Immune response in burn patients in relation to HIV infection and sepsis.

The post-burn immune dysfunction predisposes patients to sepsis and multiple organ failure leading to increased mortality. HIV infection also results in a depressed immune response. The combination of burn injury and HIV might therefore lead to an increased morbidity and mortality as compared to non-HIV infected burn patients. Twenty burn patients and 10 healthy volunteers were included in a prospective study. To evaluate their immune status, CD4+ and CD8+ T-lymphocyte counts were determined in peripheral blood. HIV serology samples were obtained on admission. Bacteriological cultures were obtained from wound surface samples and wound tissue biopsies. Six burn patients were HIV infected. Clinical signs of sepsis were observed in 10 patients. The number of CD4+ T-lymphocytes were lower in burn patients compared to healthy volunteers (P < 0.05). HIV infected burn patients had lower CD4+ lymphocyte counts than non-HIV infected patients (P < 0.05). Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.05). There was no difference in the mortality rate or the length of hospitalisation between patient groups. Burn injury, HIV infection and sepsis independently result in immunosuppression.

A Prospective study on the epidemiology of burns in patients admitted to the Harare burn units.

The purpose of this study was to record the causes and the magnitudes of burn injuries prospectively and to evaluate the outcome of treatment of patients admitted to the burn units in Harare. The median age of the 451 patients included was 6 years (range: 1 month to 71 years), 54% were female and 46% male. The burn injuries were caused by flame in 51% of the cases and hot liquids in 47%. The overall median total body surface area burnt was 13% (range: 0.5 to 99%). Parasuicidal burns (attempted suicides) were noted in 11% of the patients with a median total body surface area burnt of 30% and mortality of 73%. Lodgers were overrepresented in the material. Delayed split skin grafting was done on 26% of the patients and early primary excision and skin grafting on 3%. The overall median hospital stay was 15 days (range: 0 to 229 days). The median hospital stay for patients with delayed split skin grafting was 42 days and that for those with primary excision and split skin grafting was 17 days. The overall mortality was 22%. All patients with burns larger than 65% of the total body surface area died. Burn injuries were more frequent and larger with higher mortality in females than in males. Flame was the major cause of the burns. Self-inflicted burns, noted mainly in young women, resulted in 73% mortality. Primary excision and grafting reduced hospital stay by 60% compared to delayed skin grafting.

A prospective study of suicidal burns admitted to the Harare burns unit.

The aim of this study was to obtain prospective information on suicidal (attempted suicide) burns patients admitted to the Harare burns unit during 1995-1998. Forty-seven patients, 42 females (89%) and five males (11%), evenly distributed throughout the period of study, were included. The median age was 25 years, range 13 to 50 years. Thirty were housewives (64%). Women married according to customary law were the group most at risk. All patients were burnt by flame after dousing themselves with paraffin or petrol. Conflict in love relationships was the most common circumstance leading to attempted suicide. The median Total Body Surface Area (TBSA) burnt was 60%, range 10-90%, for all patients, 25%, range 10-40%, for those who survived and 65%, range 20-95%, for those who died. Surgery was performed on 16 patients (34%). Mortality was 68%. The overall median hospital stay for all patients was 10 days, range 0-322 days, and 5 days, range 0-322 days, for those who died.

A prospective double blind randomized study comparing the need for blood transfusion with terlipressin or a placebo during early excision and grafting of burns.

INTRODUCTION: Early excision and skin grafting has become the standard of good burn management, but it is associated with major blood loss. AIM: To determine the haemostatic effect of terlipressin compared with placebo. MATERIAL AND METHODS: Fifty-one patients with burns of 10-20% total body surface area had early excision and split skin grafting of deep burns. The surface area of the burn wound and of the healed graft were measured by planimetry. The patients were randomly allocated to medication, either terlipressin or placebo. Blood loss and number of transfused units of blood were recorded. RESULTS: Twenty-one patients received terlipressin, 13 received terlipressin late (cross-over) and 17 received placebo. Six out of 21 patients exposed to terlipressin were transfused with eleven units of packed red blood cells. Seven out of 13 patients crossed over from placebo to terlipressin (late terlipressin) were transfused with 17 units of blood. Eight out of 17 patients exposed to the placebo were transfused with 22 units of blood (P < 0.05). Graft healing was 1055 +/- 609 cm2 out of 1452 +/- 11 cm2 in terlipressin and 914 +/- 633 cm2 out of 1288 +/- 720 cm2 in the placebo group (n.s.). CONCLUSION: Terlipressin reduced the need for blood transfusion by a factor of 2.5 compared to a placebo without impairment of graft healing.

Treatment of median cleft of the lower lip, mandible, and bifid tongue with ankyloglossia. A case report.

