Main Points The United States, Europe, and parts of Central and South America have had success in eradicating malaria, whereas sub-Saharan Africa continues to bear the burden of disease. Recent advances in diagnosis include immunochromotographic dipstick assays that selleck products report sensitivity above 90% and may be a better diagnostic tool for use in pregnant women. Pregnant women are 3 times more likely to suffer from severe disease as compared with their nonpregnant counterparts and have a mortality rate from severe malarial infection that approaches 50%. Pregnant women suffer disproportionately from severe anemia as a result of malarial infection. Women with severe anemia are at higher risk for congestive heart failure, fetal demise, and mortality associated with hemorrhage at the time of delivery.

Current prevention of malarial disease in pregnancy relies on providing women with insecticide-treated bed nets and intermittent presumptive treatment.
Despite the rapid advances in laparoscopic surgery in the past 2 decades, the initial entry still accounts for approximately 40% to 50% of laparoscopic complications and should be considered the most dangerous step of a laparoscopic procedure.1,2 A variety of laparoscopic entry methods have been described. The Hungarian physician J��nos Veres first described the use of his Veres needle to induce pneumothorax in the treatment of pulmonary tuberculosis in 1936.3 Laparoscopic entry using a Veres needle followed by the blind insertion of a sharp trocar remains the most common entry method used by gynecologists.

4,5 Other entry methods include the open technique (Hasson) and direct trocar entry without a preexisting pneumoperitoneum. Unfortunately, the available literature is not clear as to which form of laparoscopic entry is superior in terms of complication risks, and the most common recommendation is for surgeons to use entry methods with which they feel comfortable.6 We would like to share our technique of initial umbilical entry, as well as our experience with alternative site entry in situations where umbilical entry is contraindicated. The basic principle of our umbilical entry technique is to take advantage of the negative intraperitoneal pressure that is generated by pulling on the abdominal fascia. We have been performing this technique for several years with good success, but recently heard of a similar technique that has been performed successfully for decades by Dr.

Entinostat Sarath De Alwis in the Cayman Islands. In his honor we have named our technique the modified Alwis method. The original Alwis method is described in Table 1. Table 1 The Original Alwis Method Umbilical Entry: Modified Alwis Method The insufflator is set on high flow from the outset and the goal intraperitoneal pressure is set at 15 mm Hg (Figure 1). Figure 1 Initial insufflator settings. A hemostat is used for exposure to gain access to the deepest portion of the belly button, where an incision is made using a 15-blade knife (Figure 2).