvement was more than 76% in maximum number of cases. Septicemia was the leading cause of death and majority of the victims died within a week. [ABSTRACT FROM AUTHOR]

Burns have tremendous medicolegal importance as they may be considered to be the commonest cause of unnatural death in India1. In this study total 43 cases of burns deaths were explored in one year. Most commonly affected age group was of young aged of 20-40 yrs (69.77%) followed by 40-60 yrs (16.28%). Most of the victims were illiterate (34.88%) & (79.07%) cases were of married. Females were leading to male; amongst them most of were housewives of Hindu families of lower middle socio-economic class. The most of victims (51.16%) sustained 76-100% burns followed by 51-75% burns (34.88%). Most common manner of death was accidental burns (95.35%). [ABSTRACT FROM AUTHOR]

In ancient times, people considered fire one of the basic elements of the universe, along with water, air, and earth. Fire can be a friendly, comforting thing, a source of heat and light, as anyone who has ever sat by a campfire in the dark of the night knows. Yet fire can also be dangerous and deadly, racing and leaping like a living thing to consume all in its path. Death due to burns was one of the commonest unnatural deaths found in society. A retrospective study of cases from January 2011 to December 2012 of death due to burns was conducted in the Department of Forensic Medicine and Toxicology, Government Medical College, Amritsar. The objective of the study was to understand various demographic aspects of deaths due to burns so as to suggest some remedial measures. [ABSTRACT FROM AUTHOR]

Introduction: Burns are considered as one of the most destructive injuries, which cause not only deaths but also major economic and psychological impacts and long term somatic sequelae. Objective: To access the magnitude of the fatal burn injuries among the victims who came to hospital. Methods: A total of 188 patients with burn injury admitted to the Bhaskar Medical College and Hospital during July 2011 to July 2015 were assessed and subsequently there were 48 in-hospital deaths. Autopsies on the dead burned patients were performed at Osmania General Hospital, Hyderabad. Results: Around three fourths of the cases were women, with 58.4% of the total cases in 21-30 age group. Accidental deaths accounted for 76.5% of the cases, while 22.1% of the patients having more than 90% of burns on their body surface. The days of survival of the burn victims was, 72 hours in most of the cases, out of which many died within 48 hours. The leading cause of death was septicemia. Conclusion: Most burn deaths may be preventable with better airway management and more aggressive but precise resuscitative efforts. However, sepsis, due to multi-drug resistant organisms, may continue to impede efforts to increase survival if we cannot develop strategies to fight these organisms. [ABSTRACT FROM AUTHOR]

Introduction: Burn injuries are a major public health concern with more than 3,00,000 deaths occurring every year globally. In India, 1,63,000 to 2,00,000 burn deaths are reported every year. Considering the enormity of the problem, we undertook this study so that the risk factors and population at risk could be identified in and around the city of Guwahati, Assam. Methods: The prospective study was done in the Mortuary of Guwahati Medical College and Hospital, Assam. A total of 91 cases of flame burns were collected for the period from 1st June 2006 to 31st May 2007. The victims were studied for age, sex, nature of incidence, educational background, occupational status, marital status, socio economic status, location of incidence, etiology, time of incidence, day and month wise distribution of incidence, seasonal variations and pregnancy history. Burns due to other causes (chemical, electricity, lightning etc) were excluded. Results: Majority of the victims were females (78.91%). Incidence of accidental burns was more common (70.34%). Most of the victims were educated upto high school (46.16%) and actively involved in household chores (58.24%). Married people were more commonly affected (64.84%). Most of the victims were from the low income group (52.74%) and belonged to urban areas (48.87%). Widespread use of kerosene appliances resulted in most deaths (37.36%). Most common time of incidence was from 6PM to 12 midnight (54.89%). A majority of the cases were reported on Sundays (18.05%). Most of the cases occurred in winter (33.08%). A majority of the victims were not pregnant at the time of incidence (90.65%). Conclusions: Hindu married, non - pregnant women of low income group living in urban areas, having low formal education and actively involved in domestic chores, are most susceptible to burns. Preventive strategies include minimizing the risk factors by proper interventions and raising awareness among the public by conducting educational programmes. [ABSTRACT FROM AUTHOR]

