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Effect on endometriosis recurrence with postoperative hormonal suppression – Contemporary Obgyn

Postoperative hormonal suppression had a statistically significant effect on reducing endometriosis recurrence and improving pain, according to a systematic review and meta-analysis published in the journal Human Reproduction Update.

As surgeons, our primary goal is to make patients feel better and we often accomplish this by surgically treating endometriosis, said co-author Ally Murji, MD, MPH, an associate professor of ob/gyn at the University of Toronto and Mount Sinai Hospital in Toronto, Canada. However, it is especially disheartening, despite our best surgical efforts, when disease recurs and patients relapse.

The authors sought to evaluate whether postoperative hormonal suppression decreases disease recurrence, compared with placebo/expectant management.

MEDLINE, Embase, Cochrane CENTRAL and Web of Science databases were searched from inception to March 2020 for randomized clinical trials (RCTs) and prospective observational cohort studies of premenopausal women undergoing conservative surgery and initiating hormonal suppression within 6 weeks postoperatively with one of the following medical therapies: combined hormonal contraceptives, progestins, levonorgesterel-releasing intrauterine system (LNG-IUS) and gonadotropin-releasing hormone (GnRH) agonists.

The review consisted of 17 studies (13 RCTs and 4 cohort studies), totaling 2,137 patients: 1,189 receiving postoperative suppression and 948 controls.

The mean follow-up ranged from 12 to 36 months, with outcomes assessed at a median of 18 months postoperatively.

Among 14 studies (11 RCTs, 3 cohort studies; 1,766 patients total), there was a significantly decreased risk of endometriosis recurrence in patients receiving postoperative hormonal suppression compared with expectant management/placebo: relative risk (RR) 0.41; 95% confidence interval (CI): 0.26 to 0.65.

However, when we limited the analysis to only RCTs, we found that the risk of postoperative endometriosis recurrence was consistently decreased with hormonal suppression, Dr. Murji told Contemporary OB/GYN.

In addition, among seven studies (6 RCTs, 1 cohort study; 652 patients total), patients receiving postoperative hormonal suppression achieved significantly lower pain scores compared with controls: standard mean difference (SMD) -0.49; 95% CI: -0.91 to -0.07.

Our review provides new evidence that postoperative hormonal suppression decreases endometriosis recurrence and pain, Dr. Murji said. This contradicts the last Cochrane review on the topic.

Furthermore, although there was significant heterogeneity in the studies included in the review, I am confident in the results, he said. We found that there is only a 4% probability that any future RCT would contradictour findings.

Dr. Murji was surprised by the magnitude of the effect. As few as eight women would need to be treated with postoperative hormonal suppression for at least 6 months to prevent one endometriosis recurrence, he said.

Dr. Murji said it is essential that clinicians educate their patients that endometriosis is a chronic condition and that surgery is not a panacea. Extensive patient counseling before surgery is necessary to educate patients and manage their expectations, according to Dr. Murji. For patients not seeking to conceive immediately after surgery, I offer hormonal suppression, he said. The plan for postsurgical prevention is also formalized preoperatively.

Due to the recent COVID-19 pandemic-related surgical delays, there is increased opportunity to help patients find the ideal medical treatment option that aligns with their individual needs so as to bridge patients to their surgery and thereafter, he said.

Dr. Murji and his colleagues have found that hormonal contraceptives, progestins, the LNG-IUS and a GnRH agonists are all consistently effective in decreasing pain and disease recurrence.

In particular, the LNG-IUS, which can be inserted under laparoscopic visualization at the time of surgery, avoids some of the issues related to discomfort/placement and provides excellent long-term suppression, Dr. Murji said.


Dr. Murji serves on the speakers bureau/advisory boards of Abbvie, Allergan, Bayer, Hologic, and Pfizer.


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Effect on endometriosis recurrence with postoperative hormonal suppression - Contemporary Obgyn

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Whats At Stake This November And How You Can Get Out The Vote – Forbes


Unless youve been living under a rock for the last 6 months, you likely know that we have an important presidential election coming up on Tuesday, November 3rd. We are constantly being inundated with political ads and told about the important issues. But with all the noise, it can be difficult to understand what is truly at stake.

I recently interviewed Kelley Robinson, who is currently the Executive Director ofPlanned Parenthood Action Fundand as the Vice President of Advocacy and Organizing atPlanned Parenthood Federation of America. We talked about what is at stake with this 2020 presidential election, especially related to our healthcare, finances, reproductive rights, and beyond.

