Body surface area is positively associated with ankle-brachial index.

BACKGROUND: Ankle-brachial index (ABI) measurement is a widely used diagnostic test for lower extremity artery disease. Previously, a larger body surface area (BSA) has been associated with lower blood pressure and lower 2-h post-load glucose concentrations in the oral glucose tolerance test. Our aim was to evaluate whether BSA has an impact on ABI and the prevalence of lower ABI values. METHODS: ABI measurements were performed on 972 subjects aged 45 to 70 years at high cardiovascular disease (CVD) risk. Subjects with previously diagnosed kidney disease, CVD, and diabetes were excluded. Their BSA was calculated by the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5th, 25th, 25th, 25th, and 12.5th percentiles of the total distribution. Effect modification by BSA in ABI between sexes was derived from a four-knot restricted cubic splines regression model. RESULTS: After adjustments for age, sex, pulse pressure, glucose regulation, waist circumference, alcohol intake, smoking status, leisure-time physical activity and medication, BSA level had a positive linear relationship with ABI (p for linearity <0.001). When BSA was less than 2.0 m2, there was no difference between the sexes, but when BSA was higher than 2.0 m2, men had higher ABI. CONCLUSION: BSA shows a positive linear relationship with ABI in CVD risk subjects without manifested CVD. The difference in ABI between men and women is modified by BSA and is appreciable when BSA is larger than 2.0 m2.

An improvement of body surface area formulas using the 3D scanning technique.

OBJECTIVES: Body surface area (BSA) is one of the major parameters used in several medical fields. However, there are concerns raised about its usefulness, mostly due to the ambiguity of its estimation. MATERIAL AND METHODS: Authors have conducted a voluntary study to investigate BSA distribution and estimation in a group of 179 adult people of various sex, age, and physique. Here, there is provided an extended analysis of the majority of known BSA formulas. Furthermore, it was supplement with a comparison with the authors' propositions of enhanced formulas coefficients for known formulas models as well as with new power models based on an increased number of anthropometric data. RESULTS: Introduction of the enhanced formulas coefficients cause a reduction of at least 30.5% in mean absolute error and 21.1% in maximum error in comparison with their known counterparts. CONCLUSIONS: In the context of the analysis presented it can be stated that the development of a single universal body surface area formula, based on a small number of state variables, is not possible. Therefore, it is necessary and justified to search for new estimation models that allow for quick and accurate calculation of body surface area for the entire population, regardless of individual body variations. The new formulas presented are such an alternative, which achieves better results than the previously known methods. Int J Occup Med Environ Health. 2024;37(2):205-19.

[The application of negative pressure wound therapy (NPWT) in potentially lethal conditions]. / A negatív nyomással végzett sebkezelés (NPWT) alkalmazása potenciálisan letális állapotokban.

Bemutatásra kerülo esetünkben egy 47 éves, generalizált septicus állapotú férfi beteg komplex terápiás megoldást igénylo kezelését ismertetjük, negatív nyomásterápia segítségével (NPWT). A páciens kezeletlen diabéteszes láb szindróma talaján kialakult szepszis, fasciitis necrotisans klinikai-radiomorfológiai képével került osztályunkra, akinél sürgosséggel feltárást, az alsó végtag valamennyi kompartmentjét érinto fasciotomiát végeztünk, NPWT-kezelést indítottunk. Kezelése során a beteg állapotát súlyosbító szövodmények léptek fel: Curling-fekély, toxicus epidermalis necrolysis (TEN). A fascitis kapcsán kialakult kb. 6% TBSA (total body surface area) kiterjedésu hámhiányt a TEN-szindróma további epidermális állományvesztéssel tovább súlyosbította. Állapotstabilizálást, kezdeti lokalis kontroll biztosítását követoen a hámhiányos felület csökkentése érdekében a sebeket szukítettük, a feltisztult sebalapok fedése 1:3 arányban hálósított félvastag bor transzplantációjával történt. Az NPWT-kezelést a transzplantációt követoen is folytattuk. A beteg három hónapos intenzív osztályos és sebészeti kezelést követoen sebészi szempontból meggyógyult. A negatív nyomásterápia korai - a kórlefolyásnak megfelelo - adekvát üzemmódban és fedési technikával történo alkalmazása a végtagvesztéssel és életveszéllyel járó nagy fokú hámhiány esetében hatékony eszköznek bizonyult. A multidiszciplináris terápiának köszönhetoen betegünk sebészeti alapbetegségét sikeresen gyógyítottuk, azonban az évtizedes tartamú kezeletlen cukorbetegsége, SARS-Covid peumoniája, a relabáló septicus állapota során fellépo szövodmények következtében felépülni már nem tudott.

