Comparative study of Pap smear test and VIA test in cervical carcinoma screening among women aged over 20 years

Objective To compare the performance of VIA and Pap smear tests as screening tools in cervical carcinoma detection in women. Methods The prospective and retrospective study was conducted on 198 women. Cervical smears were collected with Ayres’s spatula. Acetic acid was used and the results were categorized as VIA positive and VIA negative. The Pap smear was reported according to the Bethesda system 2001. Cervical biopsy was done for all the cases. Results VIA was positive in 47.47% of the cases and Pap smear was positive in 39.89% of the cases. Among 198 cases, 61 (30, 8%) cases had cervical carcinoma. When we compared VIA and Pap smear tests, 94 cases were positive to VIA, and 61cases were confirmed positive with Pap smear. The sensitivity and specificity for VIA were 88.5% and 84.68%, respectively. The sensitivity and specificity for Pap smear were 80.45% and 91.89%, respectively. The sensitivity of VIA was higher than that of Pap smear. However, the specificity of VIA was low as compared to Pap smear. Conclusion VIA is a cost effective test and could be alternatively used with Pap smear in screening of cervical carcinoma but the Papanicolaou test is the most effective test for early detection of cervical carcinoma. Keywords: Pap smear test; VIA test; cervical carcinoma; wome

Contribution of fine needle aspiration and auramine tests in diagnosis of Tuberculosis lymphadenitis at Kigali University Teaching Hospital (CHUK), Rwanda

Background Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. Tuberculosis affects mainly the lungs but other organs of the body are involved. TB lymphadenitis is most common in extrapulmonary TB. Lymphadenitis is the infection or inflammation of the lymph nodes which are essential in immune response of the body. Objective To evaluate the contribution of fine needle aspiration (FNA) and auramine tests in the diagnosis of TB lymphadenitis. Methods Smears from lymph node aspirates were prepared. Air-dried smears were stained by auramine staining for AFB examination and Diff-Quick staining cytological technique to detect malignant cells and other pathology. The slides were examined by laboratory technologists and the pathologist. Results Results are based on a total number of 137 samples; 58 (42.33%) cases were auramine positive for TB lymphadenitis while other 79 (57.67%) suspected cases were non TB lymphadenitis. Necrotizing lymphadenitis, granulomatous lymphadenitis, chronic lymphadenitis, acute lymphadenitis and reactive lymphadenitis represented 21.19%; 13.14%; 1.42%; 2.19%; and 19.71% respectively. Conclusion The use of auramine test and FNA cytology should be considered as useful in the diagnosis of tuberculosis lymphadenitis. These techniques are less expensive, quick, safe and show low complication rate. Keywords: TB lymphadenitis; fine needle aspiration; auramine tes

A pooled testing strategy for identifying SARS-CoV-2 at low prevalence

Suppressing infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will probably require the rapid identification and isolation of individuals infected with the virus on an ongoing basis. Reverse-transcription polymerase chain reaction (RT-PCR) tests are accurate but costly, which makes the regular testing of every individual expensive. These costs are a challenge for all countries around the world, but particularly for low-to-middle-income countries. Cost reductions can be achieved by pooling (or combining) subsamples and testing them in groups1-7. A balance must be struck between increasing the group size and retaining test sensitivity, as sample dilution increases the likelihood of false-negative test results for individuals with a low viral load in the sampled region at the time of the test8. Similarly, minimizing the number of tests to reduce costs must be balanced against minimizing the time that testing takes, to reduce the spread of the infection. Here we propose an algorithm for pooling subsamples based on the geometry of a hypercube that, at low prevalence, accurately identifies individuals infected with SARS-CoV-2 in a small number of tests and few rounds of testing. We discuss the optimal group size and explain why, given the highly infectious nature of the disease, largely parallel searches are preferred. We report proof-of-concept experiments in which a positive subsample was detected even when diluted 100-fold with negative subsamples (compared with 30-48-fold dilutions described in previous studies9-11). We quantify the loss of sensitivity due to dilution and discuss how it may be mitigated by the frequent re-testing of groups, for example. With the use of these methods, the cost of mass testing could be reduced by a large factor. At low prevalence, the costs decrease in rough proportion to the prevalence. Field trials of our approach are under way in Rwanda and South Africa. The use of group testing on a massive scale to monitor infection rates closely and continually in a population, along with the rapid and effective isolation of people with SARS-CoV-2 infections, provides a promising pathway towards the long-term control of coronavirus disease 2019 (COVID-19).info:eu-repo/semantics/publishe

Exploring Perceptions and Acceptance of Minimally Invasive Tissue Sampling among Bereaved Relatives and Health-Care Professionals in Rwanda.