So, whats really at stake for all of us this November? Here are just a few things:

Since the Affordable Care Act was signed into law in 2010, Republicans in Congress have been trying to have it overturned. It has repeatedly been upheld by the Supreme Court, but that hasnt stopped the Republicans from continuing to try to get rid of it. In case you dont remember (since its been over a decade), before the Affordable Care Act was law of the land, health insurance was only available through your employer or from expensive private insurance companies. Pre-existing conditions (which can be pretty much anything) were not covered by insurance, so you could be denied coverage if you have any history with illness or injury, which most of us have. Children would also get kicked off their parents insurance when they turned 18 - now, they can stay on until they are 26 years old. We are currently in the middle of a global pandemic, which means health care coverage is more important than ever. And remember, medical costs are the number one cause of bankruptcy in the United States. If thats still true even with the Affordable Care Act in place, imagine how much worse things will get without it.

Another issue that Republicans have been relentless about is to make abortion illegal across the board in the United States. Despite what you might think based on the political rhetoric, the majority of Americans actually support the decision in Roe v. Wade. In fact, 61% of Americans say that abortion should be legal in all or most cases. Regardless, there is legislation introduced seemingly everyday that seeks to restrict abortion access and reproductive rights overall. Many of these bills are already being challenged and are set to be heard by the Supreme Court any day. I will discuss what is at stake when it comes to the Supreme Court further down in this piece, but we need politicians that will protect reproductive health and access.

A number of studies have established connections between abortion access and economic outcomes. And it seems like common sense; if you have control over your reproduction, you will have more control over and access to financial security. This paper from the Institute for Womens Policy Research outlines the ways that reproductive rights influences educational attainment, workforce participation, and more.

In September, there was widespread flash flooding in my town. Many of my neighbors homes and cars were damaged or destroyed. On the same day, wildfires were raging in Northern California. These are just two examples of ways climate change will continue to impact our lives. And it will get worse if we dont mitigate the damage. When it comes to climate change, one political party denies that it is a problem or they say it is not caused by human behaviors. The other party acknowledges that climate change is a massive problem and accepts the proven science that shows what is causing it - burning fossil fuels such as oil, gas, and coal. We need a national commitment to fighting climate change and a strategy for embracing clean energy solutions. Otherwise, people will continue to suffer and die in rampant wildfires, floods, stronger and more frequent storms, and droughts.

If youre paying attention this week, you know that the Senate is currently holding hearings regarding the Supreme Court nominee Amy Coney Barrett. Regardless of your political views, this process is being forced through, much faster than ever before, while were in the middle of a pandemic and just weeks away from a presidential election. It makes it impossible for our voices to be heard and impossible for the necessary vetting to be done in time. But on top of that, this nominee is someone who is seemingly against any and all progressive strides weve made in the past several decades.

This week, she even said she could not immediately say whether or not she thinks Medicare is constitutional. Medicare is massively important for Americans over the age of 65. People who are retired or living on a fixed income would not have many options for their health care if Medicare were to be somehow eliminated in the future. Plus, she is on record opposing Roe v. Wade and the Affordable Care Act. And remember, a Supreme Court appointment is a lifetime job. Coney Barrett is only 48 years old. She could be on the Court for at least the next 40 years.

All of that being said, its easy to feel hopeless and overwhelmed when you consider everything that is at stake right now. And there are many things at stake beyond what I outlined above, including LGBTQ+ rights and racial equality. But in my conversation with her, Kelley Robinson said something incredibly inspiring: This is not a moment to be afraid. This is a moment for us to lean in and know that we've got some important decisions to make to ensure that we achieve change that makes lives better at the end of the day.

There are things we can all do to make a difference during this election and ensure that our trajectory starts going in the right direction. So, what are some of those things?

Even if you voted in the last election, its important that you make sure that you are registered to vote at your current address, under your current name. You never know if the voter rolls in your state have been purged, so err on the side of caution and double check your voter registration. Visit to see if your voter registration is up to date. To find out if you still have time to register to vote in your state, go here.

Its much easier to follow through with something if you have thought out and planned out what you are actually going to do. Whether youre requesting a mail-in ballot, voting early, or showing up on Election Day, its important that you identify that plan now. That way, you can rearrange your schedule or take other actions that will allow voting to be easier. For me, my original plan was to vote by mail, but my ballot seems to be lost in the mail somewhere! So my backup plan, after speaking to the state board of elections, is to vote early, in-person, via a provisional ballot. Once they confirm that I didnt send in my mail-in ballot, they will count my in-person vote.

Whats your plan?

