Tiny Nair - Academia.edu (original) (raw)

Papers by Tiny Nair

PubMed, Dec 1, 2018

1Cardiologist at MGM Hospital, Mumbai, Maharashtra; 2Chief of Cardiology, Holy Family Hospital, M... more 1Cardiologist at MGM Hospital, Mumbai, Maharashtra; 2Chief of Cardiology, Holy Family Hospital, Mumbai, Maharashtra; 3Interventional Cardiologist, Laxmi Hospital, Palakkad, Kerala; 4Interventional Cardiologist, PRS Hospital, Trivandrum, Kerala; 5Interventional Cardiologist, Medica Hospital, Patna, Bihar; 6Interventional Cardiologist, Apollo Hospital, Bhubaneshwar, Orissa; 7Interventional Cardiologist, Health world, Durgapur, West Bengal; 8Interventional Cardiologist, Fortis, Delhi; 9Interventional Cardiologist, Apollo Hospital, Hyderabad, Telangana; 10Interventional Cardiologist, Paritham Hospital, Kottyam, Kerala; 11Interventional Cardiologist, Krishna Medical Centre, Lucknow, Uttar Pradesh; 12Interventional Cardiologist, Sai Baba Hospital, Nasik, Maharashtra; 13Cardiologist at Old MLA Quarters, Bhopal, Madhya Pradesh

American heart journal, 2018

Background: We aimed to determine whether the angiotensin receptor neprilysin inhibitor (SAC/VAL)... more Background: We aimed to determine whether the angiotensin receptor neprilysin inhibitor (SAC/VAL) promotes myocardial angiogenesis and improves perfusion vs valsartan (VAL) alone or controls. Methods: Rats (n=91) with left coronary artery ligation were randomized at 1-wk post to treatment (SAC/VAL, VAL, CTRL) for either 1 or 5 wk. Angiogenesis was assessed by an RGD peptide (99m Tc-NC100692) with 201 Tl perfusion evaluated at rest (1 wk post-tx) and under dobutamine stress (5 wk post-tx). Images were analyzed as the ratio of ischemic to normal area. Following imaging, animals were sacrificed, and the LV sectioned for well counting with corrected counts converted to % injected dose per gram of tissue (%ID/g). Infarct size, angiogenesis, and cardiomyocyte (CM) size histology was performed. Results: SAC/VAL therapy improved infarct 99m Tc-NC100692 uptake at 1 wk post-tx with no observed difference between groups at 5wk post-tx (Fig1A). At 5wk post-tx dobutamine-induced 201 Tl uptake significantly increased in SAC/VAL compared to CTRL (Fig 1B). SAC/VAL attenuated the increase in peri-infarct CM size at 5 wk post-tx vs CTRL (Fig1C) and both VAL and SAC/VAL prevented CM hypertrophy in remote regions vs CTRL. CM hypertrophy observed at 5 wk post-tx in peri-infarct region was accompanied by an increase in capillary density (Fig1D). Conclusion: SAC/VAL therapy improved angiogenesis with an augmentation in myocardial perfusion. This was observed with an increase in capillary density and attenuation of CM growth.

Thyroid Research and Practice, 2016

Hypertension journal, 2016

Traditionally, salt intake is linked to hypertension, and salt restriction forms the foundation f... more Traditionally, salt intake is linked to hypertension, and salt restriction forms the foundation for "lifestyle" management of hypertension. Despite an increase in incidence of hypertension in the population, data did not show any increase in salt intake over longer time frame. Increased intake of processed food amounts to increase in sugars especially fructose. Rampant and excessive commercial use of high fructose corn syrup in ready-to-eat "fast" food results in hypertension by various mechanisms. This interesting shift of concept of white crystals from salt to sugar is reviewed in this commentary.

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Feb 1, 2022

The epidemic of obesity or adiposity-based chronic diseases presents a significant challenge with... more The epidemic of obesity or adiposity-based chronic diseases presents a significant challenge with the rising prevalence of morbidities and mortality due to atherosclerotic cardiovascular diseases (ASCVD), especially in low-and middle-income countries (LMIC). The underlying pathophysiology of metabolic inflexibility is a common thread linking insulin resistance to cardiometabolic-based chronic disease (CMBCD), including dysglycemia, hypertension, and dyslipidemia progressing to downstream ASCVD events. The complex CMBCD paradigm in the LMIC population within the socioeconomic and cultural context highlights considerable heterogeneity of disease predisposition, clinical patterns, and socio-medical needs. This review intends to summarize the current knowledge of CMBCD. We describe recently established or emerging trends for managing risk factors, assessment tools for evaluating ASCVD risk, and various pharmacological and nonpharmacological measures particularly relevant for LMICs. A CMBCD model positions insulin resistance and β-cell dysfunction at the summit of the disease spectrum may improve outcomes at a lower cost in LMICs. Despite identifying multiple pathophysiologic disturbances constituting CMBCD, a large percentage of the patient at risk for ASCVD remains undefined. Targeting dysglycemia, dyslipidemia, and hypertension using antihypertensive, statins, anti-glycemic, and antiplatelet agents has reduced the incidence of ASCVD. Thus, primordial prevention targeting pathophysiological changes that cause abnormalities in adiposity and primary prevention by detecting and managing risk factors remains the foundation for CMBCD management. Therefore, targeting pathways that address mitochondrial dysfunction would exert a beneficial effect on metabolic inflexibility that may potentially correct insulin resistance, β cell dysfunction and, consequently, would be therapeutically effective across the entire continuum of CMBCD.

