Comparative HPV genotype distribution among women with normal and abnormal cervical cytology in Yaoundé, Cameroon

Background: The epidemiology of human papillomavirus (HPV) infection and the pattern of HPV genotype distribution are parameters needed to assess the risk of cervical cancer. Oncogenic HPV types are well-known pathogen for lower genital tract neoplasias, representing the primary cause of cancer death in Africa and the second in Cameroon. This study was conducted to identify the various genotypes particularly the high-risk HPV types in normal and abnormal cervical cytology from women in Yaoundé, Cameroon. Methodology: This was a hospital-based, analytical cross-sectional study carried out on 226 symptomatic women wherein cervico-vaginal samples were obtained during gynaecological examination for Pap smears, HPV-DNA and genotype detection with linear array HPV strip, conducted from November 2019 to January 2021. Results: From the 226 women whose cervical samples were collected for Pap smears, 71 (31.4%) had abnormal cytology results while 155 (68.6%) had normal results. The overall HPV prevalence in the study population was 34.1% (77/226). The HPV prevalence in women with abnormal Pap smears was 100% (71/71) and are distributed in following descending order; LSIL (21.1%, 15/71), HSIL (21.1%, 15/71), ASC-US (19.7%, 14/71), ICC (19.7%, 14/71) and others (18.4%, 13/71). HPV-DNA was positive in 6 (3.9%) of the 155 women with normal cytology results, 4 (2.6%) of whom were high-risk HPV. There is statistically significant difference in the HPV prevalence between women with abnormal and normal Pap smear results (OR=3289, 95% CI=182.62-59235, p<0.0001). The frequently identified oncogenic HPV types were type 16 (31.2%, 24/77), type 45 (14.3%, 11/77) and type 18 (10.4%, 8/77). Conclusion: It is evident from our study that symptomatic women with normal Pap smear can have HR-HPV infection and should therefore be screened for HPV and followed up with periodic Pap smears to detect any abnormal change in cervical cytology results, to prevent cervical cancer development. Women should be encouraged to take up cervical screening, through Pap smears, because it is a non-invasive and cost-effective method for early detection of preinvasive lesions

Prevalence and determinants of Hepatitis C Virus Infection and Genotypes in Chronic Hemodialysis Patients in Kinshasa

Context and objective. The steady increase in the number of chronic hemodialysis patients in sub-Saharan Africa (SSA) calls for improved management of those patients. The present study aimed to determine the frequency of hepatitis C virus (HCV) infection, the prevalent genotypes, and the risk factors associated with HCV in hemodialysis patients in Kinshasa (DR Congo). Methods. A cross-sectional study was conducted from February to June 2018 in all hemodialysis centers in Kinshasa. Blood samples were collected from 127 chronic hemodialysis patients and tested for the presence of antibodies against HCV. The HCV genotype was identified by real-time polymerase chain reaction (RT- PCR). Results. Twenty-two (17.3 %) patients were positive for anti-HCV antibodies, ranging from 0 % to 52.9 % in different centers. Genotype 4 was detected in 18/22 (81.8 %), followed by genotype 2 in 2/22 (9.1%), and both genotypes 2 and 4 in one patient (4.5%). One patient had an undetermined genotype (4.5 %). Having received at least 4 transfusions [7,21 (1,09- 10,61); p=0.040)], not being under EPO treatment [5,81(1,47-12,96); p=0.012)], being on hemodialysis for at least 14 months [3,63(1,60-5,05); p=0.035)]and being dialyzed in an overloaded center [2,06(0,83-5,86); p=0.073)] were associated with a greater risk of HCV infection. Conclusion. This high HCV prevalence (17.3 %) represents a substantial health burden in HD patients from Kinshasa, DR Congo. It is largely driven by the number of blood transfusions, the duration time in hemodialysis. Observations from the present study underscore the need of reducing the number of blood transfusions in people on dialysis through the administration of erythropoietin, given the unaffordable cost of HCV therapy for most individuals in DR Congo.