Body surface area is a predictor of 90-day all-cause mortality in critically ill patients with acute kidney injury.

OBJECTIVE: To clarify the prognosis effect between body surface area (BSA) and patients with acute kidney injury (AKI), we attempted to analyze the association between BSA and 90-day all-cause mortality in critically ill patients with AKI. METHODS: Clinical data of 9195 critically ill patients with AKI were retrieved from the Medical Information Mart for Intensive Care III database were then retrospectively analyzed. BSA were calculated using the Mosteller formula. We analyzed the correlation between BSA and 90-day all-cause mortality in critically ill patients with AKI based on Kaplan-Meier curve analysis and adjusted Cox regression model. RESULTS: Of the 9195 critically ill patients with AKI, there were 3778 (41.1%) female patients and 2001 90-day all-cause deaths (female: 22.2%, male: 21.5%). Kaplan-Meier curve analysis revealed that a lower body surface area indicated a higher 90-day all-cause mortality in both male and female patients with AKI (log-rank P < 0.001). Cox regression model showed that a higher BSA was independently correlated with a lower 90-day all-cause mortality (female: hazard ratio=0.657, 95% confidence interval: 0.550-0.784, P < 0.001; male: hazard ratio=0.655, 95% confidence interval: 0.565-0.760, P < 0.001). CONCLUSIONS: BSA was negatively correlated with 90-day all-cause mortality in critically ill patients with AKI. BSA can therefore be used as a prognostic indicator for poor outcomes in critically ill patients with AKI.

Newly Developed Sex-Specific Z Score Model for Coronary Artery Diameter in a Pediatric Population.

BACKGROUND: This study aimed to generate a Z score calculation model for coronary artery diameter of normal children and adolescents to be adopted as the standard calculation method with consensus in clinical practice. METHODS: This study was a retrospective, multicenter study that collected data from multiple institutions across South Korea. Data were analyzed to determine the model that best fit the relationship between the diameter of coronary arteries and independent demographic parameters. Linear, power, logarithmic, exponential, and square root polynomial models were tested for best fit. RESULTS: Data of 2,030 subjects were collected from 16 institutions. Separate calculation models for each sex were developed because the impact of demographic variables on the diameter of coronary arteries differs according to sex. The final model was the polynomial formula with an exponential relationship between the diameter of coronary arteries and body surface area using the DuBois formula. CONCLUSION: A new coronary artery diameter Z score model was developed and is anticipated to be applicable in clinical practice. The new model will help establish a consensus-based Z score model.

Neuropathic pain in burn patients - A common problem with little literature: A systematic review.

BACKGROUND: The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80%1. Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP. RESULTS: Included articles presented findings from 11 different countries, capturing outcomes for 4366 patients. Risk factors for neuropathic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n = 7), ascorbic acid (n = 1), and lidocaine (n = 1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n = 1), electropuncture (n = 1), nerve release/reconstruction (n = 2), and somatosensory feedback rehabilitation (n = 1) were used and demonstrated promise in reducing pain intensity and improving functionality. CONCLUSIONS: Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.

Models predicting mortality risk of patients with burns to ≥ 50% of the total body surface.

