Cervical cancer prevention in Senegal: an International Cooperation Project Report

Phytochemical screening, antimicrobial, antioxidant, anticancer activities on cervical cancer cell lines and aero-digestive extract of Moringa oleifera

The phytochemical screening showed that the Moringa oleifera (MO) extract contained many compounds such as polyphenols, polyterpenes, sterols, reducing sugars, and hydrolysates tannins. The MICs of MO extract for microbial strains is 0.73 mg/ml for Escherichia coli, Pseudomonas aeruginosa, 7.5 mg/ml for Enterococcus faecalis, Staphylococcus aureus and 0.5 mg/ml for Candida albicans. The MO extract has an IC50 of 3.403 mg/ml has an antioxidant activity by DPPH radical scavenging. The cytotoxic activity of MO extract was evaluated by determining the content of lactate dehydrogenase released by the lysed cells. MO extract exhibited cytotoxic activity against HeLa and FaDu cell lines with an identical IC50 value of 25 µg/ml. We did not observe any remarkable decrease cytotoxic activity when these lines were exposed to the MO extract after 48 h. Our findings help to support the promising role of MO as anticancer agent and open a new challenge for studying DNA fragmentation.

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing

Objective

To explore the diagnosis of cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) by cervical biopsy under colposcopy and analyze the factors influencing the detection.

Methods

The clinical data of 134 CIN confirmed by colposcopy biopsy in our hospital from June 2018 to October 2019 and subsequent LEEP treatment were analyzed retrospectively. All patients were diagnosed pathologically after the operation. The diagnosis of CIN by cervical biopsy under colposcopy was observed. The influencing factors of CIN and ICC detected by colposcopy biopsy were analyzed by the pathological results of loop electrosurgical excision procedure (LEEP) as the gold standard.

Results

After LEEP, the number of the no intraepithelial or malignant lesions (NILM) or ICC were higher than that of colposcopy biopsy, and CIN-III was lower than that of colposcopy biopsy, the differences were all statistically significant (P < 0.05). Among the 134 patients, the coincidence rate between colposcopy biopsy and LEEP examination results was 79.10% (106/134), and postoperative pathological findings showed that there were 13 cases (9.70%) with the pathological upgrade and 19 cases (14.18%) with pathological decrease. Multivariate logistic analysis showed that the image quality of colposcopy image, atypical blood vessels, biopsy sampling method, and visible lesion area of the cervix were the independent influencing factors for the detection of CIN and ICC by colposcopy biopsy (P < 0.05).

Conclusion

CIN and ICC can be diagnosed by colposcopy cervical biopsy and postoperative histopathology. However, there are still some missed and misdiagnosed cervical biopsies under colposcopy, and the combined detection of the two can further ensure the diagnosis rate. The clinical registration number is E2018091.

Effects of bundled nursing combined with peer support on psychological state and self-efficacy of patients with cervical cancer undergoing chemotherapy

OBJECTIVE

This study analyzed the effects of bundled nursing combined with peer support on psychological state and self-efficacy of cervical cancer patients undergoing chemotherapy.

METHODS

A total of 86 patients with cervical cancer undergoing chemotherapy who were hospitalized from July 2019 to July 2020 were enrolled as study subjects. According to the method of a random number table, the selected patients were divided into a control group and an observation group and each group contained 43 patients. The control group was treated with bundled nursing care, while the observation group underwent combining treatment of both bundled nursing as well as education supported by peers. The changes of psychological state, self-efficacy and health-related quality of life of patients before and after nursing intervention were compared.

RESULTS

The scores of depression and anxiety in two groups were remarkably decreased after intervention compared with prior-treatment, and the range of decrease in the observation group was critically greater than that in control group (P<0.05). The self-efficacy scores of the two groups were substantially increased after nursing care, and the increase of the score in the observation group was critically higher than that in control group (P<0.05). In addition, the health-related quality of life scores of the two groups increased remarkably after nursing, and the extent of increase in the observation group was notably greater than that in control group (P<0.05). The degree of serum tumor markers CA125, CEA, CA199 and SCC-A in the observation group after intervention were notably lower than those in the control group (P<0.05).

