Evaluación de la dilatación cervical en simuladores comparada con una herramienta visual: estudio aleatorizado / Cervical dilation assessment in simulators compared to a visual tool: A randomized study / Avaliação da dilatação cervical em simuladores comparada a uma ferramenta visual: estudo randomizado

Objetivo: comprobar la tasa de evaluación correcta mediante la comparación visual directa de las medidas de dilatación cervical en modelos de cuello uterino de consistencia dura. Método: estudio aleatorizado abierto con 63 estudiantes de obstetricia a los que se les asignó usar o no la comparación visual directa con una guía de dilatación. Los estudiantes estimaron de forma ciega la dilatación cervical en simuladores con diferentes dilataciones. El resultado primario fue la tasa de evaluación correcta. Resultados: los estudiantes realizaron 441 pruebas. Se observó una mayor tasa de evaluación correcta en el grupo experimental que en el grupo control (47,3% versus 27,2%; p < 0,001; Odds Ratio = 2,41; intervalo de confianza del 95% = 1,62-3, 58). Conclusión: la comparación visual directa aumentó la precisión de la evaluación de la dilatación cervical en modelos de simulación de cuello, lo que podría ser beneficioso en el entrenamiento de laboratorio. Registro Brasileño de Ensayos Clínicos n.º U1111-1210-2389.

Objective: to verify the correct assessment rate when using direct visual comparison in the cervical dilation measures in hard-consistency cervix simulation models. Method: an open-label and randomized study conducted with 63 Obstetrics students that were designated either to use direct visual comparison in a dilation guide or not. The students estimated cervical dilation blindly in simulators with different dilations. The primary outcome was the correct assessment rate. Results: the students performed 141 tests. A higher correct assessment rate was found in the Experimental Group than in the Control Group (47.3% versus 27.2%; p<0.001; Odds Ratio = 2.41; 95% Confidence Interval = 1.62-3.58). Conclusion: the direct visual comparison increased precision of the cervical dilation assessment in cervix simulation models, with the possibility of being beneficial in laboratory training. Brazilian Registry of Clinical Trials No. U1111-1210-2389.

Objetivo: verificar a taxa de avaliação correta com o uso da comparação visual direta nas medidas de dilatação cervical em modelos de simulação de colo com consistência dura. Método: estudo randomizado aberto com 63 estudantes de obstetrícia que foram designados para usar comparação visual direta em um guia de dilatação ou não. Os estudantes estimaram cegamente a dilatação cervical em simuladores com diferentes dilatações. O desfecho primário foi a taxa de avaliação correta. Resultados: os estudantes realizaram 441 testes. Foi encontrada maior taxa de avaliação correta no grupo experimental do que no grupo controle (47,3% versus 27,2%; p <0,001; Odds Ratio = 2,41; intervalo de confiança de 95% = 1,62-3,58). Conclusão: a comparação visual direta aumentou a precisão da avaliação da dilatação cervical em modelos de simulação de colo, podendo ser benéfica no treinamento em laboratório. Registro Brasileiro de Ensaios Clínicos nº U1111-1210-2389.

Relación entre ausencia de células endocervicales y citología Papanicolaou negativa en portadoras de lesiones escamosas premalignas de cuello uterino

Objetivo : Determinar la relación entre la ausencia de células endocervicales y resultados citológicos Papanicolaou falsos negativos. Material y métodos : Estudio observacional, de enfoque cuantitativo, transversal, relacional y retrospectivo realizado en el Servicio de Anatomía Patológica del Hospital General de Huacho. Se realizó la búsqueda de resultados de biopsias de cuello uterino positivos para lesiones intraepiteliales escamosas y sus respectivos resultados citológicos Papanicolaou previos durante los años 2016 al 2018. Se seleccionó los resultados negativos con ausencia de células endocervicales. Resultados : De los 158 resultados citológicos, 23 mostraron ausencia de células endocervicales y de éstos, sólo dos (8,7%) fueron reportados como negativos. En total 11 (7%) citologías fueron negativas. Conclusiones : No se encontró relación entre la ausencia de células endocervicales y resultados citológicos falsos negativos; por tanto, no influyó de manera significativa en la detección de lesiones escamosas premalignas de cuello uterino.

SUMMARY Objective : To determine the relationship between absence of endocervical cells and false negative Pap smears in patients with squamous premalignant cervix lesions. Methods : A cross sectional study was carried out at Servicio de Anatomía Patológica del Hospital General de Huacho. A search for positive cervix biopsies for squamous intraepithelial lesions and their Pap smears from 2016 to 2018 was done. Negative Pap smears with absence of endocervical cells were investigated. Results : 23 out of 158 cytology results showed absence of endocervical cells, only two (8.7%) were reported negative. Eleven cytologies were negative (7%). Conclusions : No relationship was found between absence of endocervical cells and false negative results at Pap smears. Therefore, no influence in the detection of squamous pre-malignant cells was found.

Comparison of two different doses of hyperbaric bupivacaine for intracavitary radiotherapy in patients with carcinoma cervix ? A randomized control trial

Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.

