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Article ; Online: A Case of Acute Opioid Withdrawal after Liposuction Surgery in a Patient on Extended-release Buprenorphine.

Bobb, Raymond / Malayala, Srikrishna V / Papudesi, Bhavani Nagendra / Potluri, Deepika

Journal of addiction medicine

2023 Volume 17, Issue 5, Page(s) 621–623

Abstract: Background: The US Food and Drug Administration approved the once-monthly injectable extended-release buprenorphine product to treat moderate-to-severe opioid use disorders. The patient in our case report had a liposuction procedure and immediately ... ...

Abstract	Background: The US Food and Drug Administration approved the once-monthly injectable extended-release buprenorphine product to treat moderate-to-severe opioid use disorders. The patient in our case report had a liposuction procedure and immediately started having opioid withdrawal symptoms after the procedure. Case description: The patient is a 27-year-old African-American woman who injects drugs and has morbid obesity. She enrolled in a medications for addiction treatment program and opted to get treated with extended-release buprenorphine monthly injections. She tolerated them well for a span of 6 months. In one clinic visit, she reported opioid withdrawal symptoms and started purchasing and using sublingual buprenorphine from her acquaintances. On review of history, she underwent liposuction surgery and this triggered the opioid withdrawal symptoms. Examining her abdomen revealed surgical scars at the site of the buprenorphine injection and the residual buprenorphine depot was not palpable.A subcutaneous injection of 300-mg extended release buprenorphine was administered in the right periumbilical area in this clinic visit. The following week, she was doing well and denied any withdrawal symptoms. Discussion: This is a unique case of "iatrogenic opioid withdrawal" after a fairly common surgical procedure. The extended-release buprenorphine formulation solidifies when it comes into contact with bodily fluids forming a depot. The depot and surrounding adipose tissue may have been removed during the patient's liposuction procedure, causing an immediate drop in buprenorphine levels leading to acute opioid withdrawal.This case report highlights the precautions that need to be taken before patients go for a surgical procedure like liposuction.
MeSH term(s)	Adult ; Female ; Humans ; Buprenorphine/therapeutic use ; Delayed-Action Preparations/therapeutic use ; Injections, Subcutaneous ; Lipectomy/adverse effects ; Narcotic Antagonists/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/etiology ; Substance Withdrawal Syndrome/drug therapy ; Substance Withdrawal Syndrome/etiology
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Delayed-Action Preparations ; Narcotic Antagonists
Language	English
Publishing date	2023-04-21
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000001172
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Article: A Case of COVID-19-Induced Vestibular Neuritis.

Malayala, Srikrishna V / Raza, Ambreen

Cureus

2020 Volume 12, Issue 6, Page(s) e8918

Abstract: The World Health Organization (WHO) declared COVID-19, a novel coronavirus infection, as a pandemic in March 2020. Since the origin of the disease in Wuhan, China, understanding the pathophysiology, clinical presentation, screening guidelines, and ... ...

Abstract	The World Health Organization (WHO) declared COVID-19, a novel coronavirus infection, as a pandemic in March 2020. Since the origin of the disease in Wuhan, China, understanding the pathophysiology, clinical presentation, screening guidelines, and management of the disease has been ever-evolving. Though respiratory pathologies have been the major complications of a COVID-19 infection, other presentations like abdominal pain, deep venous thrombosis, cardiomyopathy, and even acute cerebrovascular ischemic attacks have been reported. We present a case of a young patient presenting with vertigo, possibly from COVID-19-induced acute vestibular neuritis. This is a 20-year-old Hispanic female patient presenting with intractable vertigo, nausea, and vomiting but without any typical symptoms like fever, cough, or shortness of breath. Initial examination and imaging ruled out an acute stroke. There was minimal improvement in her vestibular symptoms with the recommended COVID-19 treatment as of March 2020 (hydroxychloroquine and azithromycin) and symptomatic management. Her inflammatory markers were surprisingly normal all through the hospital course. She was then treated with oral prednisone and subsequently discharged home after a prolonged course of eight days. The pathophysiology of COVID-19-induced vestibular neuritis could be similar to any other viral infection. Clinicians should consider COVID-19 in the differential diagnosis for patients presenting with similar symptoms, especially in areas of a high prevalence of this disease. Early diagnosis of COVID-19 in such cases is important for proper isolation, to minimize exposure and avoid further unnecessary investigations. These symptoms will just resolve with symptomatic management like any other case of vestibular neuritis without any further management that is specific for a COVID-19 infection.
Keywords	covid19
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.8918
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Article: A Case of Life-Threatening Abdominal Wall Hematoma Formation in a Patient on Warfarin Therapy with Concurrent Influenza Infection.

