Atitudes e crenças de médicos ginecologistas- -obstetras e de pacientes do Hospital Universitário de Brasília sobre o rastreamento cervical e o exame pélvico / Attitudes and beliefs of obstetrician-gynecologists and patients at the University Hospital of Brasília about cervical screening and pelvic examination

Objetivo: Avaliar as atitudes e crenças de pacientes e médicos ginecologistas-obstetras sobre o rastreamento cervical e o exame pélvico no Hospital Universitário de Brasília (HUB). Métodos: Foram realizadas entrevistas com pacientes que aguardavam por uma consulta previamente agendada no ambulatório de ginecologia e com médicos ginecologistas-obstetras que atuavam no HUB. Cada grupo respondeu a um questionário que enfocava a realização do rastreamento cervical e do exame pélvico (EP). Resultados: No total, 387 pacientes responderam ao questionário. Dessas, apenas 4,13% sabiam que, de acordo com as diretrizes brasileiras, o rastreamento cervical deveria ser iniciado aos 25 anos de idade, 5,17% sabiam que ele deveria ser encerrado aos 64 anos e 97,93% esperavam um intervalo menor do que o trienal recomendado. Após serem informadas sobre as diretrizes, 66,93% acreditavam que o início aos 25 anos é tardio, 61,5%, que o encerramento aos 64 anos é precoce, 88,37%, que o intervalo trienal é muito longo e 94,06% ficaram com receio de que problemas de saúde pudessem aparecer nesse intervalo. Dos 44 médicos que responderam ao questionário, embora a maioria concordasse com as diretrizes, somente 31,82%, 38,64% e 34,1% as seguia com relação à frequência, à idade de início e à idade de encerramento, respectivamente. Quanto ao EP, aproximadamente metade dos participantes de cada grupo considerava que o exame deveria ser realizado nas consultas regulares com o ginecologista. Conclusão: Foi observada uma discrepância entre as expectativas das pacientes e as diretrizes para o rastreamento de câncer cervical. A maior parte das pacientes não as conhecia e, quando informadas, não concordava com elas. Quanto aos médicos ginecologistas- obstetras, a maioria não as seguia, apesar de conhecê-las. Quanto ao EP, grande parte dos médicos e pacientes considerava-o importante e acreditava que ele deveria ser realizado de forma rotineira nas consultas ginecológicas.

Objective: Evaluate the attitudes and beliefs of patients and obstetrician-gynecologists about cervical screening and pelvic examination in the University Hospital of Brasília (HUB). Methods: Face-to-face interviews with patients waiting for a previously scheduled consultation at the gynecology outpatient clinics and attending obstetrician-gynecologists at the HUB. Each group answered a questionnaire addressing cervical screening and pelvic examination (PE). Results: 387 patients answered the questionnaire. Of these, only 4.13% were aware that, according to Brazilian guidelines, cervical screening should begin at age 25, 5.17% that it should stop at age 64 and 97.93% expected a shorter interval than the recommended triennial. After being informed of the guidelines, 66.93% believed that starting at age 25 is late, 61.5% that stopping at 64 is early, 88.37% that the triennial interval is too long, and 94.06% would be afraid that health problems could appear during the interval. Of the 44 participating physicians, although most agreed with the guidelines, only 31.82%, 38.64% and 34.1% followed them regarding frequency, starting and stopping age, respectively. As for EP, approximately half of the participants in each group believed that it should be performed in regular consultations with the gynecologist. Conclusion: There was a discrepancy between patients' expectations and cervical screening guidelines. Most patients didn't know and, when informed, didn't agree with them. As for Ob-Gyn physicians, most did not follow these guidelines, despite knowing them. As for pelvic exam, most physicians and patients considered it important and believed it should be routinely performed during gynecological consultations.

