الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The fourth most common cancer and the fifth leading cause of cancer deaths in women worldwide is CC. It remains a leading form of cancer among women living in developing regions of the world including Egypt, this is due to the lack in health programs for CC prevention. These programs are underfunded because they compete with many other priorities. Egypt has a population of 30.55 million women aged 15 years and older who are at risk of developing CC, moreover, current estimates of the WHO indicate that every year 866 women are diagnosed with CC and 373 die from the disease. Although the HPV is confirmed to be the main cause of CC, especially HPV 16 and 18 which are responsible for 70% of CC cases, the data regarding the prevalence of cervical HPV infection are limited for Egyptian women. The aim of this study was to detect the presence of HPV in cytology samples of women undergoing primary cervical screening. HPV DNA was tested adjuvant to Pap smear examination in order to relate the presence of the virus with the abnormal transformations of the cervical cells. In addition, HR- HPV genotypes 16 and 18 were also investigated. This study was carried out during the period from May 2015 till February 2016 on 150 women attending a governmental family planning clinic (Danna Family Health Center) in Alexandria Governorate. Hundred and fifty cervical samples were collected from each woman aged over 30 years old. Detailed history was obtained including personal history (name, age, address, telephone number, marital status, number of marriages, age of first sexual contact, number of pregnancies), high risk practices (smoking either passive or active, unprotected sex) and the medical history (previous intake of hormonal contraceptives, menstrual history, gynecological history, previous pap smears). Endocervical and ectocervical samples were collected from each woman using a cell-sweep®, after cleaning the cervix using sterile cotton swab. Cell-sweep® is a medical device that enables dual sampling of endo and ectocervix. Each sampled material was smoothly spread over clean, labeled slide and fixed with 95% ethyl alcohol, for cytological examination carried out at Pathology Laboratory of MRI. Both the bristle and spatula parts of each cell-sweep®, were immediately put into specimen transport 1.5 ml plastic tube containing 500µl of sterile 0.9% sodium chloride. Tubes were transported to HIPH PCR Laboratory at 4°C and stored frozen at -20°C until tested for HPV DNA by PCR technique using different sets of primers. The main results of the study are: 1. HPV DNA was detected in 38 women (25.33%) with mean age 35.07 years. Out of the 87 women with normal cytology, only 11 women (12.6%) were positive.
2. Among the 38 HPV DNA positive women; one (2.6%) was positive for HPV-16, 13 (34.2%) were positive for HPV-18, 5 (13.2%) had mixed infection of HPV-16 and 18.
Summary and conclusion
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HPV 16 and 18 represented 50% of the infected patients; however, they represented 12.7% of the total women recruited in the study.
3. The nested PCR technique detected 32 cases out of the 38 HPV positive cases, while multiplex PCR detected the other 6cases. G1 multiplex PCR and G2 detected 10 and 14 cases respectively, out of the total HPV positive cases.
4. Among the 112 HPV DNA negative women, 76 (67.8%) had normal cytology, 24 (21.4%) had ASC-US, 7 (6.3%) had ASC-H, 2 (1.8%) had LSIL; none of them had koilocytosis, 2 (1.8%) had HSIL, and one (0.9%) had squamous cell malignancy. The Latter after further medical investigations was found to have endometrioid carcinoma.
5. Among the 38 HPV DNA positive women, 11(28.9%) had normal cytology, 10 (26.3%) had ASC-US, 4 (10.5%) had ASC-H, 15 (39.5%) cases had LSIL; 13 of them had koilocytosis (34.2%).
6. Number of abortions ranged from 0 – 2 in the HPV negative group, while it ranged from 0-3 in the HPV positive group with statistical significant difference (Z=1.975, p=0.048)
7. Women with cervicitis were significantly less likely to get HPV infection than those without cervicitis; 14.3 % of women with cervicitis were HPV positive while 31.1% of women without cervicitis were HPV positive. Conclusion: 1. HPV DNA was detected in a substantial number (25.33%) of studied women, among whom, one third (33.33 %) was positive for HPV18.
2. Using multiple sets of primers in this study increased the sensitivity of HPV DNA detection.
3. Normal cytology and cervicitis were suggestive of HPV DNA negativity while koilocytosis was suggestive to HPV DNA positivity, with statistical significance.
4. Number of abortions was the only risk factor of statistical significance when comparing the HPV DNA positive and HPV negative groups.