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Jadhav U, Nair T, Bansal S, Ray S. Efficacy and safety of bisoprolol compared to other selective beta-1 blockers in the treatment of hypertension: a systematic review and meta-analysis of randomized parallel clinical trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bisoprolol, a highly cardioselective beta-1 blocker (s-BB) has theoretical advantage over other cardio selective betablockers by way of better potency and tolerability in treating hypertension (HT). Individual published trials comparing s-BB are typically small. Meta-analysis of such trials clarifies the issue and position of bisoprolol in HT therapy.
Purpose
This meta-analysis compares bisoprolol with other s-BBs (Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol, Nebivolol) for their efficacy and safety in patients with HT.
Methods
Literature databases PubMed, Embase, Cochrane Library, Clinicaltrials.gov, Surveillance, Epidemiology and End Results Program and 12 PV databases were searched systematically to identify randomized, parallel clinical trials published from inception to October 2019. Studies which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects meta-analyses were conducted to assess mean difference (MD) and 95% confidence interval (95% CI) for blood pressure (BP), heart rate (HR) and lipid profile.
Results
13 studies compared bisoprolol with other s-BBs (metoprolol, atenolol) were included in this meta-analysis. Bisoprolol reported significant reduction in aortic systolic BP [MD: −8.00; 95% CI: −11.57, −4.43; P<0.01] and diastolic BP [MD: −2.90; 95% CI: −4.98, −0.82; P<0.01] during 8 weeks (w) treatment compared to other s-BBs. Bisoprolol treatment for 12w showed significant change in ambulatory heart rate (AHR) [MD: −5.22; 95% CI: −8.37, −2.07; P<0.01], daytime AHR [MD: −5.75; 95% CI: −9.16, 2.34; P<0.01] and nighttime AHR [MD: −3.22; 95% CI: −6.18, −0.26; P=0.03] in comparison to other s-BBs. Significant increase in low frequency HR variability [MD: 100.79; 95% CI: 16.66, 184.91; P=0.02] was reported with bisoprolol treated for 8w compared to other s-BBs. Baroreflex sensitivity significantly favored bisoprolol treated for 8w [MD: 1.01; 95% CI: 0.03, 1.98; P=0.04] in comparison to other s-BBs. HDL-C significantly increased with bisoprolol treated for 52w [MD: 6.80; 95% CI: 3.01, 10.60; P<0.01], 104w [MD: 12.00; 95% CI: 5.04, 18.96; P<0.01] and 156w [MD: 8.00; 95% CI: 0.58, 15.42; P=0.03]. There were no significant changes in total cholesterol [MD: −3.06; P=0.38], LDL-C [MD: −3.60; P=0.18] and triglyceride [MD: −21.00; P=0.26] on treatment with bisoprolol. Serious adverse events did not differ significantly on treatment with bisoprolol compared to other s-BBs.
Conclusion
The results of this meta-analysis reveal that bisoprolol showed a significant reduction of BP, HR, baroreflex sensitivity and improved HDL cholesterol levels compared to other s-BBs. Our results highlight the heterogeneity amongst the s-BBs and highlights the benefit of choosing bisoprolol in comparison to other s-BB in the management of HT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Jadhav
- MGM New Bombay Hospital, New Mumbai, India
| | - T Nair
- P R S Hospital, Trivandrum, India
| | - S Bansal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
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Jadhav U, Ray S, Bansal S, Nair T. Effectiveness of bisoprolol versus selective beta-1 blockers in the management of hypertension: a systematic review and meta-analysis of randomized cross-over trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cross-over trials carry a higher weightage in choosing a therapeutic agent in clinical practice. A meta-analysis of cross-over trials involving the use of bisoprolol in hypertension (HT) would bring about clarity in positioning this drug.
Purpose
The present study aimed to clarify the underlying benefits of bisoprolol in the reduction of blood pressure (BP) in HT patients when compared to selective beta-1 blockers (s-BBs - Atenolol, Betaxolol hydrochloride, Esmolol, Acebutolol hydrochloride, Metoprolol succinate, Nebivolol) by performing a meta-analysis of “cross-over” trials published in literature.
Methods
Systematic search was undertaken in PubMed, Embase, Cochrane Library, Clinicaltrials.gov registry, Surveillance, Epidemiology and End Results Program and 12 pharmacovigilance databases. Randomized, cross-over studies published up to October 2019 which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was performed using random effects model in terms of mean difference (MD) and 95% confidence intervals (95% CI) for BP, heart rate (HR) and lipid profile.
