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Biomedical subjects

Areta Kowal-Vern

Publications and source records attributed to Areta Kowal-Vern.

18 recordsLinked to original sources
PubMed2006

Haemophilus Influenzae contributes to morbidity but not mortality in severely burned patients.

Due to a successful Haemophilus Influenzae (HIF) vaccination program, this pathogen is no longer a major contributor to childhood morbidity and mortality. The effect on adult acquisition of HIF is unknown. The purpose of this study was to determine HIF infection frequency in severely burned patients. In a 62-month period, there were 1486 admissions. Twenty-four of 1,486 (1.6%) burn patients had HIF pneumonia: 16 (1%) within 72 h after injury; 8 (0.5%) patients developed it after the seventh day of hospitalization; 74 of 1,486 (5.0%) burn patients had pneumonia due to other organisms. There was no statistically significant difference between patients with HIF pneumonia and those with other pathogens with respect to age, race, sex, percent total body surface area (TBSA), inhalation injury, ventilator days, intensive care days, sepsis, or mortality. Nineteen percent of patients with HIF were<14 years of age compared to 12% in the other pneumonia group, p<0.01. HIF contributed to both an early and late pneumonia in burn patients. The organism responded to treatment and did not affect mortality.

Adult↗
PubMed2006

Elevated cytokine levels in peritoneal fluid from burned patients with intra-abdominal hypertension and abdominal compartment syndrome.

BACKGROUND: Burn patients with intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) undergo vigorous resuscitation and accumulate peritoneal fluid (PF) that is a plasma ultra-filtrate. This study compared antithrombin (AT) and cytokine levels in burn patient plasma and peritoneal fluid (PF). METHODS: Twenty-nine patients were studied: 22 developed IAH and 9 progressed to ACS. Burn + inhalation injury was present in 22 patients; 5 had burn only and 2 had inhalation only. Sixteen patients died: of these, 9 survived less than 48 h due to the severity of their injuries. Flow cytometry utilized the Cytometric Bead Array kit for Human Th1/Th2 cytokines. AT levels were determined by the Accucolor method spectrophotometrically. RESULTS: All cytokine levels were significantly elevated in burn plasma and PF compared to normal plasma, p < 0.001. AT plasma levels were decreased compared to normal. AT and cytokines were present in peritoneal fluid of burn patients with IAH and ACS. Patients who died had decreased plasma levels of AT and increased IFN-gamma, IL-10, IL-6, IL-4, IL-2 peritoneal fluid levels compared to survivors. CONCLUSIONS: Peritoneal fluid may be a reservoir for cytokines during initial resuscitation and contributes to homeostatic perturbations in burn patients.

Abdomen↗
PubMed2005

Burn scar neoplasms: a literature review and statistical analysis.

BACKGROUND: Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported. OBJECTIVE: To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics. MATERIALS AND METHODS: Cases were obtained through literature searches. RESULTS: There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%. CONCLUSIONS: Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.

Adult↗
PubMed2005

Comparison of dermal substitutes in wound healing utilizing a nude mouse model.

BACKGROUND: Dermal skin substitutes have become a standard of care in burn treatment. OBJECTIVE: To compare and assess wound contracture reduction and histologic incorporation into the wound, dermal substitutes were implanted into full-thickness skin wounds in nude mice. MATERIALS AND METHODS: Thirty-seven mice received a full-thickness 2 x 2 cm dorsal skin wound, and were either implanted with an acellular dermal matrix, Alloderm, Dermagraft-TC, Dermalogen, or Integra or assigned to the control group (with no dermal substitute). At 28 days postsurgery, the wounds were assessed for contraction, epithelialization, and other histological characteristics. RESULTS: Each dermal substitute decreased wound contracture, but Alloderm and the acellular dermal matrix did so significantly compared to the control (P < .01 and P < .03, respectively). Within-group and control comparisons showed no significant differences with respect to the presence of dystrophic calcification, squamous hyperplasia, infiltration of neutrophils, fibroblasts, and macrophages, epidermal keratinocyte stratification, or collagen fiber configuration. CONCLUSIONS: Integra elicited the greatest foreign body response. Although the Dermalogen group had the thickest elastin fiber fragments, Dermagraft may have initiated the earliest elastin fiber formation in the wounds. While all dermal substitutes were incorporated into the wound bed and wound contracture was decreased, acellular dermal matrix and Alloderm, both human skin-derived products, produced less contraction and the thickest new "dermis" in the healed wounds compared to the control or synthetic dermal substitutes.

