Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Background: The incidence of paediatric burn injuries is increasing in Africa. Paediatric burn injuries are among the leading causes of preventable morbidity and mortality in sub-Saharan Africa. Research on the morbidity and mortality in this setting is much needed.Methods: We conducted a prospective questionnaire-based analysis of paediatric burn patients presenting to the Maputo Central Hospital during a five-month period. Interviews were conducted with the children's caretakers by 2 paediatric surgery residents and 1 paediatrician at the Eduardo Mondlane Medical School in Maputo, with the aid of nursing staff.Results: Questionnaires were completed for 66 patients. Most burns occurred from scald injuries (n = 46), particularly from cooking (n = 27) and bathwater (n = 19), followed by fire injuries (n = 16). Burns occurred more frequently in the afternoon (n = 26) and morning (n = 23). Many patients reported no adult caretaker present at the time of the burn injury (n = 24). Most burns were grade II (n = 49). Nearly half of the patients received a blood transfusion (n = 30). One-third of the patients underwent operative surgical debridement (n = 21). Skin grafting was performed on a subset of these patients (n = 13). A large number of patients developed a wound infection (n = 39). All deaths occurred in patients who were admitted to the paediatric intensive care unit and had sepsis (n = 9). The mean total body surface area (TBSA) of burn deaths was 37% (range 20% to 50%), and many deaths were secondary to fire burns (6 of 9; 66.7%).Conclusions: Most paediatric burn injuries occur in association with domestic activities, such as cooking and bathing. Adult caretakers are frequently not present at the time of the burn injury. Mortality rates are high, especially for large body surface area burns caused by fire. Educational programmes may help reduce the incidence of burns and the associated morbidity and mortality. The improvement and expansion of emergency and intensive burn care services may help to improve survival.Keywords: burns; morbidity; mortality; paediatrics; paediatric surgery; Mozambiqu

State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PCOS, a heterogeneous disorder characterized by cystic ovarian morphology, androgen excess, and/or irregular periods, emerges during or shortly after puberty. Peri- and post-pubertal obesity, insulin resistance and consequent hyperinsulinemia are highly prevalent co-morbidities of PCOS and promote an ongoing state of excess androgen. Given the relationship of insulin to androgen excess, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the physical stigmata of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched. While lifestyle changes that concentrate on behavioral, dietary and exercise regimens should be considered as first line therapy for weight reduction and normalization of insulin levels in adolescents with PCOS, several therapeutic options are available and in wide use, including oral contraceptives, metformin, thiazolidenediones and spironolactone. Overwhelmingly, the data on the safety and efficacy of these medications derive from the adult PCOS literature. Despite the paucity of randomized control trials to adequately evaluate these modalities in adolescents, their use, particularly that of metformin, has gained popularity in the pediatric endocrine community. In this article, we present an overview of the use of insulin sensitizing medications in PCOS and review both the adult and (where available) adolescent literature, focusing specifically on the use of metformin in both mono- and combination therapy

Polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.Robert J Norman, Ruijin Wu and Marcin T Stankiewic