Self knotting of Naso gastric tube in paediatric Burns patient.

Nasogastric tube feeding is one of the most accepted modes of enteral feeding in adult as well in the paediatric patients who require prolonged hospitalization due to various conditions. Enteral feeding is one of the most commonly used method for feeding in Burns patients. As per our protocol for feeding in all Burns patients, including adults and children are kept on Ryles tube enteral feeds every hourly. We routinely take check X-rays after insertion of Ryles tube and central lines. In majority of cases we never come across any complications arising from insertion of Ryles tube but in our experience at Eric Kharas memorial Burns center, Masina hospital we had two cases in which complications were encountered from inserting long Ryles tube. The aim of this paper is to emphasize on the role of proper calculation of exact length of Ryles tube prior to insertion and routine X ray examination, which can prevent complications arising from long and coiled Ryles tube.

Bacteriology of the burn wound at the Bai Jerbai Wadia hospital for children, Mumbai, India-A 21 year study of predominant Pseudomonas species.

This study aims to assess the change in the antibiotic sensitivity pattern of Pseudomonas species with time. Microbiological data of 2399 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 21 years (1994-2014) was reviewed. The age group of patients admitted to our facility ranged from one month to fifteen years. A total of 11,402 burn wound swabs were cultured and 17507 isolates were tested for their antibiotic sensitivity. Pseudomonas was found to be 31.8% of the total number of isolates found on the burn wound which is second in line to Klebsiella species at our unit. It was found that the sensitivity of Pseudomonas species to various antibiotics tested has been restricted to very few antibiotics. The organism out plays most of the antibiotics that it is subjected to in vitro. Our efforts should now be channelized towards limiting the use of antibiotics. We must focus on preparing proper antibiotic policy which exercises control of irrelevant and excessive use of antibiotics. It should also be noted that every treatment facility has microorganisms unique to it and these change with time. It is, therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity. This will not only help to control infection related morbidity and mortality but will also curb the growing resistance to antibiotics.

Impact of Ulinastatin on Outcomes in Acute Burns Patients.

Burns is a global health problem with significant morbidity and mortality. Ulinastatin, a serine protease inhibitor, has the potential to improve outcomes in burns. A retrospective comparative case note review analysis was performed to assess the impact of ulinastatin on the outcomes in acute burns patients. Acute burns patients, admitted to Masina hospital, Mumbai, from October 2012 to April 2015, who received ulinastatin, were identified from the hospital records. A similarly sized cohort of patients, admitted before the introduction of ulinastatin, was also identified. Relevant data were obtained from archived patient files. The outcomes, mortality and length of hospital stay, were compared across different groups and subgroups. Data of 97 patients, 48 of whom received ulinastatin (ulinastatin group) and 49 of whom did not (control group), were captured. Patients in ulinastatin group had received ulinastatin 100,000 IU, 8 to 12 hourly, during a mean period of 8.8 days, based on clinical judgment, in addition to standard hospital care. The in-hospital mortality was lower (60.4%) in ulinastatin group compared with control group (75.5%). The difference in mortality was statistically significant (50% vs 77.27%; P = .04) in those with 41 to 80% burnt BSA. Mean length of hospital stay, where shorter duration of hospitalization is usually associated with death, was higher in ulinastatin group compared with the control group. Ulinastatin appears to reduce mortality in acute burns patients, especially in those with intermediate extent (40 to 80%) of burnt BSA. It also appears to delay death in those who ultimately succumbed to their burn injuries.

Antibiotic sensitivity pattern of Klebsiella species in burn wounds at Bai Jerbai Wadia hospital for children, Mumbai, India-a 21 year study.

In our study, we attempt to look at the sensitivity pattern of the most commonly found microorganism in the wound swab of pediatric burn patients at our hospital, 'Klebsiella', to a number of commonly used antibiotics and to determine whether there has been a change in the sensitivities in the 21 year period between 1994 to 2014. The sensitivity was tested in vitro and antibiotics were administered to patients based on laboratory findings. Klebsiella shows a significant change in sensitivity pattern over last 21 years. The sensitivity of this organisms to various antibiotics tested has reduced over time. The organism out plays most of the antibiotics that it is subjected to in vitro. Our efforts should now be channelized towards limiting the use of antibiotics or a proper antibiotic policy which exercises control of irrelevant and excessive use of antibiotics.

Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India-A 13-year study, Part I-Bacteriological profile.

AIM: To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief. METHOD: Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years. RESULT: Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text. CONCLUSION: Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.