Gurusaravanan Kutti Sridharan

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Research

Internal MedicineCardiology

Teaching

Internal MedicineCardiology

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Scholarly Contributions

Journals/Publications

• Fang, Y., Aravamudan, V. M., Sridharan, G. K., Mehta, K. K., Sekhar, R., Senguttuvan, N. B., Venkatachalam, I., & Abid, M. B. (2021). Kawasaki like illness due to COVID-19: a review of the literature. Journal of infection in developing countries, 15(5), 630-638.
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  Viral infections have been described as triggers for Kawasaki Disease (KD), a medium vessel vasculitis that affects young children. Akin to the H1N1 pandemic in 2009, there is a similar rise in the incidence of KD in children affected with Coronavirus disease 2019 (COVID-19). Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) has been reported to induce an exaggerated systemic inflammatory response resulting in multi-organ involvement, particularly initiated with pulmonary parenchymal damage. This review article will discuss KD-like manifestations in COVID-19 patients in the pediatric cohort.
• Hunsinger, D. H., Kutti Sridharan, D. G., Rokkam, D. V., & Fantry, D. L. (2021). COVID-19 Reinfection in An Immunosuppressed Patient Without An Antibody Response. The American journal of the medical sciences, 362(1), 103.
• Kutti Sridharan, G., & Rokkam, V. R. (2021). Macroglossia. Statpearls( Internet).
• Kutti Sridharan, G., Rokkam, V. R., Sundararajan, S., Amaraneni, A., & Thai, T. (2021). Clinical Manifestations and Treatment Outcomes of Metastatic Melanoma With Bone Marrow Infiltration. American Journal of Therapeutics, 3.
• Prudhvi, K., Jonnadula, J., Rokkam, V. R., & Kutti Sridharan, G. (2021). Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature. World journal of cardiology, 13(4), 103-110.
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  Pregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.
• Rokkam, V. R., Kutti Sridharan, G., Vegunta, R., Vegunta, R., Boregowda, U., & Mohan, B. P. (2021). Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis. Case reports in vascular medicine, 2021, 8832638.
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  The COVID-19 pandemic has created an unprecedented global health care crisis. COVID-19 patients are found to have increased thrombotic risk. Despite being on prophylactic anticoagulation, many develop serious arterial and venous thromboembolic events. Emerging reports indicate COVID-19 may be considered a novel risk factor for portal vein thrombosis. Although, intra-abdominal infections are identified as risk factors, clostridium difficile colitis has not been typically seen as a risk factor for PVT. We report a case of an elderly female with a recent diagnosis of COVID-19 and no prior history of cirrhosis or malignancy who presented with diarrhea due to clostridium difficile infection. She developed sudden onset severe abdominal pain during the course of hospitalization. Acute portal vein thrombosis was identified on CT imaging of the abdomen, and she improved well with therapeutic anticoagulation. Acute portal vein thrombosis usually results from a combination of local and systemic prothrombotic risk factors. The combination of local infection by clostridium difficile and COVID-19 coagulopathy led to development of portal vein thrombosis in our patient. To the best of our knowledge, this is the first case of portal vein thrombosis reported in a patient with clostridium difficile infection in the setting of COVID-19 coagulopathy. During the current pandemic, clinicians should strongly consider abdominal imaging in patients presenting with abdominal pain due to clostridium difficile infection in the setting of COVID-19 to rule out complications such as portal vein thrombosis. Early diagnosis and treatment of portal vein thrombosis prevent complications of portal hypertension and intestinal infarctions.
• Vegunta, R., Vegunta, R., Rokkam, V. R., & Kutti Sridharan, G. (2021). Diagnosis of Stroke on Neuroimaging of COVID-19 Patients in Coma: A Case Series. Cureus, 13(1), e13007.
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  Patients with severe coronavirus disease 2019 (COVID-19) disease suffer from many thrombotic complications including deep vein thrombosis, pulmonary embolism, myocardial infarction (MI), and stroke. Large vessel strokes have been reported in young patients with COVID-19 disease. We report four cases of stroke diagnosed based on CT scan in critically ill individuals treated in the medical intensive care unit in a health facility in New York. All patients were receiving supportive treatment and mechanical ventilation at the time of diagnosis. All patients had impaired consciousness and were unable to wake up after sedation had worn off, prompting further workup. The pathogenesis of stroke could be secondary to the embolic phenomenon vs. hypercoagulopathy in our patients. Stroke should be considered in all COVID-19 patients who present with altered mental status. Severe COVID-19 patients with risk factors of stroke may benefit from therapeutic anticoagulation.
• Boregowda, U., Perisetti, A., Nanjappa, A., Gajendran, M., Kutti Sridharan, G., & Goyal, H. (2020). Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis. Frontiers in medicine, 7, 586221.