Características microscópicas del cérvix uterino mediante citología líquida

Introducción: La citología líquida es un método que puede contribuir a identificar de manera precoz los cambios microscópicos del cérvix uterino que pudieran progresar a la malignidad, al disminuir el número de muestras insatisfactorias en relación a la citología convencional. Objetivo: Analizar las características microscópicas identificadas mediante la citología de base líquida del cérvix uterino en mujeres atendidas en la Unidad de Bienestar Estudiantil de la Universidad Técnica de Manabí, Ecuador. Métodos : Se realizó un estudio de serie de casos donde se analizaron las características sociodemográficas, microbiológicas e histológicas procedentes de las fichas médicas de 132 mujeres que participaron en la campaña de Papanicolaou realizado durante junio de 2019. Resultados: El rango de edad predominante fue el de 19 a 33 años, residían en área urbana, 64 % de las mujeres inició la vida sexual antes o durante sus 18 años. Los hallazgos microbiológicos mostraron presencia de flora cocoide en 50 % y 100 % de las muestras manifestaron la calidad adecuada. El estudio citológico presentó, según el sistema Bethesda, 75 % de muestras negativas, con 13 % de LIE de bajo grado y 11 % de ASCUS. El fondo del frotis inflamatorio leve se presentó en 52 %, mientras los antecedentes de más de tres citologías anteriores positivas resultaron en 34 % de las féminas. No se encontró relación entre la presencia de lesión intraepitelial y la edad de las pacientes (p=0,3076). Conclusiones: El total de las muestras fueron útiles lo cual puede indicar que la citología de base líquida ofrece una mayor calidad del diagnóstico histológico.

Introduction: Liquid-based cytology is a method that can contribute to the early identification of microscopic changes in the uterine cervix that can progress to malignancy, by reducing the number of unsatisfactory samples compared to conventional cytology. Objective: To analyze the microscopic characteristics identified by liquid-based cytology of the uterine cervix in women treated at the Student Welfare Unit of the Technical University of Manabí, Ecuador. Methods: A descriptive, cross-sectional, retrospective and quantitative study was carried out where the sociodemographic, microbiological and histological characteristics collected in the medical records of 132 women who participated in the Pap smear campaign carried out during June 2019 were analyzed. Results: The age range that prevailed was 19 to 33 years who lived in urban areas, 64% of women began their sexual life before or at 18 years of age. The microbiological findings showed the presence of coccoid flora in 50% and 100% of the samples showed adequate quality. The cytological study presented, according to the Bethesda system, 75% of negative samples, with 13% low-grade IEL and 11% ASCUS. The background of the mild inflammatory smears was present in 52%, the history of previous positive cytology in 34% was more than three. All of the samples were useful. No relationship was found between the presence of intraepithelial lesion and the age of the patients (p=0.3076). Conclusions: CBL can ensure a higher quality of histological diagnosis by guaranteeing a greater number of useful samples.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019 / Exame de Papanicolaou no Brasil: análise da Pesquisa Nacional de Saúde em 2013 e 2019

ABSTRACT OBJECTIVES To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. METHODS Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. RESULTS The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). CONCLUSIONS Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

RESUMO OBJETIVOS Comparar a cobertura do rastreamento do câncer de colo do útero no Brasil em 2013 e 2019, investigar os fatores associados à realização do exame e os motivos informados para não ter realizado, além de comparar o tempo do recebimento do resultado do exame no SUS e na rede privada. MÉTODOS A partir de dados da Pesquisa Nacional de Saúde (PNS) foram calculadas as prevalências e os respectivos intervalos de confiança de realização do exame preventivo do câncer do colo do útero há menos de três anos, em mulheres de 25 a 64 anos, em 2013 e 2019. Modelos de regressão de Poisson foram utilizados para comparar as prevalências do desfecho segundo características sociodemográficas. Também foram analisados os motivos para não ter feito o exame e o tempo entre a realização e o recebimento do laudo. RESULTADOS Houve aumento na cobertura do exame preventivo no Brasil entre 2013 (78,7%) e 2019 (81,3%) e redução na proporção de mulheres que nunca fizeram o exame de 9,7% para 6,1%. A prevalência de realização do exame foi maior em mulheres brancas, melhor escolaridade e renda mais alta, residentes nas regiões Sul e Sudeste. Os motivos mais frequentes para não realizar o exame foram achar desnecessário (45% em 2013 e em 2019) e nunca ter sido orientada a fazê-lo (20,6% em 2013 e 14,8% em 2019). CONCLUSÕES Apesar das elevadas coberturas de rastreamento alcançadas pelo país, há grande desigualdade no acesso ao exame, e uma parcela não desprezível de mulheres está sob maior risco de morrer por uma doença que pode ser evitada. Esforços devem ser feitos para a estruturação de um programa de rastreamento organizado que identifique e capte as mulheres mais vulneráveis.

Estimates of avoided costs attributed to a short cervix screening program to prevent preterm birth from the perspective of the Unified Health System (SUS) / Estimativa de custos evitados atribuídos a um programa de rastreio de colo curto para prevenção da prematuridade na perspectiva do SUS

ABSTRACT OBJECTIVE To perform an economic cost analysis of the implementation of a short cervix screening program to reduce preterm birth in singleton pregnancies in a short-term time horizon. METHODS We performed a cost-benefit economic analysis using the P5 trial database, a randomized multicenter clinical trial for prevention of preterm birth. Data collection was conducted from July 2015 to March 2019 in 17 different Brazilian hospitals. We conducted a cost analysis for universal cervical screening in singleton pregnancies between 18 weeks and 22 weeks plus 6 days. In subjects with a cervical length ≤ 25 mm, the analysis incorporated the costs of administering 200 mg/day of vaginal progesterone prophylactically until 36 weeks gestation. These findings were subsequently compared with the economic implications of forgoing cervical screening. The time horizon comprised from birth to 10 weeks postpartum. The outcome was measured monetarily in Brazilian real (R$) from the perspective of the Unified Health System. RESULTS Among 7,844 women, 6.67% (523) had a cervix ≤ 25 mm. The cost of screening with transvaginal ultrasound and vaginal progesterone for prevention of births with < 34 weeks was estimated at R$ 383,711.36, while non-screening generated an estimated additional cost of R$ 446,501.69 (related to the 29 non-screened preterm deliveries). Thus, screening and prophylaxis would generate a final cost reduction of R$ 62,790.33, constituting a possible cost-benefit strategy. CONCLUSION Universal short cervix screening for preterm birth has lower costs compared to non-screening within a short-term time horizon, which suggests an interesting benefit-cost ratio. Future studies should consider the cost-effectiveness of prophylactic treatment using sensitivity analyses in different scenarios within the Brazilian health system, as well as analyses that consider the long-term costs associated with preterm births, to robustly justify the implementation of a short cervix screening program.

