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Kulshrestha V, Sood M, Kumar S, Kharat K, Padhi PP, Kumar P, Shrama S, Stanley A. Early Outcomes of Modified Technique of Mobile Bearing Unicondylar Knee Replacement. Indian J Orthop 2023; 57:1209-1218. [PMID: 37525741 PMCID: PMC10387039 DOI: 10.1007/s43465-023-00907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Background Recent years have seen a resurgence in utilization of partial knee replacement. One such device frequently used is Oxford partial knee implant (OPK). Deeper tibial bone cut while performing OPK replacement may risk early failure. Methods We prospectively looked at early outcomes of a modified technique (MT) of OPK replacement adopted by our centre to save tibial bone stock at 24 months of follow up as compared to designer group described technique (DT) as a prospective cohort. Results At 2 years follow up New Knee Society Score showed patient satisfaction (38.25 in DT vs 39.02 in MT, p value 0.10), objective (92.77 in DT vs 91.07 in MT, p value 0.21), expectation scores (14.77 in DT vs 14.85 in MT, p value 0.81) and activity (60.72 in DT vs 68.17 in MT, p value 0.79 were similar in MT group as compared to DT. The stair climbing ability (22.46 in MT vs 29.96 in DT, p value < 0.001) and getting up from chair (13.16 in MT vs 19.80 in DT, p value < 0.001), was better with MT group but most other patient performance scores were similar as assessed by DOP (Delaware Osteoarthritis Profile). Both groups had failure rate of 5% at 24 months follow up. Conclusion MT resulted in similar early outcomes in terms of patient reported outcomes, satisfaction and performance as compared to DT group. The MT to save tibial bone stock did not compromise early outcomes and can be utilised in certain patients with higher risk of tibial failure.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Santhosh Kumar
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, 110010 India
| | - Kiran Kharat
- Ruby Hall Clinic, Survey No 59/6, Azad Nagar, Wanowrie, Pune, 411040 India
| | - Prashanth P. Padhi
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
| | - Pardeep Kumar
- Department of Orthopaedics, Command Hospital Air Force, Bangalore, India
| | - Saurabh Shrama
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, India
| | - Abin Stanley
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital Kanpur, Kanpur, India
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Sood M, Kulshrestha V, Kumar S, Kumar P, Amaravati RS, Singh S. "Trends and beliefs in ACL reconstruction surgery: Indian perspectives". J Clin Orthop Trauma 2023; 39:102148. [PMID: 36974199 PMCID: PMC10039028 DOI: 10.1016/j.jcot.2023.102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 01/19/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023] Open
Abstract
Objectives The survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. Methods A survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results 135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. Conclusion We presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.
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Affiliation(s)
| | | | | | | | | | - Shalendra Singh
- Department of Anesthesia, Armed Forces Medical College, Pune, 411040, India
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Kulshrestha V, Sood M, Kumar S, Kumar P, Stanley A, Padhi PP, Sharma S. Numbness Following Total Knee Arthroplasty: Role of Incision Length And Position - A Randomized Study. Clin Orthop Surg 2023; 15:59-70. [PMID: 36778989 PMCID: PMC9880504 DOI: 10.4055/cios21140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. Methods We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. Results At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. Conclusions Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Santhosh Kumar
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, India
| | - Pardeep Kumar
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Abin Stanley
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Prashanth P Padhi
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital, Kanpur, India
| | - Saurabh Sharma
- Joint Replacement Center, Army Hospital Research and Referral, New Delhi, India
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Kulshrestha V, Sood M, Kumar S, Kumar P, Stanley A, Padhi PP. Early Outcomes of Dual-Pivot Total Knee Replacement Compared to an Ultracongruent Design. Clin Orthop Surg 2022; 14:530-538. [PMID: 36518936 PMCID: PMC9715929 DOI: 10.4055/cios21091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND With a quest to optimize outcomes, there have been significant advancements in modern designs of total knee implants, attempting to mimic the natural knee motion and feel. One such new design reproducing the medial and lateral knee pivot is a dual-pivot (DP) knee. In the present study, we endeavored to compare the performance of the DP knee vis-a-vis an ultracongruent (UC) Knee design. METHODS This prospective cohort study was performed in a joint replacement center of a tertiary care military hospital. We enrolled 50 patients each in the DP knee group and the UC knee group and assessed knee flexion, patient-reported outcome (new Knee Society Score [nKSS]), patient performance (Delaware Osteoarthritis Profile Score), and function (Forgotten Joint Score [FJS]) at 2 years of follow-up. RESULTS The nKSS was similar in the two groups. In the DP group, patients had significantly better improvement in the stair climb test (p = 0.026). In the UC group, timed up and go test was significantly better (p = 0.004). The gain in knee flexion was similar in the two groups: 26.3° ± 23.3° in the DP group and 27.5° ± 27.5° in the UC group (p = 0.930). Return to activity as judged by 2-year FJS was similar in both groups (p = 0.687). CONCLUSIONS Our study showed that the DP knee design had similar knee function to the UC knee. The DP knee design had significantly better stair climbing ability, whereas getting up from chair was better in the UC knee design. With comparable patient-reported outcome and possible differences in patient performance in terms of day-to-day activities, any future trial should focus on comparing patient performance.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Santhosh Kumar
