Background: Acute gastrointestinal (GI) haemorrhage is a common clinical problem with diverse manifestations. Such bleeding may range from trivial to massive and can originate from virtually any region of the GI tract, including the pancreas, liver, and biliary tree. Several risk scoring systems have also been proposed to classify patients into high and low risk groups for complications, like re-bleeding or mortality, based on multivariate analyses. Kollef and colleagues identified the BLEED criteria: (a) ongoing Bleeding, (b) Low systolic blood pressure (BP), (c) Elevated prothrombin time (PT), (d) Erratic mental status, and (e) unstable comorbid Disease as risk factors for complication of GIH at any time during hospitalization after an initial 24 hours of stabilization. The objective of this study was to predict outcome according to a risk stratification BLEED criterion, independent of endoscopic findings. Methods: We studied all patients who presented with acute gastrointestinal bleeding to emergency department. patients with epistaxis, paranasal sinuses bleed, upper GI bleed secondary to endoscopic procedure, patients with chronic Anemia and those patients which admitted with Primary diagnosis other than UGIB were excluded. Patients meeting the BLEED criteria at their initial assessment were classified as high risk (66) and all others were categorized as low-risk (10). In-hospital complications were defined as recurrent UGIB, surgery to control the source of hemorrhage, hospital mortality, length of hospital stay and units of blood transfused. Results: There were 76 patients, with mean age of 46.37 years, 56 patients (73.3%) were case of Upper gastrointestinal bleeding, 20 patients (26.7%) were case of lower gastrointestinal bleeding. 66 (86.84%) of patients were categorized as high-risk patients and 10(13.2%) of patients were categorized as low risk patients. 14(21.1%) of patients were admitted in ICU ,13 Patients had undergone surgery (17.10%), 1 (1.5%) of patient had Re bleeding, nine (13%) had died. Stastical analysis showed significant association between components like low SBP (P=0.008), elevated prothrombin time (P=0.04), erratic mental status(P=0.001) and in hospital complications. All nine deaths were found in high risk group. Conclusions: BLEED criteria can be used as triage tool for stratifying the patients of acute gastrointestinal haemorrhage into high risk and low risk category without endoscopic findings and useful in predicting outcome in such patients and plan the treatment accordingly.

Background: Wounds and their management are fundamental to the practice of surgery. In the past 15 years there have been significant advances in complex acute and chronic wound management. One of the most significant discoveries was the improvement in wounds with negative pressure–assisted wound closure. The aim and objective of the study was efficacy of topical negative pressure dressing with that of a control group using conventional moist wound dressings, in healing of wounds, were assessed with quality of wound healing.Methods: This prospective randomized controlled study 50 patients with acute and traumatic wounds, sub-acute wounds, chronic open wounds, of which 25 patients underwent topical negative pressure dressing. The remaining 25 patients underwent conventional moist wound dressings. The results were compared after second week. Wounds were assessed depending on wound size and percentage of reduction of wound size, wound bed score and increase in wound bed score, percentage of granulation tissue cover, graft take up as the percentage of ulcer surface area.Results: Our present study shows significant reduction in wound size, in the study group 19.52 cm2 as compare to control group, (6.64 cm2) found to be statistically significant (p <0.001). There is significant increase in wound bed score in the study group (mean difference was 9.60±2.16) where as in the control group there was not much increase in wound bed score (mean difference was 5.12±1.99) (p-valve 0.00001) which is statistically significant. The % of granulation tissue formation in the study group was 81.0±8.29 and in the control group was 53.60±19.23.Conclusions: Topical negative pressure dressing was better than conventional wound dressings in quality of wound healing.