Burns : journal of the International Society for Burn Injuries
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There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. ⋯ The bottom line of management is strict observation by burn staff. The low mean hospital stay also reflects our admission and discharge policy which is to benefit the maximum number of patients who require resuscitative/intensive care, and who have extensive and deep wounds, or injury of critical nature. We conclude that providing burn care based on our model can be emulated in other LICs as the costing is driven by 'necessity of expense' rather than 'ability to spend'.
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Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. ⋯ Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches.
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It is often difficult to apply traditional ECG electrodes on patients with extensive burns due to a large operative site, compromise of sterility, the fact that traditional placement would be within the operative site or because stick-on pads cannot stick due to prep solution, bleeding and other factors. We present an effective solution based on our experience, of using a common staple or "clip" where the ECG electrode is attached. We can see the patient in the prone position with the back having been debrided and grafted. This technical improvisation gives clinicians the ability to monitor safely and accurately the patients' physiological parameters.
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The transfer of drug resistance between hospital pathogens has led to alarming increase of multidrug resistant strains imposing therapeutic challenges. These resistant isolates harbor various mechanisms to counteract the drugs administered and have been reported to deliver these factors to sensitive strains in hostile environment. The present study aimed to screen for multidrug resistant Pseudomonas aeruginosa strains for the production of extended-spectrum β-lactamases, metallo-β-lactamases, AmpC β-lactamase, drug efflux phenotypes and co-transfer the resistance for cephalosporin and other non-beta lactam antibiotics in CaCl2 treated drug sensitive E. coli strains. ⋯ A putative efflux mechanism was observed in 8 out of 23 isolates that showed decrease in the MIC of meropenem with reserpine. The plasmid profile was characterized for all the common isolates obtained from burn and ICU units. About 69.66% of E. coli recombinants scored positive for both beta lactam and non-beta lactam antibiotics is due to co transfer of resistant plasmid obtained from P. aeruginosa.
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Bacterial contamination remains a constant threat in burn wound care. Topical treatments to combat contaminations have good bactericidal effects but can have detrimental effects for the healing process. Treatments with for example silver can increase healing times. ⋯ In contrast, re-epithelialization was significantly reduced after application of Flammazine(®) compared to L-Mesitran Soft or control. This in vitro model of burn wound infection can be used to evaluate topical treatments. L-Mesitran Soft is a good alternative for treating burn wounds but the slightly lower bactericidal activity in the burn wound model warrants a higher frequency of application.