Efficacy and safety of Once-Daily Vilanterol/Fluticasone furoate MDI in persistent asthma: Phase 3 OD-INHALE Study.

INTRODUCTION: Once-daily inhalers have been shown to improve adherence leading to lesser discontinuation compared to twice- or thrice-daily inhalers in management of asthma. Combination of Vilanterol and Fluticasone Furoate (VI/FF) is approved for management of asthma and COPD and is available as a dry powder inhaler. Pressurized-Metered Dose Inhalers (pMDIs) offer ease-of-use and therapy alternatives for patients with low inspiratory flow. This study assessed the efficacy and safety of a new once-daily pMDI containing VI/FF in individuals diagnosed with persistent asthma. METHODS: This phase 3, double-blind, randomized controlled study assessed the non-inferiority of VI/FF (12.5 mcg/50 mcg & 12.5 mcg/100 mcg; 2 puffs once-daily) over Formoterol Fumarate and Fluticasone Propionate (FOR/FP, 6 mcg/125 mcg & 6 mcg/250 mcg; 2 puffs twice-daily) in patients with persistent asthma. Primary outcome was change from baseline in trough FEV1 at the end of study (12 weeks). Adverse events and number of exacerbations were used to evaluate safety. RESULTS: A total of 330 patients were randomized into VI/FF (165) and FOR/FP (165). Trough FEV1 significantly improved in both the groups at week 12, with a mean difference (VI/FF minus FOR/FP) being 54.75 mL (95% CI, 8.42-101.08 mL, p = 0.02). The low dose VI/FF had similar efficacy to that of low dose FOR/FP and high dose VI/FF had similar efficacy to high dose FOR/FP. No serious adverse events were reported during the study. CONCLUSION: Once daily VI/FF pMDI was non-inferior to twice daily FOR/FP pMDI in patients with persistent asthma.

Enhancing Immunological Memory: Unveiling Booster Doses to Bolster Vaccine Efficacy Against Evolving SARS-CoV-2 Mutant Variants.

A growing number of re-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in previously immunized individuals has sparked discussions about the potential need for a booster vaccine dosage to counteract declining antibody levels and new strains. The protective immunity produced by vaccinations, and past illnesses relies on immunological memory. CD4 + T cells, CD8 + T cells, B cells, and long-lasting antibody responses are all components of the adaptive immune system that can generate and maintain this immunological memory. Since novel mutant variants have emerged one after the other, the world has been hit by repeated waves. Various vaccine formulations against SARS-CoV-2 have been administered across the globe. Thus, estimating the efficacy of those vaccines against gradually developed mutant stains is the essential parameter regarding the fate of those vaccine formulations and the necessity of booster doses and their frequency. In this review, focus has also been given to how vaccination stacks up against moderate and severe acute infections in terms of the longevity of the immune cells, neutralizing antibody responses, etc. However, hybrid immunity shows a greater accuracy of re-infection of variants of concern (VOCs) of SARS-CoV-2 than infection and immunization. The review conveys knowledge of detailed information about several marketed vaccines and the status of their efficacy against specific mutant strains of SARS-CoV-2. Furthermore, this review discusses the status of immunological memory after infection, mixed infection, and vaccination.

Evaluation of socio-demographic profile and basic risk factors of tuberculosis patients in South 24 Parganas district of West Bengal, India: a hospital-based study.

Aim: To study and analyse the socio-demographic profile and basic risk factors of tuberculosis(TB) patients and their relation with the current epidemiological status of TB registered under the RNTEP program in the study area. Subjects and Methods: This prospective study was conducted on 1743 newly registered tuberculosis patients at TB-DOT center of South 24 Parganas, West Bengal, India from 2011-2014. Socio-demographic variables and baseline characteristics of the participants were noted by a semi-structured questionnaire. Results: Our study results indicate that more than 95% of the TB patients were from lower socioeconomic class, and had poor literacy status and tuberculosis was observed highest in non-agricultural labour and cultivators. Among the young adult's majority of the affected population were females from the lower/upper-lower socioeconomic class. Our analysis revealed that, in successful tuberculosis therapy, men were more defaulters than women. Conclusion: Our study provides a socioeconomic profile and the risk factors of tuberculosis in patients such as the status of therapeutic intervention, involvement of other chronic diseases, age, sex and malnutrition. The findings of this study can be used to plan future studies with specific risk factors of the region and also for implementing the intervention and evaluating its effectiveness.

