Tuberculosis and general practitioners.

In spite of advancement of knowledge in diagnosis and management, tuberculosis is still the biggest health problem. There are more than 400 million people infected with tuberculous bacillus and more than 14 million cases are suffering from the disease. Prevention, control and care of tuberculosis are possible. General practitioners play a major role in combating the disease. Quick and right diagnosis and treating the cases effectively should be the motto. Sputum microscopy is the backbone of diagnosis of tuberculosis. With the availability of modern chemotherapy the outcome of a tuberculosis case has undergone dramatic changes. Short-course chemotherapy is the standard choice while tackling cases of tuberculosis. Results of directly observed treatment (DOT) strategy are very good provided execution is proper. HIV/AIDS, another dreaded disease if becomes co-infected along with tuberculosis, mortality and morbidity become very high. The general practitioners are the major strength of healthcare system in any society. They should be good enough to know all about the control programmes well implemented in the country.

Physical status of newborns and neonatal outcome.

OBJECTIVE: To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age. METHOD: 11,223 consecutive live births completing 26 weeks of gestation and weighing > or = 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard's score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weight-gestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals. RESULT: Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2,000 gm. The lowest mortality was among singletons weighing 2,500-3,000 gm and of 38-40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it. CONCLUSION: Cut-off value of 2,000 gm instead of 2,500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute sgnificantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newbom care and timely Intervention.

Place of aspiration cytology in dysfunctional uterine bleeding.

In 150 cases of dysfunctional uterine bleeding the endometrial aspiration cytology was compared with histopathology in order to know the value of the former in such cases as the technique is found to be safe, simple, reliable and well accepted by patients as an outpatient department procedure. The material was adequate in 93% cases for cytology. It tallied 100% in tuberculosis and 94% in rest of the diseases with histopathology. Both the methods were equally effective in diagnosing and phasing the endometrium. But it becomes mandatory to follow up the cases where a malignant smear is not corroborated by histopathology.