Early detection & treatment for Diabetes

Diabetes is a complex, chronic illness which requires continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient education on self- management and support are critical to preventing acute complications and reducing the risk of long-term complications.

Criteria for the diagnosis of Diabetes:

  • Fasting Plasma Glucose ≥126 mg/dL. Fasting is defined as no caloric intake for at least 8 hours.* OR
  • 2-h Plasma Glucose ≥200 mg/dL during Oral Glucose Tolerance Test. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.*OR
  • Glycosylated hemoglobin HbA1C ≥6.5%.* OR
  • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL

In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples.

Diabetes can be classified into the following general categories:

  1. Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency)
  2. Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance)
  3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation)
  4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and drug- or chemical-induced diabetes (such as with steroid use)


If untreated or inadequately treated, it may lead to complications like cardiovascular diseases (heart attack), stroke (cerebrovascular accident), diabetic retinopathy and visual loss, foot ulcers, diabetic neuropathy, diabetic nephropathy with protein loss and chronic kidney disease.

Comprehensive care for a diabetic patient involves control of blood glucose, cholesterol levels, blood pressure, maintenance of ideal body weight and risk assessment for cardiovascular and peripheral vascular diseases. Regular eye check-up, foot care, self-monitoring of blood glucose, and ability to recognize hypoglycemic symptoms and take remedial measures is of paramount importance. Every person with diabetes need to know the correct technique to self- administer insulin, basics regarding anti-diabetic oral medications, and should be provided with an individualized diabetic diet plan.


With this comprehensive approach, a good control of diabetes can be achieved and the person can lead a productive life like any other individual.

The Hip in Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is a condition most commonly affects young males. It is known to cause stiffness in spine and hip joints. Importance of hip involvement in AS has been recognised as a commonly disabling problem, whereas involvement of other joints like shoulder is less frequent and less severe. In contrast to the classical changes of AS in the spine the changes in hip does not lead to formation of new bones, but it results in an erosive disease, which destroys the joint. These changes start occurring fairly early on in life, and total hip replacement is often the therapy of choice in this difficult clinical situation.


In the early stages, ankylosing spondylitis is  likely to cause:

  • pain in the lower back in the early morning which eases through the day or with exercise
  • pain in the sacroiliac joints (the joints where the base of your spine meets your pelvis), in the buttocks or the backs of your thighs.
  • Hip involvement usually comes on gradually, and although the pain often is felt in the groin area, it can sometimes be felt in other areas of the body, such as the knees or the front of the thigh


In advanced stages

  • Lower back and neck stiffness resulting in bending and twisting of torso and neck
  • Fusion of hips(Hip Ankylosis)


In the past, surgical fusion of the hip was performed to reduce the pain but at the cost of losing movement at the hip joint. Numerous studies now have however proven that total hip replacement in hip ankylosis is the most favourable line of treatment. It provides patient with pain relief , near normal movement of the hip joint and perfectly normal walking pattern.


At Udai Omni, total hip replacement for a fused or ankylosed hip has a long history of over ten years. To date, we have had a 100% success rate with no failures. This is a technically demanding procedure but if done well, the results are extremely gratifying as one can see in the example seen below:


Case Review:

A 33 year old software engineer came to us in 2009 with a fused right hip that resulted in a very awkward gait. He was obviously very conscious of his disability that affected his social life as well as his work. He had been to see many orthopaedic surgeons but could never get the confidence that he would walk normally again. During my annual visit to Udai Omni hospital from the UK, this young man consulted me and agreed to get his surgery done by me. Within six weeks, he could walk independently without a limp and eventually got back to his passion of swimming.

Video of patient swimming!


