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.

Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources

Abstract: Background The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores. Methods A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group. Results The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss. Conclusion TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.

Latissimus Dorsi Muscle Onlay Flap Post-esophagectomy Leakage with Mediastinitis and Failed Stenting.

Abstract: Despite the recent advances in techniques and principles of surgery, esophagectomy is still considered a high-risk procedure. Reported morbidities after esophagectomy are around 6% and it is associated with mortality in approximately 3% of cases [1–3]. Most dreaded of complications after esophagectomy is intrathoracic anastomosis leakage as it is associated with longer ICU stay and is the main reason for postoperative mortality [4]. It is associated with mortality in around 12% of cases [5, 6]. Management strategy for anastomosis leakage should be planned according to the general condition of the patient and degree of leakage [7]. The latest review for the management of esophageal perforations showed a mortality rate of 12%with and without reinforcement and considered surgical repair as the most successful. The mortality rate increases with the time delay between perforation and treatment, 4% for less than 24 h and 14% for a delay of more than 24 h [5, 8]. Intrathoracic anastomosis leakage with mediastinitis and sepsis is a difficult situation to manage. The primary repair has a high rate of failure. Drainage alone has been recommended in critically ill patients but has a mortality rate of 37% [5]. Endoscopic esophageal stents have also been recommended for second-degree anastomosis leakage with a success rate of up to 70% [7]. Esophagogastric disconnection and diversion is recommended for intrathoracic leakage in critically ill patients with severe mediastinal inflammation and is associated with a mortality rate of 24% [8]. In these situations, vascularized muscle onlay flap over debrided leakage site of the esophagus can be considered as a safer alternative. A large and well-vascularized muscle flap provides a good substitute without risk of narrowing and avoids diversion. Though vascularized muscle flaps are commonly used in head and neck cancer surgeries, there is the paucity of studies describing latissimus dorsi muscle flap for Ivor Lewis esophagogastric anastomosis leakage repair for malignancy. Our reported case and described technique are an attempt to highlighting the importance of muscle flap for this difficult situation.

Seasonal Influenza Incidence in India: A Retrospective Study Based on Multiple Indian Hospital and Diagnostic Laboratory Centre

Abstract: The objective of the study is to understand the seasonal variation in influenza incidence across multiple Indian states by using diagnostic laboratories data of influenza. Materials and Methods: Diagnostic laboratory-based data of subjects who were tested for influenza between 1st January April 2014 to December 2017 across seven Indian states were analysed. In diagnostic laboratories of Maharashtra, Delhi, Uttar Pradesh, Haryana, and Rajasthan RT-PCR was used for detection of H1N1 and laboratories of Tamil Nadu used GeneXpert along with RT-PCR. A total sample size of 10,755 was used in the descriptive observational retrospective study. Results: In case of H1N1, sample population had almost equal male and female proportion (5172) with 36.5 years mean age. In majority of states, >3-5 years age group had the highest positivity rate. Paediatric age group (0-18 years) contributed 25% of total H1N1 burden, while older adults (>60 years) contributed 15% of the total sample. The yearly trends showed a higher incidence rate of H1N1 in 2015, followed by a decline during 2016 and a surge in 2017. Monthly trends showed consistent rise in H1N1 positivity rate during early months (January, February, and March) of 2015, 2016 and 2017. For influenza B, paediatric age group (0-18 years) showed the highest positivity rate and contributed almost 40% of total influenza ‘B’ burden. Conclusion: This study highlights the importance of big data-based analytics and its use in understanding the epidemiological behaviour of diseases like influenza. Insight by leveraging laboratories data, like in the case of current research study, gives demographic patterns of influenza in terms of age, gender, seasons, and regions/states.

Case of cytomegalovirus colitis in a patient with Type 2 diabetes mellitus

Abstract: Cytomegalovirus (CMV) colitis usually affects immunocompromised hosts. We report a patient with type 2 diabetes mellitus who presented with massive lower gastrointestinal bleed due to CMV colitis, which proved to be fatal. Awareness about this life-threatening entity is important in patients who have impaired immune response.

Head and neck cancers: Regional trends in Kashmir

Abstract: Background: The current study is a prospective study conducted in the department of otorhinolaryngology Government Medical College and associated Hospitals Srinagar, Jammu and Kashmir for 1½ year. The aim of the study was to study the loco-regional pattern of head and neck cancers (HNCs) in our society which is different from the rest of the country with its unique environment, different sociocultural habits and customs. Material and Methods: All patients of HNCs who reported to our department were enrolled in the study. Metastatic carcinomas to head and neck from other sites and carcinoma with unknown primary were excluded from the study. Results: A total of 99 cases of HNCs were received at our tertiary care institute. The most common tumor encountered was thyroid cancer. The most common thyroid cancer was papillary carcinoma of thyroid, constituting 35% of total HNCs. Thyroid cancers were followed by head and neck squamous cell cancers (HNSCCs). Seventy percent of thyroid cancer patients presented with symptoms of neck swelling while as only 35% had lymph node metastasis, all of papillary thyroid cancer type. The majority of thyroid cancers (86%) belonged to stage 1st irrespective of cancer type (43/50), six patients (12%) were stage 2nd, and only one patient (2%) had stage 3rd. There was no stage 4th tumor in any patient with thyroid cancer. Squamous cell carcinoma of larynx (20.40%) was most common HNSCC. It was observed that the most of the patients of HNSCC had advanced stages of disease at presentation, with almost 60% of patients having T3-T4 stage and more than half of patients (53.84%) had palpable neck nodes. Conclusion: The study pointed out about the influence of environmental factors, local customs, and cultural habits on the nature and type of cancers and thus different cancer incidences and prevalences in different geographical areas.