HIV Serostatus and Tumor Differentiation Among Patients with Cervical Cancer at Bugando Medical Centre.

Evidence for the association between Human immunodeficiency virus infection and cervical cancer has been contrasting, with some studies reporting increased risk of cervical cancer among HIV positive women while others report no association. Similar evidence from Tanzania is scarce as HIV seroprevalence among cervical cancer patients has not been rigorously evaluated. The purpose of this study was to determine the association between HIV and tumor differentiation among patients with cervical cancer at Bugando Medical Centre and Teaching Hospital in Mwanza, North-Western Tanzania. This was a descriptive analytical study involving suspected cervical cancer patients seen at the gynaecology outpatient clinic and in the gynaecological ward from November 2010 to March 2011. A total of 91 suspected cervical cancer patients were seen during the study period and 74 patients were histologically confirmed with cervical cancer. The mean age of those confirmed of cervical cancer was 50.5 ± 12.5 years. Most patients (39 of the total 74-52.7%) were in early disease stages (stages IA-IIA). HIV infection was diagnosed in 22 (29.7%) patients. On average, HIV positive women with early cervical cancer disease had significantly more CD4+ cells than those with advanced disease (385.8 ± 170.4 95% CI 354.8-516.7 and 266.2 ± 87.5, 95% CI 213.3-319.0 respectively p = 0.042). In a binary logistic regression model, factors associated with HIV seropositivity were ever use of hormonal contraception (OR 5.79 95% CI 1.99-16.83 p = 0.001), aged over 50 years (OR 0.09 95% CI 0.02-0.36 p = 0.001), previous history of STI (OR 3.43 95% CI 1.10-10.80 p = 0.035) and multiple sexual partners OR 5.56 95% CI 1.18-26.25 p = 0.030). Of these factors, only ever use of hormonal contraception was associated with tumor cell differentiation (OR 0.16 95% CI 0.06-0.49 p = 0.001). HIV seropositivity was weakly associated with tumor cell differentiation in an unadjusted analysis (OR 0.21 95% CI 0.04-1.02 p = 0.053), but strong evidence for the association was found after adjusting for ever use of hormonal contraception with approximately six times more likelihood of HIV infection among women with poorly differentiated tumor cells compared to those with moderately and well differentiated cells (OR 5.62 95% CI 1.76-17.94 p = 0.004).\ud Results from this study setting suggest that HIV is common among cervical cancer patients and that HIV seropositivity may be associated with poor tumour differentiation. Larger studies in this and similar settings with high HIV prevalence and high burden of cervical cancer are required to document this relationship

Causes of maternal deaths and severe acute maternal morbidity in a regional hospital in the Northwest Province of South Africa

Magister Public Health - MPHDespite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006.South Afric

Comparative Study of the Diametric and Spatial Structures of Guarea cedrata (A. Chev.) Pellegr. (Meliaceae) in the Semi-Caducified Forests of the Central Basin Forest Massif (Tshopo Province, DRC, Congo Basin)

The comparative study of the diametric and spatial structures of Guarea cedrata (A. Chev.) Pellegr. was carried out in the semi-caducified forests of the Tshopo forest massif in the Democratic Republic of the Congo. For this study, two forest reserves were selected: the Yoko Forest Reserve and the Yangambi Biosphere Reserve, successively located in the Ubundu territory, 32 km southeast of Kisangani and in the Isangi territory, 100 km west of the same city. To conduct the present study, two devices of 200 hectares each, were installed, one in Yoko and the other in Yangambi where all the individuals of Guarea cedrata with dhp ≥ 10 cm were measured including their X, Y coordinates. A total of 177 individuals were inventoried within two reserves including 72 individuals, or 0.36 feet/ha in Yoko, and 105 individuals, or 0.525 feet/ha in Yangambi. The total basal area values are respectively 0.0695 m2/ha in Yoko and 0.1712 m2/ha in Yangambi. Both diametric structures are "stretched S" and the spatial distribution is aggregative in Yoko, while random in Yangambi. In general, perch positions and stands are independent from each other; however, there is some dependence at small scale of analysis within the two reserve

Vulnerability of the Pteridoflora Towards Climate Change in the West Albertine Rift: Case of the Mountain’s Stages of the Kahuzi-Biega National Park in the Democratic Republic of the Congo