Background: Dowry death is a burning problem of the society in India owing to prevailing traditional cultural practices, socioeconomic and psychosocial taboos and life style. Objectives: This paper appraises the patterns, socioeconomic and demographic factors of dowry deaths cases due to burns. Materials and Method: The present prospective study comprised of 212 dowry death cases pertaining to burns brought for medico-legal autopsy at tertiary teaching hospital in Telangana, India for 2 years. Data was collected and analyzed in relation to different factors from police inquest report, first information report and autopsy examination proper. Results: Deaths due to burn (n=212) constituted commonest causative factor for dowry deaths. Majority (n=141; 64.09%) were found to be homicide. Majority (n=63; 29.72%) were recorded in the age group of 23 to 26 years. 91 cases (42.92%) had more than 80% of total body surface area involved in burns. Majority of deaths (n=77; 36.32%) occurred during night (9 pm to 6 am). Husband alone was found to be most common offender (n=71; 33.49%). Majority of the victims were housewives (n=173; 81.61%). Majority of the dowry deaths were drawn from joint family (n=174; 82.08%). Incidence were more in arranged marriages (n=173; 81.60%). First and the foremost location of incidence was in-law's house (n=160; 75.47%). Conclusions: This social malicious evil needs to be targeted by a multifaceted and united approach of women welfare organizations, police and judiciary towards enhancement of socioeconomic and educational profile along with provision of strict laws and speedy justice. [ABSTRACT FROM AUTHOR]

Introduction: Electrical burns are devastating, posing development of multiple injuries with high morbidity and mortality. Electrical burn management benefits from a multidisciplinary, multispecialty collaborative approach to improve outcomes.Objective: To highlight the clinical spectrum of electrical burns in the developing world, including common etiologies, presentation, intervention, associated injuries, and complications.Materials and Methods: A prospective study was conducted from January 2010 to December 2015 that included 78 patients (75 men and 3 women), who presented with a history of electrical burns. Patients were interviewed for detailed clinical history and physical examination.Results: The study comprised 78 patients (high-voltage group: 38.46% and low-voltage group: 61.54%). The most affected age group was the 21-40 year age group. High-voltage injuries were more devastating. The most common complication was septicemia in 24.4% of the patients, which included 43.3% from the high-voltage group.Conclusion: Electrical burns affecting young adult men can impose a significant burden in developing countries. Electrical burns, especially due to high voltage, involve multiple organs benefitting from multidisciplinary management and have significant residual sequelae. Public awareness and education and proper training of industry workers remain the best way to minimize the prevalence of electric burns in the developing world. [ABSTRACT FROM AUTHOR]

Introduction: Fire can be considered as double edged sword. A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals. Globally, burns are a serious public health problem. Burns are the most common type of trauma worldwide, following traffic accidents, fall and interpersonal violence. Burn have medico-legal importance as they may be considered to be the commonest cause of unnatural death in India. Materials and Method: This present study is a prospective study undertaken at the mortuary of forensic medicine, R.N.T. Medical College, Udaipur, Rajasthan. The study includes all the burn injury cases coming to the mortuary for autopsy during period from 1 March 2018 to 30 September 2018. The main objectives is to find the cause of death in burn cases according to different age groups and sex. Results: Out of 86 cases, 61 were in 11-40 years of age, 57 died of shock. [ABSTRACT FROM AUTHOR]

Retrospective analysis of deaths because of electric shock from the medico-legal death records our college i.e. J.N.M.C., A.M.U., Aligarh, Uttar Pradesh, India. Most of the deaths were of men having the age in between 11-50 years. All deaths were inadvertent and most part of them were during the time of monsoon as compared to the deaths in western countries where, baths, warmers or hair dryers were the source of electric shocks. The death rate reported because of electric shock was 0.34 per lakhs (100000) of the population in the present study as against the figures of 0.94 and 0.14 from Bulgaria and Canada respectively. A large portion of the deaths were either prompt or quick. It implies that individuals living at home did not have basic knowledge of dangers of electric shock. In this way mindfulness about utilization of good quality electric machines is the need of great importance. [ABSTRACT FROM AUTHOR]

