Nigerian Postgraduate Medical Journal

Nanoparticles and the Vaginal Microbiota: Diagnostic and Therapeutic Innovations in Human Papilloma Virus-associated Cervical Cancer – A Systematic Review

Cervical cancer (CC) remains a significant global health challenge, with the interplay between microbiome and cancer progression becoming increasingly evident. A comprehensive literature search was conducted across multiple databases, including Embase, NCBI, Google Scholar, Elsevier, Science Direct and PubMed, utilising the specific keywords such as ‘cervical cancer’, ‘cervical microbiome’, ‘vaginal microbiome’, ‘Human papillomavirus’, ‘nanoparticles’, ‘drug delivery’ and ‘dysbiosis’. Studies published over the past 15 years were reviewed. A total of 400 articles were identified and 65 research articles were finally included. This systematic approach identified relevant studies, enabling an in-depth analysis of microbial species, such as Parabacteroides, Escherichia, Shigella, Gardnerella and Fusobacterium which are recognised as the potential biomarkers for CC diagnosis and progression. Dysbiosis is characterised by a reduction in helpful bacteria and a proliferation of harmful ones. It is linked to chronic inflammation and human papillomavirus infection, both of which facilitate the CC progression. Advanced nanotechnology presents innovative therapeutic options for CC treatment, enhancing drug delivery systems and targeting tumour cells more effectively. Moreover, incorporating nanocarriers into treatment regimens aims to improve the bioavailability and efficacy of existing therapies, potentially transforming the clinical approaches to CC management. This review highlights the dual role of the microbiome as both a diagnostic and prognostic biomarker and elucidates the potential of nanotechnology in optimising treatment strategies, advocating for further research on microbial interactions in cancer pathology.

Clinical and Pathological Patterns of Non-Epithelial Malignant Ovarian Tumours in Western Saudi Arabia

Objective: To report a single-center experience in non-epithelial malignant ovarian tumours (NEMOT), by presenting different clinical and pathological characteristics, management and outcomes. Methods: We retrospectively reviewed electronic files of all female patients who underwent surgery for NEMOT at the Gynecology Department of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from July 2003 to July 2019. We collected baseline demographic, anthropomorphic and clinical data; pathological characteristics; management and follow-up data; and outcomes including residual disease, recurrence and last follow-up status (deceased or alive). Results: Thirty-three women were included; mean (standard deviation) age = 33.24 (17.72) years, range = 4, 86 years. Granulosa cell tumor was the most frequent subtype diagnosed in 17 (51.5%) patients, followed by germ cell tumours 13 (39.4%). The majority of patients were diagnosed at FIGO Stage I (22, 66.7%) and with tumor Grade 1 (23, 69.7%), while 8 (24.2%) were diagnosed with Grade 3 tumors. Granulosa cell and Sertoli-Leydig cell tumours were diagnosed at an older age (mean age = 39.30 vs. 23.92 years) compared to germ cell tumours, respectively (P = 0.012). Two-third of the patients benefited from conservative surgery including oophorectomy + staging, and 16 (48.5%) benefited from chemotherapy with bleomycin, etoposide and platinum being the most common protocol (13, 39.4%) for germ cell tumours. Postoperatively, only 2 (6.1%) patients had residual disease. Recurrence and mortality were reported in one and four patients, respectively, resulting in recurrence rate = 3.0% (95% confidence interval [CI] = 0.01%, 15.8%) and mortality rate = 12.1% (95% CI = 3.4%, 28.2%). Conclusions: The present series of NEMOT was predominated by sex cord-stromal cell tumors, which were diagnosed in patients with older age, while germ cell tumours were underrepresented. Although survival rates were comparable to those reported internationally, more consideration should be given to following up patients regarding fertility outcomes to provide a more comprehensive evaluation of treatment success and quality of care.

Effectiveness of audio-visual and print media intervention on knowledge of cervical health among rural women in Southern India

Cervical cancer health education programmes are not accessible to rural women in developing countries. Our study aimed at assessing the health literacy about cervical cancer amongst the rural women in Udupi district, southern India, before and following intervention using audio-visual aid/face-to-face interactive sessions versus pamphlets alone. This was a quasi-experimental study. A total of 166 women participated in the study. Participant groups were allocated into two interventional (Experimental/Control) groups. Participants in the experimental group received education through the video followed by face-to-face interaction with a health educator while those in the control group received a pamphlet. A validated questionnaire was used to assess knowledge about numerous risk factors, Pap smear test and treatment of cervical cancer (pre- and post-intervention test). The findings are presented as frequencies and percentages. Paired responses were compared for individual questions using McNemar test and P < 0.05 was fixed as statistically significant. Former to the intervention, 13.5% and 19.1% in the experimental and control groups, respectively, felt that personal hygiene was important to prevent cervical cancer. Both the groups had very limited knowledge regarding risk factors (93.6%; 94%), symptoms (96.3%; 97.6%) and knowledge that Pap smears can reduce the risk of cervical cancer (91.7%; 93.9%). The change in knowledge pre-and post-intervention in both groups increased significantly. Intervention with face-to-face interactive sessions showed a positive impact on knowledge regarding cervical cancer. These findings indicate both methods can be effective in providing health education in the community.

