The Association between HIV Infection, Antiretroviral Therapy and Cervical Squamous Intraepithelial Lesions in South Western Nigerian Women.

Findings from studies that evaluated the effect of antiretroviral drug use on the development of cervical squamous intraepithelial lesion differed in their conclusions. This study investigated the association between HIV infection, antiretroviral drug use and cervical squamous intraepithelial lesion in a high HIV and cervical cancer burden setting- Nigeria

Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report

Epithelial ovarian cancers are uncommon among young girls and teenagers  compared to germ cell tumors. We report a case of bilateral ovarian serous cystadenocarcinoma in a teenage girl with the attendant challenges of diagnosis, management and follow up. HT, 19 year old had presented at a secondary care level with features suggestive of benign ovarian tumor and had ovariectomy done. However, histology report revealed a malignant epithelial cancer, necessitating a repeat exploration. She was found to have surgical stage 3c disease and subsequently has total abdominal hysterectomy with bilateral salpingectomies, right oophorectomy and omentectomy. She was further managed with  paclitaxelcarboplatin combination chemotherapy but defaulted after the 3rd cycle on account of financial constraints. She succumbed to the disease 11months post diagnosis. Though uncommon, detailed evaluation of teenage patients for malignant ovarian cancer is expedient. The financial burden of cancer care in our environment is also highlighted.Key words: Adolescent, ovarian epithelial cancer, ovariectomy, serous cystadenocarcinom

Unilateral Hypoplastic Pelvic Ectopic Kidney Presenting as a Cold Abscess: A Case Report

Renal ectopia, even though a benign condition, presents diagnostic challenges when its complications arise. Cold abscess in an abnormally sited kidney may, therefore, create a diagnostic conundrum for the clinician. We present the case of a 55-year-old male who had a suppurating ectopic kidney that mimicked an abdominal visceral mitotic lesion necessitating initial laparotomy, reviewed the literature, and highlighted the need to consider the differential diagnosis, especially in patients who have been referred from peripheral hospitals where generous antibiotic therapy has been instituted. We also recommend undertaking a preoperative split renal scintigraphy where available, especially when nephrectomy is considered

Apparent rarity of asymptomatic herpes cervicitis in a woman with intra-uterine contraceptive device

Infection with genital herpes simplex virus (HSV) remains a common viral sexually transmitted disease, often subclinical and a major worldwide problem of women of reproductive age group. Herpes cervicitis is an unusual presentation of Herpes simplex virus infection in females. The finding of herpes cervicitis on routine pap smear of an asymptomatic woman on Intrauterine contraceptive device still further supports the need for increased awareness on the possibility of Herpes simplex virus infection among women, particularly those on Intrauterine contraceptive device. The index case is a 28 years old Nigerian female who was referred to our Special Treatment Clinic on account of an abnormal pap smear cytology which was in keeping with Herpes cervicitis. There was no history of genital ulcer in this patient; however ELISA for HSV 2 IgM was positive in her. We therefore describe a case of herpes cervicitis in an asymptomatic woman on intrauterine contraceptive device. This case highlights to clinicians the need to be aware of the possibility of this association and to carry out relevant investigations so as to identify and treat these patients appropriately. Therefore, there is a need to put in place adequate public health intervention strategy to prevent genital herpes in women of reproductive age group with a view to preventing the possibility of congenital herpes in subsequent pregnancy

Socio-demographic and biologic characteristics of the 1133 women in the study.

<p><b>*HIV positive women only.</b></p

Relationships between HIV and HIV related variables and squamous intraepithelial lesion (SIL) and high grade squamous intraepithelial lesion (HSIL) after controlling for confounders in a multivariate logistic regression models.

a<p>Age groups: 18–35 and ≥35 (ref) years;</p>b<p>Marital status: Married and unmarried (ref);</p>c<p>Age at first intercourse: <20 (ref) and ≥20 years;</p>d<p>Life time sexual partner: 1 (ref) and ≥2;</p>e<p>Antiretroviral drug use: Yes(ref) and No.</p><p><b>*HIV positive women only.</b></p

The relationship between sociodemographic and biological variables and cervical smear status.

<p><b>*HIV positive women only; SIL: Squamous Intraepithelial lesion; HSIL: High grade Squamous Intraepithelial lesion.</b></p

Evaluation of direct visual inspection of the cervix in detecting cytology diagnosed squamous intraepithelial lesion in women of known HIV status. A randomized trial (CANHIV study)

A two-arm, open label, randomized study, evaluated the test characteristics of visual inspection of cervix with Acetic acid (VIA) and Lugol’s Iodine (VILI) in detecting cytology diagnosed squamous intraepithelial lesion (SIL) in 1160 women of known HIV status in southwestern Nigerian. Using SIL as reference standard and the HIV status masked, VIA and VILI had similar test characteristics except for the positive predictive value in which VIA value of 91.5% was significantly higher than 77.7% for VILI (p=0.01). Among HIV positive women, VILI performed poorly across all the 4 test characteristics compared to VIA. Among severely immuno-compromised HIV positive participants VILI performance was consistently below 80% across all test characteristics (sensitivity-70.0%; specificity-66.9%; positive predictive value-46.7%; negative predictive value (NPV) -50.0%) compared to VIA (Senstivity-71.3%; specificity-88.2%; positive predictive value-83.3%; negative predictive value-88.2). Our study shows that VILI is insufficiently sensitive and specific in the presence of HIV infection especially in those with severe immunosuppression. Based on VIA’s acceptable sensitivity and NPV in all situations, it is recommended for cervical cancer screening in HIV positive women and in settings of high HIV burden

Concurrent femoral neck fractures following pelvic irradiation: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fracture of the neck of the femur is common in older people. It often occurs in a single hip, with osteoporosis being the most common cause. Sometimes this fracture may also occur following pelvic irradiation, though this is not common. To the best of our knowledge, we present the first reported case in Nigeria of concurrent bilateral fractures of the femoral neck following pelvic irradiation.</p> <p>Case presentation</p> <p>A 74-year-old Nigerian woman presented at our surgical outpatients department with a 5-month history of pain in both hips and a 4-month history of inability to walk. She had had pelvic irradiation for carcinoma of the cervix 2 years earlier. Pelvic radiographs confirmed bilateral subcapital neck fractures.</p> <p>Conclusion</p> <p>Patients with hip pain who have been treated with pelvic irradiation should be thoroughly investigated for hip fractures.</p