Ashish Kumar Gupta

Post burn pruritus—A review of current treatment options

Post burn pruritus is a well recognised symptom in almost all burn patients. Yet, there is insufficient awareness about the etiopathogenesis and a lack of a systematic approach in the assessment and treatment of this distressing symptom. The current standard therapies include antihistamines, which are effective as sole therapy in only 20% patients, and emollients. There is a lacunae of clear consensus on the care of patients not responding to antihistamines. We review the literature on the etiology and pathogenesis of post burn pruritus, which has both central and peripheral pathways. The published studies on the currently available therapeutic options to treat itch in burns are discussed. On the basis of current evidence in literature, gabapentin used in the treatment of neuropathic pain, has demonstrated great promise, and is suggested as the next option for this subset of patients, not relieved with antihistamines.

A novel and accurate technique of photographic wound measurement

Context: Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive. Aims: To introduce a simple and accurate technique by which wounds can be accurately measured. Settings and Design: This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique. Materials and Methods: The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA. Results: The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method. Conclusions: This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.

A multi-purpose, self-adjustable aeroplane splint for the splinting of axillary burns

External splinting has been acknowledged for many years as a useful approach for preventing and correcting burn contractures. Though this practice could be traced back many centuries, there is still a dearth of knowledge regarding a good splint to serve these purposes for axillary burns. The newly designed multi-purpose, self-adjustable aeroplane splint presented in this report helps in various ways, such as improving compliance, and positioning during preoperative, postoperative and rehabilitative phases of axillary burn management. It acts as a splint that provides circumferential pressure for scar management, provides prolonged stretch to contracted tissue and acts as a serial cast in increasing the shoulder range. Most of all, it is very much user-friendly, thus enhancing compliance and giving a good outcome in axillary burns.

The Morel-Lavallee lesion: a review and a proposed algorithmic approach

Morel-Lavallee lesions (MLL) are rarely diagnosed posttraumatic sequel. They follow closed degloving injuries due to accumulation of blood and debris in the subcutaneous plane. Though they are not uncommon, they are rarely diagnosed which results in delay in their treatment. Diagnosis is through a combination of clinical examination, history, and imaging studies. MRI is the diagnostic modality of choice. Different treatments have been used for their management like compression therapy, sclerosant injection, pulse lavage, and open debridement. These treatments have met with varying success. Treatment protocols vary when managing acute and chronic MLL. The knowledge of such lesions hastens their diagnosis and treatment.

Role of Facial Artery Musculomucosal Flap in Large and Recurrent Palatal Fistulae

Objective Palatal fistulas are not uncommon after palatoplasty. Although there are currently many techniques that can be used to close large palatal fistulae, most of these procedures are usually cumbersome and mostly unreliable with high recurrence rates. The facial artery musculomucosal (FAMM) flap was described to circumvent these problems. The purpose of this study was to review our experience with the FAMM flap to reconstruct palatal fistulas, most of them being recurrent. Materials and Methods A retrospective analysis was done of 11 FAMM flaps performed between January 2007 and March 2012. Results There were no major complications. Venous congestion was seen in two cases. Two flaps developed terminal marginal necrosis. One patient had suture line dehiscence. There were no recurrences of the fistula after repair. All patients had a satisfactory closure of the fistula. Conclusion FAMM flap is a reliable and versatile flap that provides like with the like tissue and is a good option for closure of recurrent wide palatal fistulae.

A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab, India

Aim: To analyze the causes, demographic and socio-cultural aspects, and the magnitude of burn injuries prospectively and to evaluate the outcome of treatment of patients admitted to burns ICU of tertiary care hospital. Materials and Methods: A total of 892 burn patients admitted over a period of 6 years from January 2002 to December 2007 at tertiary care hospital in Punjab, India, were analyzed. Results: 54% patients were males. A majority of the patients, 704(79%), were in the age group of 15-45 years. Six hundred and thirty-four patients (72%) sustained flame burns, while 17% and 7% sustained electrical and scald burns, respectively. A total of 470(53%) patients sustained major two to three degree flame burns involving more than 45% of total body surface area (TBSA). The mortality rate was 40%, i.e. 357 patients died of burns and its related problems, in our study. Six hundred and thirty-nine patients (72%) sustained burns in closed space of which 331 patients (52%) sustained burns in kitchen. Seven hundred and seventy-nine patients sustained accidental burns. Burn victims were mainly Hindus and Sikhs. The mean hospital stay varied depending upon the percentage of burns. On an average, a patient with > 45% TBSA burns received 15 whole blood transfusions. Split skin grafting was done in 416 patients. Most common complication encountered during their hospital stay was wound infection which was seen in 671 patients, followed by ARDS in 221 patients. The most common organisms causing wound infection were Pseudomonas and Acinetobacter. Conclusion: Developing country like India need an aggressive public education program so that people become more literate about various etiological factors causing burns and means of preventing them. Also needed are burn care hospitals which are easily accessible and affordable.

