Biomedical subjects
M Prasanna
Publications and source records attributed to M Prasanna.
The role of a 'satellite-service' in the national organisation of burn care in the Sultanate of Oman.
Khoula hospital, one of the major tertiary care hospitals, situated in the capital city, is the national trauma centre of the Sultanate of Oman. The burns-unit at Khoula hospital has developed an unique collaborative service of active participation in the initial management of burns patients admitted to the peripheral hospitals of the country. The description 'Satellite-service' is used in this paper to describe this 'remote-control service' offered by the main burns center, for the management of burned patients admitted the various peripheral hospitals (the 'satellites') throughout the country, during the shock-period of the first 36 hour post-burn. Thereafter the patients are transferred to the main center for further management. This system was instigated with a common protocol for the initial management of burns all over the country in 1981. Central registration of burns patients from peripheral hospitals was started in 1994. Retrospective analysis of the statistics and records of 151 burns patients transferred from 19 peripheral hospitals to Khoula burns center during a 3 year period from September 1994 to August 1997, showed that the satellite service is very effective in the initial management of patients during the shock period, as there was no mortality due to hypovolemia. The advantages of this service include uniform and appropriate 'initial' management of all the burns patients admitted to any of the hospitals of the country. The major disadvantages of the system were the increased work-load of the main center and poor patient-compliance with post-discharge instructions. This paper also describes how the Satellite service works in practice.
A profile of methicillin resistant Staphylococcus aureus infection in the burn center of the Sultanate of Oman.
A retrospective study of patterns of infection in 168 patients admitted during 1995 and 1996 in the burns-unit of Khoula hospital at Muscat, Oman was performed. Out of 819 isolates positive for pathogenic bacterial culture, there were 326 (39.8%) isolates positive for methicillin resistant Staphylococcus aureus (MRSA) infection. Incidence of MRSA infection was marginally more than that of Pseudomonas aeroginosa. The proportion of patients developing MRSA infection sometime or the other during their burns-unit stay ranging from 1 to 112 days rose from 48% in 1995 to 52.7% in 1996. No sophisticated tests were done to identify the MRSA strain but study of the antibiograms of each MRSA positive isolate showed very similar patterns of sensitivity to different antibiotics. This suggests the source of infection to be common and in all probability 'noscomial', since all patients acquired MRSA infection in the hospital. The susceptibility of MRSA to ciprofloxacin, cotrimoxazole and fucidin was 76, 51 and 37% of isolates in 1995, and 59, 44 and 26% in 1996 were susceptible to these drugs. Vancomycin was the antibiotic to which most MRSA cultures were susceptible, but partial resistance was reported due to very low susceptibility observed in 1.4% of the isolates in 1995 and 1.1% of the isolates in 1996. The control measures being practiced in the burns-unit of Khoula Hospital, especially mechanical cleaning and chemical disinfection of all surfaces, are discussed in detail. This paper emphasizes the need for preventive measures against MRSA infection in the burns-unit.
Early burn wound excision in "major' burns with "pregnancy': a preliminary report.
Burn injury in pregnant patients is not uncommon in developing countries. The results of the management of six pregnant burns patients, admitted during an 18-month period, were analysed. Successful management of burn injuries ranging from 25 to 65 per cent TBSA occurred in patients during the second and third trimester of pregnancy, using early burn wound excision and skin grafting in four patients and by late skin grafting of a granulating wound in one patient. All five patients delivered live babies with no congenital anomalies. One patient with 60 per cent TBSA burns who was unsuitable for early excision, died of septicaemia. This report suggests the need for early burn wound excision and skin grafting in burns patients with pregnancy, in order to improve maternal and fetal survival. However, in developing countries early surgery is not advisable in patients with extensive burns because of the non-availability of biological skin substitutes.
Surgical emphysema, pneumomediastinum and bilateral pneumothoraces complicating endotracheal intubation in a burns patient.
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Tangential excision and skin grafting for ash burns of the foot in children: a preliminary report.
In India, isolated burns of the feet in children are common, but people seldom seek specialized treatment. These burns result from careless disposal of hot ash or embers after cooking or religious functions. Five children were treated for acute burns of the feet, with tangential excision and skin grafting. Early surgical treatment of these seemingly innocuous burns offers distinct advantages, i.e., avoidance of painful dressings, the need for reconstructive procedures, and reduced hospital stay. It also helps in early return to childhood activities and normal growth of the foot. A new concept of excising deep dermal burns of the "sole" is emphasized to preserve sensate unburned dermis.
Early tangential excision and skin grafting as a routine method of burn wound management: an experience from a developing country.
This study assessed the feasibility of performing early tangential excision and skin grafting for burn wounds 'routinely' in a developing country. An analysis of mortality, morbidity and hospital stay was carried out for 90 burns patients with deep partial skin loss burns out of 202 admissions, who underwent 'early' tangential excision and skin grafting. Overall survival rate was 86.5 per cent. Children below 14 years of age with burns < or = 40 per cent TBSA (total body surface area) had no mortality, 93.5 per cent of adult patients with burns < or = 60 per cent TBSA survived in contrast to those with burns of > 60 TBSA per cent who all died. Morbidity for contractures and hypertrophic scars was nil to minimal. The mean hospital stay for adult patients with major burns was 30 days, with minor burns it was 18.7 days. We conclude that in developing countries, early tangential excision and skin grafting can and should be done routinely for all minor burns and for the major burns who are admitted to a well-equipped burns centre, but not for very 'extensive burns', until biological skin substitutes are more readily available.
Congenital accessory ectopic eyelid: case report.
An extremely rare case of congenital accessory ectopic eyelid associated with an oblique facial cleft is reported. The clinical features, histological findings and morphogenesis are briefly described.