Asian Women Research Articles

A systematic review and meta-analysis on the prevalence of vulvovaginal candidiasis in Southeast Asian countries

Vulvovaginal candidiasis (VVC) is a disease caused by pathogenic Candida species. This disease typically affects women of reproductive age with high sexual activity (i.e., sex workers), poor educational attainment and economic status, and infrequent hygiene practices. VVC remains a major public health concern. VVC prevalence across Southeast Asian countries remains poorly understood. To address this concern, the current study estimated the current prevalence of VVC infections among women in Southeast Asian countries by conducting a systematic review and meta-analyses. All studies reporting the prevalence of VVC in Southeast Asia were obtained from Ovid Medline, Scopus, and CINAHL. A review of titles and abstracts was done independently by three reviewers. The quality of the studies was assessed using the Newcastle-Ottawa scale. Meta-analysis was performed in R v.4.1,1 using the ‘meta’ package (version 4.19-0). Based on the results of the current study, the pooled estimated prevalence of VVC among Southeast Asian women is 23.0% (95% CI: 18.0% to 28.0%). Across countries, Laos had the highest estimated prevalence at 33.0% (95% CI: 22.0% to 46.0%). Subgroup analysis based on pregnancy status and occupation revealed a higher estimated prevalence among non-pregnant women (32.0%, 95% CI: 25.0% to 40.0%) and non-sex workers (33.0%, 95% CI: 20.0% to 48.0%). Based on the diagnostic method, the prevalence was higher for the combinatorial approach using microscopy, a culture-based approach, and molecular techniques (51.0%) and lowest when solely based on clinical diagnosis (9.0%, 95% CI: 1.0% to 22.0%) or an exclusively culture-based approach (11%, 95% CI: 6.0% to 18.0%). Overall, further study is necessary to accurately characterize the current distribution of VVC across Southeast Asian countries. Developing more effective diagnostic and management strategies is to improve the health of affected women.

Migrant South Asian Women in the Basque Country, Spain: Processes of Empowerment

This work describes the personal and social empowerment of migrant women from South Asia in the Basque Country 1 , Spain, through the life history method. Gender roles, cultural identity and the migratory process as a transformative instrument are discussed. Based on in-depth interviews, and individual and group analysis of life histories, the findings indicated that migration had a positive effect on women in terms of self-development. Clearly, migration was a tool for transformation and empowerment.

Intersectionality and Faculty Compensation in Academic Radiology in U.S.

The impact of intersectionality on academic radiology physician compensation is not well known. The aim of this study was to assess impact of intersectionality on academic radiology financial compensation, based on rank, gender and race/ethnicity in US medical schools. Data werecollected from the AAMC Faculty Salary Survey, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for radiology faculty with MD or equivalent degree in diagnostic radiology (DR) as well as interventional radiology (IR) was collected for 2023, stratified by rank, gender, and race/ethnicity. The AAMC Faculty Salary Survey data for 2023 included responses for 683 IR (138 women, 545 men) and 2431 DR (862 women, 1569 men) faculty. Men had a higher median compensation than women at all ranks, for both IR and DR, except DR instructors. The gender pay gap was greater in IR faculty compared to DR faculty of the same rank. All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. All intersectional groups among DR faculty, except Asian Men, had a lower median compensation than White men of the same rank. Among IR faculty, Asian women assistant professors faced the greatest disparity in median compensation, down to $75K (15%) lower than White men. Among DR faculty, Black/African American women assistant professors faced the greatest disparity on median compensation, down to $48K (10.5%) lower than White men. The study results raise important concerns about impact of intersectionality on faculty compensation in radiology which needs further study and should be addressed as part of broader drive to increase diversity, equity, and inclusion in academic radiology.

