ORCID Profile
0000-0002-8801-2545
Current Organisation
Phect-NEPAL, Kirtipur Hospital
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Journal of Nepal Medical Association (JNMA)
Date: 22-11-2020
DOI: 10.31729/JNMA.5233
Abstract: Introduction: Burn injury is an important cause of mortality and morbidity in children worldwide. Mortality is higher in developing countries than in developed ones. Most of them occur in predictable domestic settings and can be prevented. The objective of this study was to find out the prevalence of acute pediatric burns in a hospital setting. Methods: A descriptive cross-sectional study was conducted by reviewing the secondary data of burn cases admitted during the years 2016 AD to 2018 AD in a tertiary care hospital after taking ethical clearance from the Institutional Review Committee (IRC No. 016-2019). The s le size was calculated and systematic random s ling was done. Data analysis was done using Statistical Package for the Social Sciences, version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The prevalence of acute pediatric burns at the hospital was found to be 101 (29.71%) (24.85-34.57 at 95% Confidence Interval). The majority of them were males 54 (53.47%) and toddlers 39 (38.61%). Scalding 54 (53.47%) was the main etiology. Most of the burn injuries occurred inside the house 76 (75.25%) and on November 11 (10.9%). The mortality rate was 11 (10.89%). Conclusions: The prevalence of acute pediatric burns in a hospital setting was lower than most other countries but mortality was higher. The majority of the burn injuries occurred inside the house. Therefore, special focus should be done on prevention at the household level. Adequate medical services for emergency management of childhood burns should be available in different parts of the country.
Publisher: Nepal Journals Online (JOL)
Date: 31-12-2021
Abstract: Surgical management of vaginal agenesis constitutes a significant technical challenge. The goal of vaginal reconstruction is to create a neovagina that is both functionally and aesthetically satisfactory using a simple and reliable technique applicable to most. Bilateral pudendal thigh flaps were used to reconstruct neovagina for a 13-y girl with congenital vaginal agenesis. She presented with cyclical abdominal pain and hematometra, had normal secondary sexual characteristics and grossly normal external genitalia with a dimpling at the site of the vaginal orifice without lower vaginal tract.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
DOI: 10.1097/GOX.0000000000001510
Abstract: In Nepal, burn trauma causes more than 55,000 injuries each year. Burn-related mortality is high in Nepal, in part due to lack of allograft, leading to high infection rates. To address this challenge, our collaboration between Kirtipur Hospital, America Nepal Medical Foundation, Stanford University, and ReSurge International established Nepal’s first skin bank. We identified 3 major tasks to create a sustainable skin banking program: 1) identify and acquire the equipment and personnel needed to collect, process, store, and graft cadaveric skin for burn injuries 2) develop safe donation protocols and documentation tools that remain feasible for low-resource settings and 3) develop a long-term awareness program to educate the Nepali people on skin donation, a previously foreign concept. Kirtipur Hospital acquired the necessary equipment and materials for the skin bank through a combination of local and international fundraising efforts. Existing U.S. skin banking protocols were adapted for the Nepali setting and piloted on potential patients, donors, and physicians. For the first time in the hospital’s history, patients with 40% total body surface area burns were successfully treated with extensive allografts. It is feasible to create a skin bank in a country with no tradition of allograft skin use. Long-term sustainability now depends on spreading awareness and education in the Kathmandu Valley to overcome religious and cultural barriers that have hindered donor recruitment. Our low-cost and high-impact skin bank provides a model to expand this system to other hospitals both within Nepal and beyond.
