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What is the greatest medical breakthrough since 1840?

Posted in cardiology-ethics, Uncategorized, tagged , , , , on October 14, 2008| Leave a Comment »

     The greatest discovery in medicine is  “ common sense” and

    “democracy”.           

                       The greatest medical discovery  is the realization that medicine is an constantly evolving science. It needs lot of knowledge to know our ignorance . Common sense has probably saved more lives and reduced suffering in this world than any other single discovery. Note this glaring irony ! It has required a large multi national long term follow  up study (INTERHERT) to prove exercise and physical activity is good for health. Whatever science is teaching us it is we, with our sixth sense have to act appropriately .It is the only defense against the potential exploitation against man kind by various forces.

Another great development is the freedom of expression and democracy in medicine,  for which journals like BMJ, Internet are striving hard . . .

Dr .S.Venkatesan ,Assistant professor of cardiology . Madras medical college Chennai , India

     

 Click on the title to view the article and all nominations . 

 

 

 

 

                         

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Dr.S.Venkatesan.MD.DM(Cardiology)

Posted in dr s venkatesan -Personal, tagged , , , , , , , , , , , , , , , , , on September 28, 2008| 2 Comments »

   Dr. Venkatesan   Sangareddi  

AK 53/1, # 9

Narmada enclave

 7th main road

Anna nagar

Chennai -600 040

Tel:044 26209009

                        

 

Age &  Date of birth

42 ,               25-5 -1964

Experience

1998–2007                  Madras  medical college                      Madras 

Asst. Professor  Of Cardiology

Work involves  intensive coronary care, invasive and non invasive cardiology.  Has special interest in  clinical research in Acute Coronary Syndromes

Has    publications in  various  Journals.

 

1997-1998                   Madras  medical college                       Madras           

Asst. Professor  Of Medicine

Worked  in intensive care medicine and  in

 Medical oncology for 6 months

 

 

1994–1996                    Madras   medical college                        Madras 

Resident   Cardiologist

Selected to resident programme   toping the state   in the super speciality  exam

Presented  papers in national conferences

Experience gained in invasive and non invasive cardiology

 

1991–1994                      Govt.  Health  Centre           Karur.       Tamil nadu

Medical Officer   

Worked in internal medicine  department

Family medicine and community health care.

And   socio economic aspects of health care.

Education

1994–1997              Madras  medical college                               Madras           

Doctorate  in cardiology (DM) 

 

1988-1991              Coimbatore medical college                          Coimbatore

 

Doctor  of Medicine (MD) Dr.M.G.R  Medical university  , Madras

 

Secured  three  gold medals for excellence in cardiology.

 

1987-1988            Coimbatore medical college          Coimbatore  India

 

Junior resident in  Medicine

 

1987                     Coimbatore medical college          Coimbatore

 

House  officer

 

1982-1986            Coimbatore medical college        Coimbatore

 

M B., B S.    Bachelor of Medicine and Bachelor of Surgery

 

                             Madras    University                           Madras     

 

Interests

Electro physiology, expert systems in cardiology., clinical research  in acute coronary  syndromes, preventive cardiology,  bio ethics, outcome analysis ,  logistics in cardiology and publishing  online journals. 

 

List Of  publications

Enclosed

Reference

Prof.V.Jaganathan. MD.,DM

Professor  &  Head of  Department

Institute of Cardiology, Madras Medical College  Chennai

   

 

Address  for   communication

 

Spouse

 

 

 

 

 

 

 Dr.Latha  Venkatesan  MD . Gynecologist,

 Sundaram  Medical  Foundation, Chennai  India.

AK 53/1, Flat no A- 9

TAS Narmada enclave

 7th main road

Anna nagar

Chennai -600 040

Tel:        044 6209009

Mobile : 9840059947

E.mail : drvenkatesans@yahoo.co.in>

 

 

 

 

 

 

 

 

 

List of publications by  S.Venkatesan

 

 

 

1.QTc  Interval  in atrial fibrillation.  The Tamilnadu Dr. M.G.R Medical university doctorate thesis 1991

 

2 .Thrombolysis in hyperacute MI.

