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Response to Letter to the Editor: “Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana” and I have some opinions about it
burns 40 (2014) 354–363
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it
Dear Editor, I read with interest the article by Pius Agbenorku entitled ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it [1]. My comments are divided into 3 parts: First, the most common cause of burn was not identical in the two groups. In group 1 (old BICU), the most common cause of burn was flame in comparison with group 2 (new BICU) in which the most common cause was hot fluid. As we know, flame burn especially in closed space may be associated with respiratory injury that increases mortality rate [2]. In the other hand flame burns are usually deeper than hot liquid burn and their management is more complex and problematic. Hot liquid burns usually heals in less than 2–3 weeks and without scar formation. They usually do not benefit from excision and grafting. Flame burns usually are deeper and do benefit from excision and grafting to heal in a timely fashion. So flame burns mortality is more that hot liquid burns [3]. Second, it is better to postpone excision and grafting after 1st 24–48 h because burn resuscitation may be compromised. Third, usage of Vaseline gauze, that do not have any antibacterial properties, on deep burn in hospitalized and immune deficient burnt patients can make them more susceptible to nosocomial wound infection and sepsis. On the other hand, application of strong antibiotics such as silver sulfadiazine on face burns that usually heal in less than 2–3 weeks and without scar formation, due to good blood supply (even in deep 2nd degree burns), can cause delay in wound healing and inadvertently scar formation. This study is a good start for further studies with similar groups.
Conflict of interest None declared.
references
[1] Agbenorku P. Modernized standards in burns management: a comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana. Burns 2013, http://www.sciencedirect.com/ science/article/pii/S0305417912004044. [2] Bloemsma GC. Mortality and causes of death in a burn centre. Burns 2008, http://www.sciencedirect.com/science/ article/pii/S0305417908000715. [3] Sharma PN. Paediatric burns in Kuwait: incidence, causes and mortality. Burns 2006, http://www.sciencedirect.com/ science/article/pii/S0305417905002391.
Mehdi Ayaz* Shiraz Burn Research Center, Department of Surgery, Ghotbeddin Shirazi Burn Hospital, Shiraz University of Medical Sciences, Shiraz, Iran *Tel.: +98 9121085896 E-mail address: [email protected] (M. Ayaz) Accepted 31 July 2013 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.07.020
Reply Response to Letter to the Editor: ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it
BURNS: response to comments Part 1 As stated in the ‘‘Letter to the Editor’’ by Mahdi Ayaz, ‘‘In group 1 (old BICU) the most common cause of burn was flame in
355
burns 40 (2014) 354–363
comparison with group 2 (new BICU) in which the most common cause was hot fluid’’ was due to a major factor which explains as follows. In the earlier study by Agbenorku et al. (2010) focus was on four fire disasters that occurred within the middle belt of Ghana (where Kumasi is located) from 2007 to 2008 which were petrol related fires; victims of these petrol related fires formed the group one patients within the period May 2007 till April 2009 who were managed in the group 1 (old BICU) whereas patients in group two (new BICU, from May 2009 to April 2011) were mostly general burns victims of which scalds dominated as the major aetiology of the admissions [1]. It is also true that flame burns especially in closed space may be associated with respiratory injury that would often increase the mortality rate. Although, the two groups had different aetiology of burn in the study, the comparative analysis revealed no significant difference for aetiology (Table 4). The interpretation of the analysis means, the variation in cause of burn in both groups does not have any effect in the comparism, in other words, aetiology of burn is not a factor to be considered in terms of comparism in both new and old groups. Additionally, it is also important to note that clinical research and studies have gone beyond the era where higher percentages were seen as the majority, hence will have an impact or effect on the study. Clinical analysis with specific applications under set confidence intervals are needed to be conclusive in ones results reportage.
Part 2 Burn resuscitation in the study had been explained in details in the ‘‘Summary of Protocol’’ section, where resuscitation was achieved within the shortest possible period. Also, the ‘‘Surgery’’ sub-section had explained various durations of surgery in the study. Hence, burns resuscitation may not be compromised.
