An appraisal of pattern and presentation of gynaecological malignancies in Bowen University Teaching Hospital, Southwest Nigeria

Background: Gynaecological malignancies are cancers that occur in or on a woman's reproductive organs and genitals which includes the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. The prevalence of gynaecological malignancies varies from one country to another. The factors responsible for the observed variance includes lifestyle, dietary pattern, level of education and the sophistication of health care system. This study aims to identify the pattern and clinical presentations of gynaecological malignancies at Bowen University Teaching Hospital, Ogbomoso over a five-year period.Methods: This was a retrospective study involving one hundred and twenty-three (123) patients with a histological diagnosis of gynecological malignancy.Results: Patients with gynaecological malignancies accounted for 3.6% of the patients seen in the period under review. Majority of these patients were multiparous and between the age range of 50 and 69 years. The commonest form of gynaecological malignancy seen was cervical cancer.Conclusion: Health care programs and policies that strengthen public awareness campaigns, health education and health promotion like human papilloma virus vaccination and follow up surveillance will help to reduce the morbidity and mortality associated with gynaecological malignancies. Keywords: appraisal, pattern, presentation, gynaecological malignancies

Microbiome & Endometriosis

Endometriosis is a chronic disease of the female reproductive system, which is characterised by the presence of endometrial tissue outside the uterus especially in the pelvic cavity that includes ovaries, fallopian tubes and it may occur extra genitally in some rare cases. 176 million women all over the world including 26 million in India suffer from endometriosis and high frequency was observed between the age group of 26-30 years, resulting in increased primary infertility. Various studies surveying the female reproductive tract have confirmed the existence of microbiota starting in the vagina, cervix, uterus, fallopian tubes and ovaries. These microbes play a crucial role at different stages ofthe reproduction, in forming a physical barrier against pathogen and the stimulation of host defence mechanisms. Direct and indirect mechanisms are observed including the production of biochemically active compounds that directly kill or inhibit pathogens. Women suffering from endometriosis lead an impaired quality of life and continue to deal with endometriosis-associated symptoms even after diagnosis and treatment of the disease. In endometriosis condition, adhesions are observed in the fallopian tubes and ovaries that block tubal motility and damage the oocyte-pickup. Progesterone resistance is familiar in endometriosis which changes the implantation window period causing the loss of implantation markers and finally leading to infertility. Malignant tumours of ovaries have also been identified and known to arise from endometriosis. Microbiome can be used as a novel diagnostic tool for endometriosis as there is a variation observed in the composition and distribution along the female reproductive tract of healthy women and endometriosis patients. A non-invasive diagnosis is achieved through this, aiming at early diagnosis and alternative treatment for endometriosis.

Factors associated with delay in seeking treatment among women with pelvic organ prolapse at selected general and referral hospitals of Southern Ethiopia, 2020

Background Pelvic organ prolapse (POP) is the descent of the vaginal wall, cervix, uterus, bladder, and rectum downward into the vaginal canal. Its prevalence is higher among women in developing countries because women are more prone to risk factors. In Ethiopia, women with prolapse seek treatments at advanced stages of prolapse; hence, surgical management has been widely practicing. Therefore, it was found to be very important to conduct research that assesses factors hindering early treatments in Southern Ethiopia. This study aimed to find out factors associated with the delay in seeking treatment of pelvic organ prolapse among patients at selected general and referral hospitals of Southern Ethiopia. Methods Cross-sectional study design was employed in 123 participants of seven randomly selected General and Referral Hospitals of Southern Ethiopia from February 01 to April 30, 2020, by using a structured questionnaire. Pre-trained two midwives in each center were deployed to collect data. Physicians performed diagnosis and physical examination. Data were entered and coded using EPI INFO version 7 and exported into SPSS version 25 for analysis. Bivariate and multivariable logistic regression analyses were performed. The goodness of fit was assessed by using the Hosmer and Lemeshow goodness test. Results In this study, out of 123 clinically diagnosed POP cases, nearly half of them were stage III, and over one-third were stage IV. Therefore, 84.6% (104 participants) of the respondents were delayed for the treatment of POP. The mean length of delay for POP treatments was 36.41 ± 3.95 months. After adjusting for covariates, lack of supports [AOR (Adjusted Odds Ratio) = 5.2 (95% CI 1.4–19.5)], low-income [AOR = 5.8 (95% CI 1.1–19.66)], and fear of social stigma [AOR = 4.7 (95% CI 1.2–18.59)] were significant factors for delayed treatments. Conclusions Most of the POP patients were delayed for POP treatments. Factors like lack of support, low-income, and fear of losing social value/stigma were associated with treatment delay. Screening for the POP cases, educating (making awareness) the community about this devastating disease to facilitate early treatment and to avoid social stigma, and raising access to treatment by making the nearby hospitals equipped with facilities to treat POP are recommended.