Contexte et Objectifs. Le nombre des patients hémodialisés en Afrique subsaharienne en constante augmentation ; justifiant de ce fait une meilleure prise en charge de ces patients. La présente étude détermine la prévalence de l'infection par le virus de l'hépatite C en en determinant les génotypes ainsi que les facteurs y associés dans ce groupe de patients. Méthodes. 127 patients hémodialisés chroniques ont subis des tests sérologiques à la recherche des anticorps anti-VHC dans plusieurs centres de Kinshasa de février à juin 2018. Le génotype viral a été déterminé par la RT-PCR. Résultats. La fréquence des anticorps anti-VHC a varié de 0 à 52,9 % dans ce groupe. Les génotypes le plus fréquents ont été le 4 (18/22) et le 2 (2/22) ; étant sumultanément rétrouvé chez un patient, et indéterminé chez un autre sujet. Avoir reçu au moins 4 transfusions [7,21 (1,09-10,61; p=0.040)], ne pas être sous EPO [5,81(1,47-12,96); p=0.012)], être en hémodialyse depuis au moins 14 mois [3,63(1,60- 5,05); p=0.035)] et être dialysé dans un centre surchargé [2,06 (0,83-5,86); p=0.073)] étaient associés à un risque plus élevé d'infection par le VHC. Conclusion. Ses principaux déterminants sont : le nombre des transfusions sanguines et la durée d'HD ; d'où la nécessité de réduire les transfusions sanguines chez les sujets dialysés par l'administration d'EPO, étant donné le coût prohibitif du traitement contre le VHC dans notre contexte

Prédisposition génétique à la néphropathie diabétique: rôle du polymorphisme I/D du gène ACE / Genetic Predisposition to Diabetic Nephropathy: Role of I/D ACE Gene Polymorphism

Introduction - La néphropathie diabétique est la principale cause de la maladie rénale chronique et représente la complication la plus fréquente et la plus grave du diabète. Sa pathogénie exacte est complexe et noncomplètement élucidée. Plusieurs facteurs et mécanismes contribuent au développement et à l'issue de cette pathologie. Les objectifs de notre travail sont de déterminer la fréquence du polymorphisme Insertion(I)/Délétion (D) du gène ACE (angiotensin-converting enzyme) chez des patients diabétiques avec et sans néphropathie et d'établir la relation entre ce polymorphisme et la néphropathie diabétique dans une population de l'Est algérien. Matériel et Méthodes - Nous avons recruté à cet effet, vingt neuf sujets diabétiques avec néphropathie et trente témoins diabétiques sans néphropathie. L'extraction de l'ADN a été réalisée sur du sang frais par la méthode au NaCl et le polymorphisme I/D du gène ACE a été déterminé par PCR (polymérase Chaine Réaction). Un consentement éclairé a été obtenu de l'ensemble des participants. Résultats - La durée moyenne du diabète chez noscas est de 19,21 ± 9,31ans ; celle des témoins est de 10,67 ± 7,66 ans. Le diabète de type 1 est plus fréquent chez les néphropathes (72,41%), chez les témoins la fréquence du diabète de type 2 est plus importante (73.33%). Les complications macro-angiopathiques sont plus prévalentes chez les néphropathes. De plus l'association de deux ou plusieurs complications est fréquemment retrouvée. Les fréquences des allèles I et D sont respectivement 13,79 % et 86,21 % chez les sujets témoins alors que les fréquences alléliques chez les sujets avec néphropathie sont respectivement 19,64 % et 80,36 %. Conclusion - Aucune association significative entre ce polymorphisme et la néphropathie diabétique n'a été démontrée.

