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Long-term mental health outcomes after unintentional burns sustained during childhood:a retrospective cohort study

Burns & Trauma 2018年第4期6卷 269-278页

作者： Janine M.Duke Sean M.Randall thirthar p.vetrichevvel Sarah McGarry James H.Boyd Suzanne Rea Fiona M.Wood Burn Injury Research Unit Faculty Health and Medical SciencesThe University of Western AustraliaM31835 Stirling HighwayCrawleyPerthWestern Australia 6009Australia Centre for Data Linkage Curtin UniversityPerthWestern AustraliaAustralia Curtin Medical School Curtin UniversityPerthWestern AustraliaAustralia School of Occupational Therapy Social work and Speech pathology Curtin UniversityPerthWestern AustraliaAustralia Burns Service of Western Australia Royal Perth Hospital and Princess Margaret HospitalPerthWestern AustraliaAustralia

Background:Burns are a devastating injury that can cause physical and psychological issues. Limited data exist on long-term mental health (MH) after unintentional burns sustained during childhood. This study assessed long-term MH admissions after paediatric burns. Methods:This retrospective cohort study included all children (pitalised for a first burn (n=11,967) in Western Australia, 1980–2012, and a frequency matched uninjured comparison cohort (n=46,548). Linked hospital, MH and death data were examined. Multivariable negative binomial regression modelling was used to generate incidence rate ratios (IRR) and 95%confidence intervals (CI). Results:The burn cohort had a significantly higher adjusted rate of post-burn MH admissions compared to the uninjured cohort (IRR, 95%CI:2.55, 2.07–3.15). post-burn MH admission rates were twice as high for those younger than 5 years at index burn (IRR, 95%CI 2.06, 1.54–2.74), three times higher for those 5–9 years and 15–18 years (IRR, 95%CI:3.21, 1.92–5.37 and 3.37, 2.13–5.33, respectively) and almost five times higher for those aged 10–14 (IRR, 95%CI:4.90, 3.10–7.76), when compared with respective ages of uninjured children. The burn cohort had higher admission rates for mood and anxiety disorders (IRR, 95%CI:2.79, 2.20–3.53), psychotic disorders (IRR, 95%CI:2.82, 1.97–4.03) and mental and behavioural conditions relating to drug and alcohol abuse (IRR, 95%CI:4.25, 3.39–5.32). Conclusions:Ongoing MH support is indicated for paediatric burn patients for a prolonged period after discharge to potentially prevent psychiatric morbidity and associated academic, social and psychological issues.

关键词： paediatric burns Depression Anxiety Substance abuse Longitudinal study Mental health

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A population-based comparison study of the mental health of patients with intentional and unintentional burns

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Burns & Trauma 2018年第4期6卷 287-296页

作者： thirthar p.vetrichevvel Sean M Randall Fiona M Wood Suzanne Rea James H Boyd Janine M Duke Burn Injury Research Unit Faculty of Health and Medical SciencesThe University of Western AustraliaM318 35 Stirling HighwayCrawleyPerthWestern Australia 6009Australia Curtin Medical School Curtin UniversityPerthAustralia Centre for Data Linkage Curtin UniversityPerthWestern AustraliaAustralia Burns Service of Western Australia Fiona Stanley Hospital and Princess Margaret HospitalPerthWestern AustraliaAustralia

Background:A number of studies report high prevalence of mental health conditions among burn patients. However there is a need to understand differences in the temporal relationship between mental health conditions and intentional and unintentional burns to hasten psychological prevention and intervention. This study aims to compare the socio-demographic profile, burn characteristics and pre-and post-burn psychiatric morbidity of burn patients by intent-of-injury. Methods:De-identified linked hospital, death and mental health (MH) case registry data of burn patients hospitalised in Western Australia between 1 January 1980 and 30 June 2012 were analysed. Crude (observed) post-burn rates of mental health admissions were generated by burn intent-of-injury. Descriptive statistics were performed to compare the characteristics of the burn patients. Results:A total of 30,997 individuals were hospitalised for a first burn;360 (1.2%) had self-harm burns and 206 (0.7%) assault burns. Over the study period, admission rates for assault burns increased by 4.8%per year (95%confidence interval (CI) 3.1–6.5%) and self-harm burns increased 6.9%per year (95%CI 4.8–9.1%). Self-harm and assault burns occurred mainly among those aged 15 to 44 years (median age, interquartile range (IQR):self-harm 30 years, 22–40;assault 31 years, 23–38). Those with self-harm burns had a longer index hospital stay (median (IQR):self-harm 15 days (5–35) vs 4 days (1–11) assault vs 4 days (1–10) unintentional) and higher in-hospital mortality (7.2%self-harm vs 1.9%assault burns vs 0.8%unintentional). More than half (55.0%) of self-harm burns had a prior hospitalisation (5-year lookback) for a MH condition vs 10.7%of assault burns and 2.8%of unintentional burns. Crude post-burn rates of MH admissions per 100 person-years (pY) by intent-of-burn subgroups:self-harm 209 per 100 pY, assault burns 11 per 100 pY and unintentional burns 3 per 100 pY. Conclusions:Intentional burn patients experienced significantly