A Review of Cancer Genetics and Genomics Studies in Africa

Cancer is the second leading cause of death globally and is projected to overtake infectious disease as the leading cause of mortality in Africa within the next two decades. Cancer is a group of genomic diseases that presents with intra- and inter-population unique phenotypes, with Black populations having the burden of morbidity and mortality for most types. At large, the prevention and treatment of cancers have been propelled by the understanding of the genetic make-up of the disease of mostly non-African populations. By the same token, there is a wide knowledge gap in understanding the underlying genetic causes of, and genomic alterations associated with, cancer among black Africans. Accordingly, we performed a review of the literature to survey existing studies on cancer genetics/genomics and curated findings pertaining to publications across multiple cancer types conducted on African populations. We used PubMed MeSH terms to retrieve the relevant publications from 1990 to December 2019. The metadata of these publications were extracted using R text mining packages: RISmed and Pubmed.mineR. The data showed that only 0.329% of cancer publications globally were on Africa, and only 0.016% were on cancer genetics/genomics from Africa. Although the most prevalent cancers in Africa are cancers of the breast, cervix, uterus, and prostate, publications representing breast, colorectal, liver, and blood cancers were the most frequent in our review. The most frequently reported cancer genes were BRCA1, BRCA2, and TP53. Next, the genes reported in the reviewed publications’ abstracts were extracted and annotated into three gene ontology classes. Genes in the cellular component class were mostly associated with cell part and organelle part, while those in biological process and molecular function classes were mainly associated with cell process, biological regulation, and binding, and catalytic activity, respectively. Overall, this review highlights the paucity of research on cancer genomics on African populations, identified gaps, and discussed the need for concerted efforts to encourage more research on cancer genomics in Africa.

Angioleiomyoma of the Uterus with Extensive Hyaline Degeneration- A Rare Case Report with Brief Review of Literature

Angioleiomyoma (AL) or vascular leiomyoma is a distinct variant of leiomyoma with prominent vascular component, usually occurs in extremities very rarely arise in internal organ. It has been documented in female genital tract including cervix, uterus, ovary and broad ligament. Uterine leiomyoma is very rare and distinct variant of conventional leiomyoma which has prominent vascular component. The diagnosis of this variant requires histopathological examination since it does not have specific clinical and radiological features unlike in soft tissues where it presents as subcutaneous painful swelling. Like conventional leiomyomyoma, AL can also undergo degenerative changes like hyalinisation, infarction, calcification and myxoid change. Here, a rare case of uterine AL with ovarian seromucinous cystadenoma is reported in a 38-year-old female who was diagnosed incidentally when she was evaluated for abnormal uterine bleeding. MRI pelvis revealed a intramural fibroid of size 5×4.5 cm noted in anterolateral myometrium of uterus and a large multiloculated cystic lesion of size 12.5×12.5×8.8 cm seen arising from left ovary. Abdominal hysterectomy was done. Grossly, sectioning of myometrium showed well circumscribed grey white to grey brown intramural fibroid measuring 4.5×3.5 cm. Histologically the lesion showed fascicles of spindle cells swirling around the thick walled blood vessels and immunohistochemically these cells were positive for Smooth Muscle Actin (SMA). Here, this rare case of uterine AL with brief review of literature is reported.

