Prevalence and Predictors of Pap Smear Cervical Epithelial Cell Abnormality among HIV-Positive and Negative Women Attending Gynecological Examination in Cervical Cancer Screening Center at Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia

Background: Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women. Methods: A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre Markos referral hospital. The study subjects were stratified by HIV status and systematic random sampling method was used to recruit study participants. Cervical smears were collected for Pap smear examination. Logistic regression analysis was employed to examine the possible risk factors of cervical ECA. Results: A total of 197 HIV+ and 194 HIV- women were enrolled in the study. The overall prevalence of cervical ECA was 14.1 % of which the prevalence of atypical squamous cells undetermined significance (ASCUS), low grade squamous intraepithelial lesion (SIL), high grade SIL, squamous cell carcinoma and ASC, cannot exclude high grade SIL (ASCH) were 5.1, 3.8, 4.1 and 1.0 %, 0.0 % respectively. Significantly higher prevalence of ECA (17.8 %) was observed among HIV+ women (COR 1.9, 95 % CI: 1.1 − 3.4, p = 0.036) as compared to HIV-women (10.3 %). Multiple sexual partnership (AOR 3.2, 95 % CI: 1.1 − 10.0, p = 0.04), early ages of first sexual contact (\u3c15 \u3eyears) (AOR 5.2, 95 % CI: 1.5 − 17.9, p = 0.009), parity greater than three (AOR 10.9, 95 % CI: 4.2 − 16.8, p \u3c 0.001) and long term oral contraceptive pills (OCP) use (AOR 11.9, 95 % CI: 2.1 − 16.7, p = 0.02) were significant predictors of prevalence of ECA. Conclusions: Cervical ECA is a major problem among HIV-infected women. Lower CD4+ T-cell counts of below 350 cells/μl, HIV infection, multiple sexual partnership, early age at first sexual contact, parity greater than three and long term OCP use were significant predictors of prevalence of ECA. Strengthening screening program in HIV+ women should be considered

Assessment of knowledge, attitude and risk behaviors towards HIV/AIDS and other sexual transmitted infection among preparatory students of Gondar town, north west Ethiopia

<p>Abstract</p> <p>Background</p> <p>The first case of HIV in Ethiopia was reported in 1984. Since then, HIV/AIDS has become a major public health concern in the country, leading the Government of Ethiopia to declare a public health emergency in 2002. Although the epidemic is currently stable, HIV/AIDS remains a major development challenge for Ethiopia. The spread of HIV in any community is in part determined by the knowledge of attitude towards sexuality of its members and by their actual sexual practices. The aim of the study was to assess students' knowledge, attitudes and practices regarding HIV/AIDS and STDs in Gondar, North West Ethiopia.</p> <p>Methods</p> <p>A cross sectional study was conducted between February 1 to March 1, 2009 in preparatory high school students. Pre-tested questioner was used to generate the data and analysis was made by SPSS version 15. Chi -square value was calculated and p-value < 0.05 was considered statistically significant.</p> <p>Results</p> <p>All the students had heard about AIDS before the interview. Knowledge on some aspect of the disease was quite low in the study group. Only half of the students knew that at present, AIDs is incurable and that HIV infection can be acquired through sexual contact with a 'familiar' person. Knowledge about STI was also quite low, 39% knew that pus in the urine is a symptom of STI and 45.4% knew that acquisition of other STIs is increases the chance of HIV transmission following unsafe sex with known cases. 25% of the study group had previous sexual intercourse and exposed at least one risk behavior. About 34% of the respondents had negative attitude towards AIDS and STDs.</p> <p>Conclusion</p> <p>Awareness about STDs and methods of prevention of HIV and STDs was low. More risk behavior was observed in male and those with alcohol and drugs of abuse.</p

Lipid droplets and the transcriptome of Mycobacterium tuberculosis from direct sputa: a literature review

