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.

Sun exposure, ultraviolet (UV) irradiance and serum 25 hydroxycholecalciferol (25OHD) in pregnant women in rural North India

Abstract: Vitamin D deficiency is rampant in India despite abundant sunshine. We aimed to estimate the amount of cutaneous vitamin D synthesis in pregnant village women (n=100) in different seasons in conjunction with serum 25OHD. We also correlated variations in surface UV energy with the presence of environmental pollution and crowding.

Feasibility of reirradiation and treatment outcome in a previously irradiated territory in head-and-neck malignancies

Abstract: Despite combined modality treatment, local persistent or recurrent disease is a primary cause of treatment failure in 30–50% of patients with advanced head-and-neck cancer (HNC). The role of reirradiation is feared because of increased risk of toxicity due to the previously irradiated target volume. In the present study, we have evaluated reirradiation by image-guided intensity-modulated radiotherapy in recurrent and second primary HNCs and its outcome. In all, 24 patients with recurrence or second primary tumors in HNC were included in the study conducted between January 2009 to August 2014. All patients were treated by the image-guided intensity-modulated radiotherapy technique. The most common site of recurrence/second primary was oral tongue. The time interval between initial radiotherapy and reirradiation ranged from 8 months to 17 years. The association between qualitative variables was tested using the χ2-test. Statistical significance was interpreted using an arbitrary cut-off of P=0.05. Kaplan–Meier Survival graph was plotted to depict the survival pattern of the study patients. The planning target volume volume of reirradiation ranged from 26.72 to 469.32 ml (median: 118.71 ml). Toxicity was more in patients receiving concurrent chemoradiation and in patients with less interval time between reirradiation. Out of the 24 patients, nine were no evidence of disease, eight patients expired (five disease progression, two comorbidities, and one due to hematemesis after the development of third primary), two recurred, one developed distant metastases, and four were lost to follow-up. Surgical resection, with or without reirradiaton, provides the highest likelihood for successful salvage in locoregional (LR) recurrences in HNCs. Patients reirradiated after a long time from initial irradiation have better tolerance.

Clinico-epidemiological profile of brain abscess- a single center study

Abstract: INTRODUCTION: The overall incidence of bacterial brain abscess has remained relatively constant despite improved treatment of underlying systemic infections and development of more effective antibiotics. The systemic antibiotics are generally given for 6-8 weeks. The Choice of surgery varies from stereotactic aspiration /open surgical method including twist drill aspiration, burr hole aspiration with or without drainage, small craniectomy with aspiration and drainage to craniotomy and excision of abscess. The purpose of this article is to share authors’ experience regarding clinico epidemiological profile of brain abscess. MATERIAL AND METHODS: Total 30 patients with brain abscess who presented to the Department of Neurosurgery, PGIMER Dr. RML Hospital Delhi, from November 2016 to April 2018 analyzed for clinical, epidemiological, microbiological profile of brain abscess patients along with modes of treatment and their outcome. RESULTS: Total 30 patients of Brain Abscess were evaluated with males outnumbering females. Predominated symptoms were fever (96.7%), headache (83.3%) and nausea and vomiting (40%). The chronic suppurative otitis media (CSOM) was predominately underlying factor in 18 patients i.e. (60%) and commonest organism isolated was streptococcus pneumonia (66.6%) followed by streptococcus Milleri (33.33%). The length of hospital stay was longer in aspiration group {21.2 days (SD ± 4.1)} compared to excision group {13 days (SD ± 1.1)}. Total 20 (66.7%) patients survived, 2 (6.7%) patients died and 8 (26.7%) were lost to follow up. CONCLUSION: Majority of time there is an underlying factor for brain abscess. The treatment of brain abscess involves both medical and surgical modalities. Third generation cephalosporins and metronidazole are the most commonly used antimicrobial agents in the treatment of brain abscesses. The length of hospital stay in excision group was less as compared to medical group and aspiration group.

Secondary infections modify the overall course of hospitalized COVID-19 patients: A retrospective study from a network of hospitals across North India

Abstract: IntroductionSARS-CoV-2 infection increases the risk of secondary bacterial and fungal infections and contributes to adverse outcomes. The present study was undertaken to get better insights into the extent of secondary bacterial and fungal infections in Indian hospitalized patients and to assess how these alter the course of COVID-19 so that the control measures can be suggested. MethodsThis is a retrospective, multicentre study where data of all RT-PCR positive COVID-19 patients was accessed from Electronic Health Records (EHR) of a network of 10 hospitals across 5 North Indian states, admitted during the period from March 2020 to July 2021.The data included demographic profile of patients, clinical characteristics, laboratory parameters, treatment modalities, and outcome in those with secondary infections (SIs) and those without SIs. Spectrum of SIS was also studied in detail. ResultsOf 19852 RT-PCR positive SARS-CO2 patients admitted during the study period, 1940 (9.8%) patients developed SIs. Patients with SIs were 8 years older on average (median age 62.6 years versus 54.3 years; P<0.001) than those without SIs. The risk of SIs was significantly (p < 0.001) associated with age, severity of disease at admission, diabetes, ICU admission, and ventilator use. The most common site of infection was urinary tract infection (UTI) (41.7%), followed by blood stream infection (BSI) (30.8%), sputum/BAL/ET fluid (24.8%), and the least was pus/wound discharge (2.6%). As many as 13.4% had infections with more than organism and 34.1% patients had positive cultures from more than one site. Gram negative bacilli (GNB) were the commonest organisms (63.2%), followed by Gram positive cocci (GPC) (19.6%) and fungus (17.3%). Most of the patients with SIs were on multiple antimicrobials - the most commonly used were the BL-BLI for GNBs (76.9%) followed by carbapenems (57.7%), cephalosporins (53.9%) and antibiotics carbapenem resistant entreobacteriace (47.1%). The usage of emperical antibiotics for GPCs was in 58.9% and of antifungals in 56.9% of cases, and substantially more than the results obtained by culture. The average stay in hospital for patients with SIs was twice than those without SIs (median 13 days versus 7 days). The overall mortality in the group with SIs (40.3%) was more than 8 times of that in those without SIs (4.6%). Only 1.2% of SI patients with mild COVID-19 at presentation died, while 17.5% of those with moderate disease and 58.5% of those with severe COVID-19 died (P< 0.001). The mortality was highest in those with BSI (49.8%), closely followed by those with HAP (47.9%), and then UTI and SSTI (29.4% each). The mortality rate where only one microorganism was identified was 37.8% and rose to 56.3% in those with more than one microorganism. The mortality in cases with only one site of infection was 28.8%, which steeply rose to 62.5% in cases with multiple sites of infection. The mortality in diabetic patients with SIs was 45.2% while in non-diabetics it was 34.3% (p < 0.001). ConclusionsSecondary bacterial and fungal infections can complicate the course of almost 10% of COVID-19 hospitalised patients. These patients tend to not only have a much longer stay in hospital, but also a higher requirement for oxygen and ICU care. The mortality in this group rises steeply by as much as 8 times. The group most vulnerable to this complication are those with more severe COVID-19 illness, elderly, and diabetic patients. Varying results in different studies suggest that a region or country specific guideline be developed for appropriate use of antibiotics and antifungals to prevent their overuse in such cases. Judicious empiric use of combination antimicrobials in this set of vulnerable COVID-19 patients can save lives.