Qualification: 
MSc
greeshmacr@aims.amrita.edu

Greeshma C. Ravindran joined as a Tutor in the Department of Biostatistics at Amrita School of Medicine in July 2017. She completed her M.Sc. Biostatistics from Amrita Institute of Medical Sciences, Kochi, in 2015 and BSc Statistics from the University of Calicut in 2013. She has 5 years of teaching and research experience in the area of statistics in medical research. She had worked as Statistical Assistant at National Ayurveda Research Institute for Panchakarma (NARIP) Cheruthuruthy (Central Council for Research in Ayurvedic Sciences (CCRAS), Ministry of AYUSH, Govt. of India) from December 2016 to July 2017, and Biostatistician in Department of Academics, at Kerala Institute of Medical Sciences (KIMS Hospital), Trivandrum from the period of October 2015 to December 2016.

Workshops Attended

  1. National Webinar on “Data Science: From Raw Data to Development” organized by Research Department of Statistics, Nehru Arts and Science College, Kanhangad on October 28, 2020  
  2. International Webinar on “Recent Advances in Biostatistics and Data Science”, organized by the Department of Data Science, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education (MAHE), Manipal on October 20, 2020
  3. Webinar on the topic “SAMPLE SIZE DETERMINATION” organized by Department of Statistics, College of Veterinary and Animal Sciences, Mannuthy in connection with World Statistics day celebration on October 20, 2020.
  4. National Webinar on “Basics of Python for Data Science” organized by Research Department of Statistics, Nehru Arts and Science College, Kanhangad on September 28, 2020
  5. Workshop on “Application of Biostatistics in Clinical Research” conducted by Department of Biostatistics at NIMHANS Bangalore, on January 25, 2020.
  6. Workshop on “Dissemination Program of National Ethical Guidelines 2017” conducted at Amrita Institute of Medical Sciences, Kochi on February 22, 2018.
  7. Workshop on “Dissemination Program of ICMR-DBT National Guidelines for Stem Cell Research 2017” conducted at Amrita Institute of Medical Sciences, Kochi February 22, 2018.
  8. National Workshop on “Art and skill project Reports and Publishing Journal Paper” Conducted by Trivandrum Management Association during November 14-15, 2015.
  9. National Conference on “Interdisciplinary Realms of Statistics” organized by the Dept. of Statistics, Sree Keralavarma College, Thrissur in association with Kerala Statistical Association from January 9-10, 2015.
  10. Workshop on “Qualitatitive Data and Analysis Methods” conducted at Amrita Institute of Medical Sciences and Research Centre, Kochi, from August 21-23, 2014.

Publications

Publication Type: Journal Article

Year of Publication Title

2021

J. Thilak, Babu, B. C., Thadi, M., Mohan, V., T. Kumar, A., Mane, P. P., and Greeshma C. Ravindran, “Accuracy in the Execution of Pre-operative Plan for Limb Alignment and Implant Positioning in Robotic-arm Assisted Total Knee Arthroplasty and Manual Total Knee Arthroplasty: A Prospective Observational Study”, 2021.[Abstract]


The objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan.

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2020

R. P., M., J., Suresh R., Savithri V., T., A., and Greeshma C. Ravindran, “Expression of CK 19 as a biomarker in early detection of oral squamous cell carcinoma”, Journal of Oral and Maxillofacial Pathology, vol. 24, no. 3, pp. 523-529, 2020.[Abstract]


