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Roy S, Schweiker-Kahn O, Jafry B, Masel-Miller R, Raju RS, O'Neill LMO, Correia CR, Trivedi A, Johnson C, Pilot C, Saddemi J, Memon A, Chen A, McHugh SP, Patel S, Daroshefski NM, Nguyen T, Wissler W, Sharma E, Hunter K. Risk Factors and Comorbidities Associated with Diabetic Kidney Disease. J Prim Care Community Health 2021; 12:21501327211048556. [PMID: 34634970 PMCID: PMC8516382 DOI: 10.1177/21501327211048556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction/objectives: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD. Methods: Retrospective medical record review of adult patients with diabetes mellitus (DM) was performed who visited our internal medicine office between January 1, 2020 and December 31, 2020. Results: Among 728 patients with DM, 471 (64.7%) patients had DKD, and 257 (35.3%) patients were without DKD. Among the group of patients with DKD, the majority were in CKD stage G1A2 (34.6%), followed equally by G2A2 and G3aA1 (16.8% each). Mean age of the patients with DKD was significantly greater than the patients without DKD (69.4 years vs 62.2 years; P < .001). For each unit increase in age, there was a 7.8% increase in the odds of DKD (95% CI 5.3-10.4; P < .001). Women had 2.32 times greater odds of DKD (95% CI, 1.41-3.81; P = .001). We found decreased odds of DKD for those who consumed alcohol moderately (OR 0.612, 95% CI 0.377-0.994; P < .05). Significantly higher frequencies of associations of several comorbid medical conditions were seen in patients with DKD compared to the patients without DKD, such as hypertension (91.9% vs 75.6%), hyperlipidemia (86.6% vs 78.2%), coronary artery disease (39.3% vs 16.8%), cerebrovascular accidents (13.4% vs 7.4%), congestive heart failure (12.9% vs 4.1%), carotid artery stenosis (11.3% vs 2.6%), aortic aneurysm (5.4% vs 2.0%), peripheral artery disease (10.8% vs 3.5%), gout (12.4% vs 5.5%), and osteoarthritis (41.4% vs 31.2%). Conclusions: In patients with diabetes, increasing age, female sex, and lack of moderate alcohol consumption were associated with increased odds of DKD. Higher frequencies of association of hypertension, hyperlipidemia, coronary artery disease, cerebrovascular accidents, congestive heart failure, carotid artery stenosis, aortic aneurysm, peripheral artery disease, gout, and osteoarthritis were also seen in patients with DKD.
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Affiliation(s)
- Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Behjath Jafry
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Riya Sam Raju
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Aditi Trivedi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | - Aatqa Memon
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Austin Chen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Sawan Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Tatyana Nguyen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Walter Wissler
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Elena Sharma
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Medical School of Rowan University, Camden, NJ, USA
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Kagedan DJ, Dixon ME, Raju RS, Li Q, Elmi M, Shin E, Liu N, El-Sedfy A, Paszat L, Kiss A, Earle CC, Mittmann N, Coburn NG. Predictors of adjuvant treatment for pancreatic adenocarcinoma at the population level. ACTA ACUST UNITED AC 2016; 23:334-342. [PMID: 27803598 DOI: 10.3747/co.23.3205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/06/2023]
Abstract
BACKGROUND In the present study, we aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (pcc) and to identify independent predictors of adjuvant treatment use. METHODS In this observational cohort study, patients undergoing pcc resection in the province of Ontario (population 13 million) during 2005-2010 were identified using the provincial cancer registry and were linked to administrative databases that include all treatments received and outcomes experienced in the province. Patients were defined as having received chemotherapy (ctx), chemoradiation (crt), or observation (obs). Clinicopathologic factors associated with the use of ctx, crt, or obs were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of adjuvant treatment versus obs, and ctx versus crt. RESULTS Of the 397 patients included, 75.3% received adjuvant treatment (27.2% crt, 48.1% ctx) and 24.7% received obs. Within a single-payer health care system with universal coverage of costs for ctx and crt, substantial variation by geographic region was observed. Although the likelihood of receiving adjuvant treatment increased from 2005 to 2010 (p = 0.002), multivariate analysis revealed widespread variation between the treating hospitals (p = 0.001), and even between high-volume hepatopancreatobiliary hospitals (p = 0.0006). Younger age, positive lymph nodes, and positive surgical resection margins predicted an increased likelihood of receiving adjuvant treatment. Among patients receiving adjuvant treatment, positive margins and a low comorbidity burden were associated with crt compared with ctx. CONCLUSIONS Interinstitutional medical practice variation contributes significantly to differential patterns in the rate of adjuvant treatment for pcc. Whether such variation is warranted or unwarranted requires further investigation.
