Dr.A.Muruganathan MD, FRCP (GLASG), FACP (USA), FPCP (Philippines), FICP (original) (raw)
Papers by Dr.A.Muruganathan MD, FRCP (GLASG), FACP (USA), FPCP (Philippines), FICP
Journal of Clinical Lipidology
Journal of the Indian Medical Association, 2020
Editor’s comment-A The covid-19 pandemic is the greatest challenge for the current generation of ... more Editor’s comment-A The covid-19 pandemic is the greatest challenge for the current generation of physicians, scientists and health administrators B Strict use of PPE, face masks, isolation and quarantine are the most effective methods of prevention of this infection C The immunomodulator hydroxychloroquine is approved for prophylactic use in asymptomatic health care workers and household contacts It is also approved as compassionate use for treatment of active covid-19 cases in the USA D Lopinavir/ritonavir and remdesivir are used in some countries, but efficacy is doubtful E Treatment with convalescent plasma may be considered in emergency situations
The Journal of the Association of Physicians of India, 2020
The Journal of the Association of Physicians of India, 2020
Currently, physicians across the world are striving to practice medicine based on evidence. Evide... more Currently, physicians across the world are striving to practice medicine based on evidence. Evidence-based medicine refers to the incorporation of the most recent clinical research physicians’ experience and patients’ wishes and needs into clinical practice. The treating physician is often confronted with the dilemma of which insulin to use and currently the use of a patient-centered approach for attaining the glycemic goals is being widely recommended. In 2009, the Indian National Consensus Group (INCG) published the “Premix Insulin: Initiation and Continuation Guidelines for Management of Diabetes in Primary Care” with the aim of providing primary care physicians (PCPs) a simplified regimen based on the patients’ and physicians’ needs and expectations. This guideline recommended the use of premix insulin regimen for its convenience, safety and efficacy. This was probably one of the first guidelines on insulin therapy in India, which provided a simple guide for initiation and inten...
The Journal of the Association of Physicians of India, 2020
The Journal of the Association of Physicians of India, 2020
Journal of Clinical Lipidology, 2020
BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India ... more BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality. OBJECTIVE: In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries. METHODS: Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement. RESULTS: The LAI recommends an LDL-C goal ,50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal #30 mg/dL in category A extreme-risk patients (eg, coronary artery disease 1 familial hypercholesterolemia) and a recommended goal #30 mg/dL in category B extreme-risk patients [coronary artery disease 1 (1) diabetes and polyvascular disease/$3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C ,50 mg/dL, or (3) homozygous familial hypercholesterolemia]. CONCLUSIONS: More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.
The Journal of the Association of Physicians of India, 2015
plus is the opt ion which now is being increasing challenged by premix regimens in Asian countrie... more plus is the opt ion which now is being increasing challenged by premix regimens in Asian countries like India and China. However, premixed insulins (a fixed combination of intermediate insulin with regularor rapidacting insulin) are limited by their relative inflexibil i ty in dosing (failure to titrate the shorter from the longer acting component) , requiring resuspension before injection, less than 24h duration of action of the basal component and adherence to a consistent meal schedule to avoid the risk of hypoglycaemia. Similarly the use of long-acting and meal time insulins, separately as part of basal-bolus therapy requires MDI and adds to the burden of treatment complexity. Therefore, an ideal insulin regimen that can provide both basal and prandial insulin coverage with complementary pharmacokinetic/ p h a r m a c o d y n a m i c ( P K / P D ) profile in a single injection can address the main barriers to timely insulin intensification in patients with diabetes while achieving or maintaining individual glycaemic targets over time. T h i s s u p p l e m e n t p r o v i d e s information on insulin degludec/ aspart (IDegAsp), a first soluble coformulation of two different insulin analogues; insulin degludec (IDeg: 70%) and insulin aspart (IAsp: 30%). The first article summarises the challenges of meal-time insulin intensification in T2DM patients Insulin Degludec / Insulin Aspart: A Novel Co-formulation for Insulin Intensification
Journal of Clinical and Scientific Research, 2015
This statement was prepared by the Writing Group of the INOSA Guidelines based on the Consensus a... more This statement was prepared by the Writing Group of the INOSA Guidelines based on the Consensus and Evidence-based Guidelines for the diagnosis and treatment of obstructive sleep apnoea in India framed by the Working Group of INOSA Guidelines.
The Journal of the Association of Physicians of India, 2014
The prevalence of diabetes continues to increase despite advances in detection and therapy. Major... more The prevalence of diabetes continues to increase despite advances in detection and therapy. Majority of the patients fail to achieve desired glycaemic targets even with maximal tolerated doses of oral anti-hyperglycaemic drugs, necessitating insulin therapy. Although, much attention has been given to early insulin initiation, yet substantial proportion of patients do not achieve glycaemic targets as they fail to initiate or intensify insulin therapy at the appropriate time. The choice of an insulin regimen and timely initiation and intensification of insulin therapy are key factors in achieving optimal glycaemic control. This current consensus guideline developed by a panel of experts aims to provide specific recommendations based on existing guidelines and published data on initiation and intensification of insulin therapy in management of type 2 diabetes mellitus (T2DM) using basal, premixed and basal-bolus insulin regimens in Indian clinical practice. The panel recognized the nee...
Oral oncology, 2013
Head and neck cancer (HNC) is a disease of the upper aerodigestive tract and is one of the most f... more Head and neck cancer (HNC) is a disease of the upper aerodigestive tract and is one of the most frequently diagnosed cancers worldwide. A high rate of cancers involving the head and neck are reported across the Asian region, with notable variations between countries. Disease prognosis is largely dependent on tumor stage and site. Patients with early stage disease have a 60-95% chance of cure with local therapy. Early diagnosis and appropriate treatment are important to increase the likelihood of cure and survival. However, the majority of patients present with locally advanced disease and require multimodality treatment. This necessitates, a multidisciplinary approach which is essential to make appropriate treatment decisions, particularly with regards to tolerability, costs, available infrastructure and quality of life issues. Unfortunately, majority of the studies that dictate current practice have been developed in the west where diseases biology, patient population and available...
Indian Journal of Cancer, 2013
The Journal of the Association of Physicians of India, 2020
Abstract Lifestyle management is the cornerstone of both primary and secondary prevention of athe... more Abstract Lifestyle management is the cornerstone of both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and the importance of lifestyle management is emphasised by all major guidelines. Despite this, actual implementation of lifestyle management is poor. Lifestyle modification includes smoking cessation, weight loss, dietary change, increasing physical inactivity, and stress management. This review summarises evidence-based opportunities and challenges for healthcare professionals to promote healthy lifestyles at an individual level for the prevention of ASCVD.
Current Vascular Pharmacology
Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in ... more Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke and recommended low density lipoprotein cholesterol (LDL-C) goals for those in a very high risk group and extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group (category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Non-statin therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be added as an adjunct to statins in patients who do not achieve LDL-C goals statins alone. In acute ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of thrombolytic therapy. Although conflicting data exist r...
Journal of the American College of Cardiology
The Journal of the Association of Physicians of India, 2017
The Journal of the Association of Physicians of India, 2016
Influenza is a global public health problem and concern especially in high risk people. Preventio... more Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented importance of vaccination, the uptake of influenza vaccine is very poor. This document provide recommendations for influenza vaccination in high-risk individuals and help implement best practices in the South Asian region and improve coverage of influenza vaccination to achieve better outcomes in this population.
The Journal of the Association of Physicians of India, 2017
Pharmacovigilance is the art and science of detection, understanding and prevention of adverse dr... more Pharmacovigilance is the art and science of detection, understanding and prevention of adverse drug reactions and not merely a critical analysis of prescriptions and errors. This field starts with reporting by clinicians of a suspected adverse drug reaction (ADR) to the pharmacologist followed by joint causality analysis and ends at the application of new information by a clinician for benefit of patients. There are a number of ways, which can be utilised for reporting adverse effects using pen and paper format to software applications for smart phones. Varied types of activities spreading from systematic reviews to the mechanistic evaluation of ADR can be performed under the umbrella of pharmacovigilance. It is of utmost importance for clinicians to understand how to identify, communicate and understand adverse effects of drugs with an aim to prevent harm to patients.
Journal of Clinical Lipidology
Journal of the Indian Medical Association, 2020
Editor’s comment-A The covid-19 pandemic is the greatest challenge for the current generation of ... more Editor’s comment-A The covid-19 pandemic is the greatest challenge for the current generation of physicians, scientists and health administrators B Strict use of PPE, face masks, isolation and quarantine are the most effective methods of prevention of this infection C The immunomodulator hydroxychloroquine is approved for prophylactic use in asymptomatic health care workers and household contacts It is also approved as compassionate use for treatment of active covid-19 cases in the USA D Lopinavir/ritonavir and remdesivir are used in some countries, but efficacy is doubtful E Treatment with convalescent plasma may be considered in emergency situations
The Journal of the Association of Physicians of India, 2020
The Journal of the Association of Physicians of India, 2020
Currently, physicians across the world are striving to practice medicine based on evidence. Evide... more Currently, physicians across the world are striving to practice medicine based on evidence. Evidence-based medicine refers to the incorporation of the most recent clinical research physicians’ experience and patients’ wishes and needs into clinical practice. The treating physician is often confronted with the dilemma of which insulin to use and currently the use of a patient-centered approach for attaining the glycemic goals is being widely recommended. In 2009, the Indian National Consensus Group (INCG) published the “Premix Insulin: Initiation and Continuation Guidelines for Management of Diabetes in Primary Care” with the aim of providing primary care physicians (PCPs) a simplified regimen based on the patients’ and physicians’ needs and expectations. This guideline recommended the use of premix insulin regimen for its convenience, safety and efficacy. This was probably one of the first guidelines on insulin therapy in India, which provided a simple guide for initiation and inten...
The Journal of the Association of Physicians of India, 2020
The Journal of the Association of Physicians of India, 2020
Journal of Clinical Lipidology, 2020
BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India ... more BACKGROUND: Rates of atherosclerotic cardiovascular disease (ASCVD) are strikingly high in India compared to Western countries and are increasing. Moreover, ASCVD events occur at a younger age with only modest hypercholesterolemia, most commonly with low levels of high-density lipoprotein cholesterol. The course of ASCVD also appears to be more fulminant with higher mortality. OBJECTIVE: In light of these issues, the Lipid Association of India (LAI) endeavored to develop revised guidelines with more aggressive low-density lipoprotein cholesterol (LDL-C) goals in secondary prevention and for patients with familial hypercholesterolemia compared to guidelines in the United States and other countries. METHODS: Owing to the paucity of clinical outcomes data in India, it was necessary to place major emphasis on expert opinion as a complement to randomized placebo-controlled data generated mostly in non-Indian cohorts. To facilitate this process, the LAI conducted a series of 19 meetings among 162 lipid specialists in 13 cities throughout India over a period of 11 months before formulating this expert consensus statement. RESULTS: The LAI recommends an LDL-C goal ,50 mg/dL in all patients in secondary prevention or very high-risk primary prevention but proposes an optional goal #30 mg/dL in category A extreme-risk patients (eg, coronary artery disease 1 familial hypercholesterolemia) and a recommended goal #30 mg/dL in category B extreme-risk patients [coronary artery disease 1 (1) diabetes and polyvascular disease/$3 major ASCVD risk factors/end organ damage, or (2) recurrent acute coronary syndrome within 12 months despite LDL-C ,50 mg/dL, or (3) homozygous familial hypercholesterolemia]. CONCLUSIONS: More aggressive LDL-C goals are needed for prevention of ASCVD in India, as described in this expert consensus statement. Use of statins and ezetimibe needs to increase in India in combination with improved control of other ASCVD risk factors. Proprotein convertase subtilisin kexin type 9 inhibitors can improve LDL-C goal achievement in patients with refractory hypercholesterolemia.
The Journal of the Association of Physicians of India, 2015
plus is the opt ion which now is being increasing challenged by premix regimens in Asian countrie... more plus is the opt ion which now is being increasing challenged by premix regimens in Asian countries like India and China. However, premixed insulins (a fixed combination of intermediate insulin with regularor rapidacting insulin) are limited by their relative inflexibil i ty in dosing (failure to titrate the shorter from the longer acting component) , requiring resuspension before injection, less than 24h duration of action of the basal component and adherence to a consistent meal schedule to avoid the risk of hypoglycaemia. Similarly the use of long-acting and meal time insulins, separately as part of basal-bolus therapy requires MDI and adds to the burden of treatment complexity. Therefore, an ideal insulin regimen that can provide both basal and prandial insulin coverage with complementary pharmacokinetic/ p h a r m a c o d y n a m i c ( P K / P D ) profile in a single injection can address the main barriers to timely insulin intensification in patients with diabetes while achieving or maintaining individual glycaemic targets over time. T h i s s u p p l e m e n t p r o v i d e s information on insulin degludec/ aspart (IDegAsp), a first soluble coformulation of two different insulin analogues; insulin degludec (IDeg: 70%) and insulin aspart (IAsp: 30%). The first article summarises the challenges of meal-time insulin intensification in T2DM patients Insulin Degludec / Insulin Aspart: A Novel Co-formulation for Insulin Intensification
Journal of Clinical and Scientific Research, 2015
This statement was prepared by the Writing Group of the INOSA Guidelines based on the Consensus a... more This statement was prepared by the Writing Group of the INOSA Guidelines based on the Consensus and Evidence-based Guidelines for the diagnosis and treatment of obstructive sleep apnoea in India framed by the Working Group of INOSA Guidelines.
The Journal of the Association of Physicians of India, 2014
The prevalence of diabetes continues to increase despite advances in detection and therapy. Major... more The prevalence of diabetes continues to increase despite advances in detection and therapy. Majority of the patients fail to achieve desired glycaemic targets even with maximal tolerated doses of oral anti-hyperglycaemic drugs, necessitating insulin therapy. Although, much attention has been given to early insulin initiation, yet substantial proportion of patients do not achieve glycaemic targets as they fail to initiate or intensify insulin therapy at the appropriate time. The choice of an insulin regimen and timely initiation and intensification of insulin therapy are key factors in achieving optimal glycaemic control. This current consensus guideline developed by a panel of experts aims to provide specific recommendations based on existing guidelines and published data on initiation and intensification of insulin therapy in management of type 2 diabetes mellitus (T2DM) using basal, premixed and basal-bolus insulin regimens in Indian clinical practice. The panel recognized the nee...
Oral oncology, 2013
Head and neck cancer (HNC) is a disease of the upper aerodigestive tract and is one of the most f... more Head and neck cancer (HNC) is a disease of the upper aerodigestive tract and is one of the most frequently diagnosed cancers worldwide. A high rate of cancers involving the head and neck are reported across the Asian region, with notable variations between countries. Disease prognosis is largely dependent on tumor stage and site. Patients with early stage disease have a 60-95% chance of cure with local therapy. Early diagnosis and appropriate treatment are important to increase the likelihood of cure and survival. However, the majority of patients present with locally advanced disease and require multimodality treatment. This necessitates, a multidisciplinary approach which is essential to make appropriate treatment decisions, particularly with regards to tolerability, costs, available infrastructure and quality of life issues. Unfortunately, majority of the studies that dictate current practice have been developed in the west where diseases biology, patient population and available...
Indian Journal of Cancer, 2013
The Journal of the Association of Physicians of India, 2020
Abstract Lifestyle management is the cornerstone of both primary and secondary prevention of athe... more Abstract Lifestyle management is the cornerstone of both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and the importance of lifestyle management is emphasised by all major guidelines. Despite this, actual implementation of lifestyle management is poor. Lifestyle modification includes smoking cessation, weight loss, dietary change, increasing physical inactivity, and stress management. This review summarises evidence-based opportunities and challenges for healthcare professionals to promote healthy lifestyles at an individual level for the prevention of ASCVD.
Current Vascular Pharmacology
Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in ... more Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke and recommended low density lipoprotein cholesterol (LDL-C) goals for those in a very high risk group and extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group (category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Non-statin therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be added as an adjunct to statins in patients who do not achieve LDL-C goals statins alone. In acute ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of thrombolytic therapy. Although conflicting data exist r...
Journal of the American College of Cardiology
The Journal of the Association of Physicians of India, 2017
The Journal of the Association of Physicians of India, 2016
Influenza is a global public health problem and concern especially in high risk people. Preventio... more Influenza is a global public health problem and concern especially in high risk people. Prevention plays a key role in avoiding complications of influenza related illnesses. Despite the existing prevalence of influenza, and documented importance of vaccination, the uptake of influenza vaccine is very poor. This document provide recommendations for influenza vaccination in high-risk individuals and help implement best practices in the South Asian region and improve coverage of influenza vaccination to achieve better outcomes in this population.
The Journal of the Association of Physicians of India, 2017
Pharmacovigilance is the art and science of detection, understanding and prevention of adverse dr... more Pharmacovigilance is the art and science of detection, understanding and prevention of adverse drug reactions and not merely a critical analysis of prescriptions and errors. This field starts with reporting by clinicians of a suspected adverse drug reaction (ADR) to the pharmacologist followed by joint causality analysis and ends at the application of new information by a clinician for benefit of patients. There are a number of ways, which can be utilised for reporting adverse effects using pen and paper format to software applications for smart phones. Varied types of activities spreading from systematic reviews to the mechanistic evaluation of ADR can be performed under the umbrella of pharmacovigilance. It is of utmost importance for clinicians to understand how to identify, communicate and understand adverse effects of drugs with an aim to prevent harm to patients.