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BACKGROUND Intensive care has developed over the past four decades in treating critically-ill patients. The cost of providing the intensive care services are also squaring up to astronomical levels. Risk scoring systems can be used to focus on quality of care provided to patients at ICU setup as they help in comparative audit that is comparison of actual and expected outcome for group of patients that can be used to compare different providers. The aim of the study is to-1. Study the usefulness of ICU scoring systems (APACHE II, APACHE IV and SAPS III) developed in the west in an Indian ICU. 2. Calculate scores of patients admitted in our ICU as per various ICU scoring systems (APACHE II, APACHE IV and SAPS III). 3. To document the observed mortality among these patients. 4. To compare the observed mortality with mortality predicted by scoring systems (APACHE II, APACHE IV and SAPS III) to see if these ICU scoring systems developed in the West can predict mortality in an Indian ICU. MATERIALS AND METHODS The study was a prospective study over a period of one year (2011-2012) and patients are enrolled as per inclusion criteria. Sample size was set to be a minimum of 100. The physiological parameters, lab investigations, surgical status, chronic health condition including the demographic details as needed by scoring systems (APACHE II, APACHE IV, SAPS III) were recorded at the time of admission to ICU. Patients were followed up till the time of discharge and mortality among the study patients were documented. Statistical Analysis-Statistical analysis is done by using SPSS software. RESULTS This prospective study of 115 ICU patients evaluated the three ICU scoring systems namely, APACHE II, APACHE IV and SAPS III in ICU of a tertiary care corporate hospital shows there is a linear correlation between the scores and observed mortality with increasing scores, the observed mortality progressively increases. This suggests that the scoring systems are valid and can accurately predict mortality in Indian setting also the observed mortality in our cohort of patients is 40%. However, the predicted mortality as per APACHE II, APACHE IV, and SAPS III is only 33.51%, 33.5% and 28.53%. The risk of death for a given patient in our ICU with mean predicted mortality (SMR) is 1.2, 3.61 and 1.4 times that of the mortality predicted by scoring systems APACHE II, APACHE IV, and SAPS III, respectively. After obtaining the score for individual patients, the mortality predicted by the scoring systems should be multiplied by the above factor. Different ICU will have different SMR for any given scoring system depending on the standard of care of that particular ICU. So, individual intensive care units should establish their own SMR for any particular scoring system. SAPS III admission scoring in predicting mortality risk stands good as it is recorded within one hour of ICU admission and other scoring systems may be influenced by treatment. The limitations of the study are that the number of patients in the study is small to establish stati...

BACKGROUND Type 2 diabetes mellitus is a chronic disease caused by a combination of lifestyle and genetic factors affecting all organs in the body. Foot ulcers are one of the common and serious long-term complications of diabetes leads to recurrent and chronic infections, which results in limb loss when treatment is delayed. The aim of this study is to find out the clinical outcome and microbiological profile in patients admitted with diabetic foot ulcers. MATERIALS AND METHODS The study conducted between November 2008 to November 2009 over 50 patients with history of foot ulceration and diabetes. 50 patients were admitted with diabetic foot ulcer over a period of one year between November 2008-2009. They were studied after getting written consent. A predesigned pro forma was used to get the parameters comprising age, gender, duration, type of diabetes mellitus, presence of neuropathy, nephropathy (serum creatinine, urine albumin), retinopathy (screening funduscopy by ophthalmologist). RESULTS Among 50 patients admitted and treated for diabetic foot ulcers with mean stay of 18 days, 29 (58%) had complete healing on conservative management, 18 (36%) underwent minor amputation (toes), 3 (6%) had major amputation (below knee/above knee). No mortality among the study groups encountered. Gram-negative aerobes E. coli (36%), Pseudomonas (52%), Klebsiella (28%), Proteus vulgaris (20%) and Acinetobacter (16%) were most frequently isolated followed by gram-positive aerobes MRSA (14%), Enterococcus (6%), Strep pyogenes (4%) and no anaerobic growth. CONCLUSION Diabetic foot infections are frequently polymicrobial and predominantly gram-negative aerobic bacteria at presentation. Multidrug resistance pseudomonas aeruginosa and MRSA in diabetic foot ulcer is at its emergence and life threatening. Initial aggressive multimodal approach with surgical intervention, culture specific and sensitive targeted combined broad-spectrum antibiotics decreases the morbidity and mortality. Early screening for diabetes, tight glycaemic control decreases the prevalence of risk factors for diabetic foot ulcer related amputations and enhances the quality of life.

BACKGROUNDSkin sutures are known as the signature of a surgeon. However, in recent times conventional suturing is being replaced by newer methods of skin closure. The commonest of them being skin staples. There are numerous other methods available like adhesives tapes and adhesive glues. Skin staples gained popularity due to the less time needed to apply the staples and the cost was comparative to the sutures used. Use of adhesive glue was restricted due to the cost. This study was designed to compare the outcomes between conventional suture closure and 2-butyl cyanoacrylate glue closure of skin after inguinal hernia surgery. MATERIALS AND METHODSThis was a prospective case-controlled study with a sample size of 50 done in Pondicherry Institute of medical sciences over a period of 18 months. Patients between the ages of 25 to 70 undergoing elective inguinal hernia surgery were included in this surgery. Patients with recurrent inguinal hernia and who had features of strangulation were excluded. RESULTSThe mean age in suture group was 48.24 and in skin glue group it was 47.92. 2 out of 25 (8%) in glue group and 7 out of 25 (18%) in the sutures group had erythema and induration 48 hours after surgery. 1 (4%) patient had serous discharge with partial wound dehiscence in glue group while there was none in suture group. 2 butyl cyanoacrylate was costlier by Rs. 120 than sutures per wound. CONCLUSIONThe use of tissue adhesive was associated with shorter closure time. Pain was much less in patients for whom skin closure was performed using skin glue and as such comparatively less analgesics were required post operatively. Glue was marginally costly than conventional sutures. KEYWORDS 2-Butyl Cyanoacrylate, Skin Closure, Inguinal Hernia HOW TO CITE THIS ARTICLE: Ashok AJ, Jacob JM, Palaniappan NK. Comparative study between 2 butyl cyanoacrylate versus conventional sutures in skin closure of inguinal hernia patients.