Anti-AIDS pill, vaginal gel unsuitable for Africa: study

JOHANNESBURG (Reuters) – Washington – A month long HIV blocker that women could use for protection without their partners knowing? Major new research is beginning in Africa to see whether a special kind of vaginal ring just might work.

Giving women tools to protect themselves when their partners won’t use a condom is crucial for battling the Aids epidemic. Women already make up half of the 34.2 million people worldwide living with HIV, the virus that causes Aids; even more – 60% – in hard-hit Africa are women.

But developing what are called microbicides has proved difficult. Previous research found an experimental anti-Aids vaginal gel offered partial protection, but remembering to use it every time they have sex would be a hurdle for some women.

The new attempt: a vaginal ring that’s inserted once a month and slowly oozes an anti-Aids drug into the surrounding tissue.

Trying to prevent HIV infection through vaginal gels or daily tablets has proven ineffective in the southern African region ravaged by the disease because people did not use the medicines properly, a study released on Monday said.

A ground-breaking study issued in 2010 indicated a vaginal gel containing an HIV drug can sharply reduce infections in women who use it before and after sex.

However, a test of the gel and two types of anti-HIV pills among more than 5,000 women in South Africa, Zimbabwe and Uganda showed that, based on blood tests, more than 70 percent did not use the medication as instructed.

“We are obviously disappointed in the results. We were very hopeful that these products, which we know have been effective in other studies and clearly have a lot of promise, would work,” Jeanne Marrazzo, a researcher on the project for the University of Washington, told reporters in a teleconference.

“Women did not use consistently any of the products. Adherence was very low,” said Marrazzo, part of the project known as the Vaginal and Oral Interventions to Control the Epidemic (VOICE).

HIV/AIDS experts said the results showed how important a factor human behavior is when devising ways to prevent HIV.

“HIV prevention is never just biomedical – behavior is key. What we’ve learned from VOICE and other trials is that adherence to the prescribed dose – the behavioral component – is the variable that determines effectiveness,” said Mitchell Warren, director of the HIV prevention advocacy group AVAC.

East and southern Africa are the areas most heavily affected by the HIV epidemic. Out of the total number of people worldwide in 2009 living with HIV, 34 percent were in 10 countries of southern Africa, according to the U.N. Programme on HIV/AIDS.

Experts have been searching for years for inexpensive, safe and simple medications to decrease the risk of transmission among a population that is largely destitute and with little access to quality health care.

The study also found the group most likely to contract HIV – unmarried women under 25 – was also the most likely not to use any of the medicines. The results were presented at a Conference on Retroviruses and Opportunistic Infections in Atlanta.

The three-year study that started in September 2009 tested a daily tablet called Truvada, which was approved for HIV prevention in July 2012 by the U.S. Food and Drug Administration after it was shown to significantly reduce the risk of HIV infection when used as a preventative measure.

The gel with a drug called tenofovir, which a previous study showed reduced HIV infections in women by 39 percent over two and a half years, and an oral tenofovir tablet were also tested.

Researchers have been trying for years to formulate a microbicide – a gel, cream, ring or tablet inserted into the vagina or rectum before sex to prevent transmission of the human immunodeficiency virus (HIV) that causes AIDS.

“We need to rethink the design of these intervention trials … in healthy people because it is difficult for anybody to take a pill or anything every day, particularly when you are healthy and do not feel that you need a drug,” said Marrazzo.

Truvada is made by Gilead Sciences, which also developed tenofovir. In 2006, Gilead assigned a royalty-free license for tenofovir gel to CONRAD.

Jonathan Mermin, an HIV/AIDS prevention expert at the U.S. Centers for Disease Control and Prevention (CDC) said these trial results underscored the complexities of getting healthy people to use preventative measures against HIV.

“Clinicians and public health professionals will have to further assess and better understand how to promote and support the high levels of adherence necessary,” he said.

‘Berlin Patient’ May Be First Man Cured Of AIDS

From CBS via Radio Television Caraibes reports:

A 45-year-old man now living in the Bay Area may be the first person ever cured of the deadly disease AIDS, the result of the discovery of an apparent HIV immunity gene.

Timothy Ray Brown tested positive for HIV back in 1995, but has now entered scientific journals as the first man in world history to have that HIV virus completely eliminated from his body in what doctors call a “functional cure.”