Background: Increased mortality in oral squamous cell carcinoma (OSCC) had been attributed to delay in diagnosis. Lack of a specific marker to assess the malignant potential of premalignant lesions is thought to be one of the reasons for late detection. Expression of Cytokeratin 19, which is widely used as an odontogenic epithelial marker had been reported in OSCC. Downregulation of CK 19 expression plays an important role in terminal differentiation of superficial squamous cell and increased expression in various epithelial malignancies has been suggested to be an indicator of malignant change.
Aims and Objectives: To assess the role of CK19 as a potential marker in predicting malignant transformation in oral precancerous lesions and as a prognostic marker in OSCC.
Materials and Methods: Study population consisted of ten samples each of normal oral mucosa, epithelial hyperplasia, varying grades of both oral epithelial dysplasias and OSCC. The tissue sections were subjected to immunohistochemical staining for the marker cytokeratin 19.
Results: An increased expression of CK19 was noted in oral epithelial hyperplasia, severe dysplasia and in superficial epithelium at the invading front in OSCC. In mild and moderate dysplasias, CK19 expression was lower than the normal mucosa. In oral squamous cell carcinoma, the expression of CK19 was restricted to either a few islands or a few cells within the islands, resulting in a lesser expression than the normal epithelium. The malignant epithelial islands in the superficial connective tissue stroma were showing greater expression than the deeper islands. The epithelial cells associated with formation of keratin pearls were found to be showing more expression than those with infrequent keratin pearls.
Conclusion: The study suggests that malignant transformation of epithelium can be predicted based on the increased expression of CK19. But it should be done with caution as a similar increased expression may also be noticed in presence of inflammation.

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2020

V. Marwaha, Anu Sasidharan, and Greeshma C. Ravindran, “Assessment of the Feedback Questionnaire from Students for a Weekend”, Indian Journal of Forensic Medicine & Toxicology, vol. 14, no. 2, pp. 158-163, 2020.

2020

G. S. Pillai, Remadevi, K. Krishnanku, Anilkumar, V., Radhakrishnan, N., Rasheed, R., and Greeshma C. Ravindran, “Clinical profile and outcome of endogenous endophthalmitis at a quaternary referral centre in south India.”, Indian J Ophthalmol, vol. 68, no. 5, pp. 827-833, 2020.[Abstract]


Purpose: The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis.

Methods: Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009-2016.

Results: In our study, 41 eyes of 34 patients were included. Most common co-morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7%) and most common infective foci was UTI (73.2%). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93% were Gram positive bacteria and 23.07% were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immunosuppressed state (72.7%) and bilateral cases (66.7%). The mean presenting vision (log MAR) of patients who died during the study were poor compared to those who survived (P = 0.014) Poor mean visual acuity at presentation was associated with more death (P = 0.014). Eyes with poor presenting vision, fungal isolates, culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7%) compared to Candida (75%) and bacteria (58.3%). Evisceration was done for 5 out of 41 eyes (12.2%). Vitrectomy rate was 53.7% in our study, with 40% of them showing overall improvement in vision.

Conclusion: Endogenous endophthalmitis is a sight threatening condition associated with high mortality particularly when caused by Aspergillus spp. in immunocompromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram-positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.

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2020

D. Nair, Laddha, A., Thomas, A., Greeshma C. Ravindran, and Pooleri, G., “Integration of yoga in the management of patients undergoing surgery for prostate cancer: A pilot study”, Amrita Journal of Medicine, vol. 16, p. 6, 2020.[Abstract]


Introduction: Integration of yoga in health-care management has beneficial effects in the management of many health-related issues with improved outcomes with no added cost. We conducted a pilot study to study the feasibility of yoga in the integrated management of patients with localized prostate cancer undergoing robotic-assisted radical prostatectomy. Methods: This prospective pilot study included twenty patients who underwent robotic-assisted radical prostatectomy between June 2019 and November 2019. The overall effects of yoga on health-related quality of life, recovery of urinary continence, and erectile function were the primary endpoints of our study. Results: Patients in the yoga group had significantly better continence rates at 1 month (90% vs. 50%) with better functional outcomes as compared to the control group at 1-month follow-up. The difference in sexual recovery was not significant in each group at 1-month follow-up.Conclusion: Yoga can be safely integrated in the postoperative management of patients undergoing radical prostatectomy with no short-term adverse side effects on overall outcomes.

