Visual Inspection With Acetic Acid (Via) Positive Results And Passive Smoker In Puskesmas Wonoayu Sidoarjo

Introduction: Cervical cancer is a malignancy in women with the number one mortality and number two morbidity in the world. As many as 77% cases are found in developing countries, including Indonesia. Although deadly, screening programs can reduce the morbidity and mortality of this malignancy. Visual Inspection with Acetic Acid (VIA) is a cervical premalignancy screening method used in primary health care in Indonesia. Smoking is one of risk factor associated with cervical cancer and data from GATS, Infodatin 2015 & Riskedas 2013 states that the number of passive smokers in Indonesia is high. Aim: The objective of this research is to look for the correlation between history of passive smoker and positive VIA Methods: This research is a retrospective cross sectional analytic study. The data used in this study is the medical records of VIA screening visitors in 2016. The data were extracted on the research questionnaire. Data processing is done by using SPSS Statistics 23 For Windows computer software. The test is Chi Square correlation test and calculation of Prevalence Ratio (PR). Result: 55 women (24.7%) had a history of passive smoking (daily cigarette smoke exposure), and 168 women (75.3%) had no daily cigarette smoke. 21 women (9.4%) received positive results, and 202 women (90.6%) received negative IVA. In the Pearson Chi-Square section, the Asymptotic Significance (2-sided) yielded results at 0.042 (

Topics on Cervical Cancer With an Advocacy for Prevention

Cervical Cancer is one of the leading cancers among women, especially in developing countries. Prevention and control are the most important public health strategies. Empowerment of women, education, "earlier" screening by affordable technologies like visual inspection, and treatment of precancers by cryotherapy/ LEEP are the most promising interventions to reduce the burden of cervical cancer.Dr Rajamanickam Rajkumar had the privilege of establishing a rural population based cancer registry in South India in 1996, as well as planning and implementing a large scale screening program for cervical cancer in 2000. The program was able to show a reduction in the incidence rate of cervical cancer by 25%, and reduction in mortality rate by 35%. This was the greatest inspiration for him to work on cerrvical cancer prevention, and he edited this book to inspire others to initiate such programs in developing countries. InTech - Open Access Publisher plays a major role in this crusade against cancer, and the authors have contributed to it very well

Combined condylomatosis and Buschke-Loewenstein tumor: case report & systematic review

Objectives: An undesired manifestation of HPV is the transformation of infected cells into neoplastic cells, with the subsequent development of precancerous intraepithelial lesions and in some instances cancer. The generally benign manifestations of HPV include asymptomatic and subclinical disease as well as anogenital condyloma acuminatum, warts and verruccosis. Certain HPV manifestations are however associated with poor outcome for the patient, and these include giant and multiple condylomas such as Buschke- Löwenstein tumor (BLT), and respiratory papillomatosis and their relapses. These conditions decrease the patient’s life quality, and have the potential to progress to malignancy, and are a particular problem for practitioners. Management of these patients is complicated due to the absence of therapies that can eliminate HPV and prevent wart recurrence, or medication that can cure genital warts and condylomas. Indeed, although there are many clinical reports describing the aggressive manifestation of genital warts in immune compromised individuals, the triggering mechanisms for such atypical lesions is not yet understood. Our objective here is to present a case report of combined condylomatosis and BLT in a patient with Henoch-Schönlein purpura and simultaneously infected with six HPV genotypes (6, 11, 18, 31, 43 & 56), and to systematicly review the literature in order to provide a better insight into these conditions. Methods: Clinical and laboratory parameters as well as a video of surgery of female patient (30 ys) with combined condylomatosis and BLT (the informed consent was obtained). Clinical and research literature over the last 15 years focusing on the immunological aspects of papillomavirus interaction with the innate and adaptive immune systems, and interference with the cellular and humoral host responses. Particular attention is given to the nature of papillomavirus clearance and persistence. Conclusions: Atypical manifestation of HPV was in our case related to systemic disease involving an autoimmune host response and long-term glucocorticoid treatment. Our review confirms that such atypical manifestations and the long-term persistence of HPV are often linked to disturbances in the hosts immune system. More specifically these comprise changes in the content of lymphocyte subsets (helper, cytotoxic and regulatory T-cells), NK cells and macrophages at HPV infected sites and in the blood, as well as changes in lymphocyte function related to the expression of INF-<& ®, IL-2; IL-4, IL-10, TGF®‚ and other cytokines

