Varalakshmi Niranjan, MD

All Publications

• Diagnosis and management of metabolic dysfunction- associated steatotic liver disease in South Asians- A clinical review. Obesity pillars Ramesh, P. R., Krishnan, P., Prabu, S., Srinivasan, V., Niranjan, V. 2024; 12: 100142

  Abstract

  Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity and metabolic syndrome. It is mainly caused by insulin resistance. With the increased risk of visceral obesity in South Asians, the prevalence of MASLD is on the rise. The morbidity associated with MASLD and its complications, including hepatocellular carcinoma is projected to increase in this South Asian population.In this narrative review we explore the diagnosis and management of MASLD in the South Asian population. We summarize the findings from the recent literature on the diagnostic methods and management options for MASLD in this population.Through our search we found no specific guidelines for the diagnosis and management of MASLD in the South Asian population. The existing general guidelines may not be applied to South Asian populations due to the differences in phenotype, genotype, social and cultural aspects. South Asian countries also have limited resources with the non-availability of newer pharmacotherapeutic agents.The goal of this review is to guide obesity physicians and primary care providers to have a stepwise approach to treat patients at risk for MASLD with a main focus on interdisciplinary management most applicable to South Asian patients. More research is needed to formulate guidelines and algorithm that are specific for the South Asian population.

  View details for DOI 10.1016/j.obpill.2024.100142

  View details for PubMedID 39498281

  View details for PubMedCentralID PMC11532278

• Case report of a female western Indian vegetarian with obesity. Obesity pillars Niranjan, V., Ozimek, J. 2024; 12: 100137

  Abstract

  South Asians are defined as those indigenous to the Indian subcontinent - India, Pakistan, Sri Lanka, Nepal, Maldives, Bhutan, and Bangladesh. This ethnic group is a unique population with increased prevalence of metabolic syndrome even at a lower body mass index (BMI). Should they also have increased BMI, the risk for development of diabetes mellitus and cardiovascular complications are further magnified. Strong cultural perceptions about ideal body weight, lack of awareness about the race and ethnicity-specific risks, and knowledge gaps regarding different dietary patterns among the healthcare providers confound further the metabolic issues pertinent to South Asians living in North America.In this case study of a South Asian patient, we present asynchronous co-management of obesity by an obesity specialist and the primary care provider in a university-based clinic.Intense lifestyle interventions including a custom-tailored Indian vegetarian meal plan and weekly injectable Semaglutide was offered to the patient as treatment plan. The patient lost 59 pounds, and BMI changed from 34.1 kg/m2 to 23.5 kg/m2.Intensive lifestyle interventions with custom-tailored dietary changes, regular physical activity and behavior modifications combined with appropriate pharmacotherapy can be very successful in the management of obesity among South Asians living in North America.

  View details for DOI 10.1016/j.obpill.2024.100137

  View details for PubMedID 39469669

  View details for PubMedCentralID PMC11513479

• Chinmaya Chintamani (A book of poems in English on the philosophy of ultimate reality of human existence Niranjan, V. 2023
• Obesity Pillars Roundtable: Obesity and South Asians. Obesity pillars Bays, H. E., Shrestha, A., Niranjan, V., Khanna, M., Kambhamettu, L. 2022; 1: 100006

  Abstract

  Compared to other races/ethnicities, individuals from South Asia with obesity are strikingly susceptible to the presence of CVD risk factors and onset of CVD events - in part due to adiposopathic anatomic and metabolic responses to positive caloric balance. Pathogenic endocrine and immune effects of adipocyte hypertrophy and visceral fat accumulation both directly and indirectly promote among the most common metabolic diseases encountered in clinical practice - many being major cardiovascular disease (CVD) risk factors. This is especially applicable to those from South Asia - largely due to genetics, epigenetics, unhealthful nutrition, and physical inactivity.This roundtable discussion included 4 obesity specialists engaged in the clinical management of obesity among patients of South Asian descent.Patients with obesity from South Asia have increased adipocyte size, fewer (functional) adipocytes, and increased visceral adiposity accompanied by functional endocrine and immune abnormalities. This helps explain the increased CVD risk factors and increased CVD risk among this unique population. These CVD risk factors include increased prevalence of metabolic syndrome (even at lower body mass index relative to other races), insulin resistance, type 2 diabetes mellitus, increased lipoprotein (a), and adiposopathic dyslipidemia [(i.e., elevated triglyceride levels, reduced high density lipoprotein cholesterol levels, increased low density lipoprotein (LDL) particle number, and increased prevalence of smaller and denser LDL particles].The four panelists of this roundtable discussion describe their practical diagnostic processes and treatment plans for patients from South Asia, with an emphasis on a patient-centered approach to obesity in this unique population.

