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Article: Cefoperazone-induced Coagulopathy in Critically Ill Patients Admitted to Intensive Care Unit.

Gudivada, Kiran Kumar / Krishna, Bhuvana / Sampath, Sriram

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2023 Volume 27, Issue 3, Page(s) 183–189

Abstract: ... Krishna B, Sampath S. Cefoperazone-induced Coagulopathy in Critically Ill Patients Admitted ...

Abstract	Background: N-methylthiotetrazole side chain (NMTT) of cefoperazone was attributed to inhibit the vitamin K epoxide enzyme. This mechanism is similar to warfarin; thus, vitamin K was suggested to antagonize the hematological effects of cefoperazone. The literature on critically ill patients receiving cefoperazone and its clinical significance on bleeding diathesis is sparse. Objectives: To assess the incidence of cefoperazone-induced coagulopathy (CIC), its clinical impact on bleeding episodes, and transfusion requirements. Predisposing factors and the role of prophylactic and therapeutic vitamin K were evaluated. Materials and methods: Prospective observational study of adult intensive care unit (ICU) patients (>18 years) receiving cefoperazone between December 2017 and December 2018. We excluded those on warfarin, those with preexisting elevated Results: Among 65 patients, 17 (26%) had probable CIC. Hypoalbuminemia and vancomycin co-administration were risk factors for CIC. Hemoglobin drops and blood transfusions were not different between INR non-elevated and elevated groups (11 vs 8 gm/dL; Conclusion: Results of this study revealed that CIC is not uncommon in ICUs. Based on the findings of the study, we suggest INR monitoring in patients receiving nephrotoxic agents and patients with hypoalbuminemia. We also recommend vitamin K administration in patients with elevated INR. How to cite this article: Gudivada KK, Krishna B, Sampath S. Cefoperazone-induced Coagulopathy in Critically Ill Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2023;27(3):183-189.
Language	English
Publishing date	2023-03-17
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24417
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: New lung cancer diagnosis after emergency department presentation in a tertiary hospital: patient characteristics and outcomes.

Niranjan, Navin / Sriram, Krishna Bajee

Hospital practice (1995)

2022 Volume 50, Issue 5, Page(s) 356–360

Abstract: Objectives: Currently, there are limited data available about patients who are diagnosed with lung cancer following an emergency department (ED) visit. This study sought to define the demographics, symptoms profile, staging, and prognosis of this cohort ...

Abstract	Objectives: Currently, there are limited data available about patients who are diagnosed with lung cancer following an emergency department (ED) visit. This study sought to define the demographics, symptoms profile, staging, and prognosis of this cohort of patients. Methods: We conducted a retrospective study of patients diagnosed with a primary lung malignancy at a lung cancer multidisciplinary meeting between January 2018 and January 2020. Medical records were reviewed to collect data around demographics, presenting symptoms, investigations, admission, cancer stage, and mortality. Results: During the study period, 890 patients were diagnosed with a primary lung malignancy of which 209 (23.5%) presented to ED prompting diagnostic work-up. Of these 209 patients, 89% were hospitalized for a median duration of 6 days. Also, 104 (50%) were female and the average age of the cohort was 70 years. Dyspnea (38%) was the most common presenting symptom. Radiological staging and tissue biopsy were performed as an outpatient procedure in 46% and 41% of patients, respectively. A total of 188 patients had non-small cell lung cancer of whom 68% had ztage IV disease. A total of 53 (25%) patients died within 3 months of ED presentation. These patients were older with more advanced disease compared to patients who were alive at 3 months. Conclusion: Emergent diagnosed patients are a significant proportion of the lung cancer population, presenting with advanced stage disease and increased short-term mortality. Future research should be directed at interventions, such as lung cancer screening program and/or community education, to reduce the need for patients to present to the ED with disabling lung cancer symptoms.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Tertiary Care Centers ; Retrospective Studies ; Carcinoma, Non-Small-Cell Lung ; Early Detection of Cancer ; Lung Neoplasms/diagnosis ; Emergency Service, Hospital
Language	English
Publishing date	2022-09-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2570453-9
ISSN	2377-1003 ; 2154-8331 ; 8750-2836
ISSN (online)	2377-1003
ISSN	2154-8331 ; 8750-2836
DOI	10.1080/21548331.2022.2121573
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Article: Correlation of Common Carotid Artery Blood Flow Parameters With Transthoracic Echocardiographic Cardiac Output for Assessing Fluid Responsiveness After Passive Leg Raising (PLR) Test in Critically Ill Patients.