RESUMO OBJETIVO Realizar uma análise econômica de custo da implementação de um programa de rastreio de colo curto para redução da prematuridade em gestações únicas num horizonte temporal de curto prazo. MÉTODOS Realizamos uma análise econômica do tipo custo-benefício utilizando o banco de dados do P5 trial, um ensaio clínico multicêntrico randomizado para prevenção da prematuridade. A coleta de dados ocorreu de julho de 2015 a março de 2019 em 17 diferentes hospitais do Brasil. Comparamos os custos do rastreamento universal em mulheres com gestação única de 18 a 22 semanas e 6 dias associado à progesterona vaginal profilática 200 mg/dia até 36 semanas naquelas com colo ≤ 25 mm com os do não rastreamento. O horizonte temporal foi do nascimento até 10 semanas após o parto. O desfecho foi medido monetariamente em real brasileiro (R$) na perspectiva do Sistema Único de Saúde. RESULTADOS Entre 7.844 mulheres, 6,67% (523) apresentaram colo ≤ 25mm. O custo do rastreio com a ultrassonografia transvaginal mais a progesterona vaginal para prevenção de nascimentos < 34 semanas foi estimado em R$ 383.711,36, enquanto o não rastreamento gerou custo adicional estimado de R$ 446.501,69 (relacionado aos 29 partos prematuros não rastreados). Assim, o rastreamento mais a profilaxia geraria uma redução de custo final de R$ 62.790,33, apresentando-se como uma possível estratégia de custo-benefício. CONCLUSÃO O rastreamento universal de colo curto para prematuridade apresenta menores custos em relação ao não rastreamento dentro de um horizonte temporal de curto prazo, o que sugere uma interessante relação de custo versus benefício. Novos estudos que considerem a custo-efetividade do tratamento profilático utilizando-se de análises de sensibilidade em diferentes cenários dentro do sistema de saúde brasileiro, assim como análises que considerem os custos de longo prazo atrelados ao nascimento prematuro, são necessários para justificar com robustez a implementação de um programa de rastreamento.

Repercussões da pandemia de COVID-19 no exame preventivo de câncer de colo uterino: percepção de enfermeiros / Repercusiones de la pandemia de COVID-19 en el tamizaje del cáncer de cuello uterino: percepción de los enfermeros / Repercussions of the COVID-19 pandemic on cervical cancer screening: nurses' perception

Resumo Objetivo compreender a percepção de enfermeiros da atenção primária sobre as repercussões da pandemia na realização do exame citopatológico do colo-uterino. Método estudo qualitativo, descritivo, com dados analisados pela Análise de Conteúdo. Foram entrevistados 12 enfermeiros, atuantes na atenção primária de Foz do Iguaçu, PR, entre fevereiro e março de 2022. Resultados emergiram três categorias temáticas que discorreram sobre os prejuízos da pandemia para o rastreamento do câncer de colo-uterino; necessidade de reorganização do serviço, destacando a baixa adesão; e falta de estratégias para o retorno das práticas em saúde. Conclusão e implicações para a prática na pandemia houve a suspensão da coleta de preventivo e após o período crítico, o medo da contaminação pelas mulheres, falta de insumos e recursos humanos dificultaram a retomada do serviço. Torna-se relevante para a prática, desenvolver ações e estratégias que incentivem a realização do exame, para assim reduzir a morbimortalidade por essa neoplasia.

Resumen Objetivo comprender la percepción de los enfermeros de atención primaria sobre las repercusiones de la pandemia en la realización de exámen citopatológico cervical. Método estudio cualitativo, descriptivo, con datos analizados por Análisis de Contenido. Fueron entrevistadas doces enfermeras que actúan en la atención primaria en Foz do Iguaçu, PR, entre febrero y marzo de 2022. Resultados surgieron tres categorías temáticas que discutieron los daños de la pandemia para el tamizaje del cáncer de cuello uterino; necesidad de reorganizar el servicio, destacando la baja adherencia; y falta de estrategias para el retorno de las prácticas de salud. Conclusión e implicaciones para la práctica en la pandemia hubo una suspensión de la recolección preventiva y después del período crítico, el miedo a la contaminación por parte de las mujeres, la falta de insumos y recursos humanos dificultó la reanudación del servicio. Se vuelve relevante para la práctica desarrollar acciones y estrategias que favorezcan la realización del examen, con el fin de disminuir la morbimortalidad por esta neoplasia.

Abstract Objective to understand the perception of primary care nurses about the repercussions of the pandemic on the performance of cervical cytopathological exam. Method qualitative, descriptive study, with data analyzed by Content Analysis. Twelve nurses working in primary care in Foz do Iguaçu, PR, between February and March of 2022, were interviewed. Results three thematic categories emerged that discussed the damages of the pandemic for cervical cancer screening; need to reorganize the service, highlighting the low adherence; and lack of strategies for the return of health practices. Conclusion and implications for practice in the pandemic, there was a suspension of preventive collection and after the critical period, the fear of contamination by women, lack of inputs and human resources made it difficult to resumption of service. It's relevant for practice to develop actions and strategies that encourage the performance of the exam, in order to reduce morbidity and mortality from this neoplasm.

