Current clinical presentation of malaria in Enugu, Nigeria

This study examined the malaria situation in a malarial endemic area of Nigeria. Structured questionnaire was applied to 300 doctors practising in Enugu urban, Nigeria and confirmation of the clinical diagnosis by laboratory technique was done using 468 patients. The result shows a high prevalence of Plasmodium falciparum infection (96.4% in children, 87.0% in adults). Malaria positivity rate was 51.9% in children and 42.8% in adults. Fever, vomiting and anorexia were the commonest malaria symptoms in children, while headache, fever, chills and rigors were the commonest malaria symptoms in adults. The diagnostic practice of the doctors was clinical. Fever, vomiting and cough were found to be more associated with malaria parasitaemia in children, while in adults fever was found to be more associated with malaria parasitaemia. Chloroquine and sulphadoxine-pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria.     

宫颈癌的青年化与早期发现

目的:探讨年轻宫颈癌患者(≤35岁)发病情况和宫颈癌的筛查方法.方法:回顾分析221例宫颈癌病例及用阴道、子宫颈、宫颈管(Vagina, cervix, endocervix,VCE)三步取材加TBS (The bathesda system,TBS)分类法门诊筛查宫颈癌或宫颈上皮内瘤变(Cervical intraepithelial neoplasia,CIN)患者.结果:宫颈癌患者的发病年龄已由1975-1984年间(54.3±9.5)岁下降到现在的(42.2±9.4)岁(P<0.005).年轻宫颈癌患者(≤35岁)的构成比从1975-1984年间的4.8%升至目前的34.1%(P<0.005).84.1%的年轻患者为0～Ⅱa期.在门诊对年轻宫颈疾病患者筛查中发现意义不明非典型鳞状上皮细胞增生20例,低度鳞状上皮内瘤样增生30例,高度鳞状上皮内瘤样增生20例,宫颈鳞癌19例和宫颈腺癌2例,并经活组织病理学检查所证实.结论:宫颈癌患者发病年龄呈明显的年轻化趋势;VCE加TBS能有效地诊断CIN和宫颈癌.     

Profile and retrospective analysis of the use of preventive strategies in patients with cervical cancer in South-South Nigeria

Background:

Cervical cancer is the commonest malignancy of the female genital tract in developing countries, with a global burden of 530,000 new cases annually. This study aims to review the current situation of this important malignancy and to assess the previous use of preventive measures in patients with cervical cancer at the Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria.

Materials and Methods:

This was a retrospective review of all cases of cervical cancer managed at the UPTH, Port Harcourt, Nigeria, between 1 January 2008 and 31 December, 2012.

Results:

The prevalence of cervical cancer was 3.53% of all gynaecological admissions. The peak age of incidence was 50-59 years, accounting for 40% of the study population. Women with high parity contributed to 93.3% of the study population. Early coitarche was observed in 78.7% and a history of multiple sexual partners in 65.3%. Vaginal bleeding was the commonest clinical feature seen in all the women studied, followed by pelvic pain in 84% of cases. Advanced-stage cervical cancer was seen in 93.4%. None of the women studied had been previously vaccinated against human papilloma virus (HPV), and only 1.3% had had any form of screening methods for early detection of cervical cancer.

Conclusion:

Cervical cancer remains an important cancer in our environment, and late presentation with advance disease is still the norm despite advances in screening and preventive modalities. The reason for this is buttressed on the finding that despite the availability of these preventive strategies, women in the South-South of Nigeria did not partake of these measures. There is an urgent need to develop programmes to re-sensitise women on the need for screening and vaccination to reduce cancer-associated morbidity and mortality in Port Harcourt, South-South Nigeria.     

Integrating cervical cancer screening with HIV care in a district hospital in Abuja,Nigeria

Background:

Human immunodeficiency virus positive (HIV+) women have a higher risk of developing invasive cervical cancer compared with uninfected women. This study aims to document programmatic experience of integrating cervical cancer screening using Visual Inspection and Acetic Acid (VIA) into HIV care as well as to describe patients’ characteristics associated with positive VIA findings amongst HIV+ women.

Materials and Methods:

A cross-sectional study analysed routine service data collected at the antiretroviral therapy (ART) and cervical cancer screening services. Our program integrated screening for cervical cancer using VIA technique to HIV care and treatment services through a combination of stakeholder engagement, capacity building for health workers, creating a bi-directional referral between HIV and reproductive health (RH) services and provider initiated counselling and screening for cervical cancer. Information on patients’ baseline and clinical characteristics were captured using an electronic medical records system and then exported to Statistical Package for the Social Sciences (SPSS). Logistic regression model was used to estimate factors that influence VIA results.