Ultrasonographic threshold of ovarian structure in premenopausal women of different ethnicity

The polycystic ovarian morphology (PCOM) is a generally accepted ultrasound marker for ovulatory dysfunction, is one of the criteria for polycystic ovary syndrome (PCOS) and is established based on the assessment of ovarian volume (OV) and the follicle number per ovary (FNPO), taking into account the upper normal values determined in healthy premenopausal women. However, there is a necessity for regular revision of the PCOM characteristics depending on ethnic and age characteristics.The aim. To develop differentiated standards for assessing the ultrasonographic ovary structure in premenopausal women of various ethnicity.Materials and methods. From March 2016 to December 2019, a multicenter cross-sectional prospective study was conducted in Eastern Siberia (Irkutsk region) and in the neighboring Republic of Buryatia. The study included 1134 participants: 715 women of Caucasian origin, 312 Asian women, 107 women of mixed ethnic subpopulation.Results. It has been established that for Caucasians, it is advisable to diagnose PCOM when the ovarian volume is 9 cm3 and/or FNPO ≥ 12; for women of the Asian population – when the ovarian volume is 7 cm3 and/or FNPO ≥ 11; for women of mixed ethnicity – when the ovarian volume is 8 cm3 and/or FNPO ≥ 9. An important advantage of our study is that all participants were recruited from a non-selective multi-ethnic population of women with comparable socio-demographic characteristics living in the same geographical conditions.Conclusion. Differentiated approach for identifying the polycystic ovarian morphology in premenopausal women of different ethnic groups requires using ethnically differentiated normative readings

Ocular Sarcoidosis Masquerading as Acute Retinal Necrosis: Two Case Reports.

To report two cases of ocular sarcoidosis (OS) initially presenting as unilateral acute retinitis, which mimicked acute retinal necrosis. Retrospective descriptive case reports. Two middle-aged healthy Asian women experienced progressive vision loss in their left eyes over a one-month period. Anterior uveitis, vitritis, and diffuse peripheral retinal infiltration were observed. Comprehensive diagnostic evaluations were conducted, including blood work-up, viral polymerase chain reaction of anterior chamber paracentesis samples, and chest X-ray, all yielding negative results. Despite prompt initiation of antiviral therapy, retinal infiltrations remained unchanged within the first 10 days. Chest CT imaging revealed multiple lymphadenopathies consistent with sarcoidosis. Case 1 was presumed OS, and case 2 was definite OS based on lung and lymph node biopsy results in accordance with the 2017 revised international workshop on OS (IWOS) criteria. In both cases, the retinal lesions gradually resolved after several weeks of systemic corticosteroids, and the best corrected vision of the affected eye improved to 20/25 at the 12 and 6-month follow-ups, respectively. Acute unilateral retinal infiltration in the peripheral region, exhibiting rapid progression resembling acute retinal necrosis, can be a rare manifestation of OS. Chest CT imaging can provide valuable assistance in the diagnostic process, especially when systemic examinations yield no significant findings.

Systematic Review and Meta-Analysis of Lifestyle and Reproductive Factors Associated with Risk of Breast Cancer in Asian Women.

Assessing breast cancer risks from lifestyle and reproductive factors is critical for developing population-specific risk prediction tools. However, limited studies have evaluated these risks in recent Asian birth cohorts. We systematically reviewed articles published from January 2010 to December 2023, examining breast cancer risk factors in Asian women. Data were described narratively, estimates pooled, and prevalence and attributable proportions compared across Asian populations. Of the 128 studies reviewed, 103 reported adjusted effect sizes for meta-analysis. Lifestyle and reproductive factors were predictive of breast cancer risk in Asian women, with varying impacts on premenopausal and postmenopausal women. Relative risks were similar within Asian populations and in comparison to European populations, except for menarche, menopause, and hormone receptor therapy. However, risk factor distributions differed across populations. While alcohol intake (21%) and oral contraceptive use (20%) emerged as the most attributable modifiable risk factors in Europeans, passive smoking (24%) and higher BMI (17%, ≥24 kg/m2 among postmenopausal women) were predominant in Asians. Our study shows that while the effects of lifestyle and reproductive breast cancer risk factors are largely similar across different populations, their distributions vary. Our analysis underscores the importance of considering population-specific risk factor distributions when developing risk prediction tools for Asian populations.

Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers.

Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.

Bilateral Oophorectomy Prevalence Among U.S. Women.

Background: Bilateral oophorectomy has been linked to numerous health outcomes, some of which can have a long latency period. Limited data are available on bilateral oophorectomy prevalence among U.S. women. Methods: The National Health Interview Survey fielded measures of bilateral oophorectomy most recently in 2010 and 2015. We pooled these 2 data years to present bilateral oophorectomy prevalence estimates by age-group, race, ethnicity, geographic region, and hysterectomy status. Results: Our study found bilateral oophorectomy was common among older women. Among women aged 70-79 years, 29% reported a bilateral oophorectomy, compared with <1% for women aged 20-29 years. By geographic region, bilateral oophorectomy prevalence among women 20-84 years was 12.3% in the South, 10.8% in the Midwest, 9.4% in the West, and 8.0% in the Northeast. Small numbers limited our ability to generate age-specific estimates for American Indian and Alaska Native women and subgroups of Asian and Hispanic women. Nearly half of women who had a bilateral oophorectomy reported their procedure occurred more than 20 years ago. Among women aged 20-84 years who reported a hysterectomy, 57% reported they also had both of their ovaries removed. Conclusion: Standard measures of incidence rates for ovarian cancer are not adjusted for oophorectomy status. These findings suggest that ovarian cancer incidence rates may be underestimated among older women. Continued monitoring of bilateral oophorectomy prevalence will be needed to track its potential impact on ovarian cancer incidence and numerous other chronic health outcomes.

Mental health priorities and cultural-responsiveness of the Mental Health First Aid (MHFA) training for Asian immigrant populations in Greater Boston, Massachusetts

BackgroundAsians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 − 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond.MethodsThis is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews.ResultsIn total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese).ConclusionCultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.

The global psychological and physical effects of domestic abuse and violence on South Asian women: a qualitative systematic review.

The purpose of this review is to systematically extract and analyse global academic literature to determine the physical and psychological effects of domestic abuse and violence on South Asian women. This review employs a qualitative systematic approach and thematic analysis to synthesize the narratives of affected women found in the literature. Given that domestic violence is often concealed and downplayed by various social factors, statistical reports and prevalence data offer only a limited view of the issue due to underreporting. Therefore, qualitative literature is deemed more dependable in this subjective domain as it captures and interprets the experiences and meanings within this under-studied group. Embase, PsycINFO, Google Scholar, Web Of Science, MEDLINE, and ASSIA were searched. All included studies were critically appraised using the CASP tool for qualitative research. Thematic analysis was conducted to develop six themes. Studies excluded did not address the research question, although intersecting population issues could be valuable topics for further research. The literature indicates severe mental and physical health consequences of domestic violence and abuse, with some traits persisting long-term. The analysis underscores the significant role of resilience, suggesting that individuals can overcome traumatic social experiences without enduring lifelong labels or a deficit model. The findings provide support for future interventions aimed at recognizing signs of abuse and preventing severe psychological and physical consequences, particularly among South Asian women. Further research is needed to understand the impact on children and other family members affected by the victim's abuse, which falls beyond the scope of this review.