Papudesi, Bhavani Nagendra / Alvarado, Isabella M / Kaur, Parneet / Malayala, Srikrishna V / Guda, Sivakoti N / Mathew, Mathew / Potluri, Sai Deepika

Cureus

2024 Volume 16, Issue 1, Page(s) e52262

Abstract: Warfarin therapy provides extensive antithrombotic benefits and, thus, is widely used in the general population. However, as with most medications, there are also risks associated with warfarin use. Specifically, because of the narrow therapeutic window ... ...

Abstract	Warfarin therapy provides extensive antithrombotic benefits and, thus, is widely used in the general population. However, as with most medications, there are also risks associated with warfarin use. Specifically, because of the narrow therapeutic window of this drug, patients taking it are at a much higher risk of accidental bleeding. Additionally, patients may also present with bleeding complications when infected with illnesses with coughing as a symptom, such as influenza or COVID-19. These patients have the potential to suffer hemorrhagic morbidities related to the increased intra-abdominal and intra-thoracic pressures that are generated from coughing. Moreover, a synergistic effect is seen when patients find themselves in a situation where they are taking anticoagulation therapy and become infected with illnesses such as influenza or COVID-19. We present a case in which an individual on warfarin therapy was infected with Influenza A. This combination of factors eventually led to massive hemorrhage and large abdominal wall hematoma formation. This case brings to light the importance of having a low threshold for considering the prospect of massive hemorrhage in any patient who is anticoagulated and develops a condition that is associated with increased abdominal pressure. Because these bleeding events can have devastating effects, raising awareness of this risk is increasingly important. Early detection of massive hemorrhage will lead to better outcomes and can ultimately be life-saving for these patients.
Language	English
Publishing date	2024-01-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.52262
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Article: Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA.

Malayala, Srikrishna V / Papudesi, Bhavani Nagendra / Bobb, Raymond / Wimbush, Aliya

Cureus

2022 Volume 14, Issue 8, Page(s) e28160

Abstract: Xylazine, an alpha-2 adrenergic receptor agonist typically used as a sedative and analgesic in veterinary medicine, is being illicitly supplied to persons who inject drugs (PWID), especially in Puerto Rico and Philadelphia, Pennsylvania in the USA. There ...

Abstract	Xylazine, an alpha-2 adrenergic receptor agonist typically used as a sedative and analgesic in veterinary medicine, is being illicitly supplied to persons who inject drugs (PWID), especially in Puerto Rico and Philadelphia, Pennsylvania in the USA. There is a high prevalence (up to 78%) of xylazine in fentanyl in these areas and also a steep increase in fatalities from its overdose. In this case report, we discuss a case of xylazine-induced skin ulcers in a PWID in the city of Philadelphia. The patient is a 37-year-old female who was injecting about eight to ten "bags" of "dope" (fentanyl, which is typically mixed with xylazine in Philadelphia) every day. She typically injected into her veins on the hands and sometimes into the legs. She presented with ulcers on her lower extremities extending from the knees to ankles, associated with copious purulent drainage and a foul smell. There was extensive necrosis of the subcutaneous tissues, abscesses, and tibial osteomyelitis. This led to multiple hospitalizations with bacteremia from Strep pyogenes, methicillin-resistant
Language	English
Publishing date	2022-08-19
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.28160
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Article: Toxic Alcohol Ingestion: A Case Report and Review of Management Pathways.

Atluri, Paavani / Vasireddy, Deepa / Malayala, Srikrishna V

Cureus

2021 Volume 13, Issue 2, Page(s) e13092

Abstract: Toxic alcohol ingestion can be fatal or produce irreversible tissue damage and hence timely recognition and treatment are very important. The physician has to often rely on clinical features and different lab values in order to derive the possible ... ...