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Pardeep Kumar
- Department of Orthopaedics and Joint Replacement Surgery, 7 Air Force Hospital, Kanpur, India
| | - Abin Stanley
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
| | - Prashanth P Padhi
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bangalore, India
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Kulshrestha V, Sood M, Kumar S, Sood N, Kumar P, Padhi PP. Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty? A Cohort Study. Clin Orthop Surg 2022; 14:56-68. [PMID: 35251542 PMCID: PMC8858904 DOI: 10.4055/cios20234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. Methods This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. Results TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). Conclusions Screening and RM can reduce 90-day complications in patients undergoing TKA.
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Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Center, Department of Orthopaedics and Major Rehabilitation Center, Command Hospital Air Force, Bangalore, India
| | - Munish Sood
- Department of Orthopaedics and Major Rehabilitation Center, Command Hospital Chandimandir, Chandigarh, India
| | - Santhosh Kumar
- Joint Replacement Center, Department of Orthopaedics and Major Rehabilitation Center, Command Hospital Air Force, Bangalore, India
| | - Nikhil Sood
- Department of Orthopaedics and Major Rehabilitation Center, Command Hospital Chandimandir, Chandigarh, India
| | - Pradeep Kumar
- Department of Orthopaedics and Major Rehabilitation Center, Air Force Hospital Kanpur, Kanpur, India
| | - Prashanth P Padhi
- Joint Replacement Center, Department of Orthopaedics and Major Rehabilitation Center, Command Hospital Air Force, Bangalore, India
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Sood M, Kumar S, Kulshrestha V, Datta B, Mittal G. Dual mobility cup in total hip replacements: a single center experience. J Orthop Traumatol Rehabil 2022. [DOI: 10.4103/jotr.jotr_108_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Sood M, Kulshrestha V, Sachdeva J, Ghai A, Sud A, Singh S. Corrigendum to "Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction". Clin Orthop Surg 2020; 12:558. [PMID: 33274036 PMCID: PMC7683188 DOI: 10.4055/cios19143re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Munish Sood
- Department of Orthopaedics, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Vikas Kulshrestha
- Department of Orthopaedics, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Julie Sachdeva
- Department of Medicine, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Amresh Ghai
- Department of Orthopaedics, Base Hospital Delhi Cantt, New Delhi, India
| | - Ajaydeep Sud
- Department of Orthopaedics, Armed Forces Medical College, Pune, India
| | - Shalendra Singh
- Department of Neuro-Anaesthesia and Critical Care, Armed Forces Medical College, Pune, India
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Sood M, Kulshrestha V, Sachdeva J, Ghai A, Sud A, Singh S. Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction. Clin Orthop Surg 2020; 12:312-317. [PMID: 32903976 PMCID: PMC7449845 DOI: 10.4055/cios19143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/03/2019] [Indexed: 11/28/2022] Open
Abstract
Backgroud Anterior cruciate ligament reconstruction (ACLR) remains the gold standard treatment for anterior cruciate ligament (ACL) injury. However, a good functional outcome even after a successful surgery depends on multiple factors. It has been observed that certain patients with a chronic ACL injury demonstrate knee instability voluntarily. The authors observed that these patients might not perform well even after a successful surgery. This study aims to assess the outcome after ACL and other ligament reconstruction in patients with voluntary knee instability. Methods From a total of 824 patients who underwent ACLR, 13 patients with a history of voluntary knee instability were selected, and data of these patients (demographic and clinical profile) were obtained. Outcomes of surgery in this group of patients were evaluated by using Lysholm score and Tegner activity level. Results All patients were young men with a chronic ACL injury and manifested instability. Associated injuries were lateral meniscus tear in 3 patients, medial meniscus tear in 2, and posterolateral corner (PLC) injury in 3. ACLR was done using the semitendinosus-gracilis graft in all patients. Further, anterolateral ligament reconstruction was done in 2 patients and PLC reconstruction, in 3 patients. The mean Lysholm score was 54.76 (range, 48–62) preoperatively and 60.92 (range, 54–78) at a mean follow-up of 14.3 months (range, 11–26 months). The median Tegner activity level was 6 (range, 5–7) before injury and 4 (range, 3–5) at the final follow-up. Twelve of the 13 patients were able to demonstrate instability voluntarily at the time of the final follow-up. Conclusions In patients with ACL and other ligament injuries who demonstrated voluntary knee instability, the functional outcome even after successful ligament reconstruction was poor.