Publisher: Nepal Health Research Council
Date: 21-01-2021
DOI: 10.33314/JNHRC.V18I4.2948
Abstract: Background: This study assessed the lower limb reconstruction outcome so that it will provide a baseline evidence to enable data-driven decision making to improve outcome in the future.Methods: In this study, hospital records from 1st January to 31st December 2019 were collected retrospectively. Complete data of all patients’ records treated for lower limb defects at Kirtipur Hospital were included and incomplete data were excluded. Univariate and Bivariate analyses were performedResults: In total 110 patients were included in this study with a male predominance of 66.4% (n=73). The mean age of the patients was 38.7 years (+/- 20). The majority of the patients were from outside Kathmandu valley 79.1% (n=87) and referred 55.5% (n=61). The commonest cause of lower limb defects was trauma 69.1% (n=76), the procedure performed was skin graft 48.5% (n=72), and complication was wound infections, 43% (n=13) of total complications. The hospital stay of more than two weeks was more common among the referred patients 63.9% (n=39) as compared to non-referred patients 30.6% (n=15) and trauma etiology 34.2% (n=26) had more complications than other etiology. The mean age of patients with complications (32.4 years) was lower than those without complications (41.1 years). More number of referred patients (n=43) required multiple surgeries than non-referred patients (n=21).Conclusions: Referred cases were more likely to have multiple surgeries and a longer hospital stay than non-referred cases. Infection was the commonest complication and the majority of complications were seen in trauma and younger age group. Keywords: Lower limb defect plastic surgery reconstruction
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BURNS.2016.11.006
Abstract: Telemedicine in outpatient burn care, particularly in burn scar management, may provide cost-effective care and comes highly rated by patients. However, an effective scar scale using both video and photographic elements has not been validated. The purpose of this study is to test the reliability of the Patient and Observer Scar Assessment Scale (POSAS) using live video-conferencing. A prospective study was conducted with in iduals with healed burn scars in Kathmandu, Nepal. Three independent observers assessed 85 burn scars from 17 subjects, using the Observer portion to evaluate vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion. The on-site observer was physically present with the subjects and used a live videoconferencing application to show the scars to two remote observers in the United States. Subjects used the Patient portion to evaluate the scar that they believed appeared the worst appearance and had the greatest impact on function. The single-rater reliability of the Observer scale was acceptable (ICC>0.70) in overall opinion, thickness, pliability, and surface area. The average-rater reliability for three observers was acceptable (ICC>0.70) for all parameters except for vascularity. When comparing Patients' and Observers' overall opinion scores, patients consistently reported worse opinion. Evaluation of burn scars using the Patient and Observer Scar Assessment Scale can be accurately performed via live videoconferencing and presents an opportunity to expand access to burn care to rural communities, particularly in low- and middle-income countries, where patients face significant access barriers to appropriate follow-up care.
Publisher: Nepal Journals Online (JOL)
Date: 10-2019
DOI: 10.3126/JCMSN.V15I3.24363
Abstract: Background: Burn infections are the major causes of morbidity and mortality in burn patients. The infectious agent could be both Gram positive and Gram negative bacteria. The aim of this research was to study the bacteriological profile of burn patients and anti-microbial susceptibility pattern of their wound isolates. Methods: This cross-sectional study was conducted in Kirtipur Hospital, Nepal from January 1st to March 31st 2019. A total of 109 burn patients were included and their wound swabs were collected at the time of admission. All isolates were identified by standardized microbiological procedures. Anti-microbial susceptibility tests were performed by Kirby Bauer disc diffusion method. Results: Of 109 burn wound s les, 56 (59%) yielded culture growth and the Gram negative isolates were more common than Gram positives (77% vs. 23%). The most common organism isolated was Klebsiella spp. (25%) followed by Acinetobacter spp. (21%) and Staphylococcus aureus (18%). Most burn wound isolates were of resistant strain. Particularly, highly resistant strain of Acinetobacter spp. were isolated, most of which were sensitive to Tigecycline, Polymyxin B and Colistin only. Conclusion : Gram negative isolates were common in burn wound isolates and the antibiotic susceptibility pattern was different for different organisms. The use of antimicrobials should be judicious to further not escalate the problem of antimicrobial resistance in the healthcare settings.
