Study on utilization of health care services at secondary level setting and satisfaction among out patients.

Background: Patient care is the primary function of a hospital. Hospital performance can be best assessed by measuring patient satisfaction. Patient satisfaction with the health care services largely determines their compliance with the treatment and thus contributes to the positive influence on health. Patient satisfaction is considered as one of the desired out comes of health care and is directly related with utilization of health. The objective of the study was to assess the level of satisfaction among out patients attending secondary level hospital and to assess the utilization of health care services. Methods: A cross sectional study was conducted among out patients (aged 18 – 85 years) attending Chidambaram Government Hospital, Tamilnadu, India. Systematic random sampling technique was used to select the respondents. A total of 152 outpatients were taken for the study purpose. A self designed, pretested, semi structured questionnaire was developed to draw the patient‟s satisfaction to the health care services. Results: 99.3% of the patients were highly satisfied with the cleanliness of the hospital.91.4% of the respondents were satisfied with the doctor‟s behavior. 62.5% of the out patient were neutral with drinking water facility. Overall satisfaction among the patients was a mean of 3.75 out of 5 (75%). Conclusions: Patients are generally satisfied with the hospital facilities. Patients inputs on various deficiencies should always be taken care by the hospital administration to improve its services to the patients satisfaction.

Lupus vulgaris and tuberculosis verrucosa cutis (TBVC)--a clinical, pathological and epidemiological study of 71 cases.

BACKGROUND: The epidemiological aspects and diagnostic problems encountered in a rural set up are largely unknown. The present study on cutaneous tuberculosis encompassing clinical, pathological and epidemiological aspects was undertaken at Rajah Muthiah Medical college and Hospital (RMMC&H), a teaching hospital mainly catering to the health needs of a predominantly rural population from villages and hamlets around Chidambaram, a taluq headquarters, located in Cuddalore district ofTamil Nadu. MATERIAL AND METHODS: During the period of study, 5744 cases (82%) of pulmonary tuberculosis and 1261 (18%) of extra-pulmonary tuberculosis were encountered. Cutaneous tuberculosis accounted for 117 (1.67%) of tuberculosis cases. RESULTS: Of the seventy-one patients with cutaneous tuberculosis, 39 had lupus vulgaris and 32 with TBVC. Lupus vulgaris was more prevalent with male pre-ponderance. The maximum incidence was seen in the second decade of life. Both LV and TBVC showed a male pre-ponderance, M:F ratio being 3:2 and 2:1 in LV and TBVC respectively. A majority of patients with LV (27 cases; 69.2%) and TBVC (31 cases; 96.8%) manifested with a single site of involvement. Lower extremities were more commonly involved among patients hailing from poor economic strata who were not habituated to the use of footwear while working out doors. Over crowding was also a contributing factor. The relationships between BCG vaccination and Mantoux test with cutaneous tuberculosis, association with pulmonary tuberculosis in addition to the underlying predisposing socio-economic factors are discussed.

Psoriasiform lupus vulgaris.

Tuberculosis is a major public health problem in both developing and developed countries. Cutaneous Tuberculosis constitutes a minor proportion of extra-pulmonary manifestations of Tuberculosis. Lupus Vulgaris (LV) is one of the clinical variants of Cutaneous Tuberculosis. A case of a large plaque type psoriasiform lesion of lupus vulgaris on the thigh, of 15 years' duration, in an 18-year-old girl is reported. This case highlights the ignorance level among the patients and consequent failure to avail proper anti-tuberculous treatment despite campaign in print and audio visual media.

Tuberculosis verrucosa cutis (TBVC)--foot with miliary tuberculosis.

Tuberculosis Verrucosa Cutis (TBVC) or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI) to Mycobacterium Tuberculosis, while Miliary Tuberculosis is associated with very poor CMI. Two widely different clinical presentations in the same patient are very rare and being reported.

Ulcerative lupus vulgaris of face: an uncommon presentation in India.

Tuberculosis affects the population world wide, more among those living in developing countries. The incidence of tuberculosis registered an upward trend even in developed countries, with the advent of HIV infection. Cutaneous tuberculosis accounts for about 1% of cases of extra-pulmonary tuberculosis. Cutaneous tuberculosis presents with various lesions ranging from ulcerative to proliferative or hyperkeratotic lesions. The lesions may sometimes be associated with marked destruction of the tissues resulting in marked disfigurement, especially when it involves face as seen in cases of Lupus Vulgaris. A case of Lupus Vulgaris in a young woman with extensive ulceration of face which responded to ATT resulting in scarring of the face is reported for its rarity amongst Indian population as against western population.