PubMed | Frontier Lifeline Hospital, Kokilaben Hospital, PD Hinduja Hospital, Holy Family Hospital and 6 more.
Type: Review | Journal: Indian heart journal | Year: 2016
Early rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis. The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of 10%, well below the 99th percentile value. It reduces the time to diagnose acute myocardial infarction from 6h to 3h. A recent study has demonstrated that hs-cTnI can further reduce the time to 1h in 70% of all patients with chest pain. The European Society of Cardiology 2015 guidelines recommend including a second sample of hs-cTnI within 3h of presentation This increases the sensitivity of the hs-TnI assay from 82.3% (at admission) to 98.2% and negative predictive value from 94.7% (at admission) to 99.4%. Combining the 99th percentile at admission with serial changes in troponin increases the positive predictive value to rule in acute coronary syndrome from 75.1% at admission to 95.8% after 3h. The 2015 ESC Guidelines recommend the use of a rapid rule out protocol (0h and 1h) when hs-cTnI with a validated 0 to1h algorithm is available. Training and displaying the clinical algorithm depicting the role of hs-TnI assay in acute cardiac care units and in EDs are an efficient way to deliver the new standard of care to patients. Compared with contemporary troponin assays, the hs-cTn assay accelerates the diagnostic pathway to 0-1h, thus reducing the time for diagnosis of NSTEMI and hence, its management.
Kumar N.V.,University of Madras |
Menon T.,University of Madras |
Pathipati P.,Frontier Lifeline Hospital |
Cherian K.M.,Frontier Lifeline Hospital
The Journal of heart valve disease | Year: 2013
Infective endocarditis (IE) is a worldwide problem, and at least one-third of cases are culture-negative despite the use of appropriate laboratory techniques. A broad-range polymerase chain reaction (PCR) amplification was performed of the 16S rRNA gene, followed by single-strand sequencing for 26 surgically removed heart valves from patients with culture-negative endocarditis who had undergone valve repair or replacement. Two of the 26 patients were PCR-positive, and sequencing of the amplicon identified the etiological agent. Gram-stained smears of the heart valves were positive in both cases. Three of the remaining 24 cases which were negative by PCR also showed the presence of micro-organisms in Gram-stained smears. The study results emphasize that, in suspected IE cases when there is no growth in culture, a combination of microscopy and 16S rRNA sequencing can be used to identify the pathogen in excised valvular tissue.
Prent S.R.,Frontier Lifeline Hospital
Indian Journal of Practical Pediatrics | Year: 2011
The common arrhythmias that a paediatrician is likely to encounter in his clinical practice are the paroxysmal supraventricular tachycardias (PSVT). Of these, AV reciprocating tachycardia (AVRT) is predominantly seen in infancy while AV nodal re-entrant tachycardia (AVNRT) and paroxysmal junctional reciprocating tachycardias (PJRT) occur in the school going age group. The non-paroxysmal supraventricular tachycardias, ventricular arrhythmias and complete heart block are infrequent in children. A clear understanding of the mechanisms that initiate rhythm disturbances namely re-entry, automaticity and block as well as knowledge of the characteristics of myocardial and accessory tissues would enable optimal management of any arrhythmias.
Subramanyan R.,Frontier Lifeline Hospital
Annals of Pediatric Cardiology | Year: 2016
India faces a huge burden of pediatric and adult congenital heart diseases (CHDs). Many acquired valvar, myocardial, and vascular diseases also need treatment in childhood and adolescence. The emergence of pediatric cardiology as an independent specialty has been a relatively recent development. A few centers of excellence in pediatric cardiology have developed. However, the requirement of pediatric cardiac care and pediatric cardiologists is far in excess of what is available. There are no guidelines at present in India for uniform training in pediatric cardiology. Many training programs are nonstructured and do not focus on the regional needs. Both core training and advanced training programs are essential to provide adequate numbers of community-level pediatric cardiologists and academic leaders respectively. This article proposes a detailed plan and curriculum for comprehensive training of future pediatric cardiologists in India. © 2016 Annals of Pediatric Cardiology | Published by Wolters Kluwer - Medknow.