A case of complete median cleft of the lower lip and mandible and bifid tongue with ankyloglossia is presented. Unlike other reported cases of similar disorders, no other abnormalities were present. A satisfactory result was achieved with early surgical correction of both hard- and soft-tissue defects.

Comparison of surface swab cultures and quantitative tissue biopsy cultures to predict sepsis in burn patients: a prospective study.

This study aimed at evaluating the possibility of predicting septicemia in burn patients by using wound surface and tissue culture techniques as well as blood cultures. Fifty patients with full-thickness burn wounds covering at least 10% of the total body surface area were included. Signs of septicemia were noted in 21 patients (42%) and 29 patients died (58%). The bacterial colonization of the burn wounds consisted mainly of Staphylococcus aureus and Pseudomonas aeruginosa. Sepsis was better correlated to quantitative burn tissue biopsy cultures than surface swab cultures but the time needed for processing limits its predictive and therapeutic value.

Reaction to the birth of a child with cleft lip or cleft palate in Zimbabwe.

Cleft lip and palate (CLP) is often a distressful abnormality for both mother and child. In our setting, CLP is generally associated with witchcraft or ancestral spirits. The mother is often accused of infidelity during pregnancy. We wanted to determine the feelings of parents and the wider public towards CLP babies, to establish what parents believed were the causes of CLP and to establish the postpartum marital status. One hundred and twenty-four parents were prospectively included in the study. They were interviewed using a structured questionnaire. One hundred and fifteen mothers and four fathers said they loved their babies. Thirty-eight parents attributed CLP to witchcraft. Nineteen percent of the mothers were divorced. The responses to our questionnaire show that although CLP babies are loved by their parents, the condition is associated with stigma and superstition.

HIV infection reduces skin graft survival in burn injuries: a prospective study.

UNLABELLED: Impaired survival of skin grafts has been noted in human immunodeficiency virus (HIV) infected patients, but the reason is not known. Alterations in inflammatory response, which might be recorded as an imbalance in cytokine production, have been implicated. The aim of this study was to determine the impact of HIV infection in patients with burn injuries by comparison of split skin graft survival, T lymphocyte count and cytokine levels in HIV-infected and non HIV-infected patients in relation to healthy and HIV-infected nonburnt volunteers.Fifty-four patients with deep dermal burns were included. Fifteen patients' were HIV-infected. Thirteen healthy and 15 HIV-infected, volunteers were recruited as controls. The burnt surface area was traced on a transparent plastic sheet and converted to area. Graft survival on day of discharge/regraft for non HIV-infected patients was 69%, and in HIV-infected 22%, (p<0.05). The median length of hospital stay for early excision among non HIV-infected patients was 21 (12-53) days and for HIV-infected, 41 days (p<0.05). Serum protein levels in HIV-infected patients were elevated compared to non HIV-infected patients (p<0.05). CD4+ lymphocytes were depressed in HIV-infected volunteers and HIV-infected burn patients compared to healthy volunteers (p<0.05). CD8+ lymphocytes were elevated in HIV-infected volunteers compared to non HIV-infected burn patients. Pro-inflammatory cytokine levels of Interleukin-2 (IL-2), Interleukin-6 (IL-6), Interferon-gama (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were depressed in HIV-infected volunteers compared to healthy volunteers and non HIV-infected burn patients. The pro-inflammatory cytokine IFN-gamma did not increase after burn injury in HIV-infected burns patients as did IL-2, IL-6 and TNF-alpha (p<0.05). Anti-inflammatory cytokine levels of IL-4 were elevated in HIV-infected volunteers compared to healthy volunteers and burn patients (p<0.05). CONCLUSION: Graft survival after split skin grafting of burn wounds in HIV-infected patients is impaired and hospital stay is prolonged. HIV infection result in immune dysregulation, which might be related to impaired skin graft survival.

Burns management : the Harare Central Hospital experience

A retrospective study of 701 burns patients admitted at Harare Central Hospital over a 4 year period; 1981 - 1984 is presented. There were 364 (52pc) adults and 337 (48pc) children. There were 276 (39.4pc) male and 271 (38.6pc) female patients. In 154 (22pc) files; the sex of the patient was not stated. The age ranged from one month to 70 years. Fire and scalding burns accounted for 582 (83pc) of all admissions. Six hundred and thirty (90pc) patients were admitted for domestic burns. Forty adult burns admissions were associated with disappointments in love affairs. There were 29 epileptic burns. Poor fluid resuscitation were indicated; was associated with high mortality (30pc). Forty adults and 21 children died. The overall mortality was 8.7; 3 higher than expected when using Bull and Fisher's grid. More than fifty percent of all burns accidents were preventable