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Affiliation(s)
- Munish Sood
- Department of Orthopaedics, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Vikas Kulshrestha
- Department of Orthopaedics, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Julie Sachdeva
- Department of Medicine, Command Hospital (WC) Chandimandir, Panchkula, India
| | - Amresh Ghai
- Department of Orthopaedics, Base Hospital Delhi Cantt, New Delhi, India
| | - Ajaydeep Sud
- Department of Orthopaedics, Armed Forces Medical College, Pune, India
| | - Shalender Singh
- Department of Neuro-Anaesthesia and Critical Care, Armed Forces Medical College, Pune, India
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Kulshrestha V, Sood M, Kanade S, Kumar S, Datta B, Mittal G. Early Outcomes of Medial Pivot Total Knee Arthroplasty Compared to Posterior-Stabilized Design: A Randomized Controlled Trial. Clin Orthop Surg 2020; 12:178-186. [PMID: 32489539 PMCID: PMC7237261 DOI: 10.4055/cios19141] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Backgroud The indications for total knee arthroplasty (TKA) have been expanded to include younger, demanding patients. Some TKA patients expect a return to high-performance activities to restore optimum quality of life. The concept of the medial pivot (MP) TKA is that more natural knee kinematics can be achieved by altering the bearing design. In the present study, we compared the early outcomes of MP TKA with posterior-stabilized (PS) TKA in terms of patient-reported outcomes, function, and performance. Methods This randomized study was performed in a high volume joint replacement facility of a tertiary care military hospital. We enrolled 40 patients each in the MP group and PS group and assessed knee flexion, patient-reported outcome (new Knee Society Score [new KSS]), patient performance (Delaware Osteoarthritis Profile Score [DOPS]), and function (Forgotten Joint Score [FJS]) at 2 years after surgery. Results Compared to PS group patients, MP group patients had similar patient-reported outcomes assessed by new KSS (satisfaction, expectation, and activity scales) and FJS. MP knee patients had better performance in the timed up and go test (p < 0.026) and self-paced walk test (p < 0.002) of DOPS. The gain in knee flexion (9.3° ± 14°) compared to baseline was significantly greater in the PS group (p < 0.013). Conclusions When assessed by DOPS, getting up from chair and walking speed were significantly better in MP knee patients than in PS knee patients. However, considering the predictable rollback ensured by cam and post, the PS knee produced better knee flexion. Despite these results, patients were equally satisfied with the two designs.
