Max Healthcare

About: Max Healthcare is a healthcare organization based out in New Delhi, India. It is known for research contribution in the topics: Population & Medicine. The organization has 391 authors who have published 410 publications receiving 14404 citations.

Polio eradication in India: the way forward.

Abstract: Despite remarkable decline in the number of poliomyelitis cases, the dream of polio eradication in India remains elusive. This is despite considerable effort and expenditure for well over a decade. Various reasons have been cited for this and interventions implemented accordingly. None of these seem to have borne fruit. It is appropriate to have a relook at the polio eradication strategies in order to learn from past errors and determine a feasible solution to achieve the goal. This article examines important tissues that hamper the eradication effort and proposes a way forward.

Raised serum uric acid is associated with higher bone mineral density in a cross-sectional study of a healthy Indian population.

Abstract: Purpose Oxidative stress has been implicated as a fundamental mechanism in the decline of bone mass. Reactive oxygen species are reported to suppress osteoblast generation and differentiation and enhance osteoclast development and activity. Increasing evidence suggests favorable effect of serum uric acid (UA) on bone metabolism due to its antioxidant properties. Therefore, we investigated the association between serum UA levels and bone mineral density (BMD) in healthy adult Indian subjects. Materials and methods We reviewed the medical records of 524 subjects who had undergone preventive health check-ups in a tertiary care hospital that included UA and BMD measurements at femur neck, total femur, and lumbar spine. Subjects concomitantly taking drugs or having a medical condition that would affect the bone metabolism or UA levels were excluded. Results The final analysis included 310 subjects (mean age: 47.2±12.2 years; females: 43.5%; males: 56.5%). Study population was categorized into two groups based on the group median value for UA (ie, 5.4 mg/dL). BMD was significantly higher at all skeletal sites in subjects with UA >5.4 mg/dL compared to subjects with UA ≤5.4 mg/dL (p<0.001). On correlation analysis, UA was positively associated with BMD at all skeletal sites (r=0.211-0.277; p<0.05). The correlation remained significant after controlling for age (p<0.05) and lifestyle factors (smoking, alcohol use, physical activity, and diet; p<0.05) independently. UA significantly (p<0.001) accounted for 4.5%-7.7% of the variance in BMD (r2=0.045-0.077) in unadjusted model and 1.6%-3.2% of the variance (p<0.05) when adjusted for age and body mass index combined at lumbar spine and right femur neck, respectively. Conclusion We conclude that raised UA levels are associated with higher BMD at all skeletal sites and UA may have a protective role in bone metabolism owing to its antioxidant effect.

Stump appendicitis: A rare clinical entity.

Abstract: Stump appendicitis is one of the rare delayed complications after appendectomy with reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. We report an 18-year-old patient with Stump appendicitis, who underwent completion appendectomy laparoscopically.

Impact of COVID-19 on medical education: introducing homo digitalis.

Abstract: To determine how members of the Societe Internationale d’Urologie (SIU) are continuing their education in the time of COVID-19. A survey was disseminated amongst SIU members worldwide by email. Results were analyzed to examine the influence of age, practice region and settings on continuing medical education (CME) of the respondents. In total, 2494 respondents completed the survey. Internet searching was the most common method of CME (76%; all ps < 0.001), followed by searching journals and textbook including the online versions (62%; all ps < 0.001). Overall, 6% of the respondents reported no time/interest for CME during the pandemic. Although most urologists report using only one platform for their CME (26.6%), the majority reported using ≥ 2 platforms, with approximately 10% of the respondents using up to 5 different platforms. Urologists < 40 years old were more likely to use online literature (69%), podcasts/AV media (38%), online CME courses/webinars (40%), and social media (39%). There were regional variations in the CME modality used but no significant difference in the number of methods by region. There was no significant difference in responses between urologists in academic/public hospitals or private practice. During COVID-19, urologists have used web-based learning for their CME. Internet learning and literature were the top frequently cited learning methods. Younger urologists are more likely to use all forms of digital learning methods, while older urologists prefer fewer methods.

The current role of laparoscopic IPOM repair in abdominal wall reconstruction.

Abstract: In the evolution of hernia repair, we have learnt that maximally invasive surgical interventions for hernia repair such as long incisions, extensive tissue mobilization and creation of large myofascial flaps lead to significant morbidity [1, 2]. Dissection of large tissue planes is associated with morbidity sequelae like wound infection, tissue necrosis, seromas, and hematomas [3]. Long fascial suture lines are potential causes of morbidity [dehiscence, internal hernia (bowel herniation following dehiscence of posterior rectus sheath suture line in eTEP repairs), bleeding, hematoma]. Since the first description by LeBlanc and Booth [4], laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh placement (IPOM) is now an established surgical procedure for primary and incisional abdominal wall hernias. The intraperitoneal site of mesh placement with the possible sequelae (visceral adhesions, bowel obstruction, fistulization, mesh migration) and bridging repair with prosthesis were concerns raised by some surgeons against the procedure. This led to the quest for an alternative site of mesh placement for hernia repair with minimal access approach. The preperitoneal site for placement of mesh was described (TAPP, transabdominal preperitoneal approach [5] and TAPE, transabdominal partially extraperitoneal approach [6] for peripheral abdominal wall hernias). An endolaparoscopic retromuscular mesh repair for midline hernias was devised (RR approach, eTEP, eRives stoppa). Lateral extensions of the retromuscular (retrorectus) plane were developed after division of transversus abdominis muscle (TAR) for extraperitoneal placement of large meshes extending to paravertebral spaces [7]. Endolaparoscopic retrorectus mesh repair for midline hernias is performed with minimal access, but is surgically maximally invasive. It involves extensive mobilization of large myofascial flaps upto semilunar lines laterally to create requisite retromuscular space for hernia repair and mesh placement. The surgical procedure requires division of the entire linea alba in the midline to create the large retrorectus space required for placement of mesh. With this approach, essentially, repair of a midline hernia necessitates complete division followed by suture of an otherwise normal linea alba (“to fix a leaking tap why change the entire plumbing?”). The normal linea alba is akin to a natural dynamic lattice of criss cross fibres that cross the midline and reinforce the contralateral sheath [8]. A divided and sutured normal linea alba (with mesh reinforcement) is a poor substitute. Additionally, there is potential for damage to important neurovascular perforators laterally near semilunar lines. The learning of these new endoscopic techniques is not easy and the use of robotics to enhance suturing capacities is being suggested. Component separation techniques have been introduced to facilitate medialisation of the abdominal wall and a tension free reapproximation of abdominal wall constituents for primary closure [9]. [“Steal from Joe (lateral compartment”) and provide to “John (medial compartment)”]. With increasing acceptance and performance of different component separation techniques, also done endolaparoscopically, the point of anatomic reconstruction gained increasing significance. These functional aspects are well studied after repair of major abdominal defect with a fascial width of > 10 cm. A significant improvement of function and quality of life by anatomical reconstruction could be shown [10]. As such these are extensive reconstructive procedures of the abdominal wall with attendant morbidity and mortality [11]. It follows that due diligence and caution is mandatory to ensure that these procedures are performed for the right indications. The TA muscle with attachments to the thoracic cage spine and pelvis has been previously described as the * A. Sharma anil.sharma@maxhealthcare.com; asharma736@yahoo.in