- Email: [email protected]
Is Alice in Wonderland? A new cause for burns due to “Bonzai abuse”
burns 42 (2016) 230–241
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Case–control or cross-sectional design? Discussing the epidemiological aspects of a recent self-immolation study
Sir, I have read with great interest the article by Ahmadi et al. entitled: ‘‘A case–control study of psychosocial risk and protective factors of self-immolation in Iran’’ [1]. Authors have done a great effort to shed light on one of the most unknown types of suicide i.e. self-immolation [2] by applying a worthwhile epidemiological types of study i.e. case–control design [3]. In their study Ahmadi et al. selected 151 cases of deliberated self-inflicted burns and compared them with 302 matched healthy controls. Controls were chosen from the similar district that the cases were selected and were matched by age, gender and calendar year [1]. However, it is not clear why Ahmadi et al. in their limitations of study stated that their findings are prone to biases inherent to cross-sectional study. It should be noted that case–control design is a sub-type of analytic epidemiological studies in which cases are compared with their matched controls in terms of previous exposures to susceptible risk/protective factors. Whilst cross-sectional design is a sub-type of descriptive epidemiological studies in which the present situation or prevalence of a phenomenon is depicted [3]. What Ahmadi et al. have carried out was a case– control and not a cross-sectional design, therefore, clarification is needed. Besides, in case–control design it would be possible to select up to four controls from different sources for each case. This approach would help to better understand the function of risk/protective factors [3]. In my point of view, instead of taking two matched healthy controls for each case, Ahmadi et al. could have selected one matched healthy control and one matched unintentional burn patient. Certainly this approach could better distinguish the function of risk/ protective factors of self-immolation. Future case–control studies in the area of self-immolation should take this important issue into account.
references
[1] Ahmadi A, Mohammadi R, Almasi A, Amini-Saman J, Sadeghi-Bazargani H, Bazargan-Hejazi S, et al. A case– control study of psychosocial risk and protective factors of self-immolation in Iran. Burns 2015;41(2):386–93. [2] Rezaeian M. Epidemiology of self-immolation. Burns 2013;39(1):184–6. [3] Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case–control studies. Emerg Med J 2003;20(1):54–60.
Mohsen Rezaeian* Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran *Tel.: +98 03915234003; fax: +98 03915225209 E-mail address: [email protected] (M. Rezaeian) http://dx.doi.org/10.1016/j.burns.2015.03.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Letter to the Editor Is Alice in Wonderland? A new cause for burns due to ‘‘Bonzai abuse’’ Dear Sir, We read the article ‘‘Alcohol and drug abuse in burn injuries’’ by Haum A. et al. [1] with great interest. We would like to contribute to some current issues that were not addressed by the author. Drug addiction is a major global problem. The fight against drugs is at the forefront of several national security policies. The social and health consequences of drug abuse are another problem altogether. Bonzai, a synthetic cannabinoid substance, has been increasingly used in recent years in Turkey. Although cannabis forms the main structure, the chemical composition
burns 42 (2016) 230–241
231
Fig. 1 – View of the patient.
of these materials varies, and the different components in various samples have been revealed by chemical analysis. Bonzai induces different effects on individuals, from deepening depressed and euphoric states to having a strong hallucinogenic effect even 3–4 days after use, ultimately resulting in forgetfulness after use. This subject has not been studied yet. We present a new cause for burns due to ‘‘Bonzai’’ in this paper. A male patient with burns due to unknown causes was admitted to our burn center (Fig. 1). The patient did not know the exact cause of the burns. The common features of the patient were unknown causes of burns and >15% of body surface area with second- and third-degree burns. The patient experienced continuous seizures in the burn unit, so he was monitored in intensive care. The continuous seizures were probably caused by the long-lasting effect of the substance and its release. Serial escharectomies and split-thickness skin graftings were performed. The follow-up period was 2 months. The patient fully recovered after a total of four operations. Skin softness, thickness, elasticity, and color were considerably improved. Bonzai is highly addictive, causing burns unknowingly and leading to long-term hospitalization and costs. Unless dealt with, this addiction will lead to more problems, and collaboration with the psychiatry clinic is of particular importance.
Conflict of interest The authors declare that they have no conflict of interest. None of the authors has a financial interest in any
of the products, devices, or drugs mentioned in this manuscript.
Funding None.
reference
[1] Haum A, Perbix W, Ha¨ck HJ, Stark GB, Spilker G, Doehn M. Alcohol and drug abuse in burn injuries. Burns 1995; 21(May (3)):194–9.
