Vikram Kate

Epidemiology of hospitalized burn patients in a tertiary care hospital in South India

BACKGROUND The epidemiological pattern of burns varies widely in different parts of the world. To suggest effective preventive measures, an insight into the pattern of injury is desirable. However, data on burn victims and outcome is limited from this part of the world. METHODS This study was conducted in the Department of Surgery, from April 2006 to April 2007. All consecutive patients with major burns admitted for in-hospital treatment during the study period were included in the study. The data collected included age, gender, cause and mode of burns, presence or absence of inhalational injury, facial burns, time delay from burn injury to admission in the hospital, burns depth, total body surface area distribution of burns, associated injuries and co-morbid illness, microbiological profile and outcome. Inhalational injury was assessed by clinical examination as bronchoscopy was not available. RESULTS A total of 222 consecutive patients admitted for in-hospital treatment of burn injury were included in the study. 177 patients were adults and 45 were <13 years of age. The female:male ratio was 1.7:1. In adults, 52.5% of burns were due to non-intentional injury and 43.9% were due to self-immolation. In patients <13 years of age, 95.6% of cases were due to non-intentional injury. The mean TBSA was 48.75% and 30.18% of patients had predominantly deep burns. The overall mortality was 60.8%. The predominant organisms colonizing the burn wound were Pseudomonas aeruginosa (81.1%) followed by Acinetobacter species and MRSA. Multivariate logistic regression analysis of factors predicting survival in patients with burn injury showed that TBSA>30%, age>20 years, female gender and presence of facial injury were statistically significant as predictors of risk of death. CONCLUSIONS In patients with burns, total body surface area involvement more than 30%, age more than 20 years, female gender and presence of facial injury are statistically significant, as predictors of poor outcome and risk of death. The strongest association was seen with facial injury, which increased the risk of death by fourfold.

Role of bone biopsy specimen culture in the management of diabetic foot osteomyelitis.

INTRODUCTION There has been increasing evidence in favor of conservative management of diabetic foot osteomyelitis which requires targeted antibiotic therapy to the causative pathogen. But the method of reliable microbiological isolation is controversial. AIMS AND OBJECTIVES To study the concordance of superficial swab culture with bone biopsy specimen culture in patients with diabetic foot osteomyelitis. MATERIALS AND METHODS A prospective study was conducted from July 2008 to July 2010. All consecutive patients with suspected diabetic foot osteomyelitis were included in the study. Superficial swab and Percutaneous bone biopsy specimens were obtained for culture. The culture results in these two groups were compared for concordance. RESULTS A total of 144 patients were included in the study. 134 cases of bone biopsy specimen and 140 cases of superficial swab showed positive culture results. Mean number of isolate per sample was similar. Staphylococcus aureus was the commonest organism grown in both cultures. The bone pathogen was identified in the corresponding swab culture in only 55 cases (38.2%). Staphylococcus aureus had the highest concordance percentage of 46.5% which was not statistically significant. CONCLUSION Superficial swab culture may not be accurate in identifying all the organisms causing diabetic foot osteomyelitis. Bone biopsy specimen taken simultaneously would increase the accuracy of detecting the bacterial isolate.

Helicobacter pylori eradication prevents recurrence after simple closure of perforated duodenal ulcer

Background and Aim:  Evidence remains inconclusive as to whether eradication of Helicobacter pylori prevents ulcer relapse after simple closure of a perforated duodenal ulcer. This study was conducted to determine the effect of H. pylori eradication using a quadruple drug regimen along with a probiotic on ulcer recurrence after perforation closure.

Necrotizing Infection of the Breast Mimicking Carcinoma

Abstract:  Necrotizing fasciitis is a polymicrobial infection of the skin, subcutaneous tissue, and fascia with a fulminant course and a high morbidity and mortality. It rarely affects the breast. We report a postmenopausal woman presenting with necrotizing infection of the breast requiring mastectomy.

Sternocleidomastoid Muscle Myocutaneous Flap for Corrosive Pharyngoesophageal Strictures

BackgroundStrictures at the pharyngoesophageal junction represent a subgroup of corrosive esophageal strictures requiring a specialized management approach. Non-dilatable cricopharyngeal strictures need surgical intervention. We report the use of the sternocleidomastoid muscle myocutaneous inlay flap (SCMMIF) for reconstruction of the cervical esophagus in patients with corrosive strictures.MethodsA SCMMIF was used in four patients with cricopharyngeal strictures. The surgical technique is described. All patients had complete dilatation of the stenosed cricopharyngeal segment as seen on postoperative endoscopy and contrast studies. One patient was managed successfully for a short midesophageal stricture by serial endoscopic dilatations. Another patient underwent an esophagocoloplasty subsequently for bypass of the long distal esophageal stricture The last two patients await esophagocoloplasty.ConclusionsThis is the first report on the use of sternocleidomastoid muscle myocutaneous inlay flap for corrosive cricopharyngeal strictures. The flap is simple to construct, is effective and can be performed in a short time, and yields good cosmetic results.

