Background: Pseudomonas aeruginosa is an important cause of hospital acquired infection especially in patients admitted in critical care units such as intensive care units and burn care units. Because of its considerable potential to become resistant to important anti-pseudomonal agents, infection of burn wounds by P. aeruginosa, especially by multi-drug resistant (MDR) strains has become a major problem. Aim: This study was carried with an aim to determine the antimicrobial resistance pattern and prevalence of MDR P. aeruginosa infection among burns patients at a tertiary care center. Materials and Methods: This cross-sectional study was carried out from June 2013 to July 2014 in microbiology laboratory of a tertiary care center. In this study, 102 nonrepetitive clinical samples from patients admitted in burn unit were collected and the isolates were identified by conventional phenotypic methods. The antibiotic sensitivity testing of all P. aeruginosa isolates was done using Kirby-Bauer disc diffusion method and the results were interpreted according to the Clinical and Laboratory Standards Institute guidelines. Results: Out of 102 clinical samples, P. aeruginosa was isolated from 56 (54.9%) samples. Out of these 56 isolates, 43 (76.8%) isolates were MDR. Majority of the isolates were resistant to amikacin (73.2%), gentamicin (84%), tobramycin (75%), ceftazidime (76.79%), ciprofloxacin (71.4%), cefepime (64.6%), piperacillin (80.36%) and imipenem (61%). Conclusion: The prevalence of P. aeruginosa infection in patients admitted in burns unit was found to be 54.9%. This study showed an increased prevalence (76.8%) of MDR P. aeruginosa infection in burn patients.

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Background: Diwali is an occasion when many people get injured or burnt. Most of the data on morbidity profile of the communities is the hospital-based and there is a lack of community-based surveys. Materials and Methods: The present study was a cross-section survey conducted in the resettlement colony of Gokalpuri, Delhi, after Diwali in the month of November and December, 2013. A total of 406 households were interviewed with questions on demographic details, any injuries suffered post-Diwali and the treatment sought thereafter. Results: In the population of 1826 surveyed, only 148 (8.1%) suffered from any problem this Diwali. Majority of the participants (105; 70.9%) had respiratory complaints ranging from mild cough and wheeze to asthmatic attack while 24 (16.2%) suffered burns on any part of the body. Eighty four (56.7%) people who suffered any problem post-Diwali didn't do anything for the problem, rather left it to get well on its own. Only 32 persons had gone to health center for treatment. Conclusion: In the current study, prevalence of post-Diwali morbidity was 8.1%. The observed prevalence in the current study is much higher than that reported in a hospital based retrospective study by Tandon et al. from Delhi which collected data from 2002 to 2010 and where the incidence was one patient with firecracker-related injury per 100,000 population of the city.

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Purpose: To investigate the common aetiological agents and their antibiotic resistivity pattern in burn wound infections in this geographical area. Methods : Swabs from the burn wounds were collected on random basis using sterile cotton swabs from the patients admitted to Burn ward of Government Hospital, Gulbarga, Karnataka (South India) during 2012-13. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method according to M02-A11 and M100 -S22 Clinical Laboratory Standards Institute (CLSI) January 2012 guidelines and procedures on Mueller-Hinton agar. Results: A total 91 swabs from burns wound infection were collected from the patients of Burn Ward, out of which 83 were positive. Pseudomonas sps (33.73%) and S. aureus (27.71%) accounted for 61.44% of the positive cases as single aetiological agents. Klebsiella sps and E. coli accounted for 22.88% of the cases. The remaining 15.65% of cases had mixed aetiological agents. The results revealed the dominance of Gram negative organisms. It is significant to note that 64.52% and 24.19% of Gram negative bacterial isolates (62) were ESBL and MBL producers respectively indicating the base for the emergence of drug resistance. S. aureus was isolated from 23 positive cases as a single aetiological agent (27.71%) while it accounted for 11 (13.24%) cases with other co-pathogens. In the present study 67.65% (23 out of 34) Staphylococcus aureus isolates were Methicillin-resistant. Conclusions: The present study has revealed the emergence of MDR strains of Gram negative bacilli especially Pseudomonas sps and S. aureus as the predominant aetiological agents in burn wound infections in the hospital environment.

