Detection of residual disease by cytology in patients with cervical intraepithelial neoplasia III post-large loop excision of the transformation zone

OBJECTIVE: To evaluate the diagnostic accuracy of cytology in detecting residual disease in patients with cervical intraepithelial neoplasia (CIN) III post-large loop excision of the transformation zone (LLETZ). METHODS: This prospective study was performed between February 1994 and August 1999 at the Department of Obstetrics and Gynecology, Ramathibodi Hospital, and involved 90 patients who underwent LLETZ and had histologic confirmation of CIN III. Simple hysterectomy was performed in all patients 2-3 months after LLETZ. Two Papanicolaou smears were taken using Ayre spatula on each patient 6 weeks after LLETZ and 1 day before hysterectomy. Histologic findings of hysterectomy specimens were used as the 'gold standard'. RESULTS: Forty-six cases (51.1%) were found to have residual diseases: seven cases with CIN I, 11 cases with CIN II, 27 cases with CIN III and one case with invasive squamous cell carcinoma. Using the most severe diagnosis of two Papanicolaou smears performed on each patient as the cytologic diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value were 28.3, 93.2, 81.3 and 55.4%, respectively. The accuracy rate was 60.0%. Residual diseases were found in 62.5 and 39.0% of cases with the presence and absence of CIN at the margin of the LLETZ specimen, respectively. CONCLUSION: Cytology using the Ayre spatula has low accuracy in detecting residual disease in the cervix post-LLETZ.     

Acne in Lomé, Togo: clinical aspects and quality of life of patients

Background

Acne is a chronic inflammatory condition affecting the pilosebaceous follicle that mainly affects adolescents and young adults. The aim of this study was to assess the quality of life (QOL) of patients with acne, and to determine the correlation between the QOL and the severity of acne, in Lomé (Togo).

Method

From July 2017 to February 2018, we conducted a study in three dermatology departments of Lomé. The clinical evaluation of acne and assessment of the QOL were done using the ECLA (Echelle de Cotation des Lésions d’acné) and CADI (Cardiff Acne Disability Index) scores respectively.

Results

We enrolled 300 patients aged 12 to 52 years; 71.3% of whom were female. The face was affected by acne in 100% of cases and papulopustular acne was the most common clinical form (66.7%). Acne was mild to moderate in 162 patients (54%) and severe in 138 (46%). Impairment was observed in all patients’ QOL (scores ranged from 1 to 14 points). There was a positive correlation between severity of acne and QOL impairment in the patients (r?=?0.21; p?=?0.0002). We also found a positive correlation between overall CADI score and factors F1 and F3 of the ECLA scale: the severity of facial acne (r?=?0.15; p?=?0.0073) and the presence of scars (r?=?0.21; p?=?0.0002). In contrast, the global ECLA score was significantly correlated with items 2, 3, and 5 of the CADI questionnaire: the patient’s relationship (r?=?0.13; p?=?0.0241), avoidance behaviors (r?=?0.21; p?=?0.0002) and perception of acne (r?=?0.16; p?=?0.0067).

Conclusion

Acne negatively impacts the QOL of patients. The severity of acne has an impact on the patient’s relationships, avoidance behaviors and perception of the acne.

     

Immunologic and virologic failure after first-line NNRTI-based antiretroviral therapy in Thai HIV-infected children

Background

High dosage of intravenous immunoglobulin (IVIG) has been observed as a possible activator of HIV gene expression in latently infected resting CD4⁺ T-cells, leading to a substantial decrease in both the reservoir and the residual plasma viremia when added to effective ART. IVIG treatment has also been reported to expand T regulatory cells (Tregs). The aim of this study was to evaluate possible long-term effect of IVIG treatment on residual viremia and T-lymphocyte activation.

Methods

Nine HIV-infected subjects on effective ART included in a previously reported study on IVIG treatment were evaluated 48-104 weeks after therapy. In addition, 14 HIV-infected controls on suppressive ART were included. HIV-1 RNA was analyzed in cell-free plasma by using an ultrasensitive PCR-method with a detection limit of 2 copies/mL. T-lymphocyte activation markers and serum interleukins were measured.

Results

Plasma residual viremia rebounded to pre-treatment levels, 48-104 weeks after the initial decrease that was observed following treatment with high-dosage IVIG. No long-term effect was observed regarding T-lymphocyte activation markers, T-regulatory cells or serum interleukins. In a post-hoc analysis, a correlation between plasma HIV-1-RNA and CD4⁺ T-cell count was found in both IVIG-treated patients and controls.

Conclusions

These results indicate that the decrease in the latent HIV-1 pool observed during IVIG treatment is transient. Although not our primary objective, we found a correlation between HIV-1 RNA and CD4⁺ T-cell count suggesting the possibility that patients with a higher CD4⁺ T-cell count might harbor a larger residual pool of latently infected CD4⁺ T-cells.     

