Kartik Motwani - Academia.edu (original) (raw)

Papers by Kartik Motwani

Frontiers in Stroke

BackgroundAneurysmal subarachnoid hemorrhage is a devastating cerebrovascular disease associated ... more BackgroundAneurysmal subarachnoid hemorrhage is a devastating cerebrovascular disease associated with high morbidity and mortality. Macrophage-mediated mural inflammation is a key pathogenic component contributing to aneurysm rupture.ObjectiveTo investigate the effect of pharmacological inhibition of the NLRP3 inflammasome on aneurysm rupture.MethodsCerebral aneurysms were induced in C57BL/6 mice with a combination of hypertension and an intracranial dose of elastase. Mice were treated with either 40 mg/kg of MCC950 or saline via intraperitoneal injections. Vascular tissue at the circle of Willis was harvested for analysis via immunofluorescent microscopy or qPCR.ResultsNLRP3+ cells are more common in the aneurysm tissue compared to the normal cerebral vasculature. The mRNA expression of the downstream NLRP3 pathway components caspase-1, IL-1β, and GSDMD is also increased in the aneurysm tissue compared to healthy vessels. There was no difference in the aneurysm formation rate betwe...

The American Journal of Emergency Medicine

Journal of Student-Run Clinics

Background: Student-run free clinics (SRFCs) can provide quality mental health care to low-income... more Background: Student-run free clinics (SRFCs) can provide quality mental health care to low-income and uninsured populations who are at a greater risk of depression. Evidence demonstrates the association between social support and severity of depression, but this relationship has not been analyzed in an SRFC. Thus, we assessed the association between social support and depressive symptoms.Methods: We used electronic health records data for patients from 2013-2020 (n=2,501 patients). The dependent variable was severity of depression symptoms as determined by scores on the patient health questionnaire-4 (PHQ-4). Higher PHQ-4 scores correspond to increased severity of depression. The main predictor was the patient's social support, which was defined by their employment status, marital status, and the number of individuals in their household. We conducted a multinomial regression model to control for other patient-level factors (i.e. race, sex, and age).Results: When controlling for ...

Stroke: Vascular and Interventional Neurology

Background Modern medicine necessitates the delivery of increasingly complex health care while mi... more Background Modern medicine necessitates the delivery of increasingly complex health care while minimizing cost. Transradial access (TRA) for neuroendovascular procedures is becoming more common as accumulating data demonstrate fewer complications, improved patient satisfaction, and high rates of treatment success compared with the transfemoral access (TFA) approach; however, disparities in cost between these approaches remain unclear. We compared supply and equipment costs between TRA and TFA for diagnostic cerebral angiography and evaluate the specific items that account for these differences. Methods We reviewed all adult patients who underwent diagnostic cerebral angiography from July 1, 2019 to December 31, 2019. Data related to patient demographics, vascular access site, catheters used, cost of catheters, arterial access sheath use, cost of sheaths, closure devices used, and cost of closure devices were collected. Results The transradial approach resulted in higher price of rad...

Journal of Men's Health

One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogen... more One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogenic lower urinary tract dysfunction (NLUTD). The type of NLUTD is variable based on location and extent of injury. SCI affects more males and NLUTD is especially debilitating for men with incomplete injury. This review summarizes the anatomical basis of NLUTD in SCI and discusses current diagnostic and management strategies that are being utilized clinically. The last two sections address new innovations and emerging discoveries with the goal of increasing scientific interest in improving treatment options for people with SCI. Areas warranting further investigation are pinpointed to address current gaps in knowledge and/or appropriate technology.

Background: Cerebral vasospasm (CV) can contribute significant morbidity for subarachnoid hemorrh... more Background: Cerebral vasospasm (CV) can contribute significant morbidity for subarachnoid hemorrhage (SAH) patients. A key unknown is how CV induction is triggered following SAH. Methods: human aneurysmal blood was collected for evaluation. To confirm mechanism, c57/bl6 wild type and c57/bl6 IL-6 female knockout (KO) mice were utilized with groups: saline injected, SAH, SAH + IL-6 blockade, SAH IL-6 KO, SAH IL-6 KO + IL-6 administration. For SAH, 50mm blood was collected from tail puncture and administered into basal cisterns. IL-6 blockade was given at various time points. Various markers of neuroinflammation were measured with western blot and immunohistochemistry. Cerebral blood flow was also measured. Vasospasm was measured via cardiac injection of india-ink/gelatin. Turning test and Garcia’s modified SAH score were utilized. P<0.05 was considered significant. Results: IL-6 expression peaked 3 days following SAH (p<0.05). Human IL-6 was increased in aneurysmal blood (p<...