Brown was living in Berlin, Germany back in 2007, dealing with HIV and leukemia, when scientists there gave him a bone marrow stem cell transplant that had astounding results.

“I quit taking my HIV medication the day that I got the transplant and haven’t had to take any since,” said Brown, who has been dubbed “The Berlin Patient” by the medical community.

Brown’s amazing progress continues to be monitored by doctors at San Francisco General Hospital and at the University of California at…

Children born to overweight mothers ‘more likely to be fat’… but breastfeeding can offset the effect

Smoking during pregnancy also increases chances of child being obese.  Being heavy at birth and rapid weight gain are factors, say researchers.  A third of ten and 11-year-olds in the UK are overweight

Children born to overweight mothers face a higher risk of being fat themselves – but breastfeeding can help offset the effect, a study has shown.

Being overweight and smoking during pregnancy both increase the chances of a child being obese, along with being heavy at birth and rapid weight gain as a baby. But breastfeeding and the late introduction of solid foods can reduce a baby’s risk of becoming overweight by about 15 per cent, claim the researchers.

Big inheritance: Children born to overweight mothers face a higher risk of being fat themselves, according to a study which could help parents make healthier choices for their babies They say it should help new mothers make healthier choices for their babies. Stephen Weng, who undertook the study, led by Dr Sarah  Redsell, of Nottingham University’s School of Nursing, Midwifery and Physiotherapy, said complex influences affected child development, ranging from genetics  to parents’ lifestyle.

He added: ‘We can speculate about how breastfeeding  mitigates the risk of obesity in childhood – it could be mixed feeding, reduced calories from breastmilk, parental attitudes, or a combination of things. ‘The research shows that breastfeeding your baby compared with never breastfeeding does have a modest benefit.’ Link: Six out of seven studies looking at infant birth weight showed a correlation between babies who were heavy at birth and obesity in later childhood In the UK a quarter of children aged four to five and a third of ten and 11-year-olds are overweight. Evidence suggests that children who are overweight by five are more likely to become obese – so overweight it threatens their health – in adulthood. The findings come from a systematic review and analysis of data from 30 previous studies involving 200,000 people. The studies investigated factors affecting babies during their first 12 months and their potential link with childhood obesity.

The study, published in the journal Archives of Disease in Childhood, discovered that children who were breastfed and introduced to solid food later  had a slightly reduced chance of becoming overweight.

Children whose mothers were overweight before pregnancy were 1.37  times more likely to be overweight at the age of three; 4.25 times more likely to be overweight at seven; and 2.36 times more likely to be overweight between nine and 14 years.

Six out of seven studies looking at infant birth weight showed a significant link between babies who were heavy at birth and obesity in later childhood. Similarly, rapid weight gain in a baby’s first year often led to obesity, with one study showing those who gained the most weight were almost four times more likely to be overweight at four. Children who were breastfed – however briefly – were 15 per cent less likely to become overweight.

Statistics: In the UK a quarter of children aged four to five and a third of ten and 11-year-olds are overweight Giving solid foods early may be linked to later obesity, with one study showing formula-fed babies given solids before four months were six times more likely to be overweight aged three than those getting them for the first time between four and five months. Smoking during pregnancy alone increased the risk of children being overweight by 47.5 per cent. However, this may be because smoking is a good indicator of other social and lifestyle characteristics, said Dr Weng. He said the findings could be used to compile a ‘checklist’ for GPs and health visitors to help them spot infants most at risk of becoming obese later in life. Healthier? Breastfeeding and the late introduction of solid foods can reduce a baby’s risk of becoming overweight by about 15 per cent, researchers claim

Why do I have stomach pain during pregnancy?

The pain could be due to uterine contractions (abnormal at this stage), or some problem related to the intestines. Please consult your gynecologist immediately – a physical exam is a must to diagnose possible cause of pain and whether or not you need admission or photolytic therapy (to stop uterine contractions).

It’s normal to feel some abdominal discomfort during pregnancy, but it can be hard to determine when it’s time to head to your health care provider to get checked out. Severe and consistent abdominal pain needs immediate attention. If pain or cramping is accompanied by bleeding, fever, changes in vaginal discharge, light-hardheadedness, urinary irritation, or nausea, then you should contact your health care provider as soon as possible.