Publisher: Nepal Health Research Council
Date: 28-01-2019
DOI: 10.33314/JNHRC.V16I41.1197
Abstract: Thumb is very important for hand function. Many options are available to reconstruct injured thumb from simple dressing (pulp injury without bone exposure) to replantation and toe transfer (significant loss of thumb length). In chronic setting, where other fingers are intact, on-top plasty can be used to reconstruct injured thumb. In this study, a case of a boy who lost his thumb in a road accident is presented. Thumb reconstruction was performed using partially injured ipsilateral index finger. At two months, successful restoration of form and function were noted. Keywords: Index finger on-top plasty thumb injury thumb reconstruction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2201
Publisher: Elsevier BV
Date: 07-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
DOI: 10.1097/GOX.0000000000002334
Abstract: There is an evident need for Negative Pressure Wound Therapy (NPWT) systems specifically designed for use in resource-constrained settings to aid in the treatment of open wounds. Prospective single-arm interventional pilot study of 14 patients with complex wounds was conducted at Kirtipur Hospital in Kathmandu, Nepal. A novel NPWT device, the Kyron Suction Unit, was used by 4 plastic surgeons. Primary outcomes were ease of use (10-point Likert scale) and device safety (adverse events recorded). Pain (Visual Analogue Scale score), quality of life (modified EuroQol Derived Single Index scores), and wound dimensions were recorded. User ratings on the 10-point Likert scale indicated high confidence and ease of use: median confidence setting up the device of 1.0 [interquartile range (IQR), 1.0 mean 2.3], median confidence maintaining the device of 1.0 (IQR, 1.0 mean, 1.5), and median ease of disassembly of 1.0 (IQR, 1.0 mean, 1.4). Significant improvement in Visual Analogue Scale scores ( P = 0.03), modified EuroQol Derived Single Index scores ( P 0.001), and a reduction in wound volume [median, 47.25–9.75 cm 3 ( P = 0.01)]. Image analysis of wounds pretreatment and posttreatment demonstrated increase in granulation tissue surface area [median, 7.6–28.7 cm 2 ( P = 0.003)] and decrease in open wound surface area [median, 48.33–33.6 cm 2 ( P = 0.01)]. The Kyron Suction Unit was safe and easily managed by plastic surgeons. The device design promoted access to NPWT, a therapy proven to reduce healing time and decrease complications for patients with open wounds, in a resource-constrained setting.
Publisher: Oxford University Press (OUP)
Date: 13-06-2019
DOI: 10.1093/JBCR/IRZ096
Abstract: In Nepal, burn is the third most common injury after falls and road traffic accidents. Infection is the leading cause of mortality in burn injury. A profile exploring predominant flora and antimicrobial sensitivity is important to facilitate treatment ahead of microbiology results and to aid prevention of multidrug-resistant organisms. The aim of this study was to document epidemiological and bacteriological data of burn wound infections at a tertiary level burns center in Nepal. S les were collected from January 2017 to May 2017, over a period of 5 months. Patient notes were referred to and information regarding baseline characteristics and burn wound infection data was collected. A total of 76 patients were included in the study during the 5-month period, which resulted in 113 s les being included for review. Females were injured most with burns 70% (n = 53) compared with males 30% (n = 23). Only 6 (8%) of 77 patients lived locally in Kathmandu. The average distance traveled by patients was 233 km (median 208, range 0–765, SD 181). Average TBSA% of burn was 22% (median 20, range 3–50, SD 12). Gram-negative organisms predominated, with Acinetobacter spp. in 42 cases (55%), Pseudomonas aeruginosa in 26 cases (34%), and Enterobacter spp. in 16 cases (21%). Colistin, polymyxin B, and tigecycline were found to be most sensitive covering 108, 98, and 94 organisms. Gram-negative bacteria colonized the majority of burn wounds. Colistin, polymyxin B, and tigecycline were the most sensitive to gram-negative bacteria. Gram-positive Staphylococcus aureus was sensitive most to vancomycin and tigecycline.
