Dear Editor,

I read the comments which have been made to the article "Enteral glutamine supplementation reducing infectious morbidity in burns patients: a randomized controlled trial [1]" by Dr Adhish Basu in his online submission of “Letter to the editor”. I welcome his comments and will make an effort to clarify them.

Firstly, I have never mentioned in any part of my article [1] that, we have used wound surface swabs for culture. It is always wound biopsy, which is sent for culture and not the wound surface swabs. This is the standard procedure, which is followed in every burns center worldwide. I do agree that I did not use ‘wound biopsy’ terminology in my article [1], as I felt ‘wound culture’ is more than enough. I am thankful to Dr Adhish Basu for highlighting about burn wound biopsy with a cross reference [2] for the same.

Secondly, as we have mentioned in the article [1] “most of the bacteria cultured from the wound were of gut origin. Thus, wound infection in patients with burns is not always due to contamination from hospital environment, it could be due to endogenous bacteria” This sentence is trying to hypothesize a different likelihood (endogenous bacteria) other than fecal contamination (contamination from hospital environment) responsible for burn wound infection. At present the standard practice any burns center is that they take ICU or room cultures simultaneously with patients wound culture, to know mainly whether both organisms are same, if so, it indicates wound infection is from hospital environment. Therefore it is worth exploring to know whether endogenous bacteria responsible for burn wound infection.

Thirdly, as we have mentioned in the article [1] that the depth of burn wound has not got any role in the initial management of patients with burns. This sentence is trying to mention about immediate resuscitation part of management not the definitive/specific management. The immediate resuscitation is same for both categories of burns. This sentence I have mentioned in drawback of study section, where I am trying to explain depth of burn wound was not taken into account.

Fourthly, as the gut is not affected in almost all the cases, which is functioning normally we found hardy any patient with ileus. We used to give multiple nasoenteral feed only after aspirating it and confirming that which is <50ml, otherwise no feed will be given for that scheduled time.

Fifthly, we have already mentioned, “the authors don’t have any disclosable interest”. Regarding use of trade name is as per IJS “Instructions for authors” [3]. “Drug names: Use generic names with the trade name in parenthesis.”

Lastly, the Results & Discussion sections have been amalgamated, as it was mentioned in the IJS “Instructions for authors” [3]. “Results and Discussion should present the results in logical sequence using appropriate, tables and figures without repetition. Indicate the conclusions that may be drawn and place them in the context of a critical appraisal of previous work. Distinguish clearly new information from previous findings, and speculation from fact. Problems arising out of the study may be identified, and relevant hypotheses may be generated.”

But still I accept that, we should have used standard format as in many indexed journals.

References:

1. Pattanshetti VM, Powar RS, Godhi AS, Metgud SC (2009) Enteral glutamine

supplementation reducing infectious morbidity in burns patients: a randomised

controlled trial. Indian J Surg 71: 193-197.

2. Mitchell V, Galizia JP, Fournier L (1989) Precise diagnosis of infection in burn wound biopsy specimens. Combination of histologic technique, acridine orange staining, and culture. J Burn Care Rehabil 10:195-202.

3. Shukla S (December 2007) Instructions for authors. Indian J. Surg. 69:277–279