Epidémiologie de l'infection à HPV en Région semi-urbaine du Cameroun: l'expérience du District de Santé de Baham, Ouest-Cameroun

Introduction. Les vaccins contre le HPV ciblent de façon privilégiée les papillomavirus humains 16 et 18. La distribution géographique de ces génotypes reste peu connue au Cameroun, ce qui a justifié notre étude. Méthodologie. Nous avons réalisé une étude transversale descriptive et analytique auprès de 157 femmes à l'hôpital de District de Baham-Ouest Cameroun. La détection et le typage des génotypes ont été obtenus par PCR à temps réel. Les analyses statistiques ont été réalisées à partir du logiciel Epi Info 3.5.1. Le test de Khi2 et de Fisher ont été utilisés pour la comparaison des taux. Une différence était considérée comme statistiquement significative lorsque p < 0.05. Résultats. Parmi les 157 prélèvements que nous avons analysés, nous avons eu 26 (16.6%) cas de positivité au HPV de haut risque, [IC à 95% (11.1-23.3%)]. Les génotypes vaccinaux (HPV 16 et, HPV 18) représentaient 30,8% de l'effectif. Le risque d'être infecté au HPV était doublé en cas d'analphabétisme [OR : 1,84(0,57-5,90) ; p=0,25], de premiers rapports sexuels pendant la jeune adolescence [OR : 2,18(0,79-6,01) ; et de recours à la contraception injectable [OR : 1,84(0,41-7,79), p=0,46].Comparées aux femmes négatives au HPV, les femmes avec infection à HPV avaient souvent une anomalie cytologique (23,5 vs 5,1 ; p=0.01). Conclusion. Dans le district de santé de Baham, les génotypes vaccinaux sont minoritaires. Le risque d'être infecté au HPV est doublé en cas d'analphabétisme, de début de rapports sexuels pendant la jeune adolescence et de recours à la contraception injectable

Burden, genotype and phenotype profiles of adult patients with sickle cell disease in Cape Town, South Africa

Background. An exponential increase in the number of sickle cell disease (SCD) patients in paediatric services in Cape Town, South Africa, has been reported. The trend in adult/adolescent services has not been investigated. Objectives. To evaluate epidemiological trends of SCD and the profile of patients affected by SCD attending the Haematology Clinic at Groote Schuur Hospital (GSH), Cape Town.Methods. (i) A retrospective review of the number of SCD patients over the past 20 years; (ii) a cross-sectional analysis of clinical and haematological characteristics of SCD patients; and (iii) molecular analysis of the haemoglobin S mutation, the haplotype in the ß-globin-like genes cluster, the 3.7 kb α-thalassaemia gene deletion and 19 selected single-nucleotide polymorphisms (SNPs) associated with fetal haemoglobin (HbF) levels.Results. From 1995 to 2016, 81 adolescent/adult patients with SCD were registered, mostly originating from other African countries (n=61, 75.3%). There was an increase of over 200% in new cases (n=47) during the last quarter of the two decades investigated. Data from 34 of 58 regular attendees (58.6%) were analysed. The mean age of the patients was 26.1 years (standard deviation (SD) 9.8), and 70.6% were male. With the exception of four patients with sickle/ß-thalassaemia, all the patients had SCD (haemoglobin SS). The co-inheritance of a single 3.7 kb α-globin deletion was found in 42.3% of cases (n=11). The Bantu haplotype was the most observed (65.4% of chromosomes). Most HbF-promoting SNPs were not associated with variable levels of haematological indices.Conclusions. There is an increasing burden of adult SCD patients at GSH. National health and academic institutions need to adapt policies and healthcare professional training accordingly

Prevalence and genetic diversity of rotavirus infection in children with acute gastroenteritis in a hospital setting, Nairobi Kenya in post vaccination era: a cross-sectional study

