642
burns 41 (2015) 638–647
*Corresponding author at: Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Bagcilar/Istanbul, Turkey. Tel.: +90 5322760209; fax: +90 2124404242 E-mail address: [email protected] (M. Bozkurt) Accepted 10 January 2015 http://dx.doi.org/10.1016/j.burns.2015.01.017 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved. Fig. 2 – View of the male patient.
Letter to the Editor Self-immolation in Afghan females Sir,
Fig. 3 – View of the female patient.
1.
Conflict of interest
None.
2.
Funding
None.
references
[1] Yarbrough 3rd DR. Burns due to aerosol can explosions. Burns 1998;24(May (3)):270–1. [2] Chen XL. An accidental explosion burn caused by household insecticide. Burns 2004;30(May (3)):289–90. [3] Stefanutti G, Yee J, Sparnon AL. Cryogenic burns from intentional use of aerosol spray in children: an emerging phenomenon. Burns 2010;36(August (5)):65–7.
Salih Onur Basat Fatih Ceran Funda Akoz Saydam Mehmet Bozkurt* Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
In my previous letter I discussed the high prevalent death rate by burning among Indian women [1]. In this letter I would like to explain the same phenomenon among Afghan females. Since Afghanistan is located very near to India and is a neighbor of Iran in which self-immolation is also prevalent among women [2], Afghani women culturally are more prone to self-immolation. It should be also noted that people of Afghanistan have suffered from more than three decades of occupation, war, armed conflicts, civil unrests, lawlessness, huge migration, collapse of social security systems, break down of social cohesion, educational constraints, unemployment, even natural disasters, etc. It is obvious that under such circumstances the vulnerable groups especially women and children will suffer most [3] as evidence suggests that all above mentioned predicaments might lead to violence against them [4,5]. Unfortunately there are other important setbacks for young Afghani girls and women such as arranged and forced marriage [6], or the trade of them for the intention or under the excuse of marriage, or even the illegal customary practice of ‘‘baad’’ which involves the giving away of them to reconcile a quarrel [7]. These may also lead to increase the rate of violence against young girls and women and their oppression and empowerment [8]. Regrettably, evidence suggests that more and more young Afghani girls and women especially within Western Afghanistan close to the border of Iran choose to respond to these constellations of problems by self-immolation. What makes this picture gloomy is that in some cases and before self-immolation the victims try to put across their problems with their family members but this makes the situation worse [9]. The curbing of this intolerable trend through social campaigns [10,11] is not only a task for Afghanistan Health Authorities but for the whole Afghan government, international organizations, non-governmental organizations and all Afghani people. The 2011 Afghan government national media campaign might be considered as a good start which should strengthen further campaigns to come [7]. Finally, a joint
burns 41 (2015) 638–647
governmental plan between Afghan and Iran might also bring fruitful outcomes for both countries.
Conflict of interest The author declares that there is no conflict of interest.
references
[1] Rezaeian M. Death by burning in Indian women. Burns 2014;40(8):1816–7. [2] Rezaeian M. Epidemiology of self-immolation. Burns 2013;39(1):184–6. [3] Amowitz LL, Heisler M, Iacopino V. A population-based assessment of women’s mental health and attitudes toward women’s human rights in Afghanistan. J Womens Health (Larchmt) 2003;12(6):577–87. [4] Hossain M, Zimmerman C, Watts C. Preventing violence against women and girls in conflict. Lancet 2014;383(9934):2021–2. [5] Rezaeian M. The association between natural disasters and violence: a systematic review of the literature and a call for more epidemiological studies. J Res Med Sci 2013;18(12):1103–7. [6] Campbell EA, Guiao IZ. Muslim culture and female selfimmolation: implications for global women’s health research and practice. Health Care Women Int 2004;25(9):782–93. [7] Taucher W, Vogl M, Webinger P, editors. Afghanistan 2014 and beyond. Austrian Federal Ministry of the Interior; 2014. [8] Rezaeian M. Suicide/homicide ratios in countries of the eastern Mediterranean region. East Mediterr Health J 2008;14(6):1459–65. [9] Raj A, Gomez C, Silverman JG. Driven to a fiery death—the tragedy of self-immolation in Afghanistan. N Engl J Med 2008;358(21):2201–3. [10] Rezaeian M. Why it is so important to prevent selfimmolation around the globe? Burns 2013;39(6):1322–3. [11] Rezaeian M. Social campaigns are needed to stop any forms of self-immolation. Burns 2014;40(2):356–7.