BACKGROUND: Several models predicting mortality risk of burn patients have been proposed. However, models that consider all such patients may not well predict the mortality of patients with extensive burns. METHOD: This retrospective multicentre study recruited patients with extensive burns (≥ 50% of the total body surface area [TBSA]) treated in three hospitals of Eastern China from 1 January 2016 to 30 June 2022. The performances of six predictive models were assessed by drawing receiver operating characteristic (ROC) and calibration curves. Potential predictors were sought via "least absolute shrinkage and selection operator" regression. Multivariate logistic regression was employed to construct a predictive model for patients with burns to ≥ 50% of the TBSA. A nomogram was prepared and the performance thereof assessed by reference to the ROC, calibration, and decision curves. RESULT: A total of 465 eligible patients with burns to ≥ 50% TBSA were included, of whom 139 (29.9%) died. The FLAMES model exhibited the largest area under the ROC curve (AUC) (0.875), followed by the models of Zhou et al. (0.853) and the ABSI model (0.802). The calibration curve of the Zhou et al. model fitted well; those of the other models significantly overestimated the mortality risk. The new nomogram includes four variables: age, the %TBSA burned, the area of full-thickness burns, and blood lactate. The AUCs (training set 0.889; internal validation set 0.934; external validation set 0.890) and calibration curves showed that the nomogram exhibited an excellent discriminative capacity and that the predictions were very accurate. CONCLUSION: For patients with burns to ≥ 50％of the TBSA, the Zhou et al. and FLAMES models demonstrate relatively high predictive ability for mortality. The new nomogram is sensitive, specific, and accurate, and will aid rapid clinical decision-making.

Efficacy of hydrosurgical eschar excision following MEEK microskin grafting in patients with massive burns: A retrospective study of a single center.

INTRODUCTION: One of the most common traumatic injuries, burn injuries lead to at least 180,000 deaths each year worldwide. Massive burns result in severe tissue loss and increase the rate of infection. Eschar excision with skin grafting is the gold standard of treatments for massive burns. Retaining dermis tissue is the key to ensuring the survival of skin grafts and rapidly closing exposed tissues. Traditional eschar excision with Humby or Weck knife controls the depth of excision until the dermis, but ensuring the accuracy of excision is challenging. Hydrosurgery minimizes damage to uninjured tissues during the removal of necrotic tissues. A foot pedal is used to adjust debridement depth for precise debridement. To figure out the clinical advantages and risks of using hydrosurgery in treating massive burns, this study has been conducted. METHOD: Forty-two patients with massive burns and total body surface area (TBSA) of > 30% were treated at the First Affiliated Hospital of Anhui Medical University from May 2020 to January 2023. They underwent hydrosurgical eschar excision with MEEK microskin graft (n = 23) or tangential excision with MEEK microskin graft (n = 19). RESULT: No statistically significant differences (p > 0.05) in the following demographics were found between the two groups: age, weight, TBSA, deep-partial-thickness burn, gender, inhalation injury, shock, excision area, and MEEK ratio. By contrast, statistically significant differences in per unit area of operation time, per unit area of operation spending, hospitalization cost, hospitalization duration, wound-healing time, skin graft survival, and scar quality were found between hydrosurgical excision group with MEEK microskin graft and conventional excision group with MEEK microskin graft. CONCLUSION: The hydrosurgical excision system showed better clinical effects for patients with massive burns.

A national analysis of burn injuries among homeless persons presenting to emergency departments.

INTRODUCTION: Burn injuries among the homeless are increasing as record numbers of people are unsheltered and resort to unsafe heating practices. This study characterizes burns in homeless encounters presenting to US emergency departments (EDs). METHODS: Burn encounters in the 2019 Nationwide Emergency Department Sample (NEDS) were queried. ICD-10 and CPT codes identified homelessness, injury regions, depths, total body surface area (TBSA %), and treatment plans. Demographics, comorbidities, and charges were analyzed. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate modeling. RESULTS: Of 316,344 weighted ED visits meeting criteria, 1919 (0.6%) were homeless. Homeless encounters were older (mean age 44.83 vs. 32.39 years), male-predominant (71% vs. 52%), and had more comorbidities, and were more often White or Black race (p < 0.001). They more commonly presented to EDs in the West and were covered by Medicaid (51% vs. 33%) (p < 0.001). 12% and 5% of homeless burn injuries were related to self-harm and assault, respectively (p < 0.001). Homeless encounters experienced more third-degree burns (13% vs. 4%; p < 0.001), though TBSA % deciles were not significantly different (34% vs. 33% had TBSA % of ten or lower; p = 0.516). Homeless encounters were more often admitted (49% vs. 7%; p < 0.001), and homelessness increased odds of admission (OR 4.779; p < 0.001). Odds of transfer were significantly lower (OR 0.405; p = 0.021). CONCLUSION: Homeless burn ED encounters were more likely due to assault and self-inflicted injuries, and more severe. ED practitioners should be aware of these patients' unique presentation and triage to burn centers accordingly.

