An early experience with transversus abdominis release for complex ventral hernias: a retrospective review of 100 cases.

BACKGROUND: Transversus abdominis release (TAR) is a relatively recent surgical technique for ventral hernia repair which allows placement of a large prosthesis in the retro-muscular plane with considerable myofascial medialization. A retrospective review of 100 cases who underwent TAR for complex ventral hernias was performed to evaluate the safety and efficacy of TAR in a series of large ventral hernias. METHODS: Between March 2016 and May 2019, 100 consecutive patients who underwent open TAR were identified from our prospectively maintained database. A retrospective review was performed to analyze patient demographics, peri-operative events, adverse outcomes and recurrence. RESULTS: 12 primary and 88 incisional hernia cases underwent TAR with prosthetic mesh repair during the study period. Mean age was 52.5 years, mean BMI was 30.87 kgs/m2, mean ASA class 1.95. In our series, 41% were diabetic, 11% had COPD. All patients underwent preoperative CT scans. The mean defect was 140.18 cm2. Average mesh area was 1344 cm2. Average blood loss was 245 mL. Defects were bridged in 19% cases despite bilateral component separation. Readmission rate at 1 month was 3%, for wound complications. We recorded 9 surgical site infections, 17 surgical site occurrences, 10 of which needed procedural interventions. We recorded no recurrences at a mean follow-up duration of 20.2 months. CONCLUSIONS: Our early results with TAR are encouraging. We have demonstrated that the repair allows anatomical reconstruction with a large sublay mesh while inflicting minimal morbidity. TAR can be a valuable tool in complex ventral hernia repair.

Evaluation of intradermal vaccination at the anti rabies vaccination OPD.

Rabies is a virtually 100% fatal acute viral encephalitis caused by an RNA virus belonging to family Rhabdoviridae and genus Lyssavirus. The virus can infect all warm blooded animals. The disease is transmitted to humans by the bite, lick or scratch of an infected animal. More than 99% of all human rabies deaths occur in the developing world. It is preventable with timely and proper usage of modern immunobiologicals (vaccines and immunoglobulins). Once exposure occurs, modern prophylaxis entails immediate wound care, local infiltration of rabies immune globulin and parenteral administration of modern cell culture vaccines in multiple doses. The annual medicinal (vaccines and other drugs) cost for animal bite treatment is Rs. 2 billion approximately (2004). The objective of the present study is to evaluate the performance of the Intradermal (i.d.) route visa vis the Intramuscular (i.m.) route in our clinical setting the Antirabies Vaccination (ARV) OPD, Sir J.J. Hospital, Mumbai. A total of 1460 patients were administered the Antirabies vaccine by the Intradermal route over the 1 year period as compared to 1075 patients who were administered the Antirabies vaccine by the Intramuscular route in the previous year. 1230 (84.2) of the patients who were administered the vaccine by the i.d. route completed the schedule and 230 (15.8%) partially completed the schedule. Four hundred thirty two (40%) of the patients who were administered the vaccine by the Intramuscular route completed the schedule and 643 (59.8%) partially completed the schedule. The vaccine cost for i.d. was Rs. 2,80,600. The vaccine cost for the intramuscular (i.m.) assuming 84% compliance was estimated as Rs. 15, 64, 000. Assuming 40% compliance the cost was estimated as Rs. 7, 82, 230. Thus a saving of Rs. 5, 01, 630 to Rs. 12, 83, 400 was effected. In our setting, the Intradermal regime was cost effective and increased patient adherence and enrolment. It has now been routinely adopted at the clinic.

Prevalence of dyslipidemia in young adult Indian population.

BACKGROUND: Cardiovascular diseases (CVD) are the major cause of morbidity and mortality in our society with dyslipidemia contributing significantly to atherosclerosis. Thus measurement of plasma lipids would help in identifying people at risk for CVD. The goal of this study was to ascertain the prevalence of Dyslipidemia among young adult population in urban India. MATERIAL AND METHODS: The study was conducted for a period of one year--from 1st January 2006 to 31st December 2006. Around 1805 subjects with > or =40 age group were selected from a population of approximately 9000 urban dwellers who had attended annual general health check ups in P. D. Hinduja National Hospital and Medical research Center. Health status was evaluated by physical check ups, complete fasting lipid profiles and blood glucose levels. Dyslipidemia risk and impaired blood sugar levels were determined as per National Cholesterol Education Program (NCEP) - Adult Treatment Panel (ATP) III guidelines and American Diabetes Association (ADA) respectively. RESULTS: The prevalence of dyslipidemia was observed to be higher in males then in females. Among participants who had a total Cholesterol (TC) concentration > or = 200 mg/dl, 38.7% were males and 23.3% were females. High density lipoprotein cholesterol (HDL-C) was abnormally low in 64.2% males and 33.8% in females. The increase of prevalence of hypercholesterolemia and hypertriglyceridemia was more prominent in 31-40 age group than in < or =30 age group. CONCLUSION: The low percentage of adults with controlled lipid concentrations suggests that there is a need for awareness programs for the prevention and control of Dyslipidemia and impaired blood sugar levels.