1
|
Gujarathi R, Lakhanpal MR, Chelikam N, Manjani D, Lahori S, Akella SA, Shivashankar PG, Savio FVD, Ali AI, Annareddy N, Singh A, Manjani L, Vanga P, Adiga A. Prevalence, Outcomes, and Complications of Vitamin D Deficiency Among Patients with Multiple Myeloma: Nationwide Burden of Disease. J Investig Med 2024:10815589241249998. [PMID: 38632835 DOI: 10.1177/10815589241249998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Multiple myeloma (MM), constituting 10% of hematological malignancies, poses significant morbidity and mortality, especially with skeletal involvement. Bisphosphonate use in MM may lead to severe hypocalcemia due to vitamin D deficiency (VDD), exacerbating bone marrow plasma cell burden. We aimed to assess VDD prevalence and its impact on outcomes in MM patients. A retrospective cross-sectional analysis (2008-2018) of nationwide inpatient data identified adult MM hospitalizations with VDD using ICD-10-CM codes. Univariate and multivariate analyses were conducted to evaluate prevalence, demographics, and outcomes, with significance set at p < 0.05. Among 330,175 MM hospitalizations, 3.48% had VDD. VDD was more prevalent among 50-75-year-olds (61.72% vs. 59.74%), females (53.36% vs. 44.34%), Blacks (23.34% vs. 22.94%), Whites (65.84% vs. 65.79%), higher income brackets (26.13% vs. 23.85%), and those with comorbidities like hypertension (71.12% vs. 69.89%), dyslipidemia (42.47% vs. 34.98%), obesity (13.63% vs. 10.19%), and alcohol abuse (1.61% vs. 1.34%). In regression analysis, VDD in MM patients correlated with higher morbidity (aOR: 1.24, 95%CI: 1.14-1.36) and major disability (aOR: 1.26, 95%CI: 1.20-1.30). MM patients with VDD exhibit worse outcomes, underscoring the importance of recognizing and managing VDD promptly. Further prospective studies are needed to validate our findings and explore the impact of vitamin D supplementation on MM patient outcomes.
Collapse
Affiliation(s)
- Rahul Gujarathi
- University of Florida Health Science Center Jacksonville, Department of Hospital Medicine
| | | | | | | | | | | | | | | | | | - Navyatha Annareddy
- Nanjing Medical University Singh, Aryak; Quinnipiac University Frank H Netter MD School of Medicine
| | - Aryak Singh
- Quinnipiac University Frank H Netter MD School of Medicine, North Haven, United States
| | - Lokesh Manjani
- MedStar Washington Hospital Center, Department of Medicine
| | - Prasanthi Vanga
- Konaseema Institute of Medical Sciences and Research Foundation Hospital
| | | |
Collapse
|
2
|
Frankel L, Ardeljan AD, Santizo G, Guerra M, Gharat G, Alnajar S, Manjani D, Ardeljan A, Takabe K, Rashid OM. Esophageal Perforation in a 76-Year-Old Man After C5-C7 Anterior Discectomy and Anterior Plate Fusion. World J Oncol 2023; 14:158-163. [PMID: 37188039 PMCID: PMC10181427 DOI: 10.14740/wjon1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is indicated for the treatment of various cervical pathologies, including myelopathy, cervical disc degeneration, and radiculopathy. Esophageal perforation is a rare postsurgical complication of ACDF, although it poses serious and potentially fatal outcomes. Esophageal perforation has been described as the most fatal complication of the gastrointestinal tract as delayed diagnosis can lead to sepsis and death. Diagnosis of this complication is often difficult because it can be masked by various symptoms such as recurrent aspiration pneumonia, fever, dysphagia, and neck pain. While this complication usually occurs within the first 24 h post-surgery, it can also develop later and persist chronically in rare cases. Awareness and early recognition of this complication may improve outcomes and reduce mortality and morbidity. A 76-year-old man underwent C5-C7 ACDF in October 2017. A thorough review of the patient's postoperative condition included computed tomography (CT) and esophagogram, which were negative for signs of acute complications. The postoperative recovery was uneventful until several months post-procedure when he began to develop vague dysphagia and weight loss of unknown etiology. A CT scan was obtained 6 months postoperatively and was negative for perforation. He then underwent a battery of inconclusive procedures and scans at multiple institutions. After several months of persistent dysphagia and weight loss without a diagnosis, the patient presented to our network for further workup and treatment recommendations. Upper endoscopy was performed and showed fistulization between the esophagus and the metal hardware in the cervical spine. Esophagram demonstrated no obstruction but decreased peristalsis of the lower esophagus and lateral rightward deviation of the left upper cervical esophagus with minimal mucosal irregularities. These findings were secondary to mass effect of the cervical plate. The patient was successfully treated with a surgical approach using esophagogastroduodenoscopy (EGD) guided repair in layers and a sternocleidomastoid muscle flap. This report demonstrates a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using the dual technique.
Collapse
Affiliation(s)
- Lexi Frankel
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Amalia D. Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Gabriela Santizo
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Maximiliano Guerra
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Ghargi Gharat
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Sarmed Alnajar
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Divesh Manjani
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Andrew Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA
| | - Omar M. Rashid
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
- University of Miami, Leonard Miami School of Medicine, Miami, FL, USA
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgical Oncology, Broward Health, Fort Lauderdale, FL, USA
- TopLine MD Alliance, Fort Lauderdale, FL, USA
- Department of Surgical Oncology Memorial Health, Pembroke Pines, FL, USA
- Department of Surgical Oncology, Delray Medical Center, Delray, FL, USA
- Corresponding Author: Omar M. Rashid, Complex General Surgical Oncology, General & Robotic Surgery, TopLine MD Alliance, Fort Lauderdale, FL 33308, USA.
| |
Collapse
|