Carole Rattray

Chlamydia trachomatis, herpes simplex virus 2, and human T-cell lymphotrophic virus type 1 are not associated with grade of cervical neoplasia in Jamaican colposcopy patients

Background A few recent studies have suggested that other sexually transmitted infections may increase the likelihood of a human papillomavirus (HPV) infection progressing to high-grade cervical neoplasia and cancer. Goal The goal was to assess whether exposures to Chlamydia trachomatis, human T-cell lymphotrophic virus type 1 (HTLV-I), and/or human simplex virus type 2 (HSV-2) are greater in colposcopy patients with cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) than in patients with low-grade cervical neoplasia (CIN1). Study Design Sequential patients (n = 447) attending a colposcopy clinic in Kingston, Jamaica, a country with high cervical cancer rates and high HTLV-I prevalence, were tested for (1) HPV DNA by L1 consensus primer (MY09/11) polymerase chain reaction assays, (2) C trachomatis DNA by ligase chain reaction, (3) C trachomatis antibodies by both microimmunofluorescence and a peptide (VS4) enzyme linked immunosorbent assay (ELISA), (4) HTLV-I antibodies by ELISA confirmed by western blotting, and (5) HSV-2 antibodies by a recombinant HSV-2-specific ELISA. Odds ratios and 95% confidence intervals were estimated with use of multinomial logistic regression models. Results HPV DNA detection was associated with grade of cervical neoplasia but other evaluated sexually transmitted infections were not. Conclusions HTLV-I, C trachomatis, and/or HSV-2 were not associated with severity of cervical neoplasia in Jamaican women.

Adeno-associated virus and development of cervical neoplasia

Evidence from several sources has suggested that adeno‐associated virus (AAV) infection might protect against cervical cancer, in part, by interfering with human papillomavirus (HPV)‐induced tumorigenesis. Detection of AAV type 2 (AAV‐2) DNA in cervical tissues has been reported. However, there have been few in vivo studies of women with cervical HPV infection or neoplasia, and these have reported inconsistent results. Therefore, we used polymerase chain reaction (PCR) assays targeted to the AAV‐2rep and cap genes to test tissue specimens from women in an epidemiological study of cervical neoplasia in Jamaica. We tested 105 women with low‐grade cervical intraepithelial neoplasia (CIN‐1), 92 women with CIN‐3/carcinoma in situ or invasive cancer (CIN‐3/CA), and 94 normal subjects. PCR amplification of human β‐globin DNA was found in almost all cervical specimens, indicating that these materials were adequate for PCR testing. The prevalence of HPV DNA, determined by HPV L1 consensus primer PCR was, as expected, strongly associated with presence and grade of neoplasia. Each of the AAV PCR assays detected as few as 10 copies of the virus genome. However, none of the 291 cervical specimens from Jamaican subjects tested positive for AAV DNA. Negative AAV PCR results were also obtained in tests of cervical samples from 79 university students in the United States. Exposure to AAV was assessed further by serology. Using a whole virus AAV‐2 sandwich enzyme‐linked immunosorbent assay, we found no relationship between AAV antibodies and presence or grade of neoplasia in either the Jamaican study subjects or women enrolled in a U.S. cervical cancer case (n = 74) ‐control (n = 77) study. Overall, the data provide no evidence that AAV infection plays a role in cervical tumorigenesis or that AAV commonly infects cervical epithelial cells. J. Med. Virol. 59:60–65, 1999.

Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice.

There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction.

Sister Society Meeting on Global Education Development and Collaboration: Meeting Report.

