517 results on '"Kesava Reddy"'
Search Results
52. Implementation of 10 Gbps optical wireless link for 200 km inter-aircraft optical communications
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Sudhakar, Muppidi Venkata, primary and Rajini, Gaddam Kesava Reddy, additional
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- 2022
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53. Exploration on Mechanical Behaviours of Hyacinth Fibre Particles Reinforced Polymer Matrix-Based Hybrid Composites for Electronic Applications
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Pradeep Kumar Panda, J. Jebastine, Madhialagan Ramarao, Shaik Fairooz, Chirra Kesava Reddy, Omaima Nasif, Saleh Alfarraj, Velu Manikandan, and I. Jenish
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Article Subject ,TA401-492 ,General Engineering ,General Materials Science ,Materials of engineering and construction. Mechanics of materials - Abstract
Biocomposites with polylactic acid (PLA), nanosilica parts, and water hyacinth fibres have been developed in this experimental study. By changing the weight percentage of nanosilica particulate matter (0, 2, 4, 6, and 8 percent) with PLA and water hyacinth fibres, five composite mates were produced through a double screw extruder and compression moulding machine. According to the ASTM standards, the process to machine, the composite specimens have been adopted from the water jet machining process. The tensile, compression, flexural, impact, hardness, and water absorption tests were performed on the composite specimens to assess various mechanical properties and absorbance behaviour. The test findings reveal the significant improvement in the tensile and flexural properties of the composites. Composites contain 6 percent of the fine nanosilica particles by weight. Concerning adding the growing weight percentage (4 percent) of nanosilica particles to the composites, the water absorption properties of the composites have significantly improved. The tensile strength of 6% nanosilica mixed specimens showed the highest tensile stress rate as 36.93 MPa; the value was nearly 3.5% higher than the 4% nanosilica mixed composite specimens.
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- 2021
54. Implementation of 10 Gbps optical wireless link for 200 km inter-aircraft optical communications
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Muppidi Venkata Sudhakar and Gaddam Kesava Reddy Rajini
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Electrical and Electronic Engineering ,Condensed Matter Physics ,Atomic and Molecular Physics, and Optics - Abstract
The enhancements related to optical devices are highly required for high-speed compact wireless optical transmission systems. This paper focuses on development and analysis of the communication system for inter-aircraft applications. The vertical cavity surface emitting laser (VCSEL) is employed at the transmitter for generating directly modulated non-return to zero (NRZ) signal. Direct detection along with Gaussian low pass filtering is employed in the receiver. The performance of the system is examined as well as compared with and without application of filtering at the receiver. The performance of optical wireless system is analyzed in terms of BER, eye-pattern, sensitivity, SNR, and Q-factor. The data rate is enhanced by 4-fold and transmission distance is improved by 250% in comparison with earlier inter-satellite links.
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- 2022
55. Influence of Nanophase Particles on the Physical, Chemical and Tribological Characteristics of SAE15W40
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Medagam Kesava Reddy, K. Muralidharan, R. Sharath Chandra, P. L. Karthik Varma, K. Venugopal, R. Vaira Vignesh, M. Govindaraju, R. Senthil Kumar, and G. Suganya Priyadharshini
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Mechanics of Materials ,Mechanical Engineering ,Materials Science (miscellaneous) ,Materials Chemistry ,Metals and Alloys - Published
- 2022
56. Risk Factors Related to Diabetes Insipidus Development Following Transsphenoidal Pituitary Adenoma Resection: A Multicentric Retrospective Cohort Study
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Marcos Ezequiel Yasuda, Daniela Renedo, Soledad Sosa, Karina Danilowicz, Rodolfo Recalde, Roberto Zaninovich, Santiago Gonzalez Abbati, Andrés Cervio, Sebastian Giovannini, Juan Villalonga, Liezel Ulloque-Caamaño, Kesava Reddy, Mariano Socolovsky, and Alvaro Campero
- Abstract
Objective: To analyze and find risk factors associated with the development of DI using a multicenter case series via TSE. Materials and methods: Medical records of patients who underwent TSS for PA resection between 2010-2021 at three different neurosurgical centers by four experienced neurosurgeons were retrospectively analyzed. The patients were divided into two groups (DI Group or Control Group). Logistic regression analysis was conducted to identify risk factors associated with postoperative DI. Univariate logistic regression was performed to identify variables of interest, and covariates with a p-value < 0.15 were incorporated into multivariate logistic regression models to identify independently associated risk factors for DI. All statistical tests were conducted using RStudio. Results: 344 patients were included; 68% were women, the mean age was 46.5 years, and non-functioning adenomas were the most frequent (171, 49.7%). The mean tumor size was 20.3 mm. Covariates associated with postoperative DI were female gender, cavernous sinus invasion (left or bilateral), intraoperative CSF leak, endoscopic surgery, left preoperative visual field involvement, complete tumor resection, Knosp score of 2 and 4, and macroadenomas. Age was associated with a lower OR for postoperative DI. Multivariable model showed female gender (OR 3.34 CI 1.50-7.99, p=0.004) and intraoperative CSF leak (OR 3.25 CI 1.25-8.85, p=0.017) were found to be independently associated with higher OR of developing postoperative DI. Age was not shown to be a protective factor for DI (OR 0.97; CI: 0.94-1.00; p=0.038). Conclusions: The independent risk factors for the development of DI were female patients and intraoperative CSF leak.
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- 2022
57. The Development of Long-Term Adverse Health Effects in Oil Spill Cleanup Workers of the Deepwater Horizon Offshore Drilling Rig Disaster
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Mark A. D’Andrea and G. Kesava Reddy
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blood disorders ,cardiac toxicity ,chemical exposure ,crude oil spill ,dispersants ,health impact ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundThe purpose of this study was to assess the long-term adverse health effects of the 2010 Deepwater Horizon Gulf oil spill exposure in workers who participated in its cleanup work.MethodsMedical charts of both the oil spill exposed and unexposed subjects were reviewed. The changes in the white blood cells, platelets, hemoglobin, hematocrit, blood urea nitrogen, creatinine, alkaline phosphatase (ALP), aspartate amino transferase (AST), alanine amino transferase (ALT) levels, as well as their pulmonary and cardiac functions were evaluated.ResultsMedical records from 88 subjects (oil spill cleanup workers, n = 44 and unexposed, n = 44) were reviewed during initial and 7 years follow up visits after the disaster occurred. Compared with the unexposed subjects, oil spill exposed subjects had significantly reduced platelet counts (×103/µL) at their initial (254.1 ± 46.7 versus 289.7 ± 63.7, P = 0.000) and follow-up (242.9 ± 55.6 versus 278.4 ± 67.6, P = 0.000) visits compared with the unexposed subjects (254.6 ± 51.9 versus 289.7 ± 63.7, P = 0.008). The hemoglobin and hematocrit levels were increased significantly both at their initial and follow-up visits in the oil spill exposed subjects compared to the unexposed subjects. Similarly, the oil spill exposed subjects had significantly increased ALP, AST, and ALT levels at their initial and follow-up visits compared with those of the unexposed subjects. Illness symptoms that were reported during their initial visit still persisted at their 7-year follow-up visit. Notably, at their 7-year follow-up visit, most of the oil spill exposed subjects had also developed chronic rhinosinusitis and reactive airway dysfunction syndrome as new symptoms that were not reported during their initial visit. Additionally, more abnormalities in pulmonary and cardiac functions were also seen in the oil spill exposed subjects.ConclusionThis long-term follow-up study demonstrates that those people involved in the oil spill cleanup operations experiences persistent alterations or worsening of their hematological, hepatic, pulmonary, and cardiac functions. In addition, these subjects experienced prolonged or worsening illness symptoms even 7 years after their exposure to the oil spill.
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- 2018
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58. Green Communication in Wireless Power Consumption and Energy Efficient Trade-offs
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Dr.A.A. Ansari, G. Chenna Kesava Reddy, and Dr.S. China Venkateswarlu
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Base station ,business.industry ,Computer science ,Wireless network ,Cellular network ,Wireless ,Profitability index ,Throughput ,Telecommunications ,business ,Wireless sensor network ,Efficient energy use - Abstract
Energy efficiency is a significant issue in portable wireless networks since the battery life of versatile terminals is restricted. Protection of battery power has been tended to utilizing numerous procedures. Wireless sensor networks (WSNs), framed by various little gadgets fit for detecting, processing, and wireless correspondence are arising as a progressive innovation, with applications in different territories. The novel highlights of wireless sensor networks have carried new difficulties and issues to the field of conveyed and communitarian data preparing. In the light of the importance of reducing operating consumpt and maintaining cellular network profitability, energy efficiency in cell networks has received a crucial consideration from both scholars and the business, despite the fact that these networks are “green communication.” Since the base station is the most important energy buyer in the business, efforts have been undertaken to review the use of the base station and to identify ways to energy efficiency improvements. The trade-offs between energy utilization and throughput, under nearby just as under helpful detecting, are portrayed. The Energy efficient tradeoffs have been arranged dependent on every convention layer and examined its effect in the organization energy efficiency.
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- 2021
59. Progressive Convolutional Recurrent Neural Networks for Speech Enhancement
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S. China Venkateswarlu, M. Renu Babu, G. Chenna Kesava Reddy, and D. Vemana Chary
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- 2022
60. Multispectral Image Compression Using Adaptive Thresholding in Wavelet Domain with Binary Plane Techniques
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M. Renu Babu, S. Chinna Venkateswarlu, G. Chenna Kesava Reddy, and D. Vemana Chary
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- 2022
61. Strategic Design and Analysis of Energy Storage and ME Applications of Low Temperature Hybrid Microwave Sintered Electroceramic Composites.