As I said above, its easier to follow through with something if there is a plan in place. That applies to the people you know too! So start asking your friends and family members what their voting plan is. If they dont have an answer right away, ask them if they need help or suggestions. Check back in later if they need a little time to think about it.

Everything is more fun with a buddy. Of course, during a global pandemic, you might not be able to drive together, and you might have to keep your physical distance, but get a friend to join you while you vote! You can meet up at the polls at the same time or you can even vote together from afar, if your polling places are different.

We are still in the midst of a global pandemic, even if a major presidential election is coming up. If youre worried about staying safe while still getting out the vote, consider voting early. In many states, you can still request a mail-in or absentee ballot so that you can vote by mail. If youre uncomfortable with that, or if you already missed the deadline, many states also allow for early voting. Find out if and when early voting begins in your state and make a plan to get there to vote. And dont forget to wear your mask and keep your physical distance from others.

Already registered to vote and have a voting plan, but you still want to be involved? You can volunteer with an organization that fights for the things you most believe in. For example, I have been volunteering to do text banking with RAICES, which is an immigrants rights organization. There are many other organizations doing the same to get out the vote and encourage folks to vote for human rights, immigrant rights, reproductive rights, and more.

Lets do this! Make sure you get out and vote on November 3rd!

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Whats At Stake This November And How You Can Get Out The Vote - Forbes

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A multimillennial climatic context for the megafaunal extinctions in Madagascar and Mascarene Islands – Science Advances

Madagascar and the Mascarene Islands of Mauritius and Rodrigues underwent catastrophic ecological and landscape transformations, which virtually eliminated their entire endemic vertebrate megafauna during the past millennium. These ecosystem changes have been alternately attributed to either human activities, climate change, or both, but parsing their relative importance, particularly in the case of Madagascar, has proven difficult. Here, we present a multimillennial (approximately the past 8000 years) reconstruction of the southwest Indian Ocean hydroclimate variability using speleothems from the island of Rodrigues, located 1600 km east of Madagascar. The record shows a recurring pattern of hydroclimate variability characterized by submillennial-scale drying trends, which were punctuated by decadal-to-multidecadal megadroughts, including during the late Holocene. Our data imply that the megafauna of the Mascarenes and Madagascar were resilient, enduring repeated past episodes of severe climate stress, but collapsed when a major increase in human activity occurred in the context of a prominent drying trend.

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A multimillennial climatic context for the megafaunal extinctions in Madagascar and Mascarene Islands - Science Advances

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C.S. Mott Center teams with Chinese university to create new International Women Health Research Program – The South End

The C.S. Mott Center for Human Growth and Development at the Wayne State University School of Medicine has teamed with the Institute of Reproductive Health of Tongji Medical College at Huazhong University of Science and Technology in Wuhan, China, to establish the International Women Health Research Program.

The goal of the new collaboration is to improve womens treatment and care, particularly in the areas of cancer and reproductive health.

Maternal mortality, pregnancy complications such as preeclampsia and recurrent abortions, gynecologic cancers and infertility are still major global problems that can only be improved by international collaborations, said Gil Mor, M.D., Ph.D., director of the Mott Center and the John M. Malone Jr., M.D., Endowed Professor of Obstetrics and Gynecology. A womans reproductive aspects have a major impact not only on her health, but on the health of her children. The International Women Health Research Program will achieve its objectives by enhancing the education of health providers, investigators, students and general public.

Because the programs success depends on improving the education of physicians and researchers involved in multiple aspects of womens health, training investigators to develop novel approaches

for diagnosis and treatment, and educating the general population on the complex aspects related to reproduction and womens health, a key component of the collaboration includes exchange programs in which trainees, physicians and scientists train at the two participating institutions.

To date, in addition to developing three courses in reproductive immunology and one in ovarian cancer, the program has mentored 11 students in Wuhan, with two trained at WSU.

Under an internship program, physicians selected for the program are trained in the design and conduct of clinical and translational research in a 12-month program at the WSU School of Medicine. The partnership also includes support for training post-doctoral fellows for two years and the exchange of speakers for seminars at both institutions.

Throughout September, WSU and Huazhong University of Science and Technology virtually hosted a four-part lecture series for faculty of both schools featuring Dr. Mor speaking on reproductive immunology, implantation, infection in pregnancy and fetal-maternal immune interaction.

The collaboration has published eight papers, with more in various stages of pre-publication, and has secured one grant.

The universities held their first International Symposium for Reproductive Immunology and Genetics in Wuhan on May 18, 2017.

