Bujji B Ainapurapu

Interests

Research

Quality improvement projects

Teaching

Bedside teaching- clinical examination, communication with patients.Small group teaching like morning reports.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Bolakale-Rufai, I. K., French, S. R., Knapp, S. M., Thompson, M., Arias, J. C., Garcia-Filion, P., Ainapurapu, B., Tan, T. W., & Weinkauf, C. C. (2025). Stratification of Clinical Microvascular Disease Severity Using Non-Invasive Monofilament Testing in Patients with Type 2 Diabetes Mellitus. Diabetology, 6(Issue 4). doi:10.3390/diabetology6040024
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  Background: Microvascular disease (MVD) describes systemic changes in small vessels (~100 µm diameter or smaller) that impair tissue oxygenation and perfusion. MVD has been demonstrated to play an independent role in the risk of limb loss. Despite this relevance, MVD is not regularly assessed clinically because tools used to evaluate and quantify the severity of MVD of the foot remain limited. We sought to evaluate if the Semmes-Weinstein 10-g Monofilament (SWM) can be used to stratify clinical MVD severity. Methods: We evaluated a racially diverse cohort of 124 patients (with 248 limbs). SWM testing was performed on the plantar aspect of the feet at 1st, 3rd, and 5th metatarsophalangeal joints. Clinical MVD was stratified in an ascending order of severity into: no diabetes; type 2 diabetes (DM); diabetes+ neuropathy (DM+N); diabetes + neuropathy + retinopathy (DM+N+R). Logistic regression models were used to examine the association between a patient’s clinical MVD severity and an abnormal SWM test. Results: Sixty-four patients (51.6%) tested had an abnormal sensation. The odds of an abnormal SWM test were significantly higher for patients with DM+N and DM+N+R compared to those with no DM respectively. (DM vs. No DM: OR: 3.58, [0.98–13.09], p = 0.05; DM+N vs. No DM: OR: 30.46, [10.33–105.17], p < 0.001; DM+N+R vs. No DM: OR: 43.00, [9.89–309.17], p < 0.001). Furthermore, we categorized SWM based on the degree of sensation loss and found that the proportion of people with a higher degree of sensation loss increased across the clinical MVD severity spectrum. Conclusions: Abnormal SWM sensation strongly correlates with the severity of clinical MVD. This suggests that a simple, non-invasive, 1-min SWM test that can be done in the clinic is a promising tool in assessing MVD in the feet, which is particularly significant considering MVD involvement in limb loss.
• Blohm, J., Panthula, M., Aggarwal, A., Swazo, R., Ashoka, A., & Ainapurapu, B. (2023). Fatal Disseminated Coccidioidomycosis in Cirrhosis: A Case Series. American Journal of Medicine, 136(7). doi:10.1016/j.amjmed.2023.04.004
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  Purpose: Coccidioidomycosis is endemic to the Southwest United States and Mexico. In this case series we describe 3 cases, occurring in the Southwest United States, of patients with disseminated coccidioidomycosis infection in cirrhosis, all with a miliary pattern present on chest imaging. Methods: This case series was performed conducting a review of patients’ electronic health records and thorough review of the literature for coccidioidomycosis infection in patients with liver disease. Results: Three patients with different etiology of liver disease with Model for End-stage Liver Disease – Sodium (MELD-Na) scores >20 had chest imaging findings indicative of a miliary pattern on presentation. Each patient subsequently had extensive infectious disease workup that showed evidence of disseminated coccidioidomycosis. All 3 patients clinically worsened and eventually died. Conclusions: This case series highlights the severity of disseminated coccidioidomycosis in patients with cirrhosis in an endemic area, as well as potential early clues such as miliary patterns on chest imaging. A review of the literature found a significant connection among potential mechanisms describing why patients with cirrhosis have such adverse outcomes in the setting of disseminated coccidioidomycosis, including cirrhosis-associated immune dysfunction and genetic defects in immune functioning.
• Khludenev, G., Le Cam, E., & Ainapurapu, B. B. (2023). Non-diabetic Euglycemic Ketoacidosis in an Adult Patient With Spinal Muscular Atrophy Type II. Cureus, 15(9), e45666.
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  Spinal muscular atrophy (SMA) is a rare neuromuscular disease that develops as a result of the degeneration of the anterior horn cells in the spinal cord and lower brainstem motor nuclei, resulting in progressive muscle weakness and atrophy. While the initial presentation of this disease involves diffuse muscular atrophy at an early age, patients with an established diagnosis and later-stage disease often present with gastrointestinal symptoms related to metabolic imbalances. Here, we examine the case of an adult patient with SMA type II who presented with complaints of 12 hours of intractable nausea and vomiting. The patient was found to be in euglycemic ketoacidosis (EKA), an uncommon, but not unheard of, metabolic derangement in SMA patients with severely decreased muscle mass.