Results
Nine randomized cross-over studies which compared bisoprolol with other s-BBs (atenolol and nebivolol) were included in this meta-analysis. Bisoprolol reported significant reduction of sitting BP [MD: −3.35, 95% CI: −6.75, 0.05; P=0.05] and reduction of diastolic BP [MD: −2.00; 95% CI: −8.04, 4.04; P=0.52, non-significant] among patients with HT when compared to other s-BBs. Heart rate (HR) decreased significantly among HT patients in bisoprolol group treated for 2 w [MD: −6.00; 95% CI: −11.30, −0.70; P=0.03] when compared to those treated with other s-BBs. Analysis of lipid profile showed non-significant reduction of serum cholesterol [MD: −7.74; 95% CI: −17.18, 1.70; P=0.11] and triglyceride [MD: −26.57; 95% CI: −64.34, 11.20; P=0.17] levels in the bisoprolol group compared to other s-BBs. Bisoprolol treatment for 8 w resulted in a slight but statistically significant change in potassium levels [MD: −0.10; 95% CI: −0.16, −0.04; P<0.01] among HT patients.
Conclusion
The results of this meta-analysis reported significant efficacy of bisoprolol on BP and HR in comparison to other s-BBs in a meta-analysis of cross-over trials. Our findings show that use of bisoprolol as a therapeutic option is efficacious and safe compared to other s-BBs in this patient population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Jadhav
- MGM New Bombay Hospital, New Mumbai, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - S Bansal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - T Nair
- P R S Hospital, Trivandrum, India
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Tonneau M, Phan K, Kazandjian S, Elkrief A, Panasci J, Richard C, Nolin-Lapalme A, El Sayed R, Ding L, Nair T, Malo J, Chandelier F, Kafi K, O'Brien J, Di Jorio L, Muanza T, Routy B. 1357P A deep radiomics approach to assess PD-L1 expression and clinical outcomes in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors: A multicentric study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - S Chandrasekaran
- Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal
| | - T Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Kaul U, Das MK, Agarwal R, Bali H, Bingi R, Chandra S, Chopra VK, Dalal J, Jadhav U, Jariwala P, Jena A, Gupta R, Kerkar P, Guha S, Kumar D, Mashru M, Mehta A, Mohan JC, Nair T, Prabhakar D, Ray R, Rajani R, Sathe S, Sinha N, Vijayaraghavan G. Consensus and development of document for management of stabilized acute decompensated heart failure with reduced ejection fraction in India. Indian Heart J 2020; 72:477-481. [PMID: 33357634 PMCID: PMC7772598 DOI: 10.1016/j.ihj.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/08/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Aim Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction. While there are multiple checklists available, an India-specific checklist that is easy to fill and validated by regional and national subject matter experts (SMEs) is required. 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.
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Affiliation(s)
- U Kaul
- Dept of Cardiology, Batra Hospital and Research Centre, 1, Mehrauli Badarpur Rd, Tughlakabad Institutional Area, New Delhi, India.
| | - M K Das
- Dept of Cardiology, CMRI Hospitals, 7/2 Diamond Harbour Road, Kolkata, West Bengal, India
| | - R Agarwal
- Dept of Cardiology, Jaswant Rai Speciality Hospital, Opp Sports Stadium, Civil Line Mawana Road Meerut, Uttar Pradesh, India
| | - H Bali
- Paras Hospital, Plot No. 2, HSIIDC Tech Park, Near NADA Sahib Gurudwara, Panchkula, Haryana, India
| | - R Bingi
- Vasavi Hospital, 15, 1st Stage, Opp. to 15E Bus Stop, 70th Cross Rd, Kumaraswamy Layout, Bengaluru, Karnataka, India
| | - S Chandra
- Dept of Cardiology, Virinchi Hospital, Virinchi Circle, Rd Number 1, Shyam Rao Nagar, Banjara Hills, Hyderabad, Telangana, India
| | - V K Chopra
- Max Superspeciality Hospital, 1, 2, Press Enclave Marg, Saket Institutional Area, Saket, New Delhi, India
| | - J Dalal
- Dept of Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, Maharashtra, India
| | - U Jadhav
- MGM Hospital, Plot No.35, Atmashanti Society, Sector 3, Vashi, Navi Mumbai, Maharashtra, India
| | - P Jariwala
- Yashoda Hospital, Raj Bhavan Rd, Matha Nagar, Somajiguda, Hyderabad, Telangana, India
| | - A Jena
- Kalinga Institute of Medical Sciences, Kushabhadra Campus, KIIT Campus, 5, KIIT Road, Patia, Bhubaneswar, Odisha, India
| | - R Gupta
- Preventive Cardiology, RUHS Hospital, Kumbha Marg, Sector 11 Rd, Pratap Nagar, Jaipur, Rajasthan, India
| | - P Kerkar
- KEM Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India; Asian Heart Institute, Bandra Kurla Complex, G/N, Bandra (E), Mumbai, Maharashtra, India
| | - S Guha
- Dept of Cardiology, Calcutta Medical College, 88, College St, Calcutta Medical College, College Square, Kolkata, West Bengal, India
| | - D Kumar