Results:

A total of 834 HIV+ women were offered VIA screening between April 2010 and April 2011, and 805 (96.5%) accepted it. Complete data was available for 802 (96.2%) women. The mean age at screening and first sexual contact were 32.0 (SD 6.6) and 18.8 (SD 3.5) years, respectively. VIA was positive in 52 (6.5%) women while 199 (24.8%) had a sexually transmitted infection (STI). Of the 199 who had a STI, eight (4.0%) had genital ulcer syndrome, 30 (15.1%) had lower abdominal pain syndrome and 161 (80.9%) had vaginal discharge syndrome. Presence of lower abdominal pain syndrome was found to be a significant predictor of a positive VIA result (P = 0.001). Women with lower abdominal pain syndrome appeared to be more likely (OR 47.9, 95% CI: 4.8-480.4, P = 0.001) to have a positive VIA result.

Conclusion:

The high burden of both HIV and cervical cancer in developing countries makes it a necessity for integrating services that offer early detection and treatment for both diseases. The findings from our study suggest that integrating VIA screening into the package of care offered to HIV+ women is feasible and acceptable.     

Knowledge,attitude and practice of cervical cancer screening among market women in Zaria,Nigeria

Background:

Cervical cancer is the most common genital cancer and one of the leading causes of death among female population. Fortunately, this cancer is preventable by screening for premalignant lesions but this is rarely provided and hardly utilised. We assessed the knowledge, attitude and utilisation of cervical cancer screening among market women in Sabon Gari, Zaria.

Materials and Methods:

This was a cross-sectional study to evaluate the knowledge, attitude and practice of cervical cancer screening among market women. A total of 260 women were administered with questionnaires which were both self and interviewer administered. These were analysed using SPSS version 11.

Results:

Respondents exhibited a fair knowledge of cervical cancer and cervical cancer screening (43.5%); however, their knowledge of risk factors was poor. There was generally good attitude to cervical cancer screening (80.4%), but their level of practice was low (15.4%).

Conclusions:

There was a fair knowledge of cervical cancer and cervical cancer screening among Nigerian market women in this study, their practice of cervical cancer screening was poor.     

Cervical cancer in Calabar, Nigeria

Objective: To assess the prevalence of cervical cancer and histologic variants as seen in Calabar,Cross River state.Methods: This is a retrospective study involving histologically verified uterine cervix carcinoma between January,1997 and December,2006.Results: There were 1,207 malignancies diagnosed during the study period;175(14.5%) were malignancies of the genital tract while 113(9.4.0%) were carcinoma of the cervix constituting 64.6% of female genital malignancies.Cervical cancer was commonest between the ages of 40-59 years.There was no patient with carcinoma of the cervix below the age of 20 years.Squamous cell carcinoma(87.6%) of the uterine cervix was the main histological type.Conclusion:Cervical cancer is still the most common female genital tract malignancy in Calabar with most of these patients in their middle age.The use of PAS/Alcian blue stain as was used in this study eliminates most false-positive squamous cell carcinomas compared with Haematoxylin and Eosin stains used in most reports from most centres in this part of the world.Epithelial malignancies continue to be the predominant histological variant with squamous cell variety the commonest.There is also an urgent need for introduction of efficient and affordable population based cervical screening programme for early detection,use of vaccines against Human Papilloma Virus(HPV) and treatment of pre-malignant cervical lesions.     

宫颈刮片脱落细胞学检查在宫颈癌普查中的作用

目的:探讨宫颈刮片脱落细胞学检查在宫颈癌筛查中的作用。方法:回顾性分析行宫颈刮片脱落细胞学检查的5 801例妇女临床资料,分析宫颈刮片脱落细胞学检查结果异常受检者的病理学诊断结果以及各年龄段受检者宫颈病变的情况。结果:5 801例中,2 799例未见核异质细胞,2 914例有轻度核异质细胞,88例有轻度不典型增生细胞。其中45~55岁年龄段受检者检查异常率最高,为1.79%（61/3 413）。80例为轻度不典型增生细胞,5例为重度不典型增生细胞,3例发现癌细胞。88例宫颈刮片脱落细胞学检查异常的受检者中,发生宫颈上皮内瘤变的有13例。结论:宫颈刮片脱落细胞学检查是宫颈癌普查的首选方法,可早期发现宫颈癌癌前病变,有利于早期实施干预,降低宫颈癌的患病率。     