Joint Replacement Summary

Update on Joint Replacement Surgery


Joint replacement surgery has come a long way over the last six decades. The most common joints that are being replaced across the world are the knee, hip, shoulder, elbow and ankle in that order.  In the USA over 700,000 knee and around 400,000 hip replacements are done annually.  These numbers are expected to rise exponentially to over 4 million procedures by 2030.  The data in India is not very robust but estimates vary between 100,000 – 200,000 knee replacement procedures. Hip replacement numbers are substantially less. Indians seem genetically more predisposed to knee arthritis compared to their counterparts in the West. The most common indication for knee replacement is osteoarthritis. In contrast, Indians seem well protected against osteoarthritis of the hip which is very common in the West.  The most common indication for a hip replacement in India is Avascular Necrosis because of injudicious and rampant use of steroids by medical practitioners.


Knee Replacement:

Indications for a knee replacement include :

  • Osteoarthrtitis
  • Rheumatoid arthrits
  • Post traumatic arthritis


When is a knee replacement advisable? I generally advise surgery in patients who have advanced arthritis when conservative measures have failed to control the pain and disability. Age should not be a criterion for advising a knee replacement.


There are two types of knee replacements : Total Knee Replacement and Partial Knee Replacement. Partial Knee replacements are done by surgeons who are trained in the procedure. Most surgeons perform a total knee as a standard procedure for osteoarthritis whether it involves a single compartment or not. At Udai Omni, we perform partial or unicompartmental knee replacement if the arthritis is limited to one compartment. About 40% of our knee replacement procedures are partial. The benefits of partial knee replacement include:

  • early recovery
  • fewer complications like MI and DVT
  • ability to sit on the floor and climb stairs
  • natural feel of the joint rather than a feeling of a lump of metal in the knee
  • ability to take part in leisure sports and activities

The success rate or survivorship of knee replacements in general are very good. Overall we are seeing a 90% survivorship at 20 years.


Many different types of implants are available. A standard implant made of cobalt chrome alloy and a polyethylene spacer is sufficient for over 90% of the patients. A ceramic coated implant like the “bionic gold” or “oxinium” prosthesis is advisable for those with allergy to artificial jewellery. There is no evidence that these implants perform better than a standard implant.


Hip Replacement:


The most common indication for a total hip replacement in India is Avascular necrosis of the femoral head. Other indications include rheumatoid arthritis, post traumatic arthritis, sequelae of childhood conditions like dysplasia, infections, Perthes’, SCFE etc.

Age is not a concern these days with advent of better materials and designs. Many patients in India tend to be young – in their 20s and 30s.


Floor activities: Traditionally, patients with hip replacements were told not to perform any activities on the floor. With better designs now available in India, a good competent surgeon should allow their patients to sit on the floor for various washroom activities and other activities like eating, praying etc. Many patients with a hip replacement get back to a normal lifestyle which can also include gentle sporting activities like badminton, table tennis, golf, trekking etc.


There are essentially two types of hip replacements – cemented and uncemented. Both perform equally well although the tendency is to do uncemented hips in the younger people. The bearing – ie the ball and the socket lining are the key for long term success. Ceramic heads and liners are generally recommended in the young and a metal head with polyethylene line may be suitable for the middle aged to elderly.


Survivorship and success of most standard hip replacements has improved significantly over the last few decades. Now, over 90% of our patients can expect their hip to survive 20 years. I would imagine this figure will get better as we follow our patients up in the future.


Enhanced Recovery after joint replacement:


Success of joint replacement, whether it is the hip or the knee depends on many factors. A well trained experienced surgeon is the key. However, other factors like patient engagement, physiotherapy and pain management are also extremely important.


At our hospital, we provide multi modal analgesia with the help of our expert anaesthetists to mobilise the patient within a day of surgery and discharge them home within 3 days on average. With advent of ambulatory selective nerve blocks and judicious use of oral and injectable analgesics, our patients mobile early and their VAS (visual analog score) for pain out of 10 is usually between 2-4. Knee and hip replacement need not be a painful experience any more.


The Future:

Surgery and joint replacement for advanced arthritis is going be around for a long time to come. There is no procedure or medicine to reverse advanced arthritic changes and deformity, whether it is the hip or the knee. No stem cell procedure or cartilage regenerative procedure will help in this regard. Media and pharmaceutical industry have a long track record of influencing the patient who would obviously prefer conservative procedures over surgery.


