Clinicopathological Features of Invasive Breast Cancer: A Five-Year Retrospective Study in Southern and South-Western Ethiopia

Background: Breast cancer (BC) is the most common type of cancer in Ethiopia. The incidence of BC is also rising, but the exact figure is still poorly known. Therefore, this study was conducted to address the gap in epidemiological data on BC in southern and southwestern Ethiopia. Materials and Methods: This is a five-year (2015-2019) retrospective study. The demographic and clinicopathological data were collected from biopsy reports of different kinds of breast carcinomas in the pathology department of Jimma University Specialized Hospital and Hawassa University Specialized Referral Hospital. Histopathological grades and stages were conducted using Nottingham grading and TNM staging system, respectively. Collected data were entered and analyzed using SPSS Version-20 software. Results: The mean age of patients at diagnosis was 42.27 (SD = 13.57) years. The pathological stage of most BC patients was stage III, and most of them had tumor sizes greater than 5 cm. Most patients had moderately differentiated tumor grade, and mastectomy was the most common type of surgery at the time of diagnosis. Invasive ductal carcinoma was the most common histological type of BC, followed by invasive lobular carcinoma. Lymph node involvement was seen in 60.5% of cases. Lymph node involvement was associated with tumor size (χ² = 8.55, p = 0.033) and type of surgery (χ² = 39.69, p < 0.001). Conclusions: This study showed that BC patients in southern and southwestern Ethiopia displayed advanced pathological stages, relatively young age at diagnosis, and predominant invasive ductal carcinoma histological patterns.

Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study

BACKGROUND

Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia.

METHODS

We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data.

FINDINGS

Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888).

INTERPRETATION

Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death.

FUNDING

Bill & Melinda Gates Foundation.

A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol

BACKGROUND

With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study.

METHODS

This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies.

DISCUSSION

This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.

Risk Factors Associated with Invasive Cervical Carcinoma among Women Attending Jimma University Specialized Hospital, Southwest Ethiopia: A Case Control Study

Background

Cervical cancer is a more serious public health problem than other cancers in women in Sub-Saharan Africa in general and in Ethiopia in particular. Thus, this study assessed risk factors related to invasive cervical carcinomas in southwestern Ethiopia.

Methods

Unmatched case control study was conducted in Jimma University Specialized Hospital from April 1 to September 30, 2010. The study consisted of 60 cases (women who had cervical cancers based on histopathologic examination) and 120 controls (women with no cervical cancers). Semi-structured questionnaire was utilized for data collection. Vaginal examinations often visualized with speculum insertions were done for both cases and controls. Punch cervical biopsies were then performed for the suspected cases at Jimma University Hospital that serves about 15 million people in a catchment radius of 250 kms. Data were analyzed using SPSS version 13.0 software. Univariate and multivariate analyes were done to describe and identify independent predictors of cervical cancer.

Results

The mean ages of cases and controls were 47.7 (SD=10.8) and 35.5 (SD =10.5) years respectively. Older women (40–59 years), (OR= 4.7; 95%CI= 2.3–9.6), more than one husband (OR= 2.0; 95%CI=1.0–3.9), as well as more than one wife in lifetime, (OR= 3.0; 95% CI= 1.5–5.9), women who had more than 4 children, (OR =10.3, 95% CI= 3.6–29.0), and age greater than 25 years at first full term delivery, (OR= 8.8; 95% CI= 3.5–22.0) were statistically significant and the latter two were independently associated with invasive cervical cancer. Only 7(11.7 %) of cases and 58(48.3%) of controls ever heard of cervical cancers; however, 2(3.3%) of cases and 7(5.8%) of controls had ever had history of papaneocolous (pap) smear tests done.

Conclusion

Poor knowledge on cervical cancer was observed that required more work to be done to increase knowledge of mothers on cervical cancer and on associated risk factors. Behavioral communication activities and establishment of cervical cancer screening programs for the young could help reduce the advancement of cervical cancer particularly among the less knowledgeable, older and grand multiparous women in our parts of the world.

GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings

INTRODUCTION

The diagnosis of tuberculous lymphadenitis (TBL) remains challenging. The routinely used methods (cytology and smear microscopy) have sub-optimal sensitivity. Recently, WHO recommends GeneXpert to be used as the initial diagnostic test in patients suspected of having extra-pulmonary tuberculosis (EPTB). However, this was a conditional recommendation due to very low-quality evidence available and more studies are needed. In this study we evaluated the performance of Xpert for the diagnosis of TBL on concentrated fine needle aspirates (FNA) in Southwest Ethiopia.