Publisher: Nepal Journals Online (JOL)
Date: 31-07-2017
DOI: 10.3126/JNGMC.V15I1.23565
Abstract: Degloving injury involves shearing of the skin from the underlying tissue due to differential gliding in response to the tangential force applied to the surface of the body leading to disruption of all the blood vessels connected to skin. The flap of degloved skin has precarious blood supply making it almost impossible for the flap to survive. We describe two cases of degloving of thigh managed differently in different settings.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
DOI: 10.1097/GOX.0000000000003428
Abstract: Plastic surgery varies in scope, especially in different settings. This study aimed to quantify the plastic surgery workforce in low-income countries (LICs), understand commonly treated conditions by plastic surgeons working in these settings, and assess the impact on reducing global disease burden. We queried national and international surgery societies, plastic surgery societies, and non-governmental organizations to identify surgeons living and working in LICs who provide plastic surgical care using a cross-sectional survey. Respondents reported practice setting, training experience, income sources, and perceived barriers to care. Surgeons ranked commonly treated conditions and reported which of the Disease Control Priorities-3 essential surgery procedures they perform. An estimated 63 surgeons who consider themselves plastic surgeons were identified from 15 LICs, with no surgeons identified in the remaining 16 LICs. Responses were obtained from 43 surgeons (70.5%). The 3 most commonly reported conditions treated were burns, trauma, and cleft deformities. Of the 44 “Essential Surgical Package'' procedures, 37 were performed by respondents, with the most common being skin graft (73% of surgeons performing), cleft lip alate repair (66%), and utations/escharotomy (61%). The most commonly cited barrier to care was insufficient equipment. Only 9% and 5% of surgeons believed that there are enough plastic surgeons to handle the burden in their local region and country, respectively. Plastic surgery plays a significant role in the coverage of essential surgical conditions in LICs. Continued expansion of the plastic surgical workforce and accompanying infrastructure is critical to meet unmet surgical burden in low- and middle-income countries.
Publisher: Nepal Journals Online (JOL)
Date: 31-10-2018
DOI: 10.3126/JNGMC.V14I2.21537
Abstract: Background: There can be multiple hand problems with which patients can present. Such hand problems can be because of any kind of trauma, birth defects, tumours, infection or other conditions. Hand surgery is a special field of plastic surgery, which deals with these hand problems. The Department of Burns, Plastic & Reconstructive Surgery of Kirtipur Hospital run by Public Health Concern Trust-Nepal has been providing hand surgery service to the patients with these hand problems.Aim of Study: To analyse the various types of surgical hand problems in patients attending Kirtipur Hospital.Material and Methods: It is a cross sectional retrospective observational study of the patients with different hand problems done at the Department of Burns, Plastic & Reconstructive surgery of Kirtipur Hospital from January to December 2016.Results: There were 124 patients who presented with various hand problems. There was male preponderance and the most common age group affected was between 15-60 years. Hand trauma was the most common cause of hand problems followed by post burn contractures.Conclusion: Hand is a complicated organ which can give rise to various problems. Hand surgery is an essential component of reconstructive surgery to deal with these problems. JNGMC, Vol. 14 No. 2 December 2016, Page: 41-43
Publisher: Journal of Nepal Medical Association (JNMA)
Date: 31-12-2013
DOI: 10.31729/JNMA.2432
Abstract: Introduction: Timely repair of cleft lip and palate maximises the benefits of surgery. Developing countries have large number of adults with unrepaired clefts. The impact of a cleft program can be determined by observing the trends of lower age at surgery. Public Health Concern Trust, Nepal has been providing a comprehensive nationwide cleft service since 1999. This study was conducted to see any change in the age at surgery. Methods: A retrospective cross sectional study was conducted to analyse the data of all the in iduals’ age at primary cleft surgery from July 1999 to June 2010. Mean and median age of in iduals as well as the proportion of in iduals operated on at the right age in different years were calculated and compared. Results: The median age for cleft lip surgery decreased from 100 to 24 months. Similarly the median age for cleft palate surgery decreased from 70 to 28 months. Proportion of surgeries carried out in the recommended age also increased. A change in the policy of the program reaching out to more remote areas and removing the age barrier for surgery resulted in older adults receiving surgery and increased median age especially for cleft palate repairs. Conclusions: A nationwide cleft program for a decade had a small impact on age at surgery. There are still many in iduals who are missing the ideal age for surgery. The program needs to reach more remote areas. This information will be useful for governmental as well as non-governmental organizations working in the area of clefts. Keywords: age cleft lip cleft palate Nepal.