The relation between active smoking and colposcopical and cytological findings in the cervix uteri

Background: All types of smoking have been associated with cervical neoplasia, and the long-term of use tobacco products and intensity of smoking could influence cervical carcinogenesis. The aim of this study is to identify the association between smoking and the presence of colposcopical and cytological abnormalities in cervix uteri.Methods: An observational case-control study was applied on 100 patients to investigate this relationship. The patients were divided into two groups, smokers’ group (70) cases and nonsmokers’ group (30) cases. All of the patients have been submitted to colposcopy and Papanicolaou smear. Comparison of colposcopic and cellular findings between both groups was done.Results: Authors found that there was a significance difference in the rate of abnormal colposcopical findings between two groups. This rate in smokers’ sample was 45.7% and in the second was 26.7% with p-value=0.04. Additionally, there was no significance difference in the rate of abnormal cytological findings. This rate in smokers’ group was 32.9% whereas in the second was 23.4% with p-value=0.6.Conclusions: This study data suggests that smoking increases abnormalities in papanicolaou smear and colposcopy.

Assessment of the Knowledge of Human Papillomavirus Infection Complications, Cervical Cancer and Vaccine among Students of Medical Sciences College at Taif University: A Cross-Sectional Survey

Background: Cervical cancer incidence globally has beencorrelated to Human papillomavirus (HPV) infection.Knowledge of HPV is essential between medical sciencesstudents.Objectives: To evaluate the knowledge of HPV, cervicalcancer and vaccine among medical sciences students at Taifuniversity.Methods: The cross-sectional study of a convenient sampleencompassed 110 students in medical sciences college at TaifUniversity, Taif, Saudi Arabia was conducted in June 2018. Aself-administrated questionnaire was distributed to all students.Answers are evaluated using Pearson’s Chi-square test. A pvalue=0.05 was considered significant.Results: More than 85% of the study group from both malesand females have a previous knowledge regarding HPV. Allstudents from different departments revealed significantknowledge about HPV. Students are also aware of cervicalcancer, HPV-vaccine availability, route of HPV transmission,Pap smear. 93.63% of the study group recommend includingHPV in premarital tests.

Comparative study of papanicolaou smear and colposcopy in the evaluation of cervical lesions

Background: Cervical cancer is the third most common type of cancer among females. Study aims to critically evaluate the sensitivity and specificity of colposcopy versus papanicolaou (Pap) smear in the early detection of dysplasias. Its secondary objective to correlate the findings in the evaluation of unhealthy cervix by cytology, colposcopy and colposcopy guided biopsy.Methods: This was a tertiary care teaching hospital based, prospective, cross sectional study done in Department of Obstetrics and Gynaecology, at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, conducted on 200 women attending Gynaecology OPD.Results: PAP smear was taken for all 200 patients. 73% of smear was found to be normal, 11% showed inflammatory atypia, 9% showed low grade squamous intraepithelial lesion (LSIL), 3.5% showed atypical squamous cells of undetermined significance (ASCUS) and 3.5% showed High Grade Squamous Intraepithelial Lesion (HSIL). Among the 200 cases studied, 38% (76/200) were diagnosed as colposcopically abnormal. Among the abnormal cases, AW areas were diagnosed in 4%. Punctate pattern of vessels was seen in 5% of women. Normal findings was present in 62%, Erosion cervix in 6%, inflammatory changes were seen in 6% and polyps were diagnosed in 7.5%, leucoplakia was found in 2% and unsatisfactory colposcopy finding was seen in 4% and underwent endocervical curettage. 32 cases out of 200 women were positive on Pap smear. 66 out of 200 women were positive on Biopsy. Pap smear was positive in 22 out of 66 biopsy proven positive cases.Conclusions: The commonest presenting complaint was vaginal discharge (182/200; 91% of the patients. the PAP smear  is found to have sensitivity of 33.33%  and specificity of 92.54%. colposcopy is found to have sensitivity of 81.82%  and specificity of 82.84%.

