Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, with infections and antimicrobial resistance posing significant challenges. Carbapenem-resistant Gram-negative bacteria are particularly concerning in burn intensive care units. The aim of the study was to evaluate bacteriological profile, and antimicrobial susceptibility patterns of burn ICU patients, and identify risk factors associated with carbapenem resistance, invasive infections, and in-hospital mortality. This retrospective, single-center study included all patients admitted to a 30-bed burns ICU in north India between January and December 2024, whose clinical sample was received for microbiological investigations. Data on demographics, clinical parameters, and microbiological findings were extracted from hospital records and analyzed using chi-square, Fisher's exact, Mann-Whitney U tests, and multivariable logistic regression. Out of 246 patients included, the mean age was 29.1 ± 20.4 years and mean total body surface area (TBSA)% was 39.0% ± 19.9%. Overall mortality was 42.3%. A total of 1586 samples yielded 1057 pathogens, predominantly Gram-negative bacteria (Pseudomonas aeruginosa 36.1%, Acinetobacter baumannii 22.3%, and Klebsiella pneumoniae 18.8%). Carbapenem resistance was observed in 85.3% of patients and was significantly associated with higher TBSA% (P < .001), longer hospital stays (P = .022), and mortality (P < .001). Invasion was present in 27.6% and was significantly associated with both carbapenem resistance and mortality. Multivariable logistic regression identified TBSA% (odds ratio [OR]: 1.07, P < .001) and invasion (OR: 4.14, P = .001) as independent predictors of mortality. Carbapenem resistance and invasive infections are highly prevalent in burn ICU patients, underscoring the urgent need for robust infection control, regular antibiogram surveillance, and targeted antimicrobial stewardship in burn care settings.

Background: Aesthetic contouring of the upper extremity is a popular procedure but presents significant challenges due to the visibility of the region, anatomical complexity and high expectations for cosmetic outcomes. Despite advancements in technique, contour irregularities, nerve injuries and poor scarring remain common if anatomical principles are not respected; we aim to define the anatomic and aesthetic units of the upper arm and evaluate outcomes of arm contouring procedures using a zone-based approach. Methods: This retrospective study analysed 154 patients who underwent upper arm contouring procedures—liposuction, traditional brachioplasty or extended brachioplasty- between July 2005 and February 2025. Data collected included demographics, operative time, liposuction volume, arm circumference reduction, complications, patient satisfaction, scar scores and revision rates. Patients were marked preoperatively using a zone-based protocol emphasising the anatomy of fat compartments. Results: Liposuction accounted for 65.6% of cases and was more common in younger patients with good skin tone. It resulted in the shortest operative time and the lowest Vancouver Scar Scale scores, with the highest proportion of ‘very satisfied’ patients. Although complication rates were low across groups, sensory changes were more frequent with liposuction, while wound dehiscence occurred frequently in traditional brachioplasty. Liposuction volumes were substantial even in brachioplasty groups, reflecting its role as an adjunctive tool. Conclusion: An anatomy-guided, zone-based approach to arm contouring achieved aesthetic results and minimised complications. Liposuction offered excellent outcomes in selected patients, while brachioplasty remained necessary for severe skin redundancy. Preoperative marking and patient-specific planning were key to safe and satisfying outcomes.

BACKGROUND:Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient-identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients. METHODS:A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi-structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach. RESULTS:A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long-term social distress. Themes for patient-proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non-medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance. CONCLUSIONS:Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient-reported solutions to mitigate FT is vital to improving patient outcomes after surgery.

Aim and background: The cleft lip nasal deformity (CLND) is characterized by numerous complex and interdependent deformities involving the soft tissues and skeleton of the nose. The underlying anatomic deformities mostly require replacement of the deficient framework with some form of cartilage grafts. With a wide array of cartilage grafts available, it becomes difficult for even the most experienced surgeon to choose the right graft for a particular patient. The primary objective of this study was to compare the properties of different cartilage grafts available for correction of secondary CLND. Methods: We present a series of 10 patients with cleft nose (all unilateral cleft) with various deformities. These patients underwent surgery between January 2018 and January 2019. Results: The follow-up period ranged from 12 to 18 months (mean: 14.7 months). Costal cartilage (n = 5) provided excellent long-term stability and versatility but was associated with high donor-site morbidity. Conchal cartilage (n = 2) offered good contouring for alar onlay grafts but showed moderate stability. Septal cartilage (n = 2) demonstrated minimal donor site morbidity and was ideal for smaller corrections, but limited availability constrained its use. One patient received a combination of costal and conchal cartilage, achieving excellent esthetic outcomes. Conclusion: A tailor-made approach to each deformity should be followed, where a suitable cartilage graft should be selected depending on the desired reconstructive goal. Clinical significance: These findings guide surgeons in choosing appropriate grafts based on factors such as stability, contouring ability, donor-site morbidity, and long-term results, ultimately improving surgical planning and patient satisfaction in managing CLND.