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Affiliation(s)
- D J Kagedan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | - M E Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, U.S.A
| | - R S Raju
- Sunnybrook Health Sciences Centre
| | - Q Li
- Institute for Clinical Evaluative Sciences and
| | - M Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | - E Shin
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - N Liu
- Institute for Clinical Evaluative Sciences and
| | - A El-Sedfy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, U.S.A
| | - L Paszat
- Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences and; Faculty of Medicine, University of Toronto, Toronto, ON
| | - A Kiss
- Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences and; Institute of Health Policy, Management and Evaluation, University of Toronto and
| | - C C Earle
- Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences and; Faculty of Medicine, University of Toronto, Toronto, ON
| | | | - N G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON;; Sunnybrook Health Sciences Centre; Institute for Clinical Evaluative Sciences and; Faculty of Medicine, University of Toronto, Toronto, ON;; Institute of Health Policy, Management and Evaluation, University of Toronto and
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Raju RS, Coburn N, Liu N, Porter JM, Seung SJ, Cheung MC, Goyert N, Leighl NB, Hoch JS, Trudeau ME, Evans WK, Dainty KN, Earle CC, Mittmann N. A population-based study of the epidemiology of pancreatic cancer: a brief report. ACTA ACUST UNITED AC 2015; 22:e478-84. [PMID: 26715886 DOI: 10.3747/co.22.2653] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Administrative data are used to describe the pancreatic cancer (pcc) population. The analysis examines demographic details, incidence, site, survival, and factors influencing mortality in a cohort of individuals diagnosed with pcc. METHODS Incident cases of pcc diagnosed in Ontario between 1 January 2004 and 31 December 2011 were extracted from the Ontario Cancer Registry. They were linked by encrypted health card number to several administrative databases to obtain demographic and mortality information. Descriptive, bivariate, and survival analyses were conducted. RESULTS During the period of interest, 9221 new cases of pcc (4548 in men, 4673 in women) were diagnosed, for an age-adjusted standardized annual incidence in the range of 8.6-9.5 per 100,000 population. Mean age at diagnosis was 70.3 ± 12.5 years (standard deviation). Five-year survival was 7.2% (12.8% for those <60 years of age and 3.6% for those >80 years of age). Survival varied by sex, older age, rural residence, lower income, site of involvement in the pancreas, and presence of comorbidity. CONCLUSIONS The mortality rate in pcc is exceptionally high. With an increasing incidence and a mortality positively associated with age, additional support will be needed for this highly fatal disease as demographics in Ontario continue to trend toward a higher proportion of older individuals.
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Affiliation(s)
- R S Raju
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - N Coburn
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - N Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - J M Porter
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - S J Seung
- Health Outcomes and PharmacoEconomics Research Centre, Sunnybrook Research Institute, Toronto, ON
| | - M C Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - N Goyert
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - N B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - J S Hoch
- Applied Research in Cancer Control, Cancer Care Ontario, Toronto, ON
| | - M E Trudeau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | - K N Dainty
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - C C Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - N Mittmann
- Health Outcomes and PharmacoEconomics Research Centre, Sunnybrook Research Institute, Toronto, ON; ; Department of Pharmacology, University of Toronto, Toronto, ON; ; International Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON
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Abstract
Properly funded national audits are vital
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Affiliation(s)
- R S Raju
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia 5006, Australia
| | - G J Maddern
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia 5006, Australia
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Yacob M, Raju RS, Vyas FL, Joseph P, Sitaram V. Management of colorectal cancer liver metastasis in a patient with immune thrombocytopaenia. Ann R Coll Surg Engl 2013; 95:e50-1. [PMID: 23484984 PMCID: PMC4098605 DOI: 10.1308/003588413x13511609957498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Immune thrombocytopaenia (ITP) was referred to previously as idiopathic thrombocytopaenic purpura and is usually of autoimmune or viral aetiology. Colorectal cancer liver metastasis with concomitant ITP is rare and only three cases have been reported in the English literature. Adverse effects of adjuvant chemotherapy may aggravate ITP. The sequencing of chemotherapy, operation for the primary and liver metastasis, and a decision on splenectomy is important. We present our experience in the management of a 52-year-old man who, having undergone anterior resection one year earlier for carcinoma of the rectum, presented with liver metastasis and ITP. He underwent splenectomy with hepatectomy prior to chemotherapy.
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Affiliation(s)
- M Yacob
- Department of HPB Surgery, Christian Medical College, Vellore, India.
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Sen I, Raju RS, Vyas FL, Eapen A, Sitaram V. Benign biliary papillomatosis in a patient with a choledochal cyst presenting as haemobilia: a case report. Ann R Coll Surg Engl 2012; 94:e20-1. [PMID: 22524914 DOI: 10.1308/003588412x13171221499504] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.
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Affiliation(s)
- I Sen
- Christian Medical College, Vellore, India
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