Sreerag Kapparath’s research while affiliated with St. John's National Academy of Health Sciences and other places

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Publications (6)


A case report of purple urine bag syndrome associated with Morganella morganii in an acute care setting
  • Article

April 2025

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6 Reads

Medical Reports

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Sreerag Kapparath

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Vyom Buch Keyurkumar

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The TOAST classification stratified based on age and gender (n=264) TOAST: Trial of Org 10172 in Acute Stroke Treatment; ODC: other determined causes
Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India
  • Article
  • Full-text available

July 2024

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83 Reads

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1 Citation

Cureus

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Sreerag Kapparath

Objectives: This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. Methods: This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. Results: The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. Conclusion: Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.

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Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis

February 2024

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60 Reads

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3 Citations

JNCI Journal of the National Cancer Institute

Background The Palliative Prognostic Score (PaP) is the most widely validated prognostic tool for cancer survival prediction, with modified versions available. A systematic evaluation of PaP tools is lacking. This systematic review and meta-analysis aimed to evaluate the performance and prognostic utility of PaP, Delirium-PaP (D-PaP), and PaP without clinician prediction in predicting 30-day survival of cancer patients and compare their performance. Methods Six databases were searched for peer-reviewed studies and grey literature published from inception till 2/6/2023. English studies must assess PaP, D-PaP, or PaP without clinician predicted survival for 30-day survival in adults ≥18 years old with any stage or type of cancer. Outcomes were pooled using the random effects model or summarised narratively when meta-analysis was not possible. Results Thirty-nine studies (n = 10,617 patients) were included. PaP is an accurate prognostic tool (pooled AUC = 0.82, 95% CI 0.79-0.84) and outperforms PaP without clinician predicted survival (pooled AUC = 0.74, 95% CI 0.71-0.78), suggesting that the original PaP should be preferred. The meta-analysis found PaP and D-PaP performance to be comparable. Most studies reported survival probabilities corresponding to the PaP risk groups, and higher risk groups were significantly associated with shorter survival. Conclusions PaP is a validated prognostic tool for cancer patients that can enhance clinicians' confidence and accuracy in predicting survival. Future studies should investigate if accuracy differs depending on clinician characteristics. Reporting of validation studies must be improved, as most studies were at high risk of bias, primarily because calibration was not assessed.


Age-Related Orthostatic Hypotension: A Comprehensive Analysis of Prevalence, Mechanisms, and Management in the Geriatric Population

January 2024

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56 Reads

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3 Citations

Cardiology in Review

Geriatric patients frequently encounter orthostatic hypotension (OH), a multifaceted condition characterized by a significant drop in blood pressure upon assuming an upright position. As the elderly population is particularly susceptible to OH, our review endeavors to comprehensively explore the complex nature of this condition and various factors contributing to its development. We investigate the impact of comorbidities, polypharmacy, age-related physiological changes, and autonomic dysfunction in the pathogenesis of OH. Geriatric patients with OH are faced with an elevated risk of falls, syncope, a decline in their overall quality of life, and hence increased mortality. These implications require careful consideration, necessitating a thorough examination of therapeutic strategies. We evaluate various pharmaceutical and nonpharmacological therapies, delving into the effectiveness and safety of each approach in managing OH within geriatric populations. We explore the role of pharmacotherapy in alleviating symptoms and mitigating OH-related complications, as well as the potential benefits of volume expansion techniques to augment blood volume and stabilize blood pressure. We place particular emphasis on the significance of lifestyle changes and nonpharmacological interventions in enhancing OH management among the elderly. These interventions encompass dietary modifications, regular physical activity, and postural training, all tailored to the unique needs of the individual patient. To optimize outcomes and ensure patient safety, we underscore the importance of individualized treatment plans that take into account the geriatric patient’s overall health status, existing comorbidities, and potential interactions with other medications. This review aims to improve clinical practice and patient outcomes by advocating for early detection, properly tailored management, and targeted interventions to address OH in the elderly population. By raising awareness of OH’s prevalence and complexities among healthcare professionals, we hope to foster a comprehensive understanding of OH and contribute to the overall wellness and quality of life of this vulnerable demographic.


Geographical distribution of Mpox caseload as of January 31, 2023 (confirmed cases only). Data source—United States Centers for Disease Control and Prevention (U.S. CDC; https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html; accessed February 1, 2023). Note that the map is only for illustrative purposes and the authors remain neutral regarding territorial disputes.
Criteria for defining Mpox probable (or likely) case in the investigated countries.
Differences in notifiable cases based on surveillance definitions.
Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries

April 2023

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280 Reads

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8 Citations

Objectives Case Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload. Methods We extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data were gathered from online public sources. Results For confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO’s criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements. Conclusion The heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, and clinicians to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.


Variations in National Surveillance Reporting for Monkeypox Virus: A Comparative Analysis in 32 Countries

October 2022

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168 Reads

Monkeypox virus (MPXV) is a zoonotic virus that has caused multiple outbreaks in the non-endemic countries globally. To combat the increasing spread of the virus, World Health Organization (WHO) had released standardized case definitions for suspected, probable, confirmed, and discarded cases. Additionally, the premier agency has also released case reporting form for data collection. Herein, we compared the various iterations of these guidelines that have been employed in 32 countries. For confirmed cases, 18 countries (56%) followed WHO guidelines and tested for MPXV using species specific PCR and/or sequencing. For probable and suspected cases, six countries in each of these definitions were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO's criteria for probable and suspected cases. Regarding discarded cases, only 11 countries (34%) reported definitions with only three countries (9%) having definition consistent with WHO guidelines. For case reporting, 11 countries (34%) were found to report both probable and confirmed cases, in line with WHO requirements. The heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization can aid data-scientists, epidemiologists, clinicians etc., to better understand the true disease burden and formulate targeted interventions to curb the virus spread.

Citations (3)


... The study conducted in Nepal indicated that a greater number of males were affected by stroke compared to females [22,23]. The majority of the population was found to be male, a trend that is consistent with most other Indian studies [24]. ...

Reference:

Study on risk factors and associated drug related problems in patients with stroke
Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India

Cureus

... The need to improve and standardise early PC is recognised worldwide, and there are several validated prognostic tools that could help clinicians to think about life expectancy and to quickly identify patients at high risk of death in need of PC [20][21][22]. Some of the most widely used are the Palliative Prognostic (PaP) score, the Delirium-Palliative Prognostic (D-PaP) score, the Palliative Prognostic Index (PPI), the modified Prognosis in PC Study (PiPS) predictor model [21] and the Necesitades Palliativas-Spain (NECPAL-Spain) [22]. ...

Palliative prognostic scores for survival prediction of cancer patients: a systematic review and meta-analysis

JNCI Journal of the National Cancer Institute

... The combination of clinical signs, laboratory findings that support the diagnosis, and anamnestic data is used to diagnose monkeypox [30,31]. As with other infections, mpox can be challenging to diagnose. ...

Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries