ABSTRACT
Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems’ perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (?) 0.59 million to ? 2.59 million [1United States Dollars (US $) = ? 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.
ABSTRACT
We report a case of Idiopathic non-lupus full-house nephropathy (NLFHN) in a 39-year-old male who had a full-house pattern of immunofluorescence study without overt systemic lupus erythematosus after a follow-up of more than 2 years. The incidence of detection of cases of NLFHN is increasing in native kidney biopsy and is critical to report as they have poor clinical outcomes. To the best of our knowledge, it is the first case of post-transplant renal biopsy and needs to be reported to plan the treatment protocol for such transplant patients.
ABSTRACT
Hydatid disease is caused by the adult and the larval stage of tapeworms belonging to the Echinococcus species. The major sites of its infection are the liver and lungs. Rarely, it affects the pelvic region including the ovary, accounting for 0.2–2.25%. The primary ovarian site is a rare finding. We report here a case series of two cases with hydatid cysts as the left ovarian and tubo-ovarian masses. In case 1, a 30-year-old woman complained about lower abdominal pain with swelling and had a 7-month-old child and amenorrhea. Ultrasonographic report exhibited multiple cysts in the ovary. In case 2, a 23-year-old female was having primary left ovarian mass and clinically reported an ovarian dermoid tumor after ultrasound scan and had abdominal lump with pain. Her vital indices were normal. The biopsy was sent for further investigation.
ABSTRACT
Mucormycosis is a rare invasive fungal disease often seen in immunocompromised individuals. The mucormycosis cases increased in COVID-19 patients from March to June 2021. Here, we report the case of a 61-year-old male hypertensive patient with COVID-19 who was treated with antibiotics and steroids for recovery. After treatment, he developed a secondary infection of osteoarticular mucormycosis which is uncommon and rare. We report this case here in detail.
ABSTRACT
Ligamentous structures connecting the middle ear and temporomandibular ligament (TMJ) are called as Otomandibular ligaments (OML). Most of the anatomists believed that OML has two parts: malleomandibular ligament (MML) and Discomallear ligament (DML). Both of these ligaments pass through the bony fissure which runs from TMJ to the tympanic cavity, called as Petrotympanic fissure (PTF). Anatomical connection between TMJ and middle ear persists mainly due to continuation of common Meckel’s structure through petro tympanic fissure (PTF). Embryological origin of the MML and DML is debatable but basically, they originates from the first arch. Though they do not play important role in primary movement of TMJ, joint dislocation, anterior disc displacement and hypermobility could happen due to stretching of the DML. MML provides the mechanical support to the head of malleus and forms a movable unit, which acts as suspensory structure for the ossicular chain. Therefore, structural alteration in the MML may plays an important role in affecting middle ear function. The disruption of MML during chronic infection or surgical release of malleus head fixation may affects middle ear sound transmission and results in conductive hearing loss. Shortening of DML by laser coagulation which permits its tightening has been suggested for the treatment of the anterior displacement of the disc. This shortening technique reduces the articular movement range, due to which it was also indicated in the treatment of recurrent temporomandibular dislocations.
ABSTRACT
BACKGROUND: Compared to hydroxyurea, treatment with interferon-alpha (IFN-alpha) is known to prolong survival in patients with chronic phase of chronic myelogenous leukaemia (CML) and was considered as first-line therapy till recently. We conducted a multicentre trial using an indigenous recombinant IFN-alpha-2b to evaluate its efficacy and toxicity in chronic phase CML. METHODS: Between September 2000 and August 2001, patients with chronic phase CML were recruited within 8 weeks of diagnosis at 7 centres in India. The study was approved by the Ethics Committee of each participating Institute and Informed, written consent was obtained from all patients. All patients were given the study drug in a dose of 5 million units daily subcutaneously. Response and survival analyses were done with intent-to-treat analysis. RESULTS: One hundred and fourteen patients (75 men and 39 women) were included in the study. Their ages ranged from 18 to 62 years (median 37 years). Fifty-seven per cent of patients had a haematological response; complete response in 31.6% and partial response in 25.4%. The median time to achieve complete haematological response was 6 months (range 3-12 months). Cytogenetic response was seen in 39.4% of patients; complete in 1.8%, partial in 28% and minimal in 9.6%. The median time to achieve partial and complete cytogenetic response was 6 and 12 months, respectively. Nineteen patients had progression (blast crisis n=15, accelerated phase n=4) while on treatment. Two patients refused further treatment after the initial 4 weeks due to IFN-a toxicity, mainly bone pains and fever. The major toxic effects of treatment were fever (78%), fatigue (25.4%) and myalgia (52%). No patient died of toxicity. Currently, 95 patients are alive, 91 in the chronic phase and 4 in the accelerated phase. Four patients were lost to follow up and all 15 patients with blast crisis died of progressive disease at a median Interval of 6.5 months (range 1-15 months). The Kaplan-Meier probability of survival at 36 months was 76%. CONCLUSION: This study confirms the efficacy of the indigenous recombinant IFN-alpha-2b in chronic phase CML. The drug has a toxicity profile similar to that of other preparations.