Application Of Cling Film Over Burn Wounds (Occlusive Wound Dressing): Our Experience.

BACKGROUND: This study shares our experience and review the outcome of the use of cling film with silver sulfadiazine cream in terms of healing time, and patient's satisfaction score. METHODS: It was a descriptive case series conducted at Jinnah Burn and Reconstructive Surgery Center, Lahore, from March 2018 to February 2019. In this study, a thick layer of silver sulfadiazine was applied and then wrapped with cling film on 35 patients sustained mix thickness burns on the trunk and limbs. Dressing was done daily after wound wash with normal saline. Consultant Plastic surgeon assessed the wound healing by observation and serial photographs. Duration of wound healing and complications were noted. RESULTS: Complete wound healing was achieved in 25 (71.4%) patients with mean healing time of 13.3 days (range 11-15 days). The wound infection was seen in 5 (14.2%) patients, that were diagnosed by change in colour of wound edges and patients with signs of sepsis (ABA scoring). Sepsis was treated in 5 patients with debridement and culture specific antibiotics. split skin graft done in 8 (22.8%) cases. CONCLUSIONS: Moist wound dressing with Silver Sulfadiazine and cling film is cost effective, easy to apply with good visibility of the wound and has good patient satisfaction, but is labour intensive.

Digital Economy and Health: Does Green Technology Matter in BRICS Economies?

The present study attempts to examine the impact of digitization and green technology on the health outcomes of BRICS countries over the period of 1993-2019. Internet users measure digitalization, and health outcome is determined by life expectancy. The study employed the ARDL estimation approach for empirical investigation of country-specific analysis. GDP per capita and current health expenditures have been incorporated as control variables. The study findings reveal that digitalization results in increasing life expectancy in the long-run in BRICS except for Brazil. While green technology tends to enhance life expectancy in the long-run in Russia and China, it produces an insignificant impact on health outcomes in the short-run. While GDP and health expenditures also improve life expectancy in mostly BRICS economies in the long-run and short-run. Our study provides some policy implications for BRICS nations.

Supporting Role of Society and Firms to COVID-19 Management among Medical Practitioners.

Measurement of job stress and employees' commitment are few of the admired topics in the corporate world amongst business writers. With a principal aim to trial the blow of exposure to COVID-19 patients on doctors' job stress and commitment, in Pakistan; data have been collected through 7-10 min telephonic interview from voluntary participants and a sample of 129 responses were analyzed by Structure Equation Modeling-Partial Least Square (SEM-PLS) path modeling through Smart PLS 3.2. The results of the study indicated; direct positive & significant impact of Extent of Exposure on Job Stress while direct negative, significant association with Commitment. Job Stress also observed having direct negative impact on commitment. The Extent of Exposure-Job Stress relationship was also found stronger among group of doctors having Low level of Perceived Organizational Support and weaker among group of doctors having High level of Perceive Organizational support. Perceived Organizational Support showed a moderating effect on the Extent of Exposure-Job Stress relationship; while, Social Support showed no moderation. Researchers are required to investigate more and management of the medical services providers (both hospitals and government) needs to focus on doctors' perception about Organizational Support, as doctors show no concern about the support from society as long as their well-being is cared for by respective hospitals. This study is an effort to stimulate more empirical evidence towards the treating and handling of COVID-19 patients and the psychological well-being of doctors.

Early Active Mobilization Vs Immobilization Following Modified Kessler Repair Of Extrinsic Extensor Tendons In Zone V TO VII.

