Assaults by Scalding in British Prisons.

We describe the trends and severity of deliberate scald injuries from assaults within prisons presenting to Pinderfields Hospital in the United Kingdom. Data were obtained using local records of the International Burn Injury Database. Between 2003 and 2019, the hospital's Department of Plastic Surgery and Burns treated 22 cases from at least seven prisons, with 20 cases occurring in the last 4 years. Boiling water was used in most cases. Other substances included syrups of boiling water and sugar, and hot fat. Mean total body surface area was 2.8%, most commonly the face, neck, shoulders, and anterior chest. National data identified 267 cases with a similar rising trend. These injuries increase logistical and financial burdens on our burns service due to the need for added security and police escorts during treatment. "Copycat attacks" within same prisons, sometime on the same day, raise concerns that incidence of these injuries is likely to increase. Outreach nursing and telemedicine facilities may minimize the challenges during the management period.

Microbial profile of burn wounds managed with enzymatic debridement using bromelain-based agent, NexoBrid®.

The antimicrobial properties of bromelain have been previously studied. However, the effect of enzymatic debridement on bacterial colonisation in burn wounds was not described in literature. In this study, we examine whether bromelain-based enzymatic debridement using NexoBrid® gel alters the microbiological pattern of burn wounds. Bacterial emergences in burn wounds that were enzymatically debrided at Pinderfields Regional Burns Centre, between July 2016 and February 2019, were studied and compared to the bacterial profile of burn wounds that were managed either by surgical debridement or dressings only during the same period. Our results showed that the microbial profile of burn wounds treated with NexoBrid® is similar to what is widely reported in cases treated without enzymatic debridement, at all stages of wound healing. This particularly showed in the predominance of Gram-positive organisms in the first week and Gram-negative in the second week.

Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries.

Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data was obtained using our local records of the international Burn Injury Database (iBID). 6059 patients were treated in our department during this period. 18.7% presented with isolated lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265). 36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133). Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended.

Validation of a semi-automated technique to accurately measure abdominal fat distribution using CT and MRI for clinical risk stratification.

OBJECTIVE: A valid method for accurate quantification of abdominal fat distribution (AFD) using both CT and MRI is described. This method will be primarily useful in the prospective risk stratification of patients undergoing reconstructive breast surgery. Secondary applications in many other clinical specialities are foreseen. METHODS: 15 sequential patients who had undergone breast reconstruction following both CT and MRI (30 scans) were retrospectively identified at our single centre. The AFD was quantified at the level of the L3 vertebra. Image analysis was performed by at least two independent operators using free software. Intra- and interobserver differences were assessed using Bland-Altman plots. Data were validated between imaging modalities by Pearson's correlation. Linear regression analyses were used to mathematically normalize results between imaging modalities. RESULTS: The method was statistically independent of rater bias (intra: Pearson's R-0.954-1.00; inter: 0.799-0.999). Strong relationships between imaging modalities were demonstrated and are independent of time between imaging (Pearson's R 0.625-0.903). Interchangeable mathematical models to normalize between imaging modality are shown. CONCLUSION: The method described is highly reproducible and independent of rater bias. A strong interchangeable relationship exists between calculations of AFD on retrospective CT and MRI. Advances in knowledge: This is the first technique to be applicable to scans that are not performed sequentially or in a research setting. Analysis is semi-automated and results can be compared directly, regardless of imaging modality or patient position. This method has clinical utility in prospective risk stratification and will be applicable to many clinical specialities.

Timing and Outcome Concerns regarding Feminizing Genitoplasty from the Perspective of Egyptian Families of Girls with Virilized External Genitalia.

BACKGROUND: Congenital adrenal hyperplasia in females leads to virilization of external genitalia and persistent urogenital sinus. There are controversies regarding the timing and outcomes of surgery. Deferring surgeries beyond childhood is difficult to implement in conservative societies, and may result in stigmatization and distress to individuals with disorders of sexual differentiation and their families. METHODS: Thirty girls with virilization due to congenital adrenal hyperplasia were admitted for single-stage feminizing genitoplasty, between 2011 and 2014. We prospectively studied the concerns and input of the families represented by the mothers. After comprehensive counselling, the mothers completed a questionnaire to clarify their priorities and concerns related to surgery. RESULTS: Surgeries were performed at a mean age of 22 months. Most cases ranged between Prader's degrees III and IV. Egyptian families believe that early surgical reconstruction is in the best interest of their girls. They are marginally more concerned about functional outcomes and future child bearing than external appearance and cosmetic outcomes. CONCLUSIONS: Social difficulties noticeably add challenges to the management plan within conservative societies. Early genital reconstructive surgery, when reasonably indicated, needs to remain a viable option. Comprehensive psychosocial support within a multidisciplinary approach is needed to defer feminizing genitoplasty in selected cases to adolescence.

Yemeni experience with phacoemulsification.

OBJECTIVE: To evaluate the first experience of phacoemulsification in Yemen from 2000-2007 regarding the visual results, and complications. METHODS: Two hundred and fifty-eight eyes of 182 adult patients with significant cataract were included during the last 96 months. All eyes underwent phacoemulsification with implantation of intraocular lenses. The results were recorded and statistically analyzed. RESULTS: The male:female ratio was 1:1, with an average age of 52 years. Phacoemulsification was carried out by scleral approach in 14 eyes, and by clear corneal approach in 244 eyes. A visual acuity of > or = 6/18 was achieved in 85.3%, and the most common serious complication was intraoperative posterior capsule rupture, which was reported in approximately 10.1%. CONCLUSION: The results of phacoemulsification are very impressive, and the most common intraoperative complication was ruptured posterior capsule.