Publisher: Oxford University Press (OUP)
Date: 03-2020
Abstract: Nepal is a low-income country where burn injury is a leading cause of preventable deaths and disabilities. A major burn center was established in 2013 to care for patients with acute injuries and reconstruction needs from local and from distant communities. We aimed to characterize the epidemiology of admissions and patterns of referral to guide health system planning and efforts. We described prospectively collected data from patients with acute burns from January 2016 to July 2019. Sociodemographic and injury data included age, sex, hospital of provenance or direct admission status, total burn surface area (TBSA), and presence of complications on admission (e.g., wound infection, sepsis). Outcomes included length of stay and mortality. Differences in proportions and medians were compared with Chi square and Wilcoxon Rank Sum tests, respectively. There were 1,813 patients admitted with acute burns over the study period. Median patient age was 26 years (IQR 12–45). More than half of patients were female (55%). Median TBSA was 15% (IQR 7–30%) with a median Baux score of 48 (IQR 27–75). Most patients were transferred from another facility (65% of admissions). Referrals came from over 300 facilities across the country. Referred patients had larger TBSA (median 16%, IQR 9–30%) compared to directly admitted patients (median 12%, IQR 5–30% (p=0.0001). Although median day post-burn day of presentation was 1 day for both groups, referrals had significant admission delays (IQR 0–7) compared to direct admissions (IQR 0–4, p=0.0001). An infection was present on admission in 5% of referrals compared to 2.4% of direct admissions (p=0.01). Median length of stay (among survivors) was longer for referrals (10 days, IQR 5–17) compared to 6 days (IQR 2–12) for direct admissions [p=0.001]). Mortality rate was relatively unchanged across the study period (23% in 2016, 21% in 2019, p=0.82). For patients with burn TBSA & %, inpatient mortality decreased from 76% in 2016 to 51% in 2019 (p=0.05), however there were few instances of hospital discharges with a palliative intent. There was no difference in mortality rate for referrals compared to direct admissions (21 vs 22%, p=0.63]. Despite significant delays in presentation and higher rates of infection on admission, mortality for referral patients was similar to directly admitted patients. Additionally, improvements in care quality have led to significant decreases in the mortality rate for large burns. These data suggest that regionalization of care in Nepal may successfully rescue and manage severe burns in a specialized center. These data support regionalization of care for patients with burn injuries in Nepal. Further work to understand the epidemiology and care of patients who do not get referred is required to address system gaps.
Publisher: Nepal Journals Online (JOL)
Date: 31-12-2019
DOI: 10.3126/JMCJMS.V7I2.30692
Abstract: Background and Objectives: Patients with hand injuries and other conditions presenting to ER or office are usually given local anaesthesia to evaluate the case or perform a certain procedure. Lignocaine in various concentrations with or without adrenaline is used. Lignocaine with adrenaline is shown to be more acidic than plain lignocaine of similar concentration causing more pain. Sodium bicarbonate has been shown to decrease the pH of lignocaine hence decrease the pain related to injection. So this study is carried out to compare buffered (sodium bicarbonate) and plain lignocaine with adrenaline for pain control and analgesia for patients undergoing hand surgery. Material and methods: Patients in the age group of 18-60 years were ided into two groups- a control group (receiving lignocaine hydrochloride with adrenaline) and a study group (receiving carbonated lignocaine with adrenaline) and were evaluated for pain at the site of injection, onset of action of the anesthetic and its duration of analgesia and anaesthesia. Results: A total of 38 patients were included, 19 in each group. There was a significant difference in the pain score at time of injection between study group and control group (median,range: 2( 1-5) and 7(4-9) respectively ) with p .001. However, there was no significant difference in terms of onset of action, duration of anaesthesia and return of pain sensation. One patient developed swelling over wrist joint who received buffered solution. Conclusion: Local anesthetics used routinely in hand department should be buffered with sodium bicarbonate to reduce pain on injection of drugs in the patients.
