Approximately 80-90% of the biliary tract cancers are Gall Bladder cancers, making it one the most common malignancy of the biliary tract. It is a rare malignancy that has silent course, initially asymptomatic and when later detected usually is fatal. An early 1 diagnosis is the key to curative treatment. The prognosis of gallbladder malignancy is grave and mainly depends on the histological subtype, grade and stage of the tumor at the time of presentation. The overall survival is usually 6 months with 5- year survival rate being less than 2 5%.
Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The rapid and extensive spread of the COVID-19 pandemic has become a major cause of concern for the healthcare profession. Development of SARS-CoV-2 vaccine is considered as the only way to signicantly reduce the threat of this pandemic in view of no proper treatment available against COVID-19 till date. However, the success of COVID-19 vaccination in India is dependent upon the acceptance of vaccine among general population, besides the proven safety and efcacy of the Indian COVID-19 vaccines (Co vishield and Co vaxin). In view of that, we conducted an online survey among the rst to be vaccinated priority group (healthcare workers) in India who are at high risk of exposure, with the aim to assess the beliefs and experiences related to Indian COVID-19 vaccines and to project that upon the general population of India. Method: This cross sectional study was conducted using a validated self administered online questionnaire that was distributed through emails, online social networking platforms (online survey) and also printed form of questionnaire in both English and Hindi languages (paper survey). The participants of the study were informed about the objectives of the study and after obtaining an informed consent, they completed the questionnaire on their background and vaccinationbehaviour related variables (including past vaccine compliance, risk factors for severe COVID-19, and COVID-19 vaccine perceptions and experience). Results: Our study included 750 healthcare workers (HCW) of which 415 were doctors, 286 were medical students and 49 were paramedical staff, Of the total number of participants, n=617 (82.3%) have received the COVID-19 vaccine. 75.6% of the study population (n=504) were not hesitant for getting vaccination against COVID-19. Majority of the HCWs believed in the safety and efcacy of COVID-19 vaccine and wanted their family members to get vaccinated. Conclusions: Our study concludes that Health Care Workers show acceptance and condence in the vaccination programme against Covid 19. This can contribute to general population compliance and willingness to accept Covid 19 vaccine.
Diaphragmatic hernia (DH) is most common in children, mainly due to an embryological defect in diaphragm, but a rare occurrence in adults. Spontaneous DH is rare, and trauma is thought to be the most common cause of DH in adults. The diagnostic issue can make management challenging, needing a comprehensive history and physical examination and necessary studies. For the repair, various techniques have been used, but the minimally invasive approach has proven to be the most effective, resulting in less postoperative morbidity, faster recovery, and a shorter hospital stay. Primary repair and strengthening by installing a synthetic mesh (Composite mesh) are usually performed laparoscopically, however, a thoracoscopic approach can also be performed. In this case report, we used a bimodal approach for diaphragmatic hernia repair, which reduced the risk of intraperitoneal adhesions and recurrence of the hernia, as well as the risk of postoperative respiratory problems.
Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.
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