Imaging and tracing the pattern of adult ovarian angiogenesis implies a strategy against female reproductive aging

Unique model of adult ovarian angiogenesis implies a strategy to extend female reproductive life span.

Multidimensional Impact of Climate Change on Human Reproduction and Fertility

Research has identified a multidimensional, interactive relationship between climate change variables and an adverse (mostly) impact on the mammalian reproductive systems, reproductive organs, and fertility in animals, but direct evidence establishing the impact of climate change on reproductive health and fertility in humans is limited. Climate change has established direct or indirect linkages with re-emergence, geospatial redistribution of pathogens of likely reproductive health significance in humans. Similarly, alterations in growth, mortality rate, reproduction, and spatiotemporal distribution of vectors (e.g., zika virus – Aedes aegypti) and intermediate hosts (e.g., Schistosomiasis – snail) of certain infectious diseases of reproductive health importance are influenced by climate change variables like temperature, precipitation, and humidity. The exposure channels or effect pathways, through which the regional and global climate change can directly or indirectly influence the human reproductive ability, health, fertility, progeny, and thus, ultimately, demography can broadly be classified as physical variables, chemical hazards, biological agents, factors related to psycho-socio-behavior, and economy. The chapter is an overall account of how each of these factors, as an inherent component of climate change has the potential to cause a variable degree of impact on human reproduction from a medical point of view. As human reproductive systems are highly vulnerable to diseases and other post-catastrophic effects of extreme climate change events, so it is high time to understand the adversity and resort to proper and sustainable control measures for a healthy reproductive life of future generations.

Evolution of synchronous bilateral breast cancers provide insights into interactions between host, tumor and immunity.

Synchronous bilateral breast cancer (sBBC) occurs after both breasts have been affected by the same germline genetics, reproductive life factors and environmental exposures for decades. It represents an opportunity to decipher the complex interplay between host, tumor, immune system and response to neoadjuvant chemotherapy (NAC). On a cohort of 17575 BCs treated between 2005 and 2012, sBBCs (n=404) were associated with less aggressive proliferative patterns and higher rates of luminal breast cancers (BCs) when compared with unilateral BCs (n=17171). The left and right tumors were concordant for the majority of clinical and pathological features. Tumor pairs of concordant BC subtype were more frequent than pairs of discordant BC subtype, with notably a particularly high frequency of pairs of luminal BCs. Intriguingly, both the levels of tumor infiltrating lymphocytes (TILs) and the response to NAC were modified by the subtype of the contralateral tumors. Whole exome sequencing and RNAseq analyses revealed that left and right tumors were independent from a somatic mutation and transcriptomic point of view, while primary tumors (PT) before NAC and specimens with residual disease (RD) after NAC were more closely related. The analysis of the TCR repertoire identified very little overlap between patients, while common clones were shared in bilateral tumors within each patient. After NAC, the TCR repertoire of RD was enriched and expanded with clones edited by the contralateral PT.

Menstrual Fluid Factors Mediate Endometrial Repair

Menstruation is a process whereby the outer functionalis layer of the endometrium is shed each month in response to falling progesterone and estrogen levels in a non-conception cycle. Simultaneously with the tissue breakdown, the surface is re-epithelialized, protecting the wound from infection. Once menstruation is complete and estrogen levels start to rise, regeneration progresses throughout the proliferative phase of the cycle, to fully restore endometrial thickness. Endometrial repair is unique compared to tissue repair elsewhere in the adult, in that it is rapid, scar-free and occurs around 400 times during each modern woman's reproductive life. The shedding tissue and that undergoing repair is bathed in menstrual fluid, which contains live cells, cellular debris, fragments of extracellular matrix, activated leukocytes and their products, soluble cellular components and extracellular vesicles. Proteomic and other analyses have revealed some detail of these components. Menstrual fluid, along with a number of individual proteins enhances epithelial cell migration to cover the wound. This is shown in endometrial epithelial and keratinocyte cell culture models, in an ex vivo decellularized skin model and in pig wounds in vivo. Thus, the microenvironment provided by menstrual fluid, is likely responsible for the unique rapid and scar-free repair of this remarkable tissue. Insight gained from analysis of this fluid is likely to be of value not only for treating endometrial bleeding problems but also in providing potential new therapies for poorly repairing wounds such as those seen in the aged and in diabetics.

Tendencia actual de la mortalidad materna. Maternidad “Concepción Palacios” 2014-2020

Objective: To analyze maternal mortality in the Maternidad “Concepción Palacios” Hospital between January 2014 and December 2020. Methods: A descriptive, analytical, and retrospective study of maternal deaths occurred in the 2013-2018 period was carried out. Results: There were 73 maternal deaths, and a ratio of 135.96 per 100,000 live births. Direct maternal deaths were 60, 82.19% of the population and 13 indirect maternal deaths, 17.80%. The causes of direct maternal death were hypertensive disorders of pregnancy 48.33%, sepsis 26.66%, and obstetric hemorrhage 23.33%, with a 1: 3 ratios of maternal deaths at extreme ages of reproductive life. Conclusions: The maternal death ratio in the Maternidad “Concepción Palacios” Hospital duplicates the goals of the sustainable development goals of the 2016-2030 agenda; there is an increase in hypertensive disorders of pregnancy as a direct cause of maternal mortality. Primiparity, the absence or lack of data from prenatal control, cesarean sections, and admission-death time of less than 24 hours prevailed. Recommendations: Advances are needed in sexual and reproductive health education, education and training of health personnel in extreme maternal morbidity, analysis by theoretical premises identifying the social determinants of maternal mortality and the health reality related to its management, implementing preventive public policies with specific care guidelines. Keywords: Maternal mortality, Hypertensive disorders of pregnancy, Maternal sepsis, Obstetric hemorrhage.