Purpose: To identify the patterns of ocular injury and to determine ocular morbidity resulting from the use of firecrackers.Methods: A prospective observational study of all patients presenting with ocular trauma consequent to fireworks usage in a tertiary eye care center in South India over a one-month period around the autumn festival of Diwali. We also reviewed the published literature from around the world reporting ocular injuries due to firecrackers.Result: 49 patients were included in the study, out of which the vast majority (40/81%) were males. The mean age was 17 years. Almost an equal number of bystanders (24/48.9%) was affected as compared to people handling the fireworks (25/51%). 13 (26.53%) patients had open-globe injury whereas 33 (67.34%) patients had closed-globe injury. Twenty-two (44.8%) patients underwent surgical intervention. Eighteen (36.7%) patients had final vision less then 20/40 (range = 20/50 to No Perception of Light) with eight patients having no perception of light in the affected eye.Conclusion: Unregulated use of firecrackers can lead to significant ocular morbidity, mainly involving children, young males, and even innocent bystanders. A combination of public awareness and appropriate legislative laws should be formulated regarding the use of fireworks to decrease the load of needless blindness on society. [ABSTRACT FROM AUTHOR]

Cell phone explosions and resultant burn injuries are rarely reported in the scientific literature. We report a case of cell phone explosion that occurred when a young male was listening to music while the mobile was plugged in for charging. [ABSTRACT FROM AUTHOR]

The occurrence of Wischnewski spots in fatal hypothermia has been considered an important indicator of reduced core temperatures, its incidence varying between 40 and 100%. Though many human and animal studies have been conducted to study this phenomenon, the underlying mechanisms contributing to the formation of Wischnewski spots are still not clearly understood. They have been largely reported in human deaths occurring from exposure to freezing temperatures. This is the first reported case of Wischnewski spots observed in a case of fatal burns. [ABSTRACT FROM AUTHOR]

Background: Honey has the antibacterial effect of silver without the toxic effect of silver on the skin. Even so, silver is the dominant antibacterial dressing used in wound healing. Objectives: To evaluate the healing effects of honey dressings compared to silver dressings for acute or chronic wounds. Design: A systematic review with meta-analysis. Method: The search, conducted in seven databases, resulted in six randomised controlled trial studies from South Asia focusing on antibacterial properties and healing times of honey and silver. Result: Honey was more efficacious for wound healing than silver, as measured in the number of days needed for wounds to heal (pooled risk difference −20, 95% CI −0.29 to −0.11, p <.001). Honey turned out to have more antibacterial qualities than silver. Conclusion: All the included studies based on burns showed the unequivocal result that honey had an even more positive effect than silver on wound healing. [ABSTRACT FROM AUTHOR]

Fire, one of the pure elements forming the world and one of the elements to provide life energy to all living beings, sometimes turns deadly. In Forensic Medicine departments, one of the most common cases for post mortem examinations is Burns case. But it becomes difficult many a times to comment on the manner of death in cases with a brief survival period. So, the current study was undertaken at Mortuary complex of Medical college, Vadodara, Gujarat during one year period from Jan 2012 to Dec 2012. There are some perplexing results like Number of Male victims outnumber the females; about 83% cases were from rural residence, which were different compared to earlier studies. [ABSTRACT FROM AUTHOR]

Death is unnatural when caused prematurely against the order of the nature by injury or other means of violence. There is a noticeable increase in unnatural deaths of females in recent times. The aim of this study was to find out demographical factors, cause and manner of death in unnatural female deaths. A total number of 100 cases of unnatural deaths in female were studied during study period. 68% of unnatural deaths were seen in 15-30 years age group. Married women were about 3.5 times more prone to unnatural deaths then unmarried. The ratio of accidental, suicidal and homicidal deaths among females was 11:6:3. The commonest cause of unnatural deaths was burns (49%) followed by accidents (17%), poisoning (14%), asphyxia (12%) and violence (7%) respectively. 44% of unnatural deaths occurred within 7 year of marriage out of which 21 were accidental while 23 were suicidal and homicidal deaths. These 23 cases were established cases of dowry deaths. This study reflects susceptibility of married women to unnatural deaths. So, there is a need to enhance the multi-pronged protective system to curb these potentially preventable deaths. [ABSTRACT FROM AUTHOR]

