ABSTRACT
Background: Management of spontaneous supratentorial hemorrhage via conservative management is controversial so our study aimed to compare between conservative and surgical treatment of spontaneous supratentorial hemorrhage. Methods: 90 patients were selected who were diagnosed with spontaneous supratentorial hemorrhage and had given written consent to participate in the study. Patients were randomly divided into two groups of early surgery group (n=45) and conservative group (n=45). Results: 90 patients with spontaneous supratentorial hemorrhage were analysed who fulfill the inclusion criteria . Both the groups were comparable with respect to age , sex, medical comorbidities, Glassgow coma score. The intraventricular hemorrhage were present in 31.1% in conservative group and 26.6% in surgical group (but no significant difference as p value 0.641). Outcome of patients was analyzed by Glasgow outcome score and modified Rankin score. There was also no significant difference in mRS of conservative and surgical group (p value -0.206). Mortality at 3 months was 31.1% in conservative group and 40% in surgical group (p value 0.378).For patients less than and equal to 55 years age group both the groups were comparable and there was no stastically significant difference between conservative and surgical groups as Glassgow outcome scale and Modified rankin score values were comparable. But for patients more than 55 years age group. Good outcome as measured by Glassgow outcome score(p value is 0.037) and Modified Rankin score(p value 0.038) was significantly more in conservative group as compare to surgical group. Conclusion: In our study, we found no significant difference in outcome between conservative and surgical management of primary spontaneous suprtentorial hemorrhage. But interestingly, for more than 55 age group, outcome of conservative management was better than surgical management. But there is no significant difference in mortality between conservative and surgical management for any age group.
ABSTRACT
Background: India is the highest TB burden country in the world. In the year 2006, annual performance of revised national tuberculosis control programme (RNTCP) in India, in terms of cure rate of new smear positive patients was 84%, default rate was 6.4% while in Madhya Pradesh it was 82% and 7.6% respectively. Rewa district have poor performance as compare to national level. Non-adherence with treatment has been recognized as an important factor responsible for low cure rate and high incidence of drug resistant TB. The objective of study was to find out the compliance rate with DOTS and associated factors responsible for non-compliance in the district. Methods: The present observational study was carried out at fifteen selected DMC cum DOTS centers of Rewa district, M.P. Results: Of the 337 patients interviewed, majority of patients 270 (80.11%) complied and 67 (19.88%) did not comply to treatment. The main reasons for non-compliance were false perception of having their disease cured because they felt well with initial treatment 26 (38.81%), side effects of drugs 23 (34.33%), anxiety of loss of wages 9 (13.43%) and Migration of patients 7 (10.44%). Conclusions: Repeated counselling and motivation of noncompliant patients would be helpful to reduce noncompliance to treatment.