Treatment of post-burn and post-traumatic atrophic scars with fractional CO2 laser: experience at a tertiary care centre.

Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO2 laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO2 laser treatment. Patient's response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as 'excellent' if the mean score achieved was > 3. A score of 2-3 was labelled as good response while a score below 1 was labelled as 'poor' response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO2 laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.

Flexible Bronchoscopy in Non-resolving Pneumonia.

OBJECTIVE: To study the utility of diagnostic flexible bronchoscopy and bronchoalveolar lavage (BAL) in children with non-resolving pneumonia. METHODS: This was a cross-sectional study conducted in a tertiary care hospital from July 2015 through June 2016. Fifty-two consecutive children of both genders from 1 mo to 14 y of age with a diagnosis of non-resolving pneumonia were included. Flexible bronchoscopy was done in all patients with or without bronchoalveolar lavage (BAL). BAL was sent for gram staining, culture, gene expert™ and lipid laden macrophages examination. Main outcome measures were to find any morphological abnormality in the tracheobronchial tree and organism profile of a positive BAL culture. RESULTS: During the period of 12 mo, 52 consecutive patients of non-resolving pneumonia were enrolled. Median (IQR) age of the study population was 12 (68.8) mo. Mean ± SD duration of illness was 22.7 ± 5.6 d. Flexible bronchoscopy was found to be very safe and effective tool that directly led to definitive diagnosis in 30.7% of cases. It was positive for different organisms in 22 (52.3%) children. Neglected foreign body was seen in five patients. CONCLUSIONS: Non-resolving pneumonia is often an area of clinical dilemma. Bacterial infections are the commonest etiology. Non-infectious causes like tracheobronchomalacia and foreign body aspiration are other important etiologies to be looked for. Early bronchoscopy and bronchoalveolar lavage analysis can play a crucial role in the evaluation of these patients and may provide an important clue or strongly support the specific diagnosis.

Morbidity pattern and impact of rehabilitative services in Earth quake victims of kashmir, India.

BACKGROUND: The Kashmir earthquake also known as South Asia earthquake, hit both sides of Jammu & Kashmir on October 8th 2005 and was quite devastating with official toll of deaths being 73,276 in Pakistan Administered Kashmir (POK) and 1,360 deaths in the Indian administered Kashmir. The injured registering on the two sides were around 100,000 and 6,300 respectively. This was followed by a series of aftershocks on both sides for another 3 weeks METHOD: A follow up (retrospective) survey was conducted by the Department of Community Medicine SKIMS, Srinagar in collaboration with National Institute of Orthopedically Handicapped (NIOH), Kolkata, immediately after the devastating earthquake of October 2008 that hit Kashmir (Jammu & Kashmir- India) and northern parts of India with the objectives to know the nature of the injuries, magnitude of disabilities, rehabilitative services provided, and service satisfaction. Addresses of earthquake victims registered with various health institutions, Tertiary Care Centre, orthopaedic hospital, district hospital and Composite Regional Centre (CRC)(through which rehabilitative services were provided initially) were collected and referral details, if any, to various health institutions. They were visited at their residence and interviewed for the desired information as per proforma by a team comprising of a doctor, physiotherapist, prosthetist and orthotist by making house to house survey in the earthquake areas. An effort for non registered injured victims, if any in the locality, was also made with health or district authorities to trace non registered injured persons RESULTS: The study shows that majority of injured were young adults and adolescent females, and primarily upper extremities, cervical spine and head were injured. The severely injured were shifted within 12-24 hrs to referral hospitals. In 2/3rd of affected families, single member was injured, whereas in 1/3rd at least two were injured. The case fatality rate was <1% because of low prevalence of crush injuries, and quick medical relief/management of the injured. A significant number of seriously injured victims (40%) required rehabilitative services and assistive devices. Probably a quick intervention by medical rehabilitative services, including facility of assistive aids and necessary customised prosthetics and orthotics first time in such disaster, has resulted in high client satisfaction, early restoration of functional and psychological status of the injured victims. CONCLUSION: A collective effort by various public and private agencies with timely response at referral hospitals to various injuries reduced the frequency and chances of major disabling conditions. Intervention by CRC for providing assistive devices has also significantly helped in bringing back the functional and psychological status of the injured victims. Proper inter-sectorial coordination, better managerial skills, training of community volunteers (NGOs), and professionals on disaster management may further reduce the injury related disability and its impact. There is need of updating medico-surgical disaster management training for health care workers on continuous basis at various levels.