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Background: Burn patients are at high risk for infection, and it has been estimated that 75% of all deaths following burns are related to infection. It is, therefore, essential for a burn institution to determine its specific pattern of burn wound microbial colonization, time-related changes in predominant flora and antimicrobial profiles. Aim: To find out the bacterial and fungal profile of burn wound and evaluate the antimicrobial susceptibility pattern of the organism isolated. Materials and Methods: The present study was conducted in the Department of Microbiology, Dr. V. M. Government Medical College, Solapur, Maharashtra from December 2012 to December 2014. The wound swabs were collected from 50 patients, having total body surface area of burn in between 20% and 40% on the 4 ^th , 10 ^th , and 16 ^th day. Total 202 wound swabs were collected aseptically and cultured for the growth of bacteria and the fungi. Bacterial growths were then subjected to various biochemical tests for identification and antibiotic sensitivity testing. Results: Single isolates were present in 71.28%, and multiple isolates were noted in 18.31% of wound swabs. The isolation rate of Gram-negative organisms was high. The most common isolate was Klebsiella pneumoniae (34.40%) followed by Pseudomonas aeruginosa (23.94%), Staphylococcus aureus (22.94%), Escherichia coli (7.34%), Acinetobacter spp. (2.75%), Proteus mirabilis (2.75%), and Citrobacter species (1.38%). Candida species (4.59%) was the only fungus isolated, of which Candida albicans (50%) was the most common. Gram-negative bacteria were the most sensitive to imipenem (93.67%) and amikacin (75.94%) while Gram-positive bacteria were the most sensitive to linezolid (100%) and vancomycin (100%). Conclusion: K. pneumoniae was found to be the most common bacterial agent involved. The results of the present study will be helpful in understanding the pattern of burn wound microbial infection, the dominant bacterial and fungal flora, and the antimicrobial resistance.

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Background: Burn patients require reconstruction of facial esthetics to return back to social life. Postburn hair restoration improves appearance and quality of life. Aim: The current study was aimed to review postburn hair restoration for eyebrow, eyelash, moustache, beard, scalp hair, frontal hairline and side locks over past 5 years in 86 cases with a 9 months to 5 years follow-up. Materials and methods: For a regular hair transplant surgeon, follicular unit extraction using 0.9 mm motorized punches is the preferred technique. For occasional hair transplant surgery, follicular unit transplant strip and suturing is recommended, where follicles are dissected from a 1.2 cm wide × 6-15 cm scalp strip harvested at the level of the occipital protuberance. Each follicular unit serves as a skin micro graft placed 2-4 mm apart. Patients require 2-3 sittings spaced 8-10 months apart. Results: Hair growth in the postburn hair transplants is delayed, it begins 5-6 months after the transplant. All the hair grafts do not commence growth together and complete result is seen after 10 months. Patients with eyebrow and mustache restoration are most satisfied. Conclusion: Follicular unit micro grafting can be used for restoration of eyebrows, eyelashes, moustache, beard, side burns, hairlines or scalp hair.

