Dr. Vivek  Nagaraja  Md image

Dr. Vivek Nagaraja Md

1500 E Medical Ctr Dr
Ann Arbor MI 48109
800 004-4176
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 4301100564
NPI: 1750684262
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Predictors of lung function decline in scleroderma-related interstitial lung disease based on high-resolution computed tomography: implications for cohort enrichment in systemic sclerosis-associated interstitial lung disease trials. - Arthritis research & therapy
The extent of lung involvement visualized by high-resolution computed tomography (HRCT) is a predictor of decline in forced vital capacity (FVC) in scleroderma-interstitial lung disease. Our objective was to evaluate the performance of three different HRCT-defined staging systems in the Scleroderma Lung Study I (SLS I) over a 1-year period.We assessed two visual semiquantitative scores: the maximum fibrosis score (MaxFib, the fibrosis score in the zone of maximal lung involvement) and visual assessment of total lung involvement (TLI) as proposed by Goh and Wells. In addition, we evaluated the computer-aided diagnosis and calculated the quantitative percentage with fibrosis (QLF) and TLI.The mean duration of the disease was 3.2 years, and the mean FVC was 67.7 %. Regardless of the staging system used, a greater degree of fibrosis/TLI on HRCT scans was associated with a greater decline in FVC in the placebo group. Using the MaxFib and QLF, the mean absolute changes in FVC from baseline were 0.1 % and -1.4 %, respectively, in <25 % lung involvement vs. a change of -6.2 % and -6.9 %, respectively, with >25 % involvement (negative score denotes worsening in FVC). Conversely, cyclophosphamide was able to stabilize decline in FVC in subjects with greater degree of involvement detected by HRCT. Using the visual MaxFib and QLF, the mean absolute improvements in FVC were 1.2 and 1.1, respectively, with >25 % involvement.HRCT-defined lung involvement was a predictor of decline in FVC in SLS I. The choice of staging system for cohort enrichment in a clinical trial depends on identifier: NCT00004563 (Scleroderma Lung Study I) ISRCTN15982171. Registered 19 Aug 2015.
Management of gastrointestinal involvement in scleroderma. - Current treatment options in rheumatology
Gastrointestinal tract (GIT) commonly affects patients with systemic sclerosis (SSc). The GI involvement is quite heterogeneous varying from asymptomatic disease to significant dysmotility causing complications like malabsorption, weight loss and severe malnutrition. This review focuses on the management of GI involvement in SSc and has been categorized based on the segment of GIT involved. A brief discussion on the role of patient reported outcome measures in SSc-GI involvement has also been incorporated.
Old medications and new targeted therapies in systemic sclerosis. - Rheumatology (Oxford, England)
SSc is a multiorgan disease with significant morbidity that is associated with poor health-related quality of life. Treatment of this condition is often organ based and non-curative. However, there are newer, potentially disease-modifying therapies available to treat certain aspects of the disease. This review focuses on old and new therapies in the management of SSc in clinical practice.© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email:
Construct validity of the Patient-Reported Outcomes Measurement Information System gastrointestinal symptom scales in systemic sclerosis. - Arthritis care & research
Gastrointestinal (GI) involvement is common in patients with systemic sclerosis (SSc; scleroderma). The Patient-Reported Outcomes Measurement Information System (PROMIS) GI symptom item bank captures upper and lower GI symptoms (reflux, disrupted swallowing, nausea/vomiting, belly pain, gas/bloating/flatulence, diarrhea, constipation, and fecal incontinence). The objective of this study was to evaluate the construct validity of the PROMIS GI bank in SSc.A total of 167 patients with SSc were administered the PROMIS GI bank and the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (GIT 2.0) instrument. GIT 2.0 is a multi-item instrument that measures SSc-associated GI symptoms. Product-moment correlations and a multitrait-multimethod analysis of the PROMIS GI scales with the GIT 2.0 symptom scales were used to evaluate convergent and discriminant validity.Patients with SSc GI involvement had PROMIS GI scale scores 0.2-0.7 SD worse than the US general population. Correlations among scales measuring the same domains for the PROMIS GI and GIT 2.0 measures were large, ranging from 0.61 to 0.87 (average r = 0.77). The average correlation between different symptom scales was 0.22, supporting discriminant validity.This study provides support for the construct validity of the PROMIS GI scales in SSc. Future research is needed to assess the responsiveness to change of these scales in patients with SSc.Copyright © 2014 by the American College of Rheumatology.
Measuring response in the gastrointestinal tract in systemic sclerosis. - Current opinion in rheumatology
Gastrointestinal tract (GIT) involvement in systemic sclerosis (scleroderma, SSc) is the most common internal complication. This review discusses the outcome measures to capture GIT involvement in clinical care and trials.Patient-reported outcome measures have been validated (UCLA Scleroderma Clinical Trial Consortium GIT 2.0 and NIH PROMIS scales) in SSc-GIT. Multiple objective measures are available to assess mucosal involvement and motility in GIT. However, these need to be validated in SSc for trials.GIT is a common cause of morbidity and has negative impact on quality of life in SSc. Recommendations are given for trial design and evaluation of GIT involvement in SSc.
Review of abdominal damage control and open abdomens: focus on gastrointestinal complications. - Journal of gastrointestinal and liver diseases : JGLD
Massive trauma and abdominal catastrophes carry high morbidity and mortality. In addition to the primary pathologic process, a secondary systemic injury, characterized by inflammatory mediator release, contributes to subsequent cellular, end-organ, and systemic dysfunction. These processes, in conjunction with large-volume resuscitations and tissue hypoperfusion, lead to acidosis, coagulopathy, and hypothermia. This "lethal triad" synergistically contributes to further physiologic derangements and, if uncorrected, may result in patient death. One manifestation of the associated clinical syndrome is the development of intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). The development of ACS is insidious. If not recognized and treated promptly, ACS leads to multi-system organ failure (MSOF) and mortality. Improved understanding of IAH and ACS led to the development of damage control (DC)/open abdomen (OA) as surgical decompressive strategy. The DC/OA approach consists of three basic management steps. During the initial step the abdomen is opened, hemorrhage/abdominal contamination are controlled, and temporary abdominal closure is performed (Stage I). The patient then enters Stage II - physiologic restoration with core rewarming, correction of coagulopathy and completion of acute resuscitation. After physiologic normalization, definitive management of injuries and eventual abdominal closure (Stage III) are achieved. The authors will provide an overview of the DC/OA approach, as well as the clinical diagnosis of ACS, followed by a discussion of DC/OA-associated complications, with focus on digestive system-specific complaints.
Pulmonary Embolism Mimicking Pneumonia in a HIV Patient. - Case reports in medicine
Recent studies have shown an increased risk of arterial and venous vascular diseases in HIV patients, pulmonary thromboembolism being one of them. HIV-infected individuals may have procoagulants predisposing them to thromboembolism. Patients with thromboembolism may have a clinical presentation mimicking common opportunistic infections. It is important to consider pulmonary embolism in the differential of HIV patients with fever, cough, and dyspnea, particularly in those with well-controlled HIV infection.

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