Abstract	Toxic alcohol ingestion can be fatal or produce irreversible tissue damage and hence timely recognition and treatment are very important. The physician has to often rely on clinical features and different lab values in order to derive the possible causative agent consumed. Gas chromatography is the definitive diagnostic test to detect the toxic alcohol but is unfortunately not available to run in house in most hospital laboratories in the acute clinical setting. We present a 41-year-old gentleman who was brought to the ED for further evaluation of vomiting and upper abdominal pain. Our clinical impression was that the patient had possible mixed toxic alcohol ingestion. General principles and treatment of alcohol intoxication include gastric lavage or use of activated charcoal. Administration of ethanol or fomepizole to delay or prevent generation of toxic metabolites needs to be initiated while sufficient alcohol remains and metabolized and measurement of blood alcohol concentrations and/or serum osmolality can be helpful. Dialysis is helpful in removing unmetabolized alcohol and possibly toxic metabolites and delivering base to patients to ameliorate metabolic acidosis.
Language	English
Publishing date	2021-02-03
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.13092
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Article: Dermatillomania: A Case Report and Literature Review.

Malayala, Srikrishna V / Rehman, Hira / Vasireddy, Deepa

Cureus

2021 Volume 13, Issue 1, Page(s) e12932

Abstract: Skin picking disorder, also termed dermatillomania is a condition that leads to repetitive picking of their skin ending up in skin and soft tissue damage. It is classified in Diagnostic and Statistical Manual of Mental Disorder Fifth edition under the " ... ...

Abstract	Skin picking disorder, also termed dermatillomania is a condition that leads to repetitive picking of their skin ending up in skin and soft tissue damage. It is classified in Diagnostic and Statistical Manual of Mental Disorder Fifth edition under the "obsessive compulsive and related disorders" section. Often associated with other psychiatric conditions like autism, alcohol abuse, obsessive compulsive, body dysmorphic, mood, anxiety and borderline personality disorders, it is a disorder that is quite often underreported. The patient in this case report is a 58-year-old male with a diagnosis of obsessive compulsive disorder (OCD) who reported severe anxiety and skin picking episodes over several years. He presented to the emergency room with an extensive wound on distal left foot with exposure of the underlying muscle tissue, that resulted from the excessive picking of skin from the left foot. This compulsive behavior started off with picking the skin around his nail beds and slowly got worse. The skin picking would get worse whenever he gets nervous or anxious. The wound was treated with topical wound care and antibiotics. At the time of discharge, he was prescribed oral antibiotics to complete his course of treatment and was referred to the hospital's cognitive behavioral therapy (CBT) program that specializes in treatment of OCD and anxiety disorders. Treatment of dermatillomania is a multipronged approach and should include treatment of the underlying psychiatric illness, the treatment for pruritus and topical treatment of the lesions. Selective serotonin reuptake inhibitors (SSRIs) have proved to be the most effective in treating the psychiatric component of dermatillomania. Non-pharmacological treatments such as behavioral therapy, habit reversal exercises and support groups have also proved to be helpful and are well tolerated amongst patients suffering from dermatillomania.
Language	English
Publishing date	2021-01-27
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.12932
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Article: COVID-19-Induced Vestibular Neuritis, Hemi-Facial Spasms and Raynaud's Phenomenon: A Case Report.

Vanaparthy, Rachana / Malayala, Srikrishna V / Balla, Mamtha

Cureus

2020 Volume 12, Issue 11, Page(s) e11752

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has created a global health crisis. Though respiratory symptoms have been the usual manifestations, the presentation in some cases may be atypical with various neurological and cutaneous manifestations. We ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has created a global health crisis. Though respiratory symptoms have been the usual manifestations, the presentation in some cases may be atypical with various neurological and cutaneous manifestations. We present a case of a 63-year-old female diagnosed with COVID-19 and associated rare manifestations during her visit to Europe.
Language	English
Publishing date	2020-11-28
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.11752
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Article: Purpuric Rash and Thrombocytopenia After the mRNA-1273 (Moderna) COVID-19 Vaccine.