Journal of NeuroInterventional Surgery

BackgroundMonocyte chemoattractant protein 1 (MCP-1) and osteopontin (OPN) have been identified s... more BackgroundMonocyte chemoattractant protein 1 (MCP-1) and osteopontin (OPN) have been identified separately as key mediators of the aneurysm healing process following coil embolization in the rodent model. The ability of protein coated coils to accelerate this process is currently unknown.ObjectiveTo create coils coated with both MCP-1 and OPN to target aneurysm healing.MethodsWe used a polymer (poly(glycolide-co-caprolactone)) (Rao pharmaceuticals) (CG910) to test whether coils could be dual coated with active proteins with sequential reliable release. Coils were coated with poly-DL-lactic glycolic acid (PLGA), CG910, and subsequently dipped with protein OPN (inner layer for delayed release) and MCP-1 (outer layer for initial release). Release assays were used to measure protein elution from coils over time. To test in vivo feasibility, coated coils were implanted into carotid aneurysms to determine the effect on aneurysm healing.ResultsThe in vitro protein release assay demonstrate...

Clinical Neurology and Neurosurgery

Cureus

Between 3.6% and 6.0% of the population has an intracranial aneurysm. The mechanisms underlying i... more Between 3.6% and 6.0% of the population has an intracranial aneurysm. The mechanisms underlying intracranial aneurysm formation and rupture are not fully known. Several rodent models have been developed to better understand intracranial aneurysm pathophysiology. Hypertension, hemodynamic changes, and vessel injury are all necessary for aneurysm induction; however, multiple invasive procedures may disrupt an animal's physiology. Therefore, we hypothesized that our method for inducing hypertension could be modified to create a simpler model. We previously developed a highly reproducible murine model of intracranial aneurysm formation and rupture that involves hemodynamic changes through ligation of the left common carotid artery, vessel wall degradation using elastase and a lysyl oxidase inhibitor, and hypertension through a high-salt diet, continuous angiotensin II infusion, and right renal artery ligation. In order to create a simpler model, we sought to eliminate renal artery ligation. We assessed aneurysm formation, aneurysm rupture, and blood pressure in two separate cohorts of C57BL/6 mice: one cohort underwent our model as above, while another cohort did not receive right renal artery ligation. Our results demonstrate that intracranial aneurysm formation and rupture rates did not differ between each group. Further, the blood pressures between cohorts did not differ at various timepoints in the model. Both cohorts, however, did have a significant increase in blood pressure from baseline, suggesting that renal artery ligation is not needed for inducing hypertension. These findings demonstrate that our murine model can be modified to eliminate right renal artery ligation. Thus, we propose this modification to our murine model for studying intracranial aneurysm pathophysiology.

Drugs & Therapy Perspectives, 2021

In the United States, overprescribing of antibiotics for viral respiratory infections and antimic... more In the United States, overprescribing of antibiotics for viral respiratory infections and antimicrobial resistance continue to be public health concerns. To date, no literature has focused on antibiotic prescribing patterns from free clinics. To address this gap, we used patient-level data from a student-run free clinic network of four primary care clinics to assess factors associated with inappropriate antibiotic prescribing for viral respiratory infections. Treatment plans were deemed inappropriate if any type of antibiotic was prescribed. We used unpaired t tests and chi-square tests to assess for differences in receiving an inappropriate antibiotic prescription by patient-level factors (i.e. age, race/ethnicity, sex, educational attainment, preferred language, insurance status). Of 298 visits, 22.5% did not meet treatment guidelines. No patient-level factors studied were associated with inappropriate antibiotic prescribing. Our findings suggest other factors, beyond those at the...

Current Neurovascular Research, 2021

Telemedicine and e-Health, 2021

Background: Disparities in telemedicine use by race, age, and income have been consistently docum... more Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Materials and Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion: The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphonespecific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.