Salih Onur Basat Fatih Ceran Muzaffer Kurt Mehmet Bozkurt* Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey *Corresponding author at: Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar/Istanbul, Turkey. Tel.: +90 5322760209; fax: +90 2124404242 E-mail address: [email protected] (S.O. Basat) http://dx.doi.org/10.1016/j.burns.2015.05.025 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Case–control or cross-sectional design? Discussing the epidemiological aspects of a recent self-immolation study
Sir, I have read with great interest the article by Ahmadi et al. entitled: ‘‘A case–control study of psychosocial risk and protective factors of self-immolation in Iran’’ [1]. Authors have done a great effort to shed light on one of the most unknown types of suicide i.e. self-immolation [2] by applying a worthwhile epidemiological types of study i.e. case–control design [3]. In their study Ahmadi et al. selected 151 cases of deliberated self-inflicted burns and compared them with 302 matched healthy controls. Controls were chosen from the similar district that the cases were selected and were matched by age, gender and calendar year [1]. However, it is not clear why Ahmadi et al. in their limitations of study stated that their findings are prone to biases inherent to cross-sectional study. It should be noted that case–control design is a sub-type of analytic epidemiological studies in which cases are compared with their matched controls in terms of previous exposures to susceptible risk/protective factors. Whilst cross-sectional design is a sub-type of descriptive epidemiological studies in which the present situation or prevalence of a phenomenon is depicted [3]. What Ahmadi et al. have carried out was a case– control and not a cross-sectional design, therefore, clarification is needed. Besides, in case–control design it would be possible to select up to four controls from different sources for each case. This approach would help to better understand the function of risk/protective factors [3]. In my point of view, instead of taking two matched healthy controls for each case, Ahmadi et al. could have selected one matched healthy control and one matched unintentional burn patient. Certainly this approach could better distinguish the function of risk/ protective factors of self-immolation. Future case–control studies in the area of self-immolation should take this important issue into account.
references
[1] Ahmadi A, Mohammadi R, Almasi A, Amini-Saman J, Sadeghi-Bazargani H, Bazargan-Hejazi S, et al. A case– control study of psychosocial risk and protective factors of self-immolation in Iran. Burns 2015;41(2):386–93. [2] Rezaeian M. Epidemiology of self-immolation. Burns 2013;39(1):184–6. [3] Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case–control studies. Emerg Med J 2003;20(1):54–60.
Mohsen Rezaeian* Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran *Tel.: +98 03915234003; fax: +98 03915225209 E-mail address: [email protected] (M. Rezaeian) http://dx.doi.org/10.1016/j.burns.2015.03.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Letter to the Editor Is Alice in Wonderland? A new cause for burns due to ‘‘Bonzai abuse’’ Dear Sir, We read the article ‘‘Alcohol and drug abuse in burn injuries’’ by Haum A. et al. [1] with great interest. We would like to contribute to some current issues that were not addressed by the author. Drug addiction is a major global problem. The fight against drugs is at the forefront of several national security policies. The social and health consequences of drug abuse are another problem altogether. Bonzai, a synthetic cannabinoid substance, has been increasingly used in recent years in Turkey. Although cannabis forms the main structure, the chemical composition
burns 42 (2016) 230–241
231
Fig. 1 – View of the patient.
of these materials varies, and the different components in various samples have been revealed by chemical analysis. Bonzai induces different effects on individuals, from deepening depressed and euphoric states to having a strong hallucinogenic effect even 3–4 days after use, ultimately resulting in forgetfulness after use. This subject has not been studied yet. We present a new cause for burns due to ‘‘Bonzai’’ in this paper. A male patient with burns due to unknown causes was admitted to our burn center (Fig. 1). The patient did not know the exact cause of the burns. The common features of the patient were unknown causes of burns and >15% of body surface area with second- and third-degree burns. The patient experienced continuous seizures in the burn unit, so he was monitored in intensive care. The continuous seizures were probably caused by the long-lasting effect of the substance and its release. Serial escharectomies and split-thickness skin graftings were performed. The follow-up period was 2 months. The patient fully recovered after a total of four operations. Skin softness, thickness, elasticity, and color were considerably improved. Bonzai is highly addictive, causing burns unknowingly and leading to long-term hospitalization and costs. Unless dealt with, this addiction will lead to more problems, and collaboration with the psychiatry clinic is of particular importance.
Conflict of interest The authors declare that they have no conflict of interest. None of the authors has a financial interest in any
of the products, devices, or drugs mentioned in this manuscript.
Funding None.
reference
[1] Haum A, Perbix W, Ha¨ck HJ, Stark GB, Spilker G, Doehn M. Alcohol and drug abuse in burn injuries. Burns 1995; 21(May (3)):194–9.
Salih Onur Basat Fatih Ceran Muzaffer Kurt Mehmet Bozkurt* Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey *Corresponding author at: Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar/Istanbul, Turkey. Tel.: +90 5322760209; fax: +90 2124404242 E-mail address: [email protected] (S.O. Basat) http://dx.doi.org/10.1016/j.burns.2015.05.025 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.