Experiences of "Antara": The Injectable Contraceptive in Rural Indian Women Presenting to a Tertiary Care Hospital of Eastern India.

Introduction: Depot medroxy progesterone acetate (DMPA) is an injectable contraceptive with well-proven effectiveness and excellent safety profile. It is marketed as Antara in India as a part of the government's family planning programme. Purpose: This study aimed to assess the experiences of women using Antara (DMPA) at a tertiary care hospital of Eastern India. Materials and methods: An institution-based retrospective cross-sectional study was carried out in the family planning unit of the study institution from April 2021 to October 2022 among 200 women of reproductive age. Each of the mothers was administered a researcher-administered questionnaire containing questions pertaining to their sociodemographic characteristics and Antara use experience. Results: The mean age of the study participants was 26.4 ± 5.9 years. Most of the participants were Hindus (55.0%), homemakers by their occupation (86.0%), and from lower socio-economic status. A significant proportion of the women had no formal education (14.0%) or had below primary education (14.5%). The most common reason provided by the participants for the discontinuation of Antara was the incidence of various side effects such as irregular menstruation, amenorrhea and apprehension. Lower educational status (p value < 0.001), poorer socio-economic status (p value < 0.001), and interval period starting of Antara (p value < 0.001) were statistically significantly associated with the discontinuation of the contraceptive. Conclusions: Most women who started taking DMPA (Antara) discontinued due to the fear of side effects. Therefore, the focus should be to educate women regarding the benefits and side effects of DMPA through proper counselling.

Factors influencing vaccine acceptance in pregnancy during the COVID-19 pandemic: A multicenter study from West Bengal, India.

Influenza, COVID-19, tetanus, pertussis and hepatitis B pose increased risk for pregnant women and infants and could be mitigated by maternal immunization. In India Tetanus-diphtheria (Td) and COVID-19 vaccines are recommended during pregnancy, while influenza and tetanus-acellular pertussis-diphtheria (Tdap) vaccines are not. We conducted a multicenter study from November 2021 to June 2022 among pregnant women (n = 172) attending antenatal clinics in three public hospitals in West Bengal, to understand the factors that influence women's decisions to get vaccinated during pregnancy. Questions assessed vaccination coverage, knowledge, intention and willingness to pay for influenza vaccine, and factors influencing decisions to get Td, influenza, and COVID-19 vaccines. 152/172 (88.4%) women were vaccinated with Td, 159/172 (93%) with COVID-19, 1/172 (0.6%) with influenza, and none with Tdap. 10/168 (6%) had received hepatitis B vaccine (HBV). Community health workers advice was crucial for Td uptake and, the belief of protection from COVID for COVID-19 vaccines. Most women were unaware about Tdap (96%), influenza (75%), and influenza severity during pregnancy and infancy (85%). None were advised for influenza vaccination by healthcare providers (HCP), albeit, 93% expressed willingness to take, and pay INR 100-300 (95% CI: ≤100 to 300-500) [$ 1.3-4.0 (95% CI: ≤1.3, 4-6.7)] for it. Vaccination on flexible dates and time, HCP's recommendation, proximity to vaccination center, and husband's support were most important for their vaccination decisions. Women were generally vaccine acceptors and had high uptake of vaccines included in the Universal Immunization Program (UIP). Inclusion of influenza, Tdap, and HBV into UIP may improve maternal vaccine uptake.

Vaccinations during pregnancy protect mothers and babies from lethal infections from tetanus, influenza, COVID-19, pertussis, and hepatitis B. In India all pregnant women get tetanus (Td) vaccines, and during the pandemic, pregnant women got COVID-19 vaccines as part of the government program. We conducted a study among pregnant women attending three public hospitals in West Bengal, India, during the COVID-19 pandemic to understand the factors that influence women's decisions to get vaccinated during pregnancy. We found that most pregnant women had gotten Td (88.4%) and COVID-19 (93%) vaccines; however, the uptake was low for influenza (0.6%), pertussis (0%), and hepatitis B vaccines (6%) which are all not available in government programs. Though the majority (92%) of women had not heard about influenza vaccines, once they learnt about them, 93% said they would get vaccinated and even pay for it. Vaccination at flexible times and their doctor's advice were important in their decisions to get vaccinated. Our research builds the case to include influenza, pertussis, and hepatitis B vaccines in programs for pregnant women.

Three-year review of a capacity building pilot for a sustainable regional network on food, nutrition and health systems education in India.