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Thirumalasetty, Avanish Babu, Krishnan, Thiyagarajan, Kota Venkata, Siva Kumar, Adiraj, Srinivas, Xavier, Deepa, Venkatachalam, Subramanian, Kesava Reddy, Rajini Gaddam, Dudekula, Zarena, and Wuppulluri, Madhuri
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- 2023
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62. Organocatalyzed Modular Synthesis of Polycyclic Dihydropyridines and Pyridines through Sulfamate Linchpin
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Vinod Bhajammanavar, Popuri Sureshbabu, Mallu Kesava Reddy, and Mahiuddin Baidya
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Dihydropyridines ,Pyridines ,Organic Chemistry ,Imines ,General Chemistry ,Sulfonic Acids ,Biochemistry ,Catalysis - Abstract
The cascade annulation between alkylidene malononitriles and cyclic sulfamidate imines has been controlled by leveraging the sulfamate functionality under organocatalysis, which allows selective access to polycyclic and densely functionalized dihydropyridines and pyridines in high yields. The protocol is scalable and shows broad substrate scope. The products were also engaged in the preparation of tetracyclic pyridopyrimidines, showcasing the synthetic versatility.
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- 2022
63. Investigation of erosion mechanisms on IN-718 based turbine blades under water jet conditions
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K. G. Thirugnanasambantham, Agnal Francis, R. Ramesh, Aravind M, and Medagam Kesava Reddy
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Modeling and Simulation ,Industrial and Manufacturing Engineering - Published
- 2022
64. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review
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Michelle M. Kameda-Smith, Taylor Duda, Donald B. Duncan, Malavan Ragulojan, Yongkyung Jung, Forough Farrokhyar, Cheryl Main, and Kesava Reddy
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Adult ,Male ,Canada ,Treatment Outcome ,Diabetes Mellitus ,Brain Abscess ,Humans ,Surgery ,Neurology (clinical) ,Retrospective Studies - Abstract
This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes.A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors.We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration.Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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- 2022
65. Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series
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Forough Farrokhyar, Kaiyun Yang, Yosef Ellenbogen, Radwan Takroni, Kesava Reddy, and Majid S. Aljoghaiman
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Leak ,medicine.medical_specialty ,Dura mater ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Lumbar ,Cerebrospinal fluid ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,Early Ambulation ,Retrospective Studies ,Lumbar Vertebrae ,Cerebrospinal Fluid Leak ,Cerebrospinal fluid leak ,business.industry ,medicine.disease ,Surgery ,Pseudomeningocele ,medicine.anatomical_structure ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Background Cerebrospinal fluid (CSF) leak is a common complication in spine surgery. Repairing durotomy is more difficult in the setting of minimally invasive spine surgery (MISS). Efficacy of postoperative bed rest in case of dural tear in MISS is not clear. Objective To assess the safety and efficacy of our protocol of dura closure without changing access, early mobilization, and discharge in cases of intraoperative CSF leak in MISS. Methods A retrospective review from 2006 to 2018 of patients who underwent MISS for degenerative and neoplastic diseases with documented accidental or intentional durotomy was conducted. The primary outcome of interest was readmission rate for repair of persistent CSF leak. Secondary outcomes captured included development of pseudomeningocele, positional headache, and subdural hematoma. Results A total of 80 patients were identified out of 527 patients. Of these, intentional durotomy was performed in 28 patients and unintentional durotomy occurred in 52 patients. Mean follow-up period was 80.6 mo. Most of the patients were discharged on postoperative day 0 (within 4 h of surgery) without activity restrictions. A total of 2 (2.5%) patients required readmission and dural repair for continuous CSF leak and 3 patients (3.75%) developed pseudomeningocele. No lumbar drain insertion, meningitis, or subdural hematoma was reported. Conclusion Early mobilization and discharge in cases of intraoperative CSF leak in MISS appear to be safe and not associated with higher rate of complications than that of reported literature.
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- 2021
66. Organocatalyzed Modular Synthesis of Polycyclic Dihydropyridines and Pyridines through Sulfamate Linchpin
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Bhajammanavar, Vinod, primary, Sureshbabu, Popuri, additional, Kesava Reddy, Mallu, additional, and Baidya, Mahiuddin, additional
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- 2022
- Full Text
- View/download PDF
67. Intraventricular Metastatic Melanomas: Two Case Reports
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Mohamed, Alhantoobi, primary, Almunder, Algird, additional, Jian-Qiang, Lu, additional, John, Provias, additional, and Kesava, Reddy, additional
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- 2022
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68. Numerical investigation on fully-developed heat transfer augmentation and friction factor with dimple shaped intrusion and different radius of curvatures on triangular ducts
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L.B. Bharath Raju, G.R.K. Sastry, S.K. Gugulothu, K. Kesava Reddy, and B. Deepanraj
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Energy Engineering and Power Technology ,Industrial and Manufacturing Engineering - Published
- 2023
69. Genetics of Colloid Cyst in Monozygotic Twins: Case Report and Review of Literature
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Melissa Lannon, Jennifer MacKenzie, and Kesava Reddy
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Pediatrics ,medicine.medical_specialty ,Colloid cyst ,business.industry ,Concordance ,digestive, oral, and skin physiology ,medicine.disease ,complex mixtures ,Asymptomatic ,Hydrocephalus ,Genetic load ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Etiology ,Surgery ,In patient ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Colloid cysts are rare developmental lesions, accounting for approximately 1% of intracranial tumors. Often, these benign lesions are asymptomatic, but they are associated with significant mortality as a result of acute hydrocephalus. This mortality in patients with vague or no symptoms dictates a need for better understanding of the etiology of colloid cysts to expedite diagnosis and management. We present a case of monozygotic twins with colloid cysts to propose a genetic etiology for colloid cyst. Case Description Previously healthy male monozygotic twins presented 4 years apart with headache secondary to hydrocephalus as a result of colloid cysts. Both patients underwent multiple surgeries and were doing well at last follow-up. Conclusions The present case adds to a body of literature of familial colloid cysts, suggesting higher concordance in monozygotic compared with dizygotic twins. This may be due to high genetic load, shared intrauterine environment, epigenetic changes, or genetic mutation. This literature review suggests that given high morbidity and mortality of colloid cysts, screening may be beneficial. Even in the absence of a single, definitive genetic etiology, we recommend consideration of genetic screening or, at a minimum, screening with neuroimaging for monozygotic twins in cases where 1 twin is diagnosed with colloid cyst.
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- 2020
70. Brain Radiation Induced Extracranial Abscopal Effects in Metastatic Melanoma
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G. Kesava Reddy and Mark A. D’Andrea
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Cancer Research ,Cell signaling ,Metastatic melanoma ,Central nervous system ,Cohort Studies ,03 medical and health sciences ,Brain radiation ,0302 clinical medicine ,Immune system ,Immune privilege ,Radiation, Ionizing ,Tumor Microenvironment ,medicine ,Animals ,Humans ,In patient ,030212 general & internal medicine ,Melanoma ,Brain Neoplasms ,business.industry ,medicine.disease ,medicine.anatomical_structure ,Oncology ,Blood-Brain Barrier ,030220 oncology & carcinogenesis ,Cancer research ,Cranial Irradiation ,business ,DNA Damage - Abstract
Historically, the brain has been viewed as a specialized neurovascular inert organ with a distinctive immune privilege. Therefore, radiation-induced extracranial abscopal effects would be considered an unusual phenomenon due to the difficulty of the immunogenic signaling molecules to travel across the blood-brain barrier (BBB). However, it is now possible that localized central nervous system radiation has the ability to disrupt the structural integrity of the BBB and increase its endothelial permeability allowing the free passage of immunogenic responses between the intracranial and extracranial compartments. Thus, the nascent tumor-associated antigens produced by localized brain radiation can travel across the BBB into the rest of the body to modulate the immune system and induce extracranial abscopal effects. In clinical practice, localized brain radiation therapy-induced extracranial abscopal effects are a rarely seen phenomenon in metastatic melanoma and other advanced cancers. In this article, we provide a detailed overview of the current state of knowledge and clinical experience of central nervous system radiation-induced extracranial abscopal effects in patients with malignant melanoma. Emerging data from a small number of case reports and cohort studies of various malignancies has significantly altered our earlier understanding of this process by revealing that the brain is neither isolated nor passive in its interactions with the body's immune system. In addition, these studies provide clinical evidence that the brain is capable of interacting actively with the extracranial peripheral immune system. Thus, localized radiation treatment to 1 or more locations of brain metastases can induce extracranial abscopal responses. Collectively, these findings clearly demonstrate that localized brain radiation therapy-induced abscopal effects traverses the BBB and trigger tumor regression in the nonirradiated extracranial locations.