Part 3 Usage of Vaseline gauze was done in addition to antibiotics (Tablets and Infusions); also wound swabs for culture and sensitivity were taken and the antibiotic regime changed or continued accordingly. This would prevent (not totally, though) sepsis in even deep burn patients (Laboratory investigations and Wound dressing Sections).
reference
[1] Agbenorku P, Akpaloo J, Farhat BF, Hoyte-Williams PE, Yorke J, Agbenorku M, et al. Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences. Burns 2010;36:1309–15.
Pius Agbenorku Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
E-mail address: [email protected] (P. Agbenorku) 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.09.001
Letter to the Editor Self-immolation – A protest against unfair practices in family/society?
We read with interest a recently published article entitled ‘‘Why it is so important to prevent self-immolation around the globe?’’ [1]. Self-immolation has a far reaching medical and social outcome and there is certainly a need for a social campaign worldwide to prevent these deaths. In this correspondence we wish to highlight certain details relating to the two types of self-immolations discussed by Rezaeian [1]. Availability, accessibility, popularity, and social acceptability are the major factors in the choice of methods of suicide, and preference of self-immolation as a method of suicide among females is well known [2,3]. Self-immolation among young married females has been a cause of concern in Indian sub-continent and ‘Dowry’ is one well recognized cause for suicides and parasuicides among young, married women in India [4]. A protest on the other hand, is an expression of dissent or disapproval of certain policies or situations. The protests likewise can involve any method. Just like a suicide chooses a certain method to commit suicide, the protesters opt for a particular method to show their dissent. The author [1] states that among the two types, the first type of self-immolation receives vast coverage by the mass media, and this vast coverage may possibly bring about some desired changes. On the other hand, second type of selfimmolation hardly receives any mass media coverage, and is not successful to change the unfair family situation. However, we would like to point out that self-immolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain. Similarly, just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true. India alone has seen the majority of the worldwide protests involving self-immolation during 1963–2002 [5]. None of these events, however, had a favourable outcome in terms of the reason for protest. On the other hand, newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause. In this regard, The Dowry Prohibition Act was enacted in 1961, which was followed by insertion of more stringent criminal laws by amendments in the Indian Penal code (IPC). Section 498A was inserted into the
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it
Dear Editor, I read with interest the article by Pius Agbenorku entitled ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it [1]. My comments are divided into 3 parts: First, the most common cause of burn was not identical in the two groups. In group 1 (old BICU), the most common cause of burn was flame in comparison with group 2 (new BICU) in which the most common cause was hot fluid. As we know, flame burn especially in closed space may be associated with respiratory injury that increases mortality rate [2]. In the other hand flame burns are usually deeper than hot liquid burn and their management is more complex and problematic. Hot liquid burns usually heals in less than 2–3 weeks and without scar formation. They usually do not benefit from excision and grafting. Flame burns usually are deeper and do benefit from excision and grafting to heal in a timely fashion. So flame burns mortality is more that hot liquid burns [3]. Second, it is better to postpone excision and grafting after 1st 24–48 h because burn resuscitation may be compromised. Third, usage of Vaseline gauze, that do not have any antibacterial properties, on deep burn in hospitalized and immune deficient burnt patients can make them more susceptible to nosocomial wound infection and sepsis. On the other hand, application of strong antibiotics such as silver sulfadiazine on face burns that usually heal in less than 2–3 weeks and without scar formation, due to good blood supply (even in deep 2nd degree burns), can cause delay in wound healing and inadvertently scar formation. This study is a good start for further studies with similar groups.
Conflict of interest None declared.
references
[1] Agbenorku P. Modernized standards in burns management: a comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana. Burns 2013, http://www.sciencedirect.com/ science/article/pii/S0305417912004044. [2] Bloemsma GC. Mortality and causes of death in a burn centre. Burns 2008, http://www.sciencedirect.com/science/ article/pii/S0305417908000715. [3] Sharma PN. Paediatric burns in Kuwait: incidence, causes and mortality. Burns 2006, http://www.sciencedirect.com/ science/article/pii/S0305417905002391.