Industry is working on improving the performance of the implant by improving the coating and bearing materials.


Preventing arthritis by keeping oneself active and lean may be the best solution to prevent future arthritis and this avoid surgery.


Biological replacement from either ones own tissue or animal tissue is still a distant dream but a lot of work is being done across the world.

3 out of 10 People are Affected by Hypertension

What is blood pressure?

Blood pressure is simply the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre.

What do the numbers mean?

A common blood pressure might be 120/80 (said as ‘120 over 80’). These values are quoted in units known as millimetres of mercury (mmHg). There are 2 numbers because the blood pressure varies with the heartbeat. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries. This pressure is called systolic pressure. The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats. This pressure is called diastolic pressure.

Does blood pressure change?

Blood pressure can be quite variable, even in the same person. Blood pressure goes up and down with different normal daily activities. For example, exercise, changes in posture and even talking changes blood pressure. Blood pressure tends to be higher during the day than at night and higher in the winter than in the summer. Blood pressure also rises when we grow older, particularly systolic blood pressure. Before adulthood, blood pressure rises in parallel with height. In adult years, weight and blood pressure are closely related. When weight goes up, blood pressure tends to go up and we can lower blood pressure by losing weight. Blood pressures differ between individuals. Some people have low, some average and some high blood pressure levels.

What is high blood pressure?

There are various definitions of high blood pressure, which is also known as hypertension, but most doctors consider blood pressures of 140/90 and greater to be high. The precise values that doctors might interpret as high blood pressure depend to an extent on individual circumstances. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80. The definition of hypertension is used by doctors to help decide which patients would benefit from medical (lifestyle and drug) treatment to lower pressure. The definitions depend on the balance of risk of not lowering blood pressure (heart attack and stroke, etc) versus the risks of treatment (drug side effects, etc). This explains why hypertension is defined at lower blood pressure levels in diabetic subjects. For the same blood pressure, cardiovascular complications (that is damage to the heart, blood vessels and brain) are more likely in diabetics and blood pressure reduction offers benefit even when a diabetic’s blood pressure is not as high as regular definitions of hypertension.

How common is high blood pressure?

Approximately 4 in 10 adults over age 25 have hypertension and in many countries another 1 in 5 have prehypertension. An estimated 9/10 adults living to 80 years of age will develop hypertension. One half of blood pressure related disease occurs in people with higher levels of blood pressure even within the normal range.

Why is blood pressure important?

Blood pressure is important because it is the driving force for blood to travel around the body to deliver fresh blood with oxygen and nutrients to the organs of the body. However, high blood pressure is important because it leads to increased risk of serious cardiovascular disease, with complications such as heart attack, heart failure, stroke, kidney failure and blindness.

Who gets high blood pressure?

High blood pressure is more common is older age groups and in people with a family history of hypertension. It is also more frequent in those who are overweight. However, high blood pressure can affect young thin people with no family history, so no one should consider himself or herself immune from high blood pressure.

Does high blood pressure need to be treated?

It is the goal of good clinical practice to reduce high levels of pressure wherever possible in order to reduce the risk of complications such as heart attack and stroke. Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment. If these approaches don’t return blood pressure to acceptable levels then drug treatment is usually required.

How do I know if I have got high blood pressure?

The truth is you cannot know your blood pressure unless you have it measured and every adult should know his or her blood pressure. Although headaches and nose bleeds can be the result of very high blood pressure, there are many more innocent causes for these common ailments.

Can high blood pressure be cured?

Although not ‘cured’ as such, modern therapeutic approaches to blood pressure are very effective and generally very safe. However, if treatment is stopped the high blood pressure usually returns reasonably quickly.