Introduction: Rotavirus is the leading cause of severe diarrhoea among infants and young children. Each year more than 611 000 children die from rotavirus gastroenteritis, and two million are hospitalized, worldwide. In Kenya, the impact of recent rotavirus vaccinations on morbidities has not been estimated. The study aimed at determining the prevalence and identity of rotavirus strains isolated from rotavirus-associated diarrhoea in vaccinated children presenting with acute gastroenteritis.Methods: Two hundred and ninety eight specimen from children presented at Gertrude Childrens' Hospital from January to June 2012 were tested by EIA (Enzyme-linked Immunosorbent Assay) for rotavirus antigens. Molecular characterization was conducted on rotavirus-positive specimens. Extracted viral RNA was separated by polyacrylamide gel electrophoresis (PAGE) and the specific rotavirus VP4 (P-types) and VP7 (G-types) determined.Results: The prevalence rate of rotavirus was 31.5% (94/298). Of the rotavirus dsRNA, 57 (60.1%) gave visible RNA profiles, 38 (40.4%) assigned long electropherotypes while 19 (20.2%) were short electropherotypes. The strains among the vaccinated were G3P [4], G12P [6], G3P [6], G9P [4], G mixed G9/3P [4] and G1/3P [4]. Specifically, the G genotypes were G9/3 (5.3%), G9 (4.3%), G3 (4.3%), G12 (2.1%) and mixed G1/3 (1.1%). The P genotypes detected were P [4] (5.3%) and P [6] (5.3%).Conclusion: The present study demonstrates diversity in circulating genotypes with emergence of genotypes G3, G9, G12 and mixed genotypes G9/3 and recommends that vaccines should be formulated with a broad range of strains to include G9 and G12

Computational Models as Predictors of HIV Treatment Outcomes for the Phidisa Cohort in South Africa

Background: Selecting the optimal combination of HIV drugs for an individual in resourcelimited settings is challenging because of the limited availability of drugs and genotyping.Objective: The evaluation as a potential treatment support tool of computational models that predict response to therapy without a genotype; using cases from the Phidisa cohort in South Africa.Methods: Cases from Phidisa of treatment change following failure were identified that had the following data available: baseline CD4 count and viral load; details of failing and previous antiretroviral drugs; drugs in new regimen and time to follow-up. The HIV Resistance Response Database Initiative's (RDI's) models used these data to predict the probability of a viral load 50 copies/mL at follow-up. The models were also used to identify effective alternative combinations of three locally available drugs.Results: The models achieved accuracy (area under the receiver-operator characteristic curve) of 0.72 when predicting response to therapy; which is less accurate than for an independent global test set (0.80) but at least comparable to that of genotyping with rules-based interpretation. The models were able to identify alternative locally available three-drug regimens that were predicted to be effective in 69% of all cases and 62% of those whose new treatment failed in the clinic.Conclusion: The predictive accuracy of the models for these South African patients together with the results of previous studies suggest that the RDI's models have the potential to optimise treatment selection and reduce virological failure in different patient populations; without the use of a genotype

Evolution fatale à moyen terme d'une cirrhose virale C traitée par bithérapie pégylée

La prévalence de l'hépatite C au Congo-Brazzaville est élevée avec prédominance du génotype 4. Nous rapportons un premier cas clinique traité dont la réponse virologique en fin de traitement a été négative du fait que la patiente présentait tous les facteurs prédictifs de mauvaise réponse. L'évolution s'est faite vers les complications classiques mortelles. Les limites d'accès aux explorations et au traitement ont influencé négativement l'évolution. Nous venons de présenter un premier cas d'hépatite C traité à Pointe-Noire avec échec thérapeutique. Ce premier cas de notre expérience nous a permis de vivre la réalité de l'histoire naturelle et des difficultés de la prise en charge de l'hépatite C à Pointe-Noire

Prevalence of Helicobacter Pylori Caga and Vaca Allelic Variants and Associated Disease Outcomes in Kenyan Patients with Dyspepsia

Although Helicobacter pylori has been linked to various gastric disorders in Western countries and Asia; its aetiopathological role in African populations is controversial. The aim of this study was to investigate the role of H. pylori and its virulence genotypes in gastrointestinal diseases in Kenyan patients with dyspepsia. Gastric biopsy specimens were obtained for DNA isolation and histopathological analysis. Amplification was performed using specific oligonucleotide primers. H. pylori positivity was determined by H. pylori stool antigen test; rapid urease test; and histology and molecular diagnostic tools. H. pylori was detected with high frequency in patients with gastritis; peptic ulcer disease (PUD) and gastro-oesophageal reflux disease. This implies a significant risk of the development of these pathologies (p-value = 0.0000 in all cases). H. pylori strains with cagA occurred more frequently in PUD (65.2). vacA s1a genotype appeared to play a more significant pathological role (82.6 PUD) than the other variants (p-value = 0.0142). The prevalence of vacA m1 was significantly higher in gastritis cases (p-value = 0.0253). vacA m2 was found to be significantly associated with gastritis (p-value = 0.0253). This finding may point to the fact that H. pylori vacA m1 and vacA m2 are independently associated with an increased risk for gastritis. Indications are that H. pylori prevalence in Kenya may be declining. The independently occurring H. pylori genotypes; as opposed to simultaneous carriage; could be the reason for the low distribution of H. pylori pathologies