‘Self-harm is wrong’: the experience of self-harming behaviours that inflict external injuries to the body in UK-based Bangladeshi, Indian and Pakistani women: an Interpretative Phenomenological Analysis

This study investigated the experience of self-harming behaviour that inflicts external injuries to the body in UK based Indian, Pakistani, and Bangladeshi (UKBIP) women. A total of eight participants were recruited via purposive sampling and semi-structured interviews were carried out. The interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analyses were carried out on an individual and group level and three super-ordinate themes, and nine sub-ordinate themes emerged. The superordinate themes were: ‘Powerlessness’ (‘Entrapment’, ‘Internalised Negativity’ and ‘Abused by my Environment’), ‘Mitigation’ (‘Releasing my Overwhelming Emotions’, ‘Connecting to my Pain’ and ‘Addicted to Self-harm’) and ‘Self-harm is Wrong’ (‘It must be Hidden’, ‘What have I done to myself?’ & ‘My Self-harm is Sinful’). The analyses revealed novel insights on the impact and importance of some South-Asian cultural values and beliefs on the experience of self-harm in South-Asian women. This paper will focus on the third superordinate theme and related sub themes, that of ‘Self-harm is Wrong’.

O-244 AMH levels in infertile women in APAC region - prospective study in multiple countries, ethnicities and centres

Abstract Secretary General, Asia Pacific Initiative on Reproductive (ASPIRE) President, Taiwan Endometriosis Society Founder &amp; CEO, Taipei Fertility Center AMH is produced by granulosa cells of small growing follicles in the ovary and serum AMH levels strongly correlate with the number of growing follicles, AMH has been used clinically as a marker for ovarian reserve. Despite being of similar ages, with similar AMH levels, durations of ovarian stimulation, and gonadotropin doses, Asian women have been documented as having decreased AFCs and lower yields of total and mature oocytes after ovarian stimulation compared to their Caucasian counter- parts. These earlier data suggested that the effect of ethnicity was as an independent marker of ovarian reserve and potentially subsequent reproductive outcomes. We conducted the first multi-nation, multi-centre, and multi-ethnicity prospective cohort study from January 2020 to May 2021 to investigate serum AMH profiles among infertile Asian women. A total of 4613 women who visited fertility clinics at 12 IVF centres in 11 regions throughout Asia were recruited from Taiwan, China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia (2 centres), Thailand, Vietnam, and Singapore. The inclusion criteria were female partners aged 20–43years and naive to any ovarian stimulation cycle. The AMH measurement was performed using an AMH automated assay on a clinically validated platform. Among the 12 centres that joined the study, most demonstrated racial homogeneity except for Singapore and Malaysia which presented a highly diverse ethnic profile, while others were supposedly monoethnic communities. Unexplained or male infertility is the most common infertility cause in most countries, except for China with a notably high incidence of tubal disease. Age, ethnicity, obesity, and PCOS are significantly associated with ovarian reserve. The highest rates of PCOS were found in Indians (18.6%), Malays (18.9%), and Vietnamese (17.7%), yet remarkably lean with lower obesity rate was found in Vietnamese. Serum AMH levels are not affected by smoking or GnRHa and OCPs pretreatment but are affected by endometrioma surgery. Moreover, the assay can be conveniently conducted on any day of the menstrual cycle and is not influenced by the use of fresh or frozen samples. The rate of decline in ovarian reserve increases with age in Asian women, at 0.13ng/ml/year at 25–33years old and 0.31ng/ ml/year at 33–43 years old. We also found that a cut-off at 4.0 ng/ml could be considered for PCOS diagnosis in the Asian region. Despite limitations, the results can help guide clinicians for personalized infertility treatment, and call for further investigation into the effects of genetic, environmental and lifestyle factors on ovarian reserve.