Patnaik, Rohit / Krishna, Bhuvana / Sampath, Sriram

Cureus

2023 Volume 15, Issue 6, Page(s) e40229

Abstract: Introduction The passive leg raising (PLR) test is a simple, non-invasive method of knowing fluid responsiveness by acting as an internal-fluid challenge. The PLR test coupled with a non-invasive assessment of stroke volume would be the ideal method to ... ...

Abstract	Introduction The passive leg raising (PLR) test is a simple, non-invasive method of knowing fluid responsiveness by acting as an internal-fluid challenge. The PLR test coupled with a non-invasive assessment of stroke volume would be the ideal method to assess fluid responsiveness. This study aimed to determine the correlation between transthoracic echocardiographic cardiac output (TTE-CO) and common carotid artery blood flow (CCABF) parameters in determining fluid responsiveness with the PLR test. Methods We performed a prospective observational study on 40 critically ill patients. Patients were evaluated with a 7-13 MHz linear transducer probe for CCABF parameters calculated using time-averaged mean velocity (TAmean) and with a 1-5 MHz cardiac probe equipped with tissue doppler imaging (TDI) for TTE-CO calculated using left ventricular outflow tract velocity time integral (LVOT VTI) with an apical five-chamber view. Two separate PLR tests (five minutes apart) were done within 48 hours of ICU admission. The first PLR test was to assess the effects on TTE-CO. The second PLR test was performed to assess the effects on CCABF parameters. Patients were designated as fluid responders (FR) if changes in TTE-CO (Δ TTE-CO) ≥ 10 %. Results A positive PLR test was observed in 33% of patients. A strong correlation was present between absolute values of TTE-CO calculated using LVOT VTI and the absolute values of CCABF calculated using TAmean (r=0.60, p<0.05). However, a weak correlation was found between Δ TTE-CO and changes in CCABF (Δ CCABF) during the PLR test (r=0.05, p<0.74). A positive PLR test response could not be detected by Δ CCABF (area under the curve (AUC): 0.59 ± 0.09). Conclusions We found a moderate correlation between TTE-CO and CCABF at baseline. However, Δ TTE-CO had a very poor correlation with Δ CCABF, during the PLR test. Considering this, CCABF parameters may not be recommended as a means to detect fluid responsiveness with PLR tests in critically ill patients.
Language	English
Publishing date	2023-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.40229
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Article ; Online: Obstructive Sleep Apnea and Colorectal Cancer: A Systematic Review and Meta-Analysis.

Niranjan, Navin / Sriram, Krishna Bajee / Gopalan, Vinod

Journal of gastrointestinal cancer

2023 Volume 54, Issue 4, Page(s) 1151–1157

Abstract: Background: Obstructive sleep apnea (OSA), characterised by recurrent episodes of upper airway collapse, intermittent hypoxia (IH) and sleep fragmentation (SF), has been associated with carcinogenesis in pre-clinical models. The relationship between OSA ...

Abstract	Background: Obstructive sleep apnea (OSA), characterised by recurrent episodes of upper airway collapse, intermittent hypoxia (IH) and sleep fragmentation (SF), has been associated with carcinogenesis in pre-clinical models. The relationship between OSA and colorectal cancer (CRC) in clinical studies is controversial. Aim: The objective of this meta-analysis was to assess the association between OSA and CRC. Methods: Two independent investigators searched studies indexed in CINAHL, MEDLINE, EMBASE, the Cochrane Database and clinicaltrials.gov that were randomised controlled trials (RCT) or observational studies evaluating the relationship between OSA and CRC. Studies were included if they had available odds ratios (OR) and relative risks (RR) or if hazard ratios (HR) with 95% confidence intervals (CI) were available and a reference group composed of participants who did not have OSA. OR and 95% CI were calculated using a random-effect, generic inverse variance method. Results: We included four observational studies out of 85 records, comprising a combined cohort of 5,651,662 identified patients in the data analysis. Three studies used polysomnography to identify OSA. The pooled OR of CRC in patients with OSA was 1.49 (95% CI, 0.75 to 2.97). The statistical heterogeneity was high with I Conclusions: Our study is unable to conclusively point towards OSA being a risk factor in the development of CRC, despite the plausible biological mechanisms for this. Further well-designed prospective RCT assessing the risk of CRC in patients with OSA and the impact of OSA treatments on the incidence and prognosis of CRC are needed.
MeSH term(s)	Humans ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/epidemiology ; Polysomnography ; Risk Factors ; Incidence ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/complications
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2452514-5
ISSN	1941-6636 ; 1559-0739 ; 1941-6628 ; 1537-3649
ISSN (online)	1941-6636 ; 1559-0739
ISSN	1941-6628 ; 1537-3649
DOI	10.1007/s12029-023-00919-2
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Article ; Online: Assessment of ACE inhibitors/angiotensin receptor blockers in COVID-19 patients.

