Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting.

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes.

Endometrial progesterone and estrogen receptors and bleeding disturbances in depot medroxyprogesterone acetate users.

BACKGROUND: Depot medroxyprogesterone acetate (DMPA) is a very popular hormonal contraceptive. Unpredictable bleeding disturbances are the main reasons for discontinuation and may be mediated through endometrial hormone receptors. This study was aimed to compare the expression of progesterone and estrogen receptors in the endometrium of bleeding DMPA users with that of amenorrhoeic DMPA users. METHODS: Subjects were recruited between April 2000 and January 2001. On the day of the third DMPA injection, 42 amenorrhoeic DMPA users and 42 DMPA users who had frequent or prolonged endometrial bleeding and were bleeding on that day were matched by age and body mass index. Endometrial biopsies were collected for immunohistochemical study of progesterone receptor A plus B (PRAB) and B alone (PRB) and estrogen receptor alpha (ERalpha) and beta (ERbeta) expression. RESULTS: There were 23 adequate endometrial samples from each group. There were no differences in any of a series of comparisons of PRAB, PRB, ERalpha and ERbeta expression in glands or stroma between the groups. Serum estradiol and progesterone levels were also not different between the groups. CONCLUSIONS: Endometrial PRAB, PRB, ERalpha and ERbeta expression in glands and stroma was not different between DMPA users who had frequent or prolonged bleeding and amenorrhoeic DMPA users.

The prevalence and risk factors of anemia in pregnant women.

OBJECTIVE: To determine the prevalence and risk factors of anemia in pregnant women. METHOD: The pregnant women were screened with complete blood count, hemoglobin electrophoresis and serology tests for hepatitis B, syphilis and HIV. In cases of anemia, serum for iron and ferritin were investigated. Anemia was defined as a hemoglobin level less than 11.0 g/dl in the first and third trimester of pregnancy or less than 10.5 g/dl in the second trimester. Factors associated with anemia were analyzed by using student's t-test and chi-square. The statistically significant factors were tested with the use of multiple logistic regression. RESULTS: A total of 1,304 pregnant women were recruited. The prevalence of anemia was 19.2 per cent (251 cases). Classified in each trimester, the prevalence was 14.8 per cent, 20.5 per cent and 38.6 per cent in the first, second and third trimester, respectively. One hundred and sixty-one cases of anemia were available for serum iron and ferritin levels. Iron deficiency anemia, by means of serum ferritin, was detected in 32 cases (19.9%). An abnormal pattern of hemoglobin electrophoresis was detected in 367 cases (28.1%). Gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status were associated with anemia during pregnancy. CONCLUSION: The prevalence of anemia in pregnant women who first attended the prenatal visit was 19.2 per cent. Factors associated with anemia during pregnancy were gestational age at first prenatal visit, abnormal hemoglobin electrophoresis and educational status.

The prevalence of Chlamydia trachomatis infection in pregnant Thai women.

Chlamydia trachomatis infection is the most common sexually transmitted infection. It can cause pelvic inflammatory disease and subsequently result in tubal infertility. Chlamydia trachomatis infection in pregnancy can also cause neonatal conjunctivitis and pneumonia. This descriptive study showed that Chlamydia trachomatis infection of the cervix among pregnant women, more than 37 weeks of gestation, attending the prenatal clinic at King Chulalongkorn Memorial hospital was found in 10 per cent by means of multiplex polymerase chain reaction (PCR) technique and 2 per cent by using culture method. The present study demonstrated that all the 182 newborn infants had no neonatal Chlamydia trachomatis infection by using multiplex PCR and culture method. All the babies had Apgar's score of more than 7. At 2 months follow-up, 155 infants were evaluated and had no evidence of Chlamydia trachomatis infection.

Relationship between progesterone receptor level in endometrium and bleeding pattern in depot medroxyprogesterone acetate users.

Bleeding disturbance is the major reason for discontinuation among depot medroxyprogesterone acetate (DMPA) users. However, the causes of progestin-induced bleeding are not well understood. The aim of the study was to examine the correlation between the occurrence of uterine bleeding and progesterone receptor (PR) levels in the endometrium. Forty-five matched pairs of age and body mass index in DMPA users with bleeding and amenorrhea were studied. The endometrial PR levels were evaluated. The PR score was assessed semi-quantitatively. Forty-two subject pairs met the criteria. There was no difference in serum estradiol and progesterone levels between the groups. No correlation between the number of bleeding days and PR score nor between the number of bleeding days and serum estradiol and progesterone level was detected. The stromal PR score in DMPA subjects with amenorrhea was significantly higher than those with bleeding (p < 0.05). By contrast, the PR score in glandular endometrium was not significantly different between the groups (p > 0.05). In conclusion, after a second dose of DMPA, subjects with amenorrhea had a higher stromal PR score than those with uterine bleeding.