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Background/Purpose: With the remarkable progress in the field of burns treatment, the outcome of extensive burns improved significantly. The increased likelihood of survival of a burn victim heightens concerns for potential psychological morbidity. Our aim of this study was to find out the magnitude of depression in burn patients, quality of life (QOL) in cases as compared to control, the correlation between depression and QOL, and the predictive factors for QOL in burns. Materials and Methods: The study sample comprised of 60 patients with burn between ages of 18 years and 65 years seeking consultation for reconstructive surgery. An equal number of healthy controls of similar age and sex were also enrolled to make a comparison group. Participants were assessed for the presence of depression and QOL by using patient health questionnaire (PHQ-9) and World Health Organization quality of life-BREF scale, respectively. Result: Depression was found statistically significant in burn patients as compared to control. 28.33%-mild, 25%-moderate, 23.33%-severe, and 15%-moderately severe as compared to control, where 86.67% of study sample had no features of depression (P < 0.001). The overall QOL was found significantly lower (32.75 ± 10.33 vs. 69.44 ± 10.87) (P < 0.001). A significant inverse fair correlation existed between the PHQ-9 and QOL. Lower QOL in burn patients positively associated with multiple factors like female patients, the involvement of exposed part, facial burn, etc. Conclusion: The high prevalence of clinically significant depression and lower QOL of in burn reconstruction patients and their relationship with body image suggest the importance of the routine psychological screening and the treatment of patients seeking reconstruction surgeries.

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A 32-year-old male presented to surgical casualty after 3 h of sustaining high voltage electrocution through palm of the right upper limb with prolapse of bowel from the anterior abdominal wall. Apparently, the current flow through the right upper limb exited from the right lower abdomen wall resulting in full-thickness abdominal wall defect causing small bowel to prolapse. He had clawing of right hand and semi-flexion at elbow with blackening and dry gangrene from mid-arm onward with distal two-third of the right upper limb being parched and black. There was 9 cm × 7 cm wound over right abdominal wall through which small bowel had eviscerated with multiple perforations discharging feculent content. Exploratory laparotomy with resections of perforated segments of small bowel with end-to-end anastomosis and right mid-arm guillotine amputation were done. The abdominal wound was debrided and temporarily covered with overlay plastic bag to prevent bowel herniation. A small enterocutaneous fistula arising from the small bowel was noted through the abdominal wound of blow out site, which was managed conservatively. The entry point of electricity is usually the skull or the upper extremity with resultant exit through the lower extremity. The exit point through the abdominal wall with resultant abdominal wall loss is rare and even remorsely seen is the abdominal wall blow out with the evisceration of bowel, a rare phenomenon.

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Context: Infections are the major cause of morbidity and mortality in burn patients. The Extended Spectrum Beta Lactamase (ESBL), AmpC Beta Lactamase (AmpC), and Metallo-Beta Lactamase (MBL) are the major mediators of antimicrobial resistance in Gram-negative organisms. Methicillin-resistant Staphylococcus aureus (MRSA) are also implicated in causing serious infections in burn patients. Aim: To find the prevalence of ESBL, AmpC, and MBL mediated resistance among Gram-negative organisms and MRSA in Staphylococcus aureus isolates in pus samples obtained from the burn unit. Materials and Methods: ESBL, Amp C, and MBL production was detected using ceftazidime and ceftazidime-clavulanic acid combination disc test, cefoxitin and cefoxitin/boronic acid disk test, and Imipenem-EDTA disk test, respectively. MRSA were screened using oxacillin disc by disc-diffusion technique. Results: High ESBL rate (37%) was seen among Escherichia coli isolates, whereas Acinetobacter cbc exhibited maximum (25%) MBL activity. Among Klebsiella pneumoniae isolates, 20% isolates were ESBL and AmpC producers, whereas no AmpC expression and no co-existence of these enzymes were seen in Escherichia coli. Co-existence of AmpC with MBLs was seen in 9.6% of Pseudomonas aeruginosa isolates while ESBL expression alone was seen in 16.1% of isolates. Conclusions: Drug resistance to antimicrobial agents is a serious threat in burn infection. Early detection of these β-lactamase producing isolates in a diagnostic laboratory could help to avoid treatment failure, as often the isolates producing this enzyme show a susceptible phenotype in routine susceptibility testing.