关键词： Intentional burns Mental health Self-harm burns Assault burns Epidemiology

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Retrograde jejunogastric intussusception following Braun's jejunojejunostomy

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World Journal of Clinical Cases 2014年第1期2卷 24-26页

作者： Raj Gopal thirthar palanivelu Elamurugan Sunny Hage Rajakannu Muthukumarassamy Vikram Kate Department of Surgery Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry 605006 India

Jejunogastric intussusception is a rare long term complication of Billroth Ⅱ gastrectomy. The case reported here is a 50 year old man with history of a Billroth Ⅱ gastrectomy and Braun's side-to-side jejunojejunal anastomosis who presented with hematemesis. On abdominal examination, there was a mass in the left iliac fossa. Computed tomography scan showed a retrograde jejunogastric intussusception across the gastrojejunostomy. On laparotomy, a retrograde intussusception of the distal jejunum through the jejunojejunal anastomosis and across the gastrojejunostomy with a gangrenous intussusceptum was found. The jejunojejunal anastomosis was taken down, the gangrenous segment was resected and bowel continuity was restored with two jejunojejunal anastomoses, proximal and distal to the gastrojejunostomy. The gastrojejunostomy was preserved. This case brings out an unusual type of retrograde gangrenous intussusception which occurred at two points of a previous anastomosis, i.e., jejunojejunostomy and gastrojejunostomy simultaneously, which could be managed with jejunal resection.

关键词： Retrograde Intussusception BillrothⅡgastrectomy Jejunojejunostomy

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Standard triple versus levofloxacin based regimen for eradication ofHelicobacter pylori

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World Journal of Gastrointestinal pharmacology and Therapeutics 2013年第2期4卷 23-27页

作者： Raj Gopal thirthar palanivelu Elamurugan Vikram Kate Sadasivan Jagdish Debdatta Basu Department of Surgery Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India Department of pathology Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherry 605006India

AIM:To compare the eradication rates for Helicobacter pylori(***) and ulcer recurrence of standard triple therapy(STT) and levofloxacin based therapy(LBT).METHODS:Seventy-four patients with perforated duodenal ulcer treated with simple closure and found to be *** infected on 3 mo follow up were randomized to receive either the STT group comprising of amoxicillin 1 g bid,clarithromycin 500 mg bid and omeprazole 20 mg bid or the LBT group comprising of amoxicillin 1 g bid,levofloxacin 500 mg bid and omeprazole 20 mg bid for 10 d *** *** eradication rates,side effects,compliance and the recurrence of ulcer were assessed in the two groups at 3 mo follow ***:Thirty-four patients in the STT group and 32 patients in the levofloxacin group presented at 3 mo follow *** eradication rates were similar with STT and the LBT groups on intention-to-treat(ITT) analysis(69% vs 80%,p = 0.425) and(79% vs 87%,p = 0.513) by per-protocol(pp) analysis *** recurrence in the STT and LBT groups on ITT analysis was(20% vs 14%,p = 0.551) and(9% vs 6%,p = 1.00) by pp *** and side effects were also comparable between the groups.A complete course of STT costs Indian Rupees(INR) 1060.00,while LBT costs only INR ***:*** eradication rates and the rate of ulcer recurrence were similar between the STT and *** LBT is a more economical option compared to STT.

关键词： Helicobacter pylori Eradication peptic perforation Levofloxacin regime Randomized control trial Standard triple therapy

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