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2020

A. Laddha, Thomas, A., Nair, D. Chandran, Greeshma C. Ravindran, and Pooleri, G. Kumar, “Outcome of TRUS Biopsy with Limited Cores in Patients with PSA More Than 50 ng/dL: Can We Reduce the Number of Cores Without Affecting Outcomes?”, Indian J Surg Oncol, vol. 11, no. 3, pp. 509-512, 2020.[Abstract]


The aims of our study were to see outcomes of limited core biopsy and compare its outcomes with standard 12-core biopsy in patients with PSA more than 50 ng/dL. We did a retrospective analysis of 149 patients undergoing prostatic biopsy with PSA more than 50 ng/dL between January 2014 and December 2018. Out of 149 patients, 49 underwent limited core (2 to 6 cores) TRUS biopsy with no systemic 12-core biopsy. Other 100 patients underwent standard 12-core biopsy under TRUS guidance. Total of 149 patient's records were analyzed and were included in the final analysis. There was no significant difference in demographics and prostate-specific antigen among the cohorts. All 49 patients in limited core TRUS biopsy had a positive biopsy with no need of re-biopsy. Fourteen out of 100 patients in TRUS biopsy had a negative biopsy. All 14 patients with negative biopsy had an average follow-up of 3.8 years with no conversion to positive biopsy. Patients with PSA more than 50 ng/dL and high clinical suspicion of prostate cancer can undergo limited core biopsy without systemic 12-core biopsy. In patients with no clinical evidence of prostate cancer, 12-core biopsy remains the gold standard for evaluation of prostate cancer.

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2020

A. Laddha, Appu Thomas, Nair, D. Chandran, Greeshma C. Ravindran, and Ginil Kumar Pooleri, “Outcomes of standard 12-core transrectal ultrasound-guided prostate biopsy in biopsy naive Indian men -single center experience”, Indian Journal of Urology, vol. 36, no. 3, pp. 179-183, 2020.[Abstract]


Introduction: Prostate cancer is now the second-most common cancer in many parts of India. Despite being the second-largest population in the world, data regarding outcomes of biopsy in Indian men are limited. We report the correlation of biopsy finding with prostate-specific antigen (PSA) level in Indian men undergoing biopsy for either elevated PSA and/or abnormal digital rectal examination (DRE) findings.
Materials and Methods: We retrospectively analyzed data of 853 men who underwent TRUS-guided prostate biopsy in a single institution from January 2014 to October 2019. The biopsy was performed when serum PSA was more than 4.00 ng/mL and/or DRE findings were suspicious for malignancy.
Results: Overall cancer detection rate was 38.8%. Patients were classified in five groups based on PSA levels, irrespective of DRE findings (0–3.99 ng/mL, 4.00–9.99 ng/mL, 10.00–19.99 ng/mL, 20.00–39.99 ng/mL, and ≥40 ng/mL). Overall prostate cancer detection rates at corresponding at PSA levels were 3/23 (13%), 62/282 (21.9%), 86/226 (38.05%), 66/126 (52.3%), and 165/196 (84.18%), respectively. 331 (38.8%) patients of the total 853 had suspicious DRE, the cancer detection rate in corresponding PSA groups, based on DRE alone was 3/23 (13.04%), 23/42 (54.76%), 39/56 (69.64%), 43/52 (82.69%), and 157/160 (98.13%), respectively.
Conclusion: The overall prostate cancer detection rate at our center was 38.8%, which is much higher as compared to other Indian data. Our study also emphasizes the role of DRE in Indian men presenting with elevated PSA

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2020

Z. U. Mohamed, Prasannan, P., Moni, M., Edathadathil, F., Prasanna, P., Menon, A., Nair, S., Greeshma C. Ravindran, Sathyapalan, D. T., Menon, V., and Menon, V., “Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock.”, Indian J Crit Care Med, vol. 24, no. 8, pp. 653-661, 2020.[Abstract]


Background: Sepsis remains a leading cause of death worldwide despite advances in management strategies. Preclinical and observational studies have found mortality benefit with high-dose vitamin C in sepsis. Our study aims to prospectively evaluate the effect of intravenous hydrocortisone, vitamin C [ascorbic acid (AA)], and thiamine (HAT) administration in reducing inpatient all-cause mortality among patients with septic shock.