Factors associated with palmoplantar or plantar pompholyx: a case-control study

BACKGROUND: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis. PATIENTS AND METHODS: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo. RESULTS: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls.DISCUSSION: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.     

Enquête comportementale et de séroprévalence du VIH chez les professionnelles du sexe au Togo en 2015

The purpose of this study is to determine the seroprevalence of HIVamong female sex workers (FSWs) and to document the behavior in this target population four years after the last study and possibly readjust these interventions. We conducted from March 27 to April 4, 2015 a crosssectional study of 1197 FSWs. Behavior data were collected by interviewer-administered questionnaires. The FSWs were then subjected to blood tests to measure the prevalence of HIV. The average age of respondents FSWs was 28 years and 20% had their first sexual intercourse before 15 years old. Overall, 48% of the FSWs received between 1 and 7 customers per working day. The majority of FSWs (90%) had consistently used condoms during their last week of work. HIV seroprevalence was 11.7% for FSWs. HIV prevalence was higher in FSWs living in Lomé, the capital city, (13.4%) than those living in the Kara region, in the North of the country (2%), P < 0.0001. The results of this study show the positive behavioral change in FSWs with a stabilization of HIV prevalence in this group after four years.     

Gonorrhea in sexually abused young girls in Lome (Togo)

INTRODUCTION: Sexually transmitted diseases due to a sexual abuse cause are rarely documented in black Africa. The purpose of this study was to demonstrate the existence of sexual abuse in young girls with gonorrhea observed in Lome (Togo). PATIENTS AND METHODS: A cross-sectional study was conducted to document cases of sexually transmitted diseases diagnosed in young children (0 to 11 years of age) seen at the dermato-venereology unit of the Lome teaching hospital over a 20 month period. Syphilis serology (TPHA-VDRL) and HIV serology were carried out for all children with sexually transmitted disease and repeated after two weeks for TPHA-VDRL, and three months for HIV serology in children who had been sexually abused. RESULTS: During this period, 13 of 33 cases of sexually transmitted diseases diagnosed in young children were gonorrhea (mean age 7.2 +/- 2.7 years). It was due to sexual abuse in 12 cases (all in young girls). The abuser was a domestic employee in the child's home (n =3), a member of the child's family (n =7), an educator (n =1), a neighbor (n =1). Mean age of the alleged authors of sexual abuse was 25.7 +/- 5.5 years. Syphilis serology was negative, but one case of HIV infection in a 10-year-old girl was observed with identification of the contaminator. CONCLUSION: The results of this study confirm that sexual abuse in children is not an uncommon occurrence in black Africa and that it often leads to gonorrhea. The classic consequences of such abuse are aggravated by the high prevalence of HIV infection observed in the majority of the countries in black Africa.     

Ifosfamide/mesna plus adriamycin as salvage therapy of advanced epithelial ovarian cancer

Linasmita V, Wilailak S, Srisupundit S, Tangtrakul S, Bullangpoti S,Israngura N. Ifosfamide/mesna plus adriamycin as salvage therapy of advancedepithelial ovarian cancer. Int J Gynecol Cancer 1997; 7:388–391.
The objective of this study was to determine the efficacy and toxicity ofifosfamide/mesna plus adriamycin as salvage therapy for epithelial ovariancancer (EOC). From October1992 to September 1995, patients with advanced EOC who had their recurrentdisease after platinum and cyclophosphamide received ifosfamide(IFX)/mesna andadriamycin (ADR). IFX wasadministered as a 24-hour infusion at a dose of 1.2 g/m² daily forthree days and 1.2 g/m² of mesna were added to the infusion solutionand run for the subsequent 24 hours after completion of the IFX. ADR was given as a singleintravenous bolus at a dose of 50 mg/m² on day 1. Measurementsinclude objective response,duration of response and toxicities to the therapy regimen. There were 20patients who received the therapy regimen, a total of 54 cycles: their medianage was 50 years, range25–71. Of the 17 evaluable patients, two achieved clinical response (1CR,1PR) for an objective response rate of 11.8%. However, among 14 patientswith platinum-refractorydisease, the response rate was only 7.1% (95% CI 0.2%,33.9%) (1CR, 0PR). At the time of the report, the patient is alivewithout evidence of disease. Eightpatients (47.0%) had stable disease. Median time to progression was fivemonths, range two to six. Alopecia and microscopic hematuria were the commontoxicities. In conclusion,the combination of ifosfamide/mesna and adriamycin has tolerable toxicities,but its efficacy as salvage therapy in platinum-refractory epithelial ovariancancer is modest.