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Affiliation(s)
| | - Munish Sood
- Department of Orthopaedics, Command Hospital, Chandigarh, India
| | - Sarang Kanade
- Department of Orthopaedics, Dr Shyama Prasad Mukherjee Hospital, Lucknow, India
| | - Santhosh Kumar
- Department of Orthopaedics and Joint Replacement, Command Hospital Air Force, Bengaluru, India
| | - Barun Datta
- Department of Orthopaedics, Joint Replacement Centre, Army Hospital R & R, New Delhi, India
| | - Gaurav Mittal
- Department of Orthopaedics, Military Hospital, Kilkee, India
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Sood M, Gambhir S, Kulshrestha V, Sahu S. Does hyperbaric oxygen therapy have a role in acute fracture healing - A Randomised Controlled Trial. J Mar Med Soc 2020. [DOI: 10.4103/jmms.jmms_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sood M, Kulshrestha V, Dhillan R. Unusual presentation of a profunda femoris pseudoaneurysm following osteosynthesis of proximal femur fracture. J Mar Med Soc 2020. [DOI: 10.4103/jmms.jmms_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sood M, Kulshrestha V. Generating good evidence in orthopedics. J Mar Med Soc 2020. [DOI: 10.4103/jmms.jmms_83_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kulshrestha V, Sood M, Kumar S, Sharma P, Yadav YK. Outcomes of Fast-Track Multidisciplinary Care of Hip Fractures in Veterans: A Geriatric Hip Fracture Program Report. Clin Orthop Surg 2019; 11:388-395. [PMID: 31788160 PMCID: PMC6867922 DOI: 10.4055/cios.2019.11.4.388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
Background Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. Methods A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. Results The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. Conclusions Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
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Affiliation(s)
| | - Munish Sood
- Department of Orthopaedics, Command Hospital, Panchkula, India
| | - Santhosh Kumar
- Department of Orthopaedics, Air Force Hospital, Bangaluru, India
| | - Pramila Sharma
- Department of Orthopaedics and Rehabilitation, Air Force Hospital, Kanpur, India
| | - Yash Kumar Yadav
- Department of Orthopaedics and Rehabilitation, Air Force Hospital, Kanpur, India
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Abstract
BACKGROUND There has been a gradual increase in the revision TKA (RTKA) workload due to expanding indications of total knee arthroplasty (TKA), coupled with improving patient longevity. Western countries are already looking at their data on RTKA to plan for the future heath care needs of these patients. Limited data is available on RTKA from developing countries. Our study attempts to fill this gap in knowledge. MATERIALS AND METHODS We prospectively documented details of all RTKA performed at our centre for a period of six years (2011-16). We recorded the volume, causes and time to failure from index surgery of all RTKA and further recorded microbiological pattern in septic failures. We looked at the proportion of each cause of failure and time from index surgery. RESULTS Of the 5068 TKA procedures performed from January 2011 to December 2016, 201 (4%) were first-time revisions. The predominant cause of revisions was prosthetic infection (61%) followed by aseptic loosening (18%) and instability (7%). In the early, mid term, and late-failure groups, prosthetic infection remained the main cause of failure. In 47% of the septic revisions, the offending organisms could be identified and of those identified most (67%) were Gram-negative. CONCLUSION The volume of first-time RTKA procedures (4%) at our center remained low compared with that of the Western countries. In Western countries, the incidence of late aseptic failures was higher than that of early-septic failures, whereas in our study, revisions were more commonly performed in the early-failure group (48%) and most failures were due to prosthetic infection (61%).
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Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
| | - Barun Datta
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India,Address for correspondence: Dr. Barun Datta, Joint Replacement Centre, Army Hospital Research and Referral, Delhi Cantt, New Delhi - 110 010, India. E-mail:
| | - Gaurav Mittal
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
| | - Santhosh Kumar
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
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Kulshrestha V, Kumar S, Datta B, Sinha VK, Mittal G. Ninety-Day Morbidity and Mortality in Risk-Screened and Optimized Patients Undergoing Two-Team Fast-Track Simultaneous Bilateral TKA Compared With Unilateral TKA-A Prospective Study. J Arthroplasty 2018; 33:752-760. [PMID: 29102512 DOI: 10.1016/j.arth.2017.09.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/07/2017] [Accepted: 09/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Simultaneous bilateral total knee arthroplasty (SBTKA) offers significant socioeconomic benefits. However, retrospective studies and public health data show increased mortality and morbidity rates in patients undergoing SBTKA compared with those undergoing unilateral TKA (UTKA), and there have been recommendations against the use of SBTKA. High-volume centers, which feature careful patient selection and fast-tracked surgery, continue to perform SBTKA and have published their results in favor of the procedure. However, the quality of evidence remains poor. METHODS We prospectively examined 90-day morbidity and mortality of SBTKA compared with UTKA in risk-screened and optimized patients in our high-volume joint replacement facility. A total of 1200 consecutive patients were recruited in each arm. RESULTS Ninety-day mortality was higher in SBTKA patients than in UTKA patients (0.58% vs 0.42%, respectively; P = .5646). Overall procedure-related complications were significantly higher in the SBTKA group (7.25% vs 4.42%, respectively; P = .0034). The relative risk of cardiovascular complications in SBTKA patients was 6.5 times higher than that in UTKA patients (1.08% vs 0.17%, respectively; P = .0136). Neurological complications were 9.5 times more common in the SBTKA group (1.58% vs 0.17%, respectively; P = .0024). All other complications were comparable in the 2 groups. CONCLUSION Risk screening and preoperative optimization reduce mortality and overall complication rates in SBTKA patients; however, overall procedure-related complications, specifically cardiovascular and neurological, remain significantly high in SBTKA patients, for which a guarded approach is recommended.
