Rajesh Kotagiri

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Journals/Publications

• Repp, M. L., Alvarez, R. A., Arevalo-Salazar, D. E., & Kotagiri, R. (2023). Metastatic Renal Cell Carcinoma and Unforeseen Adrenal Insufficiency: A Case Report and Literature Review. Cureus, 15(2), e35265.
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  Renal cell carcinoma (RCC) can metastasize to nearly every organ, yet rarely metastasizes to the adrenal glands despite their anatomical proximity. Adrenal metastases are typically incidental findings on medical imaging and are vastly clinically asymptomatic. The adrenal glands can maintain hormonal homeostasis if a tenth of total adrenal gland function is preserved. We present a patient with synchronous bilateral adrenal metastases from RCC with rapid and unexpected development of adrenal insufficiency (AI).
• Kotagiri, R., & Saunders, A. T. (2020). Septic Bilateral Cavernous Sinus Thrombosis With Persistent Methicillin-Resistant Staphylococcus Aureus Bacteremia. Cureus, 12(6), e8554.
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  Septic cavernous sinus thrombosis (CST) is an extremely rare diagnosis that is characterized by nonspecific signs and symptoms. It is often precipitated by a recent facial or sinus infection, as the venous supply from these areas drains into the cavernous sinus. This case highlights significant morbidity and mortality in septic CST where all aggressive treatments did not lead to clinical improvement, and the precipitating cause of the thrombosis was never found. The patient reported herein decompensated despite several investigations and treatment measures due to the lack of proper evidence-based approach.
• 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.
• Mohan, B. P., Asokkumar, R., Khan, S. R., Kotagiri, R., Sridharan, G. K., Chandan, S., Ravikumar, N. P., Ponnada, S., Jayaraj, M., & Adler, D. G. (2020). Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis. Endoscopy international open, 8(4), E558-E565.
• Mohan, B. P., Chandan, S., Jha, L. K., Khan, S. R., Kotagiri, R., Kassab, L. L., Ravikumar, N. P., Bhogal, N., Chandan, O. C., Bhat, I., Hewlett, A. T., Jacques, J., Ponnada, S., Asokkumar, R., & Adler, D. G. (2020). Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group.. Surgical endoscopy, 34(8), 3352-3367. doi:10.1007/s00464-019-07135-9
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  Gastric peroral endoscopic myotomy (G-POEM) is a novel minimally invasive technique in endosurgery. Data is limited as to its efficacy, safety, and predictive factors. We conducted this meta-analysis to evaluate the clinical outcomes of G-POEM and used the outcomes of surgical pyloroplasty as a comparator group in the treatment of refractory gastroparesis..We searched multiple databases from inception through March 2019 to identify studies that reported on G-POEM and pyloroplasty in gastroparesis. Our primary outcome was to analyze and compare the pooled rates of clinical success, in terms of Gastroparesis Cardinal Symptom Index (GCSI) score and 4-h gastric emptying study (GES) results, with G-POEM and pyloroplasty..Three hundred and thirty-two and 375 patients underwent G-POEM (11 studies) and surgical pyloroplasty (seven studies), respectively. The pooled rate of clinical success, based on the GCSI score, with G-POEM was 75.8% (95% CI 68.1-82.1, I2 = 50) and with surgical pyloroplasty was 77.3% (95% CI 66.4-85.4, I2 = 0), with no significance, p = 0.81. The pooled rate of clinical success, based on the 4-hour GES results, with G-POEM was 85.1% (95% CI 68.9-93.7, I2 = 74) and with surgical pyloroplasty was 84% (95% CI 64.4-93.8, I2 = 81), with no significance, p = 0.91. The overall adverse events were comparable. Based on meta-regression analysis, idiopathic gastroparesis, prior treatment with botulinum toxin and gastric stimulator seemed to predict clinical success with G-POEM..G-POEM demonstrates clinical success in treating refractory gastroparesis. Idiopathic gastroparesis, prior treatment with botulinum injections and gastric stimulator appear to have positive predictive effects on the 4-h GES results after G-POEM. Outcomes seem comparable to surgical pyloroplasty.
• Mohan, B. P., Chandan, S., Khan, S. R., Kotagiri, R., Kassab, L. L., Olaiya, B., Ponnada, S., Ofosu, A., & Adler, D. G. (2020). Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis. Endoscopy international open, 8(3), E291-E300.
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   Refractory and recurrent esophageal variceal (EV) bleeding can be life threatening. Self-expanding metal stents (SEMS) have been used as a "bridge" therapy. However, their role in the treatment protocol is not established due to paucity in data. We searched multiple databases from inception through May 2019 to identify studies that reported on SEMS and TIPS in refractory EV hemorrhage. Our primary goals were to analyze and compare the pooled all-cause mortality, immediate bleeding control and rebleeding rates.  Five hundred forty-seven patients from 21 studies were analyzed (SEMS: 12 studies, 176 patients; TIPS: 9 studies, 398 patients). The pooled rate of all-cause mortality with SEMS was 43.6 % (95 % CI 28.6-59.8, I  = 38) and with TIPS was 27.9 % (95 % CI 16.3-43.6, I  = 91). The pooled rate of immediate bleeding control with SEMS was 84.5 % (95 % CI 74-91.2, I  = 40) and with TIPS was 97.9 % (95 % CI 87.7-99.7, I  = 0). The pooled rate of rebleeding with SEMS was 19.4 % (95 % CI 11.9-30.4, I  = 32) and with TIPS was 8.8 % (95 % CI 4.8-15.7, I  = 40).  Use of SEMS in refractory EV hemorrhage demonstrates acceptable immediate bleeding control with good technical success rate. Mortality and rebleeding rates were lesser with TIPS, however, its superiority and/ or inferiority cannot be validated due to limitations in the comparison methodology.
• Ramai, D., Ofosu, A., Mohan, B. P., Kotagiri, R., Khan, S. R., Chandan, S., Aravamudan, V. M., & Adler, D. G. (2020). Sa1483 N-ACETYL CYSTEINE (NAC) IN NON-ACETAMINOPHEN INDUCED ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Gastroenterology, 158(6), S-1307. doi:10.1016/s0016-5085(20)33928-7
• Rokkam, V. R., Kotagiri, R., Sridharan, G. K., Boregowda, U., Vegunta, R., Prudhvi, K., & Vegunta, R. (2020). “Weighing” the risks and benefits – Thromboprophylaxis challenges in obese COVID-19 patients. Obesity Medicine. doi:10.1016/j.obmed.2020.100284
• 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.
• Kotagiri, R., Jayaraj, M., Ponnada, S., Ravikumar, N., Chandan, S., Sridharan, G. K., Khan, S. R., Asokkumar, R., & Adler, D. G. (2019). 1141 12-Month Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis. The American Journal of Gastroenterology. doi:10.14309/01.ajg.0000594092.01811.dc
• Mohan, B. P., Chandan, S., Jha, L. K., Khan, S. R., Kotagiri, R., Kassab, L. L., Ravikumar, N. P., Bhogal, N., Chandan, O. C., Bhat, I., Hewlett, A. T., Jacques, J., Ponnada, S., Asokkumar, R., & Adler, D. G. (2019). Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group. Surgical endoscopy.
  More info