Adequacy of PAP Smear in Females of Reproductive Age and Perimenopausal Age

Introduction: The purpose of the Papanicolou (Pap) smearin the early detection and prevention of cervical canceris well proved. However, due to lack of awareness stillmany women fail to undertake this test. To address theusefullness and awareness issue, we assessed the feasibilityand adequacy of Pap smears in females of reproductive ageand perimenopausal age. Cervical cancer is the second mostsevere cancer affecting women globally and mortality is notonly affecting India but also the other developing nations.This study aimed to study the cervical cytology and its patternin patients from reproductive age group and perimenopausalage group in Gynaec Outpatient Department of MGM medicalcollege and hospital in Jamshedpur.Material and methods: The procedure of clinical Pap smearincludes extraction of cells from squamocolumnar junctionby sweeping and then the smear was spread over glass slideand it was dipped in a small container with fixative (95%ethyl alcohol). Later on, the slides were stained (Pap stain)and observed for the cytological study according to Bethesdascoring system, 2001 for detection of cervical cancer inpatients.Results: Majority of the patients presented with single orcombination of symptoms like white discharge per vaginumand lower abdominal pain or both. The samples extractedand evaluated from the patients through the Pap smearswere put according to Bethesda scoring system, 2001;where it was found that Non-specific inflammation was76.417%, normal cervical cytology was 14.153%, LSIL((Lowgrade intraepithelial lesion) was 3.77% and inadequate/unsatisfactory was 5.660%.Conclusion: Pap smear testing related to cervical cancerpresence drastically reduces in morbidity and mortalitythrough early detection, diagnosis and management ofcervical cancer. This cytological testing is one of the meresttools available to find the occurrence of cervical cancer.

Comparison of Conventional Papanicolaou Smear and Liquid-based Cytology for Cervical Cancer Screening

Background: Cervical carcinoma is the fourth most common malignancy worldwide and the fourth most common cause ofdeaths due to cancer worldwide. Conventional Papanicolaou (PAP) smears were used for screening led to a drastic reductionin a number of cervical carcinoma cases, but have high false negativity. Hence, newer methods like liquid-based cytology(LBC) were introduced.Aim: The aim of the study was to compare LBC with conventional PAP smear for cervical cancer screening.Materials and Methods: This study was done on randomly selected 100 patients attending the pilot screening project at atertiary care teaching institute in South India. The sample for conventional PAP smear was taken using Ayre’s spatula andslide prepared. The sample for LBC was taken using the cytobrush, and the sample was rinsed in the fixative provided by themanufacturer. The sample was then centrifuged and slide prepared. Both the slides were then stained using the rapid PAPstain. The slides were analyzed and the following results were obtained.Results: Most of the patients who attended the screening program were in the fourth decade of life. Dysplasia was diagnosedin 26% of cases and most were in the age group of 21–40 years. Most of the cases were in the socioeconomic Class II of themodified Prasad’s classification. Dysplasia was found more in the socioeconomic Class III (12% of cases). 90% of cases startedsexual activity before 25 years of age, and out of these 90 patients, 92.3% had dysplasia. Dysplasia was more in patients withparity 3(14% of cases). 46% of cases presented with white discharge per vaginum. The cytological abnormality was found in28 cases (28%) by LBC, whereas conventional Pap smear detected an abnormality in only 22 cases (22%). 96 cases (96%)were satisfactory for evaluation on LBC and 92 cases (92%) in conventional Pap smear. ASC was found in 12% of cases inconventional PAP whereas it was detected in only 6% of cases in LBC. Low-grade squamous intraepithelial lesion (LSIL) andhigh-grade squamous intraepithelial lesion (HSIL) were found in 8% and 2% of cases in conventional PAP smear whereas itwas found in 12% and 8% of cases in LBC. No carcinoma was found in conventional PAP smear whereas 2% of cases hadcarcinoma features in LBC. Sensitivity and specificity of PAP smear in detecting LSIL was 40% and 93% whereas for HSILit is 50% and 100%. Sensitivity and specificity of LBC in detecting LSIL is 66% and 94% whereas for HSIL it was 100% and96%. Overall sensitivity and specificity for conventional PAP smear is 55.5% and 83.7% whereas for LBC it is 83% and 86.5%,respectively. There was a medium level of correlation between conventional PAP smear and LBC (r = 0.59).Conclusion: LBC is strongly advocated in the best interest of public health especially in countries like India where more numberof people are in the lower socioeconomic status category. It improves the sample quality and reduces the likelihood of falsenegative results and hence improving the efficacy of the screening programs.

