Case Report: Medicolegal evaluation in a case of fatal scald where a child fell into a cauldron in rural Nepal

Thermal injuries in young children involving the buttocks, perineum, and lower limbs raise suspicion of child abuse. Determining the manner of death and ruling out homicide in a fatal case of scalding remains a challenge for forensic practitioners. One such issue is reported in the present case report, where a medicolegal evaluation of a fatal scald in a two-year-old girl child is discussed. Young children sustaining serious injuries from scalds is a grave social concern. Such young lives need to be protected from scald injuries whether accidental or purposeful. Differences in injury patterns on the basis of their distribution and their characteristics are important to determine manner of death in such cases.

Estimation of ergonomic indicators of special purpose clothing for patients with thermal injuries

This article discusses the determination of the optimal design allowances for a full factorial experiment in the development of special-purpose clothing for patients with thermal injuries in a hospital. To assess the ergonomic performance of special-purpose clothing, was used of pressure exerted by clothing on the human body. Based on the results of the study, a mathematical model was developed based on a full factorial experiment. In accordance with the presented mathematical models, the minimum values of contact pressures are obtained for the following values of construction parameters: for a cut with a sewn-in sleeve Warmhole = 15 cm, Ifa = 5,0 cm, Ic = 9 cm, Hse = 10 cm; for a cut with a raglan sleeve Warmhole = 15 cm, Ifa = 6 cm, Ic = 10 cm; for a cut with a one-piece sleeve Warmhole = 16 cm, Ifa = 6 cm, Ic = 11 cm.

Methodological approaches to the application of burns classifications in determining the severity of injuries in Ukraine

The article considers the existing classifications of thermal burns by the depth of the lesion. The analysis and comparison of different classifications among themselves is carried out. The problems that may arise in forensic medical practice in determining the severity of thermal burns, which are associated with the use of different classifications, are demonstrated. The use of different classifications of burns according to the depth of the lesion can lead to incorrect determination of the severity of injuries when compiling the "Expert Conclusion". Methodological approaches that will avoid this are presented. The aim of the work. Elaboration of methodological approaches to the use of modern classifications of burns, which are introduced in Ukraine and in other countries, during forensic medical examinations of thermal injuries. Materials and methods. Analysis, synthesis, comparison and analogy of printed and electronic legal documents of Ukraine, domestic and foreign forensic and medical literature on burn injury. Results. Analysis and comparison of different modifications of burns classification by depth of injury revealed that modern classifications by combinations of numbers and letters differ from the classification of burns by depth, which is used in forensic practice in Ukraine in determining the severity of thermal injuries. The forensic expert during the examination in cases of thermal injury examines the medical records that contain information about the treatment of the victim. Victims can be treated in various medical institutions both in Ukraine and abroad. Thus, different classifications are used in the formulation of the diagnosis, which can lead to incorrect determination of the severity of the injury caused by high temperature. The result is a biased "Expert Conclusion", which may later be considered inadequate evidence in criminal proceedings. To prevent erroneous assessment of the degree of burns, the expert must find out what classification of burns is used in making a clinical diagnosis, and interpret the specified degree of burns in accordance with the gradation of burns, which regulates the activities of forensic experts. Conclusion. At present, the «Rules of forensic determination of the severity of injuries», which were approved in Ukraine in 1995, don't provide adequate methodological support for forensic expert research, which should correspond to the current level of development of medical science and clinical practice. The introduction of the achievements of world medicine into the domestic forensic medical practice should be facilitated by modern legal documents regulating the activities of forensic medical institutions of Ukraine.

Rheosorbilact in complex intensive therapy of burn toxemia

Background. Thermal injuries primarily cause coagulation necrosis and cell death with vascular thrombosis in the areas of the deepest lesion.Objective. To study the effectiveness of rheosorbilact in infusion therapy during the period of burn toxemia.Materials and Methods. The results of monitoring the daily volume of the injected fluid, infusion therapy and renal excretory activity of 25 patients admitted to the Department of Combustiology of Republican Research Center of Emergency Medicine due to burn injury were studied.Results. The average daily volume of infusion therapy in group 1, FI – 119.4 ± 38.4 units at the age of 27.3 ± 5.6 years, was 76 ± 7 ml/kg per day, in group 2 (50.7 ± 7.1 years), FI – 92.5 ± 20.8 units, the introduction of 64 ± 9 ml/kg was effective, in group 3 (71.3 ± 7.0 years), FI – 86.7 ± 12.8 units, the introduction of an average of 48 ± 11 ml/kg per day was sufficient. In the nonlinear nature of changes in intravenous infusion, 4–5-day periods can be noted, probably due to the current factors that determined the need to increase or decrease infusion therapy. The introduction of rheosorbilact in a volume of 10 ml/kg per day increased the hourly renal excretory activity in all patients during the period of toxemia. The diuretic effect was more pronounced in patients of group 1, which corresponded to a greater volume of water load and the severity of burn injury.Conclusions. The introduction of rheosorbilact in a volume of 10 ml/kg per day increased the hourly renal excretory activity in all patients during the period of toxemia.

A review of the most impactful published pharmacotherapy-pertinent literature of 2019 and 2020 for clinicians caring for patients with thermal or inhalation injury

Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years’ work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1,536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

Study of soft tissue reconstruction in postburn flexion contracture of the hand

Background: Burn contracture of the hand can leave patients with severe functional and psychological limitations. This study evaluates the severity of the deformity and various reconstructive options in post-burn hand injuries.Methods: This work includes the study of 50 patients who underwent reconstruction for post-burn flexion contracture of the hand, including fingers, in the department of plastic surgery. The patients were treated between April 2007 to April 2009.Results: Males were more commonly affected by burn injuries and thermal burns were more common than electrical burns. The little finger showed higher involvement and contracture release followed by grafting was the commonly done reconstructive procedure.Conclusions: Split thickness skin graft (SSG) were more effective in reconstruction in thermal injuries, while cross finger flaps (CFF) showed more promise in electrical injuries of the hand.

VASER Liposuction. How to Get Natural Results with Ultrasound Assisted Liposuction?

Ultrasound assisted liposuction technology is a selective technique to emulsify fatty tissue and improve the removal of fat. This technique can be used on many areas of the body such as: chin neck, back, buttocks, abdomen, legs, arms. Fatty areas, as well as, skin and cellulite can be molded in a process known as ultrasound cavitation. Results can produce significant skin contraction and smoothing of areas. Using this method reduces the need for surgical intervention and requires less energy to achieve similar results. This method is also good for treatment of fibrous scar tissue, producing less bruising and blood loss. The advantages of the VASER ultrasound prepared liposuction in comparison to the mechanical liposuction method are better with fat extraction, less blood loss, and smoother results. While the disadvantages of VASER ultrasound method are possible thermal injuries, the need for larger incisions for protective ports, increased incidence of seromas, slightly increased cost and longer preparation and operative times. However further presentation will show the benefits of this newer generation of liposuction method. Also, various probes for better fat extraction and specific treatment areas will be discussed.

Cerium(III) Nitrate Containing Electrospun Wound Dressing for Mitigating Burn Severity

Thermal injuries pose a risk for service members in prolonged field care (PFC) situations or to civilians in levels of lower care. Without access to prompt surgical intervention and treatment, potentially salvageable tissues are compromised, resulting in increases in both wound size and depth. Immediate debridement of necrotic tissue enhances survivability and mitigates the risks of burn shock, multiple organ failure, and infection. However, due to the difficulty of surgical removal of the burn eschar in PFC situations and lower levels of care, it is of utmost importance to develop alternative methods for burn stabilization. Studies have indicated that cerium(III) nitrate may be used to prolong the time before surgical intervention is required. The objective of this study was to incorporate cerium(III) nitrate into an electrospun dressing that could provide burst release. Select dosages of cerium(III) nitrate were dissolved with either pure solvent or polyethylene oxide (PEO) for coaxial or traditional electrospinning set-ups, respectively. The solutions were coaxially electrospun onto a rotating mandrel, resulting in a combined nonwoven mesh, and then compared to traditionally spun solutions. Dressings were evaluated for topography, morphology, and porosity using scanning electron microscopy and helium pycnometry. Additionally, cerium(III) loading efficiency, release rates, and cytocompatibility were evaluated in both static and dynamic environments. Imaging showed randomly aligned polymer nanofibers with fiber diameters of 1161 ± 210 nm and 1090 ± 250 nm for traditionally and coaxially spun PEO/cerium(III) nitrate dressings, respectively. Assay results indicated that the electrospun dressings contained cerium(III) nitrate properties, with the coaxially spun dressings containing 33% more cerium(III) nitrate than their traditionally spun counterparts. Finally, release studies revealed that PEO-based dressings released the entirety of their contents within the first hour with no detrimental cytocompatibility effects for coaxially-spun dressings. The study herein shows the successful incorporation of cerium(III) nitrate into an electrospun dressing.

Dermatological Manifestations of Magnesium and Thermite Poisoning

Thermite is a metal powder and metal oxide mixture that is pyrotechnic. Thermite conducts an exothermic decrease oxidation process (redox) when inflamed by the heat or chemical reaction. Burning thermite or magnesium produces predominantly thermal injury that may be considered identical to deep partial- or full-thickness thermal burns. While exposure to incendiary metals can occur in many settings, serious burns are most likely to result from industrial or military incidents. The main cause of thermal damage in combustion thermite or magnesium is the identical to the profound burning thermal burning of partial or total thickness. Thermite incendiaries can create several tiny, deep, dispersed molten iron burns. Local anesthetic may make this feasible. Outcomes and complications of incendiary metal burns are similar to other thermal injuries. In this paper we overview magnesium and thermite poisoning dermatologically and their management.