Is Omicron the end of pandemic or start of a new innings?

In the middle of November 2021, Omicron (B.1.1.529), a novel variant of SARS-CoV-2 was identified in South Africa. Owing to continuous increasing cases with rapid transmissibility and immune evasion, the World Health Organization (WHO) has categorized this strain as a variant of concern (VOC). In total, over 60 mutations have been identified in Omicron (BA.1) and latterly, its three sub-lineages (BA.1.1, BA.2, and BA.3) have also been found with additional mutations and pathogenicity. The highly contagious Omicron causes less severe sickness than Delta, but it is still dangerous for those who have not been vaccinated. Following the unique identification of the Omicron variant, a fresh debate has erupted regarding the natural vaccines. A number of experts believe that Omicron can work as a natural vaccine, because it is similar to live attenuated vaccines in certain ways. Additionally, it was highlighted that the high rate of antibody generation in individuals cured of Omicron provide suggestive evidence in favor of those researchers who claimed Omicron acts as natural vaccine. Some disagreements also noted, as it also has tremendous health effects and high infection rate, as similar to the prior variants. This review summarizes the contradictory scenario among the scientists about Omicron variant.

Alteration of dietary habits and lifestyle pattern during COVID-19 pandemic associated lockdown: An online survey study.

BACKGROUND & AIM: A few population-based studies have looked at how the Corona virus disease (COVID-19) pandemic and outbreak-related lockdown has impacted people's daily eating habits and lifestyles. Due to the emergence of the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), continuous lockdown or social isolation can alter dietary consumption patterns and lifestyle routines, resulting in significant negative health consequences. Focused on the COVID-19 and disease related lockdown effects, this study aims to reflect the evolving trend in dietary habits and lifestyle status during the COVID-19 lockdown in West Bengal through a population mediated retrospective survey distributed via social media platforms. METHODS: This survey was conducted using Google form via online platform from July 7 to July 31, 2020, with 1059 participants reported their eating habits and lifestyle preferences, as well as basic socio-demographic details. Entire variables were qualitatively examined and uttered as frequency (f) and percentage (%). The Chi-square test was performed to conclude whether categorical variables differed. RESULTS: A high number of participants reported that they were consumed healthy foods and physically active during this pandemic situation. Females were more likely to be involved in exercise and consume protein-rich food, as well as the majority of them, maintain basic dietary and Ayurvedic home remedies precautions like consumption of lemon, consumption of herbs, taking warm water, etc. A majority of older participants were tried to maintain a healthy lifestyle with extra protective essential protection during the COVID-19 stage. The frequency of going to market was decreased by the participants. Females were more likely to decrease their frequency of going to market than males. In terms of hygiene and sanitization of food items after buying from the market, females were more careful than males. Participants with higher education were more likely to be careful regarding the hygiene of food preparation and eating during this situation. CONCLUSION: From this study, dieticians, legislators, and public health experts can have a better understanding of the current situation of food intake and lifestyle trends in communities of West Bengal, India. It also has the potential to have a significant impact on future public health research.

Awareness, knowledge and acceptance of COVID-19 vaccine among the people of West Bengal, India: A web-based survey.

Objectives: Rapid vaccination is the only way to fight against COVID-19.Vaccine hesitancy is the major barrier against this strategy. The main objective of this cross-sectional study was to analyze COVID-19 vaccine acceptance in the general population of West Bengal (India), as well as to investigate the factors that were independently associated with people's desire to receive the vaccine. Methods: An online questionnaire was distributed by email, Whatsapp, and other social media platforms, and the responses were analyzed using the SPSS (Version 20) software. Results: We conducted a web-based survey in West Bengal, India (N = 803), and accumulated information on individuals' desire to adopt vaccine against COVID-19, views about the virus's effectiveness, and many knowledge-based socio-demographic factors that potentially impact the overall vaccination efforts. We found that, 12.08% of participants do not believe that vaccination against COVID-19 is necessary, but among the rest of the population, 44.33% of individuals are willing to be vaccinated once the vaccine is available, whereas 39.60% of the population responded that they will not be vaccinated immediately but will do so later. Conclusions: Despite the participants' strong vaccine willingness, our findings revealed a troubling degree of lake of awareness and insignificant scientific knowledge about the COVID-19 pandemic and its associated vaccination programme. Vaccination hesitancy is not a barrier in this survey region, but poor vaccine availability and a lack of awareness campaigns may instill unfavorable beliefs in those who refuse to be vaccinated.

