Chronic Kidney Disease of Non-traditional Etiology in a Young Man From Central America: Geography, Poverty, and Uncertain Pathophysiology Create a Formidable Medical Challenge.

A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was admitted with one month of nausea and vomiting, intermittent episodes of confusion, shortness of breath, and dysuria. He reported that many people from his native village in Central America, where he harvested sugarcane as a child, have died from kidney disease, including his father and cousin. He believed the source of disease to be agrochemicals found in the village's water supply. Although FSGS would be a rare manifestation, the patient's risk factors strongly suggested chronic kidney disease of unknown etiology (CKDu) - also known as Mesoamerican nephropathy (MeN) - a phenomenon he had never previously heard of. He took lisinopril for the last six years to manage his kidney disease. Due to uremic symptoms and abnormal electrolytes, he was initiated on hemodialysis.

Increased Urinary Cadmium Levels in Foreign-Born Asian Women-An NHANES Study of 9639 U.S. Participants.

The purpose of this study was to determine the disparities and trends in demographics, social behaviors, and occupations for cadmium exposure in the U.S. Data were obtained from the NHANES database from 2007 to 2016. Analysis of variance tests were used to compare the association of the geometric mean values of urinary cadmium levels and various demographic and behavioral characteristics. We also conducted multivariable logistic regression while adjusting for these factors to determine the risk of toxic urinary cadmium levels (≥2 µg/g) across various patient characteristics. Of the 9639 participants, 52.8% were ≥45 years old, 51.7% female, and 48.3% male. White, Black, Mexican American, other Hispanic, and Asian comprised 66.4%, 11.5%, 8.7%, 5.8%, and 5.5%, respectively. Over 82% of participants were U.S. born. A total of 19.6% were current smokers. On multivariate analysis, older age (OR: 8.87), current smoking (OR = 5.74), Asian race (OR = 4.52), female sex (OR = 4.32), and foreign nativity (OR = 1.83) were significantly associated with higher cadmium levels. Older, Asian, foreign-born females showed a measurement of 0.69 µg/g, a value more than three-fold the sample population's mean of 0.20 µg/g. A trend analysis demonstrated a cadmium level decrease over time (OR = 0.47). Asians had the highest urinary cadmium levels, especially older, foreign-born females. Smoking and poverty were also associated with significant elevations in cadmium levels.

The Healthcare Journey of Women With Advanced Gynecological Cancer From Diagnosis Through Terminal Illness: Qualitative Analysis of Progress Note Data.

OBJECTIVE: To examine women's journeys with gynecologic cancer from before diagnosis through death and identify elements of their healthcare experience that warrant improvement. METHODS: This exploratory study used longitudinal progress notes data from a multispecialty practice in Northern California. The sample included women with stage IV gynecological cancer diagnosed after 2011 and who died before 2018. Available progress notes from prior to diagnosis to death were qualitatively analyzed. RESULTS: We identified 32 women, (median age 61 years) with mostly uterine (n=17) and ovarian (n=9) cancers and median survival of 9.2 months (min:2.9 and max:47.5). Sixteen (50%) received outpatient palliative care and 18 (56%) received hospice care. The analysis found wide variation in documentation about communication about diagnosis, prognosis, goals of care, stopping treatment, and starting hospice care. Challenges included escalating/severe symptoms, repeated urgent care/emergency department/hospital encounters, and lack of or late access to palliative and hospice care. Notes also illustrated how patient background and goals influenced care trajectory and communication. Documentation styles varied substantially, with palliative care notes more consistently documenting conversations about goals of care and psychosocial needs. CONCLUSION: This analysis of longitudinal illness experience of women with advanced gynecological cancer suggests that clinicians may want to (1) prioritize earlier discussion about goals of care; (2) provide supplemental support to patients with higher needs, possibly through palliative care or navigation; and (3) write notes to enhance patient understanding now that patients may access all notes.

Progress and trends in publication of oral and video presentations at the society of gynecologic oncology annual meeting from 2006 to 2016.

