Natl Med J India
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Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder characterized by the presence of vascular naevi, varicose veins and soft tissue or bone hypertrophy affecting one or more extremities. Due to the rarity of the syndrome, there is limited literature regarding the current practice in the management of pregnancy complicated with KTS. Successful management of pregnancy with KTS is a challenge for clinicians as pregnancy exacerbates the already increased risk of thrombosis and haemorrhage associated with this syndrome. We report a patient with KTS with previous poor obstetric history managed with favourable maternal and foetal outcomes.
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. Community-based health insurance (CBHI) is a health-financing mechanism based on voluntary membership, risk pooling, with a non-profit objective and relies on social capital as a driving force. It aims to improve equity in healthcare utilization in the community. We did this study to understand if CBHI schemes reach the poor, improve healthcare utilization and protect them from catastrophic health events. ⋯ . CBHI schemes improve healthcare utilization and protect against catastrophic health expenditure among those who get hospitalized. However, there also exists a socioeconomic gradient both in membership and in utilization of healthcare services favouring those who are more affluent.
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Malignant melanoma is an aggressive malignancy with high recurrence rates after curative surgery and in advanced stages is characterized by resistance to conventional chemotherapy. With better understanding of the genomic landscape and mutational signature of these tumours over the past decade, there has been a paradigm shift in management of melanoma using immunotherapy (anti-PD-1 and anti-CTLA-4 antibodies) and targeted drugs against BRAF and MEK. ⋯ However, these drugs have varying toxicity profiles and there are no studies comparing these two classes of drugs in either the adjuvant or metastatic setting leaving the question of sequencing open to clinical judgement. Moreover, availability and cost are issues that need to be considered before use of these drugs in the Indian setting.