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C.S. Mott Center teams with Chinese university to create new International Women Health Research Program - The South End

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A tiny particle collider yields new evidence for a type of ‘quasiparticles’ called anyons – Massive Science

The president has had a life-threatening, infectious disease for over a week, and he and his doctors havent been very transparent about the timeline and course of his affliction. In lieu of detailed disclosures, reporters have to piece together his condition based on the treatments hes been receiving.

Trump was started off on an experimental therapeutic an antibody cocktail and then advanced to another remdesivir. The other biomolecules coursing through Donald Trump's system (and this week's headlines) are corticosteroids, called dexamethasone.

You may have heard of cytokine storms, where the body's immune response to severe COVID-19 bombards healthy cells, making the illness worse. Trump has been given dexamethasone, an immuno-supressant that doctors prescribe to temper that effect. Unlike the other experimental treatments, dexamethasone is common and somewhat easy to access. However, it is rarely administered to a patient with a case as (self-)reportedly mild as Donald Trumps. In an interview with New York Magazine's Intelligencer, the co-author of a recent study testing dexamethasone elaborates:

That lack of evidence is concerning as Trump heads into a critical point in the course of his illness. COVID-19 is known for being a bit of a roller coaster, with intermittent fevers, mysterious symptoms, and rapid declines. Abraar Karan, a physician with experience treating patients with COVID-19, told Monique Brouillette at Scientific American that some people have turned corners and left the hospital, only to come back feeling much sicker, with even worse oxygen levels and possibly other harm to the bodys organs.

It is theoretically possible that the early steroid treatment may ward off a dangerous auto-inflammatory reaction. But beyond the inherent risks of immuno-supression, corticosteroids may also cause behavioral side effects in the President. Trump's cognitive and behavioral state has been a point of concern for years. Potent steroids such as dexamethasone are known to increase appetite, decrease restful sleep, and bring about heightened "maniacal" energy states.

As the nation enters the weekend, Speaker of the House Nancy Pelosi is rolling out a 25th amendment commission, Trump is boasting a miraculous recovery with a Fox News doctor, and the rest of us continue to wait and learn how biology will run its course. For better or worse, the side effects our president experiences may prove to have historical consequences. To my knowledge, roid rage has never been a factor in nuclear geopolitics.

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A tiny particle collider yields new evidence for a type of 'quasiparticles' called anyons - Massive Science

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Advancing sexual and reproductive rights in scofflaw countries – OpenGlobalRights

Sex workers and allies march together for a march in Vancouver in June, 2016. Pictured here is the red umbrella, whichis the symbol of the global sex workers rights movement. Sally T. Buck/(CC BY-NC-ND 2.0)

Over the past two decades,globaladvancement of sexual and reproductivehealth andrights(SRHR)has been patchwork at best.While internationalhuman rightstreatiesespousea constellation ofrights related to sexuality and reproduction,manynationscontinue todefy their legitimacy.Thepromisesofinternational human rights law(IHRL)arethusundercut bythe realitiesofpersistently-highmaternal mortality,thecontinuedcriminalizationof sex work,thedisenfranchisementofpeople of various sexual orientations and gender identities,andthe denigration ofabortionandcontraceptionrights and access.Perversely, the very fact of international treaty support for SRHR in many countries cancause advocates tolose ground, ascriticslevelattacks on an over-weaning international regime.We categorize those countries thatflagrantlydisdain and floutIHRLwith respect tosexual and reproductiverightsasscofflaw,toco-opta colloquial term used in the US in the early 20thcentury to denote law breakers.

In thispiece,we illustrate the continued usefulness of international human rights concepts, frameworks, and principles in challenging regression on SRHR in scofflaw countries,work that is possible evenwithout citing international treaties directly.We arguethatrightsconcepts canbolsterSRHRclaimsbyhoningourcritical analysis of harmsandexpanding our imaginative capacity asscholars andadvocates.Werelyonexamples from theUS, one of the leadingscofflawcountries, whichparadoxicallyparticipated in draftinginternational human rights treatiesbywhich it has sincerefused to be bound.Our argumentconsidersbothstrengths andsomedangersin using rights in atreaty-freeway.