The classification of cause of death is real in its consequences: for the reputation of the deceased, for her family, for those who may be implicated, and for epidemiological and social research and policies and practices that may follow from it. The study reported here refers specifically to the processes involved in classifying deaths of women from burns in India. In particular, it examines the determination of ‘dowry death’, a class used in India, but not in other jurisdictions. Classification of death is situated within a framework of special legal provisions intended to protect vulnerable women from dowry-related violence and abuse. The findings are based on 33 case studies tracked in hospital in real time, and interviews with 14 physicians and 14 police officers with experience of dealing with burns cases. The formal class into which any given death is allocated is shown to result from motivated accounting processes representing the interests and resources available to the doctors, victims, victim families, the victim's husband and his family, and ultimately, the police. These processes may lead to biases in research and to injustice in the treatment of victims and alleged offenders. Suggestions are made for methods of ameliorating the risks. [ABSTRACT FROM AUTHOR]

Introduction: Burn injuries are a serious public health problem. In our study we have identified different epidemiological factors based on 10 years of our experience at a burn unit in central India and recommend some strategies to prevent burn injuries. Materials and Methods: This is a retrospective analysis (2001-2010) of database from burn unit of S.S. Medical College, Rewa, India. Results: 2499 patients with burn injury were analysed. 66.8% and 38.2% patients were females and males respectively, with a median age of 25 years. Flame (80.1%) was most common cause, home (96%) was most common place, traditional Indian stove (28.8%), kerosene lamp (26.7%), hot liquid (12.2%) and kerosene stove (10.4%) were common causes. Median Total Body Surface Area (TBSA) burn was 40.0%; females had significantly greater (P < 0.001) burn than males (median 50% vs 26.0%). High mortality (40.3%) seen; female sex (OR 3.22, 95% CI 2.65-3.92); young age (15-29 year) (OR 3.48, 95% CI 2.45-4.94); flame burn (OR 12.9, 95% CI 1.69-98.32); suicidal burn OR 6.82 95%CI 4.44-10.48) and TBSA > 76% (OR 3099, 95%CI 1302-7380) were significant risk factors for death. Median hospital stays was 8 days; shorter hospital stays seen among TBSA burn > 76% (2 days), suicidal intent (4 days), and those who expired (4 days). Septicemia (45.8%) and burn shock (41%) were the major cause for death. Conclusions: Cooking and lighting equipments are major cause of burn injury among females and young age group. Equipment modification to improve safety features and public awareness programs are necessary to reduce burn incidents. [ABSTRACT FROM AUTHOR]

Every year a substantial proportion of deaths in India occur due to burn injuries. Burn deaths are a major public health problem in our country. Prolonged morbidity and disability due to burns results in economic loss to the individual's family, the society and the state. The present retrospective study was carried out in the Department of Forensic Medicine & Toxicology, Government Medical College & Hospital, Chandigarh during the period from 1st January 2011 to 31st July 2013 and includes a total of 381 cases of death due to burn injuries, brought to the mortuary of the hospital for medico-legal postmortem examination. The objective of the study was to understand various demographic aspects of deaths due to burns so as to suggest some remedial measures. [ABSTRACT FROM AUTHOR]

Despite the great advances in the treatment of Burns Cases, they remain one of the most distressing injuries for any patient and amongst the most challenging ones for the medical care giver. A prospective study was conducted to assess the causes, magnitude and profile of burns cases coming to Government Medical College & Hospital, Chandigarh. During the one year study period a total of 116 cases of burns were admitted, with the overall male to female ratio of 1: 1.42. Forty-six percent cases were seen in the 21- 30 years age group, 48% were from the rural and urban background, each; 90% females were married. Maximum number of cases in females, 14 (21%), occurred in February, and of males 9 (19%) in November. Maximum cases in males (11; 23 %) were in 31-40% TBSA, and in females (27; 23%) in >80% TBSA. Ninety-two percent cases suffered accidental burns, and the peak time of incidence was 6.00-9.00 pm, Kitchen (71%) was the most common place where these burn injuries were suffered especially among the female patients (81%). [ABSTRACT FROM AUTHOR]

