Burn injuries in the Jeddah area of Saudi Arabia: a study of 319 cases

Three hundred and nineteen patients with different types of burns were studied at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December, 1985 to December, 1987). Scalding was the most common cause (56.4 per cent) of burn injuries compared with 41.4 per cent of patients who sustained flame injury; 84.6 per cent of the thermal injuries occurred at home, with children (less than or equal to 18 years of age) being affected most frequently (61.8 per cent). The overall mortality was 9.4 per cent.     

Screening for abdominal aortic aneurysm in the Jeddah area,western Saudi Arabia

Atherosclerosis and its complications are associated with high morbidity and mortality in the elderly. One of these complications is abdominal aortic aneurysm which may be prevented from rupturing if diagnosed early. Screening for aortic aneurysm was carried out in Jeddah, which is in the western region of Saudi Arabia, to identify the magnitude of this problem. Three groups were studied: patients with hypertension (n = 101), patients with peripheral vascular disease (n = 71) and a third group of controls (n = 220). The mean (range) age of the whole sample was 66.0 (60–80) years. Evidence of aortic aneurysm was found in seven participants: five in the peripheral vascular disease group (7.0%), one in the hypertensive group (1.0%) and one in the controls (0.5%). In view of the expected increase in the elderly population of Saudi Arabia, as a result of improvements in health care which have recently been achieved, it is expected that a similar increase in the incidence of abdominal aortic aneurysm may occur. Routine screening for abdominal aortic aneurysm in the elderly, especially in those with peripheral vascular disease, may be worthwhile.     

Malnutrition is prevalent among hemodialysis patients in Jeddah, Saudi Arabia

Malnutrition (MN) in hemodialysis patients (HDP) is prevalent worldwide. How-ever, data regarding the nutritional status among HDP living in Jeddah, Saudi Arabia, is lacking. The purpose of this study was to detect MN in HDP at the Jeddah Kidney Center, with an inexpensive nutritional assessment protocol consisting of anthropometric body mass index (BMI), triceps skin fold (TSF), mid-arm muscle circumference (MAMC) and biochemical (albumin) blood measurements and the seven-point subjective global assessment (SGA). A cross-sectional study assessed 269 HDP for MN through a questionnaire, SGA and anthropometric and biochemical measurements. Spearman's rank correlation coefficients were determined between SGA and anthropometric and biochemical measurements as well as the relative odds of MN. Statistical significance was P <0.05. These HDP were 48.7% moderately and 6.3% severely malnourished. Albumin, BMI, TSF and MAMC correlated positively with the seven-point SGA (r s = 0.16, P = 0.007; r s = 0.33, P <0.001; r s = 0.29, P <0.001; and r s = 0.34, P <0.001, respectively). Those HDP who were female (Odds ratio [OR] = 2.04, P = 0.036), older (≥55 years) (OR = 1.70, P = 0.087), uneducated (OR = 1.80, P = 0.072), with a lower BMI (<18 kg/m2) (OR = 2.00, P = 0.077) and thinner TSF (OR = 1.45, P = 0.041) had a greater risk of MN. The high prevalence of MN was detected with an inexpensive protocol. Women with thinner TSF were more likely to be malnourished. The implementation of this protocol is warranted along with dietary education and counseling to decrease MN in HDP.     

Iatrogenic vascular injuries in western Saudi Arabia

A group of 30 consecutive patients with iatrogenic vascular injury were studied to determine the aetiology of the condition and to investigate its possible prevention. Of the patients, 18 were males and 12 females; mean age was 37.0 years (range 2 weeks to 70 years). Most injuries (n = 25) involved the arterial system; eight cases (27%) were recognized during the operative procedure. The most common presentations were bleeding and chronic ischaemia. Cannulation of vessels was the cause of injury in 14 cases (47%); two-thirds of these were iatrogenic in nature. A conservative policy was adopted in nine patients; surgery was planned but not performed in two. A total of 19 patients were operated on (17 reconstructions, one ligation, one fasciotomy); two died from causes related to their original condition. In order to reduce the incidence of iatrogenic injury, medical personnel should be informed of possible vessel damage, especially during cannulation. All surgical and radiological procedures should be carefully audited.     