Sriram, Krishna / Insel, Paul A

American journal of physiology. Lung cellular and molecular physiology

2021 Volume 319, Issue 1, Page(s) L37–L38

MeSH term(s)	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; COVID-19 ; Humans ; Renin-Angiotensin System ; SARS-CoV-2
Chemical Substances	Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors
Language	English
Publishing date	2021-01-26
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1013184-x
ISSN	1522-1504 ; 1040-0605
ISSN (online)	1522-1504
ISSN	1040-0605
DOI	10.1152/ajplung.00262.2020
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Article ; Online: A Review on Additive Manufacturing Processes

Praneeth Jammula / Venkatesh Sriram / Sivarama Krishna Ledella

E3S Web of Conferences, Vol 430, p

2023 Volume 01282

Abstract: Additive manufacturing, well known as 3D printing, is used to fabricate complex geometries and customized products. Freedom to design and waste minimization are key concerns of this technology. Additive manufacturing gains significant interest in many ... ...

Abstract	Additive manufacturing, well known as 3D printing, is used to fabricate complex geometries and customized products. Freedom to design and waste minimization are key concerns of this technology. Additive manufacturing gains significant interest in many fields which includes aerospace, automotive, navy, and biomedical industries. In this technology, a geometrical CAD model is sliced into a number of layers and then stacked of material in layer-by-layer manner. In this review paper we discussed the various 3D printing methods and materials that are available now and current limitations, future trends of this technology.
Keywords	Environmental sciences ; GE1-350
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	EDP Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Design, synthesis, anti-mycobacterial activity, molecular docking and ADME analysis of spiroquinoxaline-1,2,4-oxadiazoles via [3 + 2] cycloaddition reaction under ultrasound irradiation.

Kanchrana, Madhu / Gamidi, Rama Krishna / Kumari, Jyothi / Sriram, Dharmarajan / Basavoju, Srinivas

Molecular diversity

2024

Abstract: The development of anti-tuberculosis (anti-TB) drugs has become a challenging task in medicinal chemistry. This is because Mycobacterium tuberculosis (TB), the pathogen that causes tuberculosis, has an increasing number of drug-resistant strains, and ... ...

Abstract	The development of anti-tuberculosis (anti-TB) drugs has become a challenging task in medicinal chemistry. This is because Mycobacterium tuberculosis (TB), the pathogen that causes tuberculosis, has an increasing number of drug-resistant strains, and existing medication therapies are not very effective. This resistance significantly demands new anti-TB drug profiles. Here, we present the design and synthesis of a number of hybrid compounds with previously known anti-mycobacterial moieties attached to quinoxaline, quinoline, tetrazole, and 1,2,4-oxadiazole scaffolds. A convenient ultrasound methodology was employed to attain spiroquinoxaline-1,2,4-oxadiazoles via [3 + 2] cycloaddition of quinoxaline Schiff bases and aryl nitrile oxides at room temperature. This approach avoids standard heating and column chromatography while producing high yields and shorter reaction times. The target compounds 3a-p were well-characterized, and their in vitro anti-mycobacterial activity (anti-TB) was evaluated. Among the screened compounds, 3i displayed promising activity against the Mycobacterium tuberculosis cell line H37Rv, with an MIC99 value of 0.78 µg/mL. However, three compounds (3f, 3h, and 3o) exhibited potent activity with MIC99 values of 6.25 µg/mL. To further understand the binding interactions, the synthesized compounds were docked against the tuberculosis protein 5OEQ using in silico molecular docking. Moreover, the most active compounds were additionally tested for their cytotoxicity against the RAW 264.7 cell line, and the cytotoxicity of compounds 3f, 3h, 3i, and 3o was 27.3, 28.9, 26.4, and 30.2 µg/mL, respectively. These results revealed that the compounds 3f, 3h, 3i, and 3o were less harmful to humans. Furthermore, the synthesized compounds were tested for ADME qualities, and the results suggest that this series is useful for producing innovative and potent anti-tubercular medicines in the future.
Language	English
Publishing date	2024-01-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1376507-3
ISSN	1573-501X ; 1381-1991
ISSN (online)	1573-501X
ISSN	1381-1991
DOI	10.1007/s11030-023-10790-9
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Article ; Online: Occupational therapy in adults with chronic respiratory conditions: A scoping review.