CONCLUSION

The combinative practice of bundled nursing care and the supported education of peers can effectively improve the psychological status of cervical cancer patients with chemotherapy, and improve their self-efficacy and quality of life, which are all worthy of clinical promotion.

Effect of the intensive psychological nursing on adverse mood and quality of life in patients with cervical cancer

OBJECTIVE

To evaluate the effect of intensive psychological nursing on the adverse mood and quality of life in patients with cervical cancer (CC).

METHODS

100 CC patients admitted to our hospital from January 2019 to January 2020 were enrolled and randomly allocated into two groups, namely the control group (n=50) and the experimental group (n=50). Patients in the control group and experimental group were given general nursing and intensive psychological nursing, respectively. The two groups were compared with respect to self-rating anxiety scale (SAS), self-rating depressive scale (SDS) scores, quality of life index (QLI) scores and mental status scale in non-psychiatric settings (MSSNS) scores, effective rate of nursing and the incidence of adverse reactions.

RESULTS

The experimental group displayed a statistically significant increase in the QLI scores as compared with the control group (P < 0.05); The SAS, SDS scores, and MSSNS scores were found to be markedly lower in the experimental group than in the control group (P < 0.05); The effective rate of nursing was notably higher in the experimental group (P < 0.05); Regarding adverse reactions, the experimental group was markedly lower compared with the control group (P < 0.05).

CONCLUSION

Intensive psychological nursing significantly improves the psychological state and quality of life for CC patients.

Eliminating Cervical Cancer in Mali and Senegal, Two Sub-Saharan Countries: Insights and Optimizing Solutions

BACKGROUND

The number of cases with cervical cancer is rapidly increasing in Sub-Saharan Africa driven by inadequate rates of human papilloma virus (HPV) vaccination and screening programs and accompanied by poor health delivery systems. There are other factors to contend with such as lack of awareness, social myths, reluctance to vaccine acceptance and stigma with sexually transmitted diseases. Here, we formulate strategies to implement intervention programs against HPV infections and other risk factors for cervical cancer in these countries.

METHODS

We searched PubMed, Web of Science, and African Journals Online for this review. The current status of anti-HPV vaccination and precancerous screening programs in Mali and Senegal has been assessed by onsite visits. Collaborators from Mali and Senegal collected data and information concerning HPV vaccination and screening programs in these countries.

FINDINGS

We found that anti-HPV vaccination and cervical cancer screening have been conducted sporadically mainly in urban areas of Mali and Senegal. No known population-based programs are in progress in either of the two countries. We highlighted the advantages and drawbacks of currently available screening tests and proposed that screening by visual inspection with acetic acid (VIA) accompanied by self-sampling is the most cost-effective, culturally acceptable and most feasible strategy to implement in primary care settings. In addition, HPV DNA testing would be affordable, if local laboratory facilities could be established. We found that many of the factors that increase HPV acquisition and promote the oncogenic effect of the virus are largely widespread in both Senegal and Mali. These include infections with HIV and other sexually transmitted infections (STIs), immunosuppression, polygamous marriages, high parity, early sexual activities, early pregnancies, and multiple sexual partners.

INTERPRETATION

Neither vaccines nor screening tests are within the reach of the population in Mali and Senegal because of the high cost. The effective intervention measure would be to integrate anti-HPV vaccines into the Extended Program for Immunization (EPI), which has saved 3 million young lives per year in Africa with the support of GAVI, to implement cost control mechanisms for HPV vaccinations via price negotiations with manufacturing companies, as has recently been done by Rwanda. The collective efforts by local governments, researchers, private sector, and donors may lead to the introduction of affordable screening tests. A robust awareness campaign coupled with sustained and regular engagement of local communities about the prevention and risk factors is extremely important. The projected solutions may be well applicable to other Sub-Saharan countries that face similar challenges containing cervical cancer.