Burns in Diabetes Mellitus Patients among Indian Population: Does it Differ from the Rest?

BACKGROUND: Burn injuries in adults can be complicated due to various underlying factors. Of all the co-morbidities complicating wound healing and prognosis of the patient post burn injury, diabetes mellitus is the most common in India. We therefore aimed to explore the epidemiology, interventions, complications, and outcomes in diabetic patients with burn injury. AIM: To analyze demographic characteristics, clinical and microbiological profile and outcome of diabetic burns patients in comparison with nondiabetic burns patients. MATERIALS AND METHODS: This study was a retrospective analysis of diabetic and nondiabetic burns patients admitted to Apollo speciality clinics, Vanagaram, a tertiary care facility in Chennai over a period of 3 years. Data such as age, gender, type and degree of burns, percentage of burns and length of stay, mortality rate, infection rate, type of infections, surgical procedures, and medical complications were analyzed in comparison with nondiabetic burns patients. RESULTS: Among ninety-four burns patients admitted to our hospital over a period of 3 years, 18 patients (19%) were diabetics and 76 patients (81%) were nondiabetics. Mean age of diabetics was 58.2 years (SD-17.1) and nondiabetics was 36.3 years (SD-16.4). Surgical intervention with split skin graft was performed in 50% of diabetics and 48.7% of nondiabetics. Average length of stay of diabetics was 12.6 days and nondiabetics was 16.2 days (p value: 0.334). Diabetic patients with burns were noted to have higher rate of infection (67% vs 61.8%, p value: 0.803) and mortality (44% vs 35.5%, p value: 0.482). CONCLUSION: The clinical course is different between diabetic and nondiabetic patients with burns injury. Although length of stay and surgical interventions were not significantly different, diabetes as a comorbidity appears to increase the risk of infections and mortality in patients with burns. HOW TO CITE THIS ARTICLE: Vadala R, Princess I, Ebenezer R, Ramakrishnan N, Krishnan G. Burns in Diabetes Mellitus Patients among Indian Population: Does it Differ from the Rest? Indian J Crit Care Med 2020;24(1):11-16.

Pulmonary Nocardiosis and Scrub Typhus in an Immunocompromised Host.

Pulmonary infections are not uncommon in patients with an underlying immunocompromised condition. Unusual combination of microorganisms causing concomitant infections among these patients has also been reported. However, certain rare dual occurrences are usually unanticipated as in the case we present here. This case highlights the importance of being aware of the possible coexistence of infections in immunocompromised patients. To the best of our knowledge, this is the first report of coinfection with Nocardia otitidiscaviarum and Orientia tsutsugamushi in a critically ill immunocompromised patient from South India.

Melioidosis: An Emerging Infection with Fatal Outcomes.

According to the Centers for Disease Control and Prevention, from being nonendemic for melioidosis, India has now become endemic for the disease since 2012. Until then, melioidosis cases were being reported sporadically from India. There have been isolated case reports from few states across the country for the past few years. Most of the times, Burkholderia pseudomallei may be misreported as Pseudomonas species, especially in resource-poor laboratories. Due to its varied clinical presentation, the specific clinical diagnosis can be difficult, thereby making laboratory diagnosis mandatory. This could make a huge impact on patient care as this organism has a different treatment protocol as well as virulence determinants which influence the course of management. Although known for its endemicity in Australia, Thailand, and other Southeast Asian countries, B. pseudomallei has emerged in new areas such as India, Southern China, Brazil, and Malawi. We present a rare case of melioidosis with rapid disease progression to fatal outcome from Chennai, South India.

Synthesis, structural, thermal and photo-physical properties of triazine based NLO material.

Three novel triazine based organic chromophores with D-π-A (Donor-π system- Acceptor) push-pull type have been synthesized from 2, 4-diamino-6-phenyl-1,3,5-triazine as a starting material. Structures of all the three compounds have been confirmed by UV-Visible absorption, FT-IR, NMR and Mass spectral techniques. Their photo physical and thermal properties have been investigated. Among the three compounds, 6-phenyl-2,4-((4-amino-1,5-dimethyl-2-phenyl pyrazol-3-ylidene)(4-nitro benzylidene))-diamino-1, 3, 5-triazine (NDP) showed positive solvatochromism compared to the other two compounds. The absorption in the UV region of these three compounds were found to be less dependent on solvent polarities, whereas the red shifted fluorescence was strongly dependent on solvent polarities. The TGA data indicates that all the three compounds are stable up to 160 °C. Measurement of non linear optical properties showed that there is an increased second harmonic generation (SHG) efficiency with respect to urea indicating the existence of high molecular nonlinearity in NDP.

A preliminary study on the effect of adding yeast extract to cheese curd on proteolysis and flavour development of reduced-fat Cheddar.

Yeast extract was used as a nutrient for growing lactobacilli in reduced-fat Cheddar cheese as early growth of non-starter lactic acid bacteria (NSLAB) in Cheddar cheese is suppressed by pasteurization of milk and the hostile environment of the cheese. Reduced-fat Cheddar cheese was manufactured from 100 kg standardized milk on two occasions. After milling, the curd was divided into two portions, C and E. To control portion, C, salt was added at normal levels. A mixture of salt and yeast extract was added to the experimental, E. The cheeses were ripened for 7 months at 8 degrees C and assessed for proteolysis and NSLAB growth during ripening. Mean % moisture, fat, protein, salt and pH were 40.6, 20.5, 31.1, 1.72 and 5.22 respectively, in E cheeses, and 39.5, 20.5, 30.9, 1.68 and 5.22, respectively, in C cheese. NSLAB counts in E cheeses were 10(1), 10(3), 10(5) cfu/g compared with 0, 10(1), 10(4) cfu/g in C respectively, after 1, 7 and 30 d of ripening. After 60 d, cell densities of NSLAB were similar (approximately 10(6) cfu/g) in C and E cheese. Addition of yeast extract to curd affected neither the electrophoretic patterns of cheese nor its water-soluble N content during ripening. However, the total free amino acids were significantly higher in E cheese than C cheese throughout ripening, suggesting faster secondary proteolysis in the former cheeses. A 6-member trained descriptive panel evaluated the cheese at 7 months and found that the E cheeses had higher intensities of whey, fruity, sulphur, nutty, sweet and sour flavours, but had lower intensities of brothy flavours as compared to C cheeses. Also, the E cheeses were perceived to be more mature than corresponding C cheese. Results show that addition of yeast extract to cheese curd is a promising method of enhancing flavour development in ripened cheeses.

Natural (Unhydrolyzed) Milk Versus Lactose-Hydrolyzed Milk for Cultured Dairy Products: Physiological and Practical Implications for the Starter Industry.

As a microbiological medium, lactose-hydrolyzed milk is quite different from natural milk in that the restrictive role of milk lactose (the major energy source for microorganisms) is eliminated. To emphasize the restrictive role of lactose, the enzymatic and genetic mechanisms involved in the utilization of this beta-galactoside are discussed. Elimination of this selectivity leads to certain manufacturing and storage difficulties with cultured dairy products. This important change in the raw material (milk) should be recognized in selection of starter strains for use in conversion of lactose-hydrolyzed milk to cultured dairy products.

Exotic Fermented Dairy Foods.

Cultured dairy products are on the ascendency in the United States. The yogurt market has grown almost 600% over the last decade. There is also renewed interest in products containing Lactobacillus acidophilus . For innovative development to be competitive in the U.S. food market, the cultured dairy products industry has to look to exotic fermented dairy products which could be adapted for the American palate. Three such products are dicussed, which with slight modifications and imaginative flavoring may have a very good potential in the American market.