紫杉醇在子宫颈癌及子宫内膜癌治疗中的应用

目的探讨紫杉醇在子宫颈癌以及子宫内膜癌治疗中的应用效果。方法选取2005年7月-2012年7月入住我院的经临床诊断为子宫颈癌以及子宫内膜癌患者180例,其中子宫颈癌患者数为100例,子宫内膜癌患者数为80例。将上述两组患者随机分为对照组与观察组,对照组患者给予（40～60）mg/m2静脉滴注阿霉紊,观察组患者于化疗前的6、12h预防性给予20mg地塞米松,然后使用紫杉醇注射液0．5h静脉滴注,对比两组患者不同病理类型的缓解率。结果子宫颈癌组：对照组与观察组两组患者的缓解率分别为52．0％、94．0％,差异有高度统计学意义（P〈0．01）。子宫内膜癌组：对照组与观察组两组患者的缓解率分别为67．5％、85．0％,差异有统计学意义（P〈0．05）。结论紫杉醇注射液在子宫颈癌以及子宫内膜癌的临床治疗之中的疗效显著,值得在临床上加以推广并应用。     

子宫颈酸性磷酸酶在子宫颈癌早期诊断中的应用

目的:探讨子宫颈酸性磷酸酶(cervical acid phosphatase,CAP)在子宫颈癌早期诊断中的意义。方法:用Mark-PAP试剂盒免疫组织化学染色法检测CAP蛋白在350例行常规妇科体检子宫颈组织细胞中的表达,细胞内出现红色沉淀即为CAP阳性,并与液基薄层细胞检测(TCT)确诊结果进行比较。结果:CAP在子宫颈癌患者组织细胞中阳性表达,而正常的子宫颈上皮细胞及炎症细胞中无CAP表达,CAP检测结果与TCT检测确诊结果一致。结论:CAP在子宫颈癌早期诊断中可能具有指导意义。     

Problems in determining the incidence of cervical cancer

Since cancer registries have different recording practices, the incidence rates that they report must be compared with caution. Indexes of reliability of recording indicated that in 1971 the reported incidence of cervical cancer in Ontario was too high. In 1971 Ontario used a method of passive reporting of cancer cases: the Ontario Cancer Registry linked hospital reports, death certificates and reports from the Ontario Cancer Treatment and Research Foundation's treatment centres to produce a single record for each case. Pathological confirmation was requested for cases thus recorded by the registry. In 26% of cases a diagnosis other than cervical cancer was indicated. With these cases omitted, the incidence rate became 15.1/100 000, as opposed to the 20.5/100 000 reported by the registry.     

子宫颈糜烂与子宫颈癌发病率的相关性研究

目的 探讨子宫颈糜烂与子宫颈癌发病率的相关性,为早期预防与干预提供参考.方法 选择广西壮族自治区桂东人民医院2012年3月至2013年3月660例妇科门诊子宫颈糜烂女性作为研究组,同时选择300名宫颈光滑的健康体检者作为对照组,均进行子宫颈液基细胞检查,观察两组CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌的发生率.结果 宫颈液基细胞学检查（TCT）结果显示,研究组阳性96例,阳性率为14.55％;对照组阳性38例,阳性率为12.67％;两组阳性率及各分组（CIN Ⅰ、CINⅡ、CINⅢ及宫颈癌）之间差异无统计学意义（P＞0.05）.进一步行阴道镜检查,研究组宫颈癌前病变49例,占阳性总数的51.04％,宫颈癌变3例,占阳性总数的3.13％;对照组宫颈癌前病变20例,占阳性总数的52.63％,宫颈癌变1例,占阳性总数的2.63％;两组比较差异均无统计学意义（P＞0.05）.结论 子宫颈糜烂与子宫颈癌发病率无明显的相关性.     