Materials and methods: Our single-center, prospective, open-label, randomized controlled trial recruited patients with admitting diagnosis of septic shock and assigned eligible patients (1:1) into either intervention (HAT) or control group (routine). The HAT group received intravenous combination of vitamin C (1.5 g every 6 hours), thiamine (200 mg every 12 hours), and hydrocortisone (50 mg every 6 hours) within 6 hours of onset of septic shock admission. The treatment was continued for at least 4 days, in addition to the routine standard of care provided to the control group. Thiamine and hydrocortisone use in control arm was not restricted. Vitamin C levels were estimated at baseline and at the end of the 4 days of treatment for both groups. The primary outcome evaluated was mortality during inpatient stay.

Results: Among 90 patients enrolled, 88 patients completed the study protocol. The baseline characteristics between the HAT ( = 45) and the routine ( = 43) groups were comparable. The all-cause mortality in the HAT cohort was 57% (26/45) compared to 53% (23/43) in the routine care group ( = 0.4, OR 1.19, 95% CI 0.51-2.76). The time to reversal of septic shock was significantly lower in the HAT (34.58 ± 22.63 hours) in comparison to the routine care (45.42 ± 24.4 hours) ( = 0.03, mean difference -10.84, 95% CI -20.8 to -0.87). No significant difference was observed between the HAT and the routine care with respect to changes in sequential organ failure assessment (SOFA) scores at 72 hours (2.23 ± 2.4 vs 1.38 ± 3.1), the use of mechanical ventilation (48% vs 46%), and mean Vasoactive Inotropic Score (7.77 ± 12.12 vs 8.86 ± 12.5).

Conclusion: Intravenous administration of vitamin C, thiamine, and hydrocortisone did not significantly improve the inpatient all-cause mortality among patients with septic shock.

Clinical significance: HAT protocol does not reduce hospital mortality but decreases time to shock reversal in septic shock.

How to cite this article: Mohamed ZU, Prasannan P, Moni M, Edathadathil F, Prasanna P, Menon A, Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock. Indian J Crit Care Med 2020;24(8):653-661.

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2019

G. Rampratap Agarwal, Krishna, N., Greeshma C. Ravindran, Jose, R., Padmanabhan, M., Jayant, A., and Varma, P. Kerala, “Early outcomes in patients undergoing off-pump coronary artery bypass grafting”, Indian Journal of Thoracic and Cardiovascular Surgery, vol. 35, no. 2, pp. 168 - 174, 2019.[Abstract]


In spite of general decline worldwide, off-pump coronary artery bypass grafting (CABG) surgery is performed in more than 60% of patients undergoing CABG in India; mainly because of shorter operative time and reduced procedure cost. However, paucity of data exists in literature about early outcomes following off-pump CABG from India.

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2019

V. V. Pillay, Sasidharan, A., Arathy, S. L., Karimassery Ramaiyer Sundaram, and Greeshma C. Ravindran, “Detection and estimation of arsenic and lead in coconut water - A Kerala study”, Indian Journal of Forensic Medicine and Toxicology, vol. 13, pp. 19-24, 2019.[Abstract]


Coconut is a popular food ingredient in many parts of the world and the water it contains is believed to be the purest form of natural drink available. The water is rich in potassium, sodium, chloride and many vitamins, and hence is considered the beverage of choice. In medical practice, coconut water is recommended as the preferred oral rehydration fluid in cases of severe dehydration due to diarrhoea. Chronic heavy metal poisoning has been shown to occur from plant products. However there is scanty research work relating to coconuts and heavy metal contamination. Among the various metals, lead is said to be the commonest metal involved. Arsenic is only second to lead in the incidence of chronic toxicity. When plants are exposed to heavy metals, mostly through contaminated water (irrigation), or contaminated soil, they accumulate in edible parts such as the fruits. This study was undertaken to detect the presence of two of the commonest heavy metals - arsenic and lead – in coconut water present in coconuts sold in different parts of Ernakulam district of Kerala state, and to quantitatively assess their levels. It was also decided to detect the differences in the levels of the metals between tender and mature coconut water, and also to detect inter-zonal variations within Ernakulam district in the levels of the two heavy metals, in tender and mature coconut water © 2019, Indian Journal of Forensic Medicine and Toxicology. All rights reserved.

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