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Background: India being a developing country has a high incidence of thermal injuries. Severe burn injury is followed by a state of hypermetabolism, which causes increased cardiac workload and increased resting energy expenditure causing muscle wasting, leading to increased morbidity. The aim of this study is to test the effect of propranolol in modulating the state of hypermetabolism in the acute postburn phase using various clinical and laboratory parameters. Materials and Methods: This is a prospective case-control study which includes 50 cases of thermal injuries with total burn surface area 20-60% conducted at burn unit of a Tertiary Care Center over a period of 1-year. The patients were divided into test (propanolol) and control groups. Similar burn treatment was continued in both groups and change in the laboratory, and clinical parameters were noted. Results were compared within the groups using paired t-test and in between the groups using unpaired t-test. Result: This study shows a significant reduction of 20% in the heart rate and 28% in the sleeping pulse rate with 2 weeks of propranolol therapy (P < 0.0001). There was a 2.5% increase in the weight along with 6% increase in mid-arm circumference. There was a 5% increase in total serum albumin concentration and resolution of pedal edema by the end of 2 weeks of therapy. C-reactive protein was found to be reduced by 10% (P < 0.0001). Conclusion: The results prove propranolol as an effective modulator of hypermetabolism by counteracting the effect of catecholamine, reducing infection and inflammation hence improving the overall outcome of severe burn patients.

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Burn injury is often a devastating event with long-term psychosocial effects. Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressants alleviate depressive symptoms by preventing serotonin that has been released into the brain by nerve cells from being taken back into the cells. This study investigated the impact of antidepressant drugs on the psychological status of hospitalized burn patients. This study was conducted on two equal groups of 60 adult patients in the burn unit at Assiut University Hospital, Egypt. The control group received the hospital routine medical and nursing managements, while the second group received the antidepressant drug after the third day post burn and continued to 6 weeks in addition to the routine medical and nursing managements. Studying the relations among scores of patient cooperation, nurse satisfaction, and levels of depression in the study and control groups showed that, at admission all the patients in both groups suffered from severe depression. From the second to the sixth week, the depression level in the study group changed to normal, the patients were cooperative and the nurses were satisfied.

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Background and Purpose : High voltage electric burn patients generally present with complex/composite defects requiring flap cover. Due to physiological factors as well as local factors involved in electric burns, there is high reluctance in performing free flaps in these burns patients. Our study comprised patients who were managed with free flap cover in last 3 years in the absence of local options. Comparison of acute/subacute and delayed (>6 weeks) reconstruction cases were done. Materials and Methods: It is a prospective study of data of 36 patients (32 male, 4 female) who required various free flap cover for the complex defects due to electric burns during January 2012 to December 2014 in Plastic Surgery Department, SMS Hospital, Jaipur. Eighteen patients (50%) underwent delayed reconstruction (>6 weeks) and equal number underwent surgery in acute/subacute settings. Data comprised the complications, causes of exploration and salvage rates in both groups that included various types of free flaps performed during the period. Results : Overall 5 flaps (13.8%) failed out of 36 flaps. Only one flap in delayed (5%) and 4 flaps in acute/subacute (22.2%) setting failed. Overall complication rate was 27.7% (10 patients). Conclusions : Considering low failure rate of 5% in delayed cases, as compared to 22.2% in acute/subacute cases, we propose free flap cover in a delayed manner in post electric contact burn complex defects as a better choice.

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Background: The major morbidity of split skin graft is donor site pain, soaking and delayed healing. Numerous donor site dressing modalities are available, but the ideal material remains elusive. Method: We compared the effect of bovine type 1 collagen dressing to conventional paraffin impregnated gauze dressing in 20 patients. After harvesting graft by standard technique, one-half was covered by collagen sheet and other half by paraffin gauze. Pain was assessed daily by Visual Analog Scale. Any soaking of dressing was noted. The dressing was removed on 10th day and both areas were inspected for the amount of epithelization. Results: The pain was less in the collagen area when compared to the paraffin gauze area. The difference was highest for the first 3 days (2.16 vs. 5.86, P < 0.01) reduced for the next 4 days (0.4 vs. 3.4, P < 0.01) and was minimal for the last 3 days (0 vs. 1, P > 0.02). Seven patients had soaking limited to paraffin gaze area whereas two patients had soaked in both areas. On removal of dressing on 10th day, average epithelization was slightly higher in collagen area (98%) compared with the paraffin gauze area (95%). Conclusion: Bovine type 1 collagen reduces pain and soaking at skin graft donor site with minimal effect on the rate of epithelization.