BACKGROUND: In Kolkata (India), there are high rates of malnourished children (45.9%) under the age of three, impacting growth, organ development, function, and cognition. Mothers have a major role to play during this crucial development stage, with research showing nutrition knowledge, attitudes and practices (KAP) of mothers are important determinants of childhood malnutrition. AIMS: To document 3 years of capacity building towards a sustainable nutrition education network in Kolkata, India, while assessing the ability to perform data collection in the form of needs assessments, impact assessments and capacity reviews. METHODS: Descriptive review and analysis of engagement and impact from 3 years of work by the NNEdPro Global Centre for Nutrition and Health, initiating locally led nutrition education interventions. Mapping to the Indian National Nutrition Strategy was also performed to review adherence to nationwide priorities surrounding nutrition and determine the wider application potential of the network. RESULTS: Two simultaneous projects were taken forward by a team of local healthcare professionals and student champions. Project 1-medical college workshops for medical student nutrition education with added focus on underserved populations, Project 2-preparation for a 'Mobile Teaching Kitchen' (MTK) in marginalised communities to empower local women as nutrition educators.Data collection methods used for analysing markers of impact and sustainability were semi-structured interviews of the community members, and KAP questionnaires to assess response to educational sessions. CONCLUSION: With local support it is possible to create and sustain fieldwork for an extended period with meaningful outputs and impact. This initiative demonstrates that it is possible to use healthcare professionals, students and volunteers with low-intensity training and a low-cost approach to produce action research with considerable impact and results in rapid, reliable and robust manner.

A Simple Approach for an Eggshell-Based 3D-Printed Osteoinductive Multiphasic Calcium Phosphate Scaffold.

Natural origin bioceramics are widely used for bone grafts. In the present study, an eggshell-derived bioceramic scaffold is fabricated by 3D printing as a potential bone-graft analogue. The eggshell, a biological waste material, was mixed with a specific ratio of phosphoric acid and chitosan to form a precursor toward the fabrication of an osteoinductive multiphasic calcium phosphate scaffold via a coagulation-assisted extrusion and sintering for a multiscalar hierarchical porous structure with improved mechanical properties. Physicochemical characterization of the formed scaffolds was carried out for phase analysis, surface morphology, and mechanical properties. A similar scaffold was prepared using a chemically synthesized calcium phosphate powder that was compared with the natural origin one. The higher surface area associated with the interconnected porosity along with multiple phases of the natural origin scaffold facilitated higher cell adhesion and proliferation compared to the chemically synthesized one. Further, the natural origin scaffold displayed relatively higher cell differentiation activity, as is evident by protein and gene expression studies. On subcutaneous implantation for 30 days, promising vascular tissue in-growth was observed, circumventing a major foreign body response. Collagen-rich vascular extracellular matrix deposition and osteocalcin secretion indicated bonelike tissue formation. Finally, the eggshell-derived multiphasic calcium phosphate scaffold displayed improvement in the mechanical properties with higher porosity and osteoinductivity compared to the chemically derived apatite and unveiled a new paradigm for utilization of biological wastes in bone-graft application.

Altered metabolic profile in early and late onset preeclampsia: An FTIR spectroscopic study.

OBJECTIVE: Metabolic anomalies, if any, between early and late onset preeclampsia [PE] were explored using Fourier transform infrared [FTIR] spectroscopy. SETTING: Department of Gynecology and Obstetrics, SSKM Hospital, IPGMER, Kolkata and Midnapur Medical College Hospital, Midnapur, India. SAMPLE: 80 pregnant women attending routine antenatal care units; (i) early onset PE [gestational age; GA<34weeks] (ii) late onset PE [GA>34weeks] (iii) early onset control [GA 24-34weeks] and (iv) late onset control [GA>34weeks]. METHODS: Serum FTIR spectra were obtained in the wave-number range of 600-4000cm(-1) at 4cm(-1) resolution. (1)H NMR and estimation of atherosclerotic index (AI) were performed to validate the FTIR findings. MAIN OUTCOME MEASURE(S): Clinical characteristics and metabolic profile. RESULTS: 13 spectral peaks corresponding to the carbohydrate, protein and lipid region were significantly altered in early onset PE [P<0.001; at 95% confidence interval]. Discriminant analysis identified five highly significant wave-numbers (1078, 1088, 1122, 1169 and 1171cm(-1)) having ⩾80% overall accuracy. Hierarchical cluster analysis of the obtained spectra at these 5 wave-numbers provided excellent segregation of early and late onset PE with respect to their controls. Principal component analysis revealed that these 5 wave-numbers significantly separated the two sub-groups of PE (97.95% of the total variance). (1)H NMR results showed that serum levels of glutamate, choline, alanine and lactate were significantly higher while ariginine and citrate were significantly decreased in early onset PE as compared to late onset cases. CONCLUSION: Our study reveals differences in metabolomic profiles of early and late onset preeclamptic cases.