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Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Santhosh Kumar
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Barun Datta
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - V K Sinha
- Department of Orthopaedics, KIMS Medical College, Bhubaneswar, India
| | - Gaurav Mittal
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
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Kalirajan R, Kulshrestha V, Sankar S. Synthesis, Characterization and Antitumour Activity of Some Novel Oxazine Substituted 9-Anilinoacridines and their 3D-QSAR Studies. Indian J Pharm Sci 2018. [DOI: 10.4172/pharmaceutical-sciences.1000439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kulshrestha V, Datta B, Kumar S, Mittal G. Outcome of Unicondylar Knee Arthroplasty vs Total Knee Arthroplasty for Early Medial Compartment Arthritis: A Randomized Study. J Arthroplasty 2017; 32:1460-1469. [PMID: 28065624 DOI: 10.1016/j.arth.2016.12.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With increasing number of patients with early osteoarthritis of knee opting for total knee arthroplasty (TKA), there has been increase in patients dissatisfied with surgical outcomes. It is being presumed that offering unicondylar knee arthroplasty (UKA) to them would improve outcomes. METHODS Primary objective of our study was to look for any difference in patient-reported outcome and function at 2-year follow-up in patients undergoing UKA as compared to TKA. Our study was a randomized study with parallel assignment conducted at a high-volume specialized arthroplasty center. Eighty patients with bilateral isolated medial compartment knee arthritis were randomized into simultaneous 2-team bilateral TKA (n = 40) and UKA (n = 40) group. We finally analyzed 36 patients in each group. Main outcome measure was improvement in Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and High Activity Arthroplasty Score (HAAS) obtained at 2-year follow-up. RESULTS Improvement in KOS-ADLS and HAAS at 2 years was similar (P = .2143 and .2010) in both groups. Performance as assessed with Delaware index was also similar. Length of hospital stay was less in UKA group (6.6 days as against 5.4 days). Complications and readmission rates were more in TKA group (nil in UKA group; 08 in TKA group). CONCLUSION At 2-year follow-up, UKA provides similar improvement in patient-reported outcomes, function, and performance as compared to TKA when performed in patients with early arthritis. However, UKA patients have shorter hospital stay and fewer complications.