Mohsen Rezaeian* Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran *Tel.: +98 03915234003; fax: +98 03915225209 E-mail address: [email protected] (M. Rezaeian) http://dx.doi.org/10.1016/j.burns.2015.01.010 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
643
Letter to the Editor Comment on ‘‘A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue’’ Dear Editor, I read with interest the very good and useful article by Xiao et al. titled ‘‘A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue’’ [1] but I have a few comments regarding it. 1. In Fig. 1, photo G of the article [1], patient’s left upper extremity is amputated at the level of distal arm (Fig. 1). Although in Fig. 1, photo A of the article [1] all of the patient’s wounds are deep and at least 3rd degree and even 4th degree in left 5 fingers, but as we see in photo C in the same figure, granulation tissue is formed along the left upper extremity (arm, forearm and hand encircled by red line in Fig. 1 of this letter) that is ready for grafting. As we see in Fig. 1 in the article [1], amputation may be suitable at the level of proximal of the left fingers considering that in upper extremity we should leave viable tissue as more as possible. Amputation to such high level might be due to an inappropriate event that occurred during the hospital course and it was better to be mentioned or shown in photos. 2. As it shown in Table 2 in the article [1], hospitalization time was much more in experimental group that predisposed wounds to more bacterial colonization as depicted in Table 4 in the article [1]. This colonization may predispose such immune deficient patients to more infectious complications. 3. Although partial debridement was done early in the experimental group, leaving dead tissue could predispose the patient to systemic inflammatory response syndrome (SIRS) and sepsis (although not seen in this study). 4. Coverage of burn wound (over viable bed) with autograft or allograft will decrease catabolism, infection, wound pain and increase immunity and patient’s cooperation due to better pain control. Delay in wound coverage with appropriate skin substitutes such as autograft or allograft can compromise patient’s life and increase morbidity and mortality.
burns 41 (2015) 638–647
*Corresponding author at: Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Bagcilar/Istanbul, Turkey. Tel.: +90 5322760209; fax: +90 2124404242 E-mail address: [email protected] (M. Bozkurt) Accepted 10 January 2015 http://dx.doi.org/10.1016/j.burns.2015.01.017 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved. Fig. 2 – View of the male patient.
Letter to the Editor Self-immolation in Afghan females Sir,
Fig. 3 – View of the female patient.
1.
Conflict of interest
None.
2.
Funding
None.
references
[1] Yarbrough 3rd DR. Burns due to aerosol can explosions. Burns 1998;24(May (3)):270–1. [2] Chen XL. An accidental explosion burn caused by household insecticide. Burns 2004;30(May (3)):289–90. [3] Stefanutti G, Yee J, Sparnon AL. Cryogenic burns from intentional use of aerosol spray in children: an emerging phenomenon. Burns 2010;36(August (5)):65–7.
Salih Onur Basat Fatih Ceran Funda Akoz Saydam Mehmet Bozkurt* Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
In my previous letter I discussed the high prevalent death rate by burning among Indian women [1]. In this letter I would like to explain the same phenomenon among Afghan females. Since Afghanistan is located very near to India and is a neighbor of Iran in which self-immolation is also prevalent among women [2], Afghani women culturally are more prone to self-immolation. It should be also noted that people of Afghanistan have suffered from more than three decades of occupation, war, armed conflicts, civil unrests, lawlessness, huge migration, collapse of social security systems, break down of social cohesion, educational constraints, unemployment, even natural disasters, etc. It is obvious that under such circumstances the vulnerable groups especially women and children will suffer most [3] as evidence suggests that all above mentioned predicaments might lead to violence against them [4,5]. Unfortunately there are other important setbacks for young Afghani girls and women such as arranged and forced marriage [6], or the trade of them for the intention or under the excuse of marriage, or even the illegal customary practice of ‘‘baad’’ which involves the giving away of them to reconcile a quarrel [7]. These may also lead to increase the rate of violence against young girls and women and their oppression and empowerment [8]. Regrettably, evidence suggests that more and more young Afghani girls and women especially within Western Afghanistan close to the border of Iran choose to respond to these constellations of problems by self-immolation. What makes this picture gloomy is that in some cases and before self-immolation the victims try to put across their problems with their family members but this makes the situation worse [9]. The curbing of this intolerable trend through social campaigns [10,11] is not only a task for Afghanistan Health Authorities but for the whole Afghan government, international organizations, non-governmental organizations and all Afghani people. The 2011 Afghan government national media campaign might be considered as a good start which should strengthen further campaigns to come [7]. Finally, a joint
burns 41 (2015) 638–647
governmental plan between Afghan and Iran might also bring fruitful outcomes for both countries.