Journal Article↗
PubMed2004

Infections in diabetic burn patients.

OBJECTIVE: Diabetic burn patients comprise a significant population in burn centers. The purpose of the study was to determine the demographic characteristics of diabetic burn patients and their rate of community-acquired and nosocomial infections. RESEARCH DESIGN AND METHODS: This was a 46-month retrospective chart and patient registry review comparing diabetic with nondiabetic burn patients. Statistical analysis consisted of means +/- SD, descriptive statistics, one-way ANOVA, and chi(2) tests. RESULTS: Of 1,063 adult burn patients (aged 15-54 years), 68 (6%) diabetic burns were compared with burns of 995 adult nondiabetic patients. Of 193, 62 (32%) senior (>/=55 years of age) diabetic burns were compared with 131 nondiabetic senior burns. The major mechanism of injury for the diabetic patients was scalding and contact, in contrast to that of nondiabetic patients who were injured mainly by scalding or flame burns. Adult diabetic patients had a significantly increased frequency of foot burns compared with adult nondiabetic patients (32 of 68 [68%] versus 144 of 995 [14%], P = 0.001). Adult diabetic burns had a significant increase in sepsis (P < 0.002) and community-acquired burn wound cellulitis (P < 0.001) compared with adult nondiabetic patients; and senior diabetic patients had a significantly increased frequency of urinary tract infections compared with senior nondiabetic burn patients (P < 0.04). The most common organisms in diabetic burn infections were Streptococcus, Proteus, Pseudomonas, Candida species, and MRSA (methicillin-resistant Staphylococcus aureus). Forty-two percent of the diabetic patients were admitted during the winter months and 25% in the spring. Only 49 of 130 (38%) diabetic burn patients presented for treatment within 48 h after injury compared with 669 of 1,126 (62%) nondiabetic patients (P = 0.001). CONCLUSIONS: Peripheral neuropathy may have precipitated and delayed medical treatment in lower-extremity burns of diabetic patients. Hospitalized diabetic burn patients were also at an increased risk for nosocomial infections, which prolonged hospitalization. Diabetic patient education must include not only caution about potential burn mishaps but also educate concerning the complications from burns that may ensue.

Adult↗
PubMed2003

Frequency of burn-trauma patients in an urban setting.

BACKGROUND: Burn-trauma patient encounters constitute 5% of the emergency department population. HYPOTHESIS: A large urban hospital will treat twice as many (ie, 10%) burn-trauma patients. DESIGN: Retrospective 44-month study. SETTING: Metropolitan county hospital. PATIENTS: Population-based sample of burn-only (n = 1102), burn-trauma (n = 120), and assault burn-trauma (n = 43) patients. MAIN OUTCOME MEASURES: Frequency and demographics. RESULTS: Just under 10% (n = 120) of the burn population had burn-trauma injuries. The mean +/- SD Injury Severity Score was 12 +/- 12 in these burn-trauma patients: 4 +/- 2 in outpatients and 14 +/- 13 in inpatients. The burn-only and burn-trauma groups had similar age ranges, ethnic distribution, frequency of inhalation injury, substance abuse, malnutrition, sepsis, pneumonia, diabetes mellitus, percentage total burn surface area, number of procedures, grafted areas, and mortality. Forty-three burn-trauma patients (35.8%) sustained injuries due to assault, compared with 123 (11.2%) in the burn-only group (P<.001). Burn-trauma patients who were assaulted had a mean +/- SD Injury Severity Score of 11 +/- 10. There was a significantly increased male-female ratio among the assault burn-trauma patients (6:1) compared with the burn-trauma (3:1) and burn-only (2.3:1) groups (P<.04). Most of these injuries were caused by an unknown assailant, in connection with an automobile, a motorcycle, a bicycle, or pedestrians intentionally struck by moving vehicles, or by child abuse. The main mechanism of injury was contact in 57 burn-trauma patients (47.5%), compared with 127 (11.5%) in the burn-only group (P<.001). CONCLUSIONS: A large urban population will have an increased frequency (2-fold in our center) of burn-trauma injuries. Assault and child abuse are significant contributory factors to burn-trauma injuries in this population.