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Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Barun Datta
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
| | - Santhosh Kumar
- Department Of Orthopaedics, Air Force Hospital, Jorhat, India
| | - Gaurav Mittal
- Joint Replacement Centre, Army Hospital Research & Referral, New Delhi, India
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Kriplani A, Bahadur A, Kulshrestha V, Agarwal N, Singh S, Singh UB. Role of anti-tubercular treatment for positive endometrial aspirate DNA-PCR reproductive outcome in infertile patients in Indian setting - A randomized trial. Indian J Tuberc 2017; 64:33-39. [PMID: 28166914 DOI: 10.1016/j.ijtb.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 09/15/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022]
Abstract
AIMS The aim of the study was to determine the effect of anti-tubercular therapy (ATT) versus no ATT on reproductive outcome in patients with positive endometrial aspirate DNA-PCR for tuberculosis. SETTINGS AND DESIGN Department of Obstetrics and Gynecology in collaboration with the Department of Microbiology at the All India Institute of Medical Sciences, New Delhi, India. METHODS AND MATERIALS This prospective randomized study was conducted on 100 women in the reproductive age group with primary or secondary infertility, attending the Gynecology OPD at AIIMS. Women with positive endometrial DNA-PCR, patent tubes on laparoscopy, and all other tests being negative for genital TB were randomized into two groups. In Group 1, patients received ATT for 6 months while in Group 2, patients were not given ATT. In patients who did not conceive a repeat endometrial sampling for DNA-PCR was performed at 6 months and 12 months post-laparoscopy. STATISTICAL ANALYSIS It was carried out using Stata 11.0 (College Station, TX, USA). RESULTS In Group 1 (ATT), 25 women achieved pregnancy with a pregnancy rate of 50% while in Group 2 (no ATT), 21 women achieved pregnancy with a pregnancy rate of 42% and the difference (95% CI) was 8.0% (-11.5%, 27.5%) which was not statistically significant (p=0.422). Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 6 months was 3.1% (-2.9%, 9.1%), p=0.299, while at the end of 12 months, repeat DNA-PCR remained positive in 23 patients in Group 1 and in 26 patients in Group 2. Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 12 months was 2.3% (-13.0%, 17.7%), p=0.767. CONCLUSION The present study does not validate ATT for positive DNA-PCR; however, it does provide an evidence to stop over-treating patients on the basis of positive EA DNA-PCR even after they have received a 6 months course of ATT. Repeating PCR at 6 months and at 12 months has no role and ATT should not be repeatedly given to the patient on the basis of repeat DNA-PCR alone. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2015/10/006235, www.ctri.nic.in.
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Affiliation(s)
- A Kriplani
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - A Bahadur
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - V Kulshrestha
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Agarwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Agarwal N, Kulshrestha V, Kriplani A, Kachhawa G. Comparison of Hysterosalpingography with Laparoscopic-Hysteroscopic Findings in Predicting Genital Tract Tuberculosis in Infertile Patients. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kulshrestha V, Kumar S. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study. J Arthroplasty 2013; 28:1868-73. [PMID: 23796558 DOI: 10.1016/j.arth.2013.05.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 02/01/2023] Open
Abstract
The American College of Chest Physicians (ACCP) recommended routine anticoagulation for thromboprophylaxis in patients undergoing lower limb arthroplasty. We compared results of routine anticoagulation Vs risk stratified approach for Deep Venous Thrombosis (DVT) prophylaxis after TKA in terms of symptomatic DVT and wound complications. Nine hundred TKAs done in 673 patients were randomized after DVT risk screening to routine anticoagulation (n = 450) or to risk stratification (n = 450) and selective anticoagulation. 194 patients in the risk screening group received only Aspirin. Primary outcome was symptomatic DVT and wound complication. This randomized study showed that the symptomatic DVT rates after TKA were similar whether patients were routinely anticoagulated or selectively anticoagulated after risk screening. However there was a significantly higher incidence of wound complications (P < 0.014) after routine anticoagulation.
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Kulshrestha V, Kriplani A, Agarwal N, Kachhawa G, Bhatla N. O379 COMPARISON OF EFFICACY OF LEVONORGESTREL INTRAUTERINE SYSTEM (LNG-IUS) IN ABNORMAL UTERINE BLEEDING DUE TO DYSFUNCTIONAL UTERINE BLEEDING, UTERINE-LEIOMYOMA AND ADENOMYOSIS. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agarwal N, Singh S, Kriplani A, Bhatla N, Kulshrestha V. O018 ROLE OF GABAPENTIN IN TREATMENT OF HOT FLUSHES IN POSTMENOPAUSAL WOMEN. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kriplani A, Mahey R, Dash B, Kulshrestha V, Agarwal N, Bhatla N. M518 ROLE OF INTRAVENOUS IRON SUCROSE THERAPY IN MODERATE TO SEVERE ANAEMIA IN PREGNANCY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61706-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agarwal N, Dora S, Kriplani A, Garg P, Vivekanandhan S, Kulshrestha V. W166 RESPONSE OF THERAPY WITH VITAMIN B6, B12 AND FOLIC ACID ON HOMOCYSTEINE LEVEL AND PREGNANCY OUTCOME IN HYPERHOMOCYSTEINEMIA WITH UNEXPLAINED RECURRENT ABORTIONS. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Recent studies have shown that displaced mid-shaft clavicular fractures do not have assured favourable outcomes with non-operative management and nonunion rates could be as high as 20%. In addition many malunite with significant shortening. Non-union or malunion causes functional deficit and many of them may benefit from primary internal fixation. METHODS We reviewed the results of twenty cases of displaced/comminuted midclavicular fractures, which were treated with primary open reduction and internal fixation with a reconstruction plate placed over the superior surface of clavicle. RESULT All the fractures clinically united by eight weeks. As per Rowe criterion 12 had excellent, six good and two fair results. On an average patients had full functional recovery in four months. CONCLUSION Primary internal fixation of displaced comminuted mid-shaft clavicular fractures leads to predictable and early return to function thus preventing unacceptably high complication rates of nonoperative management of these fractures.