METHODS

FNA was collected from presumptive TBL cases. Two smears were prepared from each aspirate and processed for cytology and conventional microscopy. The remaining aspirate was treated with N-acetyl-L-cysteine-NaOH and centrifuged for 15minutes at 3000g. The concentrated sediment was used for culture and Xpert test. Capilia TB-Neo test was used to differentiate M. tuberculosis complex (MTBC) from non-tuberculous mycobacteria (NTM). Composite bacteriological methods (culture and/or smear microscopy) were considered as a reference standard.

RESULT

Out of 143 enrolled suspects, 64.3% (92/143) were confirmed TBL cases by the composite reference standard (CRS). Xpert detected M. tuberculosis complex (MTBC) in 60.1% (86/143) of the presumptive TBL cases. The sensitivity of Xpert compared to CRS was 87.8% [95% CI: 81.0-94.5] and specificity 91.1% [95% CI: 82.8-99.4]. The sensitivity was 27.8% for smear microscopy and 80% for cytology compared to CRS. Cytology showed the lowest specificity (57.8%). Xpert was positive in 4 out of 45 culture- and smear-negative cases. Among 47 cytomorphologically non-TBL cases, 15 were positive on Xpert. More than half of Xpert-positive cases were in the range of very low cut-off threshold values (28

CONCLUSION

Xpert test showed a high sensitivity and specificity for the diagnosis of TBL on concentrated FNA samples. In addition, Xpert offered rapid detection of rifampicin-resistant M. tuberculosis strains from lymph node aspirates.

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Key Words Collapse

MESH Headings

• Adolescent
• Adult
• Bacteriological Techniques/methods
• Biopsy, Fine-Needle
• Ethiopia
• Female
• Humans
• Lymph Nodes/microbiology
• Lymph Nodes/pathology
• Male
• Middle Aged
• Mycobacterium tuberculosis/chemistry
• Mycobacterium tuberculosis/cytology
• Prognosis
• Rifampin/chemistry
• Sputum/microbiology
• Tuberculosis, Lymph Node/diagnosis
• Young Adult

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Grants Collapse

Affiliation(s)

Mulualem Tadesse Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
Gemeda Abebe Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
Ketema Abdissa Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
Dossegnaw Aragaw Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
Kedir Abdella Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia Mycobacteriology Research Center, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia
Alemayehu Bekele Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
Mesele Bezabih Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
Ludwig Apers Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Bouke C. de Jong Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium
Leen Rigouts Mycobacteriology Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium

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Diagnostic performance of fluorescent light-emitting diode microscopy for tuberculous lymphadenitis in a high-burden setting

OBJECTIVE

Diagnosis of tuberculous lymphadenitis using fine-needle aspiration cytology is a simple and safe but low-specificity method, whereas conventional smear microscopy has variable sensitivity due to low bacterial load. We evaluated the diagnostic performance of fluorescent light-emitting diode (LED) microscopy on routinely collected fine-needle aspirates from tuberculous lymphadenitis presumptive cases.

METHODS

Fine-needle aspirates were collected from patients clinically suspected of having tuberculous lymphadenitis as part of routine diagnosis. Smear preparation was performed from the aspirate and processed for cytology, conventional Ziehl-Neelsen and LED microscopy. The remaining aspirate was processed for culture on Lowenstein-Jensen media. Capilia TB-Neo test was used to differentiate M. tuberculosis complex from non-tuberculous mycobacteria.

RESULT

A total of 144 tuberculous lymphadenitis presumptive cases were included. 66.7% (96/144) were positive for M. tuberculosis complex on culture. Only one isolate was identified as non-tuberculous mycobacteria. The detection rates of Ziehl-Neelsen and LED microscopy were 18.8% (27/144) and 34% (49/144), respectively. As compared to culture, sensitivity was 25.0% [95% CI: 16.3-33.7] for Ziehl-Neelsen microscopy and 45.8% [95% CI: 35.9-55.8] for LED microscopy. The specificity was 93.8% [95% CI: 86.9-100] for Ziehl-Neelsen microscopy and 89.6% [95% CI: 80.9-98.2] for LED microscopy. LED microscopy showed a statistically significant increase in sensitivity and similar specificity compared to Ziehl-Neelsen microscopy. Mean reading time of positive slides was 2.62 min/slide for Ziehl-Neelsen and 1.60 min/slide for LED microscopy. Cytology showed sensitivity of 82.3% and specificity of 54.2%. LED microscopy detected TB bacilli in 33.3% of cases cytologically classified as suppurative abscess.