The Diagnostic Performance of Pap Smear during Both Phases of the Menstrual Cycle: A Community-based Study in Southern Nigeria

Background: Incidence of cervical cancer can be reduced using screening tests such as Pap smear to detect the premalignant stage of the disease. Although there has been a preference for more expensive human papillomavirus DNA testing due to its higher sensitivity, the Pap smear remains still very relevant in low-resource settings being cheaper and more readily available, hence the need to study factors influencing its performance. Objective: The objective of this study was to determine if there is a difference in the diagnostic performance of Pap smear performed during the proliferative and secretory phases of a menstrual cycle, using colposcopy as the gold standard. Materials and Methods: It was a community–based, comparative cross-sectional study conducted in Oghara, in Ethiope West Local Government Area, Delta State, Nigeria, over a 32-week period from January to July 2020. The participants had an integrated four-step procedure comprising Pap smear sample collection and colposcopy assessment performed during the proliferative and secretory phases of their menstrual cycle. Consenting participants who had an abnormal colposcopy finding during either phase of the cycle had cervical biopsy sampling. Results: There was no significant difference in the sensitivities (0.00 vs. 0.00), specificities (99.04 vs. 97.14, P = 0.300), positive predictive values (0.00 vs. 0.00), negative predictive values (93.63 vs. 94.44, P = 0.672) and accuracies (92.80 vs. 91.60, P = 0.317) of Pap smears performed at proliferative and secretory phases of menstrual cycle. Conclusion: Pap smear can be collected during either phase of a woman’s menstrual cycle.

Placental Site Trophoblastic Tumour Mimicking Placenta Previa

Abstract We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean hysterectomy on account of uncontrollable bleeding, and histopathology revealed a placental site trophoblastic tumour.

Human Papillomavirus Vaccination amongst Students in a Tertiary Institution in North Central Nigeria: A Cross-sectional Study on Sociodemographic Factors Associated with Its Awareness, Uptake and Willingness to Pay

Abstract Background: Human papillomavirus (HPV) vaccine is effective in averting 70%–90% of all HPV-related diseases. The assessment of its awareness, uptake and willingness to pay (WTP) is important in Nigeria which is one of the developing countries where more than three-quarter of the global burden of HPV-related diseases occur. This study aimed to determine the sociodemographic factors associated with the awareness, uptake and WTP for HPV vaccine amongst undergraduates in a tertiary institution in North Central Nigeria. Methods: This was a cross-sectional study. Data were collected from randomly sampled respondents through a validated self-administered questionnaire. Descriptive statistics, Chi-square and logistic regression analyses were applied to data collected to determine the awareness, uptake and WTP for HPV vaccine and their association with sociodemographic factors. The results of inferential statistics were considered significant when P &lt; 0.05. Results: A total of 240 respondents were recruited, 15.4% of the respondents had heard about HPV vaccine, 2.1% of them had received at least a dose of the vaccine, 0.4% of them had completed three doses and 35.0% of them were willing to pay for it. Marital status (adjusted odds ratio [AOR]: 10.2; 95% confidence interval [CI]: 2.840–36.635) and parity (AOR: 5.8; 95% CI: 2.314–14.565) were predictors of WTP for the HPV vaccine. Conclusion: The evidence generated from this study suggests that there is a need to increase the awareness and uptake of the vaccine at the individual and population levels. The recent introduction of the HPV vaccine is a laudable step towards improving vaccine uptake. Public health authorities at the local, state and national levels should be empowered to develop tailored vaccine demand creation and advocacy strategies for HPV vaccine. Males should also be involved in the advocacy strategies and research on HPV vaccine.

Role of Histopathology in Diagnosis of Ovarian Neoplasms

Context: Ovarian tumours are known to be diverse biologically, varying from non-malignant to malignant tumours having implication on course of the management and prognosis. To address the paucity of such study on ovarian neoplasm from our region of West Bengal, we planned and executed this study. The aim of the study was to analyse the distribution of various ovarian tumours and classify them according to the biological behaviour, age, laterality, and mode of the presentation. Setting and Design: It was a retrospective study done in a tertiary care center of Kolkata, India. Methodology: A retrospective data of 4 years comprising 84 cases were included in the study from January 2016 to December 2019. All the slides were retrieved from the archives and re-evaluated and cross-checked with patients' clinical history, demographic, and macroscopic findings. Results: Out of these 84 tumours, maximum cases were of surface epithelial neoplasms (69%) followed by germ cell tumours (26.1%). Age interval of 19–40 years accounted for the highest number of individuals with equal predominance of both sites of the ovary. Serous cyst adenocarcinoma was the most common malignant tumour. Conclusion: Histological examination remains the mainstay in the early diagnosis of ovarian tumours and facilitates timely appropriate management of patients, and hence, reduces overall mortality in women.

Knowledge and Attitude towards, and the Utilisation of Cervical and Breast Cancer Screening Services by Female Healthcare Professionals at a Tertiary Care Hospital of Eastern India

Background: Breast and cervical cancers are the two leading causes of cancer-specific mortality and morbidity amongst Indian women. Screening methods are cost-effective. However, the uptake of screening methods in India is very low. Knowledge and attitude of healthcare professionals (HCPs) play an important role in reducing the mortality related to cancer. Materials and Methods: This study aimed to assess the knowledge and utilisation of screening methods for cervical and breast cancer and to elaborate barriers for non-utilisation amongst female HCPs, both doctors and nurses. A cross-sectional study was carried out from April to July 2017 in a tertiary healthcare hospital of eastern India amongst 200 female HCPs using a pre-designed, pre-tested, self-administered questionnaire. Data were analysed using the Statistical Package for the Social Sciences version 20.0. Statistical tests such as proportion and mean were calculated and the Chi-square test was used as a test of significance for categorical variables. Results: Clinical breast examination and mammography were practiced by only 26.5% and 7% of respondents, respectively. Only seven doctors and one nurse had ever undergone Pap smear. More than 90% of respondents knew risk factors, signs and symptoms and the availability of screening tools for the detection of cervical and breast carcinoma. Conclusions: The utilisation of breast and cervical cancer screening was unsatisfactory despite having good knowledge of the preventable cancers and screening methods amongst HCPs. There is a need for attitudinal change amongst HCPs by continuous sensitisation programmes.