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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The Medical Council of India (MCI) has made research publications in indexed medical journals an obligatory requirement for promotion of medical teachers. In 2015, MCI guidelines said the first and the second author would receive credit for a research paper. In 2017, the amended guidelines provided credit to the first and the corresponding authors instead. ⋯ Standardized vocabularies and taxonomies such as the Contributor Roles Taxonomy (CRediT) system can highlight contributions of individual authors. Some suggest doing away with the authorship order altogether. Readers and assessors should look at the 'author contribution details' rather than the 'authorship order' before drawing any conclusions about contributions of each author.
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The National Programme for Control of Blindness and Visual Impairment modified the definition of blindness in 2017 in line with the internationally accepted definition. We did a systematic review and meta-analysis to compute pooled estimate of blindness in India among adults aged 50 years and above by using recent and old definitions of blindness. ⋯ There is a decrease in the prevalence of blindness in India using recent and previous definitions and a declining trend over time. High quantum of blindness remains an unfinished public health agenda for implementing programmes in larger populations to reduce its burden.
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Respectful maternity care is a fundamental right of every childbearing woman. It contributes to ensuring a positive outcome for mothers as well as newborns, and aims to address health inequalities. ⋯ The lack of respectful maternity care results in failure in accessing institutional services. Thus, it is essential to design context-specific and evidence-based interventions as well as formulate policies and programmes to reduce disrespectful maternity care.
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Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large quantities is not without adverse effects. Balanced salt solutions (BSS) contain bicarbonate or one of its precursors that act as a buffer, and the electrolyte composition resembles that of plasma. ⋯ In surgical patients, studies found only transient hyperchloraemia and increase in the base deficit in patients receiving NS. Systematic reviews and meta-analyses did not find any significant differences in adverse outcomes such as the need for renal replacement therapy or mortality with the use of saline; however, blood chloride levels were consistently higher with saline compared to BSS. There is a need for larger trials with better methodology to determine if the physiological benefits of BSS translate into better clinical outcomes.