An assessment of opinion of Indian physicians about emergency medicine in India.

BACKGROUND: Emergency medicine (EM) has recently been recognized as a specialty in India and formal training programmes are yet to be developed. METHODS: A survey was devised to elicit the opinion of recently graduated physicians in Chennai, India about EM as well as about the current state of EM in India. A convenience sample of 130 respondents filled out a 21-question survey. RESULTS: Ninety-four per cent of respondents stated that EM was essential for providing quality healthcare; 94% of respondents felt there needs to be a change in emergency departments in India, with only 20% stating they were proud of the emergency departments in India. Seventy-six per cent of respondents were more likely to consider EM if the specialty was recognized by the Medical Council of India and 76% were inclined to pursue the specialty if there were more training programmes. CONCLUSION: Recently graduated physicians found flaws in the current state of emergency care in India; however, overall they remain interested in the field of EM.

Kinetics of chemokine secretion in human macrophages infected with various strains of Mycobacterium tuberculosis.

BACKGROUND AND PURPOSE: It has been shown that chemokine secretion upon infection with Mycobacterium tuberculosis is influenced by the virulence of the strain, and it is suggested that virulence-associated differences in chemokine secretion contribute to the failure in containing the infection due to poor granuloma formation. MATERIALS AND METHODS: In this study, we used prevalent M tuberculosis clinical strains (S7 and S10) to study the chemokine secretion profile in infected THP-1 cells and monocyte-derived macrophages (MDM) and compared this with the chemokine secretion induced by laboratory strains. RESULTS: This study showed that comparatively lower levels of IP-10 were induced by clinical strains than by laboratory strains in both differentiated THP-1 and MDMs. The secretion of MIP-1alpha was also depressed but only in the THP-1 cells infected with clinical strains. This depressed chemokine secretion may hinder the movement of Th-1 cells from the periphery into the infection foci to control the infection. Correlation between IP-10 and IL-12p40 showed a negative relationship in control MDMs, while there was a positive correlation in all the infected strains, indicating their cooperative role in attracting and activating Th1 cells for a protective immune response at the site. This relationship was strain dependent, with avirulent H37Ra showing higher correlation, followed by the clinical strains and the virulent H37Rv. A positive correlation of IP-10 with IFN-gamma (S7 and H37Ra) and with IL-10 (H37Ra and H37Rv) suggested a definitive interplay of these molecules in infection. CONCLUSIONS: The chemokines secretion by infected THP-1 cells and MDMs was strain dependant and the lower induction by the clinical strains may indicate that the clinical strains maintain a quiescent nature to mislead the host immune system for their benefit.