Haemoglobin Genotypes: A Prevalence Study and Implications for Reproductive Health in Uyo; Nigeria

Background: Haemoglobinopathies are among the most common genetic disorders worldwide; inherited as autosomal recessive disorders from healthy-carrier parents. The most common are the sickle cell disorders and the thalassaemias; occurring in people of African; Asian; South European and Middle Eastern descent. The University of Uyo Teaching hospital (UUTH); Uyo; Akwa Ibom state; Nigeria is a tertiary health institution providing the health needs of the host and neighbouring states in South-south and South East Nigeria. There is currently paucity of data on the haemoglobin genotype distribution in Akwa Ibom state; hence the need for this study; considering its importance in medical diagnosis; patient management; genetic information and counselling. Methods: This is a retrospective study. Registers and results of all haemoglobin genotype investigations carried out in the department of Haematology; University of Uyo Teaching Hospital; Uyo between January; 2003 and December; 2007 were extracted; reviewed and analyzed using simple percentages. Results: Eight thousand and ninety seven Haemoglobin genotype tests carried out over a five year period were analysed: 6376 (78.7) of these were HbAA; 1580 (19.6) HbAS; 121 (1.5) HbSS; while HbAC and SC accounted for 16 (0.2) and (0.04) respectively. The ratios of Hb AA to Hb AS; HbAAto HbSS andHbAAtoHbAC were 4:1; 52:1 and 400:1 respectively. Of the 8097 subjects; 6723(83.0) were females; 1152(14.2) were males. Among the females; 4.8of HbSS and HbSc were in children under 15 years while only 0.3were in those 15 - 44 years. Conclusion: While HbAA is the predominant genotype in our environment; there is also a significant number of the abnormal haemoglobin genes. Withmany children with sickle cell disease now surviving to adulthood due to advances in medicine; a larger number of women with sickle cell disease in pregnancy with all the attendant challenges it poses should be expected in our environment. It is necessary therefore; to keep abreast with developments in the area of its management in order to cope with the challenges

Beta1- and ? 2c-Adrenoreceptor Variants as Predictors of Clinical Aspects of Dilated Cardiomyopathy in People of African Ancestry : Cardiovascular Topics

Background : Although the Beta1-adrenoreceptor (AR) Gly389Arg and ?2c-AR Del322-325 gene variants are associated with the response to Beta-AR-blocker therapy; whether this effect is associated with the risk for heart failure; or the severity or progression of heart failure is uncertain. Aims : To assess the relationship between Gly389Arg and Del322-325 variants and the presence; severity and progression of idiopathic dilated cardiomyopathy (IDC) in 403 black South African patients. Methods : Genotypes were identified using a restriction fragment length olymorphism-based technique and automated sequencing. Left ventricular ejection fraction (LVEF) and dimensions were determined at baseline and in 132 patients after six months of standard medical therapy excluding Beta- AR-blockers (not indicated as standard care at the time of completing this study). Results : All patients and controls genotyped for the ?2c-AR variant were homozygous for the Del322-325 (risk) allele. The Gly389Arg polymorphism was not associated with IDC (control n = 429) (Arg389 allele homozygosity : odds ratio = 1.03; confidence limits = 0.78-1.35); nor did it predict LVEF and cavity dimensions either before or after therapy. Conclusion : in patients homozygous for the risk allele of the ?2c-AR variant; the Beta1-AR variant neither increased the risk for IDC nor predicted its severity or progression in patients not receiving Beta-AR-blockers