OBJETIVOS: La rapidez de la vacunación es el único modo de luchar contra la COVID-19. Las dudas sobre la vacuna constituyen la mayor barrera contra esta estrategia. El objetivo principal de este estudio transversal fue analizar la aceptación de la vacuna contra la COVID-19 en la población general de Bengala occidental (India), así como investigar los factores asociados de manera independiente al deseo de recibir la vacuna por parte de las personas.Métodos: Se distribuyó un cuestionario online por correo electrónico, Whatsapp, y otras plataformas de redes sociales, y se analizaron las respuestas utilizando el software SPSS (Versión 20). RESULTADOS: Realizamos una encuesta basada en web en Bengala occidental, India (N= 803), y acumulamos la información sobre el deseo de las personas de recibir la vacuna contra la COVID-19, las opiniones sobre la efectividad del virus, y muchos factores sociodemográficos basados en el conocimiento que tienen un impacto potencial en los esfuerzos globales sobre vacunación. Encontramos que el 12,08% de los participantes no creen en la necesidad de la vacunación contra la COVID-19 pero, entre el resto de la población, el 44,33% de los individuos desean ser vacunados una vez que se disponga de la vacuna, mientras que el 39,6% de la población respondió que no se vacunarían de inmediato, aunque lo harían más adelante. CONCLUSIONES: A pesar de la sólida voluntad de los participantes por la vacuna, nuestros hallazgos revelaron un grado preocupante de falta de concienciación y conocimiento científico insignificante acerca de la pandemia de COVID- 19 y su programa de vacunación asociado. Las dudas sobre la vacuna no son una barrera en la región de esta encuesta, pero la poca disponibilidad de la vacuna y la falta de campañas de concienciación puede infundir creencias desfavorables en aquellas personas que rechazan recibir la vacuna.

Comparison between the motor function of school-aged children with normal birth weight and children with low birth weight: a cross-sectional study.

Pal A, Manna S, Dhara PC. Comparison between the motor function of school-aged children with normal birth weight and children with low birth weight: a cross-sectional study. Turk J Pediatr 2019; 61: 374-385. Low birth weight (LBW) children are prone to abnormal neurological signs in tone, coordination and reflexes, due to neonatal complications which lead to development of motor deficits and delays. The aim of the present study was a comparison between the motor function of school-age children with normal birth weight (NBW) and children with LBW. This study was conducted with 471 school-aged children from different districts of West Bengal, India. Different socio-demographic variables of the participants were studied by using a pre-structured schedule questionnaire. Gross motor function was studied by standing broad jump and vertical jump whereas fine motor function was studied by hand reaction time and speed of movement. Jumping skill was better among the boys than girls which implied that the gross motor skill of boys was better than girls. However, the hand reaction time and speed of movement among the girls was better than that of boys which implied that the fine motor skill of girls was better than boys. The postnatal growth of LBW children was significantly lower than that of NBW children. Both gross and fine motor performances of LBW children were significantly poorer than that of NBW children. This study found a strong association between birth weight and motor skills among school-age children even after controlling for the effects of age, gestational age, postnatal growth (height, weight and BMI) and socioeconomic status in a multivariable model. Thus, it appears that babies who are born with LBW have a tendency of neuro-developmental impairments during their childhood. Therefore, long-term monitoring programs and early detection and intervention is necessary in order to minimize future sequelae. The finding of this study indicates the importance of paying special attention to developmental follow up of high risk and LBW infants. It is proposed that more diagnostic evaluations be conducted on LBW infants for all aspects of development.

Work Related Musculoskeletal Disorders and Postural Stress of the Women Cultivators Engaged in Uprooting Job of Rice Cultivation.

AIMS: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. SETTINGS AND DESIGN: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. MATERIALS AND METHODS: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. RESULTS AND CONCLUSIONS: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators.