Introduction: Writing Muslim Women in South Asia

Introduction: Writing Muslim Women in South Asia

P-556 Genetic variation in genes related to folliculogenesis and steroidogenesis in Caucasian and Asian women: Baby steps towards a pharmacogenetic approach in assisted reproductive techniques

Abstract Study question What is the impact of single nucleotide polymorphisms (SNPs) in genes related to the folliculogenesis and steroidogenesis on ovarian response to stimulation? Summary answer SMAD2 rs13381619 and COMT rs4680 variants are associated with the follicular output rate (FORT). What is known already The prediction of ovarian response (OR) is crucial for an optimal and individualized management. Despite the good accuracy of ovarian reserve markers in the prediction of OR, a proportion of patients are unexpected hypo-responders. Therefore, a link between OR and individual genotype has been suggested. However, the available evidence is limited by small sample sizes and heterogeneous study designs, including patients with different profiles and allowing for dose adjustments during treatment. Our aim was to analyze the association between SNPs in genes related to folliculogenesis and steroidogenesis and OR in an ethnic diverse population treated with the same fixed-dose protocol. Study design, size, duration This is a secondary analysis of a multicenter multinational prospective study, including 368 patients from Vietnam, Belgium, and Spain (168 from Europe and 200 from Asia) recruited from 11/2016-06/2019. The study included predicted normal responders &amp;lt;38 years old undergoing their first or second ovarian stimulation (OS) cycle. All patients underwent OS in an antagonist protocol with a fixed daily dose of 150 IU rFSH until triggering. Participants/materials, setting, methods First, an interactome was developed using “FSHR” and “LHCGR” as keyword imputed in the Homo sapiens STRING database for protein network analysis. Genetic information from sixty-eight final SNPs involved in the folliculogenesis and steroidogenesis was obtained and used for clustering analysis. Secondly, genotype-phenotype analysis was performed. The prevalence of hypo-responders (&amp;lt;10 oocytes retrieved), number of oocytes retrieved, FORT and follicle to oocyte index (FOI) were compared between different SNPs genotypes. Main results and the role of chance Clustering analysis revealed four distinct genetic clusters according to the selected SNPs related to folliculogenesis and steroidogenesis. Principal component analysis (PCA) was used to display individuals’ distribution according to the fertility centre, resulting in an obvious distribution according to ethnicity. However, PCA failed to demonstrate a clinically significant association between our interactome and the outcomes of interest. We further refined our SNP panel by categorizing SNPs according to their physiological pathway and analyzed their individual impact on OR. Following multivariable linear regression adjusting for patient’s age, Anti-Mullerian hormone (AMH), duration of stimulation and ethnicity, SMAD2 rs13381619 genotype GC (estimated mean difference (EMD) 11.57, 95% Confidence interval (CI) 2.66-20.49), and COMT rs4680 genotype AA (EMD 18.31, 95% CI 4.91-31.72) were associated with improved FORT. No impact of the studied polymorphisms was found on the prevalence of hypo-response, number of oocytes retrieved nor FOI. Limitations, reasons for caution The study was performed in young women with a normal ovarian reserve to eliminate biases related to age-related fertility decline, precluding the extrapolation of the results to other populations. Moreover, the low prevalence of some genotypes might have limited the analysis of some of the included variants. Wider implications of the findings Our findings confirm the variation of SNPs prevalence according to ethnic diversity, highlighting the importance of the intercontinental design of our study. Moreover, a novel association between SMAD2 and COMT variants and OR was reported, opening new opportunities for further pharmacogenetics studies and paving the way towards personalized medicine. Trial registration number Not applicable

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol

BackgroundWomen with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4–6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore.MethodsThe study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child’s socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the “LVL UP App”, a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily “Life Hacks” (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the “HAPPY App”, a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period.DiscussionHigh rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs.Trial statusThe protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023.Trial registrationClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

Trends in Endometrial Cancer Incidence in the United States by Race/Ethnicity and Age of Onset from 2000 to 2019.