Correlation of abnormal Pap smears with histopathologic results: Philippine General Hospital experience (2014-2017)

@#<p style="text-align: justify;"><strong>Objectives:</strong> To evaluate abnormal Papanicolau smear results at the Philippine General Hospital (PGH) for the past four years by comparing abnormal smear cytology with histologic interpretations. Possible causes of discrepant results were also determined.</p><p style="text-align: justify;"><strong>Methods:</strong> All Pap smears released as abnormal from January 2014 to December 2017 and the corresponding available biopsies were retrieved. Discrepancy between cytologic and histology diagnosis was assessed and pairs with major discordance were reviewed.</p><p style="text-align: justify;"><strong>Results:</strong> There were a total of 30,237 conventional pap smears signed out of which 239 (0.79%) were abnormal and only 56 (23%) had a subsequent tissue biopsy. The overall concordance rate is 75% while strict or absolute concordance rate is 32%. The overall discordance rate is 25%. Positive predictive value is highest for pap smears signed out as atypical glandular cells favor neoplastic (AGC-NEO) (100%), followed by malignant (93%), high grade squamous intraepithelial lesion (HSIL) (83%), and then atypical squamous cells cannot exclude an HSIL (ASC-H) and atypical squamous cell of undetermined significance (ASCUS), both at 67%.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Considering that the Philippine General Hospital is a referral and academic center, we have a low percentage of abnormal pap smears compared to other developing countries and even a lower percentage of patients who had subsequent biopsies. Cytohistologic correlation detected interpretative as well as sampling errors, and the aim is to work on these deficiencies by improving quality assurance protocols and modifying current local practices of both pathologists and clinicians.</p>

Study of cervical cytology in papanicolaou smears in a tertiary care center

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions. Materials and methods: This was a prospective study aimed to evaluate all pap smears examined at KGH over a period of 6 months i.e. from December 2016 to May 2017. Detailed clinical data and pap smear cytology reports were obtained and data noted in a structured proforma. All PAP smears reported as per THE BETHESDA System 2014. Women with abnormal smears were followed up by repeat pap smears or acetic acid guided cervical biopsy. Results: Total of 770 pap smears were examined in 6 months duration. Max no. of patients (around 40%) were of 31-40 years age group. Most of the patients (90.77%) were categorized into NILM (negative for intraepithelial lesion or malignancy). Among the five organisms, we found trichomonas were 38 (4.9%), and candida 38 (4.9%) cases of total NILM cases. Epithelial cell abnormalities in cytological examination were found in total 61 cases constituting 7.92%. Among epithelial cell abnormalities, LSIL was the commonest (27 cases, 3.57%). Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.

Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic.

Background: The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology. Objectives: This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears. Methods: We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coeffi cient of correlation were used for comparison. Results: Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia. Limitations: The limitations included a small sample size, lack of correlation with histological fi ndings and bias due to STI clinic-based recruitment of the study population. Conclusion: Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.

Predictors of Iranian women’s intention to first papanicolaou test practice: An application of protection motivation theory.

BACKGROUND AND AIM: Given the importance of papanicolaou (Pap) test in the early detection and timely treatment of cervical cancer, present study was designed to determine predictors of a sample of Iranian women’s intention to first Pap test practice based on the protection motivation theory (PMT) variables. MATERIALS AND METHODS: In this cross‑sectional study, a total of 240 women referral to the 30 primary health care clinics were selected. They completed a developed scale based on PMT variables including intention, perceived vulnerability and severity, fear, response costs, response efficacy and self‑efficacy. Path analysis was used to determine the association between predictive factors and intention. RESULTS: The results showed that PMT had goodness of fit with a χ2/df = 2.37, df = 28, P = 0.001 and RMSEA = 0.076. PMT explained 42% of the variance in women’s intention to get first Pap smear test. Self‑efficacy (b = 0.55, P < 0.001) and response efficacy (b = 0.19, P < 0.001) were found to be the predictors of intention. CONCLUSION: These findings may be used to develop tailored, theory‑based educational interventions associated with Pap testing among women.

Conventional cytology, visual tests and evaluation of P16INK4A as a biomarker in cervical intraepithelial neoplasia.

OBJECTIVES: (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugol’s iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16INK4A expression by immunostaining. MATERIALS AND METHODS: Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16INK4Aexpression in biopsy samples was studied using immunohistochemistry. RESULTS: All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut‑off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p16INK4A expression was seen in eight of 15 CIN cases. CONCLUSIONS: (1) PAP test and visual techniques are complementary. (2) p16INK4Aexpression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.

Detection of HPV and its Association with Different Known Risk Factors for Neoplastic Cervical Lesions.

