Justifying formation of bladder flap at cesarean section?

Introduction  Creation of the bladder flap, i.e., dissecting the urinary bladder from the lower segment of the uterus is a standard part of cesarean section (CS). However, it is yet to be established whether the formation of bladder flap is advantageous. Review of literature  Pelosi and Ortega in 1994 introduced a new minimally invasive technique of CS, which included the omission of bladder dissection together with other modifications. Omission of the bladder flap provides short-term benefits such as reduction of operating time and incision-delivery interval, wound infection, reduced blood loss and analgesic requirement. In addition, it is associated with good long-term outcomes with regards to adhesion formation. Conclusion  Further large-scale controlled randomized clinical trials are needed to investigate the safety of this technique with respect to in deeply engaged head, preterm, subsequent pregnancies and trial of labor and also to determine the future role of this technique that will contribute to advancement and popularity of this technique amongst obstetricians.     

Investigation of an outbreak of scrub typhus in the himalayan region of India

In Indira Gandhi Medical College, Himachal Pradesh, India, during autumn of 2003 (September-November), more than 100 cases of fever of unknown origin (FUO) were reported with 15 ensuing deaths. In addition to all routine investigations and cultures, the Weil-Felix test was incorporated for the investigation of these cases. Antigen was procured from the Central Research Institute, Kasauli. Forty-six percent (45/96) of the cases demonstrated a > or =1:80 titer of agglutinins against OXK antigen. A team from the National Institute of Communicable Diseases, New Delhi, confirmed the antibodies for scrub typhus in some of the serum samples tested for leptospirosis, dengue fever, and rickettsial infections. Twelve blood samples positive for OXK antigen were sent to the Defense Research Development Establishment, Gwalior, for polymerase chain reaction studies, but none of the samples were positive, as all of the patients were already on broad-spectrum antibiotics and had reported to our hospital after 7-10 days of fever. At our institute, the Weil-Felix test has now been rountinely introduced for the investigation of cases of FUO, and the results until April 2004 (150 cases) revealed the presence of other rickettsial infections prevalent in the region. To evaluate the epidemiology and magnitude of the problem, further prospective studies are required.     

The safety, tolerability and effectiveness of generic antiretroviral drug regimens for HIV-infected patients in south India

We investigated the safety, tolerability and effectiveness of locally produced generic highly active antiretroviral therapy (HAART) regimens with a chart review conducted at YRG CARE, a tertiary HIV referral centre in India. A total of 333 patients had been on Indian-manufactured generic HAART for at least 3 months. In this cohort, generic HAART was safe, well tolerated and effective at increasing CD4 T-lymphocyte counts in patients with advanced HIV, comparable to the experience with proprietary HAART.     

Oxidative damage of erythrocytes infected with Plasmodium falciparum

Summary The extent of reduced glutathione, activity of glutathione peroxidase, amount of membrane lipid peroxidation products, and the extent of hemoglobin release from host erythrocytes during in vitroPlasmodium falciparum growth was studied. Highly synchronized parasite cultures were studied to examine the alterations caused by different growth stages of the parasite. There was a moderate increase in the reduced glutathione content as the parasite matured, which was significant only in schizontrich erythrocyte lysates (p<0.05) whereas the activity of glutathione peroxidase was significantly low in all the parasitized red blood cells (ring-infected RBC,p<0.005; trophozoite- and schizont-infected RBC,p<0.001). The lipid peroxidation product, malonyldialdehyde, of the host red cells increased gradually to more than fourfold in schizont-rich cells as compared with normal erythrocytes (p<0.001). The hemoglobin release from cultured cells was significantly higher in all parasitized red cell cultures as well as in uninfected cells kept in in vitro, as compared with normal erythrocytes. The consequence of such changes induced by the malarial parasites in the host red cells in the pathogenesis of erythrocyte destruction and anemia ofP. falciparum malaria is discussed.     

Intestinal uptake of nutrients in normal and malnourished animals infected with Giardia lamblia

The effect of malnutrition on the uptake of nutrients was studied in Swiss albino mice infected with Giardia lamblia. The moderate deficiency (8% protein-deficient diet) was observed to enhance the uptake of nutrients like glucose and alanine, whereas in severely malnourished (3% protein-deficient diet) animals the uptake was significantly decreased (p less than 0.001). G. lamblia infection in mice decreased the uptake of nutrients and this recovered slightly with the recovery of infection. The combined effect of moderate protein deficiency and infection lowered the enhanced uptake observed in moderately malnourished animals to a significant level (p less than 0.001). In severely malnourished animals, infection with G. lamblia showed further deleterious effects on the uptake of nutrients.