In the first 20 weeks, abdominal pain could be a warning signal for a couple of serious conditions:

• Ectopic pregnancy is the first problem that you’ll want to rule out because it can be fatal. An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, in the fallopian tube, ovaries, abdomen or the cervix. If you have an ectopic pregnancy, you will probably feel abdominal pain before you even know your pregnant because it will usually present itself anywhere from 4-7 weeks gestation. Sometimes a pregnancy test will give you a negative result when you have an ectopic pregnancy. Symptoms of an ectopic pregnancy include: bleeding or spotting, pain in the abdomen, back, shoulders or neck, dizziness and low blood pressure. The pain might become worse during bowel movements or physical activity. If you start to experience symptoms of shock accompanied with heavy bleeding, call 911 immediately.

• Miscarriage is the loss of a pregnancy within the first 20 weeks. Signs of miscarriage are: spotting, bleeding, passing tissue or clots, pain and cramping in the lower abdomen, persistent lower back pain and the absence of pregnancy symptoms. The symptoms might be hard to recognize because they can present themselves over a period of a couple days. Severe bleeding needs medical attention immediately. Otherwise, call your health care provider if you exhibit symptoms of a miscarriage.

Throughout your pregnancy abdominal pain can often be caused by normal bodily functions:

• Small periods of cramping before or during an orgasm are normal and do not warrant medical attention.
• Gas pains are more common during pregnancy because digestion is slowed and there is more pressure on the stomach and intestines.
• Constipation pain is also common during pregnancy. The growing uterus puts pressure on the rectum and slower digestion contributes to constipation. This pressure can also cause a Bowel obstruction, which requires medical attention.

During pregnancy, some causes of abdominal pain are related to the pregnancy and may or may not require medical attention:

• Round Ligament stretching around the abdomen occurs because as the pregnancy progresses, the ligaments stretch and become thicker. Short, stabbing pains commonly occur during the second trimester in response to movement. If the pain lingers after movements, you should contact a health care professional.
• Braxton Hicks contractions are common in mid to late pregnancy and act as “preparation exercises” for the uterus before giving birth. They are typically irregular and painless before 37 weeks.
• If contractions become painful or come in closer intervals before 37 weeks, then it could be a sign of premature labor. Premature labor is often accompanied by some vaginal discharge, possibly bloody mucus. You might also experience cramping and lower back pain. Get in touch with a medical professional if you suspect premature labor; it can sometimes be stopped.

There are also serious pregnancy complications that can cause abdominal pain throughout pregnancy:

• Preeclampsia is a common condition of pregnancy that is identified by a rise in blood pressure and protein in the urine. It’s unknown what the cause is. Swollen face, hands, feet and ankles can point to preeclampsia. Severe preeclampsia can cause intense abdominal pain often accompanied by nausea, vomiting, headache, and problems with your vision. Preeclampsia requires immediate medical attention and consistent monitoring until you give birth.
• Placental Abruption is the separation of the placenta from the uterus partially or completely. Bleeding or light spotting is the most apparent symptom. It can cause abdominal tenderness, back pain, contractions or one long, hard contraction of the uterus. Placental abruption needs treatment immediately.

Pregnant or not, there are causes of abdominal pain that all require medical attention:

• Stomach viruses
• Kidney stones (more common during pregnancy)
• Food poisoning
• Gallbladder issues (more common during pregnancy)
• Appendicitis
• Hepatitis or problems of the liver
• Problems with the pancreas (more common during pregnancy)
• Urinary tract infection (more common during pregnancy)

If you experience any abdominal pain during pregnancy and don’t know what the cause is, you should contact your health care provider. Do not panic if you experience abdominal pain – often times the cause of pain during pregnancy is not serious but it’s better to take a cautious approach. A health professional will be able to help you narrow down the possible causes and give you the attention you need should the situation become serious.

Missed periods and light bleeding

Not all women experience a missed period in those early weeks after conception – this is not only be confusing, but can lead to miscalculated due dates and worry that the pregnancy may not continue.

A few women will experience what is called an ‘implantation bleed’ instead of a normal period, even though they have conceived a baby.

This is where a light bleed occurs as the growing baby burrows into the lining of their mother’s uterus, usually about 12 days after the egg has been fertilised, or ‘conceived’ in the fallopian tube.

