Sunshine Hospitals

andhra Pradesh, India

Sunshine Hospitals

andhra Pradesh, India
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Turagam M.K.,University of Missouri | Nagarajan D.V.,Sunshine Hospitals | Bartus K.,Jagiellonian University | Makkar A.,Arizona Heart Rhythm Center | Swarup V.,Arizona Heart Rhythm Center
Journal of Interventional Cardiac Electrophysiology | Year: 2017

Background: Pocket hematoma is a recognized complication after placement of cardiac implantable electronic devices and is associated with increased device infection, length of hospitalization, and morbidity especially with uninterrupted antiplatelet agents and anticoagulants. We assessed the use of a post-surgical vest to decrease the incidence of pocket hematoma in patients undergoing device implantation with uninterrupted antiplatelet and anticoagulants. Methods: In this observational study, a vest was used by 20 consecutive patients who were compared to 20 age-, gender-, procedure-matched patients who received standard care. All patients were continued on antiplatelet and anticoagulants in the perioperative period. The pocket was assessed at post procedure day 0, 2, and 7, respectively. Results: There were no significant differences in the baseline characteristics between both groups. Baseline mean international normalized ratio (INR) was significantly higher in the vest group when compared with the control group (2.7 ± 0.4 vs. 2.2 ± 0.3 = <0.001). The incidence of pocket hematoma was significantly lower in the vest group than the control group (0 vs 30%, p = 0.02) at the end of 7 days. Control group had a total of six hematomas with one patient requiring evacuation and blood transfusion. The vest group had three hematomas on day 2 that resolved by day 7. Conclusions: The risk of moderate or large pocket hematoma is significantly reduced with the use of this vest in high-risk patients undergoing implantable devices on uninterrupted antiplatelet and anticoagulants. © 2017 Springer Science+Business Media New York

PubMed | McMaster University, Tamil Nadu Dr. M.G.R.Medical University, Byl Nair Hospital & Tn Medical College, Sunshine Hospitals and 6 more.
Type: Journal Article | Journal: Journal of long-term effects of medical implants | Year: 2014

Multi-center, cross-sectional, observational study. STUDY CENTER(S): Multiple centers in India. NUMBER OF PARTICIPANTS: 1,000. PRIMARY RESEARCH OBJECTIVE: To characterize patients and treatment utilized for orthopedic patients presenting to both private and public hospital centers in India with knee pain and symptoms suggestive of knee arthritis.All patients 18 years of age or older who present to a recruiting hospital for treatment of knee pain will be eligible for participation. The subjects must be able to understand and complete the questionnaire.Patients with total knee replacement, open wound or evidence of recent surgery, or with a current or a history of tumor and/or fracture in the tibial plateau, femoral condyle or patella, in the affected knee are not eligible.This study aims to characterize the following: general demographics of patients presenting with knee pain, severity of knee symptoms at time of presentation, severity of knee pathology at time of presentation, factors associated with the decision to seek medical care, previous treatments and health care contacts, planned treatment, and gaps in treatment perceived by the patient and treating surgeons.

PubMed | Sunshine Hospitals, Narayani Hospital and Research Center and Maxcure Hospitals
Type: Journal Article | Journal: Journal of clinical orthopaedics and trauma | Year: 2017

Optimal rotational alignment of femoral component is important for longevity and success of total knee replacement. Whiteside line (WL), posterior condylar axis (PCA) and femoral transepicondylar axis are various intra-operative landmarks to guide femoral rotation. Each of these has its pros and cons. The aims of our study were to assess the relationship of posterior condylar axis and the antero-posterior axis of femur with the surgical epicondylar axis and evaluate whether degree of deformity or severity of osteoarthritis alters the rotational alignment of the femur when posterior condylar axis is taken as a reference. Are we justified in using a 3 external rotation with respect to posterior condylar axis in each knee?The study is a single-centre, CT-based, cross-sectional, radiological study in 56 bilateral osteoarthritic varus Indian knees. The following were deduced using a uniform standardised method: Whiteside-surgical transepicondylar angle and posterior condylar angle. The study population was subdivided based on age, sex, deformity and grade of osteoarthritis.The mean posterior condylar angle (PCA and the WL are comparable in establishing the rotational alignment of the femoral component with respect to the surgical transepicondylar axis. A fixed, 3 external rotation with respect to the PCA is an oversimplification and rotational alignment of the knees should be individualised.

