Mansi Shah

Timing of early excision and grafting following burn in sub-Saharan Africa

BACKGROUND This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. METHODS All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011-2014) were studied. RESULTS 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7-19) and median total body surface area burn was 15% (IQR, 8-25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p=0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159-0.385) and 0.107 (CI 0.062-0.177) if operated ≤5 and >5 days, respectively (p=0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15-0.79, p<0.000). CONCLUSIONS Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.

A method for evaluating the murine pulmonary vasculature using micro-computed tomography

BACKGROUND Significant mortality and morbidity are associated with alterations in the pulmonary vasculature. While techniques have been described for quantitative morphometry of whole-lung arterial trees in larger animals, no methods have been described in mice. We report a method for the quantitative assessment of murine pulmonary arterial vasculature using high-resolution computed tomography scanning. METHODS Mice were harvested at 2 weeks, 4 weeks, and 3 months of age. The pulmonary artery vascular tree was pressure perfused to maximal dilation with a radio-opaque casting material with viscosity and pressure set to prevent capillary transit and venous filling. The lungs were fixed and scanned on a specimen computed tomography scanner at 8-μm resolution, and the vessels were segmented. Vessels were grouped into categories based on lumen diameter and branch generation. RESULTS Robust high-resolution segmentation was achieved, permitting detailed quantitation of pulmonary vascular morphometrics. As expected, postnatal lung development was associated with progressive increase in small-vessel number and arterial branching complexity. CONCLUSIONS These methods for quantitative analysis of the pulmonary vasculature in postnatal and adult mice provide a useful tool for the evaluation of mouse models of disease that affect the pulmonary vasculature.

Combined Medical and Surgical Management of Hepatic Mucormycosis in an Adult with Acute Myeloid Leukemia: Case Report and Review of the Literature

Hepatic mucormycosis is a disease caused by a ubiquitous fungus which is especially important in patients with hematologic malignancies. We present a case of an adult patient with acute myeloid leukemia who developed the infection after undergoing chemotherapy. His successful management was an integrated approach of a minimally invasive surgical resection with anti-fungal therapy. We describe the management of this patient and a review of the literature.