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Affiliation(s)
- V Kulshrestha
- Classified Specialist (Orthopaedics), 5 AFH, C/o 99 APO
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Abstract
OBJECTIVES The present randomized study is conducted to compare the functional and anatomical outcomes of dynamic multiplanar external fixation against that of static external fixation in the management of displaced unstable comminuted fractures of the distal radius. MATERIALS AND METHODS Sixty adult patients with displaced unstable comminuted fractures of the distal radius were randomly allocated either to the dynamic (n=30) or static (n=30) fixator groups. Patients in the dynamic fixator group were managed with closed reduction and application of Penning-type articulated fixator (Orthofix, Srl, Italy); the injured wrist was partially dynamized at 3 weeks. Patients in the static group were managed with monoplanar static external fixator of Joshi's external stabilizing system (JESS) type fixator. In both groups, the fixator was maintained for 6-8 weeks. The patients were followed-up over 2 years. The primary outcome measures were the functional outcome as measured using the Gartland and Werley and DASH scores and anatomical outcome as measured using the Lindstrom score. The secondary objective was to correlate anatomical and functional outcomes and to look at overall local complications. RESULTS Palmar tilt was better restored in the Penning fixator group (P<0.0001). There was reduced loss of ulnar tilt (P=0.05) and radial height (P=0.04) in the Penning fixator group. Gartland and Werley score was better in the Penning fixator group at each time point of the follow-up. The DASH score was similar in the two groups at 2 years (P=0.14). There was poor correlation (0.19) between functional outcome and anatomical restoration at 2 years. CONCLUSIONS In the management of displaced unstable comminuted fracture of the distal radius, use of an articulated multiplanar external fixator, allowing partial dynamization of the injured wrist at 3 weeks, resulted in improved early functional and anatomical outcome as compared to static external fixation. However, there was no significant difference in functional outcome at 2 years.
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Affiliation(s)
- Vikas Kulshrestha
- Classified Specialist Orthopaedics, Command Hospital Air Force, Bangalore,Address for correspondence: Dr Vikas Kulshrestha, Command Hospital Air Force, Air Port Road, Bangalore, Karnataka- 560 007, India. E-mail:
| | - Tanmoy Roy
- Senior Adviser Surgery and Reconstructive Surgery, Department of Surgery, Command Hospital Air Force, Bangalore
| | - Laurent Audige
- AO Clinical Investigaton and Documentation, Dübendorf, Switzerland
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Kriplani A, Anurekha J, Agarwal N, Kulshrestha V, Kumar A, Ammini A. O491 Effect of oral contraceptive containing Ethinyl Estradiol combined with Drospirenone vs Desogestrel on clinical and biochemical parameters in patients of polycystic ovarian syndrome. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Agarwal N, Kriplani A, Sowmya S, Maheshwari D, Kulshrestha V, Ammini A. V2 Clitoroplasty in cases with virilization at puberty. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kriplani A, Kulshrestha V, Agarwal N, Diwakar S. Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate. J OBSTET GYNAECOL 2009; 26:673-8. [PMID: 17071438 DOI: 10.1080/01443610600913932] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). Lack of response during treatment was seen in three patients (6.1%) TXA and in 13 patients (28.9%) with MPA (p = 0.003). In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.
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Affiliation(s)
- A Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Kulshrestha V. Mid- Clavicular Fractures- A Change in Treatment Strategies?: Reply. Med J Armed Forces India 2009; 65:199-200. [DOI: 10.1016/s0377-1237(09)80159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
BACKGROUND A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail. MATERIALS AND METHODS This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature. RESULTS All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10), 14 Gustilo type 2 (n=14), and type3 (n=6) cases. 6 cases (20%) had clamp site infection, 2 cases (6.7%) had deep infection, and in 28 cases (93%) the fracture healed and consolidated well. CONCLUSION This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection.
