Comparison of pap smear quality with anatomical spatula method and the common method [spatula- cytobrush]: a single blind clinical trial

Cervical cancer is the third most common cancer in women in the world. Papanicolaou smear is known as a standard test for cervical cancer screening; however, the most important challenge is high rates of false negative results. The aim of this study was to compare the quality of smears obtained by anatomical spatula and spatula-cytobrush. The most important factor in false negative result is inappropriate tool of sampling. One hundred married women participated in this single blind clinical trial. All participants were interviewed; two samples were obtained from every participant: one with spatula-cytobrush and another one with anatomical spatula. All slides were encoded and were assessed by two pathologists. Then, data were analyzed by means of kappa coefficient. Cell adequacy was 96.1% in anatomical spatula method and 91.2% in spatula-cytobrush method [p= 0.016]. The rates for endocervical cells and metaplasia cells in anatomical spatula method were 70.6% and 24.5% respectively and these amounts were 69.6% and 24.5% respectively in the spatula-cytobrush method [p <0.001]. No one reported any pain and the amount of bleeding was 38.2% in both methods [P>0.05]. Regarding infection and inflammatory reactions there was no statistically significant difference between two methods [p>0.05]. Based on our findings in this study, results of sampling with anatomical spatula method were more acceptable and better than those with spatula-cytobrush sampling

[ randomised cohort trial comparing amoxicillin and erythromycin effect on the treatment of asymptomatic chlamydia trachomatis infection in pregnant women]

Introduction and Objective: chlamydia trachomatis infection is one of the most common sexual infections among childbearing women. Proper treatment of this infection in pregnant women is an important public health issue. Our goal was to compare the efficacy of amoxicillin and erythromycin on treatment of asymptomatic acute and chronic chlamydia trachomatis infection in pregnant women

Material and Methods: a randomized cohort trial of pregnant women with chlamydia trachomatis IgM and IgG positive serum receiving care at two inner city, university - based prenatal clinics were randomly assigned to receive either oral amoxicillin, 500 mg three times daily for 7 days [case group 1], erythromycin 400 mg four times for 7 days [case group2] or placebo 500mg three times for 7 days[control group]. Participants referred for retesting 4 weeks after initiation of treatment and the patients were followed till delivery. Patients with positive follow up blood tests were crossed over into the alternate treatment and retested at a later visit. Statitical analysis was performed by using McNemar, exact Fisher tests and chi square analysis

Results: 333 pregnant women were enrolled in this study and 92 chlamydia infected women [27.62%] completed the protocol. There was no significant difference between delivery gestational age of the groups [39.05, 38.72, 38.6 week] showing that chlamydia infection was not associated with preterm labor. Acute chlamydia infection rates before and after treatment in both amoxicillin and erythromycin groups were significantly different.The rates of acute chlamydia infection reduced from 83.87% before treatment to 35.48% after treatment [p<0.001] in group treated by amoxicillin. This change was 64.51% before treatment vs 29.03 after treatment [p<0.001] in erythromycin group. Chronic chlamydia infection rates in erythromycin group was significantly reduced in compare amoxicillin group after treatment. Based on the results of this study, the rates of chronic chlamydia infection in erythromycin group reduced from 41.93% before treatment to 19.35% after treatment [p=0.01]. The change in amoxicillin group was observed before treatment 19.35% vs 12.9% after treatment. In the amoxicillin group, 6 women [19.35%] were intolerant, compared with 10 women [32.25%] in erythromycin group

Conclusion: chlamydia infection was not associated with preterm labor. Two kinds of treatments used in this study had the similar effects on acute chlamydia infection but erythromycin was more effective than amoxicillin on chronic chlamydia infection. Women treated by amoxicillin had less gastrointestinal complications than those treated by erythromycin