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Postburn deformities can cause loss of livelihood and a sense of self-worth. Though many can be corrected leading the patients to lead a productive life, tragically many of these patients who need help are not in the service loop. Causes may be the problems of affordability, reach or the lack of skill levels needed for difficult problems. "Hope after fire," a project to offer totally free reconstructive surgery for the correction of burn deformities is a joint initiative of the Rotary Club of Coimbatore Metropolis and Ganga Hospital. In a 3-year period from 2012,304 reconstructive procedures were done in 192 patients with a project value of Rs. 1.08 crores (US $ 166,000). The project is guaranteed the continued support of the club and the community and pledges for a similar sum are available. We feel that this success is reproducible. A patient-centric attitude, the commitment of the people involved in the project to go for it irrespective what it takes to reach the goal, efforts at rehabilitation in addition to surgical efforts, and transparency and trust between partners are the key for success. These and the other factors which we feel are important for success are detailed in this article.

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Electrical injuries cause devastating and major trauma at the site of contact as well as in other parts of the body. The contact over chest and abdomen invariably results in full thickness injury. Management of these full thickness defects is a great challenge for the burn surgeon. In this article we report the first case of full thickness chest wall defect following electrical injury in an infant following contact with household 230 volt current. A delayed primary reconstruction of the chest wall was carried out using pedicled latissmus dorsi myocutaneous flap.

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Material and Methods: This is a retrospective review of children with burns admitted to the Kanchi Kamakoti Childs Trust Hospital, a 220-bed tertiary-care children's hospital in Chennai, India. Results: Four hundred and twenty-nine children with burns were admitted and treated between 2007 and 2014. Among these, 40 patients with over 20% deep and deep partial thickness burns were transferred to the Pediatric Intensive Care Unit (PICU) for various acute complications. In the presence of invasive sepsis or complication at the time of admission or later, the children are transferred to the PICU. Of the 40 cases transferred, 13 died and 27 survived. Details of the management of these complications and the causes of death were analyzed. It was realized that the survival of 27 burnt children was possible due to the combined team approach of treatment by the burn and plastic surgeons and the intensivists of the PICU. Conclusion: Continued approach is necessary for better survival in pediatric burns.

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Background : Self-inflicted burns (SIB) are the most common and frequently occurring medical challenge to Plastic Surgery and Burn Units worldwide. Only a few reports of SIB among soldiers have been published; they may be committed as a coping mechanism to stress, psychiatric illness, or with a malingering/ulterior motive. The aim of this retrospectives study is to determine the cause and characteristic of the SIBs among soldiers treated at Burn Unit of Prince Sultan Military Medical City (PSMMC) during 2008-2014. Materials and Methods: A retrospective assessment was performed on 82 soldiers treated at Burn Unit of PSMMC for self-inflicted burn injuries. The data collected include age, cause of injuries, side of the body affected, affected organs, month and day of burn injury. Results : The majority of SIB was observed among young soldiers age range 20-35 years. The chemical burn was the most common cause of burn injuries. The SIBs mostly occurred between June and September months with a higher frequency of cases occurring in early weekdays. Most of the burns occurred in the feet and hands, left side of body suffered more burns compared to right side of the body. Conclusion : It may be concluded that chemically induced burns were the most frequent cause of SIB in this study. High frequency of SIB occurred in summer months specifically on Sundays and Mondays. Feet, hands, and legs are the most affected organs. The reason of inflicting self-injury is far from clear it may be either to cope up with stress or with an ulterior motive. Further investigation using the larger sample is suggested.

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