Ref: International Society of Hypertension


Case of The Month – May 2019

A 45-year-old lady came to our hospital with a fracture of her right thigh bone following a simple twisting injury and severe pain in her spine and was not able to sit or even turn in bed. She was in agonising pain. She was fully evaluated with blood tests, PET CT and MRI scans. There was a strong suspicion of cancer in her spine as well as the thigh bone.  She underwent surgery on her thigh bone and on her spine, which allowed us to take a tissue biopsy – as a sample from the site of cancer.  The patient was mobilised with a walker after surgery, and the cancer was diagnosed as Multiple Myeloma – cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognise and attack germs.

Following surgery, on her spine, she is almost pain-free and is now walking. She will undergo chemotherapy, which we hope will cure her cancer.

45-year-old non-diabetic female presented with complaints of:

  • Rt. thigh pain and upper back pain since 4-5 months
  • An acute increase in Rt. thigh pain after mild twisting injury 1 day back

  • Neurology: intact
x rays of the spine and fractured thigh bone


The circled area of spine shows cancer of spine

Fixed femur and sent for biopsy

Cancerous bone removed Spine stabilized with rods and screws







Swellings in the neck region are a common problem. Although a majority of them are due to benign conditions there is a rise in the incidence of malignant neck swellings in the new age world. With better understanding of the disease and with the advancement of technology, newer diagnostics and treatment modalities are now available There is scope for better survival and quality of life when the lesions are caught early.

Neck swellings can be nodal (lymph nodes)/ non nodal; benign/ malignant.




1 .Infectious mononucleosis (viral infection)

2. Diptheria, actinomycosis (bacterial)

3. Toxoplasmosis, leishmaniasis (parasitic)

4. Histoplasmosis(fungal)

5. Tuberculosis,sarcoidosis,HIV (chronic)


1. Primaries like Hodgkin’s and non hodgkins lymphoma, Leukemia

2. Metastatic from upper aerodigestive tract, Infraclavicular malignancy

3. Other draining sites like parotid, eye, scalp, skin, thyroid

Some autoimmune diseases are rheumatoid arthritis, SLE, Kikuchi, Kimura, Rosai-Dorfman, Castleman’s.

Non nodal swellings include Lymphangioma, Cystic Hygroma, Branchial Cyst, Lipoma, Sebaceous Cyst, Dermoid Cyst, Paraganglioma (Carotid body tumor), Schwannomas, Diverticulae, Laryngocele, Aneurysms, Ranula. Swellings from salivary and thyroid gland pathologies

It is nearly impossible for the common eye to differentiate whether  a benign from a malignant lesion. It is highly recommended to see a specialist without delay.


orthopedic hospital in Hyderabad

Do you need to consult VASCULAR SURGEON?

Medical world has always been evolving. Each and every medical or surgical broad speciality is branching out in to super speciality. For example earlier patients for joint related problems were treated by Orthopaedic surgeons, however, nowadays; there are Joint replacement and Revision surgeons who are Orthopaedicians specially trained to excel out in this speciality.

Vascular Surgery, better known as Peripheral Vascular Surgery is a super speciality that deals with the blood vessels of human body except those within the heart and brain.

A Vascular Surgeon is a highly trained specialist who deals with the blood vessels of our body. There are two types of blood vessels in our body: Artery-carrying oxygen rich blood to supply body organs and vein- carrying blood back to heart for purification. Smooth and uninterrupted flow of blood is essential for healthy body and “Road block” in any of these blood vessels is managed by Vascular Surgeon.

A Vascular Surgeon is trained to perform open surgery, minimally invasive Endovascular Surgery and all sorts of hybrid, complicated procedures. However, which patient to offer any surgical intervention or to treat by medicines or exercises is the key deciding factor for better patient outcomes.

The arteries of our body can become hardened (Atherosclerosis) or blocked giving rise to symptoms like Leg aches,  Leg Stroke, ulcers, gangrene which if not treated in time will end in limb loss.

The veins of our body become bigger in size and do not pump blood back to heart properly or blood clots starts forming in veins . These patients present with skin discoloration around ankle and foot, leg swelling and leg ulcers.