Background: Worldwide, over 95% of fire-related burns occur in ‘low and middle income countries’ (LMIC) . The majority of research, investment and expertise into the prevention and treatment of burns occurs in high income countries (HIC) . Bearing that in mind, this study was conducted in four different LMIC and one HIC, with a view to comparing the knowledge of, and previous exposure to, burn prevention and first aid. Methods: A 25 question survey was devised at the Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, to ascertain the knowledge, attitude, and practice of individuals in five countries, in relation to burns. Overall 1146 participants took part in the survey: 191 from Botswana, 492 from India, 198 from Pakistan, 196 from Wales and 69 from Zambia. Results: The results show a disparity between the UK and the four LMIC. A higher proportion of those in the UK received information on prevention and on first aid (51.4% vs. 38.1% and 70.9% vs. 40.1%, respectively). In addition, more of those questioned in the UK were able to identify the correct course of action should their clothing catch fire or should they spill hot oil on their arm (54.1% vs. 24.9% and 75% vs. 25.9%, respectively). Conclusion: The results show a discrepancy in the first aid provision, and level of education about burn prevention between a HIC and four LMIC. In addition they suggest an association between an increase in knowledge with better practice in relation to burn prevention and first aid. [Copyright &y& Elsevier]

To meet the ever-increasing demand for new cuisines, the catering industry in India is becoming more prominent day by day. According to a recent estimate, more than two million restaurants are now dominating the present scenario of the Indian catering industry. The health hazards in restaurants vary according to the place that a worker is employed. The hazards among kitchen staff include several different types of accidents such as burns from deep fryers, slipping on grease and cuts from knives, whereas musculoskeletal disorders are more common among waiters and helpers who usually bear load. The present cross-sectional study included 127 workers from 15 restaurants and dhabas situated at Pune—Mumbai high way. Interview technique followed by clinical examination was the tool for data collection. Musculoskeletal symptoms such as low back pain, fatigue, body ache and pain in limbs were present in 18 (14.2%) of the workers. Gastrointestinal complaints such as heartburn, abdomen pain, stomatitis, etc. were reported by 12 (9.4%) subjects, while skin-related symptoms, such as itching and discoloration were reported in 12 (9.4%) subjects. Seventy-three (57.5%) of the subjects were free from any symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Fire walking is a religious ritual practiced by predominantly Indians and some Chinese living in Singapore. Eighteen new cases of burns, directly related to a firewalking ceremony on 05 October 09, were studied as to the pattern of burns. Burns on the soles of the feet occurred in 17 patients. All these injuries were superficial or partial thickness burns. There were no deep dermal burns. The extent of burns ranged from 0.25% to 1.5% of body surface area. Burns due to falls accounted for one casualty. He sustained a mixture of deep dermal and partial thickness burns, and the extent of burns was 20% of body surface area. A new classification for the distribution of burns related to fire walking was developed based on the mechanism of injury. It was predictive of the anatomical distribution of burns, the extent of burns (in terms of body surface area), the depth of burns and the general severity of the injury: [I] Burns on the soles of the feet. This was the commonest form of injury. The surface area affected was not much – 1.5% at most. The burns were superficial. The foot was anatomically differentiated into the weight bearing and the non weight bearing parts. [II] Burns due to falls. Such injuries tended to be extensive and they could be deep. [III] Burns due to other practices: a fire walker carrying hot coals in his hands may sustain burns on the palms of the hands. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this study was to measure the effectiveness and utilization of the prevention program for domestic burn prevention for young children in Indore, India. Methodology: Families with at least one child under 4 years of two low income communities and one middle/high income community were approached for this program. We conducted an experimental pilot study with a pre–post design between February and June 2009. The program consisted of an educational program in combination with the distribution of a barrier or playpen. The effectiveness and utilization of the intervention were measured by a baseline and follow-up questionnaire. A total of 34 families completed the baseline questionnaire as well as the follow-up. Results: A significant decrease in burns was reported (p <0.01), from a total of 18 burns before the intervention to 2 burns after the placement. Furthermore, the frequency of dangerous situations occurring in the house, decreased significantly as well (p <0.01). Conclusion: The prevention program seems an effective method in the reduction of burns of young children. Additionally, most families were satisfied with the intervention and would like to use it for a longer period of time. However, a large study with multiple evaluation moments would be needed to provide evidence of the effectiveness of this prevention program. [Copyright &y& Elsevier]

