Aim : The aim of this study was the initiation of systematic data collection so as to improve the capacity for outcome measurement after cleft repair. Also, a clinical audit was done for evaluation of the process and assessment of outcomes of cleft care. Design and Setting : A questionnaire-based survey and outcome assessment was carried out over a 1-year period from March 2008 to February 2009 at the combined outpatient cleft clinic of a tertiary care center in India. Patients and Participants : Data collection (basic demographic and environmental information) was done twice a week throughout the year by students from the Department of Pediatric Dentistry, at the outpatient cleft clinic. Results : A total of 68 completed cleft lip and palate registry forms, from which all the information was available, were analyzed. There was a skewed sex ratio, with a higher preponderance of boys seeking treatment. Of affected males, 19.1% were between 2 and 5 years of age when they first reported to the cleft clinic. Surprisingly, no bilateral clefts of lip, unilateral cleft lip (right) and unilateral cleft lip and palate (right) were observed in girls. Oral health was poor in 74% of patients; among the dental referrals only 26% could be recruited for orthodontics with a reasonably good prognosis. Conclusions : Poverty, illiteracy, and superstitions prevent an average patient from India from receiving multidisciplinary cleft care. This emphasizes the need to create systems that suit the needs of our target patients.
BACKGROUND burn injury is the major public health problem in many parts of the world. It has been estimated that 75% of all deaths following burns are related to infections. Burn wound sepsis leads to both local and systemic manifestations as the burn injury destroys the skin barrier that normally protects & prevents the invasion by microorganisms, making the burn wound exposed to various infections. Topical antimicrobial decreases the microbial overgrowth but rarely prevents further colonization with other potentially invasive bacteria & fungi. Organisms keep on changing over the time. So, in depth knowledge of the organisms that are predominant in that particular period along with their sensitivity pattern is vital as many septic burn patients need to be treated with antibiotics much before the results of wound culture sensitivity are available. This would be crucial to reduce overall infection related morbidity & mortality. METHODS A prospective study was done in burn patients admitted in burn unit of Christian Medical College and Hospital, Ludhiana, during the period 2012-2013. A total of 103 patients was studied after following inclusion and exclusion criteria. Wound swab (surface smears) and biopsy/tissue culture were done on first-, second-, third-and fourth-week post admission. Organisms prevalent and antibiotic sensitivity at that particular period were determined. All types of burn patients were included from OPD and emergency department after an informed consent was obtained. All those who were not willing for participation in the study were excluded. RESULTS The most common mode of injury in our study was flame burn. Pseudomonas & Acinetobacter were most common microorganisms causing wound infections after one week of hospital stay. After that MRSA was the dominant organism. CONCLUSIONS Identification of microorganisms causing burn wound infections by wound swab cultures/tissue cultures and administering antibiotics according to their antibiotic sensitivity patterns is pivotal in managing these infections and decreasing overall morbidity and mortality in burns unit.
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