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  Tocilizumab (TCZ) is an anti-interleukin-6 antibody that has been used for the treatment of severe coronavirus disease 2019 (COVID-19). However, concrete evidence of its benefit in reducing mortality in severe COVID-19 is lacking. Therefore, we performed a systematic review and meta-analysis of relevant studies that compared the efficacy of TCZ in severe COVID-19 vs. standard of care (SOC) alone. A literature search for studies that compared "tocilizumab" and "standard of care" in the treatment of COVID-19 was done using major online databases from December 2019 to June 14, 2020. Search words "Tocilizumab," "anti-interleukin-6 antibody," and "COVID-19" or "coronavirus 2019" in various combinations were used. Articles in the form of abstracts, letters without original data, case reports, and reviews were excluded. Data were gathered on an Excel sheet, and statistical analysis was performed using Review Manager 5.3. Sixteen studies were eligible from 693 initial studies, including 3,641 patients (64% males). There were 13 retrospective studies and three prospective studies. There were 2,488 patients in the SOC group (61.7%) and 1,153 patients (68.7%) in the TCZ group. The death rate in the TCZ group, 22.4% (258/1,153), was lower than in the SOC group, 26.21% (652/2,488) [pooled odds ratio 0.57 (95% CI 0.36-0.92), = 0.02]. There was a significant heterogeneity (inconsistency index = 80%) among the included studies. The addition of TCZ to the SOC might reduce mortality in severe COVID-19. More extensive randomized clinical trials are needed to validate these findings.
• Chamarthi, G., Vegunta, R., Vegunta, R., Sridharan, G. K., Rokkam, V. R., Prudhvi, K., Ponnada, S., Mohan, B. P., Khan, S. R., Boregowda, U., & Aravamudan, V. M. (2020). Venous Thromboembolism in Hospitalized COVID-19 Patients.. American Journal of Therapeutics, 27(6), e599-e610. doi:10.1097/mjt.0000000000001295
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  Background Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. Area of uncertainty Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. Data sources Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. Therapeutic advances Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. Conclusion Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.
• Kutti Sridharan, G., Kotagiri, R., Chandiramani, V. H., Mohan, B. P., Vegunta, R., Vegunta, R., & Rokkam, V. R. (2020). COVID-19 and Avoiding Ibuprofen. How Good Is the Evidence?. American journal of therapeutics, 27(4), e400-e402.
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  Ibuprofen is an over-the-counter medication that is used widely for the treatment of pain and fever during COVID-19 pandemic. A concern was raised regarding the safety of ibuprofen use because of its role in increasing ACE2 levels within the Renin-Angiotensin-Aldosterone system. ACE2 is the coreceptor for the entry of SARS-CoV-2 into cells, and so, a potential increased risk of contracting COVID-19 disease and/or worsening of COVID-19 infection was feared with ibuprofen use. However, available data from limited studies show administration of recombinant ACE2 improves lung damage caused by respiratory viruses, suggesting ibuprofen use may be beneficial in COVID-19 disease. At this time, there is no supporting evidence to discourage the use of ibuprofen.
• Kutti-Sridharan, G., Vegunta, R., Vegunta, R., Mohan, B. P., & Rokkam, V. R. (2020). SARS-CoV2 in Different Body Fluids, Risks of Transmission, and Preventing COVID-19: A Comprehensive Evidence-Based Review. International journal of preventive medicine, 11, 97.
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  The world is combating a common and invisible enemy severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), a highly transmissible virus responsible for serious respiratory illness coronavirus disease-2019 (COVID-19). As with all respiratory viruses, public health measures are focused on contact tracing, isolation, and treatment of affected individuals, who have respiratory symptoms. However, it is spreading efficiently, and it can be explained from its stealth transmission from presymptomatic and asymptomatic individuals. Droplet and contact precautions are followed universally. Healthcare workers are at higher risk of acquiring infection and they are additionally required to follow airborne and eye protection. Recent studies indicate viral particles can be isolated from many body fluids including feces, saliva, semen, and tears, suggesting transmission could be possibly occurring through some of these routes as well. We have done an evidence-based review of all potential modes of transmission and discussed preventive measures to stop the spread. There is an urgent need for educating the healthcare professionals, governments, and public regarding other potential modes of transmission. Strict preventive measures need to be used to stop the spread.
• Mauerman, K., Durojaye, S., & Kutti Sridharan, G. (2020). A Summertime Stupor. Cureus, 12(5), e8242.
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  Most commonly seen with alcohol use disorder in the developed world, Wernicke's encephalopathy (WE), a disorder caused by thiamine deficiency can be readily missed in the setting of other predisposing conditions such as malnutrition, the most common cause worldwide. We present a case of a 21-year-old female with sudden progressive decline in her level of alertness and mentation along with severe hypothermia who had clinical features and imaging findings consistent with WE in the setting of pancreatitis and chronic gastritis. WE should be suspected in all patients who present with altered mental status (AMS) and who are at an increased risk of malnutrition despite a normal or high body mass index, so that treatment with thiamine may be initiated and further neurologic sequelae can be averted.
