Conservative surgical management of immediate post-caesarean uterine dehiscence and pelvis abscess due to proteus mirabilis infection: a rare complication of puerperal endomyometritis

Cesarean delivery is the most commonly performed major abdominal operation in women with prevalence ranging from 12% in public sectors to 28% in private sectors in India (DLHS-3 survey). Parallel to this, the complications of surgery are increased. Among these complications, uterine dehiscence and pelvic hematoma with abscess collection is rare but serious complication which might end in hysterectomy. We hereby describe the conservative surgical management of a case of infected uterine incisional necrosis and dehiscence after primary cesarean delivery. We encountered a 25-years-old woman presenting to our emergency department (ED) with severe suprapubic pain and high-grade fever. She had an emergency cesarean delivery performed 14 days prior to presentation due to non-reassuring fetal heart rate. At the ED, ultrasonography revealed collection with septation around uterus with communication into uterine cavity. CT scan of pelvis was ordered and showed an intraperitoneal collection anterior to the uterus at the level of the uterine cesarean scar. Exploratory laparotomy showed a uterine rupture at the previous incision site. We performed resection of necrotic edges, peritoneal lavage, approximation of uterine edges with separate interrupted sutures, placement of a suction drain in the cul-de-sac. During postoperative follow up, patient was stable with no symptoms or signs of uterine/pelvic infection. Conservative management by drainage and resection of necrotic edges in addition to intravenous antibiotics may be considered as an option before resorting to hysterectomy in selected young patients.

A PHARMACOLOGICAL REVIEW OF URENA LOBATA PLANT

ABSTRACTUrena lobata, commonly known as Caesarweed or Congo jute belongs to the family Malvaceae. In India, it is widely available in Andhra Pradesh,southern and some parts of northern regions. It's leaves, roots, stem, and bark have some beneficiary activities for medicinal and non‑medicinalpurposes such as antioxidant, inflammatory, antimicrobial, antidiarrheal, antidiabetic, and antihyperlipidemic, so we believe that this plant has thepotential to cure many more disease and disorders than these reported activities, so this U. lobata can be a plant to be focused on for research activities.Keywords: Pharmacological activities, Antioxidant, Antimicrobial, Antidiabetic, Hypolipidemic

Targeting extracellular DNA to deliver IGF-1 to the injured heart.

There is a great need for the development of therapeutic strategies that can target biomolecules to damaged myocardium. Necrosis of myocardium during a myocardial infarction (MI) is characterized by extracellular release of DNA, which can serve as a potential target for ischemic tissue. Hoechst, a histological stain that binds to double-stranded DNA can be conjugated to a variety of molecules. Insulin-like growth factor-1 (IGF-1), a small protein/polypeptide with a short circulating-half life is cardioprotective following MI but its clinical use is limited by poor delivery, as intra-myocardial injections have poor retention and chronic systemic presence has adverse side effects. Here, we present a novel delivery vehicle for IGF-1, via its conjugation to Hoechst for targeting infarcted tissue. Using a mouse model of ischemia-reperfusion, we demonstrate that intravenous delivery of Hoechst-IGF-1 results in activation of Akt, a downstream target of IGF-1 and protects from cardiac fibrosis and dysfunction following MI

Detection of hydrogen peroxide with chemiluminescent micelles

The overproduction of hydrogen peroxide is implicated in the progress of numerous life-threatening diseases and there is a great need for the development of contrast agents that can detect hydrogen peroxide in vivo. In this communication, we present a new contrast agent for hydrogen peroxide, termed peroxalate micelles, which detect hydrogen peroxide through chemiluminescence, and have the physical/chemical properties needed for in vivo imaging applications. The peroxalate micelles are composed of amphiphilic peroxalate based copolymers and the fluorescent dye rubrene, they have a ‘stealth’ polyethylene glycol (PEG) corona to evade macrophage phagocytosis, and a diameter of 33 nm to enhance extravasation into permeable tissues. The peroxalate micelles can detect nanomolar concentrations of hydrogen peroxide (>50 nM) and thus have the sensitivity needed to detect physiological concentrations of hydrogen peroxide. We anticipate numerous applications of the peroxalate micelles for in vivo imaging of hydrogen peroxide, given their high sensitivity, small size, and biocompatible PEG corona

Expanding the toolbox of metabolically stable lipid prodrug strategies

Nucleoside- and nucleotide-based therapeutics are indispensable treatment options for patients suffering from malignant and viral diseases. These agents are most commonly administered to patients as prodrugs to maximize bioavailability and efficacy. While the literature provides a practical prodrug playbook to facilitate the delivery of nucleoside and nucleotide therapeutics, small context-dependent amendments to these popular prodrug strategies can drive dramatic improvements in pharmacokinetic (PK) profiles. Herein we offer a brief overview of current prodrug strategies, as well as a case study involving the fine-tuning of lipid prodrugs of acyclic nucleoside phosphonate tenofovir (TFV), an approved nucleotide HIV reverse transcriptase inhibitor (NtRTI) and the cornerstone of combination antiretroviral therapy (cART). Installation of novel lipid terminal motifs significantly reduced fatty acid hepatic ω-oxidation while maintaining potent antiviral activity. This work contributes important insights to the expanding repertoire of lipid prodrug strategies in general, but particularly for the delivery and distribution of acyclic nucleoside phosphonates

H‑Gemcitabine: A New Gemcitabine Prodrug for Treating Cancer

In this report, we present a new strategy for targeting chemotherapeutics to tumors, based on targeting extracellular DNA. A gemcitabine prodrug was synthesized, termed H-gemcitabine, which is composed of Hoechst conjugated to gemcitabine. H-gemcitabine has low toxicity because it is membrane-impermeable; however, it still has high tumor efficacy because of its ability to target gemcitabine to E-DNA in tumors. We demonstrate here that H-gemcitabine has a wider therapeutic window than free gemcitabine