- MEDICA Superspeciality Hospital, 127, Eastern Metropolitan Bypass, Nitai Nagar, Mukundapur, Kolkata, West Bengal, India
| | - M Mashru
- Dept of Cardiology, Sir H N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Rammohan Roy Rd, Charni Road East, Khetwadi, Girgaon, Mumbai, Maharashtra, India
| | - A Mehta
- Sir Ganga Ram Hospital and Research Centre, Sarhadi Gandhi Marg, Old Rajinder Nagar, Rajinder Nagar, New Delhi, Delhi, India
| | - J C Mohan
- Dept of Cardiology, Jaipur Golden Hospital, 2, Naharpur Village Rd, Institutional Area, Sector 3, Rohini, Delhi, India
| | - T Nair
- Dept of Cardiology, PRS Hospital, NH 47, Killipalam, Thiruvananthapuram, Kerala, India
| | - D Prabhakar
- Apollo First Med Hospital, Poonamallee High Rd, New Bupathy Nagar, Kilpauk, Chennai, Tamil Nadu, India
| | - R Ray
- AMRI Hospital, Block-A, Scheme-L11 P-4&5, Gariahat Rd, Dhakuria, Kolkata, West Bengal, India
| | - R Rajani
- P D Hinduja Hospital & Medical Research Centre, SVS Rd, Mahim West, Shivaji Park, Mumbai, Maharashtra, India
| | - S Sathe
- Deenanath Mangeshkar Hospital and Research Centre, Deenanath Mangeshkar Hospital Road, Near Mhatre Bridge, Erandwane, Pune, Maharashtra, India
| | - N Sinha
- Sahara India Medical Institute, Sahara India Medical Institute, Sahara Hospital Rd, Viraj Khand - 1, Viraj Khand, Gomti Nagar, Lucknow, Uttar Pradesh, India
| | - G Vijayaraghavan
- Kerala Institute of Medical Sciences, 1, Vinod Nagar Rd, Anayara, Thiruvananthapuram, Kerala, India
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Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - A K Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - T Nair
- Dept. of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra
| | - M Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal
| | - S Chandrasekaran
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology & Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology & Diabetes, Royal Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Kaul U, Verberk W, Suvarna V, Wander G, Vishwanathan M, Dani S, Hiremath J, Alegesan R, Vaidyanathan P, Natarajan S, Chandwani P, Punrnanad A, Nair T, Kapoor S, Kumar S, Arambam P. India Heart Study – IHS. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Memon P, Nair T, Yadav V, Tripathi S. ISQUA18-2325Designing and Implementing Competency Based Certification Program to Improve Quality of Intra and Immediate Postpartum Care in Private Sector – Experience from India. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tripathi S, Memon P, Kujur M, Nair T. ISQUA18-1439What it Takes to get Accreditation in Small Healthcare Organizations – Case Study from India. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iyengar SS, Nair T, Hiremath JS, Jadhav U, Katyal VK, Kumbla D, Sathyamurthy I, Jain RK, Srinivasan M. Pharmacologic reperfusion therapy with indigenous tenecteplase in 15,222 patients with ST elevation myocardial infarction - the Indian Registry. Indian Heart J 2013; 65:436-41. [PMID: 23993004 PMCID: PMC3860598 DOI: 10.1016/j.ihj.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the efficacy and safety of single intravenous bolus administration of indigenously developed tenecteplase (TNK-tPA) in the management of patients with ST-elevation myocardial infarction (STEMI) in clinical practice. METHODS Observational, prescription-event monitoring study. RESULTS Data of 15,222 patients who had STEMI and received weight adjusted TNK injection was analyzed. Overall 95.43% patients had clinically successful thrombolysis (CST). In the different subgroups, hypertensives, diabetics, smokers and hyperlipidemic patients had CST rates comparable to the general patient data. CST rates were significantly lower in the elderly patients (>70 years; 92.11%; p < 0.0001), in patients with history of Ischemic Heart Disease (IHD, 93.86%; p = 0.0004) and in patients receiving delayed treatment (>6 h after onset of chest pain; 85.38%; p < 0.0001). CST was significantly higher in patients who received an early thrombolysis (<3 h after onset of chest pain; 96.54%; p = 0.006). Overall mortality was 1.69%, while it was significantly higher in the elderly (4.42%), patients with history of IHD (2.67%), females (2.93%) and in those who received delayed treatment (4.98%). The overall incidences of intracranial hemorrhage (ICH), bleeding excluding ICH, stroke and ventricular tachyarrhythmia were 0.39%, 2.01%, 0.16% and 2.35% respectively. Age >70 years, diabetes, hyperlipidemia and history of IHD were associated with a higher incidence of heart failure, myocardial re-infarction or ventricular tachyarrhythmias. However, incidence of ICH and bleeding other than ICH was comparable amongst all patient subgroups. CONCLUSION This study confirms the safety and efficacy of indigenous tenecteplase in Indian patients with STEMI, including high risk subgroups. It also highlights the fact that delayed treatment denotes denial of benefits of pharmacologic reperfusion therapy.