Sequential therapy versus standard triple drug therapy for eradication of Helicobacter pylori in patients with perforated duodenal ulcer following simple closure.

Abstract Background. Resistance to clarithromycin, a component of standard triple therapy, leads to inconsistent eradication rates of Helicobacter pylori infection. Some studies have shown higher eradication rates for H. pylori using sequential regimen. This study was done to compare the eradication rates for H. pylori infection between the standard triple drug therapy and the sequential therapy. Methods. Seventy-three patients with perforated duodenal ulcer following simple closure with H. pylori infection were randomized to receive either standard triple drug therapy or the sequential therapy. Standard triple drug therapy comprised of omeprazole, clarithromycin, and amoxicillin for 10 days. Sequential therapy comprised of omeprazole and amoxicillin or the first 5 days followed by omeprazole, clarithromycin, and amoxicillin for the next 5 days. Follow-up endoscopy was done at 2 months to assess the eradication rates, compliance, and side effects with each regimen. Results. Eradication rates for standard triple therapy and sequential regimen were 81.25% and 87.09%, respectively (p = 0.732). The cost of sequential therapy was cheaper and incidence of side effects and compliance were similar in each group. Conclusion. Standard triple therapy and sequential therapy have similar efficacy for eradication of H. pylori and sequential therapy is an economical alternative to standard triple therapy.

Clear Liquid Diet vs Soft Diet as the Initial Meal in Patients With Mild Acute Pancreatitis A Randomized Interventional Trial

BACKGROUND Patients recovering from mild acute pancreatitis are usually started on a liquid diet and advanced to a solid diet. Evidence suggests a soft diet as the initial meal is tolerated well by such patients. However, the results are controversial. OBJECTIVES To assess the safety of starting an early soft diet compared with a liquid diet in patients with mild acute pancreatitis as the initial meal. METHODS We randomized 60 patients with mild acute pancreatitis into 2 groups to receive either a clear liquid diet (CLD) or a soft diet (SD) as the initial meal, and parameters such as tolerance to diet, recurrence of pain, length of hospitalization (LOH), need to stop feeding, post-refeeding length of hospitalization (PRLOH), and postdischarge readmission rate within 30 days were analyzed. RESULTS The demographic and baseline parameters (amylase, total leucocyte count, Balthazar score) in the 2 groups were comparable. Patients in both groups tolerated the diet well except 1 patient in the SD group, who developed vomiting and diarrhea, not severe enough to stop feeding. LOH and PRLOH were significantly lower in the SD group (4.23 ± 2.08 and 1.96 ± 1.63 days, P < .0001) compared with the CLD group (6.91 ± 2.43 and 4.10 ± 1.64 days, P < .0001). PRLOH in the SD group was 2.14 days less when compared with the CLD group. CONCLUSION In patients with mild acute pancreatitis, a soft diet as the initial meal is well tolerated and leads to a shorter total length of hospitalization.

Evaluation of Helicobacter pylori infection and other risk factors in patients with benign peptic ulcer disease

Abstract Objective To assess and compare the risk factors in patients with benign gastric and duodenal ulcers and to correlate the prevalence of Helicobacter pylori ( H. pylori ) infection in benign peptic ulcer disease. Methods A total of 30 consecutive patients with peptic ulcer disease were included in this study after upper gastrointestinal endoscopy. Their clinical profile and endoscopic findings were noted. Antral biopsies were subjected to histopathological examination and urease test for detection of H. pylori . Results were correlated. The study was cleared by the Institute Research Council and the Ethics committee. Results The male: female ratio was 11:4. Overall, H. pylori infection was prevalent in 93.3% of the patients. Patients who took spicy food had a significantly higher rate of H. pylori positivity ( P =0.04). Smoking, alcohol intake and NSAIDs did not affect H. pylori status in patients. There was no significant association between the site of the ulcer and H. pylori infection. Conclusions Based on our observations we conclude that prevalence of H. pylori infection is similar in duodenal and gastric ulcers and intake of spicy food is a significant risk factor.

Coital paraphimosis causing penile necrosis

A 60-year-old man presented with blackish discoloration of the glans penis for 2 days after sexual intercourse. He also complained of inability to reduce the foreskin to its normal position after retraction that …

Splenic Artery Aneurysm Presenting as Extrahepatic Portal Vein Obstruction: A Case Report

Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism) treated by splenectomy along with excision of the aneurysm.