peer reviewed[en] PURPOSE: In most low- and lower middle-income countries (LMICs), minimally invasive tissue sampling (MITS) is a relatively new procedure for identifying the cause of death (CoD). This study aimed to explore perceptions and acceptance of bereaved families and health-care professionals regarding MITS in the context of MITS initiation in Rwanda as an alternative to clinical autopsy. METHODS: This was a qualitative phenomenological study with thematic analysis. Participants were bereaved relatives (individual interviews) and health-care professionals (focus-group discussions) involved in MITS implementation. It was conducted in the largest referral and teaching hospital in Rwanda. RESULTS: Motivators of MITS acceptance included eagerness to know the CoD, noninvasiveness of MITS, trust in medics, and the fact that it was free. Barriers to consent to MITS included inadequate explanations from health-care professionals, high socioeconomic status, lack of power to make decisions, and lack of trust in medics. Health-care professionals perceived both conventional autopsy and MITS as gold-standard procedures in CoD determination. They recommended including MITS among hospital services and commended the post-MITS multidisciplinary discussion panel in CoD determination. They pointed out that there might be reticence in approaching bereaved relatives to obtain consent for MITS. Both groups of participants highlighted the issue of delay in releasing MITS results. CONCLUSION: Both health-care professionals and bereaved relatives appreciate that MITS is an acceptable procedure to include in routine hospital services. Dealing with barriers met by either group is to be considered in the eventual next phases of MITS implementation in Rwanda and similar sociocultural contexts

Primary sarcoma of the breast in the young Rwandan females

peer reviewedPrimary breast sarcoma (PBS) is a very rare disease with an annual incidence estimated to 45 cases per million. It rises from breast connective tissue and constitutes highly recurrent tumors with poor prognosis. The management of the primary breast sarcoma relies on the tumor size, histology, and requires a multidisciplinary approach. In sub-Saharan Africa PBS was very rarely reported. We are reporting here on two cases. The two cases observed in our settings were young women who presented with high-grade sarcoma showing an aggressive form, a very fast recurrence and worse prognosis within few months following the diagnosis.PhD Project: ' Screening for Breast cancer in Rwanda by using Genomic approache

Widespread antimicrobial resistance among bacterial infections in a Rwandan referral hospital.

BackgroundResistance among bacterial infections is increasingly well-documented in high-income countries; however, relatively little is known about bacterial antimicrobial resistance in low-income countries, where the burden of infections is high.MethodsWe prospectively screened all adult inpatients at a referral hospital in Rwanda for suspected infection for seven months. Blood, urine, wound and sputum samples were cultured and tested for antibiotic susceptibility. We examined factors associated with resistance and compared hospital outcomes for participants with and without resistant isolates.ResultsWe screened 19,178 patient-days, and enrolled 647 unique participants with suspected infection. We obtained 942 culture specimens, of which 357 were culture-positive specimens. Of these positive specimens, 155 (43.4%) were wound, 83 (23.2%) urine, 64 (17.9%) blood, and 55 (15.4%) sputum. Gram-negative bacteria comprised 323 (88.7%) of all isolates. Of 241 Gram-negative isolates tested for ceftriaxone, 183 (75.9%) were resistant. Of 92 Gram-negative isolates tested for the extended spectrum beta-lactamase (ESBL) positive phenotype, 66 (71.7%) were ESBL positive phenotype. Transfer from another facility, recent surgery or antibiotic exposure, and hospital-acquired infection were each associated with resistance. Mortality was 19.6% for all enrolled participants.ConclusionsThis is the first published prospective hospital-wide antibiogram of multiple specimen types from East Africa with ESBL testing. Our study suggests that low-resource settings with limited and inconsistent access to the full range of antibiotic classes may bear the highest burden of resistant infections. Hospital-acquired infections and recent antibiotic exposure are associated with a high proportion of resistant infections. Efforts to slow the development of resistance and supply effective antibiotics are urgently needed

Author Correction: A pooled testing strategy for identifying SARS-CoV-2 at low prevalence (Nature, (2021), 589, 7841, (276-280), 10.1038/s41586-020-2885-5)

In Fig. 2 of this Article, the Ct values for the orf1ab gene (shown in Fig. 2b) in samples B16121 and B16122 at 20×, 50× and 100× dilution were accidental duplications of those of the N gene (shown in Fig. 2a). The Ct values for orf1ab have been corrected in Fig. 2 of the original Article, and Fig. 1 of this Amendment shows the original and corrected Fig. 2b, for transparency. As B16121 and B16122 are both low-Ct samples, this change has no effect on our conclusion that typical samples are easily detected after 100-fold dilution. In Extended Data Table 2 of this Article, which presents the source data for Fig. 2, the orf1ab Ct values for sample B16121 were incorrectly given as 29, 29.74 and 30.54 for 20×, 50× and 100× dilution, respectively, instead of 31, 30.51 and 30.95, respectively. In addition, the orf1ab Ct values for sample B16122 were incorrectly given as 26.81, 27.75 and 29.07 for 20×, 50× and 100× dilution, respectively, instead of 28.5, 29.4 and 30.2, respectively. Extended Data Table 2 of the original Article has been corrected online. We thank T. Carey for drawing this error to our attention. The original Article has been corrected online. (Figure presented.).SCOPUS: er.jinfo:eu-repo/semantics/publishe