Periorbital myxedema treated with intralesional hyaluronidase.

PURPOSE: Periorbital myxedema is one the most challenging symptoms for patients with Graves' eye disease (GED). The treatment of this condition is complex and often unsatisfactory. This case demonstrates the use of intralesional hyaluronidase to treat cosmetically concerning periorbital myxedema. OBSERVATIONS: Follow up showed no clinically significant recurrence of myxedema over one year. CONCLUSION: Intralesional hyaluronidase represented an effective and safe treatment of periorbital myxedema in a patient with Graves' eye disease.

Utilization and perceptions of neonatal healthcare providers in rural Uttar Pradesh, India.

OBJECTIVE: To describe the utilization and perceptions of existing neonatal health services in rural Uttar Pradesh, India. DESIGN: A prospective observational study. SETTING: The study was located in Shivgarh, a rural block of Uttar Pradesh, India. PARTICIPANTS: One hundred and fifty-three households that utilized a healthcare provider for their sick neonates. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Perceived neonatal health improvement after utilization of neonatal health services; satisfaction with aspects of neonatal health services: 'overall care', 'interaction with provider', 'waiting time' and 'explanations of immediate care and follow-up care'. RESULTS: Unqualified allopathically oriented providers (UAOPs) were utilized by 110 households (71.8%), while qualified allopathically oriented providers (QAOPs) by 43 households (28.2%). The odds of perceived neonatal health improvement were significantly higher among households utilizing UAOPs (n = 88/110, 80.0%) than those using QAOPs (n = 23/43, 53.5%) [adjusted odds ratio (OR): 3.3, 95% confidence interval (CI): 1.5-7.5]. The median healthcare fee charged was higher for UAOPs (Rs. 25) than those for QAOPs (Rs. 1). Household satisfaction with 'overall care' of neonatal health service was significantly higher among households that utilized UAOPs compared with those that used QAOPs (OR: 2.4, 95% CI: 1.2-5.0). CONCLUSION: Households that utilized UAOPs reported better perceived neonatal health outcomes and higher satisfaction levels than those that used QAOPs, despite higher costs for the former. Future research should assess what dimensions of neonatal care are important to households and identify incentive structures that promote healthcare providers to deliver better perceived care in high-mortality settings such as rural Uttar Pradesh, India.