The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management. [ABSTRACT FROM AUTHOR]

Background: Suicide is a multidimensional and multifactorial malaise. This study was to give a broad picture of all available information about the female suicide death cases dealt in Institute of Forensic Medicine and Toxicology, Government General Hospital, Chennai. Objective: The aim was to collect data, make a broad analysis, interpret and arrive at conclusive opinion about female suicide deaths in Chennai. Methodology: A retrospective analysis of female suicide deaths encountered in Institute of Forensic Medicine and Toxicology, Government General Hospital, Chennai in the year 2008 was done. This information was collected from the available records. Results: A total of 43 female suicide deaths were dealt with. Among these cases maximum number of them belong to the age group of 21 to 40 years, was married and was unemployed. 25 cases of poisoning was reported which contributed to the maximum. Organophosphorus compounds were the most common poison consumed. Other methods include hanging and burns. Interestingly abdominal pain was reported to be most common reason for committing suicide as per the records available. Conclusion: The cause of death supported by the autopsy findings has been elucidated in all the cases. Further on considering the reason for committing suicide, it is noteworthy to mention that in majority of cases abdominal pain has been the factor behind such acts as the records available. This reason could be a manifestation of psychosomatic illness. The object of the study would be more fulfilled if it throws open newer dimensions of studies like psychological autopsy to prevent such deaths in future. [ABSTRACT FROM AUTHOR]

Abstract: Burns and deaths due to burns to remain an important public health and social problem in India. Most of the victims, who survive the initial 24h after burns, succumb to infection of the burnt area and its complications. Burns cause devitalization of tissues, leaving extensive raw areas, which usually remain moist due to the outflow of serous exudate. This exposed, moist area along with the dead and devitalized tissue provides the optimum environment favoring colonization and proliferation of numerous microorganisms, which is further enhanced by the depression of the immune response. All these factors, i.e., disruption of the skin barrier, a large cutaneous bacterial load, the possibility of the normal bacterial flora turning into opportunistic pathogens and the severe depression of the immune system, contribute towards sepsis in a burns victim, which usually is life threatening. Despite various advances in infection control measures, early detection of microorganisms and newer, broader spectrum antibiotics, management of burn septicemia still remains a challenge. Pulmonary, cardiac and other complications also contribute to the delayed deaths following severe burn. [Copyright &y& Elsevier]

A prospective study was carried out in a burn unit of a tertiary care referral centre in North India. Patients with 20–70% TBSAB were enrolled. Seventy-one patients developed 59 hospital-acquired infections (HAI); the infection density being 36.2 infections per 1000 patient days. Invasive wound infections were the commonest (33), followed by blood stream infections (22), urinary tract infections (3) and pneumonia (1). Infection contributed to 75% of observed mortality. On logistic regression analysis, infected patients were more likely to die as well as stay longer in the hospital as compared to non-infected patients. Infected patients also had more central venous lines inserted. The mortality was related to percent TBSAB. Thirteen out of 18 patients who had TBSAB more than 60% died as compared to 5 out of 31 with TBSAB less than 40%. Staphylococcus aureus, Pseudomonas aeruginosa and β-hemolytic streptococci (BHS) were the most frequent organisms causing hospital-acquired infection. Except for BHS all other organisms were highly drug resistant. Better compliance with hand washing and barrier nursing techniques, stricter control over disinfection and sterilization practices and usage of broad spectrum antibiotics, and reduction of the environmental contamination with S. aureus are required to reduce the HAI rates. [Copyright &y& Elsevier]

Abstract: Burns is a preventable tragedy, which is unfortunately still common in India. The possibility of disfigurement, death and emotional trauma as a result of burns is a shattering experience to the victim as well as his/her family. Proper initial management can salvage many such unfortunate victims. Burns patients require close monitoring, barrier nursing and sympathetic attitude of medical and paramedical staff in a burns ICU to have a reasonable chance of survival. [Copyright &y& Elsevier]