Borra S.K.,Frontier Lifeline Hospital |
Mahendra J.,Meenakshi Ammal Dental College |
Gurumurthy P.,Meenakshi Academy of Higher Education and Research |
Jayamathi,Meenakshi Ammal Dental College |
And 2 more authors.
Journal of Clinical and Diagnostic Research | Year: 2014
Background: Among various reactive oxygen species, hydroxyl radicals have the strongest chemical activity, which can damage a wide range of essential biomolecules such as lipids, proteins, and DNA.Objective: The objective of this study was to investigate the beneficial effects of curcumin on prevention of oxidative damage of biomolecules by hydroxyl radicals generated in in vitro by a Fenton like reaction.Materials and Methods: We have incubated the serum, plasma and whole blood with H2O2/Cu2 +/ Ascorbic acid system for 4 hours at 37 0C and observed the oxidation of biomolecules like albumin, lipids, proteins and DNA.Results: Curcumin at the concentrations of 50,100 and 200 μmoles, prevented the formation of ischemia modified albumin, MDA, protein carbonyls, oxidized DNA and increased the total antioxidant levels and GSH significantly.Conclusion: These observations suggest the hydroxyl radical scavenging potentials of curcumin and protective actions to prevent the oxidation of biomolecules by hydroxyl radicals. © 2014, Journal of Clinical and Diagnostic Research. All rights reserved.
Sasikumar N.,Frontier Lifeline Hospital |
Kuladhipati I.,Ayursundra Advanced Cardiac Center
Heart Asia | Year: 2014
Background Complete atrioventricular block complicating acute anterior wall ST elevation myocardial infarction (MI) is classically considered one of the worst prognostic indicators. Methods We present the case of a gentleman who developed complete atrioventricular block during the course of acute anterior wall ST elevation MI, and had spontaneous resolution of the same. Mechanisms of spontaneous resolution of complete atrioventricular block in the setting of acute MI are discussed. Attention is drawn to a subgroup of patients, albeit a minority, who have a better prognosis owing to reversible causes than classically expected and seen. Results Clinical features suggested that this patient had reocclusion of the infarct-related artery after thrombolysis on presentation and spontaneous reperfusion. Conclusion Coronary angiography provides invaluable information for decision making in such clinical scenarios. Complete atrioventricular block due to reversible ischaemia produced by reocclusion of an infarct-related artery should be reversible by percutaneous coronary angioplasty of the infarct-related artery. We suggest that reversible causes be considered before attributing atrioventricular block to irreversible damage, which would require a permanent pacemaker implantation. This would be more significant in most of the developing world, where resources are scarce.
Sasikumar N.,Frontier Lifeline Hospital |
Rajasekar P.,Frontier Lifeline Hospital |
Suramanyan R.,Frontier Lifeline Hospital
Indian Heart Journal | Year: 2013
A 21-year-old male presented with severe aortic paravalvular leak. He had undergone three cardiac surgeries and also had chronic kidney disease. It was decided for a trans-catheter closure owing to the risks of a fourth surgery and co-morbidity. The device was sized based on angiogram, balloon sizing and two dimensional transesophageal echo. There was significant residual leak after deployment of first device. Hence the defect was re-crossed and two duct occluder devices were positioned across the leak from two arterial access. After confirming position and satisfactory reduction in paravalvular leak, the devices were released in tandem. There was near abolition of leak. The patient is asymptomatic at three months follow up. Larger paravalvular leaks are better addressed with two devices of smaller size rather than a single large device. Technical considerations while deploying multiple devices are discussed. Copyright © 2013, Cardiological Society of India. All rights reserved.
