Cervical Cancer in Sub-Saharan Africa: A Multinational Population-Based Cohort Study of Care and Guideline Adherence

BackgroundCervical cancer (CC) is the most common female cancer in many countries of sub‐Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS).MethodsOur observational study covered nine population‐based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44–125 patients diagnosed from 2010 to 2016 were selected in each. Cancer‐directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines.ResultsOf 632 patients, 15.8% received CDT with curative potential: 5.2% guideline‐adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow‐up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline‐adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I–III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36–8.37; HRR, 1.97; CI, 0.59–6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19–12.71) and no CDT (HRR, 9.43; CI, 3.03–29.33) showed substantially worse survival.ConclusionWe found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one‐fifth and possibly up to two‐thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients.Implications for PracticeDespite evidence‐based interventions including guideline‐adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population‐based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub‐Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub‐Saharan Africa to access timely and high‐quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer‐directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource‐constrained circumstances.     

Immunogenicity and efficacy of immunodeficiency virus-like particles pseudotyped with the G protein of vesicular stomatitis virus

Vaccination with exogenous antigens such as recombinant viral proteins, immunodeficiency virus-derived whole inactivated virus particles, or virus-like particles (VLP) has generally failed to provide sufficient protection in animal models for AIDS. Pseudotyping VLPs with the vesicular stomatitis virus G protein (VSV-G), which is known to mediate entry into dendritic cells, might allow more efficient stimulation of immune responses. Therefore, we pseudotyped noninfectious immunodeficiency virus-like particles with VSV-G and carried out a preliminary screen of their immunogenicity and vaccination efficacy. Incorporation of VSV-G into HIV-1 VLPs led to hundred-fold higher antibody titers to HIV-1 Gag and enhancement of T cell responses in mice. Repeated vaccination of rhesus monkeys for 65 weeks with VSV-G pseudotyped simian immunodeficiency virus (SIV)-like particles (VLP[G]) provided initial evidence for efficient suppression of viral load after mucosal challenge with the SIVmac239 virus. Challenge of monkeys after a 28 week vaccination regimen with VLP[G] led to a reduction in peak viremia, but persistent suppression of viral load was not achieved. Due to limitations in the number of animals available for this study, improved efficacy of VSV-G pseudotyped VLPs in nonhuman primates could not be demonstrated. However, mouse experiments revealed that pseudotyping of VLPs with fusion-competent VSV-G clearly improves their immunogenicity. Additional strategies, particularly adjuvants, should be considered to provide greater protection against a challenge with pathogenic immunodeficiency virus.     

The Empiric Use of Palm Kernel Oil in Neonatal Skin Care： Justifiable or Not？

Palm kernel oil is a vegetable oil derived from Elaeis guineensis and widely used in neonatal settings for skin care.It is a good emollient with a beneficial effect in moisturizing the skin and preventing transdermal heat and water loss.However,it’s putative roles in the prevention or treatment of fatty acid deficiency is still controversial.So is its function in the improvement of neurological development from its long-chain polyunsaturated fatty acids? We set out in this review to verify whether its empiric use in this context has any scientific justification and is recommendable.Although there is evidence that it has emollient and moisturizing properties necessary for softening the skin and restoring elasticity,controversy subsists on its other nutritional and neurodevelopmental properties.     

Vaccination of infants aged 0 to 11 months at the Yaounde Gynaeco-obstetric and pediatric hospital in Cameroon: how complete and how timely?

Background

Vaccination is a major, but simple and cost effective public health intervention in the prevention of infectious diseases, especially in children. Nowadays, many children still miss scheduled vaccines in the Extended Program of Immunization (EPI) or are being vaccinated after the recommended ages.This study was aimed at assessing vaccination completeness and timeliness in children aged 0 to 11 months attending the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital.

Methods

This was an observational cross-sectional study over a period of 3 months (1st February to 30th April 2016). 400 mothers were interviewed and their children’s vaccination booklets analyzed. Information on the children and the parents was collected using a pretested questionnaire. Data analysis was done using SPSS version 20 software. Bivariate and multivariate analysis with logistic regression was done to assess the determinants of completeness and timeliness.

Results

A total of 400 mother-infant pairs were sampled. The vaccination completeness rate was 96.3%. This rate varied between 99.50% for BCG and 94.36% for IPV. Most of the children were born at the Yaounde Gynaeco-Obstetric and Pediatric hospital where they were regularly receiving their vaccines. The proportion of correctly vaccinated infants was 73.3%. The most differed vaccines were BCG, PCV13 and IPV. Factors influencing immunization completeness were the father’s profession and the mother’s level of education.

Conclusions

Despite the high immunization coverage, some children did not complete their EPI vaccines and many of them took at least one vaccine after the recommended age.