CONCLUSION

The LED microscopy for tuberculous lymphadenitis had significantly higher sensitivity and shorter screening time than Ziehl-Neelsen microscopy. Use of LED microscopy among cases classified as suppurative abscess on fine-needle aspirate cytology improves evidence-based diagnosis of presumptive tuberculous lymphadenitis cases. Moreover, LED microscopy could be considered as an alternative approach in settings where fine-needle aspirate cytology is impractical.

Bacteriological methods as add on tests to fine-needle aspiration cytology in diagnosis of tuberculous lymphadenitis: can they reduce the diagnostic dilemma?

BACKGROUND

The diagnostic accuracy of fine-needle aspiration (FNA) cytology for the diagnosis of tuberculous lymphadenitis (TBLN) is confounded by mimicking cytomorphologic disorders. The objective of this study was to determine whether supplementing FNA cytology with bacteriological methods improves the overall accuracy of TBLN diagnosis.

METHODS

Two hundred presumptive TBLN cases were included in the study. FNA specimens were collected and examined for cytomorphologic changes, for acid-fast bacilli (AFB) by microscopy and for mycobacterial growth on culture. Culture was done using Lowenstein-Jensen (LJ) medium and mycobacteria growth indicator tube (BACTEC MGIT 960 TB detection system). Differentiation between M. tuberculosis complex (MTBc) and non-tuberculous mycobacteria (NTM) was done by using 500 μg/ml para-nitrobenzoic acid (PNB) susceptibility testing.

RESULTS

Cytomorphology detected TBLN among 80% (160/200) of the presumptive cases. Culture results were available for 188 cases. Twelve samples were excluded due to contamination on both culture methods. Culture confirmed cases accounted for 78% (147/188) of which MTBc constituted 97.3% (143/147). Among presumptive cases, classified by FNA cytology as 'abscess', 11 were culture positive. Microscopy detected 31.3% (46/147) of culture confirmed mycobacterial lymphadenitis of which 11% (4/37) were diagnosed non-suggestive for tuberculosis (TB) by FNA cytology. Compared to culture (LJ & BACTEC MGIT 960) and AFB microscopy as composite gold standard, FNA cytology had a sensitivity of 88.4% and a specificity of 48.8%. The positive predictive value was 86.1% while the negative predictive value was 54.1%. The confirming power and the ROC curve area was 1.73 and 0.69, respectively.

CONCLUSION

FNA cytology showed a relatively high sensitivity but a low specificity. Combining bacteriological methods with FNA cytology in an endemic region like Ethiopia improves the overall accuracy of the diagnosis of mycobacterial lymphadenitis, which in turn may lead to better patient management.

Concentration of lymph node aspirate improves the sensitivity of acid fast smear microscopy for the diagnosis of tuberculous lymphadenitis in Jimma, southwest Ethiopia

Background

Tuberculous lymphadenitis (TBLN) is the most common form of extrapulmonary tuberculosis. The cytomorphological features of lymph node smears have reduced specificity for the diagnosis of tuberculosis. The diagnosis of TBLN with direct smear microscopy lacks sensitivity due to the limited number of bacilli in lymph node aspirate. Therefore, we aimed to assess whether the concentration of lymph node aspirate improves the sensitivity of acid fast smear microscopy for the diagnosis of tuberculous lymphadenitis.

Methods

A cross-sectional comparative study was conducted on 200 patients clinically suspected for tuberculous lymphadenitis in Jimma, Ethiopia. Lymph node aspirate was collected. The first two drops were used for cytomorphological study and direct acid fast staining. The remaining aspirate was treated with N-acetyl-L-cysteine (NALC) and concentrated by centrifugation at 3000 g for 15 minutes. The sediment was used for acid fast staining and culture. Differentiation of M. tuberculosis complex (MTBC) from non-tuberculous mycobacteria (NTM) was done by para-nitrobenzoic acid susceptibility test.

