Electrocution Due to Fractal Wood Burning: Two Case Reports and a Review of the Medical Literature.

ABSTRACT: Fractal wood burning is a new technique of pyrography that passes an electrical current through a piece of wood resulting in decorative electrical burns. This practice has become increasingly popular with many walk-through tutorials of the process found online. This includes videos of how to build homemade devices fashioned from disassembled microwave oven transformers. There have been 31 reported deaths and many serious injuries due to fractal wood burning resulting in news headlines, warning statements, and an outright ban of the practice at certain woodworking events. The medical community has begun to recognize the danger of fractal wood burning with a few cases of severe burn injuries reported. We report 2 cases of electrocution from fractal wood burning accidents. The scene investigations were examined, including the similarities in the homemade microwave oven transformers that were used, as well as the autopsy findings. The pathophysiology of fractal wood burning and the creation of Lichtenberg figures is discussed as well as the high-voltage injury patterns seen in cases of fractal wood burning accidents. Other cases of electrical injury from fractal wood burning accidents reported in the news and medical literature were then examined in terms of demographics, burn pattern, cardiac findings, and whether a homemade wood burning device was involved.

Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays.

OBJECTIVE: To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay. STUDY DESIGN: Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated. RESULTS: The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8-2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8-2.3)], tracheostomy [OR 1.5 (95%CI 1.2-1.8)], and use of public insurance [OR 1.3 (95%CI 1.2-1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals. CONCLUSIONS: The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.

A series of COVID-19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza.

Autopsies of patients who have died from COVID-19 have been crucial in delineating patterns of injury associated with SARS-CoV-2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID-19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID-19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID-19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS-CoV-2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the 'Spanish Flu' in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID-19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID-19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID-19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID-19 and influenza, while also providing important caveats to ancillary methods of viral detection.