• Prudhvi, K., Jonnadula, J., Kutti Sridharan, G., & Dominguez, M. (2020). Systemic sclerosis with renal crisis and pericardial effusion. Clinical case reports, 8(12), 3656-3657.
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  Scleroderma renal crisis occurs in 10% of patients with systemic sclerosis carrying a poor prognosis. A kidney biopsy is consistent with thrombotic microangiopathy (TMA) with clinical findings discerning it from other TMAs. Progression to ESRD occurs in 50% of patients which can lead to further complications necessitating emergent interventions including dialysis. Patients with scleroderma can have pericardial involvement with tamponade physiology requiring intervention such as pericardiocentesis.
• Rokkam, V. R., Vegunta, R., Prudhvi, K., Vegunta, R., Kotagiri, R., Boregowda, U., & Kutti Sridharan, G. (2020). "Weighing" the risks and benefits - Thromboprophylaxis challenges in obese COVID-19 patients. Obesity medicine, 19, 100284.
• Kutti Sridharan, G., Vegunta, R., & Vegunta, R. (2019). Secondary Aortoduodenal Fistula Presenting as Gastrointestinal Bleeding and Fungemia. Cureus.
• Mohan, B. P., Asokkumar, R., Khan, S. R., Kotagiri, R., Sridharan, G. K., Chandan, S., Ravikumar, N., Ponnada, S., Jayaraj, M., & Adler, D. G. (2019). 1141 12-Month Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis. The American Journal of Gastroenterology, 114(1), S640-S641. doi:10.14309/01.ajg.0000594092.01811.dc
• Vegunta, R., Vegunta, R., & Kutti Sridharan, G. (2019). Secondary Aortoduodenal Fistula Presenting as Gastrointestinal Bleeding and Fungemia. Cureus, 11(9), e5575.
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  A 55-year-old African American man with a history of abdominal aortic pseudoaneurysm repair presented to the ED with complaints of black-colored stools mixed with fresh blood and fever for three days duration. The exam was unremarkable except for abdominal bruits and pallor. CT angiogram showed perigraft fluid collection, bowel wall thickening, and loss of normal fat planes between the aorta and adjacent bowel at the level of the third portion of the duodenum. Polymicrobial infection was noted in the aortic graft and blood cultures grew Candida. The patient underwent urgent removal of the infected graft, duodenal repair along with appropriate antimicrobial therapy. He did well postoperatively and was discharged in a stable condition. Our case highlights the importance of maintaining a high index of suspicion of aortoenteric fistula (AEF) when a patient with a prior abdominal aortic graft develops gastrointestinal (GI) bleeding as this condition is universally fatal if unrecognized.
• Sridharan, G. K., Madhavan, S., Sridharan, G. K., Kumar, K., Kannan, A., & Janardhanan, R. (2018). META-ANALYSIS OF LATE GADOLINIUM ENHANCEMENT IN DILATED CARDIOMYOPATHY. Journal of the American College of Cardiology, 71(11), A1474. doi:10.1016/s0735-1097(18)32015-1
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  Dilated cardiomyopathy (DCM) is a common form of NICM with dilated ventricle being the final common pathway to various insults. This is due to the presence of myocardial fibrosis and/or scarring. Late gadolinium enhancement (LGE) has been shown to predict the presence of myocardial fibrosis. We
• Sridharan, G. K., Madhavan, S., Sridharan, G. K., Kumar, K., Kannan, A., & Janardhanan, R. (2018). ROLE OF LATE GADOLINIUM ENHANCEMENT IN THE EVALUATION OF PATIENTS WITH CARDIAC SARCOIDOSIS: A META-ANALYSIS. Journal of the American College of Cardiology, 71(11), A881. doi:10.1016/s0735-1097(18)31422-0
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  Cardiac sarcoidosis clinically manifests as non-caseating granulomas within the myocardium that can lead to areas of late gadolinium enhancement (LGE) predominantly within the basal and mid-left ventricular septum close to the His-Purkinje system leading to increased arrhythmias and heart block.
• Sridharan, G. K., Sridharan, G. K., Madhavan, S., Kumar, K., Kannan, A., & Janardhanan, R. (2018). META-ANALYSIS ON LATE GADOLINIUM ENHANCEMENT IN HYPERTROPHIC CARDIOMYOPATHY. Journal of the American College of Cardiology, 71(11), A1645. doi:10.1016/s0735-1097(18)32186-7
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  HCM is a relatively common and frequently under diagnosed genetic disorder with significant heterogeneity with respect to genotypical and phenotypical expression and remains a leading cause of sudden cardiac death. Identification of substrate that portends poor prognosis is valuable in risk
• Cho, J. H., Kutti Sridharan, G., Kim, S. H., Kaw, R., Abburi, T., Irfan, A., & Kocheril, A. G. (2014). Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC cardiovascular disorders, 14, 64.
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  We investigated whether right ventricular dysfunction (RVD) as assessed by echocardiogram can be used as a prognostic factor in hemodynamically stable patients with acute pulmonary embolism (PE). Short-term mortality has been investigated only in small studies and the results have been controversial.

Poster Presentations

• Kutti Sridharan, G., Kotagiri, R., Mohan, B., Ashokkumar, R., Khan, S., Chandan, S., Ravikumar, N., Ponnada, S., Jayaraj, M., & Adler, D. (2019, Oct/Fall). endoscopic sleeve gastroplasty vs laparoscopic sleeve gastrectomy: a systematic review and meta-analysis.. United European Gastroenterology(UEG) Week. Barcelona, Spain.