Objective: Cervical carcinoma is one of the most common diseases in our setup studies show that it is preceded by precursor lesions. It has been suggested that persistent infections with human papillomavirus (HPV) is the major risk factor in the development of this invasive cervical neoplasia. The rationale of this study was, whether detection may contribute to the identification as a major risk factor in cervical neoplastic lesions. Study Design: Experimental study. Methods: 102 cases were selected after screening 1000 specimens through Papanicolaou stains of cervical cytology and histopathology for detection of HPV and its subtype PCR. Data for risk factors were collected by a questionnaire and association of HPV was seen with Positive PCR results. Patient demographics including their age, sexual partners, marital status, socioeconomic condition, contraceptive and screening history were evaluated to determine whether subsidiary risk factors are associated with HPV and the development of cervical lesions among Pakistani women. Major Outcome: 85% cases of cervical carcinoma were associated with high risk HPV infection. Results:46/102 (45%) cases were low grade squamous cell intraepithelial lesions(L-SILs),twenty two (21.5%) cases were high grade squamous cell intraepithelial lesions (H-SILs), 14(13.7%) cases were squamous cell carcinomas(SCC), 6 (5.8%) cases showed features of adenocarcinoma, 10(9.8%) cases showed cytology of atypical squamous cells of undetermined significance(ASCUS) and 4(3.9%) cases were of atypical glandular cells of undetermined significance(AGUS). Out of 102 cases, 88/102(86.27%) were positive for HPV and among them 32/88 (36%) cases were of HPV-16 and 56/88(64%) cases of HPV-18. There was strong association of HPV positivity with young age, early marriages, poor socioeconomic condition, abortions, multiparity and smoking but there was no association with multiple marriages. Conclusion: Frequency of HPV-18 was greater than HPV-16 in cervical neoplastic lesions and was strongly associated with certain known risk factors for cervical carcinoma.

Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi.

Background: Cervical cancer being a major cause of morbidity and mortality in women in developing countries, its awareness is essential. Aim: The aim of this study is to assess the knowledge, attitude and practices of women regarding the basic screening test for detection of cancer cervix. Settings and Design: Population based cross-sectional study. Materials and Methods: Cross-sectional prospective study was conducted. Information from consenting participants (450) was collected using structured questionnaire. Answers were described in terms of knowledge, attitude and practice and their respective adequacy with respect to Papanicolaou (Pap) test, the most common test used for early detection of cervical cancer. Adequacy was compared between the categories of socio demographic and clinical variables. Statistical Analysis: The data collected was analyzed using statistical package (SPSS version 18.0). Adequacy was compared between the categories of the control variables by χ2 test with a 5% significance level. Results: Knowledge, attitude and practices regarding Pap test were adequate in 32.7%, 18.2% and 7.3% of women respectively. Major impediment to adequate practice was lack of request by physician. Knowledge, attitudes and practices were found to increase significantly with increasing age and education. Conclusion: Effective information, education and communication strategies are required to improve the level of awareness of public. Health-care professional should be proactive in imparting knowledge at every opportunity.

Comparison of the routine Papanicolaou staining technique with the rapid, economic, acetic acid, Papanicolaou (REAP) technique.

Background: The universal stain for oral cytological screening for precancer and cancer of oral cavity is Papanicolaou stain which has been used in different laboratories with many modifications. Objectives: To assess the superiority of staining of smears by REAP technique compared to PAP technique. Material and Methods: 100 smears were collected from 50 patients. One set of smears were stained with conventional PAP technique and the other set with the REAP technique. In the REAP technique, the ethanol bath in the pre Orange G6, post Orange G6 and post EA50 stages is replaced by 1% acetic acid; Tap water is used instead of Scott’s tap water and hematoxylin is pre heated in water bath to 60°C for rapid penetration. Methanol is used for final dehydration. The two sets of smears are observed by two independent observers and assessed for the optimal and suboptimal nuclear and cytoplasmic staining. The results are compared and analyzed statistically. Results: Good cytoplasmic transparency and optimal nuclear details were seen in REAP stained smears compared to the conventional PAP smears. The cost involved in REAP method was lesser compared to conventional PAP technique. REAP technique took 3 minutes for completion compared to PAP technique that involves a minimum of 20 minutes. Conclusion: REAP technique produces better stained smears that are cost effective and involve minimal time for mass screening of oral cancer as compared to conventional PAP smears.

