Prevalence of Acanthosis Nigricans in a Population Attending a Tertiary Care Centre in Western India and it’s Utility to Detect Metabolic Syndrome

Background: Acanthosis Nigricans (AN) is a dermatosis with thickened, hyperpigmented plaques immediately recognizable. The metabolic syndrome (MetS) is a collection of metabolic risk factors that include central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides, and high blood pressure. The skin biomarker AN is linked to this syndrome.Aims and Objectives: To study the prevalence of AN and associated factors in patients that predicts the risk of MetS.Materials and Methods: Five hundred and forty-seven patients with AN were studied over a period of two years. Complete dermatological assessment of skin, including distribution and grading of AN, was performed. Evaluation for metabolic syndrome, including body mass index (BMI), waist and hip circumference, waist-hip ratio (WHR), blood pressure, was noted. Laboratory investigations like fasting blood sugar (FBS), post prandial blood sugar (PPBS), fasting insulin, lipid profile, serum B12, and thyroid function test were done in all patients of AN. Results: Prevalence of AN was 6.5%. The majority had an age between 11-20 years (32.9%). Benign acquired AN (70.7%) was the commonest type of AN, while syndromic AN (17.9%) was the second most common type. Patients of AN with MetS were older (28.4±11.7 years; p=0.0184), had BMI more than 30 (31.5±4.6; P<0.001), higher waist circumference (100.6±10.9 cm; P<0.001), higher WHR (0.92±0.05; P=0.0242), higher FBS (102.3±21.6; P<0.001) and PPBS (130.9±39.1; P<0.001) and higher fasting insulin level (25.7±13.7; P<0.001) compared to those without MetS. Linear regression revealed that BMI (R2=0.08334, P=0.0004 for patients of AN without MetS and R2=0.06377, P<0.001 for patients of AN with MetS), waist circumference (R2=0.05999, P=0.003 for patients of AN without MetS and R2=0.07336, P<0.001 for patients of AN with MetS) and WHR (R2=0.03603, P=0.0222 for patients of AN without MetS and R2=0.008235, P=0.0764 for patients of AN with MetS) has a much more significant effect on insulin in the patients of AN with MetS.Conclusion: AN was common in our study population and the presence of AN strongly predicts metabolic syndrome

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London