FHIT基因在子宫颈癌及上皮内瘤样病变中的表达

目的：研究FHIT基因在子宫颈癌和子宫颈上皮内瘤样病变（CIN）中的表达,探讨其与子宫颈癌发生和转移的关系。方法：采用免疫组化SP法检测35例宫颈癌,39例CIN,16例正常子宫颈组织标本中FHIT蛋白的表达,并分析其与子宫颈癌发生及与子宫颈癌的病理类型、组织学分级、临床分期及淋巴结转移的关系。结果：FHIT蛋白在正常宫颈、CIN及子宫颈癌 组织中均有表达,其表达率正常宫颈组织高于CIN和子宫颈癌组织（P<0.01）,CIN组织中高 于宫颈癌组织（P<0.01）;FHIT蛋白在CIN组织中的表达率高于宫颈鳞癌组织（P<0.01） ,在宫颈腺癌组织中的表达率高于鳞癌组织（P<0.05）,在有淋巴结转移组的表达率高于 无淋巴结转移组（P<0.01）;FHIT蛋白在各级CIN组织中、不同组织学分级的宫颈癌组织中及不同临床分期的宫颈癌组织中的表达差异无显著性 (P>0.05)。结论：FHIT基因与宫颈癌的发生和演进有关,可以作为临床监测CIN病变转归和判断子宫颈癌预后的参考依据。     

Prevention of cervical cancer

Cervical screening in Australia is a successful public health initiative. Since the introduction of the National Cervical Screening Program in 1991, there has been a significant fall in incidence of and mortality from cervical cancer. Laboratory quality procedures are critical to ensuring optimal outcomes. Laboratory accreditation procedures are being reviewed in line with recent government recommendations. For a sustainable program, cost-containment issues need to be considered; screening interval, management of screen-detected abnormalities, and new technologies are the critical drivers of cost.     

宫颈癌低氧放疗的疗效分析

目的 探讨宫颈癌低氧放疗的临床应用价值。方法 １９９５－０２／１９９８－０６,８０例宫颈癌随机分为低氧放疗组和常规放疗组各４０例。两组均采用腔内照射与外照射相结合的方法,腔内照射剂量４０￣５０Ｇｙ／８￣１０ｗｋ,体外照射剂量５０Ｇｙ／６￣８ｗｋ。低氧组佩戴低氧呼吸装置（相当于呼吸含氧量为１０．５％的侈氧气体）。结果 低氧组和常规放射治疗组的肿瘤完全缓解（ＣＲ）、部分缓解（ＰＲ）、无效应（ＮＲ）分别     

Downstaging of cervical cancer

Globally cervical cancer is the fifth most common cancer and of estimated 460,000 new cases each year three quarters occur in developing countries. In India annually 16% of the world's total cases occur and only 5% are reported in the early stages. Downstaging is defined as a process of screening for cancer using clinical approaches for early detection of this disease. This is distinct from screening test and results in detection of the disease at a less advanced stage in the absence of screening. This experimental approach is applicable in developing countries where cytological screening is not possible in the near future. In this method paramedical staff trained for minimum period will be able to identify any abnormality including suspicious cervix and refer the case early to centres where facilities exist for treatment of premalignant and malignant lesions, including educating the women regarding risk factors, symptoms of the disease and prophylaxis. This experimental methodology recommended by WHO for developing countries like India has to be evaluated by monitoring various ongoing projects where visual inspection screening method is used. The results are collected which include feasibility, compliance, costing, referral methodology, difficulties in implementation, specificity, sensitivity, positive predictive value and drawbacks. The methodology of visual inspection and modified aided visual inspection, frequency and results of various studies in the Indian scenario is for recommendation of downstaging in MCH care. This is to be implemented in rural areas taking into consideration their cultural background and available infrastructure since cytology screening is not possible to cover even 20% of the existing cases in the near future.     

乳腺癌组织中人宫颈癌基因的表达与预后的相关性

[目的]观察人宫颈癌基因(HCCR)的过度表达对评估乳腺癌患者预后的意义.[方法]选择105例因浸润性导管癌而行手术患者的肿瘤组织标本,采用免疫组织化学染色方法观察标本中HCCR、雌激素受体(ER)及孕酮受体(PR)的表达情况,分析HCCR表达与各组织学等级的关系、与ER,PR的相关性及与患者生存时间和生存率的相关性.[结果]105例乳腺癌患者中HCCR阳性表达率为26.7%.HCCR表达与临床分期、核异型性等级、核分裂、组织学等级及ER,PR表达均无相关关系.尽管呈HCCR的染色范围越广,患者的10年生存率越高的趋势,但无统计学意义.[结论]尚不能确定HCCR是乳腺癌的预后因子.