Controversy about embryogenesis and organisation of human female urethra: A review

Objective: To assess current knowledge on development and associated structures.Data sources: Current scientific publications in the pubmed data base on the development of human female urethra were reviewed. The embryology of human female urethra and its associated structures is presented.Study selection: The following search words: urethra development, female urethra development, and male urethra development were used.Data extraction: The first 100 publications from urethra development search and thereafter 100 publications excluding those in the first search were reviewed to determine whether they described development of female urethra.Data synthesis: There are limited studies describing the formation of female urethra. Unlike male urethra, female urethra does not undergo masculinisation meaning there is no formation of clitoral urethra. Like the male urethra, there are female urethra associated glands whose presence and functions remain speculative. Female urethra associated structures including Skene’s glands also referred to as female prostate, corpus spongiosum of female urethra and what has been described as the G-Spot may all be congenital malformations considering that they are not uniformly present.Conclusions: Female urethra development differs from that of males though there are some similarities. Studies to elucidate the development of female urethra are needed to clarify some of the misconceptions and to provide embryological explanation of gross and histological features of female urethra

Directional asymmetry in handedness and hand efficiency

Several studies analyse anthropometric dimensions of the hands, but few look at how they influence hand performance or hand efficiency. In this analytic cross-sectional study conducted amongst 162 preclinical medical students, directional asymmetry was evaluated in relation to hand preference and hand efficiency in order to determine whether it can be used as an indicator for outcomes of hand dominance. Directional asymmetry (DA) was established by calculating differences in the mean hand measurements and the mean hand volumes. Hand preference was assessed using the modified Edinburgh Handedness Inventory, and handedness categories determined by applying the Geschwind Score. Hand dominance was categorized from the laterality score obtained from differences between left and right hands. Differences in hand dimensions were evaluated in relation to hand preference and hand efficiency. An apparent similarity in the morphology of the hands was suggested by the highly positive statistically significant result in the paired samples correlation test across all the parameters (p < 0.001). A positive association (not statistically significant) was noted between the handedness categories and the demonstrated directional asymmetry. No gender disparity was found in the relationship between DA and Hand efficiency by grip strength testing. The EHI-GS hand preference category positively indicated the preferred hand but did not on its own designate hand dominance or hand proficiency. Notwithstanding the gender, EHI-GS handedness neither predicted DA nor hand efficiency. Similarly, neither EHI-GS hand preference nor hand efficiency by grip strength testing could predict DA in males and females alike. Key words: Hand performance, Hand proficiency, Hand dominance, Grip strength testing, Lateralit

Elastic Fibre System in the Shaft of Adult Human Penis

Elastic fibres play a central role in functioning of the penis. Detailed animal studies have quantified elastic and collagen fibre content in rat and rabbit penis. Though rabbit model is similar to human penis, it is important to determine whether findings in rabbits are reproducible in humans. To determine the distribution and volumetric density of elastic fibres in the corpus cavernosum (CC), corpus spongiosum (CS) and tunica albuginea (TA) of the shaft of adult human penis. Male cadaveric specimens from penile mid-shaft were obtained and processed routinely for histological studies using Weigert’s resorsin fuchsin stain. CC TA has an external longitudinal and inner circular layer. Buck’s fascia has principally  longitudinal elastic fibres. There are multiple blood vessels in CC, CS and TA. Elastic fibres are abundant in the mid-shaft of human penis. The highest volumetric density of elastic fibres is found in the CS (40%). The elastic fibres in the CS are mainly longitudinal in orientation. There is an elaborate elastic fibre meshwork in the sub-mucosal layer of urethral epithelium, surrounding para-urethral glands and blood vessels found in the midshaft of human penis. Elastic fibre content in the human CS of the urethra is higher than in CC and TA. Their concentrations around the sub-mucosal zone of the urethra epithelium suggest these fibres may have an important role in the function of urethra both for ejaculation and  passage of urine.Key words: Elastic fibres, Penis, Corpus Cavernosum, Corpus spongiosum

