PLACENTA ACCRETA IN PRIMIGRAVIDA AT PERIPHERAL SETUP – A RARE CASE REPORT

One of the risk factors for maternal mortality is morbidly adherent placenta (MAP) and accounts for 7–10% of maternal mortality cases worldwide. Placenta accreta is the most common type of MAP, while the other two types are placenta increta and placenta percreta. Placenta accrete accounts for 75–80% of MAP. Here, we present a case of 22 years old, primigravida with no known antenatal risk factors, diagnosed to have placenta accreta intraoperatively after delivering health baby. It is extremely rare for MAP to occur in a patient with no prior risk factors in a primigravida. Peripartum hysterectomy is the only option in a limited care facility with a hemodynamically unstable patient without a proper full-fledged blood bank facility. It is once again reiterated that bleeding from the vagina that does not slow or stop, drop in blood pressure and signs of shock are early signs of blood loss and should be investigated with great concern

CORONAVIRUS DISEASE 2019 VACCINATION DRIVE: THE PERCEPTIONS AND ACCEPTANCE OF VACCINATION AMONG HEALTH CARE WORKERS

Objective: Coronavirus disease 2019 (COVID-19) infection evolved as a worst nightmare across entire humanity especially for health care workers along with all stakeholders of the society ever since the beginning of year 2020. Vaccination campaign is one of the most successful public health interventions and a cornerstone for the prevention of communicable infectious diseases. To have a baseline data and to form the basis for further vaccination drive, we carried out this study with an objective to understand the perception and COVID-19 vaccine hesitancy among health care workers (HCWs). Methods: A correctional study was carried out at one of the multispecialty hospital in North India where COVID-19 vaccination for HCWs was planned and 675 HCWs were taken into the study. Data were collected by means of personal interview using pretested semi-structured questionnaire and Epi Info version 6 was used for analysis. Results: The mean age of the participants was 32.78 years. Majority were male (89.48%), working in government sector (87.7%) and paramedic (88.15%). While 94.67% were accepting vaccine voluntarily while remaining were not confident enough on their own, only 26.96% were ready to take vaccine even on payment. The overall awareness scores of study participants were calculated and found that 79.56% of them had poor awareness level while only 20.44% had satisfactory awareness level. The association of awareness score was statistically significant with job profile (designation), gender, and prior COVID-19 positivity of study participants. Conclusion: The decision of vaccine prioritization to HCWs and frontline workers will boost the morale and spirit of warriors high in future. This study was a preliminary attempt to check any vaccine hesitancy factors among HCWs and act accordingly. Although almost all had volunteered for vaccine, the knowledge about vaccine was poor in majority of HCWs as the time period was recent to vaccine rollout and detailed research findings were not yet out about vaccine. All measures to be taken including intensive information education and communications activities targeting HCWs and general population on regular basis to upgrade the knowledge on vaccine issues. A strong communicating policy in an era of misinformation is highly recommended as social media plays an important role in spreading true as well as false messages jeopardizing the entire gains of successful vaccination and attainment of herd immunity. HCWs to act as role model for general public and patients which would in turn increase the vaccine acceptance among them

CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS). Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi. Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free. Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones