1.A regression analysis of epidemiologic factors affecting survival in pediatric burn patients in a Philippine Tertiary Burn Center (January 2004 - December 2008).
Cruz Jose Joven V ; Lizardo Jesus A
Acta Medica Philippina 2011;45(3):20-27
BACKGROUND: The Alfredo T. Ramirez (ATR) Burn Center of the University of the Philippines-Philippine General Hospital, being the first burn unit assembled in the Philippines, is currently at the forefront of burn care in the country. It remains the largest tertiary burn center locally with an 11-bed capacity and caters to every Filipino in need of treatment due to burns.
OBJECTIVE: To describe the c1inico-epidemiologic profile of pediatric patients admitted to the UP-PGH ATR Burn Center from January 2004 to December 2008 as to the following: Age, Gender, % total body surface area (%TBSA) involvement, Severity of injury based on % TBSA involvement, Etiology of burn, Place of injury, Incidence of inhalational injury, Length of time prior to consult, Number of operations, Morbidity, Mortality; to determine the factors predictive of mortality among pediatric burn patients.
METHODS: A retrospective study on pediatric patients admitted to the ATR Burn Center UP-PGH treated for burn injuries from January 2004 to December 2008 was conducted. The Integrated Surgical Information System (ISIS), a computerized registry of the patients of the Department of Surgery was searched to identify pediatric burn patients aged 0 to 18 years old.
RESULTS: Of the 361 patients, 234 patients were male (64.82%) while 127 patients were female (35.18%). The odds of mortality in patients with flame burns was 2.24 (OR 95% CI: 1.01 to 4.96) times that of those who were scalded. The odds of mortality in patients with inhalational injury was 11.98 (OR 95% 0: 5.07 to 27.88) times higher than those without. The odds of mortality in patients with late consultation (>8 hours post-injury) was 2.24 (1.05 to 4.77) times that of those who were treated early. There was a significant association between survival outcome and the aforementioned factors.
CONCLUSION: The presence of inhalational injury, flame burns, delayed time of consultation, increased number of operations and the presence of nosocomial pneumonia, burn wound infection, and/or graft loss, were the variables noted to be independent predictors of mortality. Age, gender, burn size, severity, place of injury and length of stay were not found to be statistically associated with mortality.
Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Burn Units ; Incidence ; Hospitals, General ; Body Surface Area ; Length Of Stay ; Philippines ; Cross Infection ; Burns ; Morbidity ; Registries ; Pneumonia ; Wound Infection
2.Comparison of locally-produced microcellulose dressing from Acetobacter xylinum with silver sulfadiazine cream in the treatment of acute superficial partial thickness burn wounds: A preliminary report.
Velasco Lourna Leah D ; Cruz Jose Joven V
Philippine Journal of Surgical Specialties 2009;64(1):1-9
OBJECTIVES: To compare the efficacy, safety and cost of locally-produced microcellulose dressing from Acetobacter xylinum in promoting healing of superficial partial thickness burn wounds to standard dressing using silver sulfadiazine (SSD) cream and gauze in terms of the following: time to healing, morbidity/infection rate, pain score, scarring and cost of dressing
METHODS: Comparative controlled trial. Each patient served as his own control, that is, one area was randomized to the treatment group dressed with microcellulose dressing, while another was assigned to the control group dressing with SSD. Both areas were inspected regularly for signs of infection, as well as reepithelialization. The patients were also asked for the pain score at rest, and during dressing using the visual analog scale. Once healed, the Vancouver scale was used to grade the resultant scars.