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- 2020
71. Reoperation in adult patients with recurrent glioblastoma: A matched cohort analysis
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Kaiyun Yang, Yosef Ellenbogen, Amanda Martyniuk, Michel Sourour, Radwan Takroni, Mohamed Somji, Emily Gardiner, Katrina Hui, Devang Odedra, Ramiro Larrazabal, Almunder Algird, Edward Kachur, Kesava Reddy, Naresh Murty, Forough Farrokhyar, and Sheila K Singh
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General Medicine - Abstract
Background Despite maximal safe cytoreductive surgery and postoperative adjuvant therapies, glioblastoma (GBM) inevitably recurs and leads to deterioration of neurological status and eventual death. There is no consensus regarding the benefit of repeat resection for enhancing survival or quality of life in patients with recurrent GBM. We aimed to examine if reoperation for GBM recurrence incurs a survival benefit as well as examine its complication profile. Methods We performed a single-center retrospective chart review on all adult patients who underwent resection of supratentorial GBM between January 1, 2008 and December 1, 2013 at our center. Patients with repeat resection were manually matched for age, sex, tumor location, and Karnofsky Performance Status (KPS) with patients who underwent single resection to compare overall survival (OS), and postoperative morbidity. Results Of 237 patients operated with GBM, 204 underwent single resection and 33 were selected for repeat surgical resections. In a matched analysis there was no difference in the OS between groups (17.8 ± 17.6 months vs 17 ± 13.5 months, P = .221). In addition, repeat surgical resection had a higher rate of postoperative neurological complications compared to the initial surgery. Conclusions When compared with matched patients who underwent a single surgical resection, patients undergoing repeat surgical resection did not show significant increase in OS and may have incurred more neurological complications related to the repeat resection. Further studies are required to assess which patients would benefit from repeat surgical resection and optimize timing of the repeat resection in selected patients.
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- 2022
72. Immunohistochemical Markers in the Diagnosis of Calcifying Pseudoneoplasm of the Neuraxis
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Kaiyun Yang, Kesava Reddy, Bill H. Wang, Aleksa Cenic, John Provias, Snezana Popovic, William H. Yong, France Berthelet, Michel W. Bojanowski, Robert Hammond, and Jian-Qiang Lu
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Central Nervous System ,medicine.medical_specialty ,Pathology ,Neurofilament ,business.industry ,Calcinosis ,General Medicine ,CD8-Positive T-Lymphocytes ,Immunohistochemistry ,Asymptomatic ,Axons ,law.invention ,Lesion ,Pathogenesis ,Neurology ,law ,Humans ,Medicine ,Histopathology ,Neurology (clinical) ,medicine.symptom ,Electron microscope ,business ,Immunostaining - Abstract
Background:Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unknown pathogenesis. It is likely under-reported due to diagnostic challenges including the nonspecific radiographic features, lack of diagnostic markers, and often asymptomatic nature of the lesions.Methods:We performed detailed examination of 11 CAPNON specimens diagnosed by histopathology, with the help of electron microscopy and immunohistochemistry.Results:Electron microscopy revealed the presence of fibrillary materials consistent with neurofilaments. In addition to some entrapped axons at the periphery of CAPNONs, we discovered that all specimens stained positive for neurofilament-light (NF-L) within the granular amorphous cores, but not neurofilament-phosphorylated (NF-p). CAPNONs also showed variable infiltration of CD8+ T-cells and a decreased ratio of CD4/CD8+ T-cells, suggesting an immune-mediated process in the pathogenesis of CAPNON.Conclusion:NF-L and CD4/CD8 immunostains may serve as diagnostic markers for CAPNON and shed light on its pathogenesis.
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- 2020
73. Visual Outcomes After Endoscopic Endonasal Resection of Orbital Lesions
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Kesava Reddy, Almunder Algird, Doron D. Sommer, Kaiyun Yang, and Yosef Ellenbogen
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Male ,Visual acuity ,genetic structures ,Exophthalmos ,business.operation ,Visual Acuity ,Postoperative Complications ,0302 clinical medicine ,Paraganglioma ,Optic Nerve Diseases ,Orbital Diseases ,Medicine ,Child ,Diplopia ,Middle Aged ,Magnetic Resonance Imaging ,Treatment Outcome ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,Nasal Cavity ,medicine.symptom ,Transorbital ,Orbit (anatomy) ,Adult ,medicine.medical_specialty ,Adolescent ,Vision Disorders ,03 medical and health sciences ,Angioleiomyoma ,Humans ,Minimally Invasive Surgical Procedures ,Aged ,Retrospective Studies ,business.industry ,Fibrous dysplasia ,Infant ,Endoscopy ,medicine.disease ,eye diseases ,Surgery ,Orbital Neoplasms ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background The endoscopic endonasal approach (EEA) has been increasing in popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathological entities. The purpose of the present study was to examine the outcomes of patients who had undergone EEA resection of orbital lesions at our center. Methods We performed a retrospective medical record review of patients who had undergone the EEA for resection of orbital lesions and orbital apex decompression from January 1, 2006 to December 1, 2019. For all the patients, the demographic data, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. Results Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including 6 male patients and 3 female patients. The mean age was 49.4 years, and the mean follow-up period was 3.8 years (range, 1–13.5 years). The orbital pathological lesions that were treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumor, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis. All the patients presented with exophthalmos of the affected orbit. Of the 9 patients, 5 presented with decreased visual acuity on examination. Postoperatively, 1 of these 5 patients had improved to baseline visual acuity, 3 had stable vision, and 1 had brief improvement before experiencing progressive visual decline 1 month postoperatively. Two patients presented with diplopia, and both improved postoperatively. Three patients experienced new, transient, and self-limiting postoperative diplopia. Conclusions For patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients.
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- 2020
74. Incidental multifocal calcifying pseudoneoplasm of the neuraxis: case report and literature review
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Bill Hao Wang, Kesava Reddy, Kaiyun Yang, and Jian-Qiang Lu
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medicine.medical_specialty ,Retrospective review ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General Medicine ,Clipping (medicine) ,medicine.disease ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Intraventricular hemorrhage ,030220 oncology & carcinogenesis ,Right middle cerebral artery ,Biopsy ,medicine ,Surgery ,Neurology (clinical) ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Craniotomy - Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is thought to be a rare tumefactive lesion with unknown pathogenesis. Its prevalence is questionable with few previously reported cases of incidental CAPNON, and likely underdiagnosis. We report a unique case of incidental multifocal CAPNON. A 64-year-old female was admitted with loss of consciousness due to a ruptured right middle cerebral artery aneurysm with subarachnoid and intraventricular hemorrhage. She has a craniotomy and clipping. At time of operation, numerous small dural-based nodules were found, and one was excised for biopsy and was diagnosed as CAPNON. Retrospective review of her CT images identified nodules that were all ipsilateral to the ruptured aneurysm. A literature review revealed that incidental and/or multifocal CAPNONs are rare but likely underreported. Our case suggests a reactive process in the pathogenesis of CAPNON.
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- 2020
75. Spontaneous spinal CSF–venous fistulas associated with venous/venolymphatic vascular malformations: report of 3 cases
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Ryan Rebello, Marcel M. Maya, Ravi Prasad, Richard I. Farb, Franklin G. Moser, Kesava Reddy, Rachelle B. Cruz, Alexander Tuchman, and Wouter I. Schievink
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Leak ,Weakness ,medicine.medical_specialty ,business.industry ,Fistula ,General Medicine ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,Spontaneous Intracranial Hypotension ,Spinal meningeal diverticulum ,medicine.symptom ,business ,Intracranial Hypotension ,030217 neurology & neurosurgery - Abstract
Spontaneous CSF–venous fistulas may be present in up to one-fourth of patients with spontaneous intracranial hypotension. This is a recently discovered type of CSF leak, and much remains unknown about these fistulas. Spinal CSF–venous fistulas are usually seen in coexistence with a spinal meningeal diverticulum, suggesting the presence of an underlying structural dural weakness at the proximal portion of the fistula. The authors now report the presence of soft-tissue venous/venolymphatic malformations associated with spontaneous spinal CSF–venous fistulas in 2 patients with spontaneous intracranial hypotension, suggesting a role for distal venous pathology. In a third patient with spontaneous intracranial hypotension and a venolymphatic malformation, such a CSF–venous fistula is strongly suspected.
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- 2020
76. Systemic Antitumor Effects and Abscopal Responses in Melanoma Patients Receiving Radiation Therapy
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Mark A. D’Andrea and G. Kesava Reddy
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Oncology ,Cancer Research ,medicine.medical_specialty ,Combination therapy ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Melanoma ,business.industry ,Abscopal effect ,Bystander Effect ,General Medicine ,Immunotherapy ,medicine.disease ,Clinical trial ,Radiation therapy ,Immune System ,030220 oncology & carcinogenesis ,Skin cancer ,business - Abstract
Background: Malignant melanoma represents the deadliest form of skin cancer with a high tendency to metastasize during the early course of the disease. Radiation therapy has long played a key role in the management of both local and metastatic melanoma. Although local radiation therapy exerts antitumor effects by damaging the cellular DNA, it also induces an important out-of-field (distant) effect known as the “abscopal effect” in nonirradiated sites. Radiation therapy-induced abscopal effects are believed to be mediated by activation and stimulation of the immune system. Objective: To provide a detailed overview of the current state of knowledge and clinical experience of radiation therapy-induced abscopal effects in patients with malignant melanoma. Methods: Using electronic databases such as MEDLINE via PubMed and Google Scholar, a systematic literature review was performed to find published clinical evidence for radiation therapy-induced abscopal effects in patients with malignant melanoma. The clinical data on radiation therapy-induced abscopal effects were reviewed and the outcomes summarized. Results: Clinical evidence of patients with malignant melanoma was gathered using databases from MEDLINE and those findings were summarized. Although the precise mechanism of the abscopal effect of radiation therapy is still not completely understood, evidence suggests that tumor cell destruction by radiation releases tumor antigens that stimulate the immune system of the host to activate the body’s immune effector cells systemically and produce distant non-target antitumor effects. This forms a basis for using the radiation therapy with immunotherapy to augment the abscopal response rates. Conclusions: Current clinical evidence suggests that there is a large potential to enhance the abscopal effect when radiation therapy is combined with immunotherapeutic agents for the treatment of malignant melanoma. Ongoing and planned clinical trials may provide us with a more in-depth understanding of how this combination therapy can be optimally utilized clinically to achieve improved survival outcomes among patients with malignant melanoma.