BACKGROUND: The long-disputed issue of rehabilitation of extensor tendon repairs in zones V-VII has been treated with either complete immobilization or mobilization within the constraints of splint. In recent times, most authors have preferred some mobilization. Many studies have shown good results with early mobilization techniques; however, these studies have limitations. Most of these are retrospective observations. Some prospective studies are without proper controls. This study was conductive to compare the functional outcome of early active mobilization versus immobilization following repair of extensor tendons in zone V-VII. METHODS: Functional outcome was determined by total active motion, pain and complications during rehabilitation. Total active motion (TAM) was graded by scores of the American Society for Surgery of Hand as TAM=total active flexion (MCP+PIP+DIP)-total extension deficit (MCP+PIP+DIP). A randomized control trial was conducted including 50 subjects of with extensor tendon injury exclusively in zone V-VII. Patients were divided randomly in two groups. All extensor tendon repairs (zone V to VII) were performed with modified Kessler's method. The pain and TAM was assessed during all visits in both groups except TAM in group B that was assessed after four weeks. RESULTS: We found that outcome of 12% cases in Group A as excellent and no patient fell in category of fair results. While, in comparison, there was no case of excellent result in Group B. 4% cases showed fair results that were treated with immobilization. The pain score at the end of treatment, i.e., at 12 weeks were same in both the groups but, generally the score remained higher in group of EAM. There was significant difference in adhesion formation that was more in patients of immobilization group. The overall suture dehiscence was insignificant and was only 8% in each group. CONCLUSIONS: EAM has better outcome in terms of pain and range of motion.

Granulocyte Colony Stimulating Factor in Burn Patients with Neutropenia.

OBJECTIVE: To assess the role of granulocyte-colony stimulating factor (G-CSF) for improving neutropenia in burns patients with neutropenia. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from May to October 2017. METHODOLOGY: Patients with burn injury, having absolute neutrophil count (ANC) <500 / µL or where it was expected to decrease to <500/µL within the next 48 hours, were recruited in the study. A detailed demographic profile of patients was taken, burn site was evaluated, and sample collection by phlebotomy was done in the complete blood count (CBC) vial. Samples were run in a CBC analyser and verification of neutrophil count on the neubuar chamber was done. ANC was taken for 3 days for each patient. Injection Filgrastim was given 300 µg subcutaneous (S/C) or intravenous (I/V) once daily until the neutropenia improved. Improvement was categorised as good, moderate and poor, depending on the number of days for improvement in ANC. The response was further stratified on the basis of age, gender and percentage of burn. RESULTS: A total of 39 patients with mean age of 32.1±14.4 years included 84.6% (n=33) males and 15.4% (n=6) females. Mean percentage of burn was 40.5±15.7%. In 12-40 years of age, there were 30/39 (76.9%) patients. Among them, 11/30 (36.6%) were good, 13/30 (43.3%) were moderate, and 6/30 (20%) were poor responders. In 41-70 years of age, there were 9/39 (23.1%) patients. Among them, 2/9 (22.2%) were good, 4/9 (44.44%) were moderate, and 3/9 (33.3%) were poor responders (p = 0.616). CONCLUSION: The addition of G-CSF injections to the standard treatment of burn injury markedly improve the neutrophil counts in burn patients with neutropenia.

Oropharyngeal, Hypopharyngeal and Cervical Esophageal Reconstruction: An Experience of Pedicle Flaps.

OBJECTIVE: To review the experience of single-stage reconstruction following pharygolaryngectomy and cervical esophageal defect with pedicle flaps in a tertiary care centre. STUDY DESIGN: Retrospective study. PLACE AND DURATION OF STUDY: Jinnah Burn and Reconstructive Surgery Centre, Lahore, from June 2007 to June 2017. METHODOLOGY: All patients who underwent oropharyngeal, hypopharyngeal and cervical esophageal reconstruction with pedicled flaps were included. RESULTS: Thirty-two reconstructions were done, of which 16 (50.0%) were supraclavicular flaps, 12 (37.5%) were pectoralis major myocutaneous flaps (PMMF) and 4 (12.5%) platysma myocutaneous flaps (PMF). Among these, 24 (75%) were males and 8 (25%) females. The mean hospital stay was 18.75 +5.45 days. Complications were noted in 12 (37.5%), salivary fistula being the most frequent found in 6 (18.75%). Wound dehiscence was noted in 4 (12.5%), partial flap necrosis and wound infection present in 1 (3.1%) each. CONCLUSION: Oropharyngeal, hypopharyngeal and cervical esophageal reconstruction with pedicle flaps is still very useful and safe to perform, associated with minimal flap and donor site complications.