RESULTS: Ten patients were included from February to June 2008. All patients were males, with a mean age of 30.1 years (17-48 years, ± 12.05), and a mean total body surface involvement of 12.75% (4-22% TBSA,?± 7.0) superficial partial thickness burns. The time in days to complete reepithelialization was significantly lower in MCD dressings (p-value=0.05760). The mean times (in days) to complete reepithelialization for MCD and SSD were 11.4 (90 percent CI: 9.80-13.0) and 13.8 (90 percent CI: 12.33-15.27) days, respectively. Statistical analysis of differences of VAS scores during dressing changes were significantly lower in MCD dressing on days 2,6,9 and 12 post burn. Background VAS scores were also lower in those patients with MCD dressing on days 6, 9 and 12 post burn. None of the wounds in either treatment arm had signs of infection. Scarring of wounds dressed with MCD were better, based on the Vancouver scar score than those dressed with SSD (p = 0.0299). The means for the Vancouver score for MCD and SSD were 2.65 (90 percent CI: 2.25-3.05) and 4.05 (90 percent CI: 3.32-4.78), respectively.
CONCLUSION: Microcellulose dressing is significantly more effective than silver sulfadiazine in treatment of second degree burn wounds in terms of number of days to full reepithelialization and quality of scarring. Dressing with MCD was less painful on days 2, 6, 9 and 12 post burn. Background VAS scores were also lower on days 6, 9 and 12 post burn. None ofthe wounds in both treatment arms had signs of infection throughout the treatment period.
Human
;
Male
;
Silver Sulfadiazine
;
Cicatrix
;
Gluconacetobacter Xylinus
;
Burns
;
Re-epithelialization
;
Bandages
;
Wound Healing
;
Pain
3.Endoscopic nipple-sparing mastectomy for early breast cancer: A case series of a minimally-invasive technique.
Clarence Pio Rey C. Yacapin ; Karen D. Mascardo ; Judy Carissa M. Atazan ; Jose Joven V. Cruz
Philippine Journal of Surgical Specialties 2022;77(1):15-20
This study aimed to share the authors’ preliminary experience with
endoscopic nipple-sparing mastectomy in the Philippines. All medical
records of patients who underwent endoscopic mastectomy done by
the same surgeons in two institutions from March to October 2019
were collected and analyzed. Surgical margin, operating time, blood
loss volume, and post-operative complications were noted. Three
cases were recorded during the study period. The mean operative
time was 341 minutes and the mean blood loss volume was < 20 mL.
All cases had negative margins of resection on final histopathology.
One patient developed ecchymosis on the axilla, while the other
patients had unremarkable post-operative courses. Endoscopic nipplesparing mastectomy is a potentially safe and feasible alternative in
breast cancer management. Further evaluation of the procedure is
recommended.
4.Use of autologous-fat graft in postenucleation-socket syndrome
Mary Louise L. Gutierrez ; Mary Rose Pe-Yan ; Anthony Christopher G. Ortiz ; Jose Joven V. Cruz
Philippine Journal of Ophthalmology 2009;34(2):70-73
Objective:
To describe the use of autologous-fat grafting in postenucleation-socket
syndrome.
Methods:
This is a case report.
Results:
There was marked improvement in the gross appearance of the treated
orbit of the patient. There was relief in enophthalmos and superior-sulcus
deformity. Bilateral orbital symmetry was achieved. Postoperatively, only
minimal bruising and swelling both in the orbit and source site were observed,
which resolved in 4 weeks.
Conclusion
The use of autologous-fat graft is a novel but highly effective technique and
a good alternative in treating patients with postenucleation-socket syndrome.
5.Inhalational injury: The Philippine General Hospital experience (2008-2013).
Jose Joven V. Cruz ; Pinky Dirain-Beran ; Alexandra Monica L. Tan-Gayos
Philippine Journal of Surgical Specialties 2018;73(2):45-51
OBJECTIVE:
Profiling of burn patients with inhalational injury will
lead to better practices in the immediate and supportive management
of their injuries. The goal of this study was to determine demographic
and clinical factors associated with mortality in burn patients with
inhalational injury admitted at Philippine General Hospital - Alfredo
T. Ramirez (PGH - ATR) Burn Center from 2008 to 2013.
METHODS:
All patients who were admitted from 2008 to 2013 were
included in the study. The patient database was searched for cases
of burn patients with inhalation injury. Medical records were
reviewed for further analysis. This study was exempted from review
by the University of the Philippines Manila Research Ethics Board.