The Embodiment of Traditional Partería in the Colombian Pacific Region

A Traditional Partera refers to a woman who assists, by traditional practices, women during gestation, birth, and reproductive life, aside of the formal health care system. Their practice, Traditional Partería, is considered a key ancestral cultural component in marginalized communities in Colombia. A comprehensive description of the essence of Colombian Traditional Partería is currently missing, and this practice is facing the loss of its body of knowledge. Here, we describe the essence of being a Colombian Traditional Partera. Eight Traditional Parteras participated in phenomenological interviews and body maps focused on their embodied conscious experience of being a Traditional Partera in Colombia. Seventeen general meaning units were identified and grouped in three embodied components (Head, Heart, and Hands) related to practice, knowledge, feelings, perceptions, context, and culture. We discuss philosophical reflections and implications of knowing other’s world perspectives, describing a sensitive triad central in the Traditional Partería practice.

Mobile phones, non-human agents at the service of assisted reproduction: monitoring and gendered dual allegiance

For sub-Saharan women enrolled in a protocol for assisted reproductive technology (ART), the use of mobile phones entails dual allegiance: toward the services of reproductive medicine and toward their transnational family. Indispensable for medically monitoring women’s reproductive bodies, the mobile phone enters the process for producing female gametes and contributes to the gender asymmetry typical of biomedicalized procreation. It is also used to maintain contacts with transnational family members who, from a distance, obtrude in the woman’s reproductive life. The use of mobile phones extends biomedical power over the woman’s body into her everyday life and the normative power of her transnational family into reproduction. Paradoxically, the mobile telephone allows collateral relatives to support the woman seeking reproduction assistance while also “hypermedicalizing” the woman’s daily life. Also paradoxically, this everyday companion is conductive to individual autonomy while also being used for new forms of surveillance and control. The data come from fieldwork conducted in the greater Paris area between 2011 and 2013 within a network of ART professionals and their patients.

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.

Knowledge, awareness and practices regarding menses and its hygiene among adolescent girls

Menstruation is a physiological process which starts around 11-16 yrs of age in most girls andcontinues throughout the reproductive life until menopause. During these years females spend one-sixth of their time menstruating and in discomfort. It is of utmost importance that hygienic practices are followed for a healthy and safe life. Various social and cultural taboos and habits have clouded the situation along with restricted facilities creating a disease burden such as genital infections and menstrual problems, including missed days at schools and work. It is the responsibility of the policy makers and also the health care workers to help in bridging the gap of lack of knowledge and availability of resources in creating a female hygiene friendly infrastructure in all the places. The study was conducted to assess the knowledge and awareness about menarche and menstrual cycle in school going girls. Also it was carried to study the prevailing practices of menstrual hygiene among the adolescent girls. The various sociocultural restrictions and taboos under practice in relation to menstruation and were analysed the reasons alongwith their solutions to improve the present situation of female hygiene practices were tabulated. A semi structured, question answer style written survey was conducted among adolescentgirls aged 11-18 yrs from nearby schools of Index Medical College, with help of PG resident doctors and medical interns. The survey was followed by educational and awareness talk on female hygiene practices that need to be followed.The result of the study were as follows-56.4%% were aware about menstruation before attaining menarche, and 88.20% had attained menarche at the time of study. 68.5% had mother as first informant, 40.3% knew about menstruation only after getting their 1 period. 28.5% felt insecure, 18.4% had anxiety, 30.5% were worried about menstruation. 95.5% perceived menstruation as a natural process, 98.6% used sanitary pads for bleeding, 1.4% used old cloth. 98.6% cleaned private parts during menses of which 75.3% used only water. Only 78.1% had the facility to change pads in school, of which only 58.9% changed pads in school. 90.4% had a daily bath during menses. 38.6% were not allowed to pray. 5% were not allowed to attend school, 8.3% were not allowed to sleep on their regular bed, and 11% were asked not to touch family members. 5% were restricted from playing outside and were not even allowed to go out of their home. 81.3% shared their menstrual health problems with mother. This study provided an understanding of perception of menstruation amongschool going girls. It also deals with the understanding of the society that still menstruation is not taken as a natural process, but rather as a curse and menstruating girls and women are being put under a lot of restrictions due to such practices. Lack of proper infrastructural facilities are a reason why so many girls drop out and restrict their attendance at school after menarche and much still needs to be done in this field to ensure smooth and healthy transition of adolescent girls into adulthood.