World’s First Male to Female Upper Arm Transplant

Owing to reckless driving, unorganised traffic, and poor infrastructure countless lives are being lost daily. Notably, while India has about one percent of the world’s vehicle population, it also accounts for about six percent of the global road traffic incidents. Almost 70 percent of the accidents strike the younger population. 

In such an incident, in 2015, 19-year-old Shreya Siddanagowda lost both her arms as the bus in which she was traveling overturned in a fatal accident. Needless to say, her whole world collapsed having lost both hands at such a young age. The doctors at the Amrita Institute of Medical Sciences with a compassion-driven approach could develop technology to give wings to the young engineering student by conducting Asia’s first double above the elbow hand transplant. 

In a rare medical feat, the surgery was performed with 20 surgeons and 16 members of the anesthetic team. The surgery lasted 13 hours. Upper arm transplants are considered much more challenging than those at the wrist or forearm level due to the complexity involved in accurately identifying and connecting various nerves, muscles, tendons, and arteries. Rehabilitation is also much more difficult because the patient bears the weight of the transplanted hands in the upper arm. In the patient’s case, both transplants were done in the middle of the upper arm. 

What makes this even more distinct is the fact that the donor was a 20-year-old male college student who lost his life in a fatal accident. This is the first time that an upper arm transplant has been done in India or even Asia. Only nine such transplants have been conducted in the world. The patient was administered a regime of movements for her fingers, wrists, shoulders, and elbows post-surgery.

Nano Polymer Water for Brain Cancer Treatment

According to a Lancet study conducted in the year 2019, it is estimated that the number of cancer patients requiring the first course of chemotherapy will increase from 9.8 million to 15 million. This along with the rise in the number of cancer patients are quite alarming. Amrita Centre for Nano-sciences developed Amrita-LI Glio-Gel, a light-activated injectable nanoparticle gel for the treatment of recurrent glioma. The therapy is known as nano-Photodynamic Therapy (PDT), in which the drug-loaded nanoparticles gel is applied in the tumor cavity and activated by the laser light to kill the residual tumor cells. The nano-gel PDT therapy will be done after the removal of the main portions of the brain tumor. The product is licensed to Lead-invent Pharma Inc for clinical translation.

Asia’s First Upper Hand Double Hand Transplant

The number one health threat faced by the armed forces around the world is in the form of injuries. It not only affects the military readiness but also in many cases the injuries are musculoskeletal, with the member of the armed forces being amputated thereby impacting their overall life and livelihood. Once injured, the members of the forces are often left without any source of livelihood or pushed to a situation where they are unable to go ahead with their day-to-day lives normally. 

It was with a heavy heart that Abdul Rahim, a 30-year-old Afghan military captain from Kandahar approached the Amrita Institute of Medical Sciences for a medical transplant. Having lost both his hands during demining operations in the country, he had approached many hospitals around the world for transplantation before coming to AIMS as the last beacon of hope. Amrita, having been long associated with providing medical assistance to armed forces in the country, the response of reaching out to Rahim and providing the best medical treatment was just spontaneous.

Thus, Asia’s first upper hand double transplant was carried out in a marathon surgical procedure at the Amrita Institute of Medical Sciences lasting for almost 15 hours with more than 20 surgeons and eight anesthetists participating in it. Each hand required connecting two bones, two arteries, four veins, and about 14 tendons. As the identification, tagging, and connecting of the nerves, tendons, and arteries is very challenging, forearm transplants have been attempted only a few times in the world. In this case, the patient regained a considerable amount of function of both his hands, thereby enabling him to perform day-to-day activities without external assistance.

In a heartwarming response, Abdul Rahim thanked the entire faculty of doctors at Amrita for giving him a new lease of life. The childlike excitement in his eyes when he held a water bottle for the first time after the surgery was quite palpable. It is moments like this that make Amrita push forward the boundaries one at a time.

Asia’s first Open Foetal Surgery

An estimated 295 000 newborns die within 28 days of birth every year, worldwide, due to congenital anomalies. Congenital anomalies can contribute to long-term disability, which may have significant impacts on individuals, families, healthcare systems, and societies. Looking at the statistics pertaining to stillbirth, around 2 million stillbirths happened worldwide in 2019. Many of the cases of congenital anomalies and stillbirths could have been prevented with proper care. For the team of doctors at Amrita, it was quite saddening to see the state of parents after having carried the baby to term as the parents approached the Amrita Institute of Medical Sciences. As an immediate response, the team took a major leap in the area of congenital disability driven by the glimmer of hope in the eyes of the parents. 

The doctors at Amrita Hospital achieved a significant breakthrough by successfully operating on a baby with a pre-birth defect by taking it out of the mother’s womb, performing corrective surgery, placing it back inside the womb, with the baby subsequently being carried to term. The 21-week fetus had a giant tumour in the right lung that was pressing on its heart. 

The procedure done by experts from the Amrita Centre for Excellence in Foetal Care is a major milestone in the treatment of congenital problems before birth. First of its kind in Asia, this makes India the fourth country in the world to offer open surgery on fetuses. 

Robotic-Assisted DBS Implantation for Parkinson’s Disease

A 45-year-old patient of Parkinson’s disease, the only earning member of his family, got a new lease of life after undergoing Deep Brain Stimulation (DBS) implantation at Amrita Institute of Medical Sciences (Amrita Hospital). This is the first time in Asia that DBS implantation has been done using a medical robot called ROSA. This technology enables minimally invasive surgery of the central nervous system with a level of precision not possible by the human hand. 

