Ramesh Sankaran | Sri Ramachandra University (original) (raw)
Papers by Ramesh Sankaran
Indian heart journal, Nov 1, 2017
Background: There is recent surge in the incidence of cardiac diseases among young Indians. Howev... more Background: There is recent surge in the incidence of cardiac diseases among young Indians. However, the situation is preventable by bringing about positive changes to the lifestyle. It is high time to analyze and take action against this growing problem. As the whole world joins hands and fights against this preventable disease, we Indians must prove ourselves by contributing our bit to root out this disease from our country. Railway staff is privileged as Indian Railways in present times has all the right infrastructure to fight against the heart diseases. Objectives: To conduct multiple heart awareness and lifestyle modification drive programs at the doorstep in various parts of railway colonies with active participation by railway staff. To identify the asymptomatic hypertension, diabetes and ischemic heart disease among the railway population. To record its effect in form of morbidity and mortality from acute coronary event and other acute complications of risk factors such as hypertension and diabetes. Methods: This is a prospective cohort study. South East Central Railway head quarter Bilaspur has a railway colony with an area of 6.4 square km catering to almost 5000 employees with their families and other surrounding hubs harboring about 3000 employees and retired employees with families. Different pockets in the colonies were selected for heart awareness interactive programs at regular intervals using audio-visuals. In these 2-3 h sittings, all the attendants were explained by multi discipline experts and dieticians about the magnitude of the problem in the society, various reversible risk factors and their ways of control, causes of heart problems and various preventive steps. The apparently asymptomatic healthy people were asked to attend a special clinic at the central hospital for basic evaluation like biometrics, blood pressure and diabetes status etc. Those who were residing outside the colony and not attending the programs were taken as control of this study. Three years' observations from August 2013 to July 2016 were made on the incidences of hospitalizations for acute coronary syndromes (ACS), acute left ventricular failure and acute diabetic emergencies among the population that had attended the program and compared with the population that did not (controls). Results: Results have been divided in two categories. First, the prevalence of risk factors in the railway population residing inside the colony. Second, the incidences of ACS, Accelerated Hypertension with or without acute left ventricular failure and acute complicated uncontrolled diabetes mellitus among the counseled population and the control group. Prevalence of risk factors: Total counseled population was 4178 (female 1796, 43%). Age ranged from 22 to 82 years. Vegetarians were 960 (23%), physical inactive 2841 (68%), tobacco users 1023 (33%), old diabetics 459 (11%), known hypertensives 919 (22%), those with ischemic heart disease 292 (7%), asymptomatic (apparently healthy) 1712 (41%) among them hypertension 668 (16%), diabetics 332 (8%) ACS (NSTEMI & STEMI) were 37 and 51 among the counseled and non-counselled groups, respectively [p < 0.005]. STEMI occurrences were non-significantly less in counseled group. Hypertensive and diabetic emergencies were significantly low in counseled group [6 vs 14, p = 0.02 and 5 vs 14, p = 0.009]
Indian heart journal, Nov 1, 2017
(mPAP) of more than 25 mmHg. Observation: Among forty two patient in this study, there were thirt... more (mPAP) of more than 25 mmHg. Observation: Among forty two patient in this study, there were thirty three male patients and nine female patients. POPH was seen three female and two male patients with total of five out of fortytwo with prevalence of 11.9% out of which 7.1% were female and 4.8% were male. Conclusion: Portopulmoanry hypertension prevalence is 2-6%. 4 In this study pulmonary hypertension is significantly high in portal hypertensive patient with percentage of 11.9% and more prevalent in female.
Indian Heart Journal, 2018
The Egyptian Heart Journal, Jan 11, 2021
Background: Dual antiplatelet therapy is the current standard of care after acute coronary syndro... more Background: Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results: All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician's discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, reinterventions, or major bleeding manifestations was observed between the two groups. Conclusion: In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.
International Journal of Cardiology, May 1, 2021
INTRODUCTION Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome ... more INTRODUCTION Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome (ACS) management, and ticagrelor is one of the commonly used second antiplatelet agents. There is some evidence to suggest that morphine may reduce the antiplatelet effect of ticagrelor. METHODS AND RESULTS In a single-center, randomized controlled trial, we compared the effect of morphine and fentanyl on platelet aggregation (PA) among patients with ACS treated with ticagrelor. Platelet aggregation was studied by automated light transmittance aggregometry (LTA) at baseline, and at 2 h after ticagrelor loading. The primary outcome was the difference in the maximal inhibition of platelet aggregation [IPA(%)] between the groups at 2 h. Pain relief, and drug-related adverse events were secondary outcomes. Of 136 patients randomized, 70 received fentanyl and 66 received morphine. At baseline, the median (IQR) platelet aggregation [61.35% (54.6-to 70) Vs. 58.8% (52.7 to 72.9)] were comparable between the groups. There was no statistically significant difference between the fentanyl and the morphine groups in IPA at 2-h [85.88%(64.65-98.16) and 81.93%(44.2-98.03), p = 0.09]. However, morphine use was independently associated with a PA of >30% at 2 h (p- < 0.009). There was no difference in adverse events. CONCLUSION In patients with ACS, there was no significant difference between the use of fentanyl or morphine on the effect of ticagrelor on PA. (CTRI/2018/04/013423).
