Academic Paper publications:

1. Masson's Hemangioma of Proximal Radial Artery - Tumour like vascular lesions are rare. Here we report a rare case of tumor like vascular lesion from the radial artery. A pulsatile swelling in the forearm is usually diagnosed as a case of Aneurysm, AV fistul... Ramakrishna Pinjala in Indian Journal of Surgery (2012)

2. Thrombophilia – How Far and How Much to Investigate?- Thrombohemorrhagic balance is maintained by complicated interactions between the coagulation and fibrinolytic system, platelets, and the vessel wall. Dr. Virchow provided approach for investigating and managin...

R. K. Pinjala, L. R. C. Reddy, R. P. Nihar, G. V. A. Praveen… in Indian Journal of Surgery (2012)      

3. Leiomyosarcoma of the Inferior Vena Cava:Segment II- R. Pinjala  Received 20 November 2012; accepted 24 April 2013. published online 10 June 2013. PII: S1533-3167(13)00019-8 doi :10.1016/j.ejvsextra. 2013.04.002 © 2013 European Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

4. Venous thromboembolism risk & prophylaxis in the acute hospital ... Ramakrishna Pinjala on behalf of all ENDORSE-India investigators*. Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India ...www.icmr.nic.in/ijmr/2012/july/0709.pdf - Cached - Similar

5. Retrospective evidence for clinical validity of expanded genetic model in warfarin dose optimization in a South Indian population Addepalli Pavani, Shaik Mohammad Naushad, Ramesh C Mishra, Amaresh Rao Malempati, Ramakrishna Pinjala, Takallapally Ramesh Kumar, Vijay Kumar Kutala  Pharmacogenomics, June 2012, Vol. 13, No. 8, Pages 869-878. 6. Optimization of warfarin dose by population-specific pharmacogenomic algorithm. Pavani A, Naushad SM, Rupasree Y, Kumar TR, Malempati AR, Pinjala RK, Mishra RC, Kutala VK. Source Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Hyderabad, India. Pharmacogenomics J. 2012 Aug;12(4):306-11. doi: 10.1038/tpj.2011.4. Epub 2011 Mar 1. Important functions During this year 2012-13: Elected President of the Vascular Society of India Received –  Fellowship from the Vascular society of India Promoted as Senior professor – in Nizam’s Institute of Medical Sciences Academic Associate Dean of the NIMS – Appointed Examiner for the National DNB-vascular surgery examination Examiner for MCh-Vascular surgery examination Theory Paper setting for the DNB and MCh vascular surgery examinations MCQs – for the entrance examinations for the vascular surgery MCh and DNB courses MCI – inspector  for examining the facilities at the centres to start the MCh vascular surgery. Attended the National and international conferences in India. Organizing chairman for the Annual meetings of Day care surgery, Diabetic foot society of India – Annual conferences in Hyderabad. Delivered Lectures on Deep vein thrombosis, Triple Combination therapy in Hypertension, Diabetic dysvascular foot, High dose statin therapy in the prevention of cardiovascular mortality, ischemia reperfusion syndrome, Diabetic foot infections, Newer anticoagulants.

Excess dietary sodium is a major public health problem worldwide

High Salt intake is common in some parts of the world. Excessive carbohydrate intake can lead to Diabetes and excessive salt intake can lead to the hypertension and the associated complications. Many drugs and formulations contain sodium and it was observed that that can be harmful too.

Exposure to sodium-containing formulations of effervescent, dispersible, and soluble medicines was associated with significantly increased odds of adverse cardiovascular events compared with standard formulations of those same drugs. Sodium-containing formulations should be prescribed with caution only if the perceived benefits outweigh these risks.

