The “Malaria Evolution in South Asia” (MESA) program project is an International Center of Excellence for Malaria Research (ICEMR) sponsored by the US National Institutes of Health. This US–India collaborative program will study the origin of genetic diversity of malaria parasites and their selection on the Indian subcontinent. This knowledge should contribute to a better understanding of unexpected disease outbreaks and unpredictable disease presentations from Plasmodium falciparum and Plasmodium vivax infections. In this first of two reviews, we highlight malaria prevalence in India. In particular, we draw attention to variations in distribution of different human-parasites and different vectors, variation in drug resistance traits, and multiple forms of clinical presentations. Uneven malaria severity in India is often attributed to large discrepancies in health care accessibility as well as human migrations within the country and across neighboring borders. Poor access to health care goes hand in hand with poor reporting from some of the same areas, combining to possibly distort disease prevalence and death from malaria in some parts of India. Corrections are underway in the form of increased resources for disease control, greater engagement of village-level health workers for early diagnosis and treatment, and possibly new public–private partnerships activities accompanying traditional national malaria control programs in the most severely affected areas. A second accompanying review raises the possibility that, beyond uneven health care, evolutionary pressures may alter malaria parasites in ways that contribute to severe disease in India, particularly in the NE corridor of India bordering Myanmar Narayanasamy et al., 2012.

Background: The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention. Aims: This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis. An audit of maternal autopsies was carried out to evaluate current practices, identify fallacies and suggest corrective measures to rectify them. Materials and Methods: Eighty-nine autopsies of maternal deaths in the period 2003 to 2007 were studied in detail along with the clinical details. Results: There were 158 maternal deaths and 13940 live births in this five-year period. Maternal mortality rate was found to be very high (1133/ 100000 live births) in our institution with a high number of complicated referral cases (68/89 cases, 76%). Of the 89 autopsies, acute fulminant viral hepatitis was the commonest cause of indirect maternal deaths (37 cases, 41.5%). This was followed by direct causes like pregnancy-induced hypertension (12 cases, 13.4%) and puerperal sepsis (10 cases, 11.2%). Certain fallacies were noted during the audit process. Conclusion: During the audit it was realized that in maternal mortality autopsies, special emphasis should be given to clinicopathologic correlation, microbiological studies, identification of thromboembolic phenomenon and adequate sectioning of relevant organs. We found difficulty in identification of placental bed in the uterus in postpartum autopsies. A systematic approach can help us for better understanding of the pathophysiology of diseases occurring in pregnancy.

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Acute puerperal uterine inversion is an extremely rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity and beyond. Although the causes of uterine inversion are unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. We present here a series of three cases of uterine inversion managed in our hospital over a period of 3 years. Our first case, Mrs XYZ referred to our hospital after vaginal delivery followed by postpartum collapse. The patient was in hypovolemic shock with 2nd degree uterine inversion. Second case, Mrs ABC referred to our hospital after vaginal delivery and mass coming out of the vagina. The patient had postpartum haemorrhage with 2nd degree uterine inversion. Our third case, Mrs DEF, c/o full term vaginal delivery at our hospital with 2nd degree uterine inversion with postpartum haemorrhage. In all three cases, the patients were explored in the OT under general anaesthesia and uterine reposition was done vaginally. Two of the patients required mechanical ventilation post operatively and all the patients required blood and blood product transfusion. The clinical management, treatment options and surgical nuances of management of uterine inversion are discussed.

India is currently experiencing the second wave of the COVID-19 pandemic. It is widely known that there are sexdifferences in the immune system and it is believed that these have affected clinical outcomes in men and women suffering from COVID-19. We aimed to study the Case Fatality Rates in both genders in our institute and assess the gender difference, if any, and probable reasons for the same, in both waves of the COVID-19 pandemic. We analysed data from our institute from April 2020 to June 2021. It included the total admissions and case fatality rates in men and women month wise, as well as their respective patterns during the rst and second waves of the COVID-19 pandemic in our nation with a view to assess the gender difference in these groups. Case Fatality Rate (CFR) is the percentage of the total number of deaths due to a particular disease and the total number of cases due to the same disease. It is the propensity of a disease to kill and is simply the ratio of deaths to cases. Our study revealed a greater number of female admissions throughout the pandemic but a lower COVID positivity rate in women during the second wave. There were fewer Covid positive women in the second wave, but female CFR was greater than male. During the rst wave, more women were Covid positive but male CFR was more than double that of women for that period.