• Blackstone, N., Olson, A., & Ainapurapu, B. B. (2020). Physostigmine in Anticholinergic poisoning: An old antidote with resurgence. Cureus, 12(11). doi:10.7759/cureus.111739
• Siordia, J., Uhland, C., & Ainapurapu, B. B. (2020). Pomalidomide-Induced Lung Injury Mimicking COVID19 Pneumonia. Journal of Medical Case Reports, 3.
• Pahuja, M., Ainapurapu, B., & Abidov, A. (2017). Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency.. Case reports in cardiology, 2017, 7576801. doi:10.1155/2017/7576801
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  58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia.
• Swazo, R. C., & Ainapurapu, B. B. (2017). Deadly Diarrhea: The Clever Disguise of Aortic Dissection. American Journal of Medicine, 130(Issue 2). doi:10.1016/j.amjmed.2016.09.038
• Ainapurapu, B. (2015). Familiarity Breeds Contempt: "Frequent Fliers" in Medicine. Southern medical journal, 108(12), 701.
• Ainapurapu, B. (2015). Familiarity Breeds Contempt: "frequent Fliers" in Medicine. Southern Medical Journal, 108(Issue 12). doi:10.14423/smj.0000000000000375
• Hagio, T., Huang, C., Abidov, A., Singh, J., Ainapurapu, B., Squire, S., Bruck, D., & Altbach, M. I. (2015). T2 mapping of the heart with a double-inversion radial fast spin-echo method with indirect echo compensation. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 17, 24.
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  The abnormal signal intensity in cardiac T2-weighted images is associated with various pathologies including myocardial edema. However, the assessment of pathologies based on signal intensity is affected by the acquisition parameters and the sensitivities of the receiver coils. T2 mapping has been proposed to overcome limitations of T2-weighted imaging, but most methods are limited in spatial and/or temporal resolution. Here we present and evaluate a double inversion recovery radial fast spin-echo (DIR-RADFSE) technique that yields data with high spatiotemporal resolution for cardiac T2 mapping.
• Kanakadandi, U. B., & Ainapurapu, B. (2014). Trimethoprim-sulfamethoxazole induced rhabdomyolysis.. American journal of therapeutics, 21(3), e78-9. doi:10.1097/mjt.0b013e31824567fe
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  Empiric antibiotic usage is very common in clinical practice and Trimethoprim-Sulfamethoxazole (TMP-SMX) is one such antibiotic used extensively in primary care practice. Some patients experience serious adverse effects to the antibiotics that markedly increase the morbidity and the cost of medical care. We describe one such patient, a previously healthy 40-year-old Hispanic female who developed myositis and rhabdomyolysis secondary to TMP-SMX. To the best of our knowledge, this is the first report of TMP-SMX-induced rhabdomyolysis in an immunocompetent host.
• Ainapurapu, B., Galons, J. P., Squire, S., Singh, J., Kc, D. B., Huang, C., Galons, J. P., Barr, T., Altbach, M. I., Ainapurapu, B., & Abidov, A. (2012). T2 mapping of the heart with high temporal and spatial resolution using a radial double inversion fast spin-echo pulse sequence with view sharing. Journal of Cardiovascular Magnetic Resonance, 14(1), 1-2. doi:10.1186/1532-429x-14-s1-o112
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  Summary A double inversion radial fast spin echo (DIR-RADFSE) has been developed to obtain T2 maps of the heart with high-temporal and spatial resolution from data acquired in as ingle breath hold. The method allows for the quantitative assessment of inflammation in the heart. Background While DE imaging is considered a gold standard in the evaluation of myocardial scar/viability in patients with old MI or cardiomyopathy, a few recent publications demonstrate a higher diagnostic sensitivity of T2weighted techniques in patients with Non-STEMI and myocarditis where changes in T2-weighting are due to inflammation in the myocardium leading to edema (Abdel-Aty H, JACC 53:1194, 2009; Tilak GS, Invest
• Kenkare, S., & Ainapurapu, B. (2010). Erratum: Macrodactylia fibrolipomatosis presenting as a small bowel obstruction (Southern Medical Journal (2010) 103 (248-249)). Southern Medical Journal, 103(Issue 7). doi:10.1097/smj.0b013e3181ec1bda
• Kenkare, S., & Ainapurapu, B. (2010). Macrodactylia fibrolipomatosis presenting as a small bowel obstruction.. Southern medical journal, 103(3), 248-9. doi:10.1097/smj.0b013e3181ce0e36
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  A patient presented with progressive abdominal distention, discomfort, nausea, vomiting, and constipation. The patient also had congenital macrodactyly of the third, fourth, and fifth digits of the left hand. He [corrected] was diagnosed with macrodactylia fibrolipomatosis with multiple small bowel lipomas and complete small bowel obstruction. Macrodactylia fibrolipomatosis is a rare condition characterized by benign fibrofatty infiltration involving the soft tissues of the distal arm or leg with associated dactylomegaly of the associated digits. This patient had a rare presentation that included extensive small bowel lipomatosis.

