Browsing by Author "Shree Prakash Jaiswal"

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Bioelectrical Impedance Analysis: Advanced Technique To Obtain Nutritional Risk in a Patient With Major Burns
(Başkent Üniversitesi, 2022-09) Pratibha Sharma; Rajpal Singh; Shree Prakash Jaiswal; Sunil Chandiwal
ABSTRACT Patients with major burns are similar to critically ill patients; knowing their premorbid nutritional status at the time of hospitalization is important for further interventions. Bioelectrical impedance analysis is an advanced technique that helps to assess the detailed information on body composition, including basal metabolic rate, fat percentage, muscle mass, total body protein, bone health, segmental distribution of muscles and fat, and extra- and intracellular water. Patients with burns and high percentage of total burn surface area are known to be in a hypermetabolic state; a prolonged period of hypermetabolism with insufficient nutrient supply can lead to catabolism and cachexia. Finding the patient's nutritional status at the beginning of hospitalization helps to prevent further complications and to support faster recovery. Here, we present a nutritional risk analysis by using bioelectrical impedance in a patient with catabolic symptoms and major burns for management of nutrition with successful outcome.
Burn Cachexia: Diagnosis and Nutrition Support
(Başkent Üniversitesi, 2023-03) Pratibha Sharma; Rajpal Singh; Shree Prakash Jaiswal; Sunil Chandiwal
ABSTRACT Abstract Burn cachexia is a condition in which patients with major burns, especially patients with >20% total burn surface, present with significant rapid weight loss, muscle loss, and fat loss. Burn cachexia is also known as wasting syndrome and is characterized by severe weight loss, muscle and fat loss, fatigue, and anorexia. The current definition of burn cachexia includes association of an underlying disease condition characterized with muscle loss and with or without reduction in fat mass. Cachexia is driven by the molecular pathway known as the ubiquitin-proteolytic pathway. Cytokine activity plays a crucial role in the pathogenesis of cachexia; the consequent inflammation is the main cause of cachexia in major burns, and inflammatory cytokines are upregulated by reactive oxygen species that are triggered by nuclear transcription factor NF-κB. Some other well-known pathways are mitochondrial dysfunction and autophagy, endoplasmic reticulum stress, and insulin resistance. Burn cachexia is inflammation that induces protein degradation and increases cell death. Identification of burn-induced cachexia is a difficult challenge and, if untreated, can lead to death. Nutrition support is an extremely important part of burn management with cachexia and requires special attention. In this case report, we share the practical aspects of burn cachexia diagnosis and application of nutrition to prevent mortality. Our case involved a young male patient with electric burn injury who was diagnosed with burn-induced cachexia who had a successful outcome.
Nonprotein Calorie-to-Nitrogen Ratio at Flow Phase in Patients With Major Burn Injuries
(Başkent Üniversitesi, 2022-06) Pratibha Sharma; Shree Prakash Jaiswal; Rajpal Singh; Sunil Chandiwal
ABSTRACT OBJECTIVES: Protein is the only nutrient that provides nitrogen, and nitrogen has important roles in metabolism, wound healing, and recovery of burns. During burn injuries, metabolic states are similar to other higher metabolic stress clinical conditions and are classified as the ebb (early), flow (second), or anabolic (third) phase, depending on time postinjury, with the early phase from injury to 48 hours, the second phase from 48 to 72 hours, and the third phase up to 1 year. In burn patients, the flow phase is crucial because nutrient substrates are utilized, requiring patients to have a high calorie and high protein diet along with standard micronutrients supplements, with recommendations defining a 100:1 to 150:1 calorie-to-nitrogen ratio for patients with major burns. Most patients require additional protein if they have open wounds. Here, we evaluated effects and outcomes of nonprotein calorie-to-nitrogen ratio in high-calorie and high-protein diets in patients with major burns seen at our center. MATERIALS AND METHODS: Our retrospective study included 54 male and female adult patients (18-60 years of age) with 20% to 60% total burn surface area burn injury who had reached our hospital within 12 hours of injury from 2017 to 2021. After primary clinical management and resuscitation, all patients received nutritional care, with monitoring of nonprotein calorie-to-nitrogen ratio. Outcome measures included length of hospital stay, recovery of wounds, and final outcome. RESULTS: Nonprotein calorie-to-nitrogen ratio was maintained at 93:1 during the flow phase of metabolism in all patients. Maintenance of this ratio was significantly correlated with positive measures of wound healing, length of stay, and final outcome. CONCLUSIONS: The nonprotein calorie-to-nitrogen ratio has important roles in the early phase of higher metabolic stress conditions in patients with burns. Maintaining a ratio of at least 100:1 ratio can result in better outcomes for patients.
Nutrition Checklist: An Easy Way to Ensure Optimum Nutrition in Burns
(Başkent Üniversitesi, 2023-06) Shamin Joby; Pratibha Sharma; Shree Prakash Jaiswal; Shobha Chamania; Rajpal Singh; Sunil Chandiwal; Lucy Kynge
ABSTRACT OBJECTIVES: The primary goal of this study was to assess the knowledge of health care staff in basic nutrition care management of patients with burn injuries to help develop a checklist to ensure optimal nutrition support, prevent infection, and promote wound healing in patients with burn injuries. The secondary goal of the study was to promote education and awareness among health care workers on nutrition and the implementation of nutrition care. MATERIALS AND METHODS: We enrolled 20 participants, including doctors (n = 3), nurses (n = 10), medical technicians (n = 5), and patient care staff (n = 2). Data were collected by face-to-face interviews using our 2 evaluation forms (demographic details of the participants was form 1 and burns nutrition basic knowledge assessment was form 2). RESULTS: Mean age of participants was 29.9 years. Female-to-male ratio was 1:0.4. A pretest of form 2 was correctly answered by 93% of participants. Among participants, 70% stated that they had received training on nutrition in burn patients, but only 35% felt moderately confident about their knowledge and only 10% felt very confident in supporting patients in nutrition management. High-education level, receiving burns nutrition training, and seniority in the profession and in the institution were the effective factors for those with confidence in providing proper support. The posttest of form 2, after nutrition intervention education, was answered correctly by 99% of participants. CONCLUSIONS: Many participants had basic knowledge about burns nutrition, but they were not confident. Health care staff need periodical nutritional education sessions in addition to the basic awareness programs for burn injuries. The introduction of nutrition checklist can help to ensure quality nutrition to patients. The checklist compliance can be improved through education and enforcement.