Result

Complete data were available for 187 study subjects. 68% (127/187) were positive for M. tuberculosis on culture. Four isolates, 2.1% (4/187), were identified as NTM. The detection rate of direct smear microscopy was 25.1% and that of the concentration method 49.7%. Cytomorphologically, 79.7% of cases were classified as TBLN. The sensitivity of direct smear microscopy was 34.6%, for concentrated smear microscopy 66.1%, and for cytomorphology 89.8%. Two AFB positive cases on concentration method were non-tuberculosis mycobacteria (NTM). The concentration method yielded a positive result from seven cases diagnosed as suppurative abscess by cytology. Both for the direct and concentration methods the highest rate of AFB positivity was observed in smears showing caseous necrosis alone. Smear positivity rate decreased with the appearance of epithelioid cell aggregates.

Conclusion

The concentration of lymph node aspirates for acid fast smear microscopy had significantly higher sensitivity than direct microscopy.

Patterns of enlarged cervical lymph nodes among HIV positive and negative patients in southwestern Ethiopia: a cytopathlogic analysis

OBJECTIVE

The human immunodeficiency virus (HIV) epidemic facilitated the resurgence of extrapulmonary tuberculosis (TB) and other opportunistic diseases. This study assessed the sociodemographic and cytopathologic patterns of enlarged cervical lymph nodes among HIV positive and negative patients.

MATERIALS AND METHODS

This prospective cross sectional study was conducted in Agaro Health centre, Agaro town, Oromia regional state, south western Ethiopia, for a period between April 2008 and September 2008. The instruments of the study were a structured questionnaire for data collection, fine needle aspirate cytology (FNAC) technique for the lymph nodes aspirates and blood drawn for HIV testing. The aspirates were also cultured by using Löwenstein-Jensen medium (LJ) medium. Finally, all data was cleaned, entered and analyzed by using SPSS version 13.00 statistical software and P-Value was taken significant when less than 0.05.

RESULTS

A total of 82 patients were enrolled into this study. Nineteen (23.2%) patients were HIV positive. Tuberculous adenitis was the most frequent diagnosis 47/82 (57.3%). HIV positivity in patients with enlarged cervical adenopathy was 19/82 (23.2%) however, HIV and TB adenitis co-infection was 12/47 (25.5%) in the studied patients (P-Value = 0.57). TB was diagnosed cytologically in 5/11 ulcerated nodes, 11/28 purulent aspirates and 7/15 aspirates showing caseous necrosis without cellular reactions.

CONCLUSIONS

About one-fourth (25.5%) of tuberculous lymph adenitis patients were co-infected with HIV. Pussy aspirates macroscopically and caseous necroses without cellularity microscopically were more common among HIV positive patients in this study. Thus, caseous necrosis with acellular reactions with or without pussy aspirates and nodal ulceration could hint immunodeficient status in co-infected individuals but this speculation need to be verified in a larger scale prospective study.

Tuberculosis lymphadenitis in Southwest Ethiopia: a community based cross-sectional study

BACKGROUND

In Ethiopia where there is no strong surveillance system and diagnostic facilities are limited, the real burden of tuberculosis (TB) lymphadenitis is not well known. Therefore, we conducted a study to estimate the prevalence of TB lymphadenitis in Southwest Ethiopia.

METHODS

A community based cross-sectional study was conducted from February to March 2009 in the Gilgel Gibe field research area. A total of 30,040 individuals 15 years or older in 10,882 households were screened for TB lymphadenitis. Any individual 15 years or older with lumps in the neck, armpits or groin up on interview were considered TB lymphadenitis suspect. The diagnosis of TB lymphadenitis was established when acid fast bacilli (AFB) smear microscopy of fine needle aspiration (FNA) sample, culture or cytology suggested TB. HIV counseling and testing was offered to all TB lymphadenitis suspects. Descriptive and bivariate analysis was done using SPSS version 15.

RESULTS

Complete data were available for 27,597 individuals. A total of 87 TB lymphadenitis suspects were identified. Most of the TB lymphadenitis suspects were females (72.4%). Sixteen cases of TB lymphadenitis were confirmed. The prevalence of TB lymphadenitis was thus 58.0 per 100,000 people (16/27,597) (95% CI 35.7-94.2). Individuals who had a contact history with chronic coughers (OR 5.58, 95% CI 1.23-25.43) were more likely to have TB lymphadenitis. Lymph nodes with caseous FNA were more likely to be positive for TB lymphadenitis (OR 5.46, 95% CI 1.69-17.61).

CONCLUSION

The prevalence of TB lymphadenitis in Gilgel Gibe is similar with the WHO estimates for Ethiopia. Screening of TB lymphadenitis particularly for family members who have contact with chronic coughers is recommended. Health extension workers could be trained to screen and refer TB lymphadenitis suspects using simple methods.