An enlarged fetal thymus may be the initial response to intrauterine inflammation in pregnant women at risk for preterm birth

SUMMARY OBJECTIVE: Fetal thymus involvement in prematurity has been studied, and this study aimed to evaluate its relationship with short cervix and amniotic fluid sludge in the second trimester of pregnancy. METHODS: In this prospective cross-sectional study, 79 pregnant women (19+0 to 24+6 weeks) were included, and cervical length and the presence or absence of amniotic fluid sludge were evaluated. In the three-vessel view of the fetal thorax, the thymus was identified, and its perimeter and transverse diameter were measured and transformed to a zeta score based on gestational age. RESULTS: Data from 22 women with short cervix (<25 mm) and 57 patients with normal cervix (≥25 mm) were analyzed. The transverse diameter of the fetal thymus was significantly greater in the short cervix group compared to that of the normal cervix group (z-score 2.708 vs. −0.043, p=0.003). There were no significant differences in the perimeter (z-score −0.039 vs. −0.071, p=0.890) or the transverse diameter (z-score 1.297 vs. −0.004, p=0.091) of the fetal thymus associated with the presence (n=21) or absence of sludge (n=58). CONCLUSION: A short cervix is associated with an increased transverse diameter of the fetal thymus during the second trimester of gestation.

Comportamiento de las alteraciones citológicas en mujeres atendidas en una IPS de la ciudad de Medellín / Behavior of cytological alterations in women treated at an IPS in the city of Medellín

Resumen Objetivo: Analizar las características relacionadas con el diagnóstico de cáncer de las pacientes que consultan una IPS de la ciudad de Medellín. Metodología: Estudio observacional analítico. La población fueron todas las mujeres atendidas en la IPS Unidad Video Diagnóstica de la Mujer, institución que se dedica a realizar confirmación diagnóstica de mujeres con citologías alteradas. Se analizaron todos los registros de la base de datos de la institución correspondientes a las mujeres que consultaron durante el período 2012- 2017, un total de 55655 mujeres. Resultados: Se analizaron los registros de 55655 usuarias, la mediana de edad fue de 40 años (RIQ 19) y el 66.1% (36812) pertenecen al régimen subsidiado. La principal indicación para la realización de la colposcopia fueron las alteraciones citológicas con un 89.8% (49984) y más frecuente fue el LIEBG 35.3% (19649). El principal cáncer diagnosticado fue el escamocelular con 0.5% (284) y los factores asociados fueron residir en el Valle de Aburrá (OR 0.60 IC 0.42-0.84) y el resultado de citología LIEAG (OR 3.31 IC 2.22-4.94). Conclusiones: Se encontró una prevalencia de cáncer de cérvix de 7.8 por cada 1000 pacientes que consultan en la IPS.

Abstract Objective: To analyze the characteristics related to the diagnosis of cancer of the patients who consult an IPS in the city of Medellín. Methodology: Analytical observational study. The population consisted of all the women treated at the IPS Unidad Video Diagnóstica de la Mujer, an institution dedicated to performing diagnostic confirmation of women with altered cytologies. All the records of the institution's database corresponding to the women who consulted during the period 2012-2017 were analyzed, a total of 55,655 women. Results: The records of 55,655 users were analyzed, the median age was 40 years (RIQ 19) and 66.1% (36,812) belonged to the subsidized regime. The main indication for performing colposcopy was cytological alterations with 89.8% (49984) and the most frequent was LIEBG 35.3% (19649). The main cancer diagnosed was squamous cells with 0.5% (284) and the associated factors were residing in the Valle de Aburrá (OR 0.60 IC 0.42-0.84) and the LIEAG cytology result (OR 3.31 IC 2.22-4.94). Conclusions: A cervical cancer prevalence of 7.8 was found for every 1000 patients who consulted the IPS.

Índices de vascularización cervical en la predicción de parto pretérmino inminente

Objetivo. Establecer la utilidad de los índices de vascularización cervical en la predicción de parto pretérmino inminente. Diseño. Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes. Pacientes con parto pretérmino en los siguientes 7 días (grupo A) y embarazadas con parto pretérmino más allá de los 7 días (grupo B). Métodos. Las embarazadas fueron evaluadas utilizando ecografía transvaginal y seguidas hasta el parto. Principales medidas de resultado. Características generales, índices de vascularización cervical (índice de vascularización, índice de flujo e índice de vascularización / flujo), parto pretérmino inminente y eficacia pronóstica. Resultados. Fueron incluidas 350 pacientes, 75 mujeres presentaron parto pretérmino inminente (grupo A) y 251 pacientes fueron consideradas como controles (grupo B). Las pacientes del grupo A tuvieron valores significativamente más bajos del índice de vascularización e índice de flujo comparado con el grupo B (p = 0,0122 y p < 0,0001, respectivamente). Las pacientes del grupo B presentaron valores significativamente más altos de índice de vascularización / flujo comparadas con las pacientes del grupo A (p = 0,0103). Los tres índices y la combinación de estos no mostraron capacidad de discriminación de parto pretérmino inminente. Conclusiones. Las pacientes con parto pretérmino inminente presentan diferencias significativas en los índices de vascularización comparado con las pacientes que presentan parto pretérmino más allá de los 7 días de la evaluación ecográfica. Sin embargo, no son útiles en la predicción del parto pretérmino inminente.