If you have any of the above symptoms or you have risk factors like- Tobacco intake in any form (Chewing/smoking), Diabetes , Hypertension then it’s time to consult a Vascular Surgeon!


SO YOU MADE a New Year’s resolution to lose weight like the rest of us, but research shows that most resolutions go down the drain within the first month or two after Jan 1. Staying on track is tough, but it’s not impossible. To optimize your chances of reaching your goal, you’ve got to actively set yourself up for success. This is where Dr Deepa Agarwal, Our Nutritionist’s role comes in. She’s helped us identify the keys to making your resolution stick so you won’t have to start again next year.
Resolve to think small and you can reach any diet goal — one focused step at a time. Why not start with these simple tips?

New Year’s Diet Resolution No. 1: Go Slow

Resolving to get more fiber in your diet this year? Maybe more fish or fresh fruit? Any diet change is easier if you take slow, small steps. For example:
1. Vow to add a piece of produce to your brown bag lunch daily.
2. Designate a day as fish day.
3. Package up a single serving of your favorite whole-grain cereal, then treat it as your midmorning snack.

New Year’s Diet Resolution No 2: Water, Water, Everywhere

Water: It’s cheap, fat-free, and gives your body a quenching boost. Find the idea of eight cups a day daunting? Think small:
1. Drink one glass first thing in the morning, before you brush your teeth.
2. Tempted by more soda? Another glass of wine? Drink a cup of water with a splash of your favorite beverage in it first.
3. Resolve to drink one more cup of water today than you had yesterday.

New Year’s Diet Resolution No. 3: Go for the Gold … and Red … and Purple

Colorful produce is packed with disease-fighting plant compounds, so when you shop, reach for a rainbow.
1. Designate a color-a-day. Maybe Mondays are yellow, with grapefruit, golden apples, or corn starring in meals, while Tuesdays are purple with plum and eggplant.
2. Get the kids involved and go for a theme: Build a green pizza with emerald bell peppers and artichokes, or a red produce-infused chili.
3. Vary the rainbow — pick up a new-to-you fruit or veggie the next time you shop.

New Year’s Diet Resolution No 4: Tackle Mindless Munching

You’re chatting with friends around the dinner table or watching a DVD — and you just keep nibbling. Try these tips to reign in the munchies:
1. Pop a stick of gum or a sugar-free mint in your mouth.
2. Brush or floss your teeth.
3. Pay attention — look at each piece of food you plan to eat.
4. Busy your hands with a glass of water, a cup of tea, or cleaning off the table.

New Year’s Diet Resolution No 5: Stack the Odds in Your Favor

Don’t forget to help yourself succeed, and to reach out for help when you need it.
1. Buddy up with a friend or family member with diet and weight lossresolutions. Then share your ideas, plans, and successes regularly.
2. Leave the temptations — ice cream, chips, soda — at the grocery store. Promise yourself you’ll cater to cravings only outside the home, in one-serving portions.
3. Socialize with non-food events. Get your friends together in the park, for a hike, or at the movies.

Bonus New Year’s Diet Resolution: Baby Your Body

Prevention: It’s a lot less daunting than treating a chronic condition, so do the little things that keep your body thriving.
1. Get moving 30 minutes a day most days. Go for a walk, give the car a good scrub, take a hike. Whatever gets the blood pumping qualifies!
2. Get those tests you know you need. Cholesterol checks, prostate exams, pap smears — stay ahead of the game by staying healthy.
3. Get all the snooze-time you need. Sleep helps body and soul recharge, stay healthy, and cope with stress.
Take enough steps and you’ll reach any goal. Resolve to make a few small diet resolutions this year and then just watch how far you’ll go!



in conversation with Dr Raghava Dutt Mulukutla, Orthopedic Surgeon and Chief of spine surgery

Q. Doctor I am suffering from back and leg pain and I am told that my vertebra has slipped forward.

A. You are suffering from a condition called spondylolisthesis. Here one of the vertebra slips forwards over the vertebra below.