Risks of mental disorders among inpatients with burn injury: A nationwide cohort study.

OBJECTIVE: This investigation identified the association between burn injuries and the risk of mental disorders in patients with no documented pre-existing psychiatric comorbidities. We also examined the relationship of injury severity and the types of injury with the likelihood of receiving new diagnoses of mental disorders. METHODS: This population-based retrospective cohort study used administrative data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2013. In total, 10,045 burn survivors were matched with a reference cohort of 40,180 patients without burn injuries and were followed to determine if any mental disorder was diagnosed. Patients diagnosed with mental disorders in the five years before study initiation were excluded to ensure incident diagnoses throughout the research duration. Generalized estimating equations in Cox proportional hazard regression models were used for data analysis. RESULTS: In general, burn injury survivors have a 1.21-fold risk of being diagnosed with new mental disorders relative to patients without burn injuries. Total body surface area (TBSA) of ≧ 30% (aHR: 1.49, 95% CI: 1.36-1.63) and third- or fourth-degree burns (aHR: 1.49, 95% CI: 1.37-1.63) had a significantly greater risk of being diagnosed with mental disorders in comparison to the reference cohort. Patients TBSA 10-29% (aHR: 0.85, 95% CI: 0.77-0.93) and first- or second-degree burn victims (aHR: 0.89, 95% CI: 0.81-0.97) had relatively lower risk of mental disorders than the reference cohort. CONCLUSION: Burn injuries were associated with an increased risk of mental disorders. Additional research in this field could elucidate this observation, especially if the inherent limitations of the NHIRD can be overcome.

Low Mean Perfusion Pressure Indexed to Body Surface Area is a Powerful Predictor of Poor Outcomes After Heart Transplantation in Patients With High Pre-Transplant Venous Pressure: A Clinical Study With Physiological Insights From Mathematical Modelling of Biventricular Heart Failure.

BACKGROUND & AIM: The deleterious consequences of chronically elevated venous pressure in patients with profound right ventricular or biventricular dysfunction are well known, including renal and hepatic dysfunction, and volume overload. The only option for these patients, if they fail optimal medical treatment, is a heart transplant, as they are not candidates for left ventricular assist device therapy. Mean perfusion pressure (MPP) is important in the outcomes of critically ill patients with high venous pressure. The question arises whether MPP is important for the outcomes of heart transplants in patients with elevated pre-transplant venous pressure. Medical management of heart failure patients with reduced ejection fraction involves lowering the systemic afterload with vasodilators while awaiting a transplant. We hypothesised that when venous pressure is elevated prior to transplant, a substantial reduction in systemic arterial elastance (Ea) through vasodilation may significantly decrease MPP, resulting in compromised end-organ function and consequent unfavourable outcomes after heart transplantation. This study aims to investigate whether a low MPP serves as a risk factor for adverse outcomes in heart transplant recipients with high venous pressure. METHOD: A retrospective analysis was conducted on 250 heart transplant recipients undergoing isolated heart transplantation at a single institution from October 2012 to March 2020. Right atrial pressure (RAP) of more than 15 mmHg was considered high. Additionally, Ea calculated as the ratio of end-systolic pressure to stroke volume, and MPP calculated as the difference between mean arterial pressure and RAP were considered in our analysis. The outcomes of transplantation were measured in terms of 90-day mortality and survival up to 7 years. RESULTS: High RAP was a significant risk factor for short-term and medium-term survival if Ea was low (<2.7 mmHg/mL, the median value). This group had 39.39% in-hospital mortality compared to 14.49% for RAP<15 mmHg (p∼0.005). When Ea was high, this difference in survival was not evident: 8% for RAP<15 mmHg vs 4.8% for RAP>15 mmHg (p∼0.550). This effect was mediated through a lower MPP, and the mortality due to lower MPP increased strikingly with higher body surface area (BSA). A negative correlation was observed between MPP indexed to BSA (MPPI) and the Model for End-Stage Liver Disease score (r∼-0.3580, p<0.0001) as well as creatinine (r∼-0.3551, p<0.0001). MPPI less than 40 mmHg/m2 was associated with poorer short-term (23.2% for MPPI<40 mmHg/m2 vs 7.1% for MPPI>40 mmHg/m2, p∼0.001) and medium-term survival. The impact of high RAP and low Ea on survival was evident even on medium-term follow-up; only 30% survival at 7 years follow-up for high RAP and low Ea vs 75% for RAP<15 mmHg (p∼0.0033). CONCLUSION: The acceptable blood pressure during vasodilator therapy in patients with high RAP needs to be higher, especially in those with higher BSA. MPPI less than 40 mmHg/m2 is a risk factor for survival, in the short and medium-term, after heart transplantation.