Evaluation of Work-Related Musculoskeletal Disorders and Postural Stress of Female "Jari" Workers.

AIMS: The present investigation was aimed to assess the postural stress and the prevalence of musculoskeletal disorders (MSDs) of the "Jari" (golden thread) workers. SETTINGS AND DESIGN: This cross-sectional study was carried out on 156 female workers in different areas of the Purba Medinipur, Paschim Medinipur, and Howrah districts of West Bengal, India. MATERIALS AND METHODS: The MSDs of the workers were evaluated by modified Nordic questionnaire method. The postural pattern during work was assessed by direct observation method. The posture of Jari workers has been analyzed by OWAS, REBA, and RULA methods. The joint angle in normal and working posture was observed. RESULTS AND CONCLUSIONS: The prevalence of MSDs was very high among the workers. The major locations of body pains in Jari workers were lower back, upper back, neck, wrist, thigh, and shoulder. The occurrence of MSDs was higher in lower and higher age group than that of the middle age group. The total work shift of the workers was approximately 13 h including rest pause. The dominant postures adopted by the workers were sitting on the floor with stretched legs, sitting on the floor with folded knees, and kneeling posture. From the results of the postural analysis, the postures of the Jari workers had been categorized as stressful. There were a significant deviation between normal standing angles and working angles. From the overall study, it may be concluded that adoption of stressful postures for longer duration might be the cause of MSDs in different body parts of the Jari workers.

Prevalence of undernutrition and associated factors: A cross-sectional study among rural adolescents in West Bengal, India.

BACKGROUND AND OBJECTIVES: Malnutrition is a silent emergency and it is one of the most common causes of morbidity and mortality among children and adolescent throughout the world. The present study was undertaken to investigate the prevalence of malnutrition among 10 to 17 years old adolescent and its association with socio-demographic factors. DESIGN AND SETTING: This community based cross-sectional descriptive study was conducted between May 2014 to April 2015 on 839 subjects. SUBJECTS AND METHODS: Anthropometric measures were measured in 560 adolescents in rural areas of West Bengal state, India, by using standard technique. Different socio-demographic variables were studied by questioner method. RESULTS: In the present investigation, about 54% of adolescents were stunted and 49% were thin. The adolescents belonged to lower social class were significantly more likely to be stunted (OR = 2.68) and thin (OR = 2.44). Other variables like father's occupation, mother's education, economic status and sanitation showed significant and negative association with undernutrition. However, mother's working status showed significant and positive association with undernutrition. Adolescents of working mothers were more likely to be stunted and thin than those who do not worked outside of the home. The adolescents of women with higher education were less likely to be undernourished than adolescents of poor and uneducated women. Adolescents of nuclear families (family size <4) were more likely to be stunted and thin. CONCLUSIONS: Poverty is found to be an important factor of undernutrition among the adolescents. So there is a require to implement well-thought poverty reduction actions along with providing mass education regarding nutrition and health with a special focus on economically and socially deprived sections of the society.

An experimental study to evaluate musculoskeletal disorders and postural stress of female craftworkers adopting different sitting postures.

This study aimed to evaluate musculoskeletal disorders (MSDs) and postural stress among female craftworkers. The study was carried out on 75 adult female craftworkers in different districts of West Bengal. The prevalence of MSDs, body part discomfort (BPD) rating and body joint angles of the workers were evaluated with standard methods. Electromyography (EMG) of the shoulder and back muscles was recorded with the BIOPAC system. The prevalence of MSDs, BPD rating and deviation of joint angle were comparatively lower in the case of sitting on the floor with folded legs than squatting and sitting on the floor with stretched legs postures. The EMG and rms values of the shoulder and back muscles were comparatively lower in this posture. Therefore, it was concluded that sitting on the floor with folded legs was less hazardous and it imposed less postural stress in comparison to other sitting postures.

Silicosis in the form of progressive massive fibrosis: A diagnostic challenge.