Q. How does this happen?

A. There are a number of reasons for this. This could result from anomalies in the spine at birth, some in early childhood and some due to fractures and various diseases and conditions of spine.

The two most common varieties

1. the first variety, when the vertebra slips forwards between 4-6 years of age. This may cause back pain or leg pain during childhood or during adulthood. Sometimes due to extra weight of pregnancy, women come to doctors with back pain and this condition is then diagnosed

2. the second variety is one which is somewhat common in females at about the age of forty. This is due to degeneration (wear and tear) and is more common in women who are overweight.

Q. What are the treatment options for this condition

A. Most patients get better with physiotherapy and medication. Once the pain subsides it is important to start exercise programmes to strengthen back and abdominal muscle. Walking, sports, yoga, swimming all help.

Q. Do I require surgery?

A. Only if the pain does not subside with physiotherapy, restricted activity for a few weeks followed by exercises etc. Surgery is more beneficial in those who suffer from leg pain rather than back pain alone

Q. What is the type of surgery that is done?

A. In children and young adults sometimes repair of the defect in the vertebra .is done to prevent back pain.Mostly screws and rods are placed in the spine and the vertebra that has moved forwarded is brought back to its original position. Cages are also used to maintain the reduction and restore the height between the vertebrae. Fusion is routinely done .

Q. How long do I need to take rest? And what are the precautions to be taken after surgery

A. You will be out of bed 2nd or 3rd day after surgery. You need to stay in hospital for 4-5 days. You will be in ICU for a day. You will be given a brace to support your back for a few weeks.

Q. When can I get back to work?

A. You need 6 weeks time for light duties and 3 months for heavy work.

Q. Do I need to undergo lot of physiotherapy?

A. You hardly require any physio. A few months after surgery physios will teach you a set of exercises which are very easy to follow and can be done at home.

Q. How painful is the procedure?

A. The procedure is not that painful and you will be given adequate pain relief medication after surgery

Q. can I play games and sports after surgery?

A. Swimming, yoga ,sports are all beneficial. You will be told how to lift weights and also given a set of exercises to strengthen your back.

Q. Will surgery affect my married life?

A. Not at all . You can have a normal married life and women can have babies and undergo normal deliveries


Orthopedic hospital in Hyderabad

Dr Udai Prakash at the Arthrex Surgical Skills Lab – LATEST INNOVATIONS IN ADVANCED KNEE ARTHROSCOPY at Arthrolab, Germany

I was recently in Munich to update himself in the latest technology in knee ligament reconstruction. The Arthrex surgical skills lab is equipped with the latest arthroscopic wet and dry lab simulators and is stocked with a complete inventory of the latest instrumentation and implants.


The exposure certainly gave me the edge in offering my patients the latest surgical options in knee ligament surgery.


The knee has several ligaments that can get damaged after sports injuries and accidents. These include the ACL (anterior cruciate ligament), the PCL (posterior cruciate ligament), MCL (medial collateral ligament) etc.

Without surgical reconstruction many young patients can never get back to sports and an active lifestyle. The knee becomes vulnerable to getting worn out (arthritis) at a younger age than average.

Early and expert ligament reconstruction can help young people get back their former active lifestyle and delaying surgery can result in damage to other structures within the knee. It’s like a loose hinge on a door, if not repaired early can result in other hinges coming loose.

Knee arthroscopy procedures (keyhole surgery) have advanced many fold in the last few years. This was an opportunity for surgeons like myself  interested in knee surgery to update themselves.

The experienced faculty from around the world conducted practical demonstrations in some of the most advanced arthroscopic (keyhole) procedures for ligament and meniscal injuries of the knee.


knee-arthroscopy-2 This is the latest in Anterior Cruciate Ligament reconstruction  using the all inside technique which would give a patient less post -operative pain and a quicker recovery.

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