  Gastric peroral endoscopic myotomy (G-POEM) is a novel minimally invasive technique in endosurgery. Data is limited as to its efficacy, safety, and predictive factors. We conducted this meta-analysis to evaluate the clinical outcomes of G-POEM and used the outcomes of surgical pyloroplasty as a comparator group in the treatment of refractory gastroparesis.
• Mohan, B. P., Chandan, S., Khan, S. R., Kotagiri, R., Olaiya, B., Ofosu, A., & Adler, D. G. (2019). 596 Efficacy of Self Expanding Metal Stent (SEMS) in Refractory Bleeding Esophageal Varices, Is There a Mortality Benefit? An Indirect-Comparison Meta-Analysis to Trans-Jugular Intra-Hepatic Porto-Systemic Shunt (TIPS). The American Journal of Gastroenterology, 114(1), S346-S347. doi:10.14309/01.ajg.0000591916.42268.d3

Poster Presentations

• Brickner, E., Budenski, J., Albuquerque Ferreira, J. P., Zangeneh, T. T., & Kotagiri, R. (2022, October). Apophysomyces Elegans Mucormycosis in Patient Without Underlying Conditions. ACP AZ Chapter 2022 in Tucson. Tucson: American College of Physicians.
• Kazui, T., Kotagiri, R., Avila, D., Corban, M., Moynahan, K. F., Kolimas, A., & Muhammad, A. (2022, November). Infective endocarditis of the mitral valve in an immunocompetent patient caused by lactobacillus species. American Heart Association Scientific Sessions 2022. Chicago: AHA.
• Adler, D., Jayaraj, M., Ponnada, S., Ravikumar, N., Chandan, S., Khan, S., Ashokkumar, R., Mohan, B., Kotagiri, R., & Kutti Sridharan, G. (2019, Oct/Fall). endoscopic sleeve gastroplasty vs laparoscopic sleeve gastrectomy: a systematic review and meta-analysis.. United European Gastroenterology(UEG) Week. Barcelona, Spain.