     

Phase III randomized,double-blind study of paclitaxel with and without everolimus in patients with advanced gastric or esophagogastric junction carcinoma who have progressed after therapy with a fluoropyrimidine/platinum-containing regimen (RADPAC)

The RADPAC trial evaluated paclitaxel with everolimus in patients with advanced gastroesophageal cancer (GEC) who have progressed after therapy with a fluoropyrimidine/platinum-containing regimen. Patients were randomly assigned to receive paclitaxel (80 mg/m²) on day 1, 8 and 15 plus everolimus (10 mg daily, arm B) d1-d28 or placebo (arm A), repeated every 28 days. Primary end point was overall survival (OS). Efficacy was assessed in the intention-to-treat population and safety in all patients who received at least one dose of treatment. This trial is registered with ClinicalTrials.gov , number NCT01248403. Between October 2011 and September 2015, 300 patients (median age: 62 years; median lines prior therapy: 2; 47.7% of patients had prior taxane therapy) were randomly assigned (arm A, 150, arm B, 150). In the intention to treat population, there was no significant difference in progression-free survival (PFS; everolimus, 2.2 vs placebo, 2.07 months, HR 0.88, P = .3) or OS (everolimus, 6.1 vs placebo, 5.0 months, HR 0.93, P = .54). For patients with prior taxane use, everolimus improved PFS (everolimus, 2.7 vs placebo 1.8 months, HR 0.69, P = .03) and OS (everolimus, 5.8 vs placebo 3.9 months, HR 0.73, P = .07). Combination of paclitaxel and everolimus was associated with significantly more grade 3-5 mucositis (13.3% vs 0.7%; P < .001). The addition of everolimus to paclitaxel did not improve outcomes in pretreated metastatic gastric/gastroesophageal junction (GEJ) cancer. Activity was seen in the taxane pretreated group. Additional biomarker studies are planned to look for subgroups that may have a benefit.     

Met-enkephalin-like immunoreactivity in rat forebrain and spinal cord using hydrogen peroxide and Triton X-100. Ultrastructural study

Using two immunocytochemical methods, we have shown in light microscopy that the met-enkephalin-like immunoreactivity within striatum and spinal cord of the rat is differentially distributed in either perikarya or nerve terminals according to the technical conditions used [1]. The present electron microscopic study has been undertaken in order to elucidate the subcellular localization of immunoprecipitates according to the same technical conditions. In the neostriatum, numerous met-enkephalin-containing perikarya were stained (principally at the level of rough endoplasmic reticulum) when tissue sections were treated with hydrogen peroxide (H2O2) only, prior to the immunocytochemical procedure. However, injections of colchicine were required to demonstrate perikarya in the dorsal horn of the spinal cord. At variance with previous results, numerous dendritic profiles and nerve terminals were also reactive in this condition. Neurotubules, mitochondria, large granular vesicles (LGVs) and small synaptic vesicles were stained within these structures. The addition of a low concentration of Triton-X-100 (0.02%) in the first incubation medium often resulted in the disappearance of most perikarya and in the staining of only LGVs in nerve terminals. The addition of a higher concentration of Triton-X-100 (0.1%) produced diffusion of immunoprecipitates at the level of nerve terminals, which was probably responsible for the increased intensity of staining and, subsequently, for the better demonstration of fibre varicosities in light microscopy. On the contrary, the disappearance of reactive perikarya seemed to result from the diffusion of the non-protected peptide out of the cytoplasm. The diverse ultrastructural localizations of met-enkephalin-like immunoreactivity in striatum and spinal cord are finally discussed in light of intrinsic connections or afferents described in the literature.     

Zur Frage der Wärmeregulation der Säuglinge und Frühgeborenen

Zusammenfassung Die strömungskalorimetrischen Untersuchungen ziegen, daß die physikalische (vasomotorische) Wärmeregulation der jungen Säuglinge und sogar der Frühgeborenen auf thermische Reize genau so prompt und ausgiebig wie die des Erwachsenen reagiert. Durch 3 min langes Bewinden des Kopfes bzw. nur des Gesichtes, verlieren die Kinder soviel Wärme, daß sie 5–20 min lang ihre Wärmeabgabe einschränken müssen. Längere Bewindung verstärkt und verlängert die Einschränkung der Wärmeabgabe.Die sogenannte Thermolabilität der jungen Säuglinge und Frühgeborenen ist nicht auf eine Unreife der Wärmeregulation, sondern im wesentlichen auf ihr ungünstiges Obereflächen-Volum-Verhältnis, zurückzuführen, zu dem die andern Faktoren noch gravierend hinzukommen.Die für diese Untersuchung erforderlichen Geräte wurden uns freundlicherweise vom physiologischen Institut und der medizinischen Poliklinik zur Verfügung gestellt, wofür wir den Herren Professoren Dr. Schaefer und Dr. Plügge and dieser Stelle nochmals herzlich danken wollen.     

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends,associated factors and causes

Background

The fourth Millennium Development Goals targets reduction by 2/3 the mortality rate of under-fives by 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31‰ in 2011.

Objectives

We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital.

Methods

The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1st January 2004 to 31st December 2010.

Results

The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24hours of life. Mortality was higher in neonates with birth weight less than 2500g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood , primiparous and in housewives and students.

Conclusion

There has been a steady decline of neonatal mortality since 2004.Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.