Admissions to a new burn unit in Gizan, Saudi Arabia

In an attempt to introduce western treatment principles, Danish chiefs have been in charge of a new Burn Unit in Gizan for the first 2 years and 9 months. We have treated 348 burned patients with a median 16 per cent estimated area of burn (EAB). One-quarter of the patients had more than 25 per cent EAB. Flame burns were the most frequent and females suffered the more severe injury. The mechanisms of burning are discussed.     

Burn treatment in a new burn unit in Gizan, Saudi Arabia

During the 2 years and 9 months when a new burn unit was under Danish leadership, 348 admitted patients were treated. Exposure treatment and Ringer's lactate were used for burn shock. Due to lack of blood, infections and discharge against medical advice, only 106 patients had operations. Fifty-six patients died from their burns and concomitant diseases, 44 of these were women, often with very extensive burns. Our results are comparable to those reported from departments in similar geographic areas. The special problems in treatment are discussed.     

Paediatric burn injuries in Sub Saharan Africa--an overview

Paediatric burn injuries in Sub Saharan Africa are common and often lead to devastating consequences. Unfortunately relevant and accurate data regarding these injuries is sketchy and incomplete. This paper reviews the available information on the epidemiology of paediatric burns in Africa, associated health problems and contributing environmental factors responsible for these burns. The current status of burn care, the lack of infrastructure, and traditional methods of treatment, further contribute to the unsatisfactory status of overall burn management, prevention, and rehabilitation of burn survivors. A strategy for improving burn care in Africa has been formulated. The management of childhood burns will only be successful if educational, social, fiscal and infrastructure standards are improved. Traditional beliefs and methods cannot be discarded as they play an important role in the management of these children. It is furthermore essential that local and central government organisations support these initiatives. Clearly, the children of Africa deserve better burn care.     

Paediatric burn injuries in New England, USA

The authors analysed a subset of data from the New England Regional Burn Program (NERBP) to describe the epidemiology of burn injuries for children aged from birth to 19 years in the six-state New England area of the USA. The subset of the NERBP data analysed pertained to residents of the six New England states who were admitted to hospital for the treatment of a burn injury sustained between 1 July 1978 and 30 June 1979. Analysis of the data revealed that 1128 (41 per cent) of the 2742 hospitalized burns identified occurred to persons between the ages of birth and 19 years, yielding an overall burn incidence rate of 30.7 burns per 100,000 person-years. Children aged from birth to 2 years sustained a higher burn rate, 96.7 burns per 100,000 child-years, than did children in any other age category. The burn rate for males was higher than the rate for females in each age category, as were the rates for black children compared to white children. Children in Massachusetts experienced the highest overall burn rate among the six New England states; the lowest rate occurred in New Hampshire. Overall, 63 per cent of the burns occurred in a residential setting. The most common activities related to burn injury were food preparation and food consumption, which accounted for 471 (42 per cent) of the burn injuries.     

Severe mincer injuries of the hand in children in Saudi Arabia

A review of twenty-two children with a mean age of 1.9 +/- 0.3 years who sustained injuries to the fingers and hand by domestic mincer machine. In each case the child inserted his hand in the machine while in motion. The pattern of injury is discussed and recommendations to avoid these mutilating injuries are made.     

A study of burn injuries in the elderly in a regional burn centre

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.     

Predictors for morbidity and mortality following non-traumatic splenectomy at the University Hospital, Jeddah, Saudi Arabia

OBJECTIVE: To determine the pre-operative predictors of morbidity and mortality of patients undergoing elective splenectomy for non-trauma indications. METHODS: Analysis of 123 patients who underwent splenectomy at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 1986-1996. Data collected included patients' demographic data, indication for splenectomy, laboratory data, details of operative procedure and postoperative events for morbidity and mortality. Statistical analysis was carried out using the Chi-square test. RESULTS: Of the patients, 69% were males and 31% females with ages ranging from 13-72 years (mean 39 years). Portal hypertension constituted 55% of the indications and benign hematological conditions 26%. The morbidity rate was 27.6% and the commonest complication was chest and wound infection in 6.6% and 5.7%, respectively. Age of >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative time of >120 min had P values of < 0.05, <0.002, <0.03 and <0.03, respectively for postsplenectomy mortality. CONCLUSIONS: According to this study, age of >50 years is a significant predictor for morbidity following splenectomy, whereas age >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative duration >120 min were significant predictors of postsplenectomy mortality.     