Guhathakurta S.,Indian Institute of Technology Madras |
Mathapati S.,Frontier Lifeline Hospital |
Bishi D.K.,Frontier Lifeline Hospital |
Rallapalli S.,Indian Institute of Technology Madras |
Cherian K.M.,Frontier Lifeline Hospital
Asian Cardiovascular and Thoracic Annals | Year: 2014
Objectives: This study aimed to create a myocardial tissue construct by tissue engineering to repair, replace, and regenerate damaged cardiac tissue.Methods and results: Human cardiac muscles harvested from a homograft heart retrieval system were decellularized followed by coating with electrospun nanofibers to make them amenable to scaffolding. These processed cardiac tissues were nourished in modified media having ischemic cardiac tissue conditioned media in 6 separate experimental variants, and cord blood mononuclear cells were injected into 4 of them. On the 17th day of culture, the nanofiber-coated scaffolds injected with mononuclear cells and/or reinforced by electrical and mechanical forces, started contracting spontaneously at varying rates, while the control remain noncontractile. Histological staining confirmed the pre-culture acellularity as well as post-culture stem cell viability, and revealed expression of troponin I and cardiac myosin. The acellular processed scaffold when implanted into sheep ischemic myocardial apex revealed transformation into sheep myocardium after 4 months of implantation. absp Conclusion: These results provide direct evidence for the re-cellularization of decellularized cardiac tissue grafts reinforced with a polymer nanofiber coating, by human mononuclear cells injection, leading to generation of a tissueengineered myocardial construct. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Jaikanth C.,Frontier Lifeline Hospital |
Gurumurthy P.,Frontier Lifeline Hospital |
Cherian K.M.,Frontier Lifeline Hospital |
Indhumathi T.,S. B. alth Center Private Ltd
Experimental and Clinical Endocrinology and Diabetes | Year: 2013
"Less is moreo" - this is becoming the global quote on event of alarming rise in the prevalence of obesity among all age groups. The perspective of adipose tissue as merely a fat depot has changed in recent times. Focus is now being laid on the metabolic and inflammatory functions of the adipose tissue which is modulated through adipocytokines. Adipocytokines have been found to control insulin sensitivity, inflammatory activity, neuroendocrine activity, cardiovascular function, food and water intake, breeding, and bone metabolism. Few of these adipokines play a role in the positive metabolism promoting good health, while few of them pose adverse effects. Omentin is a recently identified novel adipocytokine and it falls under the category of being a good adipokine. Plasma omentin-1 levels are significantly decreased in patients with obesity, insulin resistance, and diabetes that contribute to the major components of the metabolic syndrome and other disease conditions like atherosclerosis, autoimmune disorders etc and that the review focuses on the comprehensive effects of omentin on all the major systems of the body. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart New York.
PubMed | Frontier Lifeline Hospital
Type: Journal Article | Journal: Asian cardiovascular & thoracic annals | Year: 2016
It is standard practice to band the pulmonary artery at 2 to 4 weeks of age in patients with univentricular hearts with increased pulmonary blood flow. The behavior of patients banded beyond the neonatal period has not been well elucidated.This was a retrospective chart review of 32 consecutive patients (one neonate) who underwent pulmonary artery banding for functionally univentricular heart. The mean age at banding was 5.76.0 months, and 34.4% were over 6-months old.Mortality was 15.6%. The mean systolic pulmonary artery pressure decreased from 43.69.7 to 29.67.0mm Hg. The mean pre-discharge echocardiographic band gradient was 60.613.6mm Hg (mean systemic systolic pressure 73.711.0mm Hg) and systemic oxygen saturation was 81.7%5.8%. At a mean follow-up period of 44.930.0 months, 6 patients were lost to follow-up, 13 had undergone bidirectional Glenn shunt, and 7 had Fontan operations. Pulmonary artery mean pressure was 17.24.6mm Hg at pre-Glenn catheterization. Of the 5 patients who had not undergone further surgery, only one was inoperable. All were in functional class I or II.Pulmonary artery banding beyond the neonatal period in suitable patients with univentricular hearts provides reasonable palliation in the intermediate term, with a significant number successfully undergoing Fontan stages.