Essential hypertension: A filtered serum based metabolomics study

Despite the easy and reliable methods of blood pressure measurement, the screening of essential hypertension (EH) is usually ignored due to delayed onset of symptoms. A probe into the biochemical changes in hypertension would serve as a welcome asset to provide insight into the mechanistic aspects of EH. Filtered serum samples from 64 EH patients and 59 healthy controls (HC) were analysed using 800 MHz nuclear magnetic resonance (NMR) spectroscopy. Application of principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLS-DA) following receiver operating characteristic (ROC) curve of NMR data reveals significantly perturbed metabolites: alanine, arginine, methionine, pyruvate, adenine, and uracil. This set of metabolites correctly classified 99% of cases from HC and also showed excellent correlation in both isolated elevated diastolic blood pressure (DBP) cases and combined elevated systolic-diastolic blood pressure cases. Proton NMR metabolomics of EH may prove helpful in defining associated biomarkers and serve as an alternate diagnostic tool with judicious clinical assessment.

Evaluation of trauma and prediction of outcome using TRISS method

Introduction: Trauma and injury severity score (TRISS), introduced in 1981 is a combination index based on revised trauma score (RTS), injury severity score (ISS) and patients age. In this study we have used TRISS method to predict the outcome in trauma cases. Materials and Methods: 1000 consecutive cases of trauma of adult age group admitted in casualty of Dayanand Medical College and Hospital Ludhiana, from 1/7/2000 onwards. Revised Trauma Score, Injury Severity Score and Age Index were recorded from which TRISS was determined. The performance of TS, ISS and TRISS as predictors of survival was evaluated using the misclassification rate, the information gain and the relative information gain. Results: The majority of the patients were men (83.7%) and in the age group of 20-50 years. Road traffic collisions (72%) were the most common cause of trauma. The mortality rate was 4.1%. Using PER method, the TRISS method was found to have information gain of 0.049 and a relative information gain of 0.41. Conclusions: The revised trauma score (RTS) ranged from 2.746 to 7.8408.There was a graded increase in mortality with decreasing RTS score.

Monofocal maxillary fibrous dysplasia with orbital, nasal and oral obstruction

Fibrous dysplasia is a condition characterised by excessive proliferation of bone-forming mesenchymal cells. Although a variety of causative factors are described, the exact aetiology is yet to be fully known. The maxilla is the most commonly affected facial bone, with facial asymmetry being the usual complaint. Surgery is the treatment of choice with two available options, namely, conservative bone shaving and radical excision and reconstruction. We describe the case of a 25-year-old male who presented with a giant monofocal fibrous dysplasia of the left maxilla with facial asymmetry, including obstruction of the left orbit, nasal and left half of the oral cavities and was treated with conservative surgery.

A retrospective analysis of 189 patients of maxillofacial injuries presenting to a tertiary care hospital in Punjab, India

IntroductionMaxillofacial injuries form a major aspect of trauma management in trauma centers. Prompt diagnosis and management is needed to provide better quality of life and cosmetic results as compared to delayed interventions.Material and methodsWe present a retrospective study of 189 patients of complex, operable maxillofacial injury with an analysis of patients’; age and gender, mode of injury, vehicle details and associated injuries along with the maxillofacial injuries admitted in a tertiary care hospital in Northern India over one year.ResultsMaximum patients were in the age group of 21–30, a decade early as compared to other figures, with fractures of zygoma being predominant associated with head injury as the commonest comorbid condition. Motorized two wheelers were the leading cause with more than 75% patients driving at the time of injury. Majority of the injuries were not singular and in concordance with the literature men were the most affected.DiscussionMotor vehicle accident is the most common cause for maxillofacial injury worldwide. Being a referral hospital the number of patients were low but the complexity was high with a reverse trend towards the type of injuries seen and the ones found in community hospitals. The stand alone factor of this study with respect to the other publications is the presentation of the associated symptom complex with the specified fracture and the type, number and rotation of fracture segments with each facial bone fracture; the location of the patient at the time of impact in the vehicle, type of vehicle and the associated injuries.