Conflict of interest The author declares that there is no conflict of interest.
references
[1] Rezaeian M. Death by burning in Indian women. Burns 2014;40(8):1816–7. [2] Rezaeian M. Epidemiology of self-immolation. Burns 2013;39(1):184–6. [3] Amowitz LL, Heisler M, Iacopino V. A population-based assessment of women’s mental health and attitudes toward women’s human rights in Afghanistan. J Womens Health (Larchmt) 2003;12(6):577–87. [4] Hossain M, Zimmerman C, Watts C. Preventing violence against women and girls in conflict. Lancet 2014;383(9934):2021–2. [5] Rezaeian M. The association between natural disasters and violence: a systematic review of the literature and a call for more epidemiological studies. J Res Med Sci 2013;18(12):1103–7. [6] Campbell EA, Guiao IZ. Muslim culture and female selfimmolation: implications for global women’s health research and practice. Health Care Women Int 2004;25(9):782–93. [7] Taucher W, Vogl M, Webinger P, editors. Afghanistan 2014 and beyond. Austrian Federal Ministry of the Interior; 2014. [8] Rezaeian M. Suicide/homicide ratios in countries of the eastern Mediterranean region. East Mediterr Health J 2008;14(6):1459–65. [9] Raj A, Gomez C, Silverman JG. Driven to a fiery death—the tragedy of self-immolation in Afghanistan. N Engl J Med 2008;358(21):2201–3. [10] Rezaeian M. Why it is so important to prevent selfimmolation around the globe? Burns 2013;39(6):1322–3. [11] Rezaeian M. Social campaigns are needed to stop any forms of self-immolation. Burns 2014;40(2):356–7.
Mohsen Rezaeian* Social Medicine Department, Occupational Environmental Research Center, Rafsanjan Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran *Tel.: +98 03915234003; fax: +98 03915225209 E-mail address: [email protected] (M. Rezaeian) http://dx.doi.org/10.1016/j.burns.2015.01.010 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
643
Letter to the Editor Comment on ‘‘A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue’’ Dear Editor, I read with interest the very good and useful article by Xiao et al. titled ‘‘A new method of microskin autografting with a Vaseline-based moisture dressing on granulation tissue’’ [1] but I have a few comments regarding it. 1. In Fig. 1, photo G of the article [1], patient’s left upper extremity is amputated at the level of distal arm (Fig. 1). Although in Fig. 1, photo A of the article [1] all of the patient’s wounds are deep and at least 3rd degree and even 4th degree in left 5 fingers, but as we see in photo C in the same figure, granulation tissue is formed along the left upper extremity (arm, forearm and hand encircled by red line in Fig. 1 of this letter) that is ready for grafting. As we see in Fig. 1 in the article [1], amputation may be suitable at the level of proximal of the left fingers considering that in upper extremity we should leave viable tissue as more as possible. Amputation to such high level might be due to an inappropriate event that occurred during the hospital course and it was better to be mentioned or shown in photos. 2. As it shown in Table 2 in the article [1], hospitalization time was much more in experimental group that predisposed wounds to more bacterial colonization as depicted in Table 4 in the article [1]. This colonization may predispose such immune deficient patients to more infectious complications. 3. Although partial debridement was done early in the experimental group, leaving dead tissue could predispose the patient to systemic inflammatory response syndrome (SIRS) and sepsis (although not seen in this study). 4. Coverage of burn wound (over viable bed) with autograft or allograft will decrease catabolism, infection, wound pain and increase immunity and patient’s cooperation due to better pain control. Delay in wound coverage with appropriate skin substitutes such as autograft or allograft can compromise patient’s life and increase morbidity and mortality.