Adolescent↗
PubMed2003

Antithrombin (human) concentrate infusion in pediatric patients with >50% TBSA burns.

BACKGROUND: Antithrombin (human) [AT(H)] concentrate infusions have been safely utilized in adult burn patients to counteract subclinical disseminated intravascular coagulopathy and pulmonary complications. OBJECTIVE: AT(H) concentrate was given to two thermally injured pediatric patients to evaluate safety and dosage requirements. DESIGN: The first patient was a 2-year-old with 83% total burn surface area (TBSA) full thickness flame burn and severe inhalation injury. The second patient was a 14-month-old who sustained 56% TBSA deep partial and full thickness scald injury. Each child received 10 infusions of AT(H) concentrate (106 units/kg) in the first 4 days post-injury. RESULT: For these two patients, the plasma AT level (normal range: 100+/-20%) increased, respectively, from 25 and 66% on admission to 224 and 217% on day 1, 114 and 116% on day 2, and 193 and 171% on day 3. Both patients tolerated the infusions well. In one patient, the eschar on all four extremities easily peeled off the subcutaneous tissues along a natural demarcation between viable and non-viable tissue with only a 40cc estimated blood loss (EBL). CONCLUSIONS: AT(H) concentrate is tolerated in the pediatric population in the acute phase of injury. Lack of bleeding during eschar removal may be of benefit to burn excision and grafting.

Antithrombins↗
PubMedDate not supplied

Paediatric burn rehabilitation.

Therapy is very important during all phases of burn wound care in preventing scar contractures, limb deformities, skin graft preservation and healing, and reconstruction. The following review details the#10; course of a paediatric burn injury and outlines the vital role played by the physical, occupational and child therapists during resuscitation, hospitalization and recovery.

Aftercare↗
PubMedDate not supplied

A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury.

Abdominal Compartment Syndrome (ACS) has multiple causes, and decompressive laparotomy has been the most frequent modality to prevent worsening cardiovascular, respiratory, and renal function. This pilot study evaluated the utility of percutaneous drainage (PD) of peritoneal fluid compared with decompressive laparotomy in burn patients. A 26-month review was conducted. Nine of 13 (69%) study patients developed intra-abdominal hypertension (IAH) that progressed to abdominal compartment syndrome in 4 (31%). All were treated with PD using a diagnostic peritoneal lavage catheter. Peritoneal fluid analysis revealed a sterile plasma ultrafiltrate with electrolyte and other chemistries reflecting patient serum levels. Five patients underwent PD successfully, and their IAH did not progress to ACS. Four patients with greater than 80% TBSA and severe inhalation injury did not respond to PD and required decompressive laparotomy. There was no evidence of bowel edema, ischemia, or necrosis. All patients requiring decompressive laparotomies died either from sepsis or respiratory failure. Percutaneous decompression is a safe and effective method of decreasing IAH and preventing ACS in patients with less than 80% TBSA thermal injury.

Abdomen↗
PubMedDate not supplied

Cecal perforation in thermal injury: case report and review of the literature.

Gastrointestinal complications in burn patients include ileus, constipation, hemorrhage from ulcerations, ischemic bowel, and rarely, perforations. Patients with hypotensive episodes and sepsis are at risk for developing ischemic bowel disease. There have been three reports in the literature of cecal perforation in burn patients. We present an additional case and review of the literature.

Burns↗
PubMedDate not supplied

Vacuum-assisted closure use in calciphylaxis.