- Published
- 2020
77. Skull Base Calcifying Pseudoneoplasms of the Neuraxis: Two Case Reports and a Systematic Review of the Literature
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Kesava Reddy, Jian-Qiang Lu, Michel W. Bojanowski, Bill Hao Wang, Kaiyun Yang, and Yosef Ellenbogen
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Male ,medicine.medical_specialty ,Cerebellar Ataxia ,medicine.medical_treatment ,Skull Base Neoplasms ,Neurosurgical Procedures ,Diagnosis, Differential ,Lesion ,Basal (phylogenetics) ,Meningeal Neoplasms ,medicine ,Humans ,Pathological ,Craniotomy ,Aged ,Skull Base ,Brain Diseases ,business.industry ,Calcinosis ,General Medicine ,Middle Aged ,Cranial neuropathy ,Cerebellopontine angle ,Magnetic Resonance Imaging ,Cranial Nerve Diseases ,Skull ,medicine.anatomical_structure ,Neurology ,Gait Ataxia ,Neurology (clinical) ,Radiology ,medicine.symptom ,Meningioma ,business - Abstract
Background:Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion. CAPNONs can mimic calcified meningiomas at the skull base.Methods:Here, we report two cases of CAPNON and present a systematic review of the literature on skull base CAPNONs, to compare CAPNONs with calcified meningiomas.Results:Case 1: A 57-year-old man presented with right-sided lower cranial neuropathies and gait ataxia. He underwent a subtotal resection of a right cerebellopontine angle lesion, with significant improvement of his gait ataxia. However, his cranial neuropathies persisted. Pathological examination of the lesion was diagnostic of CAPNON, with the entrapped nerve fibers identified at the periphery of the lesion, correlating with the patient’s cranial neuropathy. Case 2: A 70-year-old man presented with progressive headache, gait difficulty, and cognitive impairment. He underwent a frontotemporal craniotomy for a near-total resection of his right basal frontal CAPNON. He remained neurologically stable 7 years after the initial resection without evidence of disease recurrence. We analyzed 24 reported CAPNONs at the skull base in our systematic review of the literature. Cranial neuropathies were present in 11 (45.8%) patients. Outcomes regarding cranial neuropathies were documented in six patients: two had sacrifice of the nerve function with surgical approaches and four had persistent cranial neuropathies.Conclusion:While CAPNON can radiologically and grossly mimic calcified meningiomas, they are two distinctly different pathologies. CAPNONs located at the skull base are commonly associated with cranial neuropathies, which may be difficult to reverse despite surgical intervention.
- Published
- 2019
78. The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients
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Shaowei Dong, Doron D. Sommer, Kaiyun Yang, Ramiro Larrazabal, Almunder Algird, Kesava Reddy, Amadeo R. Rodriguez, Jeehyun Kim, and Yosef Ellenbogen
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Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Anterior Visual Pathway ,Endoscopic endonasal surgery ,Vision, Low ,Nose ,Suprasellar Meningioma ,Neurosurgical Procedures ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Meningeal Neoplasms ,medicine ,Humans ,Sella Turcica ,Aged ,Neuroradiology ,business.industry ,Retrospective cohort study ,Middle Aged ,eye diseases ,Visual field ,Surgery ,Female ,Neurology (clinical) ,Neurosurgery ,medicine.symptom ,Meningioma ,business ,030217 neurology & neurosurgery - Abstract
The endoscopic endonasal approach (EEA) has become increasingly employed in the treatment of suprasellar meningiomas. These tumors often cause visual symptoms due to compression of the anterior visual pathway. We aimed to examine long-term visual outcomes after EEA for optic nerve decompression and resection of suprasellar meningioma at our center, and to identify preoperative factors predictive of postoperative visual improvement. We performed a retrospective cohort study on 27 patients who underwent the EEA for resection of meningiomas extending into the suprasellar cistern and decompression of anterior visual pathway between January 1, 2005, and March 1, 2019. We treated 8 male and 19 female patients, with a mean follow-up of 7.6 years. The mean age of our patients at initial presentation was 60.1 years. Eighteen patients (66.7%) presented with visual acuity deficits, and 12 (44.4%) patients presented with visual field deficits. Postoperatively, 11 patients had improved visual acuity, 6 had stable visual acuity, and 1 patient had slow and progressive decline of visual acuity; 5 patients had improved visual field, 6 had stable visual field, and 1 patient had slow and progressive decline in visual field. Patients less likely to have postoperative improvement of visual acuity were those with longer than 6-month duration of visual symptoms (P = 0.024*) as well as patients with the presence of a relative afferent pupillary defect (RAPD) (P = 0.023*). The EEA can achieve good visual outcomes in patients harboring suprasellar meningiomas. Symptom duration of less than 6 months and lack of a RAPD were positive predictors of postoperative visual acuity.
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- 2019
79. Systemic Immunostimulatory Effects of Radiation Therapy Improves the Outcomes of Patients With Advanced NSCLC Receiving Immunotherapy
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G. Kesava Reddy and Mark A. D’Andrea
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Oncology ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,Ionizing radiation ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Carcinoma, Non-Small-Cell Lung ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Radiotherapy ,business.industry ,Immunotherapy ,Cell cycle ,Combined Modality Therapy ,Immune checkpoint ,Blockade ,Clinical trial ,Radiation therapy ,030220 oncology & carcinogenesis ,business - Abstract
The understanding of localized radiation therapy's immunostimulatory properties combined with its well-known effects on the cell cycle and insights into the immunomodulation mechanisms that occur at the molecular and cellular levels has changed our traditional view of the anticancer effects of ionizing radiation. The potential interactions between the tumor's immune system and radiation therapy have revealed that local radiation has the ability to induce systemic antitumor responses in patients with advanced cancers. The recognition of systemic antitumor effects of radiation therapy has allowed investigators to begin uncovering the integral players in these pathways. Parallel to this, there has been progress in understanding how tumor immunology leads to the development of novel immunotherapies using immune checkpoint blockade therapies in the treatment of advanced cancers. To date there has been limited success in this benefiting only a small fraction of patients. The concept of priming the body's immune system by radiation to make less responsive tumors more responsive to immunotherapy provides an opportunity to explore the use of the combination of radiation therapy and immunotherapy for the treatment of advanced non-small cell lung cancer and other cancers. This article provides an overview of the current state of knowledge of the clinical experience using radiation therapy in combination with immune therapy and discusses the rationale for integrating these 2 modalities in the treatment of advanced non-small cell lung cancer. Available data supports the use of radiation therapy in combination with immunotherapy to achieve improved local and systemic tumor control. Evidence from the early clinical trials has shown that using radiation therapy and immune checkpoint blockade therapies together produces a greater clinical effect than using either modality alone. To maximize the clinical benefit and successful integration of these two modalities as well as optimizing radiation therapy dosing and its schedule, improvement in its field design and the development of reliable predictors of clinical tumor response needs to be established.
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- 2019
80. Extracranial Abscopal Effects Induced by Brain Radiation in Advanced Lung Cancer
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G. Kesava Reddy and Mark A. D’Andrea
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Male ,Cancer Research ,Lung Neoplasms ,medicine.medical_treatment ,Central nervous system ,Risk Assessment ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Antigen ,Tumor Microenvironment ,medicine ,Humans ,Combined Modality Therapy ,Neoplasm Invasiveness ,030212 general & internal medicine ,Lung cancer ,Neoplasm Staging ,Brain Neoplasms ,business.industry ,Dose fractionation ,Abscopal effect ,Radiotherapy Dosage ,medicine.disease ,Survival Analysis ,Texas ,United States ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,Blood-Brain Barrier ,030220 oncology & carcinogenesis ,Cancer research ,Female ,Dose Fractionation, Radiation ,Cranial Irradiation ,business - Abstract
An extracranial abscopal effect induced by central nervous system (CNS)-radiation therapy is considered an unusual event because of the belief that brain has a distinctive immune microenvironment. Regular immune responses from radiation therapy or other interventions were thought to be very limited in the CNS. In addition, CNS autoimmunity and neurodegeneration were presumed automatic consequences of immune cell encounters with CNS antigens. Moreover, the traditional assumption is that nascent tumor-associated antigens produced by radiation therapy could not pass through the blood-brain barrier back into the rest of the body to modulate the immune system and induce extracranial abscopal responses. Emerging data from a small number of case series and individual case reports of various malignancies have radically altered our earlier understanding by revealing that the CNS is neither isolated nor passive in its interactions with the body's immune system. Furthermore, current data indicate that the CNS is both immune-competent and interacts actively with the peripheral immune system. Therefore, radiation treatment to ≥1 location of CNS metastases can induce abscopal responses in tumors away from the treated CNS metastatic sites. These observations suggest the abscopal effect traverses the blood-brain barrier. In this article, we reviewed and assessed the clinical evidence of extracranial abscopal responses of CNS-radiation therapy in patients with advanced lung cancer.
