RESUMO
The aim of this study was to investigate characteristics, outcomes and risk factors for death from burn in preschool children. A retrospective study was conducted on 3688 preschool burn children admitted to the National Burn Hospital from 1/1/2016 to 31/12/2018. Collected data included patient demographics and burn characteristics. Bivariate and multivariate analysis was conducted to determine independent risk factors for death. Results showed that preschool children accounted for 78.8% of total admitted burn children. The main causal agent was scald. Boys were predominant, and 76.5% patients lived in rural areas. The highest number of burn accidents occurred in winter. In addition, average burn surface area was of 8.8% total body surface area (TBSA) and 43.5% of patients suffered deep burn injury. Overall mortality rate was 0.5% with LA50 of 81.7% and 49.1% for full thickness burn area. A significantly higher mortality rate was seen in patients with inhalation injury. Compared to survivors, patients who died had a significantly larger burn surface area and larger deep burn area. Multivariate logistic analysis for death indicated that presence of inhalation injury and increased burn extent were independent risk factors for death. Inhalation injury resulted in a 3.4 probability unit of death. In conclusion, preschool burn injuries were more common in boys living in the countryside and were mostly caused by scald, with a high proportion of deep injuries. Except for in cases of extensive burn, inhalation injury was not common but was still the main cause of death.
Le but de ce travail rétrospectif réalisé entre le 1/1/2016 et le 31/12/2018 sur 3 688 enfants hospitalisés dans l'hôpital brûlologique national était d'étudier les caractéristiques, l'évolution et les déterminants de mortalité (analyse multivariée) des brûlures touchant des enfants d'âge pré- scolaire. Ces enfants comptent pour 78,8% des admissions pédiatriques. L'ébouillantement est le mécanisme prédominant. Les garçons sont plus touchés ; 76,5 % des patients habitent en milieu rural et les brûlures sont plus fréquemment hivernales. La surface brûlée moyenne est de 8,8% et 43,5% des patients ont des atteintes profondes. La mortalité est de 0,5% avec une DL50 de 81,7% dont 49,1% de profond. En analyse multivariée, l'augmentation de surface brûlée et l'inhalation de fumées (OR 3,4) sont des facteurs indépendants de risque de mortalité. Les brûlures survenant à l'âge préscolaire sont donc des ébouillantements de garçons ruraux, fréquemment profonds. L'inhalation de fumées est donc rare mais reste un facteur de risque mortalité.
RESUMO
BACKGROUND: Cyclosporin is used for the treatment of corticosteroid-resistant inflammatory bowel disease. Secondary liver disease is a risk. CASE REPORT: Acute hepatitis with predominant major transaminase elevation occurred in a patient treated with cyclosporin for corticosteroid-resistant Crohns disease. No viral, alcoholic, autoimmune or metabolic cause could be incriminated. Complete cure was achieved after withdrawal of cyclosporin. DISCUSSION: Only one case of cholestatic hepatitis has been reported in chronic inflammatory bowel disease. Cyclosporin was the probable cause in our case as other causes of acute hepatitis were ruled out and withdrawal led to cure. Cyclosporin can induce abnormal liver tests in 25% of cases. If reducing dose does not lead to improvement, it may be necessary to discontinue cyclosporin. Regular liver tests would thus be required for patients given cyclosporin for chronic inflammatory bowel disease.