Risk Factors and Genotypes of Hepatitis C Virus Infection in Libyan Patients

Background: The prevalence and incidence of HCV infection varies geographically due to exposure to different risk factors. Identification of HCV genotype is important to defining the epidemiology of the disease. The objective of this study was to describe genotype distribution and its relation to risk factors among HCV infected patients attending virology clinic of the Department of Infectious Diseases at the Tripoli Medical Centre. Methods: The medical records of 891 Libyan chronic HCV infected patients registered and followed up from January 2003 to January 2007 were reviewed. Data gathered includes patient/'s age, gender, risk factors and family history of HCV infection. Statistical analysis was performed using t, x2 and contingency coefficient tests. Results: The mean age was 40.22±13.09 years. Two thirds of patients were males. Normal alanine aminotransferase (ALT) at diagnosis was found in 62% of the patients. HCV RNA < 2 million copies at diagnosis was found among 54% of patients. HCV genotype 1 (G1) was the most frequent (30.9%), followed by G4 (29.2%). Genotype 2 affected 19.3% and G3 13.6%. No classification of HCV genotype was available for 2% of the patients. Many subtypes of HCV were detected with different frequencies (G1a and b, G2a, b, c and a/c, G3a and G4a and c/d). All genotypes of HCV were more common among males (P<0.001). Genotype 3 was the most frequent among male patients (88.6%). Regarding the risk factors, 33% of patients had a history of hospitalization and/or surgical procedures, and 22.7% had a history of blood transfusion. A past history of intravenous drug abuse (IVDA) was reported by 15% of the patients, and 15.9% reported a history of dental procedures. The relationship between the genotype of HCV and risk factors was statistically significant (P<0.001). No history of risky exposure was found among 10.8% of patients. Conclusion: Genotypes 1 and 4 were more predominant among HCV infected patients. Males were affected more than females and they presented themselves to the clinic at a younger age. The results of this study strongly suggest the need for implementing strict infection control measures in hospitals and dental clinics to reduce the nosocomial transmission of HCV, as well as measures to control the problem of intravenous drug users in the community

Profil genotypique du papillomavirus humain rencontre dans l'environnement de Republique democratique du Congo : interet vaccinal

Les vaccins anti-HPV proposés, Cervarix® de Glaxo-Smith-Kline et Gardasil® deMerck, ciblent deux types du HPV à haut risque, le 16 et 18, dont la prévalence a été évaluée surtout en Europe de l'Ouest et enAmérique du Nord entre 60 et 70%. L'objectif de l'étude était de caractériser génétiquement les souches du HPV rencontrées dans la population des femmes en âge de procréer vivant à Kinshasa et d'en discuter les conséquences sur le plan de la vaccination anti-HPV. La collecte des données et le prélèvement des spécimens s'étaient déroulés à Kinshasa dans des sites de dépistage volontaire et du traitement duVIH. Le génotypage du HPV était conduit sur 55 cas portant des lésions dysplasiques du col utérin, dont 85,5%(47/55) étaient séropositifs pour le VIH. La détection et le typage du HPV étaient réalisés par la technique Inno-Lipa® (Innogenetics Line ProbeAssay) de Glaxo-Smith-Kline. La recherche du HPV était positive chez 98,2%(54/55) des patientes ; sur 153 HPV isolés, 23 types de HPV étaient identifiés dont 83,0%(127/153) à haut pouvoir oncogène, en ordre décroissant de fréquence suivant : 68, 35, 51, 52, 16, 31, 18, 17, 33, 45, 56, 58 et 59. La fréquence des souches trouvées par patiente variait de 1 à 8 (moyenne ± écart-type : 2,8 ± 2,0). Les types 16, 18, représentant 11,8%des isolats (18/153), ont été détectés chez 33,3%(18/54) des patientes. Le spectre génotypique du HPV trouvé à Kinshasa semble différent de celui trouvé en Europe et en Amérique du Nord. Ce résultat, s'il est confirmé par des études plus étendues, présage une faible efficacité des vaccins anti-HPV dans l'environnement de Kinshasa