PubMed | Sunshine Hospitals and Max cure Hospitals
Type: Journal Article | Journal: Journal of orthopaedic case reports | Year: 2017

Disengagement of polyethylene insert used in total knee arthroplasty is a rare but serious complication. Still rarer is disengagement because of failure of tibial insert locking mechanism. We report a previously unpublished complication of polyethylene insert locking mechanism failure in a 10-months-old posterior stabilized total knee arthroplasty in a 70-year-old woman with osteoarthritis for whom Attune (Depuy) knee implant was used.A 70-year-old female underwent (Attune, Depuy) primary bilateral posterior stabilised total knee arthroplasty in a private hospital. The patient did not have any complaints and had had been functioning well post her arthroplasty. After five months of surgery she had a fall and sustained injury over right hip which was treated with Cemented Bipolar Hemiarthroplasty. Ten months after index surgery, she sustained trivial fall and presented to the same hospital with knee pain and swelling, where the right knee prosthesis was found to be dislocated. An attempted closed reduction under anaesthesia failed, after which she was referred to our centre with an unstable, painful, swollen right knee in a long knee brace. The physical examination at the time of admission showed posterior sag of the tibia, fullness in the postero-lateral corner, quadriceps muscle atrophy without any neurovascular deficit oflower leg. Postero-lateral dislocation was confirmed with radiographs. Surgical error as a possible causative factor was excluded because patient had been functioning well after surgery. Her comorbidities included hypertension and hyponatremia. ESR and CRP were within normal limits. An open reduction surgery was planned. On exposure, polyethylene was found in the postero-lateral corner of the knee. We were not sure that revising the polyethylene alone would suffice as the poly and locking mechanism was of a relatively new design and hence it was decided to proceed with revision of the components. Revision was done with stemmed components, distal femoral augments and a constrained prosthesis (Total Condylar 3, Depuy). Intraoperative cultures were negative. The patient had an uncomplicated post-operative course.Disengagement of polyethylene should be considered as a differential diagnosis in patients who present with acute swelling and instability of the knee. Though its a rare complication, there is a possibility that design of the implant or its locking mechanism could contribute to dislocations in future.

Mulpur P.,Sri Sathya Sai Institute of Higher Learning | Yadavilli S.,Sri Sathya Sai Institute of Higher Learning | Mulpur P.,Sunshine Hospitals | Kondiparthi N.,Sunshine Hospitals | And 4 more authors.
Physical Chemistry Chemical Physics | Year: 2015

The relatively low sensitivity of fluorescence detection schemes, which are mainly limited by the isotropic nature of fluorophore emission, can be overcome by utilizing surface plasmon coupled emission (SPCE). In this study, we demonstrate directional emission from fluorophores on flexible Ag-C60 SPCE sensor platforms for point-of-care sensing, in healthcare and forensic sensing scenarios, with at least 10 times higher sensitivity than traditional fluorescence sensing schemes. Adopting the highly sensitive Ag-C60 SPCE platform based on glass and novel low-cost flexible substrates, we report the unambiguous detection of acid-fast Mycobacterium tuberculosis (Mtb) bacteria at densities as low as 20 Mtb mm-2; from non-acid-fast bacteria (e.g., E. coli and S. aureus), and the specific on-site detection of acid-fast sperm cells in human semen samples. In combination with the directional emission and high-sensitivity of SPCE platforms, we also demonstrate the utility of smartphones that can replace expensive and cumbersome detectors to enable rapid hand-held detection of analytes in resource-limited settings; a much needed critical advance to biosensors, for developing countries. This journal is © the Owner Societies 2015.

Ramasamy R.,P.A. College | Krishnan S.,Sunshine Hospitals
International Journal of Pharma and Bio Sciences | Year: 2015

Glaucoma is one of the leading diseases which causes irreversible visual impairment and blindness throughout the world. It constitutes clinically and genetically heterogenous group of optic neuropathies. Specific mutations in the myocilin gene cause primary open angle glaucoma with varying age-of-onset and degree of severity. Though the structure of the gene and protein have been elucidated still the role of mutant protein is not clearly understood. To study myocilin and glaucoma-associated myocilin mutants in higher animals and to understand, how these molecules may alter intraocularpressure and outflow resistance, it would be more helpful if we have animal models which could be used in the study. For finding out suitable animal models, sequence anlysis approach has been the first step in many diseases. Here we took a sequence analysis approach to know more about the related orthologes of myocilin proteins from different species.

