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IntroductionTrauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care.Methods and analysisWe will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial.Ethics and disseminationWe will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry—India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.

<p class="abstract"><strong>Background:</strong> Intravenous catheters cause endothelial damage and trauma, which can predispose to venous thrombosis. Peripheral vein infusion thrombophlebitis occurs in 25- 35% of hospitalized patients with intravenous catheters and has both patient-related implications (e.g., sepsis) and economic consequences (e.g., extra nursing time). This study is designed to address this issue, by assessing the potential risk factors in those who have developed phlebitis, and deriving conclusions based on the same.</p><p class="abstract"><strong>Methods:</strong> A total of 830 patients were observed over a period of 2 months. All details of the patient were collected. Thrombophlebitis was graded using Visual Infusion Phlebitis Score. Each case was compared with a matching control.  </p><p class="abstract"><strong>Results:</strong> 53 of 830 patients observed, developed thrombophlebitis giving an incidence of 6.4%. 92.5% had IV cannulation flushed after insertion. IV cannula had to be changed at least 2 times during the hospital stay. All had an average IV cannulation for 5 days. All had insertion of same size cannula (20G). Level 1 Phlebitis was identified in 64.15% patients, level 2 Phlebitis in 33.96% patients and Level 3 Phlebitis was seen 1.88% patients.</p><p class="abstract"><strong>Conclusions:</strong> Significant association was noted between the number of times the catheter was changed since admission and administration of Potassium chloride and Certain Medications such as Piperacillin through the cannula.</p>

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Background: Appendicitis is a much studied about topic since the early years. Even with the advances in imaging techniques, appendicitis still relies upon clinical examination as a main resort of diagnosis. To aid this, several scoring systems have been developed taking into account various symptoms, signs and some basic laboratory investigations. Many studies have been done worldwide to check the sensitivity and specificity of each of these clinical scoring systems in the diagnosis of acute appendicitis. Though the most famous one is the Alvarado scoring system, there is none universally accepted scoring system used for diagnosis so far.Methods: 100 patients with RIF pain and who were suspected of acute appendicitis were evaluated for a period of 24 months. Evaluation was done with regards to RIPASA and Alvarado scoring in all these patients. All the results of both the scoring systems were reported and correlated with histopathological findings. Statistical test were applied to calculate the p value for the association between the variables of studied.Results: There was definitive agreement that both the scoring systems are positively correlating with each other with respect to the diagnosis of the disease (p value 0.0001). The difference in diagnostic accuracy of 25% between the RIPASA score and Alvarado score was statistically significant (p<0.0001). On analysis with chi-square test, both scores are significant at level 1 (p=0.0001). But RIPASA score has higher sensitivity and diagnostic value when compared to Alvarado score.Conclusions: The use of RIPASA scoring would help in decreasing the unwarranted patient admissions and also expensive radiological investigations.

Background: Appendicitis is one of the most common abdominal emergencies encountered in surgical patients and admissions due to acute appendicitis forms a major portion of hospital admissions in developed as well as developing countries. It is most commonly seen in young adolescent patients but no age is immune to this condition. Males are more commonly affected than females. Acute appendicitis is usually diagnosed clinically in patients presenting with typical history and clinical examination findings. The patients with lesser duration of symptoms usually have non perforated appendix while those having a longer duration of symptoms with signs of peritonitis are more likely to have perforated appendix. Appendicectomy is the treatment of choice. This study is conducted to study acute appendicitis with an emphasis on analyzing the difference in perforated and non perforated appendicitis in context with their presentation, intra-operative features, postoperative outcome and treatment options available for these cases. Aims and Objectives: (1)To study the clinical pattern of presentation and to analyze the difference in the anatomical , biochemical, microbiological and histological determinants in patients of perforated and non perforated acute appendicitis .(2) To evaluate the intraoperative features and postoperative outcome in patients with acute appendicitis presenting with or without perforation. (3) To evaluate the relative importance of these determinants, effect of preoperative delay, pre-hospital antibiotic therapy with postoperative morbidity of perforated acute appendicitis. Methods: This was a clinical prospective study comprising of 150 Patients presenting to a tertiary care centre with intra-operative findings of appendicitis conducted in the department of general surgery, in a postgraduate teaching institute and tertiary medical centre, in Mumbai over a period of 2 years. Results: The analysis of age distribution of the studied cases revealed that most of the patients were in their 2nd or 3rd decades of life. Maximum patients belonged to age group of 20-29 years (22.67%) and 30-39 years (18.67%). There was a male preponderance with the M:F ratio being 1: 0.57.Majority of the patients (64%) has symptoms less than that of 5 days duration. In patients presenting with perforated appendix 34/75 (45.33%) had duration of symptoms between 3-5 days and 20/75 (26.67%) had duration of symptoms between 6-7 days. The duration of symptoms less than 2 days was less commonly associated with perforation and was seen in 21.95% patients. Patients having perforated appendix most commonly presented with symptoms of abdominal pain (100 %), signs of localised peritonitis (85.33%), fever (49.33%), generalised peritonitis (48%) and vomiting (41.33%). In cases of Non-perforated appendix the patients most commonly presented with abdominal pain (100%), localised peritonitis (68%), fever (53.33%), vomiting (52%) and signs of generalized peritonitis (14.66%). Conclusion: Acute appendicites is a common surgical condition. T...