Previous research has identified factors associated with publication of plenary presentations at the Society of Gynecologic Oncology annual meeting. However, there are no detailed comprehensive trends analyses on the publications of these oral and video presentations over time. In this analysis of 11 annual meetings, we found an increase in clinical rather than translational science publications over time. There was a greater focus on chemotherapy clinical studies and palliative care medicine, with a corresponding decline in publications on surgery. Furthermore, the time interval from presentation to publication shortened over our study period. The evaluation of trends in research publications can inform clinicians and researchers about the quality, competitiveness, and neglected areas of study from national meeting presentations.

Publication of oral and video presentations from the Society of Gynecologic Oncology annual meeting over 11 years - What characteristics were important?

The goal of this study was to determine the characteristics associated with publication of oral and video presentations presented at the Society of Gynecologic Oncology annual meetings. Abstracts were reviewed using publication booklets from 2006 to 2016. PubMed and internet searches were used to determine publication status. Chi-squared test, Fisher's exact test, and logistic regression were used for statistical analyses. Of 585 oral plenary sessions, 502 (85.8%) led to publications in peer-reviewed journals. The majority (75.7%) of presentations were clinical rather than translational (24.3%). Compared to single institution studies, multicenter presentations led to a higher publication rate (89.9% 80.5%; p = 0.001). Randomized controlled trials and cohort studies had publication rates of over 90%, while chart reviews and translational research were published at a rate of 87.1% and 80%, respectively (p = 0.004). 41.4% of all publications were in the specialty journal Gynecologic Oncology. Of 56 surgical videos, 23 (41.1%) advanced to publication in either peer-reviewed journals or as online videos: 32.1% were in print media, 5.4% were posted as accessible online videos (YouTube, Google Video, university websites). On multivariate analysis of oral presentations, multicenter studies (OR: 1.95; 95% CI: 1.15-3.31; p = 0.01), cohort studies (OR: 3.13; 95% CI: 1.30-7.58; p = 0.01), and international studies (OR: 4.02; 95% CI: 1.20-13.40; p = 0.02) were most likely to be published. Over 11 Society of Gynecologic Oncology annual meetings, >85% of oral plenary sessions led to peer-reviewed publication and 41% of surgical videos were published or accessible online. Multicenter, international, and cohort studies were more likely to be published.

Trends in the Utilization of Palliative Care in Patients With Gynecologic Cancer Who Subsequently Died During Hospitalization.

OBJECTIVE: To determine factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. METHODS: Data were abstracted from the National Inpatient Sample database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were used for statistical analyses. RESULTS: Of 4559 women (median age: 65 years; range: 19-102), 1066 (23.4%) utilized PC. Patients were 24.9% low socioeconomic status (SES), 23.9% low-middle, 23.7% middle-high, and 25.1% high SES. Medicare, Medicaid, and private insurance coverage were listed at 46.2%, 37.5%, 11.3% of patients; 36.2%, 21.1%, 18.1%, 24.6% were treated in the South, West, Midwest, and Northeast. Over the 7 year study period, the use of PC increased from 12% to 45%. Older age (odds ratio [OR]: 1.36; 95% CI: 1.11-1.68; P = .003), high SES (OR: 1.41; 95% CI: 1.12-1.78; P = .003), more recent treatment (OR: 9.22; 95% CI: 6.8-12.51; P < .0001), private insurance (OR: 1.81; 95% CI: 1.46-2.25; P < .001), and treatment at large-volume hospitals (OR: 1.36; 95% CI: 1.04-1.77; P = .02), Western (OR: 2.00; 95% CI: 1.61-2.49; P < .001) and Midwestern hospitals (OR: 1.35; 95% CI: 1.08-1.68; P = .001) were associated with higher utilization of PC. CONCLUSIONS: The use of inpatient PC for patients with gynecologic cancer increased over time. The lower utilization of PC for terminal illness was associated with younger age, lower SES, government-issued insurance coverage, and treatment in Southern and smaller volume hospitals, and warrants further attention.