CD4 T-Lymphocyte Subsets in Women with Invasive Cervical Cancer in Kenya

Objective: Invasive cervical cancer (ICC) and HIV are common in  sub-Sahara Africa. Both ICC and HIV are immunosuppressive, and are associated with decreased CD4 and CD8 profiles. In a group of women with ICC starting radiotherapy, we determined their CD4 profiles.Design: A cross-sectional study.Settings: Kenyatta National Hospital, Nairobi, Kenya, radiotherapy unit.Subjects: Women with invasive cervical cancer (344) seeking radiotherapy treatment for the first time between January 2000 and March 2003, had blood samples analyzed for CD4 and CD8 cell counts by flow cytometry. Haemoglobin, white cell count, lymphocyte and platelet counts were determined using coulter machine. All patients had received pre- and post HIV counseling.Results: The mean age was 49+13 years. About 13.1% of the women with ICC were HIV positive. Overall, mean and median CD4 cell count was 829+355 cells/mm3 and 792 cells/mm3. Among HIV+ patients, mean and median CD4 cell counts were 451+288 cells/mm3 and 405 cells/mm3 respectively. The mean CD4 cell count for the HIV+ women was 886+329 cells/mm3 with median of 833 cells/mm3, range 147-2065 cells/mm3.Only nine (20%) of the 45 HIV+ women had CD4 cell count of 0-200. HIV+ women had lower CD4 percentage and cell count and higher CD8 percentage and cell count as compared to HIV negative women, p < 0.001. HIV infection was significantly and independently associated with high proportion of women who had CD4 cell count of less than 200 cells/mm3 or less than 350 cells/mm3, p < 0.0001.Conclusions: Women with ICC and concurrent HIV infection have decreased CD4 cell subset. These results suggest HIV infection may be associated with more severe CD4 depletion in women with ICC

Castration causes progressive reduction of length of the rabbit penis

Androgenic hormones are important in normal embryonic development and maintenance of the structural integrity of the penis. This structural integrity is vital in the physiology of penile erection. Its alteration may therefore lead to functional impairment resulting in erectile dysfunction as seen in hypogonadic conditions. The link between hypogonadism and erectile dysfunction is partly anatomical, involving alteration of normal structural elements of the penis such as smooth muscle cells, connective tissue fibers and vascular sinusoids. The penile length, although considered controversial issue, may also be influenced by such tissue alterations. Understanding of the alterations of the penile size in hypogonadism is important in clinical examination of hypogonadic patients. The aim of this study was to describe the changes in the rabbit penile length after castration. Fifteen adult male rabbits were used for the study. Nine of these were castrated under local anesthesia to induce hypogonadism and six remained as controls. The penile lengths were measured using a digital Vernier caliper (accuracy 0.5mm). There was progressive reduction in the average non-erect penile length by 0.7%, 3.4% and 8.7% in the castrated group at the end of the third, sixth and ninth week respectively. Castration causes progressive reduction in the non-erect penile length. Such length reduction may impair the normal penile physiology hence contribute to anatomical basis of erectile dysfunction in hypogonadism.Keywords: Hypogonadism, penile lengt

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

Prevalence of trachoma in six districts of Kenya

Objectives: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachomaendemic districts in Kenya. Design: Community based survey. Setting: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North).Subjects: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. Results: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North).Conclusions: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.East African Medical Journal Vol. 83(4) 2006: 63-6

Regulating pharmacists as contraception providers: a qualitative study from Coastal Kenya on injectable contraception provision to youth

Introduction Young people worldwide are often reticent to access family planning services from public health facilities: instead, they choose to get contraception from private, retail pharmacies. In Kenya, certain contraceptives are available in pharmacies: these include injectables, which can be dispensed but not administered, according national guidelines. However, Kenya struggles with enforcement of its pharmacy regulations and addressing illegal activity. Therefore, in this qualitative study, we assessed private pharmacies as an existing source of injectable contraception for young Kenyans (age 18–24), and investigated the perceived quality of service provision. Methods This study used: focus group discussions (6) with young community members; in-depth interviews (18) with youth who had purchased contraception from pharmacies; key informant interviews with pharmacy personnel and pharmacy stakeholders (25); and a mystery shopper (visiting 45 pharmacies). Results The study found that for injectable contraception, private pharmacies had expanded to service provision, and pharmacy personnel’s roles had transcended formal or informal training previously received–young people could both purchase and be injected in many pharmacies. Pharmacies were perceived to lack consistent quality or strong regulation, resulting in young clients, pharmacy personnel, and regulators being concerned about illegal activity. Participants’ suggestions to improve pharmacy service quality and regulation compliance focused on empowering consumers to demand quality service; strengthening regulatory mechanisms; expanding training opportunities to personnel in private pharmacies; and establishing a quality-based ‘brand’ for pharmacies. Discussion Kenya’s recent commitments to universal health coverage and interest in revising pharmacy policy provide an opportunity to improve pharmacy quality. Multi-pronged initiatives with both public and private partners are needed to improve pharmacy practice, update and enforce regulations, and educate the public. Additionally, the advent of self-administrable injectables present a new possible role for pharmacies, and could offer young clients a clean, discreet place to self-inject, with pharmacy personnel serving as educators and dispensers