Calciphylaxis-induced chronic wounds are difficult to heal. The value of vacuum-assisted closure (VAC) was assessed in two patients with calciphylaxis. Two middle-aged females with type 2 diabetes were transferred to the burn unit with a clinical diagnosis of necrotizing fasciitis, although the pathologic diagnosis was calciphylaxis. With extensive debridement, antibiotics, and meticulous wound care, one patient had progressive necrosis of her skin from 18 to 48% TBSA, whereas the other progressed from 5 to 10% TBSA only. The patient with the smaller chronic wound healed well and left the hospital at 72 days after admission. Although there was some success with the use of VAC, the patient with the extensive progressive wounds developed a fungal wound infection that did not respond to treatment; she died 78 days after initiation of burn center treatment. Some disadvantages to the usefulness would be extensive contiguous wounds and the lack of an intact skin surface. The VAC system was of value in healing wounds resulting from calciphylaxis.

Calciphylaxis↗
PubMedDate not supplied

Circulating endothelial cell levels correlate with proinflammatory cytokine increase in the acute phase of thermal injury.

Circulating endothelial cells (CECs) are increased in sickle cell disease, myocardial infarction, and acute lung injury. The purpose of this study was to determine whether CECs are a prognosticating marker for the development of pneumonia in burn patients with/without inhalation injury in addition to their relationship to proinflammatory cytokines. There were 24 patients: 6 with inhalation injury, 5 with burn only,and 13 with burn plus inhalation injury. CECs were measured by anchored cytometry (Clarient ChromaVision, San Juan Capistrano, CA). In addition, plasma levels of tumor necrosis factor-alpha, interferon-gamma, and interleukins (IL)-10, IL-6, IL-4, and IL-2 were compared with CEC levels. Patients with inhalation injury had a significant (P < .001) paucity of CECs compared with the thermally injured with inhalation. There was a statistically significant increase in inteferon-gamma, tumor necrosis factor-alpha, and IL-6, IL-4, and IL-2 compared with control patients (P < .01), with a concomitant increase in the number of CECs. The numbers of CEC levels did not prognosticate which patients would develop pneumonia. Burn patients with/without inhalation injury had concurrent increase in CECs and proinflammatory cytokines during the acute phase of injury.

Adult↗
PubMedDate not supplied

Trends in burn research as reflected in American Burn Association presentations, 1998 to 2003.

The American Burn Association (ABA) mission promotes burn care, research, rehabilitation, teaching, and prevention. Therefore, we sought to determine recent burn research trends by reviewing 1595 accepted abstracts from the Proceedings of the American Burn Association from 1998 to 2003. This study encompassed a retrospective, descriptive audit of ABA abstracts accepted for presentation, including topic, institution, accreditation status, and presentation. Overall, Shriners Hospitals for Children (SH) provided 31%, non-Shriners burn centers (N-S) provided 53%, international and nonburn center hospitals provided 13%, and multicenter ventures provided 2% of the abstracts. Abstract topics addressed most frequently in this time period were cell biology 271 (17%), general care 240 (15%), and pain 235 (15%). Multicenter trials were negligible from the period of 1998 to 2000 but increased to 3% to 4% annually since 2001. In 2003, 39 of 128 (30%) of U.S. burn centers were accredited and delivered 67% of the presentations. SH abstracts increased from 26% in 1998 to 35% in 2003, whereas the N-S decreased from 61% to 48%. Thirty-seven percent of the abstracts reported prospective studies, 28% retrospective, and basic research abstracts comprised 18%. Four SH and 91 N-S (U.S.) hospitals primarily shared the podium, although N-S presentations decreased annually since 1998. On the basis of 2003 ABA/ACS accreditation data, there was an association between accreditation and research activity. SH and N-S collaborative studies for better patient care are the trend for the future as burn centers pool data and resources.

Accreditation↗
PubMedDate not supplied

Purpura fulminans in an adult patient with Haemophilus influenzae sepsis: case report and review of the literature.

Purpura fulminans is a rare complication of a coagulopathy or an infection. Haemophilus influenzae infection, which has decreased since the haemophilus influenzae type B vaccine was initiated, is an unusual initiating cause of purpura fulminans. This case is the first reported in the literature of an adult who developed purpura fulminans after Haemophilus influenzae sepsis. Her elevated beta2 glycoprotein 1 ratio may have contributed to the severity of her disease. Although rare, Haemophilus influenzae may precipitate purpura fulminans. Current therapy is directed at control of precipitating factors, removal of nonviable tissue, treatment of secondary infections, and physiologic support. There also is evidence that patients respond well to hyperbaric oxygen therapy, with decreasing limb and tissue loss.