McCowan, Amanda / Gustafsson, Louise / Bissett, Michelle / Sriram, Bajee Krishna

Australian occupational therapy journal

2023 Volume 70, Issue 3, Page(s) 392–415

Abstract: Introduction: Chronic respiratory diseases have a clear impact on occupational performance and engagement. Although occupational therapists have long provided services to this population, evidence regarding the unique role and true impact of ... ...

Abstract	Introduction: Chronic respiratory diseases have a clear impact on occupational performance and engagement. Although occupational therapists have long provided services to this population, evidence regarding the unique role and true impact of occupational therapy is emerging. Aims/objectives: The purpose of this scoping review was to explore the range, context, and outcomes of occupational therapy services for adults with chronic respiratory conditions. Methods: A scoping review guided by the methodological framework of Arksey and O'Malley was completed. To be included articles needed to be peer reviewed primary studies published in English between 2000 and September 2022 describing occupational therapy service delivery for people with chronic respiratory conditions. Results: Twenty-six articles met inclusion criteria including 12 cohort studies, seven randomised control trials, four qualitative, two case reports, and one service evaluation. Interventions were targeted at body functions and structures (n = 18), activities and participation (n = 17), and environmental factors (n = 14). Ten studies reported impacts of occupational therapy ranging from physiological responses through to quality of life. Conclusion: Occupational therapy service delivery is common for this population, often occurring as part of multidisciplinary programs, and is inclusive of a range of assessments and interventions. Further details in future primary research are needed to describe the mode and unique occupational nature of service delivery.
MeSH term(s)	Humans ; Adult ; Occupational Therapy ; Quality of Life ; Occupational Therapists
Language	English
Publishing date	2023-02-01
Publishing country	Australia
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	604554-6
ISSN	1440-1630 ; 0045-0766
ISSN (online)	1440-1630
ISSN	0045-0766
DOI	10.1111/1440-1630.12861
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Article ; Online: Inhaled

Sriram, Krishna / Insel, Michael B / Insel, Paul A

Pharmacological reviews

2021 Volume 73, Issue 4, Page(s) 488–526

Abstract: Inhaled long- ... ...

Abstract	Inhaled long-acting
MeSH term(s)	Administration, Inhalation ; Adrenal Cortex Hormones ; Adrenergic beta-Agonists/pharmacology ; Endothelial Cells ; Humans
Chemical Substances	Adrenal Cortex Hormones ; Adrenergic beta-Agonists
Language	English
Publishing date	2021-11-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209898-2
ISSN	1521-0081 ; 0031-6997
ISSN (online)	1521-0081
ISSN	0031-6997
DOI	10.1124/pharmrev.121.000356
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Article: Feud, Flower, and Fatal Electrocardiograms.

Veeraraghavan, Sriram / Kidambi, Bharath Raj / Reddy, Sai Krishna / Vijay, Soorampally / Munisingh, Abhilasha / Ponnangati, Vasundhara

Cureus

2024 Volume 16, Issue 1, Page(s) e52531

Abstract: Oleander is a prevalent tropical plant used in many parts of India for deliberate self-harm. The active ingredients act in a mechanism similar to cardiac glycosides; hence, the toxicological profile is similar to digoxin toxicity. Cardiac toxicity occurs ...

Abstract	Oleander is a prevalent tropical plant used in many parts of India for deliberate self-harm. The active ingredients act in a mechanism similar to cardiac glycosides; hence, the toxicological profile is similar to digoxin toxicity. Cardiac toxicity occurs in the form of a heart block with concomitant ventricular arrhythmia. Identifying the distinct electrocardiographic pattern for early diagnosis and initiating emergency management is imperative. Here, we present two such interesting cases of oleander intoxication, one with Nerium oleander and the other with Thevetia peruviana.
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.52531
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