Use of the modified meek technique for the coverage of extensive burn wounds.

INTRODUCTION: Autologous split thickness skin grafting using meshing technique remains the preferred option for the management of deep dermal and full thickness burns. The limited donor site availability seen in patients with extensive burns, however, restricts use of the mesh grafting technique for skin expansion. Meek micrografting was developed to allow for greater expansion, and, therefore, more reliable treatment of extensive burns. This study aimed to present our outcomes using the Meek micrografting technique and identify risk factors for graft failure. METHODS: A retrospective review of patients admitted to our large academic hospital who were treated with the Meek micrografting technique from 2013 to 2022 was conducted. Patient demographics, surgical characteristics and outcomes were reported. Regression analyses were performed to identify factors that influence graft take and reoperation rate. RESULTS: A total of 73 patients with a mean age of 45.7 ± 19.9 years and mean burn size of 60.0 ± 17.8%TBSA, with 45.3 ± 14.9% TBSA being third degree burns, received Meek transplantation. The mean graft take after removal of the pre-folded polyamide gauze at the tenth post-operative day was 75.8 ± 14.7%. Pre-treatment with use of an allograft, longer waiting time between admission and Meek grafting and transplantation over a dermal matrix were identified as positive predictors for graft take, while age was established as a negative predictor. CONCLUSION: By examining the outcomes of the Meek micrografting technique in extensive burn wounds we identified that preconditioning of the wound bed, through allograft or negative pressure wound therapy application, positively correlates with improved outcomes, including higher graft take. At the same time, older age was seen to negatively correlate with graft take. Overall, Meek transplantation displays a favorable safety profile with promising outcomes. Future prospective studies and clinical trials can optimize the procedure and help establish it as the golden standard for extensive and complex burns.

Assessing resuscitation in burn patients with varying degrees of liver disease.

We find minimal literature and lack of consensus among burn practitioners over how to resuscitate thermally injured patients with pre-existing liver disease. Our objective was to assess burn severity in patients with a previous history of liver disease. We attempted to stratify resuscitation therapy utilised, using it as an indicator of burn shock severity. We hypothesized that as severity of liver disease increased, more fluid therapy is needed. We retrospectively studied adult patients with a total body surface area (TBSA) of burn greater than or equal to 20% (n = 314). We determined the severity of liver disease by calculating admission Model for End-Stage Liver Disease (MELD) scores and measured resuscitation adequacy via urine output within the first 24 h. We performed stepwise, multivariable linear regression with backward selection to test our hypothesis with α = 0.05 defined a priori. After controlling for important confounders including age, TBSA, baseline serum albumin, total crystalloids, colloids, blood products, diuretics, and steroids given in first 24 h, we found a statistically significant reduction in urine output as MELD score increased (p < 0.000). In our study, severity of liver disease correlated with declining urine output during first 24-hour resuscitation more so than burn size or burn depth. While resuscitation is standardized for all patients, lack of urine output with increased liver disease suggests a new strategy is of benefit. This may involve investigation of alternate markers of adequacy of resuscitation, or developing modified resuscitation protocols for use in patients with liver disease. More investigation is necessary into how resuscitation protocols may best be modified.