First, a brief meditation onwhat we mean by rights talk in this context.When we discuss thehumanrightsmostuseful for advancing SRR incountries like the US,werefer tothe newerversionof rightsbuiltover the lastthree decadesfrom within international treaty obligations.This version understandsdomains of sexual and reproductive life, and the linked but distinct domains of gender and race,as constitutedbysystems ofpowerthat rightshavea rolein dismantling.This versionof rightsalsosupportsthe capacity todetermine oneslifeacross publicandprivate domains,andtoextend state accountability tonon-state actors,fromthe husbandtothe trans-national corporation.Understood this way,rightstalkmovesbeyondliberal theorysabstract individualismand grappleswith thestructural conditions (inmarkets, housing, education, labor, scientific knowledge, etc.) necessary to realizeSRHR.

This version of human rightsbuiltthroughtheorization and practice globallyfunctions in two ways: it isat oncea law-based practiceand an act ofradical political imagination.These functionshelp us to identifythecontinued instrumentality ofhuman rightsinthe face of regression.Internationalhuman rights concepts, frameworks, and principlescan be mobilizedwithout invoking IHRL explicitlyin order to1)clarify acute and systematic failures to protect SRHRand 2)imagine and articulate a differentvision for theaffirmativefulfilment ofhealth and rights.

Two examples serve to illustrate thistreaty-freeapproach; while we rely on examples from the USdrawn fromourwork withGlobal Health Justice Partnership(GHJP),we recognizethat there aremany other ways and strategies for doing this kind ofunder-the-radaryetsubversive human rights workaround the world.

In 2017, GHJP collaborated with theBlack Mamas Matter Alliance(BMMA) andCenter for Reproductive Rights(CRR)to support advocacy on maternalhealth and racial justiceinthe state ofGeorgia.Ourfinal reportidentifiedstate-levelpolicies and institutionalpracticesperpetuating devastating and racially-inequitablerates ofmaternal mortality.We used the now-establishedrights framework of respect, protect, and fulfill to flag sites of state (in)actionlegislative, fiscal, administrativewhich led to the abrogation of the rights of pregnant womenof color.We mobilized the concepts of state obligation and accountability, along withreproductive justice frameworks,to developnew andempirically-grounded analyses thatlinkedstate policy decisionsonhealthcare funding and Medicaid expansion tomaternalhealth outcomes.

Another more recent US examplewasGHJPs collaborationwith theSex Workers and Allies Network(SWAN) in New Haven,Connecticutto develop apeer-led surveyon the experiences of street-based sex workers seeking social services.Our jointanalysishighlights structural barriers to adequate services, including but not limited to criminal legal system surveillance.TheAAAQ (availability, accessibility, acceptability, and quality)assessmentmodel, established by the Committee on Economic, Social, and Cultural Rightsin 2000, framedourevaluation ofservices and helpedrevealbarrierssuch asad hocclinichours, abusive treatment, and substandard care.The reportuses the AAAQ model totiesuchfailurestospecific state and city legislativepolicies, funding decisions, andgaps inmonitoring/accountability.

Mobilizingthe language ofinternational human rightsin analyses onstate and municipal SRHR outcomes ina country like the USmay not seemparticularly useful. In our Georgia report, weacknowledge outrightthat manydomestic policymakersare not necessarily concerned with whether or not state practices adhere to human rights principles.So whydid weneverthelessinject them intoouradvocacy?

First and foremost, internationalhuman rights conceptsuniquelybolstered ouranalysisof state practices: theyclarifiedconnections betweenupstreampolicy decisionsanddownstreamhealth outcomesfor pregnant womenof colorin Georgia and sex workers inConnecticut.Althoughthe obligations we attached to the statewere not framed with reference toUNtreaties,global human rightsallowedfor theidentificationand systematization ofharmsthat may otherwisehavebeen difficult to catalogueand attribute toroot causes.

Human rights frameworks didnt just help organize our critiques of broken systems; they also provided the glue for us as researchers to collaborate with advocate partners and imagine affirmative fulfilments of SRHR. For instance, human rights frames helped GHJP to continue engaging with SWAN in crafting demands for city policymakers, such asthis AAAQ-informed analysison the COVID-19responsein New Haven. The imaginative capacity of human rights language enables discussions of radically different futures characterized by welfare and well-being in scofflaw countries where preventing harm is usually the (minimalist) primary focus.

Weseehuman rights asa powerful waytotranslateinternationalprinciples into transformative, empirically-supported,measurabledomesticpolicydemands.However,the choice to wield human rights in somewhat covert fashionwithoutdirectreference to international legal obligationsadmittedlyhas its downsides. Whatisgainedinlocal political tractioncomes witha potential loss inhuman rights awareness:domesticpolicymakersinlaggardcountriesget no exposure to the idea of legally-binding international human rights nortoreflecting ontheiracts as part of acommonglobalcommitment.

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