Regresión de las lesiones escamosas cervicales intraepiteliales de alto grado en gestantes

Objetivos: Determinar la regresión colposcópica de las lesiones cervicales intraepiteliales de alto grado en gestantes. Diseño: Estudio observacional descriptivo, transversal. Institución: Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú. Participantes: Gestantes con diagnóstico de lesión cervical intraepitelial de alto grado - LIEAG (NIC II, NIC III, cáncer in situ). Intervenciones: Se procedió a la búsqueda en el software de anatomía patológica sobre los resultados de Papanicolaou con informe citológico de LIEAG, desde el año 2004 hasta 2008. Principales medidas de resultados: Regresión colposcópica de lesiones de alto grado en mujeres puérperas. Resultados: La distribución de las LIEAG difirió estadísticamente entre la muestra de Papanicolaou y la colposcopia, pero en ambas se mantuvo el orden de NIC II, III y cáncer in situ. Según la colposcopia, en el preparto la LIEAG más frecuente fue NIC II (83,3%), seguida de NIC III y cáncer in situ (15% y 1,7%, respectivamente). En el control posparto, 38,3% presentó un estudio colposcópico normal y los casos que continuaban siendo patológicos (61,7%) mostraron mejoría hacia lesiones de riesgo bajo, como NIC I (26,7%). Solo en 35% persistieron las lesiones de riesgo alto (NIC II, III, cáncer in situ, con 25%, 6,7% y 3,3%, respectivamente). Estas modificaciones de las LIEAG en el posparto fueron estadísticamente significativas. El parto vía vaginal se relacionó con menor persistencia de lesiones de riesgo alto, a diferencia de la vía cesárea. Destacó la mejoría del estudio colposcópico en las pacientes de 36 a más años de edad, las que habían tenido una sola pareja y en quienes iniciaron las relaciones sexuales después de los 20 años. Conclusiones: La regresión espontánea de las lesiones cervicales de grado alto en el posparto ocurrió en 65%, más en quienes fueron atendidas de parto vaginal, quienes tenían 36 años o más, las monógamas y quienes iniciaron relaciones sexuales después de los 20 años.

Objectives: To determine high-grade intraepithelial cervical lesions colposcopic regression in pregnant women. Design: Cross-sectional observational study. Setting: Hospital Nacional Docente Madre Niño San Bartolome, Lima, Peru. Participants: Pregnant women with high grade intraepithelial cervical lesion diagnosis - HSIL (CIN II, CIN III, cancer in situ). Interventions: Results of HSIL in Papanicolaou cytology reports from 2004 until 2008 were searched in Pathology Service software. Main outcome measures: Colposcopic regression of high degree lesions in puerperal women. Results: HSIL distribution was statistically different between Papanicolaou and colposcopy reports but both maintained CIN II, CIN III and cancer in situ order. According to colposcopy HSIL was more frequent than CIN II (83.3%) and cancer in situ followed by CIN III and cancer in situ (15% and 1.7% respectively). In post partum control 38.3% had normal colposcopy and 61.7% of cases remained pathological but presented improvement to low-risk lesions such as CIN I (26.7%). Only 35% persisted as high-risk lesions (CIN II, CIN III, cancer in situ: 25%, 6.7% and 3.3% respectively). These post partum changes were statistically significant. Birth by vaginal delivery was related to lower persistence of high risk lesions in the post partum compared to birth by caesarean section. Thirty-six and older women showed improvement in the post partum as well as those having a single sexual partner and beginning sexual relations after age 20. Conclusions: Post partum spontaneous regression of high degree cervical lesions occurred in 65% of puerperal women, more in those with vaginal delivery, 36 year-old or older, history of one sexual partner and beginning sexual relations after age 20.

