Developing Standard Treatment Workflows—way to universal healthcare in India

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC

Extensive alopecia areata treated with betamethasone oral mini-pulse therapy: an open uncontrolled study

BACKGROUND: Extensive alopecia areata is known to respond to daily oral corticosteroids. To minimize the side effects of daily corticosteroids, oral mini-pulse therapy with betamethasone has been used in vitiligo and other dermatoses. There are a few studies in alopecia areata also. AIM: To evaluate the efficacy of oral mini-pulse therapy in extensive alopecia areata. METHODS: It is an open study on sixteen adolescents and adults with alopecia areata/ totalis/universalis treated with oral mini-pulse therapy for a minimum period of six months. The patients were evaluated clinically and with serial photographs for response and periodical investigations were undertaken to look for the side effects. All the patients were followed up for 5-8 months to look for any relapse. RESULTS: Seven (43.7%) patients showed an excellent response and five (31.2%) patients had good response. Two patients (12.5%) had unsatisfactory response and another two (12.5%) were non-responders. There were insignificant / minimal side effects. CONCLUSION: Oral mini-pulse therapy with betamethasone is a safe and effective therapeutic modality for extensive alopecia areata

Unilateral multi-segmental leiomyomas: A report of rare case

A 30-year-old female presented to us with multiple tender erythematous papules and nodules. These lesions showed multi-segmental distribution along 5 th cervical, 6 th dorsal, and 1 st sacral segments of right half of the body. Histopathological examination confirmed the clinical diagnosis of leiomyoma. Patient was started on nifedipine 10 mg thrice-daily with significant symptomatic improvement in 3 months. Though segmental distribution of leiomyoma is common, unilateral multi-segmental distribution has not been so far reported in the literature. Hence, the case is being reported for its rare presentation and the need for long-term follow-up in view of its association with aggressive renal carcinoma