Changes in context, typology and programme outcomes between early and recent periods of sex work among young female sex workers in Mombasa, Kenya: a cross-sectional study

INTRODUCTION: The sex work context and typology change continuously and influence HIV related risk and vulnerability for young female sex workers (YFSW). We sought to describe changes in the context and typology of sex work between the first (early) and past month (recent) of sex work among YFSW to inform HIV prevention programming for sex workers. METHODS: We used data from a cross-sectional survey (April-November 2015), administered using physical location-based sampling to 408 cis-women, aged 14-24 years, who self-identified as sex workers, in Mombasa, Kenya. We collected self-reported data on the early and recent month of sex work. The analysis focused on changes in a) sex work context and typology (defined by setting where sex workers practice sex work) where YFSW operated, b) primary typology of sex work, and c) HIV programme outcomes among YFSW who changed primary typology, within the early and recent month of sex work. We analysed the data using a) SPSS27.0 and excel; b) bivariate analysis and χ2 test; and c) bivariate logistic regression models. RESULTS: Overall, the median age of respondents was 20 years and median duration in sex work was 2 years. Higher proportion of respondents in the recent period managed their clients on their own (98.0% vs. 91.2%), had sex with >5 clients per week (39.3% vs.16.5%); were able to meet > 50% of living expenses through sex work income (46.8% vs. 18.8%); and experienced police violence in the past month (16.4% vs. 6.5%). YFSW reported multiple sex work typology in early and recent periods. Overall, 37.2% reported changing their primary typology. A higher proportion among those who used street/ bus stop typology, experienced police violence, or initiated sex work after 19 years of age in the early period reported a change. There was no difference in HIV programme outcomes among YFSW who changed typology vs. those who did not. CONCLUSIONS: The sex work context changes even in a short duration of two years. Hence, understanding these changes in the early period of sex work can allow for development of tailored strategies that are responsive to the specific needs and vulnerabilities of YFSW

Survival of cervical cancer patients at Moi teaching and Referral Hospital, Eldoret in western Kenya

Background Cervical cancer is a major health burden and the second most common cancer after breast cancer among women in Kenya. Worldwide cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are greatest among the low-income countries because of lack of awareness, screening and early-detection programs and adequate treatment facilities. The main aim was to estimate survival and determine survival predictors of women with cervical cancer and limited resources in western Kenya. Methods Retrospective charts review of women diagnosed with cervical cancer and follow-up for two years from the date of the histologic diagnosis. The outcome of interest was death or survival at two years. Kaplan Meier estimates of survival, log-rank test and Cox proportional hazards regression were used in the survival analysis. Results One hundred and sixty-two (162) participants were included in the review. The median duration was 0.8 (interquartile range (IQR) 0.3, 1.6) years. The mean age at diagnosis was 50.6 years (SD12.5). The mean parity was 5.9 (SD 2.6). Fifty percent (50%) did not have health insurance. Twenty six percent (26%) used hormonal contraceptives, 25.9% were HIV positive and 70% of them were on anti-retroviral treatment. The participants were followed up for 152.6 person years. Of the 162 women in the study, 70 (43.2%) died giving an overall incidence rate (IR) of 45.9 deaths per 100 person years of follow up. The hazard ratios were better for the patients who survived (0.44 vs 0.88, p-value \u3c 0.001), those who had medical insurance (0.70 vs 0.48, p-value = 0.007) and those with early stage at diagnosis (0.88 vs 0.39, p-value \u3c 0.001). Participants who were diagnosed at late stage of the disease according to the International Federation of Gynecology and Obstetrics staging for cervical cancer (FIGO stage 2B-4B) had more than eight times increased hazard of death compared to those who were diagnosed at early stage (1-2A): Hazard Ratio: 8.01 (95% CI 3.65, 17.57). Similarly, those who underwent surgical management had 84% reduced hazard of mortality compared to those who were referred for other modes of care: HR: 0.16 (95% CI: 0.07, 0.38). Conclusion: Majority of the participants were diagnosed late after presenting with symptoms. The 1 and 2-year survival probability after diagnosis of cervical cancer was 57% AND 45% respectively. It is imperative that women present early since surgery gives better prognosis or better still screening of all women prioritized