Trends in cervical pap smear cytology in a tertiary hospital: implications for cervical cancer screening in low-income countries

Introduction: An estimated 99% of largely preventable maternal deaths occur across developing regions characterized by a cascade of well-established delays at all levels. Data on community deaths remains scanty hence a wide reliance on institutional data. Target 3.1 of the SDG aims to attain a global reduction of less than 70/100000 live births by 2030. Ghana's MMR of 350/100000 live births is accounted for by commensurately high MMR across its 10 administrative regions. The MMR of the Eastern region, ranked among the top 5 by MMR, has exceeded the national average since 2011. Studies are largely cross sectional, not computing individual risk. This study aimed to (1) identify trends of institutional maternal deaths, (2) estimate magnitudes of individual risk with exposure to specific factors and (3) recommend preventive strategies. Methodology: Records on 479 maternal deaths were compared with 616 records on obstetric clients over the same period that did not die from 2011 - 2016 using an unmatched case control study design. Data were analyzed with epi info 3.5.4. Results: Maternal deaths were mainly direct. Controls were largely urban residents, with traceable addresses, engaged in formal occupations, of higher educational backgrounds and ANC attendants. Leading cause of death was obstetric hemorrhage. Most abortions, mainly cases, were unsafe. Mean maternal age was higher for cases. Maternal age of 11 - 20 and ≥ 35, rural residence, underlying medical conditions, informal occupations, multi- and grand multiparity increased risk of maternal deaths, while, ≥ SHS education and ANC ≥ 4 reduced risk of death. Recommendations: Health policies to address concerns of fertility control for adolescents and clients ≥ 35, inequitable access to CEmONC services, quality ANC, low literacy and awareness on the abortion law should be prioritized

The Histological Significance of Atypical Glandular Cells on Cervical Cytology: Experience at Groote Schuur Hospital; Cape Town; South Africa

BACKGROUND:Atypical glandular cells (AGC) identified on Pap tests may be markers for potentially significant pathology. OBJECTIVES:Primarily; to correlate AGC findings at Groote Schuur Hospital (GSH; Cape Town; South Africa) with subsequent histological investigations and attempt to identify predictors of pathology relevant to the clinical management of women with a cytological diagnosis of AGC. Secondly; to compare the GSH data with data from similar international studies. METHODS:Records of AGC Pap tests were retrieved from the laboratory database in the anatomical pathology laboratory at GSH and clinically relevant information was summarised based on the available information. Standard descriptive statistics were used to summarise the study data; and Fisher's exact test was used to compare categorical outcomes; where possible. RESULTS:Of the 237 women with a cytological diagnosis of AGC and who had subsequent histological diagnoses; 120 (50.6%) had significant pathology (cervical intraepithelial neoplasia (CIN) 2 or worse). Significant cervical pathology was most common in women aged etlt;50 years; while significant endometrial pathology predominated in women aged =50 years. The results of the GSH study were largely consistent with international findings; but the risk of malignancy was six times higher in the GSH population than in a comparable international group.CONCLUSION: AGC identified on Pap tests may be markers for potentially significant pathology. Human papillomavirus DNA testing is recommended for younger women diagnosed with AGC to reduce invasive investigations and minimise expenses in a resource-poor setting

Utility of Aspiration Cytology in the Evaluation of Oral and Maxillofacial Lesions

Background: Fineneedle aspiration cytology (FNAC) as a cheap diagnostic technique has helped reduce diagnostic turnaround time of pathological entities from different body sites. It is thus also important to evaluate its utility in the diagnosis of maxillofacial lesions in view of heterogeneity of morphological patterns noted for this site. Methodology: Cytology and corresponding histology reports for lesions from patients where both were available were compared for concordance between specific cytological diagnosis and final histological diagnosis. From these; sensitivity; specificity; positive predictive value and accuracy of FNAC were calculated. Result: Cytological diagnosis of maxillofacial lesions demonstrated a sensitivity; specificity; positive predictive value and accuracy of 100; 95.7; 97 and 98.2; respectively. The concordance of specific cytological diagnosis with final histological diagnosis was 85.5. Conclusion: This study concludes that FNAC is a cheap and diagnostically reliable technique for evaluation of maxillofacial lesions in a resource poor setting

Cost and Cost-Effectiveness of Conventional and Liquid-Based Cytology in South Africa: A Laboratory Service Provider Perspective

Background. South Africa has a high prevalence of cervical cancer. Early detection can significantly reduce the burden of this disease. New screening technologies to detect cervical pathology have become available in recent years.Objectives. To determine the cost and cost-effectiveness of liquid-based cytology (LBC) versus conventional cervical cytology; from the perspective of the National Health Laboratory Service (NHLS). Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data collected from NHLS expenditure records and cytology laboratory data sources with data from the literature. Results. Total average cost per conventional slide was found to be R (South African rands) 64 (95confidence interval (CI) 59 - 69) compared with R85 (95 CI 77 - 92) for an LBC slide. Conventional cytology was found to be more cost-effective (R10 786; 95 CI 9 335 - 12 699) than LBC (R18 911; 95 CI 16 180 - 22 435) in detecting CIN II or greater lesions. An improvement in the specificity of LBC and/or a decrease in the cost of consumables utilised in processing LBC specimens could potentially make it a cost-effective alternative to conventional cytology.Conclusion. An estimate of the total average public sector laboratory cost per slide for each modality was calculated. Definitive assessment of cost-effectiveness will require a prospective study that incorporates human papillomavirus testing and is conducted from a societal perspective

Protéinurie et syndrome néphrotique de l'adulte dans le service de néphrologie de l'unité d'hémodialyse de l'hôpital du Point G :à propos de 65 cas

Le syndrome néphrotique est une affection assez fréquente dans le monde en général et dans les pays sous-développés en particulier, lié au bas niveau socio-économique. En Afrique, en particulier au Mali, plusieurs facteurs interviennent dans la pathogénie de la maladie modifiant son aspect caricatural. Nous avons réalisé une étude rétrospective portant sur un échantillon de 65 patients âgés de 15 à 63 ans. L'objectif était d'étudier la protéinurie au cours du syndrome néphrotique de l'adulte, afin de déterminer les aspects quantitatifs, les signes cliniques et biologiques associés et les aspects thérapeutiques. Il ressort que la protéinurie était supérieure à 3g/24h dans 70,76% des cas, comprise entre 1 et 3 g/24 h dans 21,54% des cas et entre 0,5 et 1g/24h dans 7,69% des cas. Les signes cliniques étaient plus fréquents chez les patients présentant une protéinurie supérieure à 3g/24h. Quant aux signes biologiques, ils étaient diversement observés selon le taux de protéinurie. Le traitement spécifique de la protéinurie a consisté en une corticothérapie, utilisée dans 93,85% des cas, seule ou associée aux IEC et aux immunosuppresseurs. Le traitement non spécifique a fait appel aux IEC dans 6,15% des cas