Adult↗
PubMedDate not supplied

A prototype for an economical vertical microstomia orthosis.

One of the complications of thermal injury is the development of scars and contractures during the healing process. This scarring can be devastating, especially when it involves the mouth. The purpose of this report is to describe the construction of an alternative vertical mouth stretching orthosis for vertical microstomia. By using thermoplastic splinting material and a long thread screw, a vertical mouth-stretching orthosis can be custom-fit to any patient's mouth. The device can be fabricated for a pediatric or adult patient for the rehabilitation of a circumferential mouth burn, especially targeting the vertical diameter. When using this device, patients gave positive feedback for comfort and ease of use, with increased mouth mobility and range of motion. This vertical orthotic device provides an economical and comfortable alternative for vertical mouth diameter enlargement to the current five devices available in the literature.

Burns↗
PubMedDate not supplied

Use of blood bank services in a burn unit.

Burn patients may need transfusions, especially during surgery. The purpose of the study was to determine blood bank services utilization at an urban burn center. This was a retrospective review (March 1999 to May 2004) of burn patient data on blood utilization. There were 1615 admissions; 800 (49.5%) of the patients had a type and screen (T and S); 180 of 1615 (11%) were transfused with 1691 red blood cell (RBC) units; 616 units of fresh- frozen plasma (FFP), 399 units of pooled platelets, and 38 units of apheresis platelets. Of the 180 transfused patients, 140 (79%) received RBCs, 11 (6%) received RBCs plus FFP, 23 (13%) received RBCs plus FFP plus platelets, and 3 (2%) each received RBCs plus platelets and FFP. Overall, 3393 red cell units were cross-matched, and 1691 units were transfused for a cross-match/transfused unit (C/T) ratio of 2.01. Seventy-three (5.7%) of 1282 of patients with 0% to 10% TBSA required transfusions; 42 (21%) of 193 with 11% to 20% TBSA; 24 (39%) of 61 with 21% to 30% TBSA; and 62% of patients with 31% or greater TBSA required transfusion (P = .001). As %TBSA increased, more of the cross-matched units were transfused: 37% in the 0% to 10% TBSA to 59% in the 30% or greater TBSA burn. The C/T ratio in the 0% to 10% TBSA was 2.69; only 18% of patients with a T&S received blood. Although most patients who underwent transfusion were in the less than 30% TBSA group, more of the red cell units were used in patients with a 30% or greater TBSA burn. Elimination of admission T&S and cross matches in burn patients with less than 20% TBSA may improve the C/T ratio in this cohort.

Adult↗
PubMedDate not supplied

Demographics of the homeless in an urban burn unit.

There are few articles about the homeless in burn literature. We sought to determine the demographic characteristics of the homeless citizens admitted to an urban burn center. This was a retrospective review from March 1999 to May 2004. Statistical analysis included chi2 and one-way analysis of variance. There were 1615 burn admissions, and 73 (4.5%) of these patients were homeless. Although the %TBSA affected was similar for the homeless and domiciled patients, the mean (+/-SD) age of the homeless was 44 +/- 10 years and their length of stay was 15 +/- 15 days, compared with 31 +/- 22 years and 9 +/- 13 days, respectively, for the domiciled. Twenty-one (29%) of the 73 homeless were admitted for frostbite, vs 21 (1.4%) of the 1542 domiciled patients (P= .000). Because of the frostbite, the majority (53%) arrived in the winter, compared with 15% in each of the other three seasons (P= .000). The homeless had a higher frequency of acute and chronic ethanol and cocaine use than the domiciled population (21% vs 6%). There was no significant difference between the homeless and the domiciled population in %TBSA affected, nutritional values, and assault frequency. More than half of the homeless patient admissions to the burn unit resulted from assault or frostbite. The homeless were mainly African-Americans and Caucasians, with a higher frequency of ethanol and cocaine use than in the domiciled burn population. Lack of discharge options for the homeless prolonged the average length of stay, leading to increased costs, often borne by the burn unit.

Adolescent↗