- Published
- 2019
81. Hypertrophic Interstitial Neuropathy of the Trigeminal Nerve: Case Report and Literature Review
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Kesava Reddy, Dragos Catana, John Provias, and Alick Wang
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Male ,Trigeminal nerve ,Pathology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cranial nerves ,Microvascular decompression ,Hypertrophy ,Middle Aged ,Trigeminal Neuralgia ,medicine.disease ,Lesion ,Trigeminal Nerve Diseases ,Trigeminal neuralgia ,Neuralgia ,medicine ,Humans ,Hypertrophic interstitial neuropathy ,Surgery ,Trigeminal Nerve ,Neurology (clinical) ,medicine.symptom ,business ,Onion bulb formation - Abstract
Background and importance Hypertrophic interstitial neuropathy (HIN) is an uncommon, non-neoplastic lesion typically affecting peripheral nerves. Cranial nerve (CN) involvement is exceedingly rare. We present a case of isolated trigeminal nerve HIN manifesting with V3 distribution neuralgia. Clinical presentation A 50-yr-old male presented with left sided trigeminal neuralgia refractory to medical management. The patient underwent retromastoid craniectomy for possible microvascular decompression. Intra-operatively, the trigeminal nerve appeared to be focally enlarged with a sausage-like configuration. We selectively resected 1 fascicle which was predominantly involved. Histopathological examination revealed onion bulb formations composed of Schwann cells around centrally placed axons. A diagnosis of HIN was made. Postoperatively, the patient experienced complete resolution of symptoms. Conclusion This is the third case of isolated trigeminal nerve HIN in the literature. We performed a selective resection in a patient presenting with trigeminal neuralgia, resulting in complete resolution of symptoms. It is reported here with intraoperative microscope images, along with a review and analysis of this topic as it related to CN.
- Published
- 2019
82. How Complex is DNS?
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Kakarla, Siva Kesava Reddy, primary, Beckett, Ryan, additional, Millstein, Todd, additional, and Varghese, George, additional
- Published
- 2021
- Full Text
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83. Craniocerebral gunshot injury bullet migration to the cardiac right ventricle
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Taylor Duda, Kesava Reddy, and Euan Zhang
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac Ventricle ,Atelectasis ,medicine.disease ,medicine.anatomical_structure ,Paradoxical embolism ,Embolism ,Craniocerebral gunshot injury ,Ventricle ,Bullet migration ,Case report ,Medicine ,Surgery ,Neurology (clinical) ,Embolization ,Radiology ,business ,Complication ,Neurotrauma ,Sinus (anatomy) - Abstract
Background: Missile embolism is the process of slow velocity projectiles penetrating into vascular spaces followed by arterial, venous, or paradoxical embolism of the fragments. This is a rare complication in craniocerebral gunshot injuries (CGI), with only five other cases previously published demonstrating pulmonary or arterial emboli from these injuries. There is a high rate of mortality from these injuries. Case Description: A patient presented with a CGI from an occipital trajectory, causing penetrating fragments into the venous sinus system. The weapon was a Glock Model 17M 9 mm with a hollow-point bullet, fired close range. Initial chest X-ray demonstrated only atelectasis. After stabilization, 18 min from the initial chest X-ray, subsequent computed tomography (CT) imaging demonstrated extensive intracranial injuries and fragmentation of the bullet with the expected devastating intracranial injuries. Unexpectedly, chest CT revealed metallic fragments in the right cardiac ventricle which was redemonstrated on follow-up chest X-ray. Unfortunately, his extensive intracranial injuries and poor clinical status were nonsurvivable, and thus the family elected to discontinue supportive measures. Conclusion: This case demonstrates radiographic imaging of a metallic intravascular fragment from CGI through presumed transvenous mechanisms. The imaging provides a consistent timeline demonstrating migration can occur in the acute phase. This study additionally supports the presumed mechanism for pulmonary of migration through the right heart. Fragment embolization should be considered in cases of acute deterioration in this patient population.
- Published
- 2021
84. Campion
- Author
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Matt Brown, Yuval Tamir, Ryan Beckett, Alan Tang, Siva Kesava Reddy Kakarla, Todd Millstein, Ennan Zhai, and George Varghese
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Router ,Static routing ,business.industry ,Computer science ,media_common.quotation_subject ,ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS ,Open Shortest Path First ,Modular design ,Debugging ,Backup ,Routing (electronic design automation) ,business ,Route reflector ,media_common ,Computer network - Abstract
We present a new approach for debugging two router configurations that are intended to be behaviorally equivalent. Existing router verification techniques cannot identify all differences or localize those differences to relevant configuration lines. Our approach addresses these limitations through a _modular_ analysis, which separately analyzes pairs of corresponding configuration components. It handles all router components that affect routing and forwarding, including configuration for BGP, OSPF, static routes, route maps and ACLs. Further, for many configuration components our modular approach enables simple _structural equivalence_ checks to be used without additional loss of precision versus modular semantic checks, aiding both efficiency and error localization. We implemented this approach in the tool Campion and applied it to debugging pairs of backup routers from different manufacturers and validating replacement of critical routers. Campion analyzed 30 proposed router replacements in a production cloud network and proactively detected four configuration bugs, including a route reflector bug that could have caused a severe outage. Campion also found multiple differences between backup routers from different vendors in a university network. These were undetected for three years, and depended on subtle semantic differences that the operators said they were "highly unlikely" to detect by "just eyeballing the configs."
- Published
- 2021
85. A Case Report on Follicular Lymphoma
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Dhana Lakshmi P, Hima Bindu N, Mariamma B, Umadevi I, and Sai Kesava Reddy A
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Follicular Lymphoma, Non Hodgkins Lymphoma, Indolent, Aggressive, Transformation, B Cell Lymphoma - Abstract
Follicular lymphoma is one type of cancer which belongs to Non Hodgkin lymphoma [NHL], in which the lymphatic system would affect the most. The lymphatic system plays a key role in immune system as it provides protection to the body in order to fight from infections and diseases. Generally the lymphocytes are categorized into 2 types such as B-lymphocytes and T-lymphocytes. B- cells works by producing specific type of antibodies which mainly helps to fight against specific type of microorganism but in other type the infected host cells will be killed directly by the T- cells and further activates other immune cells which may produce cytokines and helps in the regulation of immune system. Follicular lymphoma belongs to B-cell lymphoma in which there is an alteration of normal B cell into cancerous B cell. In the follicular lymphoma we can notice an amplification of lymph nodes due to atypical, unconstrained growth and proliferation of malignant B cells and further spread to other body tissues and organs. Follicular lymphoma is considered to be the prototype of indolent lymphoma which can be marked by slow progression and increased response to the therapy. As most of the patients gradually developing resistance to disease over time, there is an transformation of indolent lymphoma to an aggressive subtype, in which there would be a poor outcome to the therapy as there is a reduced sensitivity to the chemotherapy.
- Published
- 2021
86. Annulation Cascade of Sulfamate-Derived Cyclic Imines with Glycine Aldimino Esters: Synthesis of 1,3-Benzoxazepine Scaffolds
- Author
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Mahiuddin Baidya, Vinod Bhajammanavar, and Mallu Kesava Reddy
- Subjects
Annulation ,010405 organic chemistry ,Chemistry ,Organic Chemistry ,010402 general chemistry ,Cleavage (embryo) ,01 natural sciences ,Biochemistry ,Combinatorial chemistry ,Cycloaddition ,0104 chemical sciences ,Cascade reaction ,Cascade ,Glycine ,Amine gas treating ,Physical and Theoretical Chemistry - Abstract
An efficient (3 + 2) cycloaddition triggered annulation is reported to access 1,3-benzoxazepine frameworks. With amine base, sulfamate-derived cyclic imines readily react with glycine aldimino esters to furnish benzo-fused seven-membered heterocyclic products in good yields. The cascade reaction involves the formation of one C-C, one C-N, and one C-O bond along with the cleavage of two C-N bonds and one S-O bond. The synthesis of o-tyrosine analogues has also been accomplished from annulation products.
- Published
- 2021
87. Pituitary metastasis: From pathology to clinical and radiological considerations
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Almunder Algird, Kesava Reddy, E. Zhang, Michelle Kameda-Smith, Melissa Lannon, and J-Q. Lu
- Subjects
Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Disease ,Radiosurgery ,Metastatic carcinoma ,Lesion ,Physiology (medical) ,medicine ,Tumor Microenvironment ,Humans ,Disseminated disease ,Pituitary Neoplasms ,Retrospective Studies ,business.industry ,Pituitary tumors ,General Medicine ,medicine.disease ,Primary tumor ,Radiography ,Neurology ,Radiological weapon ,Surgery ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Purpose A review of the literature with respect to pituitary metastases (PM) with clinical and radiological considerations are summarized to facilitate clinical decision making in the management of PM Methods A review of literature associated with PM and tumour to tumour metastases in the English literature was reviewed and summarized Results Pituitary metastases account for 1.0–3.6% of all surgically treated pituitary lesions. Often identified in parallel with extensive disseminated disease, once diagnosed, the prognosis is generally poor, although survival is highly heterogeneous and dependent on the primary tumor histology. Within this anatomical region is also the observation of tumor-to-tumor metastases and collision tumours. Both the tumor macro- and microenvironment play central roles to the progression of disease with distinctive radiological features that may suggest a metastatic sellar lesion as opposed to a primary pituitary lesion. Surgical resection is the first line of therapy followed by adjuvant chemoradiotherapy and endocrinological evaluation for hormonal supplementation Conclusion PMs are relatively rare but important oncological entities representing disseminated disease in the majority of cases. Careful consideration of the relevant clinical history and radiological features can aid the clinician differentiate between a metastatic lesion to the pituitary region and a primary pituitary tumor. While surgical resection is first line therapy, stereotactic radiosurgery in carefully selected patients is emerging as a viable alternative.
