A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis

publishedVersio

Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract

BACKGROUND: Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. METHODS: Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). RESULTS: FGS was associated with a higher frequency of CD14 + cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4 + cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14 + cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). CONCLUSIONS: The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this

The Association Between Female Genital Schistosomiasis and Other Infections of the Lower Genital Tract in Adolescent Girls and Young Women: A Cross-Sectional Study in South Africa

This study aimed to explore the relationship between female genital schistosomiasis (FGS), sexually transmitted infections, bacterial vaginosis, and yeast among young women living in Schistosoma haematobium-endemic areas. In a cross-sectional study of young women, sexually active, aged 16 to 22 years in rural KwaZulu-Natal, South Africa, in 32 randomly selected rural schools in schistosomiasis-endemic areas, the authors performed gynecological and laboratory investigations, diagnosed FGS and other infections, and did face-to-face interviews.publishedVersio

Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa.

BACKGROUND: Urine microscopy is the standard diagnostic method for urogenital S. haematobium infection. However, this may lead to under-diagnosis of urogenital schistosomiasis, as the disease may present itself with genital symptoms in the absence of ova in the urine. Currently there is no single reliable and affordable diagnostic method to diagnose the full spectrum of urogenital S. haematobium infection. In this study we explore the classic indicators in the diagnosis of urogenital S. haematobium infection, with focus on young women. METHODS: In a cross-sectional study of 1237 sexually active young women in rural South Africa, we assessed four diagnostic indicators of urogenital S. haematobium infection: microscopy of urine, polymerase chain reaction (PCR) of cervicovaginal lavage (CVL), urogenital symptoms, and sandy patches detected clinically in combination with computerised image analysis of photocolposcopic images. We estimated the accuracy of these diagnostic indicators through the following analyses: 1) cross tabulation (assumed empirical gold standard) of the tests against the combined findings of sandy patches and/or computerized image analysis and 2) a latent class model of the four indicators without assuming any gold standard. RESULTS: The empirical approach showed that urine microscopy had a sensitivity of 34.7% and specificity of 75.2% while the latent class analysis approach (LCA) suggested a sensitivity of 81.0% and specificity of 85.6%. The empirical approach and LCA showed that Schistosoma PCR in CVL had low sensitivity (14.1% and 52.4%, respectively) and high specificity (93.0% and 98.0, respectively). Using LCA, the presence of sandy patches showed a sensitivity of 81.6 and specificity of 42.4%. The empirical approach and LCA showed that urogenital symptoms had a high sensitivity (89.4% and 100.0%, respectively), whereas specificity was low (10.6% and 12.3%, respectively). CONCLUSION: All the diagnostic indicators used in the study had limited accuracy. Using urine microscopy or Schistosoma PCR in CVL would only confirm a fraction of the sandy patches found by colposcopic examination

Association of urogenital symptoms with history of water contact in young women in areas endemic for <i>S. haematobium</i>:a cross-sectional study in rural South Africa

Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16–22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p &lt; 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p &lt; 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis

Verdien av en digital læringsressurs for realfagsstoff i 2. semester

This qualitative study seeks to answer whether the electronic learning resource «Nevrofysiologi», aimed at the first-year students of the Medical Doctor Degree at the University of Oslo, contributes to facilitate the learning of complex physiological mechanisms and whether it will be used by the students. The study was a usability test in the form of an interview combined with live interaction with the electronic learning resource in question. The subjects where selected from the 1st, 2nd and 3rd semesters. The results shows that this learning resource is very well structured but that not all of the animations are intuitive enough. The electronic learning resource needs to be well advertised for and the content has to be conceived of as relevant to the exam for the students to be motivated to use it

Bruk av støttestrømper i kombinasjon med heparin som tromboseprofylakse etter kolorektalkirurgi

Vi har valgt å skrive om bruken av støttestrømper i tillegg til heparin som et profylaktisk tiltak mot tromboemboliske hendelser hos pasienter som har gjennomgått kolorektalkirurgi. Vi utførte en survey på de gastrokirurgiske avdelingene ved Rikshospitalet, Diakonhjemmet og Asker og Bærum sykehus som viste at det er sprikende og inkonsistent bruk av støttestrømper postoperativt. Ingen av de spurte sykehusene hadde retningslinjer for bruk av støttestrømper for pasientene sine. Kunnskapsgrunnlaget er godt for at kombinasjonen av heparin og støttestrømper gir den beste profylaksen mot tromboemboliske hendelser etter kolorektalkirurgi. Vi har hovedsaklig basert oss på en systematisk review med meta-analyse1, som gir god evidens for dette. Tiltaket vårt for å øke bruken av denne kombinasjonen, innebærer etablering av en retningslinje som sier at pasienter som har gjennomgått kolorektalkirurgi, skal få heparin i kombinasjon med støttestrømper under det postoperative sykehusoppholdet. I tillegg har vi tenkt at det er hensiktsmessig å involvere både helsepersonellet (som den utøvende faktoren) og pasientene (som den mottakende faktoren) i denne prosessen ved å fokusere på informasjon, både muntlig og skriftlig. Tiltaket vil bli innført ved en trinnvis strategi hvor det administrative med innkjøp av strømper og informasjon rettet mot helsepersonellet kommer i første omgang. Deretter vil informasjon følge tiltaket gjennom hele forløpet, nå også rettet mot pasientene som skal bruke strømpene. Tiltakets effekt vil hele tiden måles med den valgte indikatoren (andelen pasienter som bruker støttestrømper), for deretter å vurderes mer helhetlig med en fokusgruppe som involverer helsepersonell og pasienter ved avdelingen. Målet med fokusgruppen blir å avdekke eventuelle problemer med organiseringen av tiltaket med mulighet for konkrete innspill til mulige endringer og videre tilrettelegging. Vi regner med at det vil kunne være motstand i startfasen av tiltaket, men at dette tross alt er et forholdsvis beskjedent tiltak som etterhvert vil bli godt innarbeidet i rutinene ved avdelingen. Tiltaket vi skisserer er ikke overveldende dyrt, og det er dokumentert et lavt number neaded to treat (NNT = 6). Sammenlignet med de ressursene som kan spares inn på at man sjeldnere vil se tromboemboliske hendelser i avdelingen, mener vi at det i høyeste grad vil være et kostnadseffektivt tiltak

Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa

Objectives It has been hypothesised that ectopy may be associated with increased susceptibility to sexually transmitted infections (STIs). In this cross-sectional study, we wanted to explore the association between STIs (including HIV) and cervical ectopy. Methods We included 700 sexually active young women attending randomly selected high schools in a rural district in KwaZulu-Natal, South Africa. The district is endemic of HIV and has a high prevalence of STIs. We did computer-assisted measurements of the ectocervical area covered by columnar epithelium (ectopy) in colposcopic images and STI analyses on cervicovaginal lavage and serum samples. All participating women answered a questionnaire about sexual behaviour and use of contraceptives. Results The mean age was 19.1 years. Ectopy was found in 27.2%, HIV in 27.8%, chlamydia in 25.3% and gonorrhoea in 15.6%. We found that age, parity, chlamydia and gonorrhoea, years since menarche, years since sexual debut and number of sexual partners were associated with ectopy. In multivariate analysis with chlamydia infection as the dependent variable, women with ectopy had increased odds of having chlamydia infection (adjusted OR 1.78, p=0.033). In women under 19 years of age, we found twofold higher odds of being HIV-positive for those with ectopy (OR 2.19, p=0.014). Conclusions In conclusion, cervical ectopy is associated with Chlamydia trachomatis infection and HIV in the youngest women