Challenges for Transformation: A Situational Analysis of Mental Health Care Services in Sehore District, Madhya Pradesh.

The proportion of individuals with mental disorders receiving evidence based treatments in India is very small. In order to address this huge treatment gap, programme for improving mental health care is being implemented in Sehore district of Madhya Pradesh, India. The aim of this study was to complete the situational analysis consisting of two parts; document review of Sehore district mental health programme followed by a qualitative study. The findings suggest that there are major health system challenges in developing and implementing the mental health care plan to be delivered through primary health care system in Sehore district

Challenges for Transformation: A Situational Analysis of Mental Health Care Services in Sehore District, Madhya Pradesh

The proportion of individuals with mental disorders receiving evidence based treatments in India is very small. In order to address this huge treatment gap, programme for improving mental health care is being implemented in Sehore district of Madhya Pradesh, India. The aim of this study was to complete the situational analysis consisting of two parts; document review of Sehore district mental health programme followed by a qualitative study. The findings suggest that there are major health system challenges in developing and implementing the mental health care plan to be delivered through primary health care system in Sehore district

Clinical management of severe infections caused by carbapenem-resistant Gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations.

OBJECTIVES: Optimal treatment of carbapenem-resistant Gram-negative (CR-GNB) infections is uncertain due to the lack of good-quality evidence and the limited effectiveness of available antibiotics. The aim of this survey was to investigate clinicians' prescribing strategies for treating CR-GNB infections worldwide. METHODS: A 36-items-questionnaire was developed addressing the following aspects of antibiotic prescribing: respondent's background, diagnostic and therapeutic availability, preferred antibiotic strategies and rationale for selecting combination therapy. Prescribers were recruited following the snowball-sampling approach, and a post-stratification correction with inverse proportional weights was used to adjust the sample's representativeness. RESULTS: 1012 respondents from 95 countries participated in the survey. Overall, 298 (30%) of respondents had local guidelines for treating CR-GNB at their facility and 702 (71%) had access to Infectious Diseases consultation, with significant discrepancies according to country economic status: 85% (390/502) in High-Income-Countries vs 59% (194/283) in Upper-Medium-Income-Countries and 30% (118/196) in Lower-Middle-Income-Countries/Lower-Income-Countries). Targeted regimens varied widely, ranging from 40 regimens for CR-Acinetobacter spp. to more than 100 regimens for CR-Enterobacteriaceae. Although the majority of respondents acknowledged the lack of evidence behind this choice, dual combination was the preferred treatment scheme and carbapenem-polymyxin was the most prescribed regimen, irrespective of pathogen and infection source. Respondents noticeably disagreed around the meaning of 'combination therapy' with 20% (150/783) indicating the simple addition of multiple compounds, 42% (321/783) requiring the presence of in vitro activity and 38% (290/783) of in vitro-synergism. CONCLUSIONS: Management of CR-GNB infections is far from being standardized. Strategic public health focussed randomised controlled trials are urgently required to inform evidence-based treatment guidelines

Peritoneal dialysis related peritonitis due to Mycobacterium spp.: A case report and review of literature

AbstractMycobacterium tuberculous peritonitis is a less common cause of peritoneal dialysis related infection in developed countries. As both CAPD and APD are being used as renal replacement therapy in developing countries of South Asia, Mycobacterium tuberculous peritonitis are being reported. Any culture negative peritonitis should be investigated for this entity. In this manuscript, we report an index case and our experience with literature review of Mycobacterium tuberculous peritonitis. The diagnostic techniques, management and outcome are described

Comparative evaluation of oral corticosteroids versus low molecular weight heparin in the treatment of lichen planus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lichen planus (LP) is an immunologically mediated inflammatory disorder involving the skin, nails, hair follicles and mucous membranes. Though several drugs and phototherapy are tried and mentioned in the literature, dermatologists are still depending on corticosteroids, which have various serious side effects on long term usage. Thus, in search for an alternative therapy, the present study is conducted to compare the efficacy of systemic corticosteroids and low dose low molecular weight heparin in management of lichen planus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients with biopsy proven LP were selected and divided randomly into two groups with 30 patients each. Group 1 was treated with oral corticosteroids and group 2 was treated with low molecular weight heparin for 8 weeks. Follow up was done for a period of 6 months, at monthly intervals in all patients and any relapses if any were noted.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 60 patients with biopsy proven LP were selected and divided randomly into two groups with 30 patients each. Group 1 was treated with oral corticosteroids and group 2 was treated with low molecular weight heparin for 8 weeks. Follow up was done for a period of 6 months, at monthly intervals in all patients and any relapses if any were noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Low dose enoxaparin in the treatment of lichen planus could be considered as an alternative to oral corticosteroids because of equal efficacy and fewer side effects.&lt;/p&gt;</jats:p