- Published
- 2021
88. Campion
- Author
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Tang, Alan, primary, Kakarla, Siva Kesava Reddy, additional, Beckett, Ryan, additional, Zhai, Ennan, additional, Brown, Matt, additional, Millstein, Todd, additional, Tamir, Yuval, additional, and Varghese, George, additional
- Published
- 2021
- Full Text
- View/download PDF
89. Radiation Necrosis Following Stereotactic Radiosurgery for Trigeminal Neuralgia
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Anthony Whitton, Crystal Fong, Tanishq Suryavanshi, Maura Marcucci, Kesava Reddy, and Alick Wang
- Subjects
Radiation necrosis ,medicine.medical_specialty ,Neurology ,Trigeminal neuralgia ,business.industry ,medicine.medical_treatment ,medicine ,Neurology (clinical) ,General Medicine ,Radiology ,medicine.disease ,business ,Radiosurgery - Published
- 2020
90. Organocatalyzed Annulation Cascade toward Asymmetric Functionalization of Dibenzoxazepines and Dibenzothiazepines with Vicinal Tertiary Stereogenic Centers
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Mallu Kesava Reddy, Isai Ramakrishna, and Mahiuddin Baidya
- Subjects
Annulation ,Stereochemistry ,Chemistry ,Cascade ,Organocatalysis ,Surface modification ,General Chemistry ,Dibenzoxazepines ,Vicinal ,Stereocenter - Published
- 2019
91. The systemic immunostimulatory effects of radiation therapy producing overall tumor control through the abscopal effect
- Author
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G. Kesava Reddy and Mark A. D’Andrea
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cancer ,Abscopal effect ,Immunotherapy ,medicine.disease ,Tumor control ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,business ,Relevant information ,Immune activation - Abstract
Emerging studies show that radiation therapy produces an important out of field (distant) effect known as the ‘‘abscopal effect” in nonirradiated tumor sites. The objective of this study was to provide an overview of the current state of knowledge and clinical experience of radiation therapy producing abscopal effects in the management of different types of malignant diseases. Peer-reviewed published clinical evidence on the abscopal effect of radiation therapy was collected using electronic databases such as Medline via PubMed and Google Scholar. The reference lists were searched in the publications that we obtained in an attempt to find additional relevant publications. Non-indexed peer-reviewed journals were manually searched and relevant information was extracted. The search was restricted to English language articles. The clinical data on the abscopal effect of radiation therapy were reviewed and the outcomes have been summarized. Currently, only clinical case reports and anecdotes have slowly converted into solid clinical data and interest is building in the field of radiation therapy, specifically on how local radiation can produce the abscopal effects for the management of different types of malignant tumors. Extensive clinical evidence suggests that the radiation therapy induced abscopal antitumor effects are mediated by immune cells such as the T-lymphocytes. This forms a basis for using radiation therapy in combination with immunotherapy to augment the abscopal response rates in cancer patients. Current evidence demonstrates that radiation therapy induces abscopal responses across many tumor types. Together, the clinical outcomes from published reports suggest that localized radiation therapy is capable of inducing abscopal effects in a wide variety of malignant tumors. With the advent of novel immunotherapies, the potential for immune activation by radiation defines a novel role for radiation therapy in the treatment of systemic disease. A clinical consideration of the abscopal effects produced by radiation therapy could lead to a revolutionary change in the current management of patients including radiation treatment strategies and immunotherapies for various malignant tumors.
- Published
- 2019
92. Discrepancies Between Patient and Surgeon Expectations of Surgery for Sciatica
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Nadia Rehman, Meredith Vanstone, Lisa Schwartz, Aleksa Cenic, Yasir Rehman, Brett Dunlop, Brian Drew, Gordon H. Guyatt, Wojtek Wiercioch, Jason W. Busse, Edward Kucher, Kesava Reddy, Naresh Murty, and Muzammil H. Syed
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,genetic structures ,Clinical Decision-Making ,MEDLINE ,Sciatica ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Decompressive surgery ,medicine ,Humans ,Orthopedics and Sports Medicine ,Risks and benefits ,Qualitative Research ,Surgeons ,Physician-Patient Relations ,030222 orthopedics ,business.industry ,General surgery ,Patient Satisfaction ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Qualitative research - Abstract
Qualitative study.The objective of this study was to compare the perceptions of patients and surgeons regarding the risks and benefits of lumbar decompressive surgery for sciatica following a consultation meeting.Evidence regarding pain improvement in patients following lumbar decompressive surgery for sciatica is inconsistent. Given this inconsistency, patients choosing to undergo lumbar decompressive surgery must accept the risks associated with the surgery despite uncertainty regarding benefits. This raises questions as to the nature of informed decision-making for patients choosing to undergo surgery for sciatica.We undertook a qualitative descriptive study with 12 adult lumbar decompressive surgery candidates and six of their spine surgeons and analyzed data using inductive content analysis.Our analysis revealed that most patients were satisfied with the consultation despite limited understanding of lumbar decompressive surgery. We found discrepancies between patients' preoperative expectations and understanding of information provided by surgeons and what surgeons believed they had conveyed. Surgeons and patients disagreed on how much information is needed about postsurgical activity modifications and long-term outcomes to make a decision about whether or not to undergo surgery, with patients desiring more information. As a result, for most patients, the decision-making process extended beyond the information provided by surgeons and incorporated information from family members, friends, family doctors, and the internet.Our results highlight misunderstandings between patients and surgeons, particularly in regard to prognosis and activity modifications. Since this information is important for patients choosing whether to undergo a surgical intervention, our study provides guidance to improve informed decisions about sciatica and, potentially, other elective surgeries.4.
- Published
- 2019
93. Surgical Performance Determines Functional Outcome Benefit in the Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation (MISTIE) Procedure
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Andras Buki, Ludwig Schuerer, Barbara A. Gregson, Joshua N. Goldstein, Jared Knopman, Alexandra D Baker, Ashutosh P Jadhav, Laszlo Csiba, Terry Quinn, Kristi Tucker, Gayane Yenokyan, E. Francois Aldrich, Richard E. Thompson, John Laidlaw, Steven Mayo, Alastair Wilson, Michael L. James, Krista Vermillion, Andreas Unterberg, Fernando Muñoz Hernandez, Karin Jonczak, Jesse Dawson, Alejandro Carrasco Gonzalez, Jamie Braun, Rishi Malhorta, Lisa Yanase, Hua Feng, Craig S. Anderson, Ying Cao, Michael Rosenblum, Roddy O'Kane, Jeffrey S. Schweitzer, Krishna K. Mohan, Robert Hoesch, Robert D. Ecker, Rong Hu, Cian O'Kelly, Nader Pouratian, Igor Rybinnik, Yi Huang, Julius Gene Latorre, Peter Brindley, Scott Janis, Huy Tran, Weimin Wang, Mohammed Rehman, Nataly Montano Vargas, Zhiyuan Yu, Tiffany R. Chang, Christianto B. Lumenta, Rosario Sarabia, Paul M. Vespa, David Antezana, Keith W. Muir, Ying Wang, Kennedy R. Lees, Thomas Kerz, Steven J. Barrer, Safdar Ansari, Elizabeth A. Sugar, Louis Tony Whitworth, Romuald Girard, Thomas A. Bergman, Myriha Wrencher, Gaurav Gupta, Krissia Rivera Perla, Judy Huang, Doug Anderson, Joshua Betz, Ryan S. Kitagawa, Mohammed Hussain, Marcelino Báguena, Sepideh Amin-Hanjani, Krisztian Tanczos, Avinash B. Kumar, Brian L. Hoh, W. David Freeman, Tracey Economas, Dheeraj Gandhi, Mary Leigh Gelea, Hiren C. Patel, Esther Jeon, Byron Willis, Gonzalo Tamayo, Saman Nekoovaght-Tak, Lior Ungar, Ahmed Maswadeh, Adrian R Parry-Jones, Marc D. Malkoff, Michael Abraham, Carlos Alarcon Alba, Michael R. Chicoine, George A. Lopez, Jeanne Teitelbaum, Scott McCaul, Walter Galicich, David Schel, Ryan Majkowski, Douglas Franz, Agnieszka Ardelt, Issam A. Awad, Yunke Li, Hasan Ali, Satish Krishnamurthy, Yi Hao, Geza Mezey, Amal Abou-Hamden, James Leiphart, Xuxia Yi, Darren Lovick, Colin P. Dierdeyn, Jack Jallo, Jennifer