  View details for DOI 10.1016/j.obpill.2021.100006

  View details for PubMedID 37990701

  View details for PubMedCentralID PMC10661885

• Atmanandalahari (A book of poems in English based on the philosophy of oneness- Advaita Vedanta) Niranjan, V. 2022
• Lessons learnt from a single physician-led weight loss programme in primary care setting. International journal of clinical practice Niranjan, V., Sliwinska, A., Chen, F., Ramanan, S., Maheshwari, N., Wu, H. 2021; 75 (10): e14535

  View details for DOI 10.1111/ijcp.14535

  View details for PubMedID 34535049

• Bilateral sciatic hernias in an elderly woman successfully managed with robotic surgery: A case report and literature review. International journal of surgery case reports Zeng, F., Shames, B., Appel, E., Varalakshmi, N., Mortensen, E., Maheshwari, N. 2021; 86: 106333

  Abstract

  Sciatic hernias are the rarest form of pelvic floor hernias as well as an uncommon cause of sciatica. A high index of suspicion is required to make the diagnosis due to its variable clinical presentation. This is the first case describing bilateral intestinal sciatic hernia, diagnosis, and robotic surgical repair.A 77-year-old female with history of chronic back pain and diverticulitis presented with three weeks of abdominal pain, radiating down her legs bilaterally. Computed tomography (CT) revealed bilateral sciatic notch hernias without evidence of bowel obstruction. Magnetic resonance imaging (MRI) confirmed compression of the sciatic nerves within the sciatic notch bilaterally. She underwent robotic bilateral retroperitoneal sciatic notch hernia repair successfully.There are several independent causes of abdominal pain and bilateral radiating leg pain. Sciatic hernias are an unusual cause of both. Aside from bowel, the hernia can involve other structures, such as the bladder, ureters, or ovaries, potentially creating drastically different clinical pictures. Laparoscopic or robotic repair have been proven superior to open surgery in the literature.This case demonstrates that bilateral sciatic hernias can present as uncomplicated sciatica in an elderly patient, but the addition of seemingly unrelated abdominal pain should warrant further investigation. Minimally invasive robotic repair can successfully treat sciatic hernias.

  View details for DOI 10.1016/j.ijscr.2021.106333

  View details for PubMedID 34454211

  View details for PubMedCentralID PMC8405977

• Innovative way to create physician supervised weight loss program in primary care office setting Journal General Internal Medicine Niranjan, V. 2019
• Soup a day keeps the Doctor Away Varalakshmi, N. 2018
• Vaazhkai Oru Payanam (Life is a Journey- A book of poems in Tamil) Niranjan, V. 2017
• Nalam Vazha ( A book on health education in Tamil ) Niranjan, V. 2015
• Anticoagulation in ambulatory care: an evidence-based review of the literature. Professional case management Venkatachalam, V., D'Attilio, K., Lewis, A., Acevedo, M. 2007; 12 (2): 106-11

  Abstract

  PURPOSE OF THE MANUSCRIPT: Anticoagulation is warranted for the treatment of various disorders including cardiac, vascular, and postsurgical causes. Many centers have nurse case managers to coordinate care for patients on anticoagulation. This increases the demand for specific guidelines to assist nurse case managers to ensure quality of care. This review will address guidelines for nurse case managers and providers regarding initiating anticoagulation treatment and monitoring prothrombin time and international normalized ratio. Information will also be provided regarding when the nurse case manager should notify the providers to establish target international normalized ratio. This review will also provide educational tools to serve as standards for patient teaching, including drug and food interactions.This article applies to adult ambulatory practice that includes primary care, cardiology, and vascular and surgical settings.The complexity of managing anticoagulation in ambulatory practice warrants case management. The nurse case manager will establish a rapport with patients to improve compliance, providing patient education about diet, dosages, and drug interactions to reduce medication errors and bleeding complications. This review on anticoagulation management will assist nurse case managers and providers to provide better quality of care.

  View details for DOI 10.1097/01.PCAMA.0000265345.47268.bd

  View details for PubMedID 17413676

• Web based interactive dermatological and fundoscopic curriculum for internal medicine residents Venkatachalam, V. SPRINGER. 2006: 188-189

  View details for Web of Science ID 000202962000671

• Destiny--more than Geography! Connecticut medicine Venkatachalam, V. 2004; 68 (9): 588

  View details for PubMedID 15532440

• Educating the next generations on Diabetes Care- How are we doing? - A Report on Quality Assessment of Diabetes Mellitus in an Ambulatory practice of a teaching hospital Journal of General Internal Medicine Venkatachalam, V. 2004
• A tale of two tumors. Venkatachalam BLACKWELL PUBLISHING INC. 2002: 76

  View details for Web of Science ID 000175158200233

• Spinal tumour: a diagnostic lesson. Journal of accident & emergency medicine Varalakshmi, V., Idowu, A., Jeevan, S. 1998; 15 (3): 199

  View details for DOI 10.1136/emj.15.3.199

  View details for PubMedID 9639190

  View details for PubMedCentralID PMC1343070