Cervical cancer in women diagnosed at the National Health Laboratory, Sudan: A call for screening

Background: Cancer of the cervix is the second most prevalent cancer of women to date in the Sudan, in a concerted review of the records of the hospital-based cancer registry of the Radiation & Isotope Centre of Khartoum (RICK). However, in spite of a wealth of data, this is the first study to date describing the histopathologic prevalence of cervical cancer in the Sudan.Objectives: To identify the percentage and clinicopathological pattern of cervical cancer cases diagnosed at Histopathology Department, National Health Laboratory (NHL) in Khartoum, Sudan.Material and Methods: This is a cross-sectional, descriptive study  conducted at the NHL. All cases with histopathological diagnosis of cervical neoplasm in the period from 2004-2009 were reviewed. Patients’ clinical data were obtained from clinical records. Exclusion criteria included inadequate clinical information and unavailability of both Hematoxylin and Eosin stained (H&E) sections and formalin-fixed paraffin-embedded (FFPE) blocks. The WHO classification of cancer of the cervix (2003) was used to describe disease type. SPSS data analysis was applied.Results: A total of 287 cases were reviewed and 195 cases were included in the study. The mean of cervical cancer cases diagnosed per year at NHL is 7.9%. The commonest age group affected was patients grouped between 41- 60 years (52%) followed by 61-80 years (26.3%). Histologically, 95.9% of the cases were carcinomas. Squamous cell carcinomas were 90.9%, Adenocarcinomas 4.8%, and other epithelial tumours were 4.3%. Of the Squamous carcinomas, 98.8% were invasive and 1.2% intraepithelial (cervical intraepithelial neoplasia). The majority of case presentations were that of a protruding cervical mass. We noticed the commonest symptom being bleeding per vagina.Conclusion: To determine the incidence of cervical cancer in the Sudan a national populationbased registry is necessary. The mean age of patients presenting with cervical cancer to NHL is 53.25 years. This is in keeping with the natural history of the human papilloma virus (HPV). The late presentation of patients with aggressive disease necessitates health  education and cervical cancer screening as well as strict guidelines for medical record keeping in line with good medical practices, enabling good data collection for the newly established population-based cancer registry.Keywords: HPV, invasive squamous cell carcinoma

How Can Recessions Be Brought To An End? Effects Of Macroeconomic Policy Actions On Durations Of Recessions

This paper analyzes how effective macroeconomic policy actions are in ending recessions. We also investigate which structural factors help the country to experience shorter recessions. We implement survival regression analysis and conclude that expansionary monetary policy significantly decreases durations of recessions whereas fixing the exchange rate does not have an effect on the durations of recessions. Expansionary fiscal policy has undesired effects and decreases the probability that recession will end, thus increasing the durations of recessions. The analysis of country specific factors indicates that emerging countries experience shorter recessions. Recessions in countries with higher trade openness last significantly longer. Financial openness and institutional quality do not have significant effects of recession durations. The empirical analysis takes into account alternative probability distributions and endogeneity of policy actions

In transition: current health challenges and priorities in Sudan

A recent symposium and workshop in Khartoum, the capital of the Republic of Sudan, brought together broad expertise from three universities to address the current burden of communicable and non-communicable diseases facing the Sudanese healthcare system. These meetings identified common challenges that impact the burden of diseases in the country, most notably gaps in data and infrastructure which are essential to inform and deliver effective interventions. Non-communicable diseases, including obesity, type 2 diabetes, renal disease and cancer are increasing dramatically, contributing to multimorbidity. At the same time, progress against communicable diseases has been slow, and the burden of chronic and endemic infections remains considerable, with parasitic diseases (such as malaria, leishmaniasis and schistosomiasis) causing substantial morbidity and mortality. Antimicrobial resistance has become a major threat throughout the healthcare system, with an emerging impact on maternal, neonatal, and paediatric populations. Meanwhile, malnutrition, micronutrient deficiency, and poor perinatal outcomes remain common and contribute to a lifelong burden of disease. These challenges echo the UN sustainable development goals and concentrating on them in a unified strategy will be necessary to address the national burden of disease. At a time when the country is going through societal and political transition, we draw focus on the country and the need for resolution of its healthcare needs