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Affiliation(s)
- Vikas Kulshrestha
- Department of Orthopaedics, Air Force Hospital, Jorhat - 785 005, Assam, India,Correspondence: Dr. Vikas Kulshrestha, No. 5 Air Force Hospital, Rowriah, Jorhat-5, Assam, India. E-mail:
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Awasthi K, Kulshrestha V, Nathawat R, Acharya N, Singh M, Avasthi D, Vijay Y. Conduction nature of conical pores in PET membrane. Polym Bull (Berl) 2006. [DOI: 10.1007/s00289-006-0625-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kulshrestha V, Awasthi K, Acharya NK, Singh M, Avasthi DK, Vijay YK. Swift heavy ion irradiated polymeric membranes for gas permeation. J Appl Polym Sci 2006. [DOI: 10.1002/app.24595] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pathak SC, Kulshrestha V. Experimental aspergillosis in the German cockroach Blattella germanica: a histopathological study. Mycopathologia 1999; 143:13-6. [PMID: 10205882 DOI: 10.1023/a:1006993430806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Inoculation of a spore suspension of Aspergillus flavus in the haemocoel of the German cockroach (Blatella germanica) resulted in large-scale invasion of various internal organs as seen in tissue sections stained with a fungal stain. The organs affected were the alimentary canal, fat bodies, muscle fibres, malpighian tubules and the cerebral neurosecretory cells. No invasion of the trachea and tracheoles was noted.
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Affiliation(s)
- S C Pathak
- Department of Biological Sciences, Rani Durgavati University, Jabalpur, India
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Affiliation(s)
- M Balakrishnan
- Associate Professor, Armed Forces Medical College, Pune 40
| | - V P Pathania
- Professor and HOD, Armed Forces Medical College, Pune 40
| | - V Kulshrestha
- Trainee, Department of Orthopaedics, Armed Forces Medical College, Pune 40
| | - Hariqbal Singh
- Reader, Department of Pathology, Armed Forces Medical College, Pune 40
| | - S K Khanna
- Specialist, Radiodiagnosis, Command Hospital (SC), Pune 40
| | - N S Mani
- Senior Advisor, Radiodiagnosis, Command Hospital (SC), Pune 40
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Abstract
Natural infection of Aspergillus flavus was observed in adults of Blattella germanica. Though the adult insects exhibited no external symptoms, they became hypoactive and later died. The dead and experimentally infected insects repeatedly yielded Aspergillus flavus in culture on Czapek's medium. Direct microscopic observation of the tissues of infected insects revealed fungal material. The blood films stained with Giemsa stain showed granulocytes (GRs) engulfing fungal hyphae. A remarkable increase in GR and plasmatocyte (PL) counts occurred in differential haemocyte counts (DHCs) of the infected insects. Two main types of immunological responses of the insect noticed were phagocytosis and encapsulation. DHC showed maximum involvement of GRs and PLs in immune mechanism.
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Affiliation(s)
- V Kulshrestha
- Department of Biological Sciences, Rani Durgavati University, Jabalpur, India
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Prasad O, Kulshrestha V. Neurosecretion in the central nervous system of an Indian spider Oxyopes sakuntale Tikader (Araneidae: Oxyopidae). Z Mikrosk Anat Forsch 1980; 94:376-382. [PMID: 6158192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Neurosecretory cells have been observed in the entire central nervous system of an adult Indian spider Oxyopes sakuntale Tikader. These cells are present in groups at various locations in the central nervous system. They can be divided into two types on the basis of their shape, size and cytomorphic properties. Unlike insects here the median group of pars intercerebralis has very few cells. All the neruosecretory cells have similar staining reaction and can not be differentiated into types on the basis of their staining property. Majority of the cells are circular in shape, bigger in size and dark staining. In between there are few cells which are elleptical in shape, smaller in size and light staining. They all stain green with PAF (As modified by Ewen 1962) light blue with CHP (Gomori 1941) and red with HEIDENHAINS Azan stain.
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