Publisher: Bangladesh Journals Online (JOL)
Date: 30-09-2021
DOI: 10.3329/JBCPS.V39I4.55945
Abstract: Introduction: The COVID 19 pandemic has adversely impacted all aspects of health care throughout the world. Burn care in lower and middle income countries has suffered the most. We aimed to compare burn care at Kirtipur Hospital before and during the pandemic and explore psychological issues and practice behaviour among burn care worker (BCW). Methods: Retrospective data analysis of burn patients admitted during April to August of 2019 and 2020 was done. Internet based survey of BCW was done. Results: Burn admissions, demographics and characteristics did not change. Fewer surgeries were undertaken in 2020. Almost half of the BCW worked 12 hours shift or longer. Most were working on half pay. Nearly everyone was using hand sanitizers, hand washing and masks. Few had access to level II personal protective equipments (PPE) to see suspected patients fewer had access to face shield, KN 95 masks and boot. Even gloves and caps were scarce. Many feared getting themselves or family members infected. Majority realized the need of clear hospital policy on how they would be managed when infected. Conclusion: Number, types, severity and mortality did not change. Number of surgeries decreased. Issues like pay cuts, longer working hours and lack of PPEs were reported by majority. J Bangladesh Coll Phys Surg 2021 39: 241-248
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.BURNS.2022.05.016
Abstract: Enterally based resuscitation for major burn injuries has been suggested as a simple, operationally superior, and effective resuscitation strategy for use in austere contexts. However, key information to support its implementation is lacking, including palatability and acceptability of widely available rehydration drinks. We performed a single-blinded, cross-sectional survey of 60 healthy children (5-14 years), adults (15-54 years) and older adults (≥55 years) to determine palatability and overall acceptability of five oral rehydration solutions (ORS) and a positive control drink (Sprite Zero®) in Ghana. Quantitative data were described and differences between our control drink and the others across age groups were visually examined with Likert plots. Qualitative responses were analyzed using a content analysis framework. Twenty participants in each age group completed the study. Participants were as young as 5 years and as old as 84 years. Nearly two thirds of the s le identified as male (n = 38, 63% of all participants). The positive control was reported to taste 'good or 'very good' by the majority of participants (89%) followed by lemon-flavored ORS (78%) and orange-flavored ORS (78%). Conversely, homemade and low-osmolarity ORS were reported to taste 'good' or 'very good' by only 20% and 15% of participants, respectively. There were no major taste differences across the age groups. However, children more frequently reported positively (i.e., tastes 'good' or 'very good') about flavored and sweet drinks than did adults and older adults. When faced with the hypothetical situation of being critically injured and needing resuscitation, participants tended to be more agreeable to consuming all the drinks, even low-osmolarity and homemade ORS. These findings can be used to support the development of protocols that may be more acceptable among patients undergoing enterally based resuscitation, thus improving the effectiveness of the treatment. Specifically, enterally based resuscitation should likely include citrus-flavored ORS when available, given superior palatability and the fact that different flavor additives for patients of different ages do not seem necessary.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Oxford University Press (OUP)
Date: 04-2021
Abstract: The study country has a disproportionally high burn incidence rate compared to other low- and middle-income countries. Preventable death and disability are common due to poor population-level spatial access to organized burn care, including no organized system of ground or aeromedical transport. Currently, severe burns are referred to a single facility nationwide, often with suboptimal stabilization and/or significant care delay. Therefore, we aimed to identify existing candidate hospitals that would optimize population-level access to acute burn care if burn stabilization capabilities were strengthened in each hospital. The 175 general hospitals that referred patients to the single national burn referral center between 2016–2020 were designated as candidate hospitals. Demand points for location-allocation modelling were derived from a 2020 estimated population density grid for the country (total population 30,184,338). Road network and national speed limit data were extracted from publicly available geodata to inform travel distance and time. Six models were developed (Models A-F) using cost-distance and network analyses to identify the 3 vs 5 candidate hospitals that would optimize population-level spatial access if their initial burn stabilization capabilities were strengthened. Three travel time thresholds (≤2, 6, and 12 hours) were used for both sets of models. Currently, 6,151,298 people (20.3% of the national population) have access to organized burn care within 2 hours of travel, 11,240,957 (37.2%) within 6 hours and 21,925,928 (72.6%) within 12 hours [Table 1]. If acute burn stabilization capabilities were strengthened, Models A-C of 3 chosen hospitals would increase population-level burn care access to 45.2%, 89.4%, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. Models D-F demonstrated that 5 chosen hospitals would increase population-level burn care access to 53.4%, 95.0%, and 99.9% of national the population at ≤2, 6, and 12 travel-hours, respectively. This exercise demonstrates two sets of models for increasing population-level access to acute burn stabilization in the study country. If acute burn stabilization capabilities were strengthened in the identified hospitals, approximately 90% of the national population would have access to burn care within 6 travel-hours in both the 3 and 5 hospital scenarios. Although the models with 5 strengthened hospitals reduce mean travel time, the percent of population with improved travel time access is only marginally higher. Strategic, organized efforts to increase burn stabilization capabilities might reduce the rates of preventable burn-related death and disability country-wide by reducing delays.