Wi-Fi-Enabled Automatic Eating Moment Monitoring Using Smartphones

Dietary habits are closely correlated with people’s health. Study reveals that unhealthy eating habits may cause various diseases such as obesity, diabetes and anemia. To help users create good eating habits, eating moment monitoring plays a significant role. However, traditional methods mainly rely on manual self-report or wearable devices, which either require much user efforts or intrusive dedicated hardware. In this work, we propose a user effort-free eating moment monitoring system by leveraging the WiFi signals extracted from the commercial off-the-shelf (COTS) smartphones. In particular, our system captures the eating activities of users to determine the eating moments. The proposed system can further identify the fine-grained food intake gestures (e.g., eating with fork, knife, spoon, chopsticks and bard hand) to estimate the detailed eating episode for each food intake gesture. Utilizing the dietary information, our system shows the potential to infer the food category and food amount. Extensive experiments with 10 subjects over 400-min eating show that our system can recognize a user’s food intake gestures with up to 97.8% accuracy and estimate the dietary moment within 1.1-s error

Nevirapine Resistance and Breast-Milk HIV Transmission: Effects of Single and Extended-Dose Nevirapine Prophylaxis in Subtype C HIV-Infected Infants

Daily nevirapine (NVP) prophylaxis to HIV-exposed infants significantly reduces breast-milk HIV transmission. We assessed NVP-resistance in Indian infants enrolled in the "six-week extended-dose nevirapine" (SWEN) trial who received single-dose NVP (SD-NVP) or SWEN for prevention of breast-milk HIV transmission but who also acquired subtype C HIV infection during the first year of life.Standard population sequencing and cloning for viral subpopulations present at > or =5% frequency were used to determine HIV genotypes from 94% of the 79 infected Indian infants studied. Timing of infection was defined based on when an infant's blood sample first tested positive for HIV DNA. SWEN-exposed infants diagnosed with HIV by six weeks of age had a significantly higher prevalence of NVP-resistance than those who received SD-NVP, by both standard population sequencing (92% of 12 vs. 38% of 29; p = 0.002) and low frequency clonal analysis (92% of 12 vs. 59% of 29; p = 0.06). Likelihood of infection with NVP-resistant HIV through breast-milk among infants infected after age six weeks was substantial, but prevalence of NVP-resistance did not differ among SWEN or SD-NVP exposed infants by standard population sequencing (15% of 13 vs. 15% of 20; p = 1.00) and clonal analysis (31% of 13 vs. 40% of 20; p = 0.72). Types of NVP-resistance mutations and patterns of persistence at one year of age were similar between the two groups. NVP-resistance mutations did differ by timing of HIV infection; the Y181C variant was predominant among infants diagnosed in the first six weeks of life, compared to Y188C/H during late breast-milk transmission.Use of SWEN to prevent breast-milk HIV transmission carries a high likelihood of resistance if infection occurs in the first six weeks of life. Moreover, there was a continued risk of transmission of NVP-resistant HIV through breastfeeding during the first year of life, but did not differ between SD-NVP and SWEN groups. As with SD-NVP, the value of preventing HIV infection in a large number of infants should be considered alongside the high risk of resistance associated with extended NVP prophylaxis.ClinicalTrials.gov NCT00061321

Poor prognostic clinicopathologic features correlate with VEGF expression but not with PTEN expression in squamous cell carcinoma of the larynx

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to assess the relationship between expression of vascular endothelial growth factor (VEGF) and phosphatase and tensin homolog deleted in chromosome ten (PTEN), angiogenesis and clinicopathological parameters of squamous cell carcinoma of the larynx.</p> <p>Methods</p> <p>We examined immunohistochemical expression of VEGF and PTEN and CD34 for microvessel density (MVD) in sections of formalin-fixed, paraffin embedded tissue blocks of 140 patients with squamous cell carcinoma of the larynx. The intensity of VEGF and PTEN staining and the proportion of cells staining were scored.</p> <p>Results</p> <p>The tumor grade was not significantly related to PTEN expression, but it was to VEGF expression (p = 0.400; p = 0.015, respectively). While there was no significant relationship between PTEN expression and tumor size and cartilage invasion (p = 0.311, p = 0.128), there was a significant relationship between the severity of VEGF expression and tumor size (p = 0.006) and lymph node metastasis (p = 0.048) but not cartilage invasion (p = 0.129). MVD was significantly higher in high-grade tumors (p = 0.003) but had no significant relationship between MVD, lymph node metastasis, and cartilage invasion (p = 0.815, p = 0.204). There was also no significant relationship between PTEN and VEGF expression (p = 0.161) and between PTEN and VEGF expression and the MVD (p = 0.120 and p = 0.175, respectively).</p> <p>Conclusions</p> <p>Increased VEGF expression may play an important role in the outcome of squamous cell carcinoma of the larynx. PTEN expression was not related to VEGF expression and clinicopathological features of squamous cell carcinoma of the larynx.</p

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.

Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (<six lashes touching eye). This trial investigated whether epilation is noninferior to surgery for managing minor trichiasis