Houser, Vikram Madan, Julián Carrión-Penagos, Jean-Louis Caron, Paul J. Camarata, Nichol McBee, Ania Pollack, Lorenzo F. Munoz, Sarah Lenington, Lauren H Sansing, Kathrine Thomas, Alberto Torres Díaz, Joel D. MacDonald, J. Ricardo Carhuapoma, Pedro Enriquez, Janet Mighty, Salvatore Insinga, Ottó Major, Steven M. Greenberg, Jinbiao Luo, Jennifer Jaffe, W. Andrew Mould, Cully Cobb, Sagi Harnof, Robert F James, Yan Wang, Ali R. Zomorodi, David B. Seder, Ventatakrishna Rajajee, Arun Lakhanpal, Robert H. Brown, Yongge Xu, Karen Lane, Naureen Keric, A. David Mendelow, David Ledoux, Azmil Abdul-Rahim, Babak S. Jahromi, Janne Koskimäki, Chitra Venkatasubramanian, Dennis G. Vollmer, Charles C. Matouk, William C. Broaddus, Julio A. Chalela, Fred Rincon, Sean P. Polster, Kevin N. Sheth, Patrick Mitchell, Daryl R. Gress, Daniel F Hanley, Bing Cao, Indalecio Moran Chorro, Mario Zuccarello, Maged D Fam, Carolyn Koenig, Aditya S. Pandey, Patricia Lynn Money, Christiana E. Hall, Baltasar Sanchez, Kesava Reddy, Hartmut Vatter, Robert L. Dodd, Panos Varelas, James C. Torner, Michael Schneck, Christina Grabarits, Azam Ahmed, Diederik Bulters, Paul A. Nyquist, Michael N. Diringer, Jason M Davies, Radhika Avadhani, Ben Jonker, Katalin Szabo, Agnieszka Stadnik, Donald Seyfried, Brian T. Jankowitz, Joshua E. Medow, Erzsebet Ezer, Pál Barzó, Luisa Corral, Inam Kureshi, Ronald Reimer, David Altschul, Fuat Arikan, Alex Nee, Stacey Q Wolfe, Mohamed Okasha, Matthew B. Maas, Mark R. Harrigan, John Terry, Natalie Ullman, Dana Leifer, Yuhua Fan, Jiajun Wen, Gregory Thompson, Alejandro M Spiotta, Amanda J. Bistran-Hall, Fernando D. Testai, Noeleen Ostapkovich, Eugene Gu, Kyra J. Becker, David Miller, Carlos S. Kase, Carol B. Thompson, Shawn E. Wright, Wendy C. Ziai, Philipp Taussky, Peter Nakaji, Nicki Karlen, Halinder S. Mangat, Andrew P. Carlson, Shakeel A. Chowdhry, Azize Boström, Rachel Dlugash, Michael T. Stechison, Kate McArthur, Larami MacKenzie, Matthew R. Fusco, and Draga Jichici
- Subjects
Male ,medicine.medical_specialty ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Fibrinolytic Agents ,Randomized controlled trial ,Modified Rankin Scale ,law ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,cardiovascular diseases ,Research—Human—Clinical Trials ,Intraparenchymal hemorrhage ,Stroke ,Aged ,Intracerebral hemorrhage ,business.industry ,Recovery of Function ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Surgery ,Treatment Outcome ,Tissue Plasminogen Activator ,030220 oncology & carcinogenesis ,Emergency evacuation ,Female ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Fibrinolytic agent - Abstract
Background Minimally invasive surgery procedures, including stereotactic catheter aspiration and clearance of intracerebral hemorrhage (ICH) with recombinant tissue plasminogen activator hold a promise to improve outcome of supratentorial brain hemorrhage, a morbid and disabling type of stroke. A recently completed Phase III randomized trial showed improved mortality but was neutral on the primary outcome (modified Rankin scale score 0 to 3 at 1 yr). Objective To assess surgical performance and its impact on the extent of ICH evacuation and functional outcomes. Methods Univariate and multivariate models were used to assess the extent of hematoma evacuation efficacy in relation to mRS 0 to 3 outcome and postulated factors related to patient, disease, and protocol adherence in the surgical arm (n = 242) of the MISTIE trial. Results Greater ICH reduction has a higher likelihood of achieving mRS of 0 to 3 with a minimum evacuation threshold of ≤15 mL end of treatment ICH volume or ≥70% volume reduction when controlling for disease severity factors. Mortality benefit was achieved at ≤30 mL end of treatment ICH volume, or >53% volume reduction. Initial hematoma volume, history of hypertension, irregular-shaped hematoma, number of alteplase doses given, surgical protocol deviations, and catheter manipulation problems were significant factors in failing to achieve ≤15 mL goal evacuation. Greater surgeon/site experiences were associated with avoiding poor hematoma evacuation. Conclusion This is the first surgical trial reporting thresholds for reduction of ICH volume correlating with improved mortality and functional outcomes. To realize the benefit of surgery, protocol objectives, surgeon education, technical enhancements, and case selection should be focused on this goal.
- Published
- 2019
94. Trigeminocardiac Reflex: Case Report and Literature Review of Intraoperative Asystole in Response to Manipulation of the Temporalis Muscle
- Author
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Dillon Horth, Alick Wang, Husain Shakil, Saeda S. Nair, and Kesava Reddy
- Subjects
Bradycardia ,medicine.medical_treatment ,Epidermal Cyst ,Temporal Muscle ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Asystole ,Intraoperative Complications ,Craniotomy ,Skull Base ,Trigeminal nerve ,business.industry ,Cranial nerves ,Middle Aged ,medicine.disease ,Oculocardiac reflex ,Heart Arrest ,Reflex, Trigeminocardiac ,030220 oncology & carcinogenesis ,Anesthesia ,Reflex ,Female ,Surgery ,Neurology (clinical) ,Bone Diseases ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background The trigeminocardiac reflex is a sudden onset of bradycardia, hypotension, apnea, or gastric hypermotility in response to stimulation of the trigeminal nerve. Case Description A 60-year-old female underwent a left orbitozygomatic craniotomy to debulk a large skull base epidermoid cyst compressing the brainstem and cranial nerves. Intraoperatively, retraction of the temporalis muscle consistently produced asystole. Cessation of retraction resulted in prompt return of sinus rhythm. Conclusions Our report describes an unusual and extreme example of the trigeminocardiac reflex and explores possible etiologies. This is the third reported surgical case in which manipulation of the temporalis muscle alone was sufficient to elicit bradycardia and asystole, and the first such case within the context of neurosurgery. We emphasize the importance of surgical teams to be cognizant of such extreme examples of this reflex.
- Published
- 2019
95. Petersenʼs small bowel obstruction after laparoscopic Roux-en-Y gastric bypass (RYGB) surgery: D04
- Author
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Parampalli, Umesh, Goralczyk, Adam, and Mannur, Kesava Reddy
- Published
- 2015
96. Postoperative Continuous Positive Airway Pressure Use and Nasal Saline Rinses After Endonasal Endoscopic Skull Base Surgery in Patients With Obstructive Sleep Apnea: A Practice Pattern Survey
- Author
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Erik K. Weitzel, Kesava Reddy, Doron D. Sommer, Brian W. Rotenberg, Almunder Algird, David L Choi, and Allan Vescan
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Rhinology ,Canada ,medicine.medical_specialty ,medicine.medical_treatment ,Nose ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Immunology and Allergy ,In patient ,Postoperative Period ,Continuous positive airway pressure ,Practice Patterns, Physicians' ,030223 otorhinolaryngology ,Saline ,Skull Base ,Sleep Apnea, Obstructive ,Cerebrospinal Fluid Leak ,Continuous Positive Airway Pressure ,business.industry ,Endoscopy ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Nasal saline ,Surgery ,Obstructive sleep apnea ,Skull ,medicine.anatomical_structure ,030228 respiratory system ,Otorhinolaryngology ,Skull base surgery ,Fluid Therapy ,Saline Solution ,business - Abstract
Background Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA. Methods A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. Results Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients’ CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon’s choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P Conclusion Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.
- Published
- 2018
97. Variation of Eckert number on hydrodynamic convective fluid flow in the presence of thermal radiation
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Y. Sunita Rani and V. Kesava Reddy
- Subjects
Convection ,Physics ,Work (thermodynamics) ,Eckert number ,Thermal radiation ,Fluid dynamics ,Mechanics ,Variation (astronomy) ,Finite element method ,Dimensionless quantity - Abstract
The aim of this research work is to analysis in the presence of a transverse magnetic field with thermal radiation, variations in eckert numbers on the unstable convective flow in the saturated program on an infinite vertical plate. With dimensionless variables, the governing scheme of partial difference equations is transformed into dimensional equations. Number-free equations are resolved using the technique of finite elements for the frequency, temperature and concentration profile equations using graphs.