It was difficult for Zubair, a 45-year-old auto-rickshaw driver from Kerala’s Guruvayur district suffering from Parkinson’s, to complete a single trip, as he would start shaking uncontrollably midway, terrifying his passengers. Often, he had to request them to disembark and take another auto for their safety. Zubair would then take his medications on the roadside, wait for the effects to kick in, and make another trip to earn a living and support his wife and two children. 

Zubair was just 35 years old when the symptoms of Parkinson’s first came to light. Running from pillar to post to find a solution to her husband’s medical condition, Zubair’s wife reached the Amrita Institute of Medical Sciences where she was directed to its Movement Disorder Clinic. Just when Zubair had lost all hope of leading a normal life, doctors suggested a new course of treatment, Deep Brain Stimulation (DBS) using a medical robot for high precision surgery. Zubair agreed. This procedure remains the first-ever robotic-assisted DBS implantation performed in India, and Asia, for Parkinson’s disease. 

After the trail-blazing surgery conducted by Dr. Ashok Pillai, Dept. of Neurosurgery, at Amrita Hospital, Zubair’s symptoms of Parkinson’s disease have disappeared and he is now able to lead his life as any other healthy adult. Considering the financial situation of the patient, the hospital conducted the surgery free of cost. After the successful surgery, Zubair is extremely happy about his newfound freedom. The symptoms of Parkinson’s have disappeared. He says, “After so many years, I can watch a movie with my family without any disturbance. Earlier, I couldn’t go out to a social gathering or even attend family functions because everyone would stare at my tremors.” Now he is back on the road with a permanent smile on his face as he effortlessly ferries passengers in his auto-rickshaw, all thanks to the electrodes embedded in his brain.

India’s first wind-pipe transplantation on a cancer patient

In yet another first to its medical credit, the Amrita hospital successfully conducted the initial phase of a complex transplantation process which involved the first-ever windpipe transplantation in India and only the second known instance in the world. The 37-year old female patient suffering from cancer in the trachea (windpipe) was on the verge of losing hope, as she approached the Amrita Institute of Medical Sciences. As the team of doctors embarked on the highly complex affair, the one that takes six weeks to complete, the surgical achievement was made possible due to the willingness shown by the donor’s relatives who agreed to donate the organs after the person suffered a brain hemorrhage and was declared brain-dead.

The doctors performed the first windpipe transplant on the cancer patient. The entire transplantation takes six weeks and the complex surgery is done in two phases. In the first phase, the windpipe harvested from the donor is embedded in the recipient’s forearm after stripping it of all cells. After two months, the recipient’s damaged windpipe is transplanted with the one which has been reseeded with his own.

India’s First Double Organ Transplant

For the 31-year-old man, who was suffering from Type 1 Diabetes and Kidney failure was undergoing a chronic state due to poor control of diabetes. The team of medical professionals conducted the double organ transplant, a novelty in India out of sheer compassion looking at the chronic state of the patient. On diagnosis, the doctors identified that if the kidney alone is transplanted and the diabetes is poorly controlled, then even the transplanted kidney will slowly be affected by the high blood sugar levels. The team of doctors conducted the complicated surgery with the organs transplanted from a 38-year-old brain-dead patient in Kochi.

The main advantage of this combined transplantation is improvement in quality of life and freedom from diabetes-related complications and dialysis. This also avoids frequent blood sugar testing and the occurrence of life-threatening fall in blood sugar levels.

The complicated surgery was performed by the Solid Organ Transplant Surgery team with the cooperation of multiple departments at the AIMS, including Nephrologists, Endocrinologists, Anesthesia, and Critical Care Specialists.

This combined procedure of transplanting both the Kidney and Pancreas in a single surgical operation is particularly effective for patients who have Type 1 Diabetes and chronic renal failure. Following the surgery, his blood sugars are normal on a normal diet and his diabetes has been cured. The Kidney function has also normalised, the doctors said. The main advantage of this combined transplantation is improvement in quality of life and freedom from diabetes-related complications and dialysis. This also avoids frequent blood sugar testing and the occurrence of life-threatening fall in blood sugar levels.

Automated Insulin Pump

Diabetes is a chronic disorder characterised by abnormal blood glucose levels due to problems associated with insulin production and action. When glucose levels rise too high, diabetes becomes dangerous. Without medical care, it can increase the risk of heart disease and stroke and in late stages can cause blindness, kidney failure, and loss of limbs.

Worldwide, 285 million people are afflicted, but it is worse in developing countries where less than half the cases go undiagnosed. A staggering 50.8 million affected people live in India. The World Health Organization (WHO) projects that by the year 2030 there will be about 75 million Indians who are diabetic, giving India the dubious distinction of becoming the diabetic capital of the world.

Responding to India’s high incidence of diabetes, researchers at Amrita designed an automated insulin pump. Normally, insulin pumps are expensive and cost about $4500, making it unaffordable for the average Indian diabetic patient. 

This led the researchers at Amrita to develop a low-cost, automated insulin pump designed for personalized and continuous delivery of insulin in a subcutaneous matter with all functionalities. The innovation was awarded a U.S. patent and the Alexander Graham Bell Award in the category of mHealth.