Comparison of risk and protective factors for chronic diseases in the population with and without health insurance in the Brazilian capitals, 2011 / Comparação dos fatores de risco e proteção de doenças crônicas na população com e sem planos de saúde nas capitais brasileiras, 2011

INTRODUCTION: The article compares the risk and protective factors for Non-communicable Diseases (NCD), referred morbidity and access to preventive examinations in the population with and without health insurance in all Brazilian State capitals. METHODS: The study population consists of adults (≥ 18 years old) living in households with landlines in 26 Brazilian State capitals and the Federal District. Estimates of selected variables are presented according to possession of health plans ("Yes" or "No") and sex. A post-stratification was performed according to age, gender and education in both populations, and prevalence ratios were calculated, adjusted for age and sex between people with and without health insurance for the risk and protective factors for NCDs. RESULTS: A total of 54,099 people at the age of 18 or older were evaluated, 47.4% of them were beneficiaries of health plans. The coverage of health insurance tends to increase with age and level of education. Compared to non-beneficiaries of health plans, beneficiaries were more likely to have protective factors, such as healthy eating, physical activity, coverage tests, such as mammography and Pap test, and lower prevalence of risk factors such as smoking, physical inactivity, poor health assessment and hypertension. Alcohol abuse, consumption of excessively fat meats, overweight, obesity and diabetes were not associated with the variable possession of health insurance. When controlled by education, individuals who have health insurance generally have better indicators. CONCLUSION: This information is important to establish measures for reducing differences among people with and without health insurance. .

INTRODUÇÃO: O artigo compara os fatores de risco e proteção de Doenças Crônicas Não Transmissíveis (DCNT), morbidade referida e acesso a exames preventivos na população com e sem planos de saúde nas capitais brasileiras. MÉTODOS: A população de estudo é composta por adultos (≥ 18 anos) moradores de residências com telefones fixos nas 26 capitais dos estados brasileiros e no Distrito Federal. As estimativas das variáveis selecionadas são apresentadas segundo planos de saúde ("Sim" ou "Não") e sexo. Foi realizada pós-estratificação segundo idade, sexo e escolaridade nas duas populações, e foram calculadas as razões de prevalência ajustadas por idade e sexo para os fatores de risco e proteção de DCNT. RESULTADOS: Foram avaliadas 54.099 pessoas com 18 ou mais anos de idade, sendo 47,4% beneficiários de planos de saúde. A cobertura de planos de saúde tende a aumentar com a idade e escolaridade. Os beneficiários de planos apresentaram maior chance de ter fatores de proteção, como alimentação saudável, prática de atividade física, cobertura de exames, como mamografia e Papanicolau, e menor prevalência de fatores de risco, como tabagismo, inatividade física, avaliação de saúde ruim e hipertensão arterial. O consumo de bebida alcoólica de forma abusiva, o consumo de carne com excesso de gordura, excesso de peso, obesidade e diabetes não tiveram associação com a variável posse de plano de saúde. Quando controlados por escolaridade, os indivíduos que têm planos de saúde geralmente apresentam melhores indicadores. CONCLUSÃO: Essas informações são importantes para reduzir iniquidades entre a população com e sem plano de saúde. .

Interpretation of Papanicolaou Smear Test and Gram Stain Results for the Diagnosis of Infectious Vaginitis is Affected by Knowledge of Additional Related Test Results

BACKGROUND: Infectious vaginitis is a common gynecologic disease that is primarily caused by three pathogens (Trichomonas vaginalis, Gardnerella vaginalis, and Candida species). The aim of this study was to confirm the effects of other infectious vaginitis-related test results on the interpretation of Gram stain and Papanicolaou (Pap) smear test results for disease diagnosis. METHODS: A total of 300 vaginal samples were collected from women presenting symptoms of vaginitis. The presence of the three previously mentioned pathogens was evaluated using both a Gram stain and Pap smear test, and interpreted twice by 4 different observers. The first interpretation was performed without any information, and a second interpretation was performed with knowledge of results of an Affirm VPIII test that was used to diagnose infectious vaginitis. The results from the two interpretations were compared and the sensitivity and specificity of both tests were evaluated. RESULTS: For the Gram stain samples, the detection rates of G. vaginalis were increased in the second interpretation by 6.2%, while the detection rates of Candida spp. were decreased by 0.3%. For the Pap smear test samples, the detection rates of G. vaginalis were increased in the second interpretation by 7.0%, and the detection rates of Candida spp. were increased by 2.0%. The sensitivity of both tests was increased in the second interpretation by 5.5% to 66.7%. There was no difference in the specificity between the two interpretations. CONCLUSIONS: We demonstrated that there is significant inter-observer variation when using Gram stain and Pap smear test results to diagnose infectious vaginitis. The detection rates and sensitivity of both tests changed when the results from an additional test were incorporated into the interpretation. Additional studies are needed to develop objective criteria and a standardized interpretation system for the evaluation of results from these diagnostic tests.

