Assessing the pros and cons of vaginal birth after caesarean relative to elective repeat caesarean section

Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored

SAFETY OF HYDROXYCHLOROQUINE FOR COVID-19 PROPHYLAXIS AMONG HEALTHCARE WORKERS: AN OBSERVATIONAL STUDY

Objective: Indian Council of Medical Research recommended hydroxychloroquine (HCQ) for prophylaxis of COVID‐19 for healthcare workers and the Food and Drug Administration approved its use in the treatment and prophylaxis of COVID‐19 disease. Even though HCQ is adequately tolerated in usual circumstances, still questions about the harmful effects of the drug remain a cause for concern in adults treated with HCQ. The objective of this study was to evaluate the major and minor adverse effects of prophylactic HCQ for COVID-19 among healthcare workers. Methods: Our analysis was intended to analyze HCQ’s adverse drug reaction profile for COVID‐19 prophylaxis in prophylactic doses in health-care staff. This was a cross-sectional study carried out among healthcare workers taking HCQ prophylaxis for COVID‑19. The study was carried out over 08 weeks period from April to May 2020. The data were obtained regarding age, sex, comorbidities, and possible adverse effects. A pretested and validated online questionnaire was provided to the participants to assess the harmful effects that they experienced when taking HCQ. Furthermore, pre and post 8 weeks prophylaxis, individuals underwent general and systemic examination, along with ECG and blood sugar level monitoring. Results: The research group comprised 70 previously healthy and health-care staff. In 70 patients, 27 minor adverse effects were reported (18.9%). Headache was the most frequently reported symptoms followed by nausea and vomiting, itching, and skin rashes. There was no statistically relevant variation in harmful effects due to age or number of doses administered. However, none of the adverse effects was serious or debilitating. Conclusion: With adequate pre-prophylaxis evaluation, health education, and regular monitoring, HCQ prophylaxis is safe and devoid of any serious adverse effects in previously healthy individuals

Review and practical recommendations for peripheral nerve block during Coronavirus Disease-2019 pandemic

Coronavirus disease-2019 (COVID-19) was announced as a global pandemic by the World Health Organization on March 11, 2020 due to its rapid spread and multinational involvement. Operating room preparedness in these times should encompass increased vigilance, protective measures, and alternative procedures in an effort to mitigate the spread from a proven or suspected case. Specifically, by reducing aerosol-generating procedures as in general anesthesia, anesthesiologists can decrease exposure to patient's respiratory secretions and transmission of virus to the health-care professional and other patients. The Interoperability Standards Advisory in its advisory has also recommended regional anesthesia over general anesthesia as one of the steps that can reduce aerosol spread. Further, to restrict airway manipulation, peripheral nerve blocks (PNB) should be considered whenever possible in suspected or confirmed cases of COVID-19 undergoing surgery. PNB has the advantage of maintenance of respiratory functions, prevention of aerosolization, and so preventing viral transmission. This article explores the practical information and suggested measures for conducting PNB in COVID-19 patients with suggestions toward resource planning, clinical environment modification, equipment preparation, supply of drugs, choosing of correct personal protective equipment, safe PNB procedures, anesthesia monitoring, and postanesthetic care. By addressing these issues, infection control during anesthesia can be achieved and which is essential in the present era with emerging infection and novel pathogens such as coronavirus 2 causing the severe acute respiratory syndrome. Thus, framing a structured protocol for PNB among these patients is essential for the best perioperative outcome

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Not AvailableRural development programs act as boon to millions of rural inhabitants globally. So, it becomes extremely important for policy makers to study the perception of grassroot beneficiaries for effective implementation of ongoing program as well as plan for similar programs in future. In this study, the authors have attempted to study an ambitious rural development program named as Sansad Adarsh Gram Yojana launched by Government of India, through the lens of the beneficiaries. The program aims at adoption of villages and transforming them into Model Villages. The perception of the villagers was measured and perceived factors facilitating and inhibiting the program were identified through a multi-dimensional perception scale constructed through Principal Component Method. The study was carried out in four villages of Maharashtra and Telangana during 2018. The perception of 320 respondents when analysed, resulted in factors like Government-Public liaison (Y1=671.86), Infrastructure and Education (Y2=383.14), Local political environment (Y3=267.42), Collective power of villagers and youth (Y4=255.98), Equality (Y5=236.71) and Cultural and inherent values (Y6=143.03) facilitating the program while lack of separate funding (Y10= -12.88), bureaucratic hurdles (Y8=19.09), presence of village factions (Y9=25.05), lack of coordination among government departments (Y11=59.65) and faulty village adoption policy (Y7=130.85) hindering the progress of the program. Majority of villagers from Tikekarwadi (53.33%) of Maharashtra and from Dandepally (56.66%) of Telangana had favourable perception towards potential of the program while villagers from Inovolu (63.33%) of Telangana had neutral perception and from Malunja Budruk (80%) of Maharashtra had unfavourable perception. The classification was done on basis of Cumulative Cube Root Frequency Method (CCRF) and significant difference was found in perception scores of the respondents.Not Availabl