Indian heart journal, Jul 1, 2020

Sulphonylureas (SU) form an important role in management of people with type 2 diabetes. This saf... more Sulphonylureas (SU) form an important role in management of people with type 2 diabetes. This safety history of SU was tainted for various reasons, the predominant one being lack of demonstration of cardiovascular safety. Since its introduction, SU's have never been subjected to a formal study for its cardiovascular safety. The cardiovascular safety of SUs was derived from small, inadequately powered randomised controlled trials (RCT) and observational studies. CAROLINA (CARdiovascular Outcome study of LINAgliptin versus glimepiride in patients with type 2 diabetes) trial planned as a cardiovascular outcome trial randomised people with type 2 diabetes and high cardiovascular risk to Linagliptin and Glimepiride. This opinion paper outlines the salient features of this landmark trial and its implications in general cardiology practice.

Journal of Human Hypertension, May 14, 2019

Hypertension is regarded as a major contributor to vascular disease. Vascular disease is a fairly... more Hypertension is regarded as a major contributor to vascular disease. Vascular disease is a fairly common denominator in a large percentage of cases of dementia. Despite this strong connecting link, dementia is often not considered as a mainstream problem consequent to hypertension, though there is an alarming increase in the number of cases of dementia. While established dementia has very few treatment options, prevention of development and slowing of progression of dementia by proper treatment of hypertension could be an important strategy, especially so, in a financially challenged Indian subcontinent with inhomogeneous health coverage.

Journal of Cardiac Failure, Dec 1, 2018

Background: Long-term data on outcomes of participants hospitalized with heart failure (HF) from ... more Background: Long-term data on outcomes of participants hospitalized with heart failure (HF) from low-and middle-income countries are limited. Methods and Results: In the Trivandrum Heart Failure Registry (THFR) in 2013, 1205 participants from 18 hospitals in Trivandrum, India, were enrolled. Data were collected on

Heart Failure Journal of India

Journal of Association of Physicians of India, Feb 1, 2023

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed qua... more Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Wellcome Open Research

Background: Heart failure (HF) is a debilitating condition associated with enormous public health... more Background: Heart failure (HF) is a debilitating condition associated with enormous public health burden. Management of HF is complex as it requires care and coordination with different cadres of health care providers. In resource poor settings, physician driven initiatives to improve HF management is difficult due to multiple barriers. We propose to develop a team based collaborative care model (CCM), facilitated by a trained nurse, for management of HF with the support of mHealth and evaluate their acceptability and effectiveness in Indian setting. Methods: The proposed study will use mixed-methods research for assessment. A formative qualitative research will identify barriers and facilitators for implementing CCM for the management of HF and develop components of the intervention. Subsequently, a cluster randomised controlled trial (RCT) involving 22 centres (tertiary hospitals) with more than 1500 HF patients will be conducted to assess the effectiveness of the CCM in improving...

Journal of the Association of Physicians of India

Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure... more Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy

Journal of Association of Physicians of India, Mar 1, 2022

AIM To address the existing gaps in knowledge about long-acting nitroglycerine (LA-NTG) and provi... more AIM To address the existing gaps in knowledge about long-acting nitroglycerine (LA-NTG) and provide recommendations to address these issues. METHODOLOGY Approved LA-NTG questionnaire that included 17 questions related to the role of LA-NTG in the management of angina and chronic coronary syndrome (CCS) was shared with 150 expert cardiologists from different regions from India. Results of these survey questionnaires were further discussed in 12 regional level meetings. The opinions and suggestions from all the meetings were compiled and analyzed. Further, recommendations were made with the help of attending national cardiology experts and a consensus statement was derived. RESULTS This is the first consensus on LA-NTG, summarizing the clinical evidence from India and suggesting recommendations based on these data. The experts recommended early use of LA-NTG as a first-line antianginal therapy in combination with beta-blocker since it improves exercise tolerance in patients with CCS. A strong consensus was observed for using LA-NTG in patients with co-morbid hypertension, diabetes, chronic kidney disease and post-percutaneous coronary intervention angina. As a part of cardiac rehabilitation, LA-NTG allows patients with angina to exercise to a greater functional capacity. CONCLUSIONS A national consensus was observed for several aspects of LA-NTG in the management of angina and CCS. The clinical experience of the experts confirmed an extremely satisfied patient perception about the efficacy of LA-NTG.

Current Medical Research and Opinion, 2021

Abstract Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guideli... more Abstract Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions.

$Research paper thumbnail of Consensus and development of document for management of stabilized acute decompensated heart failure with reduced ejection fraction in India$

Indian Heart Journal, 2020

Heart failure with reduced ejection fraction Consensus document Heart failure clinic Heart failur... more Heart failure with reduced ejection fraction Consensus document Heart failure clinic Heart failure monitoring India Methodology: A total of 25 Cardiology SMEs who consented to participate from India discussed data from literature, current evidence, international guidelines and practical experiences in two national and four regional meetings. Results: Recommendations included HF management, treatment optimization, and patient education. The checklist should be filled at four time points-(a) transition from intensive care unit to ward, (b) at discharge, (c) 1st follow-up and (d) subsequent follow-up. The checklist is the responsibility of the consultant or the treating physician which can be delegated to a junior resident or a trained HF nurse. Conclusion: This checklist will ensure GDMT, simplify transition of care and can be used by all doctors across India. Institutions, associations, and societies should recommend this checklist for adaptability in public and private hospital. Hospital administrations should roll out policy for adoption of checklist by ensuring patient files have the checklist at the time of discharge and encourage practice of filling it diligently during follow-up visits.

Journal of Family Medicine and Primary Care, 2020

Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-... more Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.