Objective: To establish the usefulness of cervical vascularization low he in the prediction of impending preterm labor. Design: Case-control study. Institution: "Dr. Urquinaona" Central Hospital, Maracaibo, Venezuela. Participants: Patients with preterm delivery within 7 days (group A) and pregnant women with preterm delivery beyond 7 days (group B). Methods: Pregnant women were evaluated using transvaginal ultrasound and followed until delivery. Main outcome measures: General characteristics, cervical vascularity low he (vascularity index, low index and vascularity / low index), impending preterm delivery, and prognostic efficacy. Results: A total of 350 patients were included, 75 women presented imminent preterm labor (group A) and 251 patients were considered as controls (group B). Patients in group A had significantly lower values of vascularization index and low index compared to group B (p = 0.0122 and p < 0.0001, respectively). Patients in group B had significantly higher values of vascularization / low index compared to patients in group A (p = 0.0103). The three low he and the combination of these did not show the ability to discriminate imminent preterm labor. Conclusions: Patients with imminent preterm labor showed significant differences in the vascularization low he compared to patients presenting preterm labor beyond 7 days of ultrasound evaluation. However, they are not useful in predicting impending preterm labor.

High risk factors for endometrial polyps in 304 cases / 中国基层医药

Objective:To investigate the high risk factors for endometrial polyps (EP).Methods:The clinical data of 669 cases who underwent hysteroscopic examination due to abnormal vaginal bleeding and ultrasonic indications in Binzhou Medical University Hospital from October 2019 to September 2020 were retrospectively analyzed. According to postoperative pathological results, these patients were divided into an EP group ( n = 304) and a non-EP group ( n = 365). The clinical data of these patients were subjected to univariate and multivariate analysis using SPSS 22.0 software. Results:Univariate analysis showed that age (median age: 45 years in the EP group and 47 years in the non-EP group), number of pregnancies (median number of pregnancies: 2 in the EP group and 3 in the non-EP group), number of births (median number of births: 1 in the EP group and 2 in the non-EP group), menopause [49 cases (16.12%) in the EP group and 83 cases (22.74%) in the non-EP group], chronic endometritis [111 cases (36.51%) in the EP group and 174 patients (47.67%) in the non-EP group], cervical polyps [58 cases (19.08%) in the EP group and 46 cases (12.06%) in the non-EP group], hypertension [48 cases (15.79%) in the EP group and 88 cases (24.11%) in the non-EP group], diabetes mellitus [14 cases (4.61%) in the EP group and 31 cases (8.49%) in the non-EP group] were the risk factors of EP ( Z =-3.71, -4.30, -2.50, χ2 = 4.59, 8.44, 0.02, 0.01, 0.04, all P < 0.05). Multivariate analysis showed that age, number of pregnancies, chronic endometritis and cervical polyps had significant effects on the incidence of EP ( OR = 0.97, 95% CI 0.95-0.99, OR = 0.80, 95% CI 0.72-0.90, OR = 0.53, 95% CI 0.38-0.74, OR = 1.73, 95% CI 1.10-2.72, all P < 0.05). Conclusion:Age, number of pregnancies, chronic endometritis and cervical polyps are all risk factors for the development of endometrial polyps.

Mortalidad por cáncer de cuello uterino en la amazonia de Colombia / Cervical cancer mortality in the Colombian Amazon

Resumen OBJETIVO: Analizar el pico de mortalidad por cáncer de cuello uterino registrado en 2018 en Guainía, Colombia. MATERIALES Y MÉTODOS: Estudio ecológico basado en los datos de todas las instituciones con información de la morbilidad y mortalidad y atenciones relacionadas con el cáncer de cuello uterino en Colombia, entre enero de 2009 y diciembre de 2019. Se incluyeron todos los datos disponibles para Guainía. Se excluyeron las bases sin datos entre 2016 y 2018. Se analizaron la morbilidad y mortalidad, atenciones y procedimientos, y se compararon con el comportamiento en 2018 respecto de los demás años. RESULTADOS: Las personas atendidas, las atenciones y los procedimientos relacionados con cáncer de cuello uterino disminuyeron en 2016 y 2017. La concentración de atenciones por persona más baja del periodo se dio en 2017. En 2019, aumentó la cantidad de personas con diagnóstico de infección por papilomavirus. CONCLUSIONES: La reducción en el tamiz, las atenciones y los procedimientos relacionados con el cáncer de cuello uterino, en un territorio, puede ocasionar aumentos en la mortalidad por este tipo de cáncer. Es fundamental sostener en el tiempo las acciones de prevención, diagnóstico y tratamiento, para evitar esta mortalidad.

Abstract OBJECTIVE: To analyze the cervical cancer mortality peak, in Guainía, in 2018. MATERIALS AND METHODS: Ecological study. Data from all institutions with cervical cancer morbidity, mortality and attention information in Colombia, between January/2009 and December/2019, were analyzed. All available data for Guainía were included. The databases with no data between 2016 and 2018 were excluded. Morbidity, mortality, attention, and procedures were analyzed, comparing the behavior in 2018 to the other years. RESULTS: Cervical cancer-related patients, care and procedures decreased in 2016 and 2017. The lowest concentration of care per person in the period was in 2017. In 2019, the number of people diagnosed with papillomavirus infection increased. CONCLUSIONS: The reduction in screenings, care and procedures related to cervical cancer, in a territory, can lead to increases in mortality from this type of cancer. It is essential to sustain prevention, diagnosis, and treatment actions over time to avoid this mortality.