Endometrial cancer is one of few cancers that has continued to rise in incidence over the past decade with disproportionate increases in adults younger than 50 years old. We used data from the Surveillance, Epidemiology, and End Results Registry (2000-2019) to examine endometrial cancer incidence trends by race/ethnicity and age of onset among women in the United States. Case counts and proportions, age-adjusted incidence rates (per 100,000), and average annual percent changes were calculated by race/ethnicity, overall and stratified by age of onset (early vs late). We found a disproportionate increase in endometrial cancer incidence among women of color, for both early and late onset endometrial cancer. The highest increases in early onset endometrial cancer (<50 years old) were observed among American Indian/Alaska Native women (4.8), followed by Black (3.3), Hispanic/Latina (3.1), and Asian and Pacific Islander women (2.4), whereas white women (0.9) had the lowest increase. Late onset (>50 years old) endometrial cancer incidence followed a similar pattern, with the greatest increases for women of color. The increasing burden of endometrial cancer among women of color, particularly those younger than 50 years old, is a major public health problem necessitating further research and clinical efforts focused on health equity.

P-327 A multicenter retrospective study of the investigation of detailed immunological inflammatory grading for chronic endometritis and their correlation with the endometrial microbiome

Abstract Study question There exists refractory chronic endometritis which does not respond to antibiotic treatment. This study aims to elucidate its pathogenesis and develop detection methods. Summary answer Through treatment intervention for chronic endometritis (CE), the inflammatory grade decreased overall and the bacteria most associated with endometritis were Lactobacillus iners. What is known already CE and endometrial dysbiosis have been reported to be associated with recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF), but there is insufficient data confirming the interrelation between them. Moreover, the diagnosis of CE typically involves single immunohistochemical staining with CD138, but the diagnostic criteria vary across reports (e.g., McQueen’s method, Liu’s method, etc.) and moreover, use of this classical inflammatory assessment methods raises concerns about their sufficiency in evaluating the pathogenesis of endometritis in cases of RPL and RIF. Study design, size, duration A retrospective analysis was conducted on 206 samples of endometrial specimens collected from infertile patients at seven participating assisted reproductive healthcare facilities from 2021 to 2023. Among these, 73 samples (from 48 cases) had undergone both histological examination and simultaneous endometrial microbiome testing, and data on pregnancy outcomes (including implantation success and ongoing pregnancy rate) were collected until December 2023 for these cases. Participants/materials, setting, methods The endometrial specimens from cases with RIF or RPL were obtained through intrauterine aspiration in luteal phase. Immunohistochemical staining using CD138, CD56, and CD8 antibodies was performed. A composite grading for endometritis, based on histological findings and immunohistochemistry intensity, was established (INF grading; grade 0 to 5). Furthermore, a portion of the specimens underwent microbiome analysis using next-generation sequencing targeting the 16SrRNA, exploring correlations between bacterial taxa, abundance, histological findings, and pregnancy outcomes. Main results and the role of chance Among analyzed 48 cases, 11 cases underwent repeated endometrial microbiome analysis post-treatment again, while 7 cases had additional testing without improvement in chronic endometritis (CE) or endometrial dysbiosis. The McQueen’s method diagnosed 27 cases with CE, while the Liu method identified 4 cases. According to our INF grading, 11 cases were classified as endometritis grade 3 or above. Successful embryo implantation was achieved in 18 cases (37.5%), with ongoing pregnancy in 13 cases (27.1%). CE treatment involved broad-spectrum oral antibiotics, mainly doxycycline and metronidazole, resulting in improvement to grade 2 or below in 9 out of 11 cases with INF grade 3 or above. However, clear associations between pregnancy outcomes and INF grades were not apparent, with the most significant correlation found in CE diagnosis using Liu’s method. Analyzing biomarkers for CE through LEfSe (Linear discriminant analysis effect size), both McQueen’s method and INF grading 2 or above were associated with the intrauterine presence of Lactobacillus iners. Estimating endometrial inflammation based on intrauterine Lactobacillus iners presence yielded an AUC of 0.733 for McQueen’s CE and 0.723 for INF grade 2 or above. Limitations, reasons for caution This study is a retrospective analysis, and the treatment protocols and intervention criteria for chronic endometritis vary among different facilities. The number of cases is also limited, and it is desirable to conduct a unified prospective multicenter cohort study with consistent protocols. Wider implications of the findings The combination of the endometrial microbiome testing and detailed inflammatory grading suggests the potential for establishing appropriate treatment intervention strategies and predicting the success rate of infertile treatment. Since Lactobacillus iners tends to colonize extensively in the vaginal environment of East Asian women, it is necessary to explore region-specific measures. Trial registration number not appicable