JACC: Cardiovascular Interventions
Journal of the American College of Cardiology
JOURNAL OF INDIAN COLLEGE OF CARDIOLOGY
Journal of the Practice of Cardiovascular Sciences
Journal of the American College of Cardiology
Journal of the American College of Cardiology
Journal of the American College of Cardiology
European Heart Journal, 2022
Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in In... more Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction. PURPOSE –We intent to study outcomes of acute coronary syndrome associated with COVID-19 patients . METHODS – This is a single center case-control study done in an University hospital in south India , from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without COVID -19 in the same period. RESULITS – 508 patients were admitted between May 2020 to October 2020 with ACS and out of which 58 patients were positive for COVID-19 and 450 patients were COVID-19 negative. In COVID positive gro...
Journal of the Practice of Cardiovascular Sciences
Annals of Clinical Cardiology
A Relationship Between Epistemological Beliefs on the Nature of Mathematics and Pedagogy of Mathe... more A Relationship Between Epistemological Beliefs on the Nature of Mathematics and Pedagogy of Mathematics
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women an... more Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less likely to undergo revascularisation compared to men. Aim: To study the risk factors, clinical characteristics, severity of CAD and to evaluate the outcomes in women undergoing coronary angiogram. Materials and Methods: This retrospective study included 912 women who had undergone coronary angiogram in our hospital from January 2018 to December 2018. The patients were divided into three groups- Group A consisted of 230 (25%) women with age <50 years. Group B consisted of 591 (65%) women with age between 50 to 69 years. Group C consisted of 91 (10%) women with age >70 years. Continuous variables were analysed by paired t-test and categoric...
The Egyptian Heart Journal
Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrom... more Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6...
Indian heart journal, Nov 1, 2017
Background: There is recent surge in the incidence of cardiac diseases among young Indians. Howev... more Background: There is recent surge in the incidence of cardiac diseases among young Indians. However, the situation is preventable by bringing about positive changes to the lifestyle. It is high time to analyze and take action against this growing problem. As the whole world joins hands and fights against this preventable disease, we Indians must prove ourselves by contributing our bit to root out this disease from our country. Railway staff is privileged as Indian Railways in present times has all the right infrastructure to fight against the heart diseases. Objectives: To conduct multiple heart awareness and lifestyle modification drive programs at the doorstep in various parts of railway colonies with active participation by railway staff. To identify the asymptomatic hypertension, diabetes and ischemic heart disease among the railway population. To record its effect in form of morbidity and mortality from acute coronary event and other acute complications of risk factors such as hypertension and diabetes. Methods: This is a prospective cohort study. South East Central Railway head quarter Bilaspur has a railway colony with an area of 6.4 square km catering to almost 5000 employees with their families and other surrounding hubs harboring about 3000 employees and retired employees with families. Different pockets in the colonies were selected for heart awareness interactive programs at regular intervals using audio-visuals. In these 2-3 h sittings, all the attendants were explained by multi discipline experts and dieticians about the magnitude of the problem in the society, various reversible risk factors and their ways of control, causes of heart problems and various preventive steps. The apparently asymptomatic healthy people were asked to attend a special clinic at the central hospital for basic evaluation like biometrics, blood pressure and diabetes status etc. Those who were residing outside the colony and not attending the programs were taken as control of this study. Three years' observations from August 2013 to July 2016 were made on the incidences of hospitalizations for acute coronary syndromes (ACS), acute left ventricular failure and acute diabetic emergencies among the population that had attended the program and compared with the population that did not (controls). Results: Results have been divided in two categories. First, the prevalence of risk factors in the railway population residing inside the colony. Second, the incidences of ACS, Accelerated Hypertension with or without acute left ventricular failure and acute complicated uncontrolled diabetes mellitus among the counseled population and the control group. Prevalence of risk factors: Total counseled population was 4178 (female 1796, 43%). Age ranged from 22 to 82 years. Vegetarians were 960 (23%), physical inactive 2841 (68%), tobacco users 1023 (33%), old diabetics 459 (11%), known hypertensives 919 (22%), those with ischemic heart disease 292 (7%), asymptomatic (apparently healthy) 1712 (41%) among them hypertension 668 (16%), diabetics 332 (8%) ACS (NSTEMI & STEMI) were 37 and 51 among the counseled and non-counselled groups, respectively [p < 0.005]. STEMI occurrences were non-significantly less in counseled group. Hypertensive and diabetic emergencies were significantly low in counseled group [6 vs 14, p = 0.02 and 5 vs 14, p = 0.009]
Indian heart journal, Nov 1, 2017
(mPAP) of more than 25 mmHg. Observation: Among forty two patient in this study, there were thirt... more (mPAP) of more than 25 mmHg. Observation: Among forty two patient in this study, there were thirty three male patients and nine female patients. POPH was seen three female and two male patients with total of five out of fortytwo with prevalence of 11.9% out of which 7.1% were female and 4.8% were male. Conclusion: Portopulmoanry hypertension prevalence is 2-6%. 4 In this study pulmonary hypertension is significantly high in portal hypertensive patient with percentage of 11.9% and more prevalent in female.