Prevalence of pulmonary TB and spoligotype pattern of Mycobacterium tuberculosis among TB suspects in a rural community in Southwest Ethiopia

Background

In Ethiopia where there is no strong surveillance system and state of the art diagnostic facilities are limited, the real burden of tuberculosis (TB) is not well known. We conducted a community based survey to estimate the prevalence of pulmonary TB and spoligotype pattern of the Mycobacterium tuberculosis isolates in Southwest Ethiopia.

Methods

A total of 30040 adults in 10882 households were screened for pulmonary TB in Gilgel Gibe field research centre in Southwest Ethiopia. A total of 482 TB suspects were identified and smear microscopy and culture was done for 428 TB suspects. Counseling and testing for HIV/AIDS was done for all TB suspects. Spoligotyping was done to characterize the Mycobacterium tuberculosis isolates.

Results

Majority of the TB suspects were females (60.7%) and non-literates (83.6%). Using smear microscopy, a total of 5 new and 4 old cases of pulmonary TB cases were identified making the prevalence of TB 30 per 100,000. However, using the culture method, we identified 17 new cases with a prevalence of 76.1 per 100,000. There were 4.3 undiagnosed pulmonary TB cases for every TB case who was diagnosed through the passive case detection mechanism in the health facility. Eleven isolates (64.7%) belonged to the six previously known spoligotypes: T, Haarlem and Central-Asian (CAS). Six new spoligotype patterns of Mycobacterium tuberculosis, not present in the international database (SpolDB4) were identified. None of the rural residents was HIV infected and only 5 (5.5%) of the urban TB suspects were positive for HIV.

Conclusion

The prevalence of TB in the rural community of Southwest Ethiopia is low. There are large numbers of undiagnosed TB cases in the community. However, the number of sputum smear-positive cases was very low and therefore the risk of transmitting the infection to others may be limited. Active case finding through health extension workers in the community can improve the low case detection rate in Ethiopia. A large scale study on the genotyping of Mycobacterium tuberculosis in Ethiopia is crucial to understand transmission dynamics, identification of drug resistant strains and design preventive strategies.

Isolation and characterisation of novel antioxidant constituents of Croton zambesicus leaf extract

A 1,1-diphenyl-2-picrylhydrazyl (DPPH)-activity-directed fractionation was used to target antioxidant constituents of the ethyl acetate fraction obtained from a 20% aqueous methanol crude extract of Croton zambesicus leaf. Repeated column chromatography of the fraction on silica gel and Sephadex LH-20 led to the isolation of a new natural product, identified as quercetin-3-O-β-6″(p-coumaroyl) glucopyranoside-3'-methyl ether, helichrysoside-3'-methyl ether (1), along with kaempferol-3-O-β-6″(p-coumaroyl) glucopyranoside, tiliroside (2) and apigenin-6-C-glucoside, isovitexin (3) as the antioxidant constituents. The structures of the isolated compounds were elucidated using spectroscopic techniques, namely NMR (1D and 2D) and mass spectrometry. Compounds 1 and 2 are reported from this species for the first time. In the qualitative antioxidant assay, the three isolated compounds instantly bleached the DPPH (0.2% MeOH) purple colour indicating antioxidant activity. In the quantitative antioxidant assay, all the isolated compounds demonstrated weak antioxidant activity compared to quercetin and rutin used as positive control antioxidant agents. The compounds displayed little to no cytotoxicity against Vero cells in an in vitro assay. The presence of these antioxidant compounds in the leaf extract of C. zambesicus could provide a rationale for the ethnomedicinal use of the plant in the management of oxidative-stress-related diseases in folk medicine.

Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia

BACKGROUND

Perceived stigma and lack of awareness could contribute to the late presentation and low detection rate of tuberculosis (TB). We conducted a study in rural southwest Ethiopia among TB suspects to assess knowledge about and stigma towards TB and their health seeking behavior.

METHODS

A community based cross sectional survey was conducted from February to March 2009 in the Gilgel Gibe field research area. Any person 15 years and above with cough for at least 2 weeks was considered a TB suspect and included in the study. Data were collected by trained personnel using a pretested structured questionnaire. Logistic regression analysis was done using SPSS 15.0 statistical software.