Objectives To identify common barriers to teaching and training and to identify strategies that would be useful in developing future training programs in gynecologic oncology in low- and middle- income countries. Methods There is a lack of overall strategy to meet the needs of education and training in gynecologic oncology in low- and middle- income countries, the leaderships of sister societies and global health volunteers met at the European Society of Gynecologic Oncology in October 23, 2015. The challenges of the training programs supported by gynecologic oncology societies, major universities and individual efforts were presented and discussed. Strategies to improve education and training were identified. Results Major challenges include language barriers, limited surgical equipment, inadequate internet access, lack of local support for sustainability in training programs, inadequate pathology and radiation oncology, finance and a global deficiency in identifying sites and personnel in partnering or developing training programs. The leaderships identified various key components including consultation with the local Ministry of Health, local educational institutions; inclusion of the program into existing local programs, a needs assessment, and the development of curriculum and regional centers of excellence. Conclusions Proper preparation of training sites and trainers, the development of global curriculum, the establishment of centers of excellence, and the ability to measure outcomes are important to improve education and training in gynecologic oncology in low- and middle- income countries.

Bilateral psoas abscess in a case of granuloma inguinale

The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported

Screening for gestational diabetes mellitus: a Caribbean perspective

Abstract Gestational diabetes mellitus (GDM) is defined as a glucose intolerance first recognised in pregnancy. The World Health Organization (WHO) in 2015 revised the definition into either diabetes in pregnancy (DIP) which includes pre-existing diabetes (type 1 or type 2) that antedates pregnancy or diabetes diagnosed during pregnancy with the WHO diagnostic criteria for diabetes mellitus (DM) in the non-pregnant state, and GDM for milder forms of hyperglycaemia in pregnancy. The main purpose of the screening and diagnosis of GDM is to identify pregnancies in which the foetus is at a high risk of an adverse perinatal outcome, and the mother and the offspring are of serious long-term sequelae. This review of the literature provides an overview of associated prevalence, risk factors and diagnosis of GDM. It also addresses the benefits of screening with supportive evidence. Based on this review, we recommend especially in low-resourced countries such as the Caribbean, adoption of a universal screening with the two-step method.

An Audit of Wait Times for Service Offered by the Gynaecology Oncology Unit at the University Hospital in Jamaica: Are We Meeting the Standards?

Abstract 53Background:The European Board and College of Obstetrics and Gynaecology recommends that time from referral of suspected or proven gynaecological cancers to consultation should be within two weeks and that initiation of treatment should occur within six weeks. It is has been shown that a delay in waiting times beyond these international standards results in significantly increased morbidity and mortality.Methods:An audit of wait times was performed for all patients who presented to the gynaecology oncology unit at the University Hospital in Jamaica for consultation between January 1, 2013 and December 31, 2013. Wait time for consultation was calculated as the date of first referral to the date of initial consultation. Wait time for treatment was calculated as time from consultation to either surgery or initiation of radiation therapy or chemotherapy. Primary site, stage, and the region from which the referrals came were abstracted from the medical record.Results:A total of 1,289 unique patients ...

Knowledge and Attitudes of a Cohort of Male University Students in Jamaica Regarding Human Papilloma Virus (HPV) and the HPV Vaccine

Abstract 51Background:Cervical cancer is the second most common cancer in Jamaica with an incidence of 17.4/100,000. (1). Cervical cancer is acquired sexually, with the human papilloma virus (HPV) being the most important causative agent (2,3). HPV infection is associated with the development of other cancers such as anogenital, vaginal, vulvar and anal cancers in women, and penile and anal cancers in men.(2) It is also responsible for genital warts and oropharyngeal cancer in both men and women. Two vaccines were approved for the prevention of cervical cancer by the Food and Drug Administration (FDA) and are available in Jamaica (4,5). This study assessed the knowledge and attitudes in a male cohort towards HPV and HPV vaccine.Methods:This was a cross-sectional study in which two hundred male students were recruited. Information for this study was gathered from responses given in a self-administered questionnaire. Data was analyzed using the statistical package for social sciences (SPSS) version 20.Resul...

Outcome of radical hysterectomies performed by general gynecologists in Jamaica

To review the modified (type II) radical hysterectomy procedures performed by 4 general gynecologists at the University Hospital of the West Indies, and to compare the outcomes with those of other published studies.