Prevalence of abnormal cervical cytology among women infected with HIV in Machakos County Hospital Kenya

Background: Cervical cancer is increasingly becoming a major threat to health among women in the world particularly in developing countries where screening programs are not well established. In Kenya, cervical cancer is the second most frequent cancer among women and the leading cause of cancer deaths in women of reproductive age.Studies have shown that women infected with HIV especially those with low CD4 counts or decreasing immunity are at a higher risk of developing pre cancerous cervical lesions and invasive cervical cancer than those in the general population without HIV infection.Objective: To determine the prevalence of abnormal Pap smears in HIV positive women attending Comprehensive care clinic at Machakos Level 5 Hospital.Design: Cross sectional descriptive studySetting: Machakos County hospital.Subjects: Women infected with HIV attending Machakos County Hospital Comprehensive care clinic.Results: 295 women infected with HIV were enrolled in this study and cervical smear taken for cytology screening. 22 were excluded from the analysis due to unsatisfactory smears. The prevalence of cervical cytology abnormalities was 14 out of 273 (5.1%) with HSIL being the most prevalent at 5 out of 273 (1.8%). Other lesions were ASC-H 4 (1.46%), LSIL 3 (1.05%), SCC and Adenocarcinoma both with 1(0.36%).In this study, age and Pap smear findings had no statistically significant association, X²=6.262, p=0.618.Conclusion: This prevalence of abnormal cervical cytology among HIV infected women in this study was 5.2%. There was no statistically significant association between age and Pap smear findings

HPV DNA testing and pap smear cytology co-testing as a‘test of cure’ in patients previously treated for cervical lesions by leep at Kenyatta National Hospital

Background: HPV infection is a pre-requisite for the development of the majority (99.7%) of precancerous cervical lesions. Treatment of cervical precancerous lesions reduces the risk of invasive cervical cancer by 90%; however, treated women still have five times risk of invasive cancer compared to women who have  always had a normal Pap smear, thus special follow-up measures are critical to reduce these risks.Objective: To determine the utility of co-testing by conventional Pap smear and HPV testing as a ‘test of cure’ in patients previously treated for cervical lesions by LEEP at KNH.Design: Cross sectional descriptive study.Setting: Kenyatta National Hospital and KAVI molecular laboratory.Subjects: Women on follow for cervical lesions post LEEP treatment.Results: Out of the 25 participants, 22(88%) had a report of NILM while 3(12%) had a report of ≥ASCUS). 16 (64%) were positive for HPV. HPV 56 was the commonest HPV subtype detected in 11 patients (41%). The Cohen’s Kappa correlation between Pap smear and HPV DNA test not statistically significant = 0.143, 95% CI: -0.17 to 0.46, p=0. 166.There was no statistically significant association between HIV status and pap smear findings post LEEP, X²=0.711, p=0.399Conclusions: Co-testing with HPV DNA testing and Pap smear is a useful approach to stratify women with no cytological abnormalities according to their risk of residual diseas

Non-invasive diagnosis of endometriosis based on a combined analysis of six plasma biomarkers

Lack of a non-invasive diagnostic test contributes to the long delay between onset of symptoms and diagnosis of endometriosis. The aim of this study was to evaluate the combined performance of six potential plasma biomarkers in the diagnosis of endometriosis. This case-control study was conducted in 294 infertile women, consisting of 93 women with a normal pelvis and 201 women with endometriosis. We measured plasma concentrations of interleukin (IL)-6, IL-8, tumour necrosis factor-alpha, high-sensitivity C-reactive protein (hsCRP), and cancer antigens CA-125 and CA-19-9. Analyses were done using the Kruskal-Wallis test, Mann-Whitney test, receiver operator characteristic, stepwise logistic regression and least squares support vector machines (LSSVM). Plasma levels of IL-6, IL-8 and CA-125 were increased in all women with endometriosis and in those with minimal-mild endometriosis, compared with controls. In women with moderate-severe endometriosis, plasma levels of IL-6, IL-8 and CA-125, but also of hsCRP, were significantly higher than in controls. Using stepwise logistic regression, moderate-severe endometriosis was diagnosed with a sensitivity of 100% (specificity 84%) and minimal-mild endometriosis was detected with a sensitivity of 87% (specificity 71%) during the secretory phase. Using LSSVM analysis, minimal-mild endometriosis was diagnosed with a sensitivity of 94% (specificity 61%) during the secretory phase and with a sensitivity of 92% (specificity 63%) during the menstrual phase. Advanced statistical analysis of a panel of six selected plasma biomarkers on samples obtained during the secretory phase or during menstruation allows the diagnosis of both minimal-mild and moderate-severe endometriosis with high sensitivity and clinically acceptable specificity

The role of scientists and clinicians in raising public support for animal research in reproductive biology and medicine

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