Comparison of hydro-fiber silver dressing and 1% silver sulfadiazine dressing for treatment of pediatric burns.

Burn is a debilitating and devastating emergency with many physical and psychological sequelae. Essential steps in burn wound management include cleansing/wound debridement, application of topical antimicrobial and dressing of affected body areas. Objective of this study is comparison in effectiveness of Hydro-fiber Silver dressing and 1% silver sulfadiazine dressing in management of pediatric burn patients in terms of wound healing. After ethical approval, 264 patients were enrolled and divided into two groups. Patients were managed with hydro-fiber silver dressing in group A and 1% silver sulfadiazine dressing in group B. An experienced pediatric surgeon examined the wounds for re epithelialization and efficacy was labeled after 15 days. Out of 264 enrolled patients 148(56.06%) were males and 116(43.94%) were females. Mean age of patients was 3.73±2.34 years. Type of burn was Scald in 215(81.4%) patients and flame in 49(18.6%). Depth of burn was 2nd degree in 185(70.08%) patients and 3rd degree in 79(29.92%) patients. Mean TBSA was 19.93±9.62%. In group A the efficacy was achieved in 91(68.9%) patients whereas in group B the efficacy was achieved in 73(55.3%) patients (p-value<0.05). Hydro-fiber Silver dressing is significantly more efficacious as compared to 1% silver sulfadiazine dressing for treatment of pediatric burn.

A large abdominal cyst as a manifestation of pelviureteric junction obstruction in a neonate.

Intraabdominal cystic lesions diagnosed during antenatal period are uncommon. They are found to have varying origins, with renal tract being the most common site. Rarely, a large unilateral cystic lesion of renal origin is caused by Pelviureteric junction obstruction, crossing the midline, leading to compression of the contralateral kidney. We present a case of a neonate who was diagnosed with a large abdominal cyst in the antenatal period. The cyst persisted and crossed the midline causing hydronephrosis on the contralateral side. This is an unusual presentation of a commonly occurring condition, usually such large cyst at birth origins from alimentary tract rather renal system. It is important to understand unusual presentations of intraabdominal lesions and the associated pathology. It is mandatory to rule out renal obstruction, if there is any decompression of renal function, it is mandatory to save renal function till the time of definitive surgery.

Eczema Herpeticum in children with burns.

BACKGROUND & OBJECTIVE: Eczema herpeticum (EH) is a disseminated viral infection occurring in pre-existing skin conditions and burns. The objective of this study was to determine the frequency, treatment, and outcome of EH in pediatric burn patients. METHODS: This retrospective study was conducted in the pediatric surgery department, King Edward Medical University/ Mayo Hospital, Lahore, from October 2015 to July 2018 after ethical approval. All pediatric burn patients diagnosed with EH and not sensitive to Acyclovir or suffering from chemical burns were enrolled in the study. Diagnosis was confirmed by presence of umbilicated lesions in burnt area and a positive Tzanck smear. Intravenous acyclovir and supportive treatment was started. Mortality, development of contractures, length of hospital stay/ time for wound healing, re-activation of EH was calculated. RESULTS: Out of 3958 admitted pediatric burn patients, 94(2.4%) developed EH. Girls were 58(61.7%) and boys were 36(38.3%). Mean age was 5.16 ±2.88 years. Scald burn was in 43(45.7%) patients, flame burn in 48(51.1%) patients, and electric flash burn in 3(3.2%) patients. Mean TBSA was 21.74+10.38%. Vesicular eruptions settled in 92 (97.9%) patients after treatment with acyclovir. Mean duration of treatment was 19.89+ 8.9 days and hospital stay was 29.84+ 16.98 days. Twenty three patients (24.5%) developed contractures and two patients (2.1%) developed disseminated EH and expired. Six (6.4%) patients had re-activation of EH. CONCLUSION: EH occurred in 2.4% of admitted pediatric burn patients. Intravenous acyclovir was successful in 97.9% of the patients, although 2.1% developed disseminated EH and expired. Re-activation occurred in 6.4% of the cases and was associated with prolonged hospital stay.