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Affiliation(s)
- S S Iyengar
- Head, Department of Cardiology, Manipal Heart Institute, Bangalore 56001, India.
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Basu P, Krishnaswamy N, Shah N, Nair T, Farhat S, Ang L. PL-010 Turmeric enema: a novel therapy for C. difficile colitis (CDAD): A randomized, double blinded, placebo controlled prospective clinical trial. Int J Infect Dis 2011. [DOI: 10.1016/s1201-9712(11)60136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kanazawa T, Iwashita T, Kommareddi P, Nair T, Misawa K, Misawa Y, Ueda Y, Tono T, Carey TE. Galanin and galanin receptor type 1 suppress proliferation in squamous carcinoma cells: activation of the extracellular signal regulated kinase pathway and induction of cyclin-dependent kinase inhibitors. Oncogene 2007; 26:5762-71. [PMID: 17384686 DOI: 10.1038/sj.onc.1210384] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Galanin receptor 1 (GALR1) maps to a common region of 18q loss in head and neck squamous cell carcinomas and is frequently inactivated by methylation. To investigate effects of GALR1 and its signaling pathways, we stably expressed hemaglutinin-tagged GALR1 in a human oral carcinoma cell line (UM-SCC-1-GALR1) that expresses no endogenous GALR1. In transfected cells, galanin induced activation of the extracellular-regulated protein kinase-1/2 (ERK1/2) and suppressed proliferation. Galanin stimulation mediated decreased expression of cyclin D1 and increased expression of the cyclin-dependent kinase inhibitors (CKI), p27(Kip1) and p57(Kip2). Pretreatment with the ERK1/2-specific inhibitor U0126 prevented these galanin-induced effects. Phosphatidylinositol 3-kinase (PI3K) pathway activation did not differ in UM-SCC-1-GALR1 and UM-SCC-1-mock cells after galanin treatment. Pertussis toxin and LY294002 inhibition demonstrated that galanin and GALR1 induce ERK1/2 activation via Galphai, not the PI3K pathway-linked to the Gbetagamma subunit. Galanin and GALR1 also inhibit colony formation and tumor growth in vivo. Our results implicate GALR1, a Gi protein-coupled receptor, as a tumor suppressor gene that inhibits cell proliferation via ERK1/2 activation.
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Affiliation(s)
- T Kanazawa
- Laboratory of Head and Neck Cancer Biology, Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109-0506, USA
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Singh J, Nair T, Jena SK. A Training Aid for IV Access. Med J Armed Forces India 2003; 59:242. [PMID: 27407525 DOI: 10.1016/s0377-1237(03)80017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Starting intravenous drip is one of the first steps in the treatment of a patient. Training is the key to attain proficiency to get intravenous access.