An implantation bleed will typically occur just before, or around the time, the next period would have been due. However, it is usually not as heavy, or as long as a normal period.

Doctors or midwives will usually try and find out if a woman’s last ‘period’ was normal, to avoid calculating the baby’s due date from an implantation bleed, which would miscalculate the baby’s due date at about 3 to 4 weeks later.

Occasionally, a woman will continue to have a small, red or pinkish vaginal loss for a day or so around the time that their period would have been due, for example at around 4, 8, 12 and 16 weeks of the pregnancy.

This is more common during early pregnancy, but can persist into later pregnancy as well.

Some women will experience bright spotting (fresh bleeding), or brown spotting (bleeding that happened a day or so ago), at some stage during their pregnancy. This may appear as a heavy bleed, like a period, or like a ‘light period’ or simply as something small which is noticed when wiping herself after going to the toilet.

About 50% of women who experience bleeding during the first 12 weeks of their pregnancy will continue to experience a normal pregnancy.

Spotting after intercourse is often the result of the increased sensitivity of your cervix to any kind of minor bumping or irritation. After the first trimester; spotting is less likely to occur, and even if it does, it’s still not necessarily an ominous sign. If you feel cramps in your abdomen (the area around your stomach), don’t panic right away. Sometimes cramping is nothing more than a gentle reminder to take it easy, and at other times it might be a sign of digestive problems. Occasionally, however, cramping can be an emergency signal that says you need medical attention.

Take It Easy

The muscles and ligaments that support your uterus are being pulled and stretched in all directions during pregnancy. This can cause occasional cramping. The pain might be mild or sharp. It might be particularly noticeable when you make a quick move, get up out of a chair, cough, or sneeze. This is nothing to worry about. Some women get cramps when they exercise and put additional stress on muscles and ligaments that are already strained. If you feel cramps while exercising, listen to your body. Stop and rest. This is not the time to work through pain.

Cramps can also remind you to watch what you eat. As in your prepregnancy days, poor digestion will cause cramps. If you overeat or eat the wrong foods, you might feel stomach cramps. If you are constipated, you will feel cramps that can be very painful.

Warning

Sometimes cramps are a danger signal that shouldn’t be ignored. There are three specific medical conditions that are usually accompanied by cramping:

Miscarriage. About 20 percent of all pregnancies end in a miscarriage within the first three months of pregnancy. (Miscarriage is the delivery of a baby before it is developed enough to survive outside the womb.) Severe cramping in the first trimester (often accompanied by bleeding from the vagina) can signal trouble. If you feel constant abdominal pain (with or without bleeding), call your doctor right away.    Ectopic pregnancy. When the fertilized egg settles somewhere outside the uterus, you will get a positive pregnancy test, but as the egg begins to grow it cannot survive and will cause sharp abdominal pains and bleeding.

Preterm labor. Each year, hundreds of thousands of babies are born long before they are due. These babies announce their plans for an early entrance with a variety of signals that include cramping.

If your cramps are severe and/or persistent, call your doctor immediately.

Stomach ulcer

Helicobacter pylori:  The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers.

It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion).

Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations.

Ulcer bleeding: This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication.

Symptoms of a peptic ulcer can be  :
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e.g. dexamethasone and prednisolone).

In patients over 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by esophagogastroduodenoscopy.

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents, therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2–3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum.

Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient’s age. Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear.Usually, children and the elderly do not develop any symptoms unless complications have arisen.

Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. However, peptic ulcer disease symptoms may be different for every sufferer.

A gastric ulcer develops once the formation of small erosions along the stomach lining form. Erosion is caused by the acidity of the stomach fluids, which contain hydrochloric acid and the enzyme pepsin (hence the name peptic ulcer). Usually, a thick mucosal layer protects the lining of the gastrointestinal (GI) tract. This layer is continually rebuilt as the acid continually destroys it. Overproduction of acid tips the equilibrium in favor of those forces favoring breakdown, and as the mucosa begins to degrade, erosion occurs and an ulcer begins to form. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause or worsen this condition.

The mechanisms of erosion are still not fully understood, but somehow, Helicobacter pylori are able to survive stomach’s acidic environment and reproduce in its mucosa. This infection causes tissue damage and leads to ulcer formation.

