Cervical cancer screening utilization, and associated factors, in Nepal: a systematic review and meta-analysis

OBJECTIVE

To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.

STUDY DESIGN

Systematic literature review and meta-analysis.

METHODS

PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.

RESULTS

The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.

CONCLUSION

Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.

Muramidase (lysozyme) findings in sural and radial nerve biopsies in leprosy patients after varying periods of treatment

Using the immunoperoxidase staining method, tissue muramidase (lysozyme) activity was studied in 34 nerve biopsies from leprosy patients and compared to findings in the skin. In a majority of lepromatous and borderline-lepromatous leprosy patients, the enzyme was seen to form a saccular pattern within the cells; whereas a granular pattern was found at the tuberculoid end of the leprosy spectrum, as well as during reversal reactions. Indeed, the most intense enzymatic activity was found in four patients with reversal reactions. Compared to the skin, muramidase activity was found to be more intense and persisted longer in the nerves. Successful antileprosy treatment reduced the enzymatic activity in both the nerves and the skin, but more so in the skin. Schwann cells and axons did not show muramidase activity, indicating that the muramidase-positive cells are not of neuronal origin. Our results suggest that a high percentage of mononuclear cells infiltrating the peripheral nerves in leprosy are derived from blood monocytes. The function of tissue muramidase in leprosy is not yet clear. Its peculiar intracellular distribution pattern in the different forms of leprosy, however, warrants further study to elucidate its role in the pathogenesis of the disease.

Sural nerve biopsy in leprosy patients after varying periods of treatment: histopathological and bacteriological findings on light microscopy

As part of a larger study of nerve biopsies from leprosy patients in Ethiopia for the presence of muramidase (lysozyme), sections were also examined by light microscopy after staining with hematoxylin and eosin for cellular infiltrate and a modification of the Ziehl-Neelsen stain for leprosy bacilli. The muramidase findings will be reported separately. This paper describes the infiltrative and bacterial findings in a group of 18 patients, including four with nonlepromatous forms of leprosy who were suffering from delayed hypersensitivity reaction at the time of biopsy. The findings were unexpectedly interesting and revealing. Lepromatous and borderline-lepromatous patients all showed endoneurial and perineurial infiltration of considerable extent and, in several instances, bacilli were wide-spread from one end of the biopsy to the other; in two patients, solid-staining bacilli and globi were found, indicating relapse. In all except two of the nonlepromatous patients (mainly borderline-tuberculoid) there was an extensive and severe granulomatous infiltration, and in one case there was marked caseation in the endoneurial zone. Within the limits of the present study, the findings indicate that biopsy of a peripheral nerve, even when it is not obviously associated with a skin lesion, may reveal pathological changes which are greater in degree than those suggested by skin biopsy or clinical examination. These observations in a somewhat heterogeneous group of patients treated for varying periods of time, and in a study which was not prospectively planned, suggest that similar observations in a larger group of untreated and treated patients, including those who have relapsed, may be of value.

Bilateral opponens replacement in post polio thenar paralysis, using different techniques. A case report

A patient is presented with bilateral thenar paralysis, due to poliomyelitis. On the right hand a successful abductor digiti minimi transfer was performed. On the left hand weakness of the hypothenar muscles prevented a good result. Subsequently an opponens replacement, using flexor digitorum superficialis from the ring finger, yielded a good result.

An unusual location of leproma of bone; a case report

A hyperactive leproma, stimulating osteoclastoma, was excised from the distal metaphysis of the left ulna in an 18-year-old girl with borderline-lepromatous leprosy of short duration.

The viperheaded tendon tunneller

The requirements for the design of a suitable instrument for retrograde tendon tunnelling are enumerated. The viperheaded tendon tunneller is described. It is shown that this instrument fulfills these requirements.