Primary peripheral T-cell lymphoma of the cervix with mononeuritis multiplex: an unusual case presentation

Peripheral neuropathy (PN) is characterized by the injury to the peripheral nervous system of varied etiology. Lymphoma is one of the etiologies of PN, presenting various neurological manifestations. Neuropathy associated with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is unusual and fewer cases are documented in the literature. In addition, PTCL, NOS is extremely rare as primary in the female genital tract, especially uterine cervix, and exhibits aggressive clinical course with poor therapy response. We hereby describe a 47-year-old female who presented with fever and chills for 15 days. Clinical examination revealed left-sided lower motor neuron type of facial nerve palsy with Bell's phenomenon. Nerve conduction study of all four limbs illustrated asymmetrical axonal neuropathy (motor > sensory), suggesting mononeuritis multiplex. She developed vaginal bleeding during her hospital stay. Pelvic examination and imaging revealed a 4x3cm polypoidal mass on the posterior lip of the cervix, which was excised and diagnosed as extranodal primary PTCL, NOS based on morphology, immunohistochemistry, and in-situ hybridization findings. Besides, the cerebrospinal fluid (CSF) was infiltrated by the lymphoma cells, detected on cell block preparation. The patient succumbed to her illness within one week despite best efforts and the commencement of chemotherapy. No consent was obtainable for nerve biopsy and autopsy. Thus, we report an extremely rare case of primary extranodal PTCL, NOS of the uterine cervix with unusual presentation of mononeuritis multiplex. Further, we discussed the differentials of PTCL, NOS at this extranodal site.

Fatores associados às alterações citológicas cervicais em mulheres usuárias da Atenção Primária à Saúde / Factors associated with cervical cytological alterations in women using Primary Health Care

Objetivo: Analisar os fatores associados às alterações citológicas cervicais em mulheres usuárias da Atenção Primária à Saúde, de um município do interior do Rio Grande do Sul (RS), no período de 2014 a 2017. Métodos: Estudo descritivo e transversal com base nos exames citopatológicos registrados no Sistema de Informações do Câncer (Siscan), do município do interior do RS e Prontuários Eletrônicos. Os dados foram analisados por meio de estatística descritiva e pelo Teste de Associação Exato de Fisher (p≤0,05). Resultados: Observou-se aumento no diagnóstico de alterações citológicas no período estudado, com predomínio de mulheres na faixa etária entre 25-64 anos (77,8%), de baixa escolaridade (68,7%), com companheiro (63,3%) e de cor branca (83,3%). As atipias de significado indeterminado apresentaram associação com a faixa etária <25 anos (p=0,040) e cor da pele branca (p=0,033). As lesões intraepiteliais de alto grau (HSIL) estiveram associadas à faixa etária entre 25-64 anos (p=0,040). Escolaridade, estado civil, uso de anticoncepcional oral, histórico de infecção sexualmente transmissível, vaginose bacteriana e Gardnerella vaginallis não apresentaram associação com as alterações citológicas. Conclusão: O estudo permitiu a identificação dos fatores associados às alterações citológicas cervicais, contribuindo com informações para o desenvolvimento de ações que qualifiquem o rastreamento do câncer cervical.

Objective: To analyze the factors associated with cervical cytological alterations in women using Primary Health Care in a municipality in the interior of the state of Rio Grande do Sul (RS), in the period from 2014 to 2017. Methods: Descriptive and cross-sectional study based on cytopathological exams registered in the cancer information system (Siscan) and Electronic Medical Records of the municipality of the interior of RS. Data were analyzed using descriptive statistics and Fisher's Exact Association Test (p≤0.05). Results: An increase in the diagnosis of cytologic changes was observed in the period studied, with a predominance of women aged between 25-64 years (77.8%), low schooling (68.7%), with partner (63.3% %), and white (83.3%). The atypia of indeterminate meaning was associated with age <25 years (p = 0.040) and white skin color (p = 0.033). High-Grade Squamous Intraepithelial Lesions (HSIL) were associated with the age range between 25-64 years (p = 0.040). Schooling, marital status, oral contraceptive use, history of Sexually Transmitted Infections (STI's), bacterial vaginosis, and Gardnerella Vaginallis were not associated with cytologic alterations. Conclusion: The study allowed the identification of the factors associated with the cervical cytological alterations, contributing with information to the development of actions that qualify the cervical cancer screening.

Primary lymphoma of the uterine cervix: case report

ABSTRACT Introduction: Primary lymphoma of the uterine cervix is a rare disease, with nonspecific symptoms, that seldom alters Pap smear results since it develops in the cervical stroma. Chemotherapy, radiation therapy, and surgery, as well as their combination, are some of the medical options available for treatment. The unique location of the lymphoma in the cervix is considered a good prognostic factor. Case presentation: A 49-year-old female patient consulted due to pelvic pain and vaginal discharge and bleeding. She underwent a colposcopy due to cytology findings of ASC-H (atypical squamous cells that do not exclude high-grade squamous intraepithelial lesions). The biopsy reported diffuse large B-cell lymphoma, which was initially treated with three cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, and was then switched to two cycles with rituximab, ifosfamide, carboplatin and etoposide due to a poor response with the first scheme. A new biopsy was performed after the last cycle of chemotherapy with a report of endocervical polyp and abundant clusters of glandular cells with focal atypia. Post-treatment diagnostic imaging studies reported concentric thickening of the cervix-vagina junction. Seven years after being diagnosed with lymphoma, another biopsy was performed. The result was negative for dysplasia or malignancy. At the time of writing this case report, 10 years after diagnosis, the patient is asymptomatic and disease-free. Conclusions: Primary lymphoma of the uterine cervix is an unusual condition that is rarely detected through an abnormal Pap smear result, as in this case. A colposcopy was done because of this finding, confirming the diagnosis of diffuse large B-cell lymphoma. This case report describes the satisfactory evolution of the patient and disease-free survival after 10 years.