Maggots in prolapsed uterus - Polluted progress of life style.

Myiasis is infestation by dipterous larva that thrives on host's living or necrotic tissue and cause massive tissue infection. We present a case of Myiasis in uterine cavity of a prolapsed uterus of a 77-year-old multiparous lady of West Midnapore District, West Bengal, India. It is a very rare case as only a few reports have been previously published in literature. She had presented with genital pruritus and vague perennial discomfort for last 1 month along with bleeding and foul smelling discharge from vagina for last 2 days. Pelvic examination revealed 'Stage-IV' genitourinary prolapse according to POP-Q classification, with a big excavatory ulcer indwelled with maggots of Musca domestica. About 80 to 90 such maggots were subsequently manually removed with a forceps under anaesthesia. She was advised to undergo definitive surgical treatment for prolapsed uterus. Owing to very low socioeconomic condition or for the fear of the operation, the patient ultimately never turned up.

Malignant phylloides tumor of breast in a pregnant woman with coincidental nulliparous vaginal prolapse.

Malignant phylloides tumor is a relatively rare and rapidly growing tumor of the breast. Presentation during pregnancy is uncommon. Reports regarding malignancy in these tumors differ greatly in incidence, and most of them are stromal malignancies. We report this case in which 24-year old primigravid patient in the 36(th) week of her pregnancy had a malignant phylloides tumor of breast with sudden growth and fine needle aspiration cytology of the breast was positive for malignancy. Ultimately after her caesarean delivery, excision biopsy was in favor of a malignant process. Pregnancy with nulliparous prolapse is also a rare condition. Those conditions are not associated with each other, but presence of two rare conditions in the same time in the same person is unique.

Knowledge and information on psychological, physiological and gynaecological problems among adolescent schoolgirls of eastern India.

BACKGROUND: Sex education aims to reduce the risks of potentially negative outcome from sexual behavior such as fear and stigma of menstruation, unwanted and unplanned pregnancies and sexually transmitted infections including HIV. Hence, this study was conducted to determine sex education knowledge level of school going adolescents in semi urban area of Midnapore, West Bengal, India. METHODS: A cross-sectional study was conducted in two selected premier secondary school of girls in the Midnapore Town from September - October 2007. A total of 521 adolescent aged 10-19 years were selected randomly from two secondary schools of girls. However, schools were selected purposively. All information was collected by using open-ended pre-tested questionnaire. RESULTS: Of the total subjects 94.2% of them were in the age of 13-16 years. Nearly, 94% respondents reported their age at menarche and maximum i.e. 54% respondents experienced in the age of 11 - 13 years. It was observed that 18%, 60.7% and 21.3% of the respondents had good knowledge, moderate or some knowledge and very poor knowledge of puberty, pubertal problems and their prevention. Thirty three percent said that they had faced one or some other kind of physical problems and out of them 60% indicated that they had visited to a doctor for their problems. The suffering of any gynecological problems had 2.48 (95% CI: 1.42 - 4.36) and 1.94 (95% CI: 1.01 - 3.73) times greater among subjects with little or some knowledge and minimum or no knowledge compare to subjects with good knowledge of sex education. CONCLUSION: Thus, the results show that not only knowledge regarding sex education was poor among the subjects but also their knowledge regarding sexual infections including AIDS was not satisfactory. School based sex education programs are particularly good at providing information, skills development and attitude clarification in more formal way through lesson within the curriculum. Therefore, appropriate sex education program should be initiated from the adolescence to prevent health hazards.

Yours faithfully -- prevention of parent to child transmission (PPTCT).

The objective of this study is to find out the reasons behind drop out of the mothers from the prevention of parent to child transmission (PPTCT) programme, thereby going undiagnosed of their HIV serostatus. A retrospective 6-year study was undertaken among mothers attending antenatal clinic and the unbooked cases delivering at the medical college. The percentage of mothers taking pretest counselling was 95.19; 94.09 per cent agreed to have their blood tested among those who had registered at the antenatal clinic only. Of them, 33 were found to be seropositive, 12 being found in 2009 alone. But the daily average of unbooked cases delivering at this institution was 16.42 out of 28. And a huge number (58.9%) were unregistered ie, unknown HIV serostatus deliveries were taken place during this 6-year of study (2004-2009). By this study we have found out that our ignorance, work pressure and patients' lack of knowledge, fear of so called 'HIV-AIDS', social stigmas are creating the big gaps in PPTCT programme and thus made it unsuccessful.