Malayala, Srikrishna V / Mohan, Gisha / Vasireddy, Deepa / Atluri, Paavani

Cureus

2021 Volume 13, Issue 3, Page(s) e14099

Abstract: The mRNA-1273 vaccine, popularly called the "Moderna vaccine" is being widely administered in the United States for the prevention of COVID-19 infection since December 2020. Mild to moderate intensity side effects like low-grade fever, myalgia, chills ... ...

Abstract	The mRNA-1273 vaccine, popularly called the "Moderna vaccine" is being widely administered in the United States for the prevention of COVID-19 infection since December 2020. Mild to moderate intensity side effects like low-grade fever, myalgia, chills and malaise were reported in the trials related to the vaccine. With this case report, we report a case of purpuric rash and thrombocytopenia after receiving the first dose of the m-RNA-1273 vaccine. The patient, in this case, is a 60-year-old male patient who received the first vaccine dose and within two days, he developed diffuse papular rash associated with some thrombocytopenia. He had a history of tobacco use, Hepatitis C liver cirrhosis, chronic kidney disease stage 4, untreated hypertension and systolic congestive heart failure at the baseline. With review of the limited literature related to the vaccine and its side effect profile and with no other etiology explaining the sudden onset of rash, we attribute this thrombocytopenia and purpuric rash as the side effects of the mRNA-1273 vaccine.
Language	English
Publishing date	2021-03-25
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.14099
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Article: Chronic Pediatric Pain and Mental Illness During the COVID-19 Era: A Case Series From Inpatient Child Psychiatry Unit.

Jain, Ankit / Gee, Sage / Malayala, Srikrishna V / Laboe, Christopher W

Cureus

2021 Volume 13, Issue 11, Page(s) e20032

Abstract: Chronic pain is defined as pain that persists following tissue injury or disease processes and is believed to have taken place after healing. It is a functional impairment that causes discomfort and leads to the inability to perform various essential ... ...

Abstract	Chronic pain is defined as pain that persists following tissue injury or disease processes and is believed to have taken place after healing. It is a functional impairment that causes discomfort and leads to the inability to perform various essential daily activities. Chronic pain in pediatrics can be of various types, the most commonly prevalent types being headaches, abdominal pain, and limb pain. Adolescents with chronic pain have been found to have generalized anxiety scores twice that of the average population, along with significant impairment of family dynamics. Some forms of chronic pain respond effectively to medication and psychotherapy, and recurrence is common when stress is triggered by external or environmental factors, most recently in the form of COVID-19. In this case series, we discuss three cases of worsening mental health presentations and chronic pain exacerbation in the context of the COVID-19 pandemic. We talk about the unique perspective of chronic pain in the pediatric population and comorbid mental illnesses and their management from a psychiatric standpoint.
Language	English
Publishing date	2021-11-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.20032
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Article: Acute COVID-19 Cerebellitis: A Rare Neurological Manifestation of COVID-19 Infection.

Malayala, Srikrishna V / Jaidev, Praveena / Vanaparthy, Rachana / Jolly, Taranjeet S

Cureus

2021 Volume 13, Issue 10, Page(s) e18505

Abstract: The COVID-19 virus is well known to cause respiratory tract infections but several non-respiratory presentations and post-infectious complications have been well reported since its origin. With this case report, we present a rare manifestation of COVID- ... ...

Abstract	The COVID-19 virus is well known to cause respiratory tract infections but several non-respiratory presentations and post-infectious complications have been well reported since its origin. With this case report, we present a rare manifestation of COVID-19 infection that presented as acute cerebellitis. This is a case of a 63-year-old Caucasian male patient who presented with altered mental status and ataxia. He was diagnosed with COVID-19 infection about five days prior to presenting to the hospital. Neurological exam was consistent with cerebellar symptoms like broad bases gait, truncal ataxia and subsequent imaging revealed white matter degeneration and edema of the cerebellar hemispheres. The symptoms completely resolved following treatment of ongoing COVID-19 infection with corticosteroids and intravenous remdesivir. With this case report, we intend to discuss the available literature regarding the clinical manifestations, management, and prognosis of COVID-19-induced cerebellitis.
Language	English
Publishing date	2021-10-05
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.18505
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