Sputum smear positivity at two months in previously untreated pulmonary tuberculosis patients

In pulmonary tuberculosis, bacteriological status at two months affects subsequent treatment and prognosis. The effect on treatment outcome and risk factors for sputum conversion at two months treatment in previously untreated pulmonary tuberculosis [PTB] patients was studied in the following report. A 1:1 case-control study was performed from June 2006 to February 2008 on patients in the Revised National Tuberculosis Control Program in a tertiary level institute in Delhi, India. Patients with previously untreated PTB with sputum smear positive at 2 months of treatment [cases] were compared with those who achieved conversion [controls]. In 74 cases and 74 controls, independent risk factors for sputum smear positive at two months were: illness for >2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment. Patients with smear positive at 2 or 3 months of treatment were more likely to fail or default from treatment. Aforesaid factors were also associated with sputum culture positive status at 2 months in univariate analysis. Patients who interrupted treatment >/=3 times in the first two months were more likely to be culture positive at two months and had a higher rate of default and failure. Illness for more than 2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment are independent risk factors for sputum smear positivity at two months, which in turn is associated with poor treatment outcomes. Patients with these factors merit special attention under the national program

Practice of physical activity among future doctors: a cross sectional analysis

Non communicable diseases [NCD] will account for 73% of deaths and 60% of the global disease burden by 2020. Physical activity plays a major role in the prevention of these non communicable diseases. The stress involved in meeting responsibilities of becoming a physician may adversely affect the exercise habits of students. So, the current study aimed to study the practice of physical activity among undergraduate medical students. A cross sectional study was conducted among 240 undergraduate medical students. Quota sampling method was used to identify 60 students from each of the four even semesters. A pre tested, semi structured questionnaire was used to collect the data. Statistical Package for Social Sciences [SPSS] version 16 was used for data entry and analysis and results are expressed as percentages and proportions. In our study, 55% were 20 to 22 years old. Over half of the students were utilizing the sports facilities provided by the university in the campus. Majority of students 165 [69%] had normal body mass index [BMI], [51] 21% were overweight, while 7 [3%] were obese. Of the 62% who were currently exercising, the practice of physical activity was more among boys as compared to girls [62% v/s 38%]. Lack of time 46 [60.5%], laziness [61.8%], and exhaustion from academic activities [42%] were identified as important hindering factors among medical students who did not exercise. A longitudinal study to follow up student behavior throughout their academic life is needed to identify the factors promoting the practice of physical activity among students

Coagulation disorders after head injury

It has become apparent that head trauma triggers abnormalities in numerous body systems, including the haemocoagulative system. Coagulopathy after head trauma is an important aspect from a neurosurgeon's viewpoint. Coagulopathy following head injury may be a relatively more common problem than is appreciated. Various alterations are hypothesized for the occurrence, but the basic abnormality is probably the stimulation of the coagulation system owing to the brain tissue thromboplastins released as a result of brain injury. This may then lead to a brief period of fibrinolysis, and the overall abnormality may flare into a full-fledged disseminated intravascular coagulation [DIC] syndrome. This requires timely evaluation of the Coagulation status, and appropriate corrective measures when present. This is obviously paramount in patients with clinical evidence of DIC, and those requiring urgent neurosurgical interventions. In the remaining, there is debate as to any beneficial effect of treating the abnormal haemostasis. The pathogenesis and the management of this syndrome are discussed in relation to the currently available evidence