The importance of immediate verification of a cervical cytological abnormality with histology.

Background: A serious proportion of the patients with invasive cervical cancer can be women who have had abnormal smear findings known for at least 6 months. Aims: The aims of the study were to evaluate the cervical cytohistopathologic correlation in the population studied, and to discuss the acceptability of immediate histological verification for minor Papanicolaou smear abnormalities. Materials and Methods: A total of 443 patients who were admitted with abnormal smear results and had undergone immediate colposcopy, cervical biopsy and endocervical curretage in the gynecologic oncology clinic between the years of 2003-2009 were enrolled into the present retrospective study. One-way analysis of variance and independent t-tests were used to study the results. Results: The distribution of abnormal smear results were documented as 46.27%, 29.57%, 13.76%, 7.67%, 1.58%, 0.67%, and 0.45% for atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), squamous cell carcinoma (SCC), atypical glandular cell (AGC), and adenocarcinoma, respectively. The percentages of cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) and greater lesions were 70.49%, 35.29%, 15.26%, and 9.75% for HSIL, ASC-H, LSIL, and ASC-US, respectively. Moreover, 38.36% of all the CIN 2-3 or cancer (n = 104) cases originated from those with low grade referral diagnosis (ASC-US and LSIL). Conclusions: The majority of cases in the study were predominantly ASC-US and LSIL and approximately 40% of all the high grade lesions came from those with low grade referral diagnosis. This shows poor cytohistopathological correlation and calls the triage of minor cytological abnormalities into question.

Evaluation of Korean Version of the Beliefs about Papanicolau Test and Cervical Cancer in Unmarried University Students

PURPOSE: This study was conducted to evaluate Korean version of the beliefs about Papanicolau (Pap) test and cervical cancer [CPC-28] in unmarried university students. METHODS: The Korean version of CPC-28 (K-CPC-28) was developed through forward-backward translation techniques. A reliability, confirmatory factor analysis and correlations coefficients were evaluated. Data were collected from 303 unmarried female students attending university using a questionnaire that included28 items of CPC, 5 items of susceptibility of cervicalcancer and 8 items of HPV knowledge. RESULTS: K-CPC-28 had reliable internal consistency with Cronbach's alpha=.74 of six subscales ranged from .66 to .80. Factor loadings of the 28 items of subscales ranged from .31 to .86. Six factors in this study explained 55% of the total variance. In convergent validity of the K-CPC-28, the subscales of K-CPC-28 were significantly correlated with susceptibility scale of cervical cancer and HPV knowledge scale. CONCLUSION: K-CPC-28has satisfactory construct validity and reliability. It seems to be an acceptable tool to assess the attitudes toward cervical cancer prevention and Pap smear in unmarried women. This tool would be also applicable to screen the risk group in cervical cancer prevention and to identify its association with actual Pap test or cervical cancer prevention behaviors.

Predictors Associated with Repeated Papanicolaou Smear for Cervical Cancer Screening

PURPOSE: The purpose of this study was to identify predictors of repeated Papanicolaou (Pap) smears in women older than 30 years being offered free national cervical cancer screening. METHODS: Data were collected using self-administered questionnaires from October 15 to November 30, 2012. Data were analyzed using t-test, chi-square test and multiple logistic regression. This study was to investigate the association of general factors, health status, risk factors of cervical cancer, and health beliefs associated with repeated Pap smeasr. RESULTS: The rate of repeated Pap smear was 23.5%. Factors that influence repeated Pap smear included breast cancer screening (OR=2.16, 95% CI=1.037-4.491) and perceived sensitivity (OR=1.49, 95% CI=1.008-2.192). CONCLUSION: The results of this study suggest that to increase the rate of repeated Pap smear tests, education and promotion should be carried out together, considering the relationship between cervical and breast cancer. Also, health education should emphasize perceptivity and sensibility for the incidence of cervical cancer.