Reddy V.G.,Sunshine Hospitals | Kumar R.V.,Sunshine Hospitals | Mootha A.K.,Sunshine Hospitals | Thayi C.,Sunshine Hospitals | And 2 more authors.
Indian Journal of Orthopaedics | Year: 2011

Background: Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA) with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA. Materials and Methods: 16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator. Results: Union was achieved in 15 patients (93.75%). The mean duration for union (frame application time) in these patients was 28.33 weeks (range 22 to 36 weeks). Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034). Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls) was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035). Conclusion: Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.

Reddy V.,Sunshine Hospitals | Mootha A.K.,Sunshine Hospitals | Thayi C.,Sunshine Hospitals | Kantesaria P.,Sunshine Hospitals | And 2 more authors.
Indian Journal of Orthopaedics | Year: 2011

Background: Variations in the anatomy of knee are well described, however the true incidence of component asymmetry in bilateral total knee arthroplsties is rarely reported. Incidence of component asymmetry in bilateral total knee arthroplasties (TKA) was retrospectively analysed in 289 cruciate retaining total knee arthroplasties. Materials and Methods: Medical records of these 289 patients were evaluated for the incidence of asymmetry of either femoral or tibial components. Clinical outcomes were compared between the cases of asymetrical components to that of symmetrical components. Results: Incidence of femoral component asymmetry was found to be 9.2% and tibial component asymmetry to be 8.7%. Of 289 cases, TKA 178 were done in a single day (group A), while 111 were done at 2- to 3-day intervals (group B). Asymmetric and symmetric knees were equally distributed among both groups, male and female patients in both groups, and the incidence of component asymmetry was similar between all four different implants - Optetrak-CR (Exactech, Gainesville, FL, USA), Nexgen-CR (Zimmer, Warsaw, IN, USA), PFC-Sigma CR (DePuy, Warsaw, IN, USA), Genesis II CR (Smith and Nephew, Memphis, TN, USA) we used. The pre- and postoperative range of motion and pre- and postoperative knee society scores were compared between the symmetric and asymmetric cases in both the groups and the difference was found to be insignificant. Conclusion: We conclude that incidence of component asymmetry in bilateral total knee arthroplasty is around 9 % and independent sizing of both knees during bilateral arthoplasty is recommended rather than simply relying on the contralateral knee measurements.

Reddy V.G.,Sunshine Hospitals | Mootha A.K.,Sunshine Hospitals | Chiranjeevi T.,Sunshine Hospitals | Kantesaria P.,Sunshine Hospitals | And 2 more authors.
International Journal of Surgery Case Reports | Year: 2011

INTRODUCTION: Periprosthetic fracture following total knee arthroplasty is a potentially serious condition. Here we report a case of bilaterally symmetrical (mirror) fracture of supracondylar area following trivial trauma. PRESENTATION OF CASE: Both fractures were OTA 33A2 and according to Rorabeck classification they were type II. Both fractures were fixed by dual plating technique using non locking plates. Intra operative fracture site biopsy revealed marked osteopenia and hence the patient was treated for osteoporosis. DISCUSSION: Both fractures united well at 14 weeks. At final follow up of 6 years there were no radiological signs of implant loosening and the patient was able to walk without any aids and had a range of 80° and 60° flexion in the right and left knees respectively. CONCLUSION: We conclude that in the pre locking plate's era such difficult case has been successfully managed by dual plating technique. © 2011 Surgical Associates Ltd. Elsevier Ltd. All rights reserved.

PubMed | Sunshine Hospitals
Type: Journal Article | Journal: Journal of orthopaedic case reports | Year: 2016

Bicondylar Hoffa fracture is a rare injury with implant failure and non unions as known complications.Two cases of Bicondylar Hoffa fractures with implant failure and nonunion treated successfully with long stem total knee arthroplasty are reported here. At a minimum follow up of 2 years both the implants were well fixed and the fractures have united. The knee society scores in both the patients improved from 14 and 19 to 86 and 82 respectively. To our knowledge there are no reports of such rare fractures managed successfully with non hinged arthroplasty.A long stem total knee arthroplasty can be used as a treatment option in cases of nonunion bicondylar Hoffa fractures.

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