Characteristics and risk factors for electrical burn injuries: a study based on World Health Organization Global Burn Registry.

OBJECTIVE: Electrical burn injuries (EBIs) represent an important subset of burn injuries, but the information on them from the global level is limited. We aimed to investigate the characteristics and risk factors for EBIs reported to the World Health Organization Global Burn Registry. METHODS: Patients with EBIs and non-EBIs were identified from the registry. Patient demographics, income of the country, setting of the injury occurred, and outcomes were described and compared. Multivariable analysis was performed to identify risk factors associated with the EBIs and their outcomes. RESULTS: Of the 9276 patients, 814 (8.8%) were grouped as EBIs. EBIs patients had a median age of 28 years, and they were predominantly males (89.2%). EBIs were more likely to occur in lower-middle- and low-income countries (60.9% versus 43.4%) and in an occupational setting (49.1% versus 6.7%) than the non-EBIs. Older age, male, lower-income, and occupational and public setting were risk factors for EBIs. For EBIs patients, adolescents and young adults, those from low-middle and low-income countries, and those injured by high-voltage electricity were more likely to have more than 15% of the total body surface area. In addition, those from low-middle and low-income countries and those injured by high-voltage electricity were more likely to die. CONCLUSION: The characteristics of EBIs are significantly different from that of non-EBIs. To prevent EBIs and avoid unpleasant outcomes, particular attention should be given to adolescent boys and young adult men who are employed in electrical jobs in lower-income countries.

Differences in burn wound size estimation between points of referral and the burn unit: experience at a major burn center in southwestern Nigeria.

BACKGROUND: Accurate burn wound size estimation is important for resuscitation and subsequent management. It is also important for the development of referral guidelines in Nigeria. OBJECTIVE: To establish whether a significant discrepancy exists in burn size estimation between referral centers and burn units. METHODS: A retrospective review of burn patients managed at the burn unit of a premier tertiary hospital in Ibadan, southwestern Nigeria, between January 1, 2016, and October 31, 2019 was conducted. Patients' demographic and other characteristics, inclusive of TBSA estimation from point of referral and the burn unit, were retrieved and analyzed. RESULTS: A total of 96 burn injury records were found for the study period, with a male-to-female ratio of 1.3:1. Thirty-five records (36.5%) included no burn size estimation by the referring physician. There was a statistically significant difference in TBSA estimation between referring physicians and burn unit physicians (P = .015). Burn wounds were more likely to be overestimated than underestimated (P = .016). Overestimation is more likely with minor burns and in pediatric patients. Underestimation was more likely in adults. CONCLUSION: There is a significant difference in burn size estimation between burn unit physicians and referring physicians. This finding underscores the need for continuous education on burn estimation to aid proper referral and management.

Normalization of Cardiac Structural dimension and Function to Body Surface Area in South East Nigeria Children.

BACKGROUND: Standardizing cardiac valve structures and function to body surface area will help the clinician and surgeons in decision-making. AIM: To evaluate the z-scores of the sizes of cardiac structures and function and to present them in Gaussian curves and reference values. MATERIALS AND METHODS: This was a cross-sectional study that involved 300 apparently healthy children. This study was performed among healthy children from birth to 18 years. Children with a normal echocardiogram, those with no chronic illness, no congenital heart defect, and no acquired heart defect were included in the study. RESULT: The majority fell within the normal limits, as shown in the Gaussian curves. For instance, 40 (13.3%) of atrioventricular (AV) valve diameters were +1 Z-score above the normal, and only 5 (1.7%) were +2 Z-score above the normal. About 9.3% (28/300) had below -2 Z-score below normal, while only 5% had -1 Z-score below normal. Similarly, the left ventricular function z-scores were also derived at -3 Z-scores to +3 Z-scores. The standard reference values were compared with the results obtained from our Z score values. There was no significant difference noted in the Z-scores. P values ranged from 0.07 to 0.84 for all the cardiac structures except for gender, where Z-scores of the mitral valve and left pulmonary artery varied significantly (P = 0.02). CONCLUSION: Reference values of cardiac structure and function were presented using Z scores, and we noted no significant difference when compared with the Western standard values except for the mitral valve and left pulmonary artery.