 Indian Heart Jr  1999:51: 321

 

3. Circadian  Response To  Thrombolysis  In Acute Myocardial Infarction Indian Heart Jr  1999:51:686

 

4. Left Ventricular Mass in Pregnancy Induced Hypertension.

  Indian Heart Jr.  1999:51

 

5. Dissection of  interventricular septum by unruptured  right  sinus of valsalva    aneurysm  resulting in complete heart block.

Indian Heart Jr  1995 Nov-Dec: 605

 

6.Angiosarcoma  of leftventricle presenting as hemopericardium and  cardiac tamponade. Indian Heart Jr  1995 Nov-Dec:636

 

7.Asymtomatic multivessel disease  following  myocardial infarction

 Indian Heart Jr  1999:51: 686

 

8. Transmitral pulse doppler echo correlates of mitral regurgitation severity Indian Heart Jr  1999:51:636

 

9. Safety and efficacy of intravenous nicorandil  in unstable angina. Indian Heart  Jr  1999:51:704

 

10. Efficacy of nicorandil as monotherapy in ischemic heart disease Indian Heart Jr  1999:51:728

 

11. Left ventricuar function by angiogram in significant LAD disease. Indian Heart Jr  1999:51:687

 

12. Aortic root dimension in isolated rheumatic mitral stenosis

Journal of association of physicians of India abst: 1998

 

13. Serum phosphate in acute myocardial infarction

Indian J Physiol  Pharmacol 2000  44(2):225-8

 

14.Differential  Response  to  right  and  left  coronary  artery  thrombolysis   Indian Heart Jr  2000:52:715

 

 

15. Therapeutic  issues  in  Stable Ventricular  tachycardia: A coronary  care  unit  perspective Indian Heart Jr  2000: 52: 808.

 

 

16.Current   cardiology  practice: evidence  or  experience  based ?    An  analysis of  ACC/AHA  guidelines. World congress of cardiology   2002 sydney  Oral  presentation.(Published in Journal of American college of cardiology)JACC :2001.39:9 Sup.B 462B

 

17.Isolated  Diastolic Hypertension .World congress of cardiology  2002 sydney  poster  presentation..

( Published in Journal of American college of cardiology) JACC :2001.39:9 Sup.B 175B

 

18.Rescue thrombolysis in  acute myocardial infarction

Journal of association of physicians of India abst: 2002

 

19.Canadian   cardiovascular  society  classification of  angina:

 An  angiographic  correlation. Indian Heart Jr Abstract issue 2001

 

20.Non invasive management  of high risk unstable angina

Accepted for oral presentation in cardiological society of India annual scientific session Kolkata  Dec2003

 

21.Non dilated cardiomyopathy

Accepted for oral presentation in cardiological society of India annual scientific session  Kolkata  Dec 2003

 

22.Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS).
Am Heart J. 2004 Apr;147(4):E19

 

23.Rheumatic heart disease occurrence, patterns and clinical correlates in children aged less than five years.J Heart Valve Dis. 2004 Jan;13(1):11-4.

 

24. Estimation of subjective stress in acute myocardial infarction.
J Postgrad Med. 2003 Jul-Sep;49(3):207-10.

 

25. Serum phosphate in acute myocardial infarction.
Indian J Physiol Pharmacol. 2000 Apr;44(2):225-8.

 

26. Canadian Cardiovascular Society classification of effort angina: An angiographic correlation.
Coron Artery Dis. 2004 Mar;15(2):111-4.

 

Coming soon :

 

List of  top ten  leading famous  cardiologist  in india

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In ACC/AHA guidelines, how can a grade one recommendation be based on type C evidence ?

Posted in Cardiology -Interventional -PCI, cardiology-ethics, Infrequently asked questions in cardiology (iFAQs), tagged , , , , , , , , , , , , , , on September 7, 2008| Leave a Comment »

CURRENT   CARDIOLOGY  PRACTICE: EVIDENCE  OR  EXPERIENCE  BASED ?    AN  ANALYSIS OF  ACC/AHA  GUIDELINES.