RESUMEN Introducción. El linfoma primario del cuello uterino es una patología infrecuente, de síntomas inespecíficos y que pocas veces altera el examen de citología del cuello uterino dado que se desarrolla en el estroma cervical. Para su tratamiento existen varias opciones, incluyendo quimioterapia, radioterapia y cirugía, así como combinaciones de estas. La localización única del linfoma en el cuello uterino se considera un factor de buen pronóstico. Presentación del caso. Paciente femenina de 49 años, quien consultó por dolor pélvico y flujo y sangrado genital. Se ordenó colposcopia por reporte de ASC-H (células escamosas atípicas que no excluyen lesiones intraepiteliales de alto grado) en citología vaginal. La biopsia reportó linfoma difuso de células B grandes, el cual se trató con rituximab, ciclofosfamida, doxorrubicina, vincristina y prednisolona por tres ciclos, y con rituximab, ifosfamida, carboplatino y etopósido por dos ciclos; este cambio se hizo debido a una mala respuesta con el primer esquema. Se realizó nueva biopsia después del último ciclo de quimioterapia con reporte de pólipo de tipo endocervical y abundantes grupos de células glandulares con atipia focal. Los estudios de imágenes diagnósticas posteriores al tratamiento reportaron engrosamiento concéntrico de la unión entre cuello uterino y vagina. A los 7 años del diagnóstico del linfoma se realizó otra biopsia que resultó negativa para displasia o malignidad. Al momento de la elaboración del presente reporte, 10 años después del diagnóstico, la paciente se encontraba asintomática y libre de enfermedad. Conclusiones. El linfoma primario del cuello uterino es una patología rara que en pocas oportunidades se evidencia con anormalidad en la citología vaginal como en el caso reseñado. Dado este hallazgo se realizó una colposcopia mediante la cual se confirmó el diagnostico de linfoma difuso de células B grandes. Se presenta un caso con evolución satisfactoria y supervivencia libre de enfermedad después de 10 años.

Melanoma primario de cuello uterino: Reporte de caso / Primary malignant melanoma of the cervix: Case report

Resumen El melanoma primario de mucosas representa el 1% de todos los cánceres. Su localización en cuello uterino es rara y existen menos de 100 casos reportados en la literatura hasta la fecha. Los datos son limitados en cuanto su estadificación y tratamiento y su pronóstico es malo con tasas de supervivencia del 10% a 5 años. Se presenta el caso clínico de una paciente de 82 años con sangrado vaginal, con evidencia de una lesión melanótica en cuello uterino, la biopsia de la lesión reportó compromiso por tumor maligno pobremente diferenciado, con inmuno perfil que confirma melanoma maligno. Los estudios de extensión no mostraron enfermedad metastásica a distancia, se presentó el caso en junta multidisciplinaria de ginecología oncológica por lo que se indicó tratamiento con radioterapia pélvica externa exclusiva con intención paliativa para control de síntomas, teniendo en cuenta: la edad, las comorbilidades y el estado funcional ECOG (Eastern Cooperative Oncology Group) 3; luego de 10 meses de seguimiento la paciente falleció.

Abstract Primary mucosal melanoma represents 1% of all cancers, the location in the cervix is rare, there are less than 100 cases reported in the literature to date, the data is limited in terms of staging and treatment, its prognosis is poor with survival rates of 10% at 5 years. We present a clinical case of a primary melanoma of the cervix in an 82-year-old patient with vaginal bleeding with evidence of a melanotic lesion in the cervix. The biopsy of the lesion reported poorly differentiated malignant tumor involvement, with an immuno-profile that favors melanoma. Extension studies were performed that did not show distant metastatic disease, the case was presented in a multidisciplinary oncological gynecology meeting, indicating treatment with exclusive external pelvic radiotherapy with palliative intention for symptom control taking into account patient comorbidities and ECOG functional status. (Eastern Cooperative Oncology Group) 3, after 10 months of follow-up the patient died.

"Me sentí enfermar": percepciones y comprensión de las mujeres del resultado positivo de un test de virus del papiloma humano en Jujuy, Argentina / "I felt myself getting sick:" women's perceptions and understandings of a positive human papillomavirus test in Jujuy, Argentina

RESUMEN Con el objetivo de analizar las percepciones y clasificar las modalidades de comprensión sobre un resultado positivo del test de virus del papiloma humano (VPH+), en 2016 realizamos 38 entrevistas en profundidad a mujeres con diagnóstico de VPH+ (prueba de Papanicolaou normal y anormal), realizado en el sistema público de salud de Jujuy. Se elaboró una tipología que delimita perfiles de mujeres en función del tipo de comprensión del resultado: 1) comprensión; 2) no-comprensión, a) subestimación, b) sobreestimación, y c) confusión. Entre aquellas que no comprendían, las entrevistadas que confundían el resultado relataron percepciones contradictorias con relación al VPH y su gravedad; quienes lo subestimaban tendían a mencionar ausencia de síntomas y a expresar escasa preocupación; mientras que aquellas que lo sobreestimaban se consideraban enfermas y expresaban preocupación, relato de una ruptura biográfica y dolores físicos. Los hallazgos confirman la necesidad de mejorar los mecanismos de entrega e información sobre los resultados para disminuir el impacto psicosocial en las mujeres y aumentar la adherencia al seguimiento sugerido.

ABSTRACT With the purpose of analyzing women's perceptions and classifying their modes of understanding a positive human papillomavirus (HPV+) test, we conducted 38 in-depth interviews with women who had received an HPV diagnosis (normal and abnormal Pap smear), screened in Jujuy's public health system in 2016. A typology based on women's understandings of the result was developed: 1) understanding; 2) lack of understanding; a) underestimation; b) overestimation; c) confusion. The interviewees who experienced confusion over the results reported contradictory perceptions in relation to a positive HPV test and its severity; those who underestimated it tended to mention the absence of symptoms and expressed little concern over the result; while those who overestimated it considered themselves sick and described concern, narrating a biographical disruption and physical pain. These findings confirm the need to improve the delivery of results and the provision of information in order to decrease psychosocial impact and increase follow-up adherence in HPV-positive women.