- Published
- 2021
98. Organocatalyzed Modular Synthesis of Polycyclic Dihydropyridines and Pyridines through Sulfamate Linchpin.
- Author
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Bhajammanavar, Vinod, Sureshbabu, Popuri, Kesava Reddy, Mallu, and Baidya, Mahiuddin
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DIHYDROPYRIDINE ,ORGANOCATALYSIS ,ANNULATION ,IMINES ,HETEROCYCLIC compounds - Abstract
The cascade annulation between alkylidene malononitriles and cyclic sulfamidate imines has been controlled by leveraging the sulfamate functionality under organocatalysis, which allows selective access to polycyclic and densely functionalized dihydropyridines and pyridines in high yields. The protocol is scalable and shows broad substrate scope. The products were also engaged in the preparation of tetracyclic pyridopyrimidines, showcasing the synthetic versatility. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
- View/download PDF
99. Calcifying Pseudoneoplasm of the Neuraxis: From Pathogenesis to Diagnostic and Therapeutic Considerations
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Jian-Qiang Lu, Robert Hammond, Kaiyun Yang, Ivan Chebib, and Kesava Reddy
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Pathology ,medicine.medical_specialty ,Neurofilament ,Neurosurgical Procedures ,Pathogenesis ,Lesion ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Immune system ,Neoplasms ,Medicine ,Humans ,Pathological ,Brain Diseases ,business.industry ,Calcinosis ,Syndrome ,medicine.disease ,Immunohistochemistry ,030220 oncology & carcinogenesis ,Comorbid disease ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumefactive lesion that can develop anywhere within the neuraxis. The incidence is likely underreported, given its nonspecific imaging features and because CAPNON has often been overwhelmed by the presence of comorbid disease. CAPNON is typically diagnosed by the histopathological examination findings. However, the histopathological diagnosis is often challenging owing to the existence of similar calcifying pathological entities. Although the pathogenesis of CAPNON has remained elusive, emerging evidence supports a reactive proliferative and immune-mediated process involving the aggregation of neurofilament light chain protein and the infiltration of immune cells. The management of CAPNON is largely dependent on the symptoms, which are mainly related to the location and associated mass effects. Maximal surgical resection will result in excellent patient outcomes with rare recurrence, especially in patients presenting with epilepsy. The discovery of neurofilament light chain protein within CAPNON suggests that neurofilament might be implicated in the pathogenesis of CAPNON, serve as an immunohistochemical marker to improve the diagnostic accuracy of CAPNON, and hold therapeutic potential for the treatment of CAPNON.
- Published
- 2020
100. Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center
- Author
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Parth Rali, Oisin O'Corragain, Lawrence Oresanya, Daohai Yu, Omar Sheriff, Robert Weiss, Catherine Myers, Parag Desai, Nadia Ali, Anthony Stack, Michael Bromberg, Andrea L. Lubitz, Joseph Panaro, Riyaz Bashir, Vladimir Lakhter, Roberto Caricchio, Rohit Gupta, Chandra Dass, Kumaran Maruti, Xiaoning Lu, A. Koneti Rao, Gary Cohen, Gerard J. Criner, Eric T. Choi, Aaron Mishkin, Abbas Abba, Abhijit S. Pathak, Abhinav Rastogi, Adam Diamond, Aditi Satti, Adria Simon, Ahmed Soliman, Alan Braveman, Albert J. Mamary, Aloknath Pandya, Amy Goldberg, Amy Kambo, Andrew Gangemi, Anjali Vaidya, Ann Davison, Anuj Basil, Beata Kosmider, Charles T. Bakhos, Bill Cornwell, Brianna Sanguily, Brittany Corso, Carla Grabianowski, Carly Sedlock, Charles Bakhos, Chenna Kesava Reddy Mandapati, Cherie Erkmen, Chethan Gangireddy, Chih-ru Lin, Christopher T. Burks, Claire Raab, Deborah Crabbe, Crystal Chen, Daniel Edmundowicz, Daniel Sacher, Daniel Salerno, Daniele Simon, David Ambrose, David Ciccolella, Debra Gillman, Dolores Fehrle, Dominic Morano, Donnalynn Bassler, Edmund Cronin, Eduardo Dominguez, Ekam Randhawa, Ekamjeet Randhawa, Eman Hamad, Eneida Male, Erin Narewski, Francis Cordova, Frederic Jaffe, Frederich Kueppers, Fusun Dikengil, Jonathan Galli, Jamie Garfield, Gayle Jones, Gennaro Calendo, Gerard Criner, Gilbert D'Alonzo, Ginny Marmolejos, Matthew Gordon, Gregory Millio, Fernandez Gustavo, Hannah Simborio, Harwood Scott, Heidi Shore-Brown, Hernan Alvarado, Ho-Man Yeung, Ibraheem Yousef, Ifeoma Oriaku, Iris Jung-won Lee, Isaac Whitman, James Brown, Jamie L. Garfield, Janpreet Mokha, Jason Gallagher, Jeffrey Stewart, Jenna Murray, Jessica Tang, Jeyssa Gonzalez, Jichuan Wu, Jiji Thomas, Jim Murrett, Joanna Beros, John M. Travaline, Jolly Varghese, Jordan Senchak, Joseph Lambert, Joseph Ramzy, Joshua Cooper, Jun Song, Junad Chowdhury, Kaitlin Kennedy, Karim Bahmed, Karim Loukmane, Karthik Shenoy, Kathleen Brennan, Keith Johnson, Kevin Carney, Kraftin Schreyer, Kristin Criner, Maruti Kumaran, Lauren Miller, Laurie Jameson, Laurie Johnson, Laurie Kilpatrick, Lii-Yoong Criner, Lily Zhang, Lindsay K. McGann, Llera A. Samuels, Marc Diamon, Margaret Kerper, Maria Vega Sanchez, Mariola Marcinkienwicz, Maritza Pedlar, Mark Aksoy, Mark Weir, Marla R. Wolfson, Marla Wolfson, Robert Marron, Martin Keane, Massa Zantah, Mathew Zheng, Matthew Delfiner, Maulin Patel, Megan Healy, Melinda Darnell, Melissa Navaro, Meredith A. Brisco-Bacik, Michael Gannon, Michael Jacobs, Mira Mandal, Nanzhou Gou, Nathaniel Marchetti, Nathaniel Xander, Navjot Kaur, Neil Nadpara, Nicole Desai, Nicole Mills, Norihisa Shigemura, Ohoud Rehbini, Oneida Arosarena, Osheen Abramian, Paige Stanley, Patrick Mulhall, Pravin Patil, Priju Varghe, Puja Dubal, Puja Patel, Rachael Blair, Rajagopalan Rengan, Rami Alashram, Randol Hooper, Rebecca A. Armbruster, Regina Sheriden, Rogers Thomas, Rohit Soans, Roman Petrov, Roman Prosniak, Romulo Fajardo, Ruchi Bhutani, Ryan Townsend, Sabrina Islam, Samantha Pettigrew, Samantha Wallace, Sameep Sehgal, Samuel Krachman, Santosh Dhungana, Sarah Hoang, Sean Duffy, Seema Rani, Shapiro William, Sheila Weaver, Shelu Benny, Sheril George, Shuang Sun, Shubhra Srivastava-Malhotra, Stephanie Brictson, Stephanie Spivack, Stephanie Tittaferrante, Stephanie Yerkes, Stephen Priest, Steve Codella, Steven G. Kelsen, Steven Houser, Steven Verga, Sudhir Bolla, Sudhir Kotnala, Sunil Karhadkar, Sylvia Johnson, Tahseen Shariff, Tammy Jacobs, Thomas Hooper, Tom Rogers, Tony S. Reed, Tse-Shuen Ku, Uma Sajjan, Victor Kim, Whitney Cabey, Wissam Chatila, Wuyan Li, Zach Dorey-Stein, Zachariah Dorey-Stein, and Zachary D. Repanshek
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Deep vein ,Hypercoagulable state in COVID-19 ,030204 cardiovascular system & hematology ,COVID-19 VTE ,Article ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,COVID-19 coagulopathy ,medicine ,Humans ,Thrombophilia ,030212 general & internal medicine ,cardiovascular diseases ,Prospective cohort study ,Retrospective Studies ,Philadelphia ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,business.industry ,SARS-CoV-2 ,Incidence (epidemiology) ,Incidence ,COVID-19 ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Prognosis ,equipment and supplies ,Respiration, Artificial ,Confidence interval ,Pulmonary embolism ,medicine.anatomical_structure ,Cohort ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism - Abstract
Background Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center. Methods We performed a retrospective cohort study of 147 patients who had been admitted to Temple University Hospital with coronavirus disease 2019 (COVID-19) from April 1, 2020 to April 27, 2020. We first identified the VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) incidence in our cohort. The VTE and no-VTE groups were compared by univariable analysis for demographics, comorbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify the early predictors of VTE. Results The 147 patients (20.9% of all admissions) admitted to a designated COVID-19 unit at Temple University Hospital with a high clinical suspicion of acute VTE had undergone testing for VTE using computed tomography pulmonary angiography and/or extremity venous duplex ultrasonography. The overall incidence of VTE was 17% (25 of 147). Of the 25 patients, 16 had had acute PE, 14 had had acute DVT, and 5 had had both PE and DVT. The need for invasive mechanical ventilation (adjusted odds ratio, 3.19; 95% confidence interval, 1.07-9.55) and the admission D-dimer level ≥1500 ng/mL (adjusted odds ratio, 3.55; 95% confidence interval, 1.29-9.78) were independent markers associated with VTE. The all-cause mortality in the VTE group was greater than that in the non-VTE group (48% vs 22%; P = .007). Conclusions Our study represents one of the earliest reported from the United States on the incidence rate of VTE in patients with COVID-19. Patients with a high clinical suspicion and the identified risk factors (invasive mechanical ventilation, admission D-dimer level ≥1500 ng/mL) should be considered for early VTE testing. We did not screen all patients admitted for VTE; therefore, the true incidence of VTE could have been underestimated. Our findings require confirmation in future prospective studies.
- Published
- 2020
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