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Affiliation(s)
| | - Tgm Nair
- Senior Advisor (Anesthesiology), Army Hospital (R&R), Delhi Cantt
| | - S K Jena
- Medical Officer, 436 Field Ambulance C/o 56 APO
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Cicerello A, Cullum C, Kingsbury S, Nair T, Garver D. Neuropsychological functioning in MRI-derived subgroups of schizophrenia. Arch Clin Neuropsychol 2000. [DOI: 10.1093/arclin/15.8.759a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nair T. Endothelial dysfunction--relevance to atherosclerotic vascular complications. Indian Heart J 1999; 51:336-7. [PMID: 10624079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- T Nair
- Department of Cardiology, PRS Hospital, Thiruvananthapuram
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Abstract
Murine monoclonal antibodies against cochlear structures were previously generated to obtain probes for elucidating the function of cochlear cell subsets. Preliminary immunocytochemical characterization showed that the monoclonal antibody KHRI 3 binds to supporting cells but not sensory cells in the guinea pig cochlea. We have now investigated KHRI 3 epitopes in other species and other parts of the inner ear. The KHRI 3 epitope appears to be species-specific since no immunolabeling was seen in rat inner ear nor in chick inner ear. In immunocytochemical assays in the guinea pig vestibular tissues KHRI 3 stained saccular wall cells and transitional epithelial cells in the utricle and ampules as well as clusters of cells in the endolymphatic sac. In Western blots KHRI 3 stained a broad 70-75 kDa band in lanes loaded with guinea pig cochlea homogenates--as seen previously--as well as in lanes loaded with vestibular tissue homogenates. The immunolabeling patterns suggest that KHRI 3 epitopes are cell membrane components or related to membrane structures. Thus the monoclonal antibody KHRI 3 appears to define a nonsensory cell subset in the guinea pig inner ear that can be identified by expression of KHRI 3 epitopes.
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Affiliation(s)
- M Ptok
- HNO-Hearing Research Laboratories, Department of Otolaryngology, University of Tübingen, FRG
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Nair T, Joy MV, Subramanyan R, Venkitachalam CG, Balakrishnan KG. Two-dimensional and Doppler echocardiographic study of coronary arteriovenous fistulas. Indian Heart J 1990; 42:149-52. [PMID: 2258197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sixteen patients with coronary arteriovenous fistula (CAVF) were studied by two-dimensional echocardiography (2DE). Of these 12 had Doppler studies. In all, the diagnosis of CAVF was confirmed by aortic root or selective coronary angiography. In 8 patients, the 2DE findings suggested CAVF. Five patients had dilated main coronary arteries and in 4 patients abnormal fistulous channels were identified. Two had diastolic flutter of the tricuspid valve and one had spontaneous contrast in the right atrium. In 11 out of 12 patients, Doppler analysis picked up a continuous flow (to the right atrium in 5, right ventricle in 4 and to both ventricles in 2 patients) prior to the cardiac catheterisation. We conclude that noninvasive diagnosis of CAVF can be made with the combined use of two-dimensional and Doppler echocardiography in most of the patients.
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Affiliation(s)
- T Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Salvaterra PM, Bournias-Vardiabasis N, Nair T, Hou G, Lieu C. In vitro neuronal differentiation of Drosophila embryo cells. J Neurosci 1987; 7:10-22. [PMID: 3100730 PMCID: PMC6568841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Early gastrula-stage Drosophila embryo cells will differentiate in vitro to form several cell types, including neurons. We report here the morphological appearance of cultured embryo cells, the pattern of DNA synthesis, and the expression of neurotransmitter-metabolizing macromolecules. The cells initially exhibit no overt morphological differentiation, and all cells incorporate 3H-thymidine following a 1 hr pulse-labeling period. As cells undergo morphological differentiation, fewer total cells as well as qualitatively different cell types incorporate label. By the time cells are 8 or 9 hr old, no myocytes or myotubes are labeled. In contrast, some neurons are labeled with a thymidine pulse as late as 18 hr. We have also stained cultured cells of various developmental ages with the insect neuron-specific antibody: anti-HRP. Some positive cells can be detected as early as 5 hr, when no overt morphological differentiation is apparent. As the cells differentiate, the staining is limited to the small, round neuronal type and its processes. These findings suggest that this neuron-specific cell marker is expressed very early in cultured gastrula-stage cells and may be used to identify neuronal precursor cells. We have studied the patterns of expression of several macromolecules involved in acetylcholine metabolism using these cultures. The appearance of choline acetyltransferase (ChAT), the biosynthetic enzyme for ACh production, is first detected in 5-hr-old cells. There is an initial phase of low-level expression, followed by a rapid rise in activity shortly after the differentiating neuron clusters make contact with one another. ChAT activity reaches a plateau in 36-48-hr-old cells. Acetylcholinesterase activity can be detected several hours before ChAT and also shows a period of low-level expression followed by a rapidly increasing phase, reaching a plateau at around 36-48 hr. 125I-alpha-bungarotoxin binding appears in cells about 4 hr old and rapidly approaches maximum levels by about 36 hr. The in vitro expression pattern for ChAT and AChE is similar to that seen in vivo. AChE activity has been localized histochemically to the neurons and their processes in vitro. The normal in vitro expression pattern for ChAT and AChE can be altered by adding various cholinergic drugs to the culture medium during cell differentiation. Medium conditioned by older cultures can also result in lower levels of ChAT and AChE expression.(ABSTRACT TRUNCATED AT 250 WORDS)
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