Indian Heart Journal, 2018
The Egyptian Heart Journal, Jan 11, 2021
Background: Dual antiplatelet therapy is the current standard of care after acute coronary syndro... more Background: Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results: All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician's discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, reinterventions, or major bleeding manifestations was observed between the two groups. Conclusion: In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.
International Journal of Cardiology, May 1, 2021
INTRODUCTION Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome ... more INTRODUCTION Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome (ACS) management, and ticagrelor is one of the commonly used second antiplatelet agents. There is some evidence to suggest that morphine may reduce the antiplatelet effect of ticagrelor. METHODS AND RESULTS In a single-center, randomized controlled trial, we compared the effect of morphine and fentanyl on platelet aggregation (PA) among patients with ACS treated with ticagrelor. Platelet aggregation was studied by automated light transmittance aggregometry (LTA) at baseline, and at 2 h after ticagrelor loading. The primary outcome was the difference in the maximal inhibition of platelet aggregation [IPA(%)] between the groups at 2 h. Pain relief, and drug-related adverse events were secondary outcomes. Of 136 patients randomized, 70 received fentanyl and 66 received morphine. At baseline, the median (IQR) platelet aggregation [61.35% (54.6-to 70) Vs. 58.8% (52.7 to 72.9)] were comparable between the groups. There was no statistically significant difference between the fentanyl and the morphine groups in IPA at 2-h [85.88%(64.65-98.16) and 81.93%(44.2-98.03), p = 0.09]. However, morphine use was independently associated with a PA of >30% at 2 h (p- < 0.009). There was no difference in adverse events. CONCLUSION In patients with ACS, there was no significant difference between the use of fentanyl or morphine on the effect of ticagrelor on PA. (CTRI/2018/04/013423).
JACC: Cardiovascular Interventions
Journal of the American College of Cardiology
JOURNAL OF INDIAN COLLEGE OF CARDIOLOGY
Journal of the Practice of Cardiovascular Sciences
Journal of the American College of Cardiology
Journal of the American College of Cardiology
Journal of the American College of Cardiology
European Heart Journal, 2022
Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in In... more Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction. PURPOSE –We intent to study outcomes of acute coronary syndrome associated with COVID-19 patients . METHODS – This is a single center case-control study done in an University hospital in south India , from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without COVID -19 in the same period. RESULITS – 508 patients were admitted between May 2020 to October 2020 with ACS and out of which 58 patients were positive for COVID-19 and 450 patients were COVID-19 negative. In COVID positive gro...
Journal of the Practice of Cardiovascular Sciences
Annals of Clinical Cardiology
A Relationship Between Epistemological Beliefs on the Nature of Mathematics and Pedagogy of Mathe... more A Relationship Between Epistemological Beliefs on the Nature of Mathematics and Pedagogy of Mathematics
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women an... more Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less likely to undergo revascularisation compared to men. Aim: To study the risk factors, clinical characteristics, severity of CAD and to evaluate the outcomes in women undergoing coronary angiogram. Materials and Methods: This retrospective study included 912 women who had undergone coronary angiogram in our hospital from January 2018 to December 2018. The patients were divided into three groups- Group A consisted of 230 (25%) women with age <50 years. Group B consisted of 591 (65%) women with age between 50 to 69 years. Group C consisted of 91 (10%) women with age >70 years. Continuous variables were analysed by paired t-test and categoric...
The Egyptian Heart Journal
Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrom... more Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6...