RESULTS

Of the 476 pulmonary TB suspects, 395 (83.0%) had ever heard of TB; "evil eye" (50.4%) was the commonly mentioned cause of TB. Individuals who could read and write were more likely to be aware about TB [(crude OR = 2.98, (95%CI: 1.25, 7.08)] and more likely to know that TB is caused by a microorganism [(adjusted OR = 3.16, (95%CI: 1.77, 5.65)] than non-educated individuals. Males were more likely to know the cause of TB [(adjusted OR = 1.92, (95%CI: 1.22, 3.03)] than females. 51.3% of TB suspects perceived that other people would consider them inferior if they had TB. High stigma towards TB was reported by 199(51.2%). 220 (46.2%) did not seek help for their illness. Individuals who had previous anti-TB treatment were more likely to have appropriate health seeking behavior [(adjusted OR = 3.65, (95%CI: 1.89, 7.06)] than those who had not.

CONCLUSION

There was little knowledge about TB in the Gilgel Gibe field research area. We observed inappropriate health seeking behavior and stigma towards TB. TB control programs in Ethiopia should educate rural communities, particularly females and non-educated individuals, about the cause and the importance of early diagnosis and treatment of TB.

Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program

Background

In Ethiopia, where HIV and tuberculosis (TB) are very common, little is known about the prejudice and misconceptions of rural communities towards People living with HIV/AIDS (PLHA) and TB.

Methods

We conducted a cross sectional study in Gilgel Gibe Field Research area (GGFRA) in southwest Ethiopia to assess the prejudice and misconceptions of rural and urban communities towards PLHA and TB. The study population consisted of 862 randomly selected adults in GGFRA. Data were collected by trained personnel using a pretested structured questionnaire. To triangulate the findings, 8 focus group discussions among women and men were done.

Results

Of the 862 selected study participants, 750(87%) accepted to be interviewed. The mean age of the respondents was 31.2 (SD ± 11.0). Of the total interviewed individuals, 58% of them were females. More than half of the respondents did not know the possibility of transmission of HIV from a mother to a child or by breast feeding. For fear of contagion of HIV, most people do not want to eat, drink, and share utensils or clothes with a person living with HIV/AIDS. A higher proportion of females [OR = 1.5, (95% CI: 1.0, 2.2)], non-literate individuals [OR = 2.3, (95%CI: 1.4, 3.6)], rural residents [OR = 3.8, (95%CI: 2.2, 6.6)], and individuals who had poor knowledge of HIV/AIDS [OR = 2.8, (95%CI: 1.8, 2.2)] were more likely to have high prejudice towards PLHA than respectively males, literates, urban residents and individuals with good knowledge. Exposure to cold air was implicated as a major cause of TB. Literates had a much better knowledge about the cause and methods of transmission and prevention of TB than non-literates. More than half of the individuals (56%) had high prejudice towards a patient with TB. A larger proportion of females [OR = 1.3, (95% CI: 1.0, 1.9)] and non-literate individuals [OR = 1.4, (95% CI: 1.1, 2.0)] had high prejudice towards patients with TB than males and literate individuals.

Conclusion

TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of the communities to rectify the widespread prejudice and misconceptions.

Superficial malignant neoplasms in southwestern Ethiopia: a cytopathological approach

The aim of this study was to describe the distributions of superficial malignant neoplasms diagnosed by fine-needle aspiration cytology (FNAC). A prospective cross-sectional study was conducted within the Jimma Teaching Hospital, Pathology Department, Jimma University during the years between September 1998 and August 2002. Cases fulfilling cytopathological evidences of superficial malignancies were included whereas deep-seated malignancies were excluded from the study. An air-dried smear stained with the Wright staining procedure was utilized for the FNAC diagnostic technique. A total of 3,200 cases were investigated during the study period where 267 (8.3%) cases were of primary superficial malignant neoplasms, with 98 cases in the peak age group of 40-59 yr (36.7%) and a median age of 38.0 yr (range, 0.2-88 yr). The most frequent superficial cytodiagnosis was breast carcinoma, 79 (29.6%) cases; followed by non-Hodgkin's lymphomas, 37 (13.9%) cases; and soft tissue sarcomas, 26 (9.7%) cases. The overall male-to-female ratio showed preponderance to female patients (1:1.3). Carcinomas were identified more frequently in those >40 yr of age whereas sarcomas were identified in those <40 yr of age (P > 0.05). The most common malignant neoplasm in women was breast carcinomas found in 74 (27.7%) cases, whereas in men non-Hodgkin's lymphomas were found in 29 (10.9%) cases. Large proportions of carcinomas (88 cases, 33.0%), lymphomas (33 cases, 12.4%), and sarcomas (20 cases, 7.5%) were detected on the trunk, head, and neck, as well as on the lower limb regions, respectively. This study uncovered different types of superficial malignant neoplasms that are prevalent in the southwestern part of Ethiopia. The most common types of cytodiagnoses such as breast carcinomas, etc. may suggest that attention be given to future high-caliber prospective studies in trying to identify some of the associated strong risk factors for the disease under study. This study may be helpful to local health planners in prioritizing some of the commonest malignancies. Some of the diagnostic challenges of lymphomas and thyroid follicular lesions were shown also. This investigation is the first in Ethiopia and therefore may act as baseline data for similar studies in the future.