Silicosis is a major occupational lung disease with a relatively fatal and irreversible outcome. Early diagnosis for shifting the potential candidates to safe modes of workplace as well as for prevention of further progression is the cornerstone of management. Here, we present a complicated case of silicosis in the form of progressive massive fibrosis, which was initially interpreted as tuberculosis; radiological images had resemblance with tuberculosis and cryptogenic organizing pneumonia. Radiology-guided trucut biopsy was imperative to confirm the diagnosis.

Rare Endobronchial metastasis from uterine leiomyosarcoma.

Uterine sarcomas are rare and represent approximately 3.2% of all invasive uterine cancers. The annual incidence rate is less than two per 100,000 women. The median age at which uterine sarcoma diagnosed is 56 years. The most common histologic pattern is leiomyosarcoma (LMS) which originates from the myometrium or myometrial vessels. Uterine LMSs are aggressive tumors with high rates of recurrence. The most common mode of spread is hematogenous, with lymphatic spread being rare. Recurrences of up to 70% are reported in stage I and II disease with the site of recurrence being distal, most commonly the lungs or the upper abdomen. But the intra bronchial spread is extremely rare. Here we are reporting a case of uterine LMS with endobronchial metastasis causing whole lung collapse.

PHYSIOLOGICAL STRAIN AMONG WOMEN POTATO CULTIVATORS IN WEST BENGAL, INDIA.

The present study was aimed to evaluate physiological strain among women cultivators engaged in potato cultivation. The cross-sectional descriptive study was conducted on 150 women participants in different districts of West Bengal State, India. The physiological strain was evaluated by working heart rate, blood lactate and oxygen consumption. The average working heart rate was 109.97 ± 9.94 beats/min when all tasks were considered together. According to the working heart rate, oxygen consumption and energy cost, the potato cultivation job was categorized as a moderate work category. Whereas, according to cardiovascular stress index (CSI), all tasks of potato cultivation were categorized into a stressful category. The more experienced workers were more productive than their less experienced counterparts, and this increased productivity appeared to be a combination of greater efficiency and greater physical exertion. Stepwise multiple linear regression analyses revealed that work pace and work experience had significant association with all the indices of physiological strain. Work pace had strongest significant impact on these indices even after controlling the effect of age, work experience and efficiency. It was concluded that during performing potato cultivation tasks the workers had a great extent of physiological strain.

Mesothelioma with superior vena cava obstruction in young female following short latency of asbestos exposure.

An 18 years female was admitted with right-sided chest pain, dry cough, and low-grade fever and weight loss for last 1 month. On examination, patient had features of superior vena cava (SVC) syndrome with right-sided pleural effusion. Chest X-ray showed mediastinal widening with nonhomogenous opacity mainly in the periphery of right upper and mid zone with right-sided pleural effusion. Ultrasonography thorax confirmed mild pleural effusion. Pleural fluid analysis showed lymphocytic, exudative, low adenosine deaminase with negative for Pap smear. Contrast-enhanced computed tomography (CT) thorax revealed large extensive nodular soft tissue lesion along right mediastinum as well as costal pleura, with enlarged pretracheal lymphadenopathy and SVC obstruction. CT guided Tru-cut biopsy report came as malignant epithelial tumor with polygonal shape, abundant eosinophilic cytoplasm and nuclei with prominent nucleoli suggestive of mesothelioma of epithelioid type. The tumor cell expressed calretinin, WT-1, and immunonegative for thyroid transcription factor-1.

An ergonomic approach for designing indian traditional vegetable cutter.

BACKGROUND: In India varieties of hand tools have been used to cut the vegetables. Traditional vegetable cutter is a commonly used hand tool which has been used for years in the kitchen. The tool may have some design related problems. The present study was undertaken to reduce those problems. OBJECTIVE: The study objective was to evaluate a new design of traditional vegetable cutters for use in the Indian kitchen. PARTICIPANTS: One hundred and fifty Indian women who regularly used a vegetable cutter for cooking purposes participated in this study. METHODS: The design of the vegetable cutter was modified based on the postural preference of the users and other anthropometric factors including the blade angle, length, breadth and width of the sitting area. The prevalence of musculoskeletal disorders was assessed by means of a questionnaire for subjects' feedback. New concepts of the design were proposed and a few prototypes were made and were tested by paired comparison using the EMG system. RESULTS: A large number of subjects (61%) used the vegetable cutter while sitting on the floor with folded knees and the prevalence of MSD in most of the body parts was comparatively lower in this posture than that in squatting posture. In the new design, a broad platform was suggested to provide a more comfortable sitting when a subject sits on it with folded knees. For the vegetable cutter, the blade angle was made at 120° with a broad folded wooden base as the final prototype of the cutter. The length, breadth, and thickness of the base were selected based on the results of the anthropometric measurements among the prototypes of the cutters. The selected vegetable cutter showed the least myoelectric activity among the prototypes during cutting vegetables. CONCLUSION: The modified vegetable cutter appeared to be ergonomically effective, less prone to muscular stress, and compatible for preferred posture of the users.