P14.02 An electronic behaviour diary: Monitoring the effects of advanced obstetric surgical skills training

Objective: Training should lead to improvements in the quality of clinical care delivery. It is essential to follow up participants after a training intervention to monitor changes in behaviour associated with adoption of lessons learned into clinical practice. We introduced an electronic diary to facilitate monitoring whilst minimising effort for participants. Method: An electronic diary was created using a freely available on-line platform. Following a training intervention on advanced obstetric surgical skills, obstetric residents from Kenya were invited to pilot completing the diary after their labour ward shifts. Entries were anonymised. Participants were asked to enumerate the times they utilised specific skills, or to state why they had been unable to do so, using tick box options. Reflections on skills used were entered using free comments. Results: All participants reported changed behaviours, for example, improved surgical knot-tying, safer needle handling, separate closure of uterine incision angles and techniques for delivery of the impacted fetal head. 6 reported conducting vaginal breech birth and 6 performed vacuum-assisted birth. All reported improvements in use of the safe surgical checklist, obtaining consent and respectful maternity care. 7 had participated in newborn resuscitation. Reflections suggested participants experienced improved levels of confidence and satisfaction when implementing new skills. Conclusion: This pilot study has demonstrated the feasibility of monitoring clinical behaviour change following training using an electronic platform. Monitoring the effect of training is essential to prove that training results in improvements to clinical practice. We plan to roll out this intervention following future training interventions

P14.01 An example of too much too soon? A review of caesarean sections performed in the first stage of labour in Kenya

Objective: Caesarean Section (CS) has potential short and long-term complications and is associated with excess maternal death. Decisions to perform (CS) are frequently made by inexperienced and unsupported non-specialist doctors, sometimes resulting in inappropriate decision-making and surgery. Our study assesses decision-making for CS in the first stage of labour in Kenya. Method: A panel of one UK and six Kenyan expert obstetricians reviewed clinical data extracted from 87 case-notes, that were randomly selected from a series obtained from seven referral hospitals in five Kenyan counties over six months in 2020. Following a preliminary review of the data and email discussion, an online panel was convened to discuss outstanding cases where consensus was yet to be reached. Agreement was reached by the panel in all but 5 cases. Results: In 41.3% cases, CS was considered appropriate, including 8% where CS was performed too late. The decision to delivery interval exceeded 2 h in 58.6% cases, including 16 cases of non-reassuring fetal status. In 10.3% it was considered that due to delay, further reassessment should have occurred. In 9.1% the CS was done too soon. There was insufficient information available to make a full assessment in 21.8% of cases. In 11.5% the CS was inappropriate. Conclusion: This review demonstrates that unnecessary caesarean sections are being performed, while some with appropriate indications are subject to delays. There is need for improved support for decision-making, coupled with improved record-keeping, improved quality of fetal monitoring during labour and more timely surgery when necessary

P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Objective: Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya. Method: A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach. Results: Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff. Conclusion: Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels

Infections

• Infections with viruses, bacteria, and macroparasites have been identified as strong risk factors for specific cancers. • Overall, about 2 million (16%) of the total of 12.7 million new cancer cases in 2008 are attributable to infections. This fraction varies 10-fold by region; it is lowest in North America, Australia, and New Zealand (≤ 4%) and highest in sub-Saharan Africa (33%). • Helicobacter pylori, hepatitis B and C viruses, and human papillomaviruses are responsible for 1.9 million cancer cases globally, including mainly gastric, liver, and cervical cancer, respectively. • Infection with HIV substantially increases the risk of virusassociated cancers, through immunosuppression. • Application of existing methods for infection prevention, such as vaccination, safe injection practices, and safe sexual behaviour, or antimicrobial and antiparasite treatments could have a major impact on the future burden of cancer worldwide