Determination of aetiology of superficial enlarged lymph nodes using fine needle aspiration cytology

OBJECTIVE

To asses the causes and patterns of enlarged superficial lymph nodes.

DESIGN

Cross sectional survey.

SETTING

Jimma Teaching Hospital, Pathology Department, Jimma University, Southwest Ethiopia for a study conducted between September 1999 and August 2001.

PARTICIPANTS

Eight hundred and eight patients presenting with enlarged superficial lymph nodes in cervical, axillary, inguinal etc. regions were included (456 males and 352 females) whereas non lymph node samples and deep-seated lymphoid lesions were excluded from the study.

MAIN OUTCOME MEASURES

Fine needle aspiration cytology (FNAC) technique and Wright's staining procedure were utilized to diagnose the causes of enlarged lymph nodes.

RESULTS

Of the 1693 patients attended to at the cytologic diagnostic service, 808(47.7%) had lymph node disorders with benign and malignant causes of lymph node enlargements comprising of 93.2% and 6.8% respectively. The most frequent cause of benign enlargement was tuberculous lymph adenities (66.3%), followed by reactive lymph node hyperplasia (19.2%). Among malignant ones, non-Hodgkin's lymphomas (2.7%) and metastatic carcinomas (2.2%) were most frequently diagnosed. The cervical region was the most frequent site for enlarged lymph node disorders accounting for more than three quarters of all cases.

CONCLUSION

This study revealed a huge burden of benign lymph node enlargements in general, and tuberculous lymph adenities in particular. The latter was responsible for about two-third of lymph node enlargements in South Western parts of this country. It is recommended that health providers undertake intensive public health education and screening activities in order to help salvage our community from these potentially preventable and treatable causes of enlarged lymph node disorders.

Patterns of chronic dermatoses in an Ethiopian central teaching hospital: a histopathologic approach

BACKGROUND

This study was designed to describe the causes and distributional patterns of chronic infective-parasitic dermatoses.

METHODS

A histology-based cross-sectional study was conducted for the years between January 1985 and December 1998 within the Tikur Anbessa Hospital, Department of Pathology, Addis Ababa University. The data were retrieved from the department's archives and all dermatologic cases fulfilling bacterial, viral, fungal, and parasitic etiologies were included in the study. Formalin fixed, and paraffin embedded tissues were stained with the routine hematoxylin and eosin staining procedure and visualized under light microscopy.

RESULTS

Out of 162 cases of chronic specific infective-parasitic dermatoses diagnosed, the mean ages for men and women were 31.5 (SD, 16.6) and 25.1 (SD, 14.3) years respectively and the peak age group was 20-29 years (30.2%). Moreover, the ratio of men to women was 1.1:1. The most commonly diagnosed dermatosis was wart (38.9%), followed by cutaneous tuberculosis (17.9%), and cutaneous leishmaniasis (14.2%). The most frequently involved region was the lower limb (46.3%), followed by the face (23.5%).

CONCLUSION

This study tried to surface the frequency distribution of the histopathologically-proven dermatoses that are prevalent in our part of the world. The lower limbs being the most frequent sites of dermatoses, their predisposing factors need to be addressed in our communities in order to lessen the effects of these dermatoses. This study may act as a baseline for similar investigations that may be undertaken in the future.