Long-term psychosocial adjustment in patients with severe burn injuries: a follow-up study.

An investigation of the long-term psychosocial adjustment of patients with severe burn injuries is presented. In the selected 13-year period (1968-80) 46 patients fulfilled the entry criteria: burns covering more than 30 per cent body surface area (deep dermal or full skin thickness). Seventeen patients died early and one later. Of the remaining 28 patients, contact was made with 25 (89.3 per cent) who all participated. The observation time ranged between 7 and 21 years. The patients received a semi-standardized interview adjusted for age at the time of burn injury, a psychiatric interview and a physical examination to assess the permanent character and functional loss. The principal findings were: no correlation could be found between degree of disfiguration/function loss and the long-term psychosocial adaptation after severe burn injuries. The determinant factor was the premorbid psychiatric/psychological integration and, to some extent, support from staff and relatives.     

Kidney transplantation in Saudi Arabia: a unique experience

Summary Kidney transplantation in the kingdom of Saudi Arabia began 16 years ago. In this relatively short period, transplantation has developed so quickly that Saudi Arabia currently has the largest cadaveric kidney transplantation program in the Moslem world. This article illustrates the achievements and progress made through the past and casts a light on differences in the transplantation practice in this part of the world.     

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21–30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11–20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.     

"Outbreak" of hand injuries during Hajj festivities in Saudi Arabia.

Pediatric hand surgeons in Europe and North America are aware of the yearly "outbreak" of pediatric hand injuries on Halloween from carving pumpkins. This study reports another yearly "outbreak" of hand injuries--in Saudi Arabia from slaughtering sheep. During the 3 days of festivities following the Hajj ceremony, hundreds of thousands of sheep are slaughtered. Over 4 consecutive years, 298 patients attended the emergency room of Riyadh Central Hospital with injuries related to the slaughtering of animals sustained during the 3 days of festivity. Almost three quarters of patients (73%) were injured on the first day of festivity. The majority (92%) were nonprofessionals. Children accounted for 6.7% of patients. In adults, the female-to-male ratio was 1:7. The most common mechanism of injury was a knife cut (80.9%). Almost three quarters of injuries (73.5%) affected the hands, with more involvement of the left than the right hand. Only 7.7% of patients with hand injuries were admitted to the hospital for treatment. It was concluded that implementing safety measures while slaughtering, and educating the general population would be important in the prevention of these hand injuries in Saudi Arabia.     

Paediatric burn injuries in Enugu,South-East Nigeria: A 7-year multi-centre retrospective review

Burn injuries contribute significantly to childhood morbidity and mortality. This study was designed to document the pattern of presentation and outcome of pediatric burn injury in Enugu.MethodsAll children with burn injuries over a 7-year period (June 2011 to May 2018) and were managed at three tertiary health institutions, were studied. Information including their socio-demographics, clinical features and treatment outcome were obtained and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0.Results198 out of 201 records were available for analysis. Most (186; 93.9%) burn injuries occurred at home. Hot liquid (112; 56.7%) was the commonest cause of burn injury. A lot of substances were used topically for first aid, raw eggs (52; 31%) being the commonest. The outcome had significant association with cause of injury, depth of injury, total burn surface area (TBSA), and inhalation injury. Most were safely discharged home while a total of thirteen (6.6%) children died. LA₅₀ was 54.87%, while the maximum TBSA salvaged was 65%.ConclusionBurn injuries in children in this environment remain a serious challenge in the face of widespread lack of awareness regarding safe practices in handling hot and flammable items at home.     

Osteoarticular complications of childhood brucellosis: a study of 57 cases in Saudi Arabia.

Fifty-seven (36%) of a cohort of 157 children with brucellosis from Saudi Arabia had arthritis. Most gave a history of contact with farm animals or drinking unpasteurized milk. Associated features included pyrexia, arthralgia, hepatosplenomegaly, and lymphadenopathy. A subacute presentation with peripheral oligoarthritis predominantly affecting hips or knees was common. Specific chemotherapy resulted in rapid defervescence followed by slower resolution of the arthritis. Children with osteoarticular brucellosis had a higher relapse rate and a longer hospital stay. Supervised combination chemotherapy for at least 6 weeks was effective in preventing relapse. A brucellar etiology should be considered in any child from an endemic area who has osteoarticular manifestations.