Natl Med J India
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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.
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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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Cardiopulmonary resuscitation (CPR) is widely practised by healthcare professionals to revive heart beat and breathing in a patient suffering from cardiac/respiratory arrest. It is increasingly being recognized that in some patients with specific medical conditions, CPR does not alter the overall outcome of illness, and is likely to increase suffering and further deteriorate the quality of life. ⋯ While ordering DNAR on the patient's medical case record, every effort should be made to treat the underlying disease and continue optimal medical care with compassion. This policy document describes the principles for DNAR, offers an algorithm and format for its implementation, and guidance on frequently asked questions.