Charulata Ramaprasad

Kaiser Permanente, Oakland, California, United States

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Publications (8)32.86 Total impact

  • K S Gregg, B Barin, D Pitrak, C Ramaprasad, K Pursell
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    ABSTRACT: As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined. Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models. The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort. These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.
    Transplant Infectious Disease 09/2013; · 1.98 Impact Factor
  • Charulata Ramaprasad, Stephanie Pouch, David L Pitrak
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    ABSTRACT: Bone marrow and hematopoietic stem cell transplants are life saving procedures for a variety of hematologic malignancies. Unfortunately, long-term survival is significantly impacted by the development of invasive fungal and bacterial infections, in part attributable to innate and adaptive immunologic defects post-transplant. This review focuses specifically on neutrophil function after autologous and allogeneic bone marrow and hematopoietic stem cell transplant.
    Leukemia & lymphoma 03/2010; 51(5):756-67. · 2.61 Impact Factor
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    Charulata Ramaprasad, Arkalgud Ramaprasad
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    ABSTRACT: ‘Noncompliant’ (NC) patient is a common label in medical records. While it encapsulates many dimensions of undesired patient behavior, the semiotics by which it is generated and applied is unclear: What data indicate noncompliance? How are the data analyzed and interpreted to label a patient as noncompliant? How does the label frame the physician’s thinking? How does it affect the physician’s diagnosis, treatment, instructions and actions? How does it affect medical outcomes? This lack of semiotic clarity can result in medical errors. We provide a framework (a) for conceptualizing the semiotics of NC, and (b) to understand the sources of potential medical errors. We illustrate the framework with a case study. The framework can be used to manage noncompliance effectively and reduce medical errors, especially with EMRs.
    HEALTHINF 2010 - Proceedings of the Third International Conference on Health Informatics, Valencia, Spain, January 20-23, 2010; 01/2010
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    ABSTRACT: Background: Hemorrhagic cystitis manifesting as gross hematuria (GH) is a well described BK virus associated syndrome after HSCT. Other BK virus associated syndromes, such as polyoma virus associated nephropathy (PVAN), are reported as cases in the HSCT literature. Data regarding the spectrum, incidence, treatment, and treatment response of BK virus associated syndromes in a large patient cohort are few. The primary aim of this study was to describe these features in a large cohort of allogeneic HSCT recipients. Methods: Charts of 115 allogeneic HSCT recipients were reviewed. Continuous variables were compared using the t-test. Results: 11 patients had gross hematuria (GH). In 6/11 cases, GH resolved without intervention. 2/11 cases required urologic procedures and the remaining 3 were treated with cidofovir. Mean urinary BK viral load (VL) was 17,349,496 copies/mL (c/mL) in GH cases and 5,615,542 c/mL in those without GH (p = 0.001). Mean blood BK VL was 9689 c/mL in GH cases and 78,208 c/mL in patients without GH (p = 0.18). 9 patients had cystitis symptoms other than GH (uncomplicated cystitis, UC). None required directed therapy. Mean urinary BK VL was 19,817,151 c/mL in UC cases and 5,055,767c/mL in those without UC (p < 0.0001). Mean blood BK VL was 11,380 c/mL in UC cases and 77,119 c/mL in patients those without UC (p = 0.20). 2 patients developed PVAN. Both were treated with leflunomide, required dialysis, and had urinary BK VLs greater than 25,000,000 c/mL and blood BK VLs greater than 100,000 c/mL persistently for over 6 months. Discussion: Our understanding of clinical syndromes associated with BK virus continues to evolve. Urinary BK VL was associated with all BK associated syndromes reported. In patients with UC, symptoms resolved without anti-viral treatment. PVAN was seen in 2.7% of the present cohort and may represent an emerging BK virus associated syndrome.
    Infectious Diseases Society of America 2009 Annual Meeting; 10/2009
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    ABSTRACT: BK virus (BKV) is an important pathogen and cause of nephropathy in renal transplant recipients, but its significance following hematopoetic stem cell transplantation (HSCT) is less well described. We measured blood and urine BKV in 124 allogeneic HSCT patients (67 had undergone prior HSCT [surveillance cohort]; 57 were monitored from transplant day 0 [prospective cohort]). BK viruria was manifest in 64.8% of the patients; 16.9% developed viremia. In the prospective cohort, the median time from transplantation to BK viremia development (128 days) was longer than for viruria (24 days; P < .0001). Among clinical factors (sex, disease, transplant type, alemtuzumab use, cytomegalovirus [CMV] viremia, graft-versus-host disease [GVHD], donor HLA C7 allele), only CMV viremia was more common in patients with BKV infection (P < or = .04). There was a direct relationship between blood and urine BKV levels and the occurrence, and degree, of hematuria (P < or = .03). Finally, BKV infection was analyzed along with other clinical factors in relation to the development of post-HSCT renal impairment. On multivariate analysis, only BK viremia (P=.000002) and alternative-donor transplantation (P=.002) were independent predictors of development of post-HSCT renal impairment, with BK viremia associated with a median 1.62mg/dL rise in creatinine from the pretransplant baseline. Among 8 patients in the surveillance cohort with BK viremia, 2 developed biopsy-proven BKV nephropathy requiring hemodialysis. Investigation of whether prophylaxis against, or treatment of, BKV in the post-HSCT setting mitigates the associated morbidities, especially kidney injury, warrants prospective evaluation.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 09/2009; 15(9):1038-1048.e1. · 3.15 Impact Factor
  • The Lancet Oncology 06/2006; 7(5):436-8. · 25.12 Impact Factor
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    ABSTRACT: Due to the rising incidence of diabetes mellitus, the increasing populations of immunocompromised individuals of varied etiologies, and the progresses that have been made in the management of the critically ill, the incidence of invasive fungal infections, in particular those caused by the Mucorales, is increasing. Currently available diagnostics frequently miss this infection. Knowledge of the factors placing individuals at risk for and the varied clinical presentations of mucormycosis should alert clinicians of the possible presence of this infection. Survival of individuals with mucormycosis is dependant on prompt diagnosis and aggressive therapy with antifungal agents; surgical debridement; and, if possible, reversal of the risk factors predisposing the individual to this infection. It is hoped that improved diagnostic testing, improvements in pharmacotherapy, and adjunctive therapies will improve the morbidity and mortality of mucormycosis. KeywordsMucormycosis-Zygomycosis-Antifungal therapy
    Current Fungal Infection Reports 4(1):8-16.
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    Charulata Ramaprasad, Randee Estes, Sangeeta Bhorade, David Pitrak
    International Journal of Infectious Diseases. 12:S12.