Mehdi Ayaz* Shiraz Burn Research Center, Department of Surgery, Ghotbeddin Shirazi Burn Hospital, Shiraz University of Medical Sciences, Shiraz, Iran *Tel.: +98 9121085896 E-mail address: [email protected] (M. Ayaz) Accepted 31 July 2013 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.07.020
Reply Response to Letter to the Editor: ‘‘Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana’’ and I have some opinions about it
BURNS: response to comments Part 1 As stated in the ‘‘Letter to the Editor’’ by Mahdi Ayaz, ‘‘In group 1 (old BICU) the most common cause of burn was flame in
355
burns 40 (2014) 354–363
comparison with group 2 (new BICU) in which the most common cause was hot fluid’’ was due to a major factor which explains as follows. In the earlier study by Agbenorku et al. (2010) focus was on four fire disasters that occurred within the middle belt of Ghana (where Kumasi is located) from 2007 to 2008 which were petrol related fires; victims of these petrol related fires formed the group one patients within the period May 2007 till April 2009 who were managed in the group 1 (old BICU) whereas patients in group two (new BICU, from May 2009 to April 2011) were mostly general burns victims of which scalds dominated as the major aetiology of the admissions [1]. It is also true that flame burns especially in closed space may be associated with respiratory injury that would often increase the mortality rate. Although, the two groups had different aetiology of burn in the study, the comparative analysis revealed no significant difference for aetiology (Table 4). The interpretation of the analysis means, the variation in cause of burn in both groups does not have any effect in the comparism, in other words, aetiology of burn is not a factor to be considered in terms of comparism in both new and old groups. Additionally, it is also important to note that clinical research and studies have gone beyond the era where higher percentages were seen as the majority, hence will have an impact or effect on the study. Clinical analysis with specific applications under set confidence intervals are needed to be conclusive in ones results reportage.
Part 2 Burn resuscitation in the study had been explained in details in the ‘‘Summary of Protocol’’ section, where resuscitation was achieved within the shortest possible period. Also, the ‘‘Surgery’’ sub-section had explained various durations of surgery in the study. Hence, burns resuscitation may not be compromised.
Part 3 Usage of Vaseline gauze was done in addition to antibiotics (Tablets and Infusions); also wound swabs for culture and sensitivity were taken and the antibiotic regime changed or continued accordingly. This would prevent (not totally, though) sepsis in even deep burn patients (Laboratory investigations and Wound dressing Sections).
reference
[1] Agbenorku P, Akpaloo J, Farhat BF, Hoyte-Williams PE, Yorke J, Agbenorku M, et al. Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences. Burns 2010;36:1309–15.
Pius Agbenorku Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
E-mail address: [email protected] (P. Agbenorku) 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.09.001
Letter to the Editor Self-immolation – A protest against unfair practices in family/society?
We read with interest a recently published article entitled ‘‘Why it is so important to prevent self-immolation around the globe?’’ [1]. Self-immolation has a far reaching medical and social outcome and there is certainly a need for a social campaign worldwide to prevent these deaths. In this correspondence we wish to highlight certain details relating to the two types of self-immolations discussed by Rezaeian [1]. Availability, accessibility, popularity, and social acceptability are the major factors in the choice of methods of suicide, and preference of self-immolation as a method of suicide among females is well known [2,3]. Self-immolation among young married females has been a cause of concern in Indian sub-continent and ‘Dowry’ is one well recognized cause for suicides and parasuicides among young, married women in India [4]. A protest on the other hand, is an expression of dissent or disapproval of certain policies or situations. The protests likewise can involve any method. Just like a suicide chooses a certain method to commit suicide, the protesters opt for a particular method to show their dissent. The author [1] states that among the two types, the first type of self-immolation receives vast coverage by the mass media, and this vast coverage may possibly bring about some desired changes. On the other hand, second type of selfimmolation hardly receives any mass media coverage, and is not successful to change the unfair family situation. However, we would like to point out that self-immolation as a method of protest may attract vast media coverage but whether the same is likely to bring desired changes is uncertain. Similarly, just because individual cases of self-burning in the second type of self-immolation do not receive much coverage in media, it does not bring about changes in the unfair family situation may not hold true. India alone has seen the majority of the worldwide protests involving self-immolation during 1963–2002 [5]. None of these events, however, had a favourable outcome in terms of the reason for protest. On the other hand, newer laws have been enacted in India time and again to curb the problem of dowry deaths for which self-burning is recognized as the most common cause. In this regard, The Dowry Prohibition Act was enacted in 1961, which was followed by insertion of more stringent criminal laws by amendments in the Indian Penal code (IPC). Section 498A was inserted into the