Reproductive system infections in women: lower genital tract syndromes

ABSTRACT Gynecological and obstetrical infectious diseases are an important component of women's health. A system approach to gynecological and obstetrical infection helps unify and classify microbial etiology and pathogenesis within a clinical anatomical framework of lower and upper genital tract syndromes. The reproductive system of women includes the vulva, vagina, cervix, uterus, fallopian tubes and ovaries. During pregnancy, additional tissues include the chorioamnion and placenta together with the fetus and amniotic fluid. We review in two parts reproductive system infection syndromes in women using selected research results to illustrate the clinical utility of the system approach in terms of diagnosis, treatment and prevention. We conclude that a reproductive system perspective will lead to improvements in understanding, management and prevention of these diseases.

Neovagina creation using sigmoid colon in vaginal agenesis: a case report and review of literature

Mullerian duct anomalies are rare and can present with abnormalities in upper vagina, cervix, uterus, and fallopian tubes. The exact incidence of cervicovaginal agenesis is unknown and there are very few cases recorded in the literature. Authors report a 12-year-old girl referred from gynaecologist with chronic cyclical abdominal pain with underdeveloped, geniatilia and developed secondary sexual characters. Radiological investigations showed hypoplastic cervix with hematometra and left hemato salpinx. A definitive repair with creation of a neovagina using a sigmoid colon segment was performed in a single stage. Many techniques are described for reconstruction of cervicovaginal canal. Use of colon in creation of a neovagina is described by authors. Here we report a case of complete vaginal agenesis presenting with Hematometra-Hematosalpinx where a neovagina was created using a segment of sigmoid colon. Single staged surgery for neovagina creation using segment of sigmoid colon offers a promising and safe alternative for cervicovaginal agenesis.

Genitourinary syndrome of menopause (GSM) and laser VEL: a review

The purpose of this publication is to summarize the results of the vaginal erbium:yttrium-aluminum-garnet (Er:YAG) Smooth® laser (VEL) on the vaginal atrophy component of the genitourinary syndrome of menopause (GSM). GSM has two categories of clinical signs related to estrogen deficiency: symptoms of vulvovaginal atrophy (VVA) and urinary symptoms. This symptomatology is chronic, progressive over the years and affects a majority of women concerned by natural menopause but not exclusively: we must also consider the growing number of survivors of gynecological or non-gynecological cancers (breast, cervix, uterus, vagina, anus, etc.). At a time when hormonal treatment of menopause is contested as is the installation of under urethra prosthesis, the innovation provided by the VEL technology has the merit of offering the women concerned an effective therapeutic alternative with the security of a patent. The VEL technology has an original and unique process: acting only by thermal effect and not by ablation on tissue, VEL is a safe solution in terms of side effects and potential complications. Studies have been increasing since 2012 and all demonstrate a significant improvement in the GSM signs and symptoms, as well as an improved sexual life after VEL treatment. Double-blind, placebo-controlled, randomized studies are expected in order to ultimately confirm the safety and effectiveness of VEL.

EFEK CURCUMA AERUGINOSA TERHADAP PENYEMBUHAN PERINEUM IBU POSTPARTUM DI BPM AMIRUL DAN BPM PANCA MOJOKERTO

Background: Labor often causes injury to the birth canal. Injury in the birth canal that occurs at the base of the pelvis / perineum, vulva and vagina, cervix, uterus. The overall change genitalia tool is called involution. At this time occurred also other important changes, changes in the reproductive system including uterus, lochia,and vagina. Perineal wound care after childbirth can use traditional medicine which has long been known and in use by the people of Indonesia. One herb plants that are useful for postpartum mothers is Curcuma aeruginosa (black meeting) that have benefits to cleanse the blood after childbirth. Objective: The purpose of this study was to analyze the effectiveness of consumption of Curcuma aeruginosa extract on wound healing of the perineum on maternal postpartum Methods: The research design used a Quasi-experimental approach with Non-equivalent control group or a non-randomized control group pretest-posttest design. Observation consumption Curcuma aeruginosa extract on wound healing of the perineum on maternal postpartum. Result: Based on the statistic test it shows there is influence of curcuma aeruginosa exstract on wound healing of the perineum on maternal postpartum Conclussion: The results of this study are expected to provide a positive contribution in the field of obstetrics including: to be used as a basis for the use of herbs in the surrounding environment. Preventive efforts in the treatment of postpartum mothers. Keywords: Curcuma aeruginosa, wound healing of the perineum.