Mycobacterium tuberculosis (Mtb), the main etiology of tuberculosis (TB), is predominantly an intracellular pathogen that has caused infection, disease and death in humans for centuries. Lipid droplets (LDs) are dynamic intracellular organelles that are found across the evolutionary tree of life. This review is an evaluation of the current state of knowledge regarding Mtb-LD formation and associated Mtb transcriptome directly from sputa. Based on the LD content, Mtb in sputum may be classified into three groups: LD positive, LD negative and LD borderline. However, the clinical and evolutionary importance of each state is not well elaborated. Mounting evidence supports the view that the presence of LD positive Mtb bacilli in sputum is a biomarker of slow growth, low energy state, towards lipid degradation, and drug tolerance. In Mtb, LD may serve as a source of chemical energy, scavenger of toxic compounds, prevent destruction of Mtb through autophagy, delay trafficking of lysosomes towards the phagosome, and contribute to Mtb persistence. It is suggest that LD is a key player in the induction of a spectrum of phenotypic and metabolic states of Mtb in the macrophage, granuloma and extracellular sputum microenvironment. Tuberculosis patients with high proportion of LD positive Mtb in pretreatment sputum was associated with higher rate of poor treatment outcome, indicating that LD may have a clinical application in predicting treatment outcome. The propensity for LD formation among Mtb lineages is largely unknown. The role of LD on Mtb transmission and disease phenotype (pulmonary TB vs extra-pulmonary TB) is not well understood. Thus, further studies are needed to understand the relationships between LD positivity and Mtb lineage, Mtb transmission and clinical types

Comparison of loop-mediated isothermal amplification assay and smear microscopy with culture for the diagnostic accuracy of tuberculosis

Published online: 17 January 2017Background: Tuberculosis (TB) caused by Mycobacterium tuberculosis is one of the leading causes of death from infectious diseases worldwide. Sputum smear microscopy remains the most widely available pulmonary TB diagnostic tool particularly in resource limited settings. A highly sensitive diagnostic with minimal infrastructure, cost and training is required. Hence, we assessed the diagnostic performance of Loop-mediated isothermal amplification (LAMP) assay in detecting M.tuberculosis infection in sputum sample compared to LED fluorescent smear microscopy and culture. Method: A cross-sectional study was conducted at the University of Gondar Hospital from June 01, 2015 to August 30, 2015. Pulmonary TB diagnosis using sputum LED fluorescence smear microscopy, TB-LAMP assay and culture were done. A descriptive analysis was used to determine demographic characteristics of the study participants. Analysis of sensitivity and specificity for smear microscopy and TB-LAMP compared with culture as a reference test was performed. Cohen’s kappa was calculated as a measure of agreement between the tests. Results: A total of 78 pulmonary presumptive TB patients sputum sample were analyzed. The overall sensitivity and specificity of LAMP were 75 and 98%, respectively. Among smear negative sputum samples, 33.3% sensitivity and 100% specificity of LAMP were observed. Smear microscopy showed 78.6% sensitivity and 98% specificity. LAMP and smear in series had sensitivity of 67.8% and specificity of 100%. LAMP and smear in parallel had sensitivity of 85.7% and specificity of 96%. The agreement between LAMP and fluorescent smear microscopy tests was very good (κ = 0.83, P-value ≤0.0001). Conclusions: TB-LAMP showed similar specificity but a slightly lower sensitivity with LED fluorescence microscopy. The specificity of LAMP and smear smear microscopy in series was high. The sensitivity of LAMP was insufficient for smear negative sputum samples.Baye Gelaw, Yitayal Shiferaw, Marta Alemayehu and Abate Assefa Basha