O conhecimento dos discentes de enfermagem acerca do câncer de colo do útero / El conocimiento de los estudiantes de enfermería sobre el cáncer de cuello uterino / The knowledge of nursing students about cervical cancer

Objetivo: analisar o conhecimento dos discentes do curso de enfermagem acerca dos fatores de risco e prevenção do câncer de colo do útero. Método: estudo transversal, quantitativo, realizado com 112 discentes do curso de enfermagem de uma instituição pública de ensino superior no Nordeste do Brasil. Dados coletados em junho de 2017, utilizando questionário estruturado, com análise bivariada entre conhecimento sobre os fatores de risco e prevenção do câncer de colo do útero e as variáveis sociodemográficas, comportamentais e acadêmicas. Resultados: verificou-se associação entre o conhecimento acerca dos fatores de risco e prevenção e a participação dos discentes em atividades extracurriculares, período de curso e assistência à mulher com ênfase no câncer de colo do útero. Conclusão: salienta-se a necessidade de aprimoramento das abordagens dessa temática no curso de graduação em Enfermagem por meio da participação dos alunos em atividades extracurriculares.

Objective: to analyze the knowledge of nursing undergraduate students about the risk factors and prevention of cervical cancer. Method: a cross-sectional, quantitative study, carried out with 112 nursing students from a public higher education institution in Northeast Brazil. Data collected in June 2017, using a structured questionnaire, with bivariate analysis between knowledge about the risk factors and prevention of cervical cancer and the sociodemographic, behavioral and academic variables. Results: there was an association between the undergraduate students' knowledge about risk and prevention factors and their participation in extracurricular activities, semester and assistance to women with an emphasis on cervical cancer. Conclusion: It is emphasized the need to improve the approaches to this theme in the undergraduate nursing course through the participation of students in extracurricular activities.

Objetivo: analizar el conocimiento de los estudiantes de enfermería sobre los factores de riesgo y prevención del cáncer de cuello uterino. Método: estudio transversal, cuantitativo, realizado con 112 estudiantes de enfermería de una institución pública de educación superior en el noreste de Brasil. Los datos fueron recogidos en junio de 2017, a través de un cuestionario estructurado, con análisis bivariado entre el conocimiento sobre los factores de riesgo y prevención del cáncer de cérvix y las variables sociodemográficas, comportamentales y académicas. Resultados: comprobose asociación entre el conocimiento sobre factores de riesgo y prevención y la participación de los estudiantes en actividades extracurriculares, período de curso y asistencia a mujeres con énfasis en cáncer de cuello uterino. Conclusión: se enfatiza la necesidad de mejorar los enfoques de esta temática en el grado de enfermería a través de la participación de los estudiantes en las actividades extracurriculares.

Mioma en remanente cervical tras histerectomía supracervical laparoscópica, presentación de un caso y revisión de la literatura / Myoma in cervical remnant after laparoscopic supracervical hysterectomy, case report and literature review

INTRODUCCIÓN: Los leiomiomas uterinos son el tumor pélvico más frecuente en la mujer, derivan de las células musculares lisas del miometrio y pueden localizarse en cualquiera de las porciones uterinas. Se clasifican según su relación con las diferentes capas del útero mediante la clasificación de la FIGO. Pueden ser asintomáticos o producir síntomas como sangrado, problemas reproductivos o dolor por compresión de estructuras vecinas. El tratamiento puede ser médico o quirúrgico, teniendo dentro de este último grupo, la posibilidad de realizar una miomectomía o una histerectomía total o subtotal. La histerectomía subtotal permite mantener el cérvix uterino, de tal forma que la técnica quirúrgica es más sencilla, sin embargo, requiere de la morcelación de la pieza para su extracción; mientras que la histerectomía total elimina el riesgo de recidiva de la patología uterocervical, aunque precisa de una mayor curva de aprendizaje. CASO CLÍNICO: Presentamos el caso de una paciente de 52 años a la que se le realizó una histerectomía supracervical laparoscópica por miomas. Posteriormente, se objetivó la aparición de un nuevo mioma en el remanente cervical, que requirió de una traquelectomía vía vaginal. CONCLUSIÓN: La histerectomía subtotal laparoscópica en úteros con múltiples miomas puede tener como efecto adverso la recidiva miomatosa en el cérvix o la aparición de miomas parasitarios secundarios a la morcelación uterina no estanca. Además, implica continuar con el cribado para la prevención del cáncer de cérvix uterino.

BACKGROUND: Uterine leiomyomas are the most frequent pelvic tumor in women. They derive from smooth muscle cells of the myometrium and can be in any of the uterine parts. They are classified according to their relationship with the different layers of the uterus by the FIGO classification. Uterine leiomyomas can be asymptomatic or produce symptoms such as compression pain, reproductive problems and metrorrhagia. The treatment can be medical or surgical. Within this last group there is the possibility of performing a myomectomy or a total or subtotal hysterectomy. The subtotal hysterectomy allows the uterine cervix to be maintained and therefore the surgical technique is simpler. However, it requires the morcellation of the piece for its removal. Alternatively, total hysterectomy eliminates the risk of recurrence of uterocervical pathology, but this procedure presents a steeper learning curve. CLINICAL CASE: We present the case of a patient of 52 years who underwent a laparoscopic supracervical hysterectomy for myomas. Subsequently, the appearance of a new myoma in the cervical remnant was observed, which required a vaginal trachelectomy. CONCLUSION: Laparoscopic subtotal hysterectomy in myomatous uterus can have as an adverse effect myomatous recurrence in the cervix or the appearance of parasitic myomas secondary to non-contained uterine morcellation. In addition, it involves continuing screening for the prevention of cervical cancer.