Publisher: Oxford University Press (OUP)
Date: 04-2021
Abstract: Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally. A cookstove is any apparatus that provides heat and is used for cooking (e.g., three-stone fire, traditional or improved cookstove). There are limited data on patterns of cooking behaviors and CSBs to inform prevention initiatives and advocacy. We aimed to describe the epidemiology, risk factors and outcomes of cooking-related burns and CSBs, specifically. Patients with cooking and non-cooking related burns from 2018 to 2020 were identified in the World Health Organization (WHO) Global Burn Registry (GBR). Patient demographics, cooking arrangement, injury characteristics [mechanism, total body surface area (TBSA), revised Baux score] and outcomes were described. Differences in proportions and medians were compared. Bivariate regression was performed to identify risk factors associated with occurrence of CSB. GBR contained data of 6,965 burn-injured patients from 17 countries 88% were from middle-income countries. One quarter of burn injuries (1,723 burns) were cooking-related. More than half of cooking-related burns (55%) occurred in females. Median age for cooking-related burns was 11 years (IQR 2–35). Of cooking-related burns, 22% were cookstove-related burns (CSBs 311 burns). The most common mechanism in CSB was flame (87%), whereas the most common mechanism in other cooking burns was scald (62%). Patients with CSBs were more often female (65% vs 53% p& 0.001) and much older than patients with other cooking burns (32 years, IQR 22–47 vs 5 years, IQR 2–30). CSBs were significantly larger in TBSA size (30%, IQR 15–45% vs 15%, IQR 10–25% p& 0.001), had higher revised Baux scores (70, IQR 46–95 vs 28, IQR 10–25 p& 0.001) and more often resulted in death (41 vs 11% p& 0.001) than other cooking burns (Table1). Patients with CSBs were more likely to be burned by fires (OR 4.74 95% CI 2.99–7.54) and explosions (OR 2.91, 95% CI 2.03–4.18) than other cooking injuries. Kerosene had the highest odds of CSB than all other cooking fuels (OR 2.37, 95% CI 1.52–3.69). Cooking-related burns are common and have different epidemiology than CSBs, specifically (e.g., more often female, older, larger burn size, higher mortality). CSBs were more likely caused by structural factors (e.g., explosion, fire) than behavioral factors (e.g., accidental movements) when compared to other cooking burns.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Publisher: Georg Thieme Verlag KG
Date: 06-07-2020
Abstract: With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
Publisher: F1000 Research Ltd
Date: 26-10-2021
DOI: 10.12688/F1000RESEARCH.73840.1
Abstract: Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population s ling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Multinomial logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190 95% CI, 1.08-1.32 p .001). Conclusions: Accidental spill burns were more common but mortality was significantly higher for hot cauldron burns. The majority of burn injuries occurred inside the kitchen emphasizing appropriate parental precautions. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.
No related grants have been discovered for Kiran K. Nakarmi.