Venkata Rokkam

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Scholarly Contributions

Books

• Rokkam, V. (2020). Hemophilia B.. StatPearls.
• Rokkam, V. (2020). Omentum Tumors.
• Rokkam, V. (2020). Secondary Thrombocytosis..

Chapters

• Rokkam, V. (2020). Macroglossia. In Stat Pearls.

Journals/Publications

• Rokkam, V. R. (2022). Hesitancy of Covid-19 Vaccination among Teenagers and Young Adults. SOJ Medical and Clinical Case Reports, 2(1). doi:10.53902/sojmccr.2022.02.000510
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  Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. It is a global pandemic and has led to serious illness and death among all ages and even in younger adults who are otherwise healthy. The best way to prevent and slow down the transmission of this deadly disease is to get vaccinated. As per the CDC teenagers and young adults between the ages of 12 to 24 have the lowest vaccination rate among those eligible to receive a COVID vaccine. We did a survey-based study among high school and college students to find out the reasons for the reluctance of Covid 19 vaccination.
• 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., Kotagiri, R., Chandiramani, V. H., Mohan, B. P., Vegunta, R., Vegunta, R., & Rokkam, V. R. (2021). 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., 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.
• Kutti Sridharan, G., Rokkam, V. R., 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, 1-4. doi:10.1155/2021/8832638
• 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. (2021). Macroglossia. Statpearls( Internet).
• 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.
• Sridharan, G. K., Vegunta, R., Rokkam, V. R., Meyyur Aravamudan, V., Vegunta, R., Khan, S. R., Ponnada, S., Boregowda, U., Prudhvi, K., Chamarthi, G., & Mohan, B. P. (2021). Venous Thromboembolism in Hospitalized COVID-19 Patients. American journal of therapeutics, 27(6), e599-e610.
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  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.
• 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.
• 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., 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.
• Rokkam, V. R., Aggarwal, A., & Taleban, S. (2020). Esophagitis Dissecans Superficialis: Malign Appearance of a Benign Pathology. Cureus, 12(6), e8475.
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  Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a very rare condition and may affect the whole esophagus, resulting in complete sloughing of the mucous membrane. EDS has been associated with various medications and dermatological conditions. In our case, EDS was suspected secondary to methotrexate treatment in a patient with Crohn's disease, although the definitive etiology remains unknown. It is very important for physicians to recognize the endoscopic appearance of EDS to provide appropriate clinical management and differentiate it from other esophageal disorders.
• 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.
• Aggarwal, A., Rokkam, V. R., & Karasek, V. (2019). Atypical Gastric Ulcer With Impending Perforation due to Cocaine Use. ACG case reports journal, 6(9), e00218.
• Bigg, P. W., Baldo, G., Sleeper, M. M., O'Donnell, P. A., Bai, H., Rokkam, V. R., Liu, Y., Wu, S., Giugliani, R., Casal, M. L., Haskins, M. E., & Ponder, K. P. (2013). Pathogenesis of mitral valve disease in mucopolysaccharidosis VII dogs. Molecular genetics and metabolism, 110(3), 319-28.
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  Mucopolysaccharidosis VII (MPS VII) is due to the deficient activity of β-glucuronidase (GUSB) and results in the accumulation of glycosaminoglycans (GAGs) in lysosomes and multisystemic disease with cardiovascular manifestations. The goal here was to determine the pathogenesis of mitral valve (MV) disease in MPS VII dogs. Untreated MPS VII dogs had a marked reduction in the histochemical signal for structurally-intact collagen in the MV at 6 months of age, when mitral regurgitation had developed. Electron microscopy demonstrated that collagen fibrils were of normal diameter, but failed to align into large parallel arrays. mRNA analysis demonstrated a modest reduction in the expression of genes that encode collagen or collagen-associated proteins such as the proteoglycan decorin which helps collagen fibrils assemble, and a marked increase for genes that encode proteases such as cathepsins. Indeed, enzyme activity for cathepsin B (CtsB) was 19-fold normal. MPS VII dogs that received neonatal intravenous injection of a gamma retroviral vector had an improved signal for structurally-intact collagen, and reduced CtsB activity relative to that seen in untreated MPS VII dogs. We conclude that MR in untreated MPS VII dogs was likely due to abnormalities in MV collagen structure. This could be due to upregulation of enzymes that degrade collagen or collagen-associated proteins, to the accumulation of GAGs that compete with proteoglycans such as decorin for binding to collagen, or to other causes. Further delineation of the etiology of abnormal collagen structure may lead to treatments that improve biomechanical properties of the MV and other tissues.

Case Studies

• Rokkam, V. (2023. Spinal Cord infraction resulting from intramural hematoma of the thoracic aorta(pp -).