Stillbirths in a referral medical college hospital, West Bengal, India: a ten-year review.

AIM: To evaluate the stillbirth rate, its major demographic and obstetric risk factors and its trend in a referral teaching hospital. MATERIAL AND METHODS: A hospital-based cross-sectional retrospective study of stillbirths was done among all deliveries over a decade from January 1999 to December 2008. The stillbirth rate and its changing trends over 10years were evaluated and its associated risk factors were also assessed. RESULTS: The stillbirth rate in the present study decreased from 44.87 per 1000 total births in 1999-2003 to 24.15 per 1000 total births in 2004-2008. Maternal age over 35 years, pregnant women having parity≥4, lower socioeconomic status and poor antenatal check up were responsible for highest number of stillbirths. Other associated risk factors responsible for stillbirths were antepartum hemorrhage (8.35%), medical diseases of mother (8.00%), severe prematurity (7.34%), birth trauma (3.12%) and intrapartum asphyxia (16.73%). Thirty-six percent of the stillbirths occurred at term and 27% at 34-36 weeks of pregnancy. Only 2% of fetuses had congenital anomalies. Incidence of fresh stillbirth was high. Lower segment cesarean section rate was 16%. CONCLUSION: Poor antenatal check-up, lower socioeconomic status and weak referral facilities were the major factors responsible for stillbirths. Most of the stillbirths were preventable by improving women's education and compliance to antenatal care. So proper antenatal care, prompt referral services and availability of emergency obstetric care will provide a pivotal role for reduction of stillbirths.

A prospective study for the prediction of preeclampsia with urinary calcium level.

OBJECTIVES: To assess the efficacy of calciuria as a diagnostic test for the prediction of preeclampsia, and also to determine the changes in urinary excretion of calcium in preeclampsia and normotensive women. METHODS: A prospective study was conducted on 60 primi mothers in the age group of 20-30 years, and all were enrolled at 16 weeks of gestation with clinical follow up by 4 weeks and 24 h urinary calcium and creatinine estimation. Ten mothers developed preeclampsia (study groups) and fifty remained normotensive (control groups). By means of Receiver-operator curve, a cut-off level of urinary calcium in 24 h was chosen for predicting preeclampsia. RESULTS: Preeclamptic women excreted significantly less total urine calcium (87.0 ± 3.59 mg/24 h) than normotensive women (303.68 ± 17.699 mg/24 h) (p < 0.0001) at 40 weeks of gestation. Urinary calcium and calcium/creatinine (Ca:Cr) ratio decreases progressively from 28 weeks to 40 weeks in the study group when compared to normotensive group. CONCLUSIONS: Preeclamptic women excrete less calcium than normotensive women. This parameter would predict preeclampsia earlier in pregnancy.

Genito-urinary fistulae--an evaluation.

A total number of 39 cases of genito-urinary fistulae were managed during the period January, 2001 to August, 2006 in the department of obstetrics and gynaecology, Burdwan Medical College, Burdwan. All patients were evaluated clinically and investigations done accordingly. The incidence of genito-urinary fistula was 0.74% of all gynaecological operations. Out of 39 cases, 23 were primipara, 41.02% were in the age group 20-30 years. In 20 cases the site was at midvaginal region. Prolonged and obstructed labour constituted the major aetiology in 25 cases. Surgery was contemplated in 34 cases. Thirty cases had successful operation after primary surgery, 3 cases had successful repair after second attempt. Only one case needed third attempt. Urethral catheter was required in 15 cases. Proper training of the care providers, more vigilant intrapartum care and timely referral are the important factors to minimise the distressing disorder.