Germline BRCA1 Mutation inSquamous Cell Carcinoma of Oesophagus: Driver versus Passenger Mutation

We report a rare case of 62-year-old South Asian women who visited the Molecular Pathology and Genomics Department for hereditary germline cancer genetic testing after being diagnosed with oesophageal cancer, reported as invasive keratinizing squamous cell carcinoma metastasized to the lymph nodes. Her personal history revealed that she was diagnosed with triple-negative breast cancer five years before oesophageal cancer. Germline cancer testing showed pathogenic variants in BRCA1 gene c.68_69delAG, which proved it a hereditary breast and ovarian cancer syndrome. She was started on PARP inhibitors but developed some secondary respiratory failure and succumbed to death. Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

On Anticolonial Homemaking

ABSTRACT This article explores anticolonial maternal politics by turning away from the conventional formulation of the singular enfleshed maternal body and toward the body of the maternal home. It does so through an architectural approach to kinship emerging from a feature-film collaboration, The Nest. A return to the author’s childhood home, the film looks to lost histories and kinship structures embedded in place. Focusing on the Indigenous/Métis, Deaf, Japanese, and South Asian girls and women who lived in the house across 140 years of Canadian history, the film upends national history in service of “brick and mortar kinships,” a counter-historical approach that captures the untold and disregarded radical maternities that characterize domestic space in the settler colony. Framed by the author’s own maternal relations, the essay considers the transtemporal, trans-maternal, and transcultural political bonds that arise through shared space.

Individualised Lifestyle Intervention in Polycystic Ovarian Syndrome Women Who Desire Fertility: A Feasibility Study.

Polycystic ovarian syndrome (PCOS) is one of the common causes of anovulatory infertility among women in the reproductive age group. Women with PCOS and obesity often have difficulty in conceiving, and they are more prone for developing metabolic syndrome. Lifestyle modification plays a key role in women with PCOS, who are overweight or obese and is recommended as a first line management option. The earlier trials evaluating the role of lifestyle intervention in infertile PCOS women had methodological issues, smaller sample size and high dropout rates and none of these trials reported live birth as their outcome. The current study was planned to explore the feasibility of conducting large adequately powered multicentric trial in future in South Asian women with PCOS who desire fertility. The study was done in the Department of Reproductive Medicine and Surgery & the Department of Endocrinology and Metabolism at a university level tertiary care hospital. The study is an open label, single center, randomized controlled trial. A total of 60 PCOS women aged between 18-40 years with body mass index of > 23 kg/m2 who desire fertility, were randomized to individualized lifestyle intervention and usual care. The primary outcome was the dropout rate, and the secondary outcomes were change in body weight, anthropometric parameters, clinical pregnancy rates and the quality of life specific to PCOS after the trial period. All the participants were followed up for 6 months and the outcomes were assessed. Comparison between the intervention and control groups was done using statistical tests using the SPSS and R software. The dropout rates were significantly higher in the individualized lifestyle intervention arm compared to usual care control arm (19/30, 63% vs 9/30, 30%, P=0.019). We did not find any statistically significant difference in anthropometric measurements, pregnancy rates (P=0.57) and clinical pregnancy rates (P=0.21) and quality of life specific to PCOS compared with sixth month visit from baseline visit. The current feasibility study showed significantly higher dropout rates in individualized lifestyle intervention arm compared to usual care control arm. The knowledge gained from the feasibility study has been used to design an adequately powered trial to evaluate effectiveness of individualized lifestyle intervention in women with PCOS who wish to conceive.