The present article aims at analysing the floristic composition of Lycophytes and Ferns to test the disturbances on the vegetation structure occurring in the mountains zones of the Kahuzi-Biega National Park (KBNP), further, to prove/underline the main threat and the vulnerability which actually is impacting the biodiversity in the mountains of the Western Albertine Rift due to climate changes and resulting in habitat loss as well as result of anthropogenic activities. The KBNP is located at the crossroad of the phytogeography regions of the Guinea-Congolese and Afromontane between 650 to 3326 m of altitude. During 10 years, we conducted comparison studies in the habitats (disturbed and undisturbed) encountered on the vegetation that scales between 1250 à 3300 m of altitude in 30 plots, 15 transects on a one kilometre. The results obtained reveal a variation in the flora composition within the three stages. The difference in the height, the diametric distribution (trees and shrubs) as well as the presence of Pteridophytes between undisturbed and disturbed habitats is highly significant within the 10 years’ observations. In stable and mature parcels, Pteridophytes constitute a very rich, diversified and stable population. Permanent threat manifested through the fragility of the habitats and is further translated by a modification of the floristic composition of the canopy, and sometimes trough the taming of the undergrowth in disturbed parcels. The mountainous part of the KBNP might probably constitute a climatic refuge for Pteridophytes in the Albertine Rift considering their diversity. Furthermore, considering these adaptations, the diversity and the specificity of the biotopes occupied, as well as the bioecological services recognized to Lycophytes and Ferns, they are the real markers for bioindicators of the delicatessen towards climate changes observed in the western rift Albertine. However, anthropogenic effects and sometimes, natural hazards resulting in this protected area, may also constitute a source of vulnerability for Pteridophyte

HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study

BACKGROUND: Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. METHODS: Data were derived from a case-control study that examined the association between hormonal contraceptives and invasive cervical cancer. The study was conducted in the Western Cape (South Africa), from January 1998 to December 2001. There were 486 women with invasive cervical cancer, 103 control women with atypical squamous cells of undetermined significance (ASCUS), 53 with low-grade squamous intraepithelial lesions (LSIL), 50 with high-grade squamous intraepithelial lesions (HSIL) and 1159 with normal cytology. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multiple logistic regression. RESULTS: The adjusted odds ratios associated with HIV infection were: 4.4 [95% CI (2.3 – 8.4) for ASCUS, 7.4 (3.5 – 15.7) for LSIL, 5.8 (2.4 – 13.6) for HSIL and 1.17 (0.75 – 1.85) for invasive cervical cancer. HIV positive women were nearly 5 times more likely to have high-risk human papillomavirus infection (HR-HPV) present compared to HIV negative women [OR 4.6 (95 % CI 2.8 – 7.5)]. Women infected with both HIV and high-risk HPV had a more than 40 fold higher risk of SIL than women infected with neither of these viruses. CONCLUSION: HIV positive women were at an increased risk of cervical pre-cancer, but did not demonstrate an excess risk of invasive cervical cancer. An interaction between HIV and HR-HPV infection was demonstrated. Our findings underscore the importance of developing locally relevant screening and management guidelines for HIV positive women in South Africa

Increased alpha-9 human papillomavirus species viral load in human immunodeficiency virus positive women

Abstract Background Persistent high-risk (HR) human papillomavirus (HPV) infection and increased HR-HPV viral load are associated with the development of cancer. This study investigated the effect of human immunodeficiency virus (HIV) co-infection, HIV viral load and CD4 count on the HR-HPV viral load; and also investigated the predictors of cervical abnormalities. Methods Participants were 292 HIV-negative and 258 HIV-positive women. HR-HPV viral loads in cervical cells were determined by the real-time polymerase chain reaction. Results HIV-positive women had a significantly higher viral load for combined alpha-9 HPV species compared to HIV-negative women (median 3.9 copies per cell compared to 0.63 copies per cell, P = 0.022). This was not observed for individual HPV types. HIV-positive women with CD4 counts >350/μl had significantly lower viral loads for alpha-7 HPV species (median 0.12 copies per cell) than HIV-positive women with CD4 ≤350/μl (median 1.52 copies per cell, P = 0.008), but low CD4 count was not significantly associated with increased viral load for other HPV species. High viral loads for alpha-6, alpha-7 and alpha-9 HPV species were significant predictors of abnormal cytology in women. Conclusion HIV co-infection significantly increased the combined alpha-9 HPV viral load in women but not viral loads for individual HPV types. High HR-HPV viral load was associated with cervical abnormal cytology

Customary Rights and the New Conservation Paradigm in the Context of the Conflict in Kahuzi Biega National Park in Eastern Democratic Republic of Congo

This paper examines the Kahuzi Biega National Park (PNKB) Development and Management Plan 2009-2018, the revised version of 2013, in accordance with the international principles of the new conservation paradigm. Three-dimensional modelling as a tool for knowledge transmission and socio-ecological education to indigenous youth was carried out to illuminate the impact on the life of the Batwa indigenous people on their ancestral land. Sixteen former camps within the PNKB were identified, including other cultural spaces such as places of refuge, hunting, exchange, and commercial barter occupied by indigenous Batwa within the PNKB, conferring on them customary rights to the park. The return of the Batwa indigenous people to the park in 2018, believing that the authorities had not kept their promises, followed by 54.5% of the traces of occupation of their former customary spaces. A related cultural, environmental, and educational development plan is essential to conciliate the interests of conservation in this conflict context among the indigenous resident