If you think you might have an ulcer, it’s important to seek medical advice for diagnosis and treatment. If left untreated, an ulcer can further erode the mucosa until bleeding, obstruction, or perforation occurs. Follow-up is always recommended, as recurrence is likely if H. pylori is not completely eradicated. In some untreated cases, gastric ulcers have been shown to progress to malignancy, leading to a greater chance of developing stomach cancer.

A wide range of therapies exist to effectively treat symptoms and heal ulcers, so only in rare cases is surgery needed. So it’s important to realize that treatment failure does not necessarily mean that your case is untreatable. The main reason treatments fail is noncompliance (i.e., not sticking to the medical treatment your doctor has suggested). Risk factors like alcohol, caffeine, aspirin and other NSAIDs, (such as ibuprofen) and especially cigarettes have been shown to aggravate existing ulcers, so it’s important to follow your doctor’s advice regarding diet and lifestyle modifications.

Story: 1stnews9

Sushruta: The Grandfather of Surgery and father of plastic surgery

The roots of ancient Indian surgery go back to more than 4000 years ago. Sushruta, one of the earliest surgeons of recorded history (600 B.C.) is believed to be the first individual to describe Rhinoplasty. The detailed description of the Rhinoplasty operation by Sushruta is amazingly meticulous, comprehensive and relevant today.

The historical evidences suggest that plastic surgery originated in India more than two millennia ago and the oldest plastic surgery operation probably relate to nasal reconstruction. Sushruta,  an ancient Indian surgeon in 600 BC. is believed to be the first individual to describe Rhinoplasty.

Sushruta (also known as the “Father of Indian surgery”  and “Father of Indian plastic surgery)” authored famous ancient encyclopaedic treatise Sushruta Samhita’  (Sushruta’s compendium) and vividly described the technique of Rhinoplasty. ‘Sushruta Samhita’ is onsidered to be the most advanced compilation of surgical practices prevalent in India around two thousand millennia ago.

In‘Sushruta Samhita’, Sushruta emphasized all the basic principles of plastic surgery and vividly described numerous operations in  various fields of surgery with significant contributions to Plastic Surgery.

The notable contributions in Plastic Surgery are technique of pedicle flap, repair of ear lobe defects ,repair of traumatic and congenital clefts of the lip, classification of burns ,description of sharp (20 types) and blunt (101 types)instruments, practice of mock operations, cadveric dissection ,use of wine to dull the pain of surgical incisions, code of ethics; however the Rhinoplasty remains the greatest highlight of Sushruta’s surgery.

The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. In ancient times, amputation of nose was frequently done as a punishment for criminals, war prisoners or people indulged in adultery. The practice of Rhinoplasty slowly started as a result of the need to reconstruct the external nose and later developed to the full fledged science.

Sushruta is considered as the innovator of the Rhinoplasty technique practised since 600 B.C.The detailed description of the Rhinoplasty operation in the Sushruta Samhita is amazingly precise and comprehensive.

The English translation of Sushruta’s original Sanskrit  description of the method is as follows : -

“The portion of the nose to be covered should be first measured with a leaf. Then a piece of skin of the required size should be dissected from the living skin of the cheek, and turned back to cover the nose, keeping a small pedicle attached to the cheek. The part of the nose to which the skin is to be attached should be made raw by cutting the nasal stump with a knife. The physician then should place the skin on the nose and stitch the two parts swiftly, keeping the skin properly elevated by inserting two tubes of eranda (the castor-oil plant) in the position of the nostrils, so that the new nose gets proper shape. The skin thus properly adjusted, it should then be sprinkled with a powder of liquorice, red sandal-wood and barberry plant. Finally, it should be covered with cotton, and clean sesame oil should be constantly applied. When the skin has united and granulated, if the nose is too short or too long, the middle of the flap should be divided and an endeavor made to enlarge or shorten it.”

The Sanskrit text of ‘Sushruta Samhita’ was later translated in Arabic by Ibn Abi Usaybia (1203-1269 AD). As the historical pages started opening up, the knowledge of Rhinoplasty spread from India to Arabia and Persia and from there to Egypt. However, it took centuries for the principles and the technique of Rhinoplasty to travel to Europe and other parts of the world. In the 15th century, Gaspare Tagliacozzi from Italy documented similar technique of nasal reconstruction. He successfully reconstructed the nose by using the skin of the upper arm. The principle of Italian procedure was precisely the same as of the pedicle flap which was described two millennia ahead by Sushruta. Ackernecht aptly observed “There is little doubt that plastic surgery in Europe which flourished in medieval Italy is a direct descendant of classical Indian surgery”.

