A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes.

INTRODUCTION: Trauma 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 ANALYSIS: We 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 DISSEMINATION: We 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.

Saree Cancer: a Rare Case.

Skin cancers are rather uncommon malignancies comprising less than 1% of all the cancers in India. Drawstring dermatitis is a type of frictional dermatitis that can result from traditional tightly worn garments like "sari" and "salwaar-kameez". The resulting chronic friction at the waist can lead to lichenified grooves, post inflammatory depigmentation/leukoderma and aggravating pre-existing dermatoses like vitiligo and lichen planus. Chronic friction combined with sweating and humid environment of the tropics predisposes to candida, dermatophytes and bacterial infections. Rarely, squamous cell carcinoma has been reported. Prevention of the condition lies in weight reduction and tying the drawstrings loosely, especially in those inclined to develop koebnerizing conditions. Saree cancer is a rare type of squamous cell carcinoma (SCC). Saree and dhoti are traditional male and female costumes, respectively, which is unique to the Indian subcontinent. Constant wear of this clothing tightly around the waist results in changes in pigmentation and scaling of the skin, acanthosis, scar and ulceration and subsequent, gradual malignant changes. The process of repeated trauma over a long time and consequent interference with the healing process may be the reason for malignant transformation. We are presenting a rare case of saree cancer in a 68-year-old woman, with distant ulceroproliferative growth in left loin, along the waistline, which showed well-differentiated SCC on biopsy. Wide excision with primary closure was done.

Efficacy and safety of oxum in treatment of the venous ulcer.

The present study was carried out to find out the efficacy and safety of oxum in the treatment of venous ulcers. The oxum (superoxidised water) is a pH neutral, non-irritating, aqueous solution that possesses a good antiseptic, antimicrobial activity and wound healing properties. The study was conducted in 30 patients of venous ulcers with a culture examination positive for pathogenic microbial flora. All patients received a gauze dressing impregnated with oxum followed by compression bandage for 28 days. The primary endpoint was the calculation of ulcer size using ulcer tracing. Assessment of periwound oedema, periwound erythema, wound fibrin and wound granulations were considered as secondary endpoints. There was a singificant reduction in ulcer size starting from day 7 of the treatment. Significant improvements in secondary endpoints were observed. This study has demonstrated that oxum improved the clinical status, reduced the signs of inflammation in venous ulcers in addition to its well confirmed anti-infective properties.

Giant mesenteric cyst of abdomen herniating into scrotum.

Cystic mesenteric tumors are rare abdominal neoplasms. We report a 55-year-old man with recurrent benign mesothelioma arising from the left colonic mesentery and extending into the scrotal sac. He recovered well after excision of the abdominal and scrotal mass.

Acute necrotizing gastritis.

A 17-year-old man presented with signs of peritonitis. Laparotomy revealed gangrene of the stomach without obvious cause. The patient underwent total gastrectomy with esophago-jejunal anastomosis with formation of jejunal pouch. Bacterial culture of the peritoneal fluid grew Strept. pyogenes and E. coli. The patient was discharged on day 21 after a stormy postoperative course.