Epidemiology and matrix metalloproteinases associated with pelvic organ prolapse: narrative review of the literature

Pelvic organ prolapse carries a risk of recurrence and leads to several disorders which bother the patient and alter her quality of life and her self-esteem. The objective of this review is to provide an overview of the published literature on the epidemiology and matrix metalloproteinases involved in the development of pelvic organ prolapse. We carried out online searches in electronic databases: Hinari, Google scholar, Pubmed and Embase; and manual searches of the references of each selected article to identify more studies not captured by the online search. Studies on adult women published in English and French over the past 25 years were collected. We excluded animal studies, those published multiple times, duplicates, letters, commentaries, editorial notes, congress report, clinical practice guidelines, case reports, studies of comorbidities (cervical cancer, fistulas, pregnancy), and those evaluating paraclinical examinations and treatment. A total of 153 articles were read and 84 studies were retained, including 33 on the prevalence of genital prolapse, 24 on its epidemiological and physiopathological risk factors, 7 on the recurrence of genital prolapse and its risk factors, 20 on the matrix metalloproteinases associated with pelvic organ prolapse and their regulatory factors. The identification of the epidemiology and matrix metalloproteinases associated with pelvic organ prolapse appears important for improving its treatment through appropriate advice and measures.

Néoplasies intraépithéliales du col utérin chez la congolaise à Kinshasa : intérêt des biomarqueurs immunohistochimiques: Intraepithelial neoplasias of the uterine cervix in the Congolese in Kinshasa : interest of immunohistochemical biomarkers

Context and objective. Although cervical cancer remains the second most frequent in women in Africa, immunohistochemical biomarkers for its diagnosis is rarely used in sub-Saharan Africa. The aim of this study was to demonstrate the contribution of biomarkers p16 and Ki-67 in the diagnosis of cervical intraepithelial neoplasia. Methods. This was a retrospective study carried out in five Pathology laboratories in Kinshasa. Biopsy slides were reread and reclassified by at least two independent pathologists in Kinshasa University Hospital based on the nomenclature of Bethesda/WHO. Immunolabelling (p16 and Ki-67) was carried out with external quality control in Europe. Results. A total of 70 cases were included. All 24 cases of high grade intraepithelial neoplasia (CIN2, CIN3 and CIS) were positively marked by p16 and Ki-67 whereas low grade lesions were positively marked for 41 cases of CIN1 and negatively marked for 5 cases (3 of CIN1 and 2 of CP). Certain lesions have been reclassified. Immunohistochemical labeling was significantly associated with the grade of intraepithelial neoplasia for p16 (p = 0.001) and for Ki-67 (p = 0.004). Conclusion.  p16 and Ki-67 are specific and reliable biomarkers for an optimal diagnosis of intraepithelial neoplasia of the cervix. Contexte et objectif.  Bien que le cancer du col utérin soit le deuxième cancer plus fréquent chez la femme en Afrique, le recours aux biomarqueurs immunohistochimiques reste exceptionnel en Afrique subsaharienne. La présente étude avait pour objectif de montrer l’apport des biomarqueurs p16 et Ki-67 dans le diagnostic des néoplasies intra-épithéliales du col utérin. Méthodes. C’était une étude rétrospective réalisée dans cinq laboratoires d’Anatomie Pathologique de Kinshasa. Des lames biopsiques ont été relues et reclassées par au moins deux pathologistes indépendants aux Cliniques Universitaires de Kinshasa en suivant la nomenclature de Bethesda/OMS. L’immunomarquage (p16 et Ki-67) a été réalisé avec un contrôle qualité externe en Europe. Résultats. 70 cas ont été inclus. Les 24 cas des néoplasies intra-épithéliales de haut grade (CIN2, CIN3 et CIS) étaient marquées positivement par p16 et Ki-67 alors que celles de bas grade étaient marquées positivement pour 41 cas de CIN1 et négativement pour 5 cas (3 de CIN1 et 2 de CP). Certaines lésions ont été requalifiées. L’immunomarquage était significativement associé au grade des néoplasies pour la p16 (p=0,001) et pour le Ki-67 (p=0,004). Conclusion. P16 et Ki-67 sont des biomarqueurs spécifiques et efficaces pour un diagnostic optimal des néoplasies intra-épithéliales du col utérin. &nbsp

Cancer research across Africa: a comparative bibliometric analysis.

INTRODUCTION: Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. METHODOLOGY: Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009-2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. RESULTS: African countries in total published 23 679 cancer research papers over the 12-year period (2009-2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa's contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria's contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. CONCLUSIONS: There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer

Fertility intentions and the adoption of long-acting and permanent contraception (LAPM) among women: evidence from Western Kenya

Abstract Background The use of long-acting and permanent method (LAPM) for family planning (FP) is of importance to the FP movement. A better understanding of how fertility-related intentions shape the usage of LAPM is important for programming. This paper explored the interaction of fertility intentions with LAPM use in rural western Kenya. Methods We draw on monitoring data from 28,515 women aged 15–49 years who received FP services between 2013 and 2015 as part of a community-based FP project. We assessed the association between the use of LAPM and fertility intentions, adjusting for age, parity, education, service delivery model, FP counseling and year of data collection. Results Of the 28,515 women who accessed FP services during the period (2013–2015), about two-thirds (57%) reported using LAPM, much higher than the national rates, and around 46% wanted another child within or after two years. In a multivariable regression model, women who desired no more children tended to use LAPM more than those wanting a child within or after some years as well as those uncertain about their future intentions. Conclusion The significant rates of utilization of LAPM between both women who desired no more children and the fair proportion of use among women spacing births underscore the benefits of sustained community level interventions that address both the demand and supply barriers of contraceptive adoption and use

Efficacy of antiviral drug AV2 in the treatment of human papillomavirus-associated precancerous lesions of the uterine cervix: A randomized placebo-controlled clinical trial in Kinshasa, DR Congo. (KINVAV study)

Background: Cervical Cancer (CC) is a major public health problem in DR Congo; the high incidence of CC is due to the inexistence of effective screening programs based on cytology and/or HPV detection followed by appropriate treatments. This situation highlights the need to implement efficacious and inexpensive treatment methods. This study aims at evaluating the efficacy of a topical antiviral drug named AV2® as a treatment for HPV-associated lesions of the cervix. Methods: Women will undergo cytology sampling, HPV testing and Visual inspection of the cervix after application of 5% acetic acid (VIA). VIA-positive women will be randomized to one of two groups to receive treatment by either AV2®or placebo. They will undergo control examinations after two months and after six months. In case of persistent lesions on VIA, treatment by cryotherapy will be done. The primary outcomes will be the change of lesions, the clearance of HPV DNA, and the correlation of the two 2 months after treatment with AV2®. Conclusion: This study is the first large-scale study in Africa to evaluate systematically the efficacy and safety of a topical antiviral drug for the treatment of HPV associated lesions of the cervix. Its findings will direct the planning of suitable algorithms for CC screening and treatment. Clinical trial registration: ClinicalTrials.gov – Unique identifier: NCT02346227, registered on November 8, 2014