The classical cheek flap Rhinoplasty of Sushruta was later modified by using a rotation flap from the adjacent forehead, The Traditional Indian Method of Rhinoplasty. This technique was kept a secret for centuries in India, and practiced by Marathas of Kumar near Poona, certain Nepali families and Kanghairas of Kangra (Himachal Pradesh) .

The resurgence of Indian method began in the 1700s when British surgeons working for the East India Company saw the work done by Indian surgeons. During Mysore War of 1792 between Tipu Sultan and the British. Cowasjee, a cart-driver with the British and four other native sepoys were captured by the Sultan’s soldiers. Their noses and a hand each were cut off by the Mysore army. After a year without a nose, he and four of his colleagues submitted themselves to treatment by a man who had a reputation for nose repairs. The operations were witnessed by Thomas Cruso and James Findlay ,surgeons at the British Residency in Poona. They appear to have prepared a description of what they saw and diagrams of the procedure. The technique used for Rhinoplasty was a modification of the ancient Rhinoplasty described by Sushruta. Sushruta’s version has the skin flap being taken from the cheek; Cowasjee’s was taken from the forehead. A photo feature on the sensational surgery was published in the Madras Gazette. Subsequently, the details and an engraving from the painting were reproduce The operation was described as follows: 

“A thin plate of wax is fitted to the stump of the nose so as to make a nose of good appearance; it is then flattened and laid on the forehead. A line is drawn around the wax, which is then of no further use, and the operator then dissects off as much skin as it had  covered, living undivided a small slip between the eyes. This slip preserves the blood circulation till a union has taken place between the new and the old parts. The cicatrix of the stump of the nose is next paired off, and immediately behind the new part, an incision is made through the skin which passes around both alae, and goes along the upper lip. The skin, now brought down from the forehead and being twisted half around, is inserted into this incision, so that a nose is formed with a double hold above and with its alae and septum below fixed in the incision. A little Terra Japonica (pale-catechu) is softened with water and being  spread on slips of cloth, five or six of these are placed over each other to secure the joining. No other  dressing but this cement is used for four days. It is then removed, and cloths dipped in ghee are applied. The connecting slip of skin is divided about the twentieth day, when a little more dissection is necessary to improve the appearance of the new nose. For five or six days after the operation, the patient is made to lie on his back, and on the tenth day, bits of soft cloth are put into the nostrils to keep them sufficiently open. This operation is always successful. The artificial nose is secured and looks nearly as well as the natural nose, nor is the scar on the forehead very observable after a length of time.”

This story encouraged Carpue, an English surgeon, to study the details and soon he recognized the immense potential of the operation. Carpue successfully performed the first Rhinoplasty operation (37  minutes) on October 23, 1814 followed by a second successful operation7. Subsequently, through the publication of these successful operations by Carpue in 1816, the use of Indian technique gained popularity amongst British and European surgeons. By 1897, at least 152 rhinoplasties had been performed in Europe.

One of the earliest European descriptions of Indian rhinoplasty is as follows :

The surgeons belonging to the country cut the skin of the forehead above the eyebrows, and made it fall down over the wounds on the nose. Then, giving a twist so that a live flesh might meet the other live surface, by healing applications, they fashioned for them other imperfect noses. There is left above, between the eyebrows, a small hole, caused by the twist given to the skin to bring the two live surfaces together. In a short time the wounds heal up, some obstacle being placed beneath to allow of respiration. I saw many persons with such noses, and they were not so disfigured as they would have been without any nose at all.” (Storia do Mogor 1653-1708 AD).

These Rhinoplasties were widely appreciated as the ‘Indian Nose’ and generated tremendous interest in the medical fraternity paving way for corrective Rhinoplasty in Europe , United states and other part of the world. Later, with the dissemination and refinement of the technique it became an established procedure worldwide. Though today the technique has received few modifications but the basic  principles laid down by Sushruta still remains true. Today, the world acknowledges India as the cradle of Rhinoplasty and the contemporary use of the “Indian flap” for nasal reconstruction testifies to its practicality and success for more than 2500 years.

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