Soil transmitted helminths and schistosoma mansoni infections among school children in zarima town, northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, because of low quality drinking water supply and latrine coverage, helminths infections are the second most predominant causes of outpatient morbidity. Indeed, there is a scarcity of information on the prevalence of soil transmitted helminths and Schistosomiasis in Ethiopia, special in study area. Therefore, the aim of this study was to determine the prevalence and associated risk factors of soil transmitted helminths and intestinal Schistosomiasis.</p> <p>Methods</p> <p>Cross-sectional study was conducted among 319 school children of Zarima town from April 1 to May 25, 2009. A pre-tested structured questionnaire was used to collect socio-demographic data and possible risk factors exposure. Early morning stool samples were collected and a Kato Katz semi concentration technique was used to examine and count parasitic load by compound light microscope. Data entry and analysis was done using SPSS-15 version and p-value < 0.05 considered statistically significant.</p> <p>Results</p> <p>Out of 319 study subjects, 263 (82.4%) of the study participants infected with one or more parasites. From soil transmitted helminths, <it>Ascaris lumbricoides </it>was the predominant isolate (22%) followed by Hookworms (19%) and <it>Trichuris trichiura </it>(2.5%). <it>Schistosoma mansoni </it>was also isolated in 37.9% of the study participants. Hookworm and <it>S. mansoni infections </it>showed <it>s</it>tatistically significant associations with shoe wearing and swimming habit of school children, respectively.</p> <p>Conclusion</p> <p>Prevalence of soil transmitted helminths (STH) and <it>S.mansoni </it>was high and the diseases were still major health problem in the study area which alerts public health intervention as soon as possible.</p

Factors affecting the frequency of lipid body positive tubercle bacilli in human sputum

Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB). Mtb cells contain intracellular lipid bodies (LBs) in sputum and the levels vary between patients. Previous reports showed the essential role of nitric oxide (NO) in killing Mtb in vivo and that Mtb forms LBs in vitro upon NO treatment. These treated populations are tolerant to isoniazid and rifampicin, but the reasons for varing LB levels in vivo are not understood. The objective of this study was to determine the association between fractional exhaled nitric oxide (FeNO) concentrations with the proportion of LB[superscript +ve] tubercle bacilli in sputum. The majority of TB patients (65%) showed ≤ 20.6 ppb FeNO concentration. FeNO concentration was weak but significantly associated with the proportion of LB[superscript +ve] tubercle bacilli in sputum. FeNO concentration was also significantly associated with the proportion of LB[superscript +ve] tubercle bacilli among HIV[superscript +ve] P[superscript -] and HIV[superscript –ve] P[superscript +]/TB patients. High esosinophil count was significantly associated with FeNO concentration in both HIV[superscript –ve] and HIV[superscript +ve] /TB patients infected with intestinal parasite. The CAS and EAL Mtb spoligotypes were the dominant Mtb spoligotypes in Gondar. FeNO concentration was significantly associated with the proportion of LB[superscript +ve] tubercle bacilli among TB patients infected with the CAS Mtb spoligotype (p<0.01; r²=0.323) but not among patients infected with the EAL. The anti-microbial susceptibility pattern showed an 11.9% either mono or multi-drug resistance. The average proportion of LB[superscript +ve] tubercle bacilli among drug resistant TB patients was relatively higher than the corresponding drug sensitive TB patients. The proportion of LB[superscript +ve] tubercle bacilli was also higher among MDR-TB patients. The association between FeNO concentrations with the proportion of LB[superscript +ve] tubercle bacilli raises questions regarding L-arginine supplementation during TB treatment. The association of FeNO concentration with the proportion of LB[superscript +ve] tubercle bacilli among specific Mtb spoligotypes may reflect difference in NO tolerance

The reliability of blood film examination for malaria at the peripheral health unit

Background: Malaria is a common and serious problem in Ethiopia. Blood film examination is the best tool for diagnosing malaria where feasible. Objective: To assess the reliability of blood film examination at the primary health care level. Method: Two specimens were taken from all suspected patients in five health center and one hospital in north Gondar zone in Ethiopia. One to be stained and read by the operational readers, the other to be sent unstained to the reference reader. Result: Out of 3625 patients whose blood film was sent, 44% were females and 28% were positive for malaria. The peak age was 15-29. The proportion of P. falciparum and P. vivax was 64.6% and 35.6%. The specificity and positive predictive values were low and the overall chance corrected agreement (kappa score) of the operational and reference reader was less than 0.53. Conclusion and recommendation: The agreement and species identification of the operational and reference readers were low. Continuous retraining and supervision are indispensable. Ethiop.J.Health Dev. 2003;17(3):197-20