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39 results on '"Boregowda, Umesha"'

2. Update on the management of gastrointestinal varices

Author

Boregowda, Umesha, Umapathy, Chandraprakash, Halim, Nasir, Desai, Madhav, Nanjappa, Arpitha, Arekapudi, Subramanyeswara, Theethira, Thimmaiah, Wong, Helen, Roytman, Marina, and Saligram, Shreyas

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Liver Disease, Oral and gastrointestinal, Good Health and Well Being, Ectopic varices, Endoscopy, Esophageal varices, Gastric varices, Portal hypertension
Abstract

Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality.

Published
2019

3. Endoscopic ultrasound guided gallbladder drainage - is it ready for prime time?

Author

Boregowda, Umesha, Umapathy, Chandraprakash, Nanjappa, Arpitha, Wong, Helen, Desai, Madhav, Roytman, Marina, Theethira, Thimmaiah, and Saligram, Shreyas

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Bioengineering, Biomedical Imaging, Acute acalculous cholecystitis, Acute cholecystitis, Endoscopic ultrasound guided gallbladder drainage, Percutaneous cholecystostomy, Trans-papillary gallbladder drainage
Abstract

Management of acute cholecystitis includes initial stabilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography (ERCP). Although, these conservative measures are effective, they can cause significant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel method of gallbladder drainage first described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneous cholecystostomy and trans-papillary gallbladder drainage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy.

Published
2018

6. S3663 DILI - Gently Differentiating Autoimmune Liver Diseases

Author

Al-Zakwani, Mohammed S., primary, Boregowda, Umesha, additional, Ritter, Jacob, additional, Pedicone, Lisa, additional, Landaverde, Carmen, additional, Lawitz, Eric, additional, Petrasek, Jan, additional, Poordad, Fred, additional, Rodas, Fabian, additional, and Tsai, Eugenia, additional

Published
2023
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7. Venous Thromboembolism in Hospitalized COVID-19 Patients

Author

Sridharan, Gurusaravanan Kutti, Vegunta, Radhakrishna, Rokkam, Venkata Ram Pradeep, Meyyur Aravamudan, Veeraraghavan, Vegunta, Rathnamitreyee, Khan, Shahab R., Ponnada, Suresh, Boregowda, Umesha, Prudhvi, Kalyan, Chamarthi, Gajapathiraju, and Mohan, Babu P.

Published
2020
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12. COVID MED - An Early Pandemic Trial of Losartan for Hospitalized COVID-19 Patients

Author

Freilich, Daniel, primary, Victory, Jennifer, additional, Jenkins, Paul, additional, Wheeler, James, additional, Vail, G Matthew, additional, Riesenfeld, Erik, additional, Cross, Peggy, additional, Gilmore, Catherine, additional, Huckabone, Melissa, additional, Schworm, Anna, additional, Boregowda, Umesha, additional, Deshmukh, Farah, additional, Choi, Yuri, additional, Kahn, Azkia, additional, and Gadomski, Anne, additional

Published
2022
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13. Current advances in the management of chronic pancreatitis

Author

Mann, Rupinder, primary, Boregowda, Umesha, additional, Vyas, Neil, additional, Gajendran, Mahesh, additional, Umapathy, Chandra Prakash, additional, Sayana, Hari, additional, Echavarria, Juan, additional, Patel, Sandeep, additional, and Saligram, Shreyas, additional

Published
2021
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17. Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis

Author

Rokkam, Venkata Ram Pradeep, Kutti Sridharan, Gurusaravanan, Vegunta, Rathnamitreyee, Vegunta, Radhakrishna, Boregowda, Umesha, and Mohan, Babu P.

Subjects
Article Subject
Abstract

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.

Published
2021
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30. Direct-acting oral anticoagulants versus warfarin in relation to risk of gastrointestinal bleeding: a systematic review and meta-analysis of randomized controlled trials.

Author

Aloysius, Mark M., Perisetti, Abhilash, Goyal, Hemant, Boregowda, Umesha, Jecmenica, Mladen, Cheryala, Mahesh, Bajaj, Anurag, Milekic, Bojana, Babic, Milos, Bansal, Pardeep, and Enders, Greg H.

Subjects
MECHANICAL hearts, GASTROINTESTINAL hemorrhage, PROSTHETIC heart valves, RANDOMIZED controlled trials, WARFARIN, INTERNATIONAL normalized ratio, ANTICOAGULANTS
Abstract

Background Direct-acting oral anticoagulants (DOACs) are increasingly used, with studies showing a lower risk of gastrointestinal bleeding (GIB), but overall data for GIB risk remains debatable. The objective was to assess non-fatal and fatal GIB risk in patients on DOACs compared with warfarin from randomized clinical trials (RCTs). Methods RCTs comparing warfarin and DOACs for various indications (atrial fibrillation, thromboembolism, insertion of mechanical heart valves) were included. The primary endpoint was any GIB event. Other clinical events, such as fatal GIB, and effects of age (=60 years or older), time in therapeutic range for warfarin, and choice of individual DOACs on GIB risk, were also assessed. Results 14 RCTs were included, comprising 87,407 participants (DOACs n=46,223, warfarin control n=41,184). The risk of GIB with DOACs was similar to that of warfarin (relative risk [RR] 1.04, 95% confidence interval [CI] 0.85-1.27). Compared with warfarin, rivaroxaban (RR 1.23, 95%CI 1.03-1.48) and dabigatran (RR 1.38, 95%CI 1.12-1.71) had a higher risk of any GIB, whereas fatal GIB risk was lower in the DOACs group (RR 0.36, 95%CI 0.15-0.82). The risk of DOAC-related fatal GIB was lower in patients aged =60 years and in those with poor coagulation control (RR 0.39, 95%CI 0.15-0.98). Conclusions DOACs compared with warfarin have a lower risk of fatal GIB, especially in those aged <60 years and those with poor coagulation control. However, the risk of GIB was comparable with warfarin and DOACs, except for rivaroxaban and dabigatran. [ABSTRACT FROM AUTHOR]

Published
2021
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31. Mo1768 – Elevated Risk of Metachronous Neoplasia with Sessile Serrated Adenoma in Addition to High-Risk Adenoma Compared to High-Risk Adenoma Alone: A Systematic Review and Meta-Analysis of Literature

Author

Umapathy, Chandraprakash, primary, Desai, Madhav, additional, Boregowda, Umesha, additional, Halim, Nasir, additional, Sandhu, Sunny, additional, Theethira, Thimmaiah, additional, Roytman, Marina, additional, Wong, Helen, additional, and Sali, Shreyas, additional

Published
2019
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36. Beware of the Darkness

Author

Boregowda, Umesha Naragalu, primary, Batey, Andrew, additional, Sharma, Manav, additional, and Gupta, Nupur, additional

Published
2013
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39. Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis

Author

Ram Pradeep Rokkam, Venkata, Kutti Sridharan, Gurusaravanan, Vegunta, Rathnamitreyee, Vegunta, Radhakrishna, Boregowda, Umesha, and P. Mohan, Babu

Abstract

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.

Published
2021
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