Fine needle aspiration cytology of suspected tuberculous lymphadenitis

Fine needle aspiration cytology of suspected tuberculous lymphadenitis The aims of this cross-sectional study were to describe the distributional patterns of tuberculous lymphadenitis and to assess the correlation between fine needle aspiration cytology (FNAC) and the Ziehl Neelsen staining technique in diagnosing tuberculous lymphadenitis. Romanowsky's method (Wright's stain) for cytological diagnosis and Ziehl Neelsen (hot method) for the identification of acid-fast bacilli were utilized. Out of one hundred and twenty-eight consecutive patients attending the cytological diagnostic service of the Department of Pathology within Jimma University, 89 (69.6%) of the patients were younger than 30 years of age. The male to female ratio was 1.3 : 1. The cervical region was the most common site and involved 95 cases (74.2%), followed by the axillary and inguinal lymph node regions (20.3% and 4.3%, respectively). The Wright's-stained cytology smears were grouped into three categories: epithelioid granulomas without necrosis, epithelioid granulomas with caseous necrosis and necrosis without epithelioid granulomas. The Ziehl Neelsen stains were undertaken on separate slides: 20.0% of the cases showing epithelioid granulomas without necrosis, 61.9% of those with epithelioid granulomas with necrosis/abscesses and 69.7% of those with necrosis without granulomas were found to be positive for acid-fast bacilli. The overall positivity for the ZiehlNeelsen stained cases was 59.4%. It can therefore be concluded that FNAC is a reliable diagnostic tool in helping to avert the more invasive surgical procedures undertaken in the diagnosis of tuberculous adenitis. The ZiehlNeelsen stain for identification of acid-fast bacilli should be incorporated as an adjunct to increase the diagnostic accuracy of tuberculous lymphadenitis.

Antiplasmodial and antioxidant isofuranonaphthoquinones from the roots of Bulbine capitata

The roots of B. capitata yielded the new compounds 5,8-dihydroxy-1-tigloylmethylnaphtho[2,3-c]furan-4,9-dione, 1-acetoxymethyl-8-hydroxynaphtho[2,3-c]furan-4,9-dione, and 1-acetoxymethyl-5,8-dihydroxynaphtho[2,3-c]furan-4,9-dione, in addition to the known compounds chrysophanol, 10,10'-chrysophanol bianthrone, 8-hydroxy-1-methylnaphtho[2,3-c]furan-4,9-dione, 5,8-dihydroxy-1-methylnaphtho[2,3-c]furan-4,9-dione, 5,8-dihydroxy-1-hydroxymethylnaphtho[2,3-c]furan-4,9-dione, and 8-hydroxy-5-methoxy-1-methylnaphtho[2,3-c]furan-4,9-dione, or 5-hydroxy-8-methoxy-1-methylnaphtho[2,3-c]furan-4,9-dione. The new as well as the known isofuranonaphthoquinones showed antioxidant and weak antiplasmodial activities.

Cytological diagnosis of soft tissue tumours

Cytological diagnosis of soft tissue tumours The aims of this study were to determine the patterns of soft tissue tumours and also to try to assess the utility of fine needle aspiration cytology (FNAC) in diagnosing soft tissue tumours. Of 15 361 patients who visited the cytology diagnostic service of the Pathology Department, Medical Faculty, Addis Ababa University, 623 (4.1%) cases with a diagnosis of soft tissue tumours were retrieved from the department's records for the years 1991-96. Fifty-three soft tissue tumours (25 benign and 28 malignant tumours) with combined FNAC and surgical biopsy results were traced for cyto-histological correlations. Twenty-two out of 25 benign soft tissue tumours were correctly diagnosed, with three false cytologic diagnoses where one mesenchmal neoplasm, one haemangioma, and one haemorragic lesion were identified; and out of 28 malignant soft tissue, 23 were correctly diagnosed however, the five false cytological diagnoses were one soft tissue sarcoma, one dermatofibrosarcoma, one malignant mesenchymal neoplasm, one spindle cell neoplasm and one menechymal neoplasm. Thus, in this study a sensitivity and specificity of 88.5% and 81.5% respectively for the diagnosis of soft tissue tumours were reported. In conclusion, FNAC of soft tissue tumours is a fast, effective and reliable diagnostic tool that may help in categorizing soft tissue tumours into benign and malignant groups for clinical management.

Antiplasmodial activity of knipholone and related natural phenylanthraquinones

phenylanthraquinone knipholone (1) and three of its natural derivatives as well as seven structurally related but simplified compounds have been examined for their antiplasmodial activity against asexual erythrocytic stages of two strains of Plasmodium falciparum in vitro (K1/chloroquine-resistant and NF 54/chloroquine-sensitive). All the phenylanthraquinones showed considerable activity with only little cytotoxicity, while their anthraquinone and phenyl moieties were completely inactive. Knipholone (1) and its natural derivatives can therefore be considered as a new group of potential antimalarials