S. Venkatesan,  Madras Medical College. Chennai

 

If  a  major therapeutic procedure is adviced based on simply by experience or expert opinion  how can we say evidence based medicine is practiced !

 

                                    Evidence based cardiology  is  the  buzz word  in global cardiovascular  health care  organizations. All diagnostic  and therapeutic  interventions are  undergoing  rigorous randomized  trials  for  proof of  efficacy  and  safety. ACC/AHA   have published  management guidelines and it  has been accepted  as de-facto standard of clinical cardiology practice world wide.  In these guidelines  class  1  indication  is defined as Conditions for which there is evidence for and/or general agreement that the procedure is useful and effective. These indications are supported by three levels of evidence.(A,B,C) .It has been observed,   many of the recommendations  in  class 1  were supported by only level  C  evidence. (Expert consensus or  agreement  ). We  analysed how much of todays guidelines is  agreement based  and  how much is evidence based. The  latest  practice  guidelines  of  ACC/AHA   for  Acute myocardial infarction , Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction , chronic  stable angina  ,coronary angiography  were analysed. The  no  of  class 1  indications  were counted  in each set of guidelines  and  each  of the indication were  sub grouped with reference to the  levels of  evidence  to which it was supported. There  were a total  of 210  class 1  indications.

  

 

Class  1

Level A

Class   1

Level  B

Class  1

Level  C

P value

1A vs 1C

AMI(54)

7

25

22

<.0001

UA  (66)

11

26

29

<.0001

CSA(59)

8

29

22

<.0001

CAG(31)

3

12

16

<.0001

Total(210)

29(13.9%)

92(43.8%)

89(42.4%)

<.001

 13.9%   of class 1  indications were based on  level  A evidence.  42.4%  of class 1 indication were based  on Level C  ( agreement  of experts).Though evidence based cardiology   is   considered  to  define  the  standards in  Cardiology  practice  in reality  we lack evidence in most of the situations. 

                                       We  conclude  that  consensus or  agreement  based cardiology  practice is the dominant theme in current   ACC/AHA 

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Journal club debates : Can a “Aim of a study” be wrong ?

Posted in cardiology -Therapeutics, tagged , , , , , , , , , , , , , , , , , , on July 27, 2008| 2 Comments »

Peer review of an article even in major journals never scrutinise the “Aim of  a study ” . However big is the journal,  they seem to bother only about the authors, materials, methods, and statistical analysis.  If only they peer review an article , right from the “Aim of the study” like ,

  • Who asks the research questions?
  • Who  defines the aim of the study ?
  • Who decides which drug to be compared with which drug ?
  • Who steers the steering commitee of a trial ?

If only , we could answer these questions without bias , pharma industry and their  regulators  would have ,  far more better image than what they have now !

A typical example for , the aim of the study  to be  wrong  , is  the “ONTARGET’ study on telmisartan.

Here they ( Who ? ) raised an inappropriate  question of     “Non inferiority” of one drug with other  without any  valid reason to compare these two drugs that will benefit the man kind !

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Should Rifampicin be added to all patients with infective endocarditis ?

Posted in cardiology -Therapeutics, tagged , , , , on June 20, 2008| Leave a Comment »

Infective endocarditis  remains a  major cardiac emergency.

Medical management has an initial role and  the many will require some form of surgery

( Mainly valve  replacement). But the surgeons request a realtively stable patients to operate upon as

surgical mortality is high in patients with uncontrolled infection and destabilsed CHF.

Even though there are battery of antibiotics, and volumes of texts written on the medical management

of infective endocarditis the medical therapy fails in bulk of the patients.

We have observed  emprical (Scientific guess work ) therapy has helped many patients .

While rifampicin according to scientific worls it’s useful only in prosthetic valve endocardtis

we have found it quiet useful in all resistant IE patients.

IE being a chronic inflammatory state rifampicin might work 

also as an anti inflammatory or immune   modulator.

This paper was presented in Cardiological society of India , Annual scientific sessions at  Mumbai 2005 . Download PPT

 

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