Cureus, 2020

Despite the reduced caloric content of artificially sweetened beverages (ASBs) relative to those ... more Despite the reduced caloric content of artificially sweetened beverages (ASBs) relative to those sweetened with sucrose, consumption of ASBs fail to consistently decrease the risk of obesity and associated diseases. This failure may be due to the inability of ASBs to effectively reduce appetite and hence overall caloric intake. A variety of non-nutritive sweeteners (NNS), however, remain to be screened for effectiveness in promoting satiety and reducing calorie consumption. Erythritol is well-tolerated, low-calorie sugar alcohol widely used as a sugar substitute. It is unique among NNS due to its low sweetness index relative to glucose, meaning that it is typically served at much higher concentrations than other common NNS. Animal and human studies have noted correlations between osmolarity, satiety, and levels of satiety hormones, independent of the effects of sweetness or nutritive value. We hypothesized that consumption of a beverage sweetened with erythritol to the sweetness and osmolarity of a common soft drink will improve selfreported satiety and more strongly affect the magnitude of changes in the hormone ghrelin than would an iso sweet beverage sweetened only with aspartame, a sweetener with a high sweetness index relative to glucose. Using a randomized double-blind crossover trial, we found that serum ghrelin was significantly decreased after consumption of an erythritol-sweetened beverage compared to aspartame. Likewise, consumption of the erythritol-sweetened beverage increased various measures of satiety in volunteers. Knowledge gained from this project demonstrates that high-osmolarity NNS may be useful in formulating ASBs that are satiating and low in calories.

Neurosurgery, 2019

INTRODUCTION Cerebral aneurysm rupture results in subarachnoid hemorrhage which has a mortality o... more INTRODUCTION Cerebral aneurysm rupture results in subarachnoid hemorrhage which has a mortality of up to 40%. Current prophylactic treatment options include surgical clipping, flow diversion, and endovascular coiling. A significant drawback of coiling is that up to 20% of aneurysms recur and require retreatment due to insufficient fibrotic healing. Thus, it is crucial to develop more effective treatments. As inflammation appears to be critical in cerebral aneurysm pathophysiology, it is necessary to investigate aneurysm healing in the context of key inflammatory mediators. Using a novel in Vitro flow chamber model, we found increased expression of CXCL1, a neutrophil chemoattractant, at arterial bifurcations and in aneurysms. We hypothesized that CXCL1 is a key mediator in aneurysm healing. METHODS Using our murine aneurysm healing model, aneurysms were created in the right common carotid artery of female C57BL/6 mice using elastase. Three weeks later, aneurysms were implanted with ...

Frontiers in neurology, 2018

Local delivery of monocyte chemotactic protein-1 (MCP-1/CCL2) our drug-eluting coil has been show... more Local delivery of monocyte chemotactic protein-1 (MCP-1/CCL2) our drug-eluting coil has been shown to promote intrasaccular aneurysm healing an inflammatory pathway. In this study, we validate the importance of local MCP-1 in murine aneurysm healing. Whether systemic, rather than local, delivery of MCP-1 can direct site-specific aneurysm healing has significant translational implications. If systemic MCP-1 is effective, then MCP-1 could be administered as a pill rather than by endovascular procedure. Furthermore, we confirm that MCP-1 is the primary effector in our MCP-1 eluting coil-mediated murine aneurysm healing model. We compare aneurysm healing with repeated intraperitoneal MCP-1 versus vehicle injection, in animals with control poly(lactic-co-glycolic) acid (PLGA)-coated coils. We demonstrate elimination of the MCP-1-associated tissue-healing response by knockout of MCP-1 or CCR2 (MCP-1 receptor) and by selectively inhibiting MCP-1 or CCR2. Using immunofluorescent probing, we...

Behavioural neurology, 2017

In the article titled "Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms... more In the article titled "Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms" [1], Dr. Rabia Qaiser was missing from the authors' list. Dr. Qaiser supervised the project and reviewed the text and revised the reporting of the clinical management and tables. The corrected authors' list is shown above.

Behavioural Neurology, 2016

Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditi... more Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more...

Clinical Neurology and Neurosurgery, 2022

The genetics of intracranial aneurysms is complex. Much work has been done looking at the extrace... more The genetics of intracranial aneurysms is complex. Much work has been done looking at the extracellular matrix surrounding cerebral vasculature as well as the role of matrix metalloproteinases. This comprehensive review summarizes what is known to date about the important genetic components that predispose to aneurysm formation and critically discusses the published findings. We discuss promising pre-clinical models of aneurysm formation and subarachnoid hemorrhage, and highlight avenues for future discovery, while considering limitations in the research to date. This review will further serve as a comprehensive reference guide to understand the genetic underpinnings for aneurysm pathophysiology and act as a primer for further investigation.