RESULTS:
Out of 1900 burn patients included in the study, 134
presented with concomitant inhalation injury with a prevalence rate
of 7.0% and with a mortality rate of 38.06%. The study showed that
the following variables: 1) percent total body surface area (%TBSA),
2) length of time from injury to resuscitation, 3) nebulization with
N-acetylcysteine, 4) development of pneumonia, 5) administration
of systemic antibiotics, and 6) performance of bronchoscopy
correlated significantly with patient outcomes (p<0.05). Other
variables did not show significant correlations with outcomes. The
study also revealed that most of the patients were males with a mean
age of 30.62, who sustained severe burns usually greater than 39%
TBSA.
CONCLUSION
Poorer prognostic indicators include: 1) larger burnt
body surface area, 2) delayed intubation, 3) delayed resuscitation,
and 4) development of pneumonia.
Burns
6.Profile of patients admitted in the University of the Philippines - Philippine General Hospital Alfredo T. Ramirez Burn Center from August 2013 to July 2015.
Alexandra Monica L TAN ; Jose Joven V CRUZ ; Ma. Adela A. NABLE-AGUILERA
Philippine Journal of Surgical Specialties 2017;72(2):52-62
OBJECTIVE: This study aimed to describe the demographic profile of patients admitted at the UP-PGH ATR Burn Center from August 2013 - July 2015, and correlate it with outcomes of burn injury.
METHODS: A retrospective study of patients admitted at the UP- PGH ATR Burn Center from August 2013 to July 2015 was conducted, using the data in the Integrated Surgical Information System. Descriptive statistics was used to summarize the clinical characteristics of patients. Logistic regression analysis determined the significant predictors of mortality. STATA 12.0 was used for data analysis.
RESULTS:The age groups most commonly involved were: 1 operation). Ninety-one percent (91%) of the admitted burn patients improved; 9% of the patients died. The most common cause of death was multiple organ dysfunction syndrome (40%). Significant factors associated with mortality included: 1) percent total body surface area, 2) inhalational injury and 3) involvement of the head, lower extremities and perineum.
CONCLUSION: Burns continue to be a big burden to developing countries. To confront the burden of burns especially in developing countries like the Philippines, key primary preventive measures should be implemented and be a priority for public health advocates.
Human ; Male ; Female ; Multiple Organ Failure ; Perineum ; Cause Of Death ; Burns ; Hospitalization ; Head ; Lower Extremity
7.Inhalation injury: A two-year pilot assessment on the adherence to the clinical pathway for adult burn patients at high risk for inhalation injury in the Philippine General Hospital.
Jose Joven V. Cruz ; Mario Emmanuel L. Lopez de Leon ; Alexandra Monica L. Tan-Gayos ; Miriam Quinto ; Jubert P. Benedicto
Philippine Journal of Surgical Specialties 2020;75(2):132-140
OBJECTIVE:
This study determined the mean overall adherence to
the clinical pathway formulated by the Section of Pulmonology
together with the Division of Burns for adult burn patients at high
risk for inhalation injury admitted at the UP-PGH ATR Burn Center
in a two-year period
METHODOLOGY:
A retrospective cohort study regarding adherence
to the clinical pathway of acutely burned adult patients at high risk
for inhalation injury admitted at the UP-PGH ATR Burn Center
between August 2016 to July 2018 was conducted. Medical records
were reviewed and an adherence checklist was used to assess each
item in the clinical pathway. For the adherence and patient profile,
descriptive statistics were used.
RESULTS:
This pilot assessment study showed acceptable rates of
adherence and implementation of the clinical pathway. Overall, 60%
of the cases followed the clinical pathway completely. While 26.67%
had acceptable rates of compliance (more than half of items adhered),
while 13% of the cases scored adhered to less than half of the items.
CONCLUSION
The pathway has been shown to be a feasible clinical
pathway that can be implemented in a tertiary hospital setting.
Burns