Iontophoretic delivery of lidocaine hydrochloride through ex-vivo human skin.

Background: Iontophoresis is one of the widely used noninvasive and painless transdermal drug delivery technique.Objective: Transdermal delivery of Lidocaine Hydrochloride using continuous and modulated iontophoresis were evaluated across human skin ex-vivo and further assessed for skin tolerance in-vivo in the Swiss albino mice.Methods: Continuous DC was modified into modulated DC by introducing ON-OFF time in continuous DC. Iontophoresis studies were conducted on human skin samples for 60 min.Results: Drug permeation of 2% lidocaine HCl was enhanced in current density-, duty cycle- and time-dependent manner across human skin. The lidocaine HCl concentration obtained with modulated DC and continuous DC iontophoresis were about three-fold and four-fold higher than passive group respectively for all current densities across human skin. Continuous DC iontophoresis was found to be more effective than modulated DC. However, no significant difference was observed in transport of lidocaine HCl between 75% and 100% (continuous) duty cycle at all current density. Further, in-vivo reversibility studies with mice confirmed that modulated iontophoresis was well tolerated by the tissue and the injury caused is transient and reversible.Conclusion: For clinical application, modulated DC iontophoresis with 75% duty cycle at 0.5 mA/cm2 current density would be recommended.

Development of tissue bank.

The history of tissue banking is as old as the use of skin grafting for resurfacing of burn wounds. Beneficial effects of tissue grafts led to wide spread use of auto and allograft for management of varied clinical conditions like skin wounds, bone defects following trauma or tumor ablation. Availability of adequate amount of tissues at the time of requirement was the biggest challenge that forced clinicians to find out techniques to preserve the living tissue for prolonged period of time for later use and thus the foundation of tissue banking was started in early twentieth century. Harvesting, processing, storage and transportation of human tissues for clinical use is the major activity of tissue banks. Low temperature storage of processed tissue is the best preservation technique at present. Tissue banking organization is a very complex system and needs high technical expertise and skilled personnel for proper functioning in a dedicated facility. A small lapse/deviation from the established protocol leads to loss of precious tissues and or harm to recipients as well as the risk of transmission of deadly diseases and tumors. Strict tissue transplant acts and stringent regulations help to streamline the whole process of tissue banking safe for recipients and to community as whole.

Firecracker injuries during Diwali festival: The epidemiology and impact of legislation in Delhi.

SETTING AND DESIGN: A hospital-based retrospective study of firecracker-related injuries was carried out at a government sponsored hospital in Delhi. MATERIALS AND METHODS: 1373 patients attended the emergency burn care out-patients clinic during 2002-2010 pre-Diwali, Diwali and post-Diwali days. Every year, a disaster management protocol is revoked during these 3 days under the direct supervision of the Ministry of Health and Family Welfare, Government of India. RESULTS: There was an increase in the number of patients of firecracker-related injuries in Delhi national capital region from the year 2002 to 2010, based on the hospital statistics. During the study period, the hospital received approximately one patient with firecracker-related injury per 100,000 population of the city. 73.02% of the victims were 5-30 years old. Majority (90.87%) of them sustained <5% total body surface area burn. CONCLUSIONS: In spite of legislations and court orders, the number of patients is on the rise. The implementation agencies have to analyse the situation to find a way to control this preventable manmade accident. Websites, emails, SMS, social sites, etc. should be used for public education, apart from conventional methods of public awareness.

The versatility of perforator-based propeller flap for reconstruction of distal leg and ankle defects.

Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

Interactions between bacteria and Candida in the burn wound.

In order to understand whether the presence of some bacterial species affects the growth of Candida sp. in the wounds of burn patients, we have studied the effect of various bacterial species, collected from burn wounds on the growth of Candida sp. on Sabouraud dextrose agar (SDA) slants. A total of 300 burn patient samples were analyzed over a period of 2 years. Results of this analysis revealed that Pseudomonas sp. when present alone or in combination with other bacterial species invariably inhibited Candida sp. growth. Thus, we conclude that the absence of Candida sp. in burn wounds, where Pseudomonas sp. is present, is due to the inhibition of Candida growth by this bacterial species.

Epidemiology and molecular typing of Candida isolates from burn patients.

This study, spread over a span of 2 years describes Candida infections in burn patients of an Indian hospital. A total of 220 burn patients were monitored and Candida could be isolated from 138 patients. A total of 228 different Candida species were obtained from various body locations of these patients. Species identification revealed that Candida albicans was the most predominant (45%) followed by Candida tropicalis (33%), Candida glabrata (13.5%), C. parapsilosis (4%), C. krusei (2.75%) and C. kefyr (1.75%). DNA fingerprinting of all C. albicans isolates was done by using CARE-2 probe. Fingerprinting analyses of all the C. albicans strains revealed that strains collected from different patients were different. It is noteworthy that patients with disseminated candidiasis had a similar, but unique strain isolated from all body locations, suggesting a possibility that commensal isolates might be turning pathogenic. Taken together, this is probably the first ever detailed survey of Candida infections in burn patients in India and is expected to lead to better clinical management of this group of patients.

Chronically exposed calvarium following electrical burns.

Electrical burns of the scalp and calvarium are uncommon, but due to various conditions peculiar to India such injuries are seen frequently. The presentation of such patients at hospital is late because of the paucity of specialized care facilities and understanding of the disease process. Such injuries usually cause necrosis of the scalp and underlying calvarium with sequestered bone being retained in situ by the flimsy adhesions of underlying granulation tissue and overhanging edges of the scalp all around caused by secondary wound contraction. This paper gives our experience of 14 such cases, explaining the reasons for the chronic state and their subsequent clinical management.