Proceedings Publications

• Ainapurapu, B., Uhland, C., & Siordia, J. (2021). Pomalidomide-Induced Lung Injury Mimicking COVID19 Pneumonia. In American Thoracic Society.

Presentations

• Ainapurapu, B. B., Ainapurapu, B. B., Shirazi, F., Shirazi, F., Swazo, R., Swazo, R., Ainapurapu, B. B., Shirazi, F., & Swazo, R. (2019, May). Confused and Belligerent Professor. Medicine Grand Rounds/CPC. UACOM.

Poster Presentations

• Ainapurapu, B. B., Rubio, V., Singh, V., Giaque, N., & Parsons, D. (2024, October).

  TAFRO Syndrome, Case Report on a Poorly Understood Manifestation of Castleman’s Disease. Poster presented at: 2024 

  . Arizona Chapter Annual Scientific Meeting; Tucson, AZ.
• Ainapurapu, B. B., Singh, V., Tumac, A., & Samara, T. (2024, October).

  ·      Singh V, Tumac AC, Samra T, Ainapurapu B.  Cefepime neurotoxicity presenting with stroke-like deficits. 

  . Arizona Chapter Annual Scientific Meeting; Tucson, AZ..
• Ainapurapu, B. B., Long, M., & Pham, H. Y. (2023, October). More than meets the eye: A case of acute onset diffuse systemic sclerosis. ACP AZ Chapter Meeting. Tempe, AZ: ACP.
• Kumar, S., Power, E., & Ainapurapu, B. B. (2018, Oct). How to aDRESS complication of Allopurinol. ACP-AZ chapter. Tempe: ACP.
• Ainapurapu, B. B., & Blumenkron, F. (2017, October). • Uncommitted to this Ring. ACP-AZ chapter meetingAmerican College of Physicians.
• Ainapurapu, B. B., & Britt, J. (2017, October). Too many platelets and still bleeding!. ACP-AZ Chapter MeetingACP.
• Ainapurapu, B. B., & Kannaiyan, R. (2017, October). The story of a Catwoman. ACP-AZ chapter meetingACP.
• Ainapurapu, B. B., O'Hara, G., & Danawala, L. (2017, October). Anaplastic Large Cell Lymphoma with Cutaneous Involvement. ACP-AZ chapter meetingACP.
• Ainapurapu, B. B., Swazo, R., & Lam, P. (2017, October). From birth control to blindness. ACP-AZ Chapter Meeting.
• Ainapurapu, B. B., Yousman, W., & Huang, J. (2017, October). Rapidly Progressive Cardiac Allograft Vasculopathy in a Heart Transplant Patient. ACP-AZ Chapter MeetingACP.
• Khare, S. B., Jasper, S., & Khare, S. (2017, October). Cushing’s syndrome and The Lost Art of History and Physical Examination. ACP-AZ chapter meetingACP.
• Tariq, S., Ainapurapu, B. B., & Jaswal, N. (2017, October). The disappearing mole act. ACP-AZ Chapter Meeting.
• August, J., Ainapurapu, B. B., & Zangeneh, T. T. (2016, May). Running Out of Sight- Neuroretinitis secondary to Borrelia Hermsii infection. ACP NationalsAmerican College of Physicians National Meeting.
• Ainapurapu, B. B. (2015, 10/Fal). An unusual cause of a common complaint. ACP-AZ Chapter meeting. Tucson: ACP.
• Jaffer, F., Patel, S., Potharaju, A., Bruzzi, B., & Ainapurapu, B. B. (2015, 10/Fall). Impact of Resident Education in System based practice to improve patient care. ACP-AZ chapter meeting. Tucson: ACP.
• Sandoval, J., Salazar, B., & Ainapurapu, B. B. (2015, 10/Fall). Cranial Germinoma: A rare cause of Panhypopituarism. ACP-AZ chapter meeting. Tucson: ACP.
• Singh, N., Natt, B., Ainapurapu, B. B., & Trowers, E. A. (2015, November/Fall). Hereditary Spherocytosis Leading to Pulmonary Hypertension. American College of Physicians Arizona Meet. Tucson, AZ.

Reviews

• Blohm, J. E., Panthula, M., Aggarwal, A., Swazo, R., Ashoka, A., & Ainapurapu, B. (2023. Fatal Disseminated Coccidioidomycosis in Cirrhosis: A Case Series(pp 707-709).
  More info

  Coccidioidomycosis is endemic to the Southwest United States and Mexico. In this case series we describe 3 cases, occurring in the Southwest United States, of patients with disseminated coccidioidomycosis infection in cirrhosis, all with a miliary pattern present on chest imaging.

Others

• Ainapurapu, B. B., Acuna, J., Adhikari, S. R., Situ-LaCasse, E., & Siordia, J. (2020, October). Does Artificial Intelligence guidance help Internal Medicine residents acquire better diagnostic point of care ultrasound images. Research Project.
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  This is a research project where we tested whether artificial intelligence (AI) guidance using caption health device helps IM residents to get better diagnostic quality images. This was done on standardized patients and surveys were also conducted on whether performers felt the AI guidance was helpful or not. Project is currently underway.