[VENOUS THROMBO-EMBOLISM IN BURNS: INCIDENCE AND RISK FACTORS]. / MALADIE THROMBOEMBOLIQUE VEINEUSE CHEZ LE BRÛLÉ : INCIDENCE ET FACTEURS DE RISQUE.

Venous thromboembolic disease (VTE) in burn patients is an under-diagnosed and potentially serious complication. Its incidence varies according to studies performed. This retrospective and descriptive study conducted in an intensive burn care department in Tunisia over a period of 22 months (January 1, 2021 to October 30, 2022) included 24 patients who presented a thromboembolic complication among a total of 785 admissions (incidence of 3%): pulmonary embolism in 15 cases and deep venous thrombosis (DVT) in 9 cases. The mean age of the patients was 43.8 years, with a male:female sex ratio of 2:1. Two thirds of patients (n=17) had a pathological history: hypertension (n=3); diabetes (n=2) and neoplasia (n=2). Three patients were obese. The average TBSA was 29%. Burns involved lower limbs in 19 patients (79%). The mean time to onset of VTE was 27.8 days. Acute dyspnea was present in 1/2 of cases and tachycardia in 1/3 of cases. The association hypoxia-hypocapnia was found in 5 patients. The diagnosis was confirmed by: thoracic angioscan (n=14), pulmonary scintigraphy (n=1), venous Doppler ultrasound of the lower limbs (n=2) and phleboscan of lower limbs (n=7). Factors correlated with thromboembolic risk in our study were: TBSA 20% - 39% (p=0,029; RR=4), with lower limb involvement (p=0,068), catheterization duration ≥7 days (p=0,048; RR=3) and number of catheters >1 (p=0,01; RR=3). The outcome was favorable in 13 patients and fatal in 11 patients.

[FEET BURNS AND DIABETES MELLITUS : A 34-CASE SERIES]. / BRÛLURES DES PIEDS CHEZ LE DIABÉTIQUE : À PROPOS DE 34 CAS.

Diabetes causes peripheral neuropathy with loss of sensitivity of feet to pain, predisposing diabetic patients to a high risk of severe burns. Our retrospective study aimed to look at epidemiological, clinical, therapeutic and outcome characteristics of feet burns occurring in patients with diabetes, hospitalized in the burn trauma center of Tunis over 4 years (from 2019 to 2022). We included 34 patients, among which 9 had only feet burns. Their mean age was 60 years (range: 41-83 years), with male predominance (sex ratio = 1.83). A quarter of patients (n=9) were on oral antidiabetic drugs (OADs) and more than half (n= 18) were at the stage of degenerative complications. At admission, blood glucose level was higher than 10 mmol/l in 73% of patients. TBSA was 19%. Twenty-two patients had deep feet burns, among which 5 patients underwent aponerrotomy for deep, circular burns. Amputation was done in 15 patients: toes (n=9), one limb (n=3) and two limbs (n=3). Duration of ICU stay was 18.3 days and mortality was 20.58%.

[HIGH VOLTAGE ELECTRICAL INJURIES IN CHILDREN: A TUNISIAN SERIES]. / ÉLECTRISATION À HAUT VOLTAGE CHEZ LES ENFANTS: UNE SÉRIE TUNISIENNE.

Electrical burn injuries (EBI) affect both adults and children and are responsible for a very high number of major limb amputations. Their management is still a major challenge. This retrospective review concerns 42 children, admitted to an intensive burn care department in Tunisia for high electrical burns, from January 2016 to September 2022. The average age of our patients was 12 years, with a male predominance (90.5%). Electrotrauma was accidental in the majority of cases (93%) and secondary to a domestic accident in 54.8% of cases. Total body surface area was 19%. Burns were second degree in 2/3 of cases and third degree in 1/3 of cases. The most affected areas were distal extremities in 2/3 of the cases. Rhabdomyolysis was observed in 93% of cases and troponins were elevated in half of the patients. Escharotomy was required in 38% of cases. Amputation was performed in 18 children (43%): one limb (n=10); 2 limbs (n=6) and 3 limbs (n=2). The outcome was favorable in 9 children (21.4%); functional and cosmetic sequelae with an impact on schooling and psychology were reported in 25 cases. Mortality was 16.7%.

[DISTRIBUTION OF CARBAPENEMASES IN TUNISIAN BURN PATIENTS]. / DISTRIBUTION GÉOGRAPHIQUE DES CARBAPÉNÉMASES CHEZ LES BRÛLÉS TUNISIENS.

Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11).

[Burns and Diabetes Mellitus: Epidemiology, Clinical Presentation and Prognosis]. / Brûlures Chez Le Diabétique: Étude Épidémiologique, Clinique et Pronostique.

Burns in diabetics are quite frequent and serious in relation to diabetic neuropathy, which is common in this population, delaying healing and predisposing to the risk of infection. The objective of this study was to describe the characteristics of burns in diabetics hospitalized at the CTB of Tunis over 18 months. During the study period, 891 patients were hospitalized, including 43 diabetics (5%). The average age of our patients was 57 years old with a male predominance (65%). Type 2 diabetes was present in 86% of cases and type 1 diabetes in 14% of cases. Degenerative complications were reported in 10 cases (23%), such as diabetic retinopathy (n=6), diabetic nephropathy (n=4) and diabetic neuropathy (n=6). The circumstances of burns were related to a domestic accident in 2/3 of the cases (76.7%). Thermal burns were involved in 83.7% of cases. 86% of the patients had decompensated their diabetes during their hospitalization. Sepsis marked the evolution of the patients in 55.8% of cases. In our study, poor prognostic factors were: a glycosylated haemoglobin > 13%, an extent of burns greater than 20%, and a delay in consultation greater than 6 hours. The mortality rate was 18.6%.

Brûlure Et Atteinte Oculaire: Incidence, Facteurs De Risque Et Pronostic.

Ocular lesions in burns are common and diagnosis is often late, leading to functional impairment including loss of vision to these individuals. A retrospective study was conducted to assess ocular lesions in burns during ICU stay (01/01/2013 to 30/09/2020) in a 20-bed burn ICU in Tunis. Twenty-six cases combining burns and ocular lesions were reviewed. The average age was 26, with a sex-ratio 3.3/1. TBSA was 22±13%. Face was affected in 23 patients, and mechanical ventilation was required in 10 cases. Diagnosis of ocular lesion was noted at 4.5 H (1-33 H) after burn injury. Main clinical signs were: eye redness (n=5) and purulent eye discharge (n=5). Lesions were mainly corneal abscess and corneal ulcer. Treatment combined local antibiotics (n=16) associated to systemic antibiotics in 10 cases. Surgery was required in 2 cases. Loss of vision was noted in 2 patients. Risk factors of corneal abscess were: facial burn (p=0,01); burn depth (p=0,02) and mechanical ventilation (p=0,04).