Excess dietary sodium is a major public health problem worldwide. In response to a 2010 report by the Institute of Medicine, the National Salt Reduction Initiative (NSRI) was established with a goal to reduce dietary sodium consumption in the United States by 20% in five years. Reducing sodium intake in the US to the recommended 2.3 g/day (100 mmol/L or one teaspoonful) could prevent 11 million cases of hypertension, save $18bn (£11bn, €13bn) healthcare dollars, and gain 312 000 quality adjusted life years (QALYs) valued at $32bn annually. In the United Kingdom, the Food Standards Agency also launched a campaign in 20023 to reduce salt intake in the estimated 26 million people in the UK who have high dietary sodium intake. It has been estimated that a 3 g/day reduction in salt (1.2 g/day reduction in sodium) could prevent 30 000 cardiovascular events and save the National Health Service (NHS) at least £40m/year (€48m, $64m).
The dispersible and effervescent formulations of paracetamol 500 mg, however, can contain 18.6 mmol and 16.9 mmol of sodium in each tablet, respectively, and therefore the maximum daily dose of eight tablets/day results in the ingestion of 148.8 mmol and 135.2 mmol of sodium, respectively. This exceeds the recommended total daily allowance of sodium for one drug alone. Added to a typical Western diet, these drugs could result in high sodium intake. Curiously, unlike foods, pharmaceutical manufacturers are not placed under any restrictions or obligations with regards to sodium content or labeling of these sodium-containing formulations.
Beware of Tablets with High sodium content especially in patients where you are restricting salt intake !!!

Varicose GSV and catheter directed foam sclerotherapy

In India, surgical therapies or endovenous ablative therapies for varicose veins are going to be more expensive than the sclerotherapy under local anesthesia. It is possible to treat more people if the sclerotherapy results are improved further with less primary or secondary failures. Sclerotherapy for the axial veins (GSV) is considered to be inadequate as they have a larger lumen and it is difficult to decide the concentration of the sclerosant solution prior to injection. Catheter directed foam sclerotherapy seems to be good in these patients to maintain the appropriate contact between the foam and venous endothelium. Some times we feel that the vein lumen reduction can help us to achieve better results. I noted a study in which vein (GSV) diameter was reduced by perivenous tumescent local anesthesia before the infection of foam sclerosant in the through a catheter. 8ml of 2% foam was used for occluding the GSV. Patients were followed 1, 6, 12 months period. No benefit could be found using additional TA to reduce the vein diameter before the treatment.

Eur J Vasc Endovasc Surg. 2013 Oct 30. pii: S1078-5884(13)00649-7. doi: 10.1016/j.ejvs.2013.10.017. [Epub ahead of print]

Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia.

Devereux N, Recke AL, Westermann L, Recke A, Kahle B.

Source

Department of Dermatology, University of Schleswig-Holstein, Campus Luebeck, Germany.

Abstract

OBJECTIVES:

The aim of this study was to evaluate occlusion rates of great saphenous veins (GSV) with a diameter between 5-10 mm that received a pre-treatment size reduction via perivenous tumescent application (TA) followed by catheter-directed foam sclerotherapy (CDFS).

METHODS:

A prospective blinded randomized clinical trial comparing the occlusion rates of GSV at 1-, 6-, and 12-month follow-up. Fifty patients were included and randomized into two groups. CDFS was performed accessing the GSV at knee level and applying 8 mL of 2% polidocanol-foam (EasyFoam) while the catheter was withdrawn. Strictly perivenous TA was performed in group 1 before applying the sclerosant agent. Occlusion rates and clinical scores were assessed by blinded examiners.

RESULTS:

After 12 months in group 1 full occlusion was achieved in 73.9%, partial occlusion in 8.7%, and 17.4% were classified as treatment failure. In group 2, 75% of the targeted GSV were fully occluded, 20% were partially occluded, and 5% were diagnosed as treatment failure. Both groups showed a significant reduction of the vein diameter. Patient's tolerance and satisfaction with the treatment was high in both groups.

CONCLUSION:

No benefit could be found using additional TA to reduce the vein diameter before the treatment.