Aim/background:Fiberoptic bronchoscopy (FOB) is the gold standard for assessing airway involvement in burn patients but is invasive. Ultrasound (USG) has not been previously used to evaluate the airway in burn patients. Our study evaluated the feasibility of using USG to assess airway involvement in inhalational burn injury and correlated its efficacy with FOB. Materials and methods:This prospective observational study was conducted in the burns intensive care unit (ICU) of a tertiary care hospital. Bedside airway USG was performed to evaluate vocal cord (VC) width for edema and other airway parameters, including tongue thickness, pre-epiglottis space depth, inter-arytenoid distance, epiglottis-to-midpoint of VC, distance between the true VCs, distance between the false VCs, tracheal wall thickness, and tracheal air column width. Fiberoptic bronchoscopy was then performed to assess airway involvement, and findings were correlated with USG at the VC level. Results:About 51 patients were included. Airway USG assessment was able to predict the VC edema, correlating with FOB findings in 30 patients. Ultrasound showed a sensitivity and specificity of 85.2 and 81.3%, respectively, with a positive and negative predictive value of 90.9 and 72.2%, respectively, for assessing airway edema at the level of VC. The mean right and left VC widths were 21.15 ± 9.52 mm and 22.03 ± 9.52 mm, respectively, in patients with VC edema. The pre-epiglottis space in patients with (n = 33) vs without VC edema (n = 18) was found to be statistically significant (14.5± 5.64 mm vs 10.87 ± 4.36 mm; p = 0.02). Conclusion:Ultrasound can be used as a reliable, non-invasive bedside predictor of airway involvement in patients with suspected inhalational injury. How to cite this article:Garg H, Agarwal S, Kumar A, Kumar S, Darlong V, Kashyap L, et al. Correlation of Ultrasound Examination with FOB for Airway Assessment in Burn Patients with Inhalational Injury: A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):314-319.

Importance:Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored. Objective:To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients. Design, Setting, and Participants:This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling. Exposures:Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period. Main Outcomes and Measures:Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points. Results:A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13). Conclusions and Relevance:Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.

Severe burn contractures of the knee and elbow are debilitating deformities. The shortened musculotendinous units and neurovascular structures stand out as bowstrings and damage to these structures is possible when attempted to straighten it forcefully. However, with proper planning and tissue selection and replacement, desirable results can be achieved. This single-stage radical release has been described for non-burn contractures such as cerebral palsy and other spastic disorders, but the literature for post-burn contractures is scant, especially for severe elbow and knee contractures. In this article, we discuss the excellent outcomes offered by radical release and reconstruction of severe burn flexion contractures of the knee and elbow through three representative cases.

INTRODUCTION:Food insecurity, defined as a lack of access to adequate nutrition, impacts approximately 30% of the global population. Despite clear evidence regarding the benefit of proper nutrition on clinical outcomes, the burden of incident food insecurity after surgical intervention in previously food secure patients is unknown. The goal of the study was to quantify incident food insecurity post operatively and to identify associated risk factors. METHODS:A multicenter, prospective, longitudinal study was conducted among adult surgical trauma patients at tertiary care public and private hospitals in India. The primary outcome was new food insecurity from initial admission for traumatic injury to 6 mo post operatively. Cox proportional hazards models were used to evaluate associations between clinical and sociodemographic variables and incident food insecurity. RESULTS:Of 774 patients enrolled, 20% were food insecure at baseline. During the follow-up period, 21% of patients who were food secure at baseline experienced new food insecurity. Incident food insecurity was associated with longer length of stay (hazard ratio (HR): 3.76, 95% confidence interval (CI): 1.62-8.74; P = 0.002), intensive care unit admission (HR: 1.87, 95% CI: 1.05-3.31; P = 0.032), receiving welfare support (HR: 2.00, 95% CI: 1.00-3.98; P = 0.049) and daily wage, rather than salaried, employment (HR: 2.95, 95% CI: 1.24-7.06; P = 0.015). Higher total household income was associated with maintaining food security (HR: 0.24, 95% CI: 0.13-0.44; P < 0.001). Hospitalization-related financial toxicity was significantly associated with incident food insecurity (HR: 3.07, 95% CI: 2.09-4.50; P < 0.001). CONCLUSIONS:High levels of incident food insecurity were observed among surgical trauma patients. This highlights the need for serial food insecurity assessment post discharge. In lieu of serial follow-up, risk factors associated with incident food insecurity can be used to identify high-risk patients prior to discharge to facilitate connection to food insecurity interventions such as food prescription programs, monetary support, and nutritional welfare policies.