Assessment of health-related quality of life in patients with burns injuries during the COVID-19 epidemic: A critical topic for burn survivors.

PURPOSE: It is well known that the coronavirus disease 19 (COVID-19) epidemic had an adverse effect on the health-related quality of life (HRQOL) of patients with disabilities, or neurological or chronic conditions. The aim of this study was to examine the possible factors affecting HRQOL in patients with burn injuries during COVID-19 epidemic. METHODS: The study included a total of 40 burns patients. The demographic and burn injury information of the patients were recorded. The active range of motion was measured with a goniometer. The HRQOL, community integration, scar tissue quality and anxiety level were evaluated using the Burn-Specific Health Scale (BSHS), the Community Integration Questionnaire Revised (CIQ-R), Patient and Observer Scar Assessment Scale, and the State-Trait Anxiety Inventory, respectively. RESULTS: The history of COVID-19 infection, total burn surface area (TBSA), community integration level, work-related burns, the presence of trunk burn injury, the presence of face burn injury, and the presence of a major burn injury were determined to be significantly associated with the HRQOL of burns patients (p < 0.05). CONCLUSION: The history of COVID-19 infection, community integration level, and burn-related parameters (TBSA, localization, severity etc.) were found to be factors associated with the HRQOL during the epidemic. The history of COVID-19 and community integration level should be evaluated in addition to the burn injury parameters to improve the quality of life of burn survivors. It can be recommended that these clinical parameters should be considered when planning the treatment program during and after the epidemic.

Relation of body surface area-to-mass ratio to risk of exertional heat stroke in healthy men and women.

Risk of exertional heat stroke (EHS) is an ongoing challenge for United States military personnel, for athletes and for individuals with occupational stressors that involve prolonged activity in hot environments. Higher body mass index (BMI) is significantly associated with increased risk for EHS in activity duty U.S. Soldiers. During exercise, heat is generated primarily by contracting skeletal muscle (and other metabolically active body mass) and dissipated based on body surface area (BSA). Thus, in compensable environments, a higher BSA·mass-1 may be a benefit to heat dissipation and decrease the risk of EHS. The purpose of the present analysis was to test the hypothesis that BSA·mass-1 ratio is an important biophysical characteristic contributing to the risk of EHS. We employed a matched case-control approach, where each individual with a diagnosis of EHS was matched to five controls who were never diagnosed with EHS but were in the same unit and had the same job title. We used a multivariate conditional logistic regression model including variables of BSA·mass-1, sex, age, military rank, and race. BSA·mass-1 significantly predicted EHS risk (P = 0.006), such that people with higher BSA·mass-1 were at lower risk of developing EHS when controlling for other potential factors such as age and race. This relationship persisted after adjustment for other anthropometric measures of body size including weight, BMI, and BSA. These data suggest that biophysical factors play an important role in EHS risk, particularly in a healthy military-aged cohort of men and women.NEW & NOTEWORTHY With the impacts of climate change yielding higher average ambient temperatures over time, the incidence of EHS for individuals participating in outdoor activities may consequently increase. With the larger sample size in this study compared with prior research in this field, we were able to use various methods that had not been applied before. For example, we were able to mutually adjust for different measurements of body size to understand which metric had the highest association with EHS risk. Understanding factors that may be modifiable may be important for developing interventions to counteract the increased risk of EHS associated with climate change.

Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data.

INTRODUCTION: Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care. METHODS: This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented. RESULTS: A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children < 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children < 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury. CONCLUSION: The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries.