Prevalence of premalignant cervical lesions among women in community-based screening program using visual inspection with acetic acid in Metro Manila / Philippine Journal of Obstetrics and Gynecology

Background@#Cervical cancer remains a health-care burden in our country. Majority of women afflicted with this cancer are diagnosed in advanced stage. Several groups like the Philippine Society for Cervical Pathology and Colposcopy (PSCPC) have put forth efforts to decrease and eventually eliminate cervical cancer through improvement in level of awareness on the disease and community-based cervical cancer screening programs using visual inspection using acetic acid (VIA). Data on the prevalence of premalignant lesions using this screening method are limited in our country. Thus, the initiative of the society (PSCPC) to embark on this study. @*Objective@#The objective of this study was to determine the prevalence of premalignant cervical lesions among women screened in community-based screening program using VIA in Metro Manila.@*Methodology@#A retrospective cross-sectional study with collection of data from medical records of cervical screening programs done by the PSCPC from March 2017 to December 2019 was done. VIA was done for screening. All VIA-positive women underwent colposcopy and those with abnormal findings had colposcopically guided cervical punch biopsy.@*Results@#A total of 1072 women were screened with a positivity rate of 14.6%. One hundred and fifty-six women were VIA positive and 79 of these women underwent colposcopically guided biopsy. Premalignant cervical lesions were seen in 21 women. The prevalence rate of premalignant cervical lesions in VIA-positive women was 13.5%. The prevalence of premalignant cervical lesions among all women screened was 2%. Risk factors associated with premalignant lesions were early coitarche and smoking.@*Conclusion@#The prevalence of premalignant cervical lesions among women who underwent community-based cervical cancer screening using VIA is lower compared to other studies at 2%.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study

Abstract BACKGROUND: Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. OBJECTIVES: Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. DESIGN AND SETTING: This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. METHODS: We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. RESULTS: We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. CONCLUSION: This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Incidencia de cáncer de mama a 5 años en mujeres con lesiones premalignas / Incidence of breast cancer at 5 years in women with premalignant lesions

Resumen OBJETIVO: Determinar la incidencia acumulada de cáncer de mama a cinco años de seguimiento en pacientes con lesiones preinvasoras o premalignas de la glándula mamaria en un centro de referencia y establecer los factores de riesgo asociados. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectiva efectuado en pacientes atendidas en el Hospital Ángeles Lomas entre los años 2012 a 2016 con diagnóstico, durante su tamizaje mastográfico, de alguna lesión precursora o preinvasora de cáncer de mama. El seguimiento fue a cinco años para determinar la incidencia. Las variables categóricas se expresan en frecuencias y porcentajes. Se utilizó la prueba de χ2 para diferencia de proporciones entre grupos. RESULTADOS: Se obtuvieron 3360 pacientes que acudieron al servicio de Mastología durante el tiempo establecido. Se obtuvieron 245 pacientes con lesiones premalignas pero 30 de ellas no cumplieron con el seguimiento a cinco años y se perdieron en ese tiempo estipulado de vigilancia. Al final quedaron 215 pacientes que cumplieron todos los criterios de inclusión establecidos. La incidencia acumulada global de cáncer de mama invasivo fue que a 5 años el 14.9% de las pacientes con lesiones premalignas tendrá cáncer de mama. El carcinoma lobulillar in situ fue el de mayor incidencia o progresión de cáncer invasor, con un 32.1% a los cinco años, seguido de las lesiones mucocele-like, carcinoma ductal in situ y papiloma intraductal con un 23.1, 21.1 y 17.1%, respectivamente. CONCLUSIONES: El cáncer de mama sigue siendo un problema de salud pública en México y en todo el mundo. Si bien cada vez se dispone de más y mejores programas de tamizaje, ello ha traído consigo otras problemáticas, como las lesiones premalignas o de alto riesgo de carcinogénesis, que han aumentado su incidencia.

Abstract OBJECTIVE: To determine the cumulative incidence of breast cancer at five years of follow-up in patients with preinvasive or premalignant lesions of the mammary gland in a referral canter and to establish the associated risk factors. MATERIALS AND METHODS: Retrospective cohort study carried out in patients seen at Hospital Ángeles Lomas between 2012 and 2016 with a diagnosis, during their mastographic screening, of a precursor or pre-invasive lesion of breast cancer. Categorical variables are expressed in frequencies and percentages. The χ2 test was used for difference of proportions between groups. RESULTS: We obtained 3360 patients who attended the mastology service during the established time. We obtained 245 patients with premalignant lesions but 30 of them did not comply with the five-year follow-up and were lost within the stipulated surveillance period. This left 215 patients who met all the inclusion criteria. The overall cumulative incidence of invasive breast cancer was that at 5 years 14.9% of patients with premalignant lesions will have breast cancer. Lobular carcinoma in situ had the highest incidence or progression of invasive cancer, with 32.1% at 5 years, followed by mucocele-like lesions, ductal carcinoma in situ and intraductal papilloma with 23.1, 21.1 and 17.1%, respectively. CONCLUSIONS: Breast cancer remains a public health problem in Mexico and worldwide. Although more and better screening programmes are becoming available, this has brought with it other problems, such as premalignant or high-risk carcinogenic lesions, which have increased in incidence.

Impacto de la pandemia COVID-19 en el tiempo entre la detección de lesiones premalignas de cuello de útero y su tratamiento

Introducción: la pandemia por COVID-19 ha afectado la salud de la mujer y en particular a los derechos sexuales y reproductivos. En el contexto de cambios asistenciales por la pandemia COVID 19, podría verse afectado el tamizaje y seguimiento de las lesiones premalignas de los cánceres de cuello de útero (CCU), poniendo en riesgo su diagnóstico oportuno y tratamiento precoz. El objetivo de este estudio es reportar los tiempos transcurridos entre el resultado de screening patológico y el tratamiento de lesiones premalignas de CCU, cotejando con los plazos establecidos por la ordenanza ministerial vigente y comparando los tiempos observados antes y durante la pandemia. Métodos: se realizó un estudio observacional, analítico, de corte transversal, mediante un análisis comparativo antes y después de la pandemia por COVID-19. Se incluyeron usuarias a quienes se les realizó conización quirúrgica en el Centro Hospitalario Pereira Rossell en dos períodos de tiempo: 1 de marzo de 2019 a 29 de febrero de 2020, y 1 de marzo de 2020 a 28 de febrero de 2021. Resultados: la media en días observada desde el PAP hasta la conización fue de 245 para el primer periodo y de 242 para el segundo. El porcentaje de pacientes que cumplen con la ordenanza ministerial en ambos períodos no supera el 5%. Conclusiones: no se evidenció una mayor demora en el seguimiento y tratamiento de estas usuarias durante la pandemia por COVID-19, sin embargo los tiempos observados superan ampliamente los establecidos por Ordenanza Ministerial en los periodos pre pandemia y durante la misma.

Introduction: the COVID-19 pandemic has affected women's health in general, and in particular their sexual and reproductive rights. Within the context of changes in health care services due to the COVID-19 pandemic, the screening and follow up of cervical precancerous lesions could be affected, and in turn, this could prevent timely diagnosis and early treatment. This study aims to report the period of time be-tween pathological findings in screening tests and the treatment of precancerous lesions of cervical cancer, analyze it within the context of deadlines set in the Ministry of Health regulations in force, and compare it to pre-pandemic deadlines and time frames during the COVID-19 pandemic. Method: observational, analytical and transversal study conducted by means of analyzing the situation before and after the COVID-19 pandemic. The study included users who underwent surgical conization at the Pereira Rossell Hospital during two periods of time: Between March 1, 2019 and February 29, 2020 and between March 1, 2020 and February 28, 2021. Results: average number of days from the PAP test until conization was 245 days for the first period and 242 for the second one. The percentage of patients that comply with the Ministerial decree in both periods is lower than 5%. Conclusions: the study found time to treatment in the follow up and management of users did not increase during the COVID-19 pandemic. However, the times ob-served widely exceed the deadlines set in the ministerial decree in both periods, that is before and during the pandemic.

Introdução: a pandemia de COVID-19 afetou a saúde das mulheres e em particular os direitos sexuais e reprodutivos. No contexto das mudanças na saúde devido à pandemia de COVID 19, o rastreamento e o acompanhamento das lesões pré-malignas do câncer de colo de útero (CCU) podem ser afetados, colocando em risco o diagnóstico oportuno e o tratamento precoce. Objetivo: descrever os tempos decorridos entre o resultado do rastreamento patológico e o tratamento das lesões pré-malignas do CCU, comparando-os com os períodos estabelecidos pela atual Portaria Ministerial, e comparar os tempos observados antes e durante a pandemia. Métodos: foi realizado um estudo observacional, analítico e transversal por meio de uma análise comparativa antes e após a pandemia de COVID19. Foram incluídos as usuárias que realizaram a conização cirúrgica no Hospital Pereira Rossell em dois períodos de tempo: 1º de março de 2019 a 29 de fevereiro de 2020 e 1º de março de 2020 a 28 de fevereiro de 2021. Resultados: a média de dias observados do PAP à conização foi de 245 para o primeiro período e 242 para o segundo. O percentual de pacientes que cumprem a Portaria Ministerial em ambos os períodos não ultrapassa 5%. Conclusões: não houve evidência de maior demora no acompanhamento e tratamento desses usuários durante a pandemia por COVID-19, porém os tempos observados superam em muito os estabelecidos por Portaria Ministerial nos períodos pré-pandemia e durante a mesma.

A comprehensive update: gastrointestinal microflora, gastric cancer and gastric premalignant condition, and intervention by traditional Chinese medicine / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

With the recent upsurge of studies in the field of microbiology, we have learned more about the complexity of the gastrointestinal microecosystem. More than 30 genera and 1000 species of gastrointestinal microflora have been found. The structure of the normal microflora is relatively stable, and is in an interdependent and restricted dynamic equilibrium with the body. In recent years, studies have shown that there is a potential relationship between gastrointestinal microflora imbalance and gastric cancer (GC) and precancerous lesions. So, restoring the balance of gastrointestinal microflora is of great significance. Moreover, intervention in gastric premalignant condition (GPC), also known as precancerous lesion of gastric cancer (PLGC), has been the focus of current clinical studies. The holistic view of traditional Chinese medicine (TCM) is consistent with the microecology concept, and oral TCM can play a two-way regulatory role directly with the microflora in the digestive tract, restoring the homeostasis of gastrointestinal microflora to prevent canceration. However, large gaps in knowledge remain to be addressed. This review aims to provide new ideas and a reference for clinical practice.

Prevalence of vulvar intraepithelial neoplasia: Experience in a tertiary Government Hospital / Philippine Journal of Obstetrics and Gynecology

@#Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion involving the squamous epithelium of the vulva. This retrospective descriptive study aims to determine the prevalence of VIN in a tertiary government hospital in a developing country. Medical records of outpatient consultations with the diagnosis of VIN from January 2000 to June 2012 were reviewed. The prevalence of VIN was 1.6/100,000 women over the 12 years. The diagnosis was based on biopsy results of an incidental finding of vulvar lesions on physical examination. The profile of a patient with VIN was a woman aged 40 years old and above, married, multigravid, nonsmoker, high school graduate, and unemployed. Vulvar lesions noted were multiple hyperpigmented papules located at the posterior labia majora. VIN was associated with abnormal colposcopy findings, and 40% were associated with concomitant cervical disease. Treatment was wide local excision. Prompt diagnosis and appropriate treatment of VIN aim to prevent its progression to vulvar carcinoma. Although vulvar carcinoma is a rare condition, there has been a notable rise in prevalence in recent years. Hence, gynecologists should be vigilant and have a high index of suspicion to detect the disease early in its course.

Test para el diagnóstico precoz de lesiones premalignas de colon / A Test for Early Diagnosis of Premalignant Colonic Lesions

Introducción: El cáncer colorrectal en nuestro país ocupa la tercera causa de muerte por tumores malignos y constituye un problema de salud a nivel mundial, que en la actualidad es prevenible al realizar pruebas para la detección de lesiones premalignas. Objetivo: Evaluar el valor presuntivo de lesiones premalignas colónicas en pacientes con sangre oculta en las heces. Métodos: Se realizó estudio observacional, descriptivo, transversal, en pacientes con sangre oculta en las heces, atendidos en el Servicio de Gastroenterología del Hospital Docente Clínico Quirúrgico Diez de Octubre, a los cuales se les realizó colonoscopia, en el período comprendido de enero de 2016 a enero de 2017. Para evaluar las variables se utilizó el porcentaje como medida matemática y los resultados fueron expuestos en tablas. Resultados: Al finalizar el estudio se observó un predomino del sexo femenino. La pesquisa, el cambio del hábito intestinal y las diarreas crónicas fueron las indicaciones más frecuentes de sangre oculta en heces. Los pólipos y las lesiones de aspecto malignas fueron los diagnósticos colonoscópicos más frecuentes. Las lesiones de aspecto malignas se localizaron en mayor proporción en colon izquierdo. El diagnóstico histológico más frecuente fueron los adenomas y adenocarcinomas. Conclusiones: El test de sangre oculta en heces es un método predictivo en la pesquisa de lesiones premalignas y malignas de colon en pacientes atendidos en el primer nivel de atención(AU)

Introduction: In Cuba, colorectal cancer accounts for the third cause of death by malignant tumors, while it is a worldwide health problem, currently preventable by performing tests for the detection of premalignant lesions. Objective: To evaluate the presumptive value of colonic premalignant lesions in patients with fecal occult blood. Methods: An observational, descriptive and cross-sectional study was carried out in patients with fecal occult blood, who received attention in the gastroenterology service of Diez de Octubre Surgical Clinical Teaching Hospital and underwent colonoscopy, in the period from January 2016 to January 2017. To evaluate the variables, the percentage was used as a mathematical measure and the results were shown in tables. Results: At the end of the study, a predominance of the female sex was observed. Screening, change of bowel habit and chronic diarrhea were the most frequent indications of fecal occult blood. Polyps and malignant lesions were the most frequent colonoscopic diagnoses. Malignant-appearing lesions were mostly located in the left colon. The most frequent histological diagnosis was made up of adenomas and adenocarcinomas. Conclusions: The fecal occult blood test is a predictive method for the detection of premalignant and malignant lesions of the colon in patients who receive attention at the first level of care(AU)

Caracterización de pacientes con lesiones premalignas de esófago / Characterization of patients with esophagus premalignant lesions

Introducción: Los tumores de esófago constituyen lesiones benignas o malignas, que afectan las diferentes capas del órgano. Objetivo: Caracterizar a pacientes con lesiones premalignas de esófago halladas en endoscopia bucal, según variables seleccionadas. Métodos: Se efectuó un estudio observacional, descriptivo y transversal en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el 2015. El universo estuvo constituido por 57 pacientes de 20 años y más, con diagnóstico endoscópico e histológico de lesión premaligna de esófago. Las variables analizadas fueron: edad, sexo, lesiones premalignas de esófago, grado de esofagitis y diagnóstico histológico. Resultados: La endoscopia mostró un predominio de la esofagitis por reflujo en los pacientes de 62 años y más (61,7 %), así como del grado A de la clasificación de los Ángeles en ambos sexos (39,7 y 30,1 % de mujeres y hombres, respectivamente). Según el diagnóstico histológico primaron la esofagitis crónica (48,4 %) y la esofagitis crónica con displasia (17,1 %). Conclusiones: La identificación de pacientes con lesiones premalignas de esófago constituye el punto de partida para futuras acciones preventivas e intervencionistas, con vistas a disminuir la incidencia del cáncer de esófago.

Introduction: The esophagus malignancies constitute benign or malignant lesions that affect the different layers of the organ. Objective: To characterize patients with esophagus premalignant lesions found in oral endoscopy, according to selected variables. Methods: An observational, descriptive and cross-sectional study was carried out in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, during 2015. The universe was constituted by 57 patients aged 20 and over, with endoscopic and histologic diagnosis of esophagus premalignant lesion. The analyzed variables were: age, sex, esophagus premalignant lesions, degree of esophagitis and histologic diagnosis. Results: The endoscopy showed a prevalence of the esophagitis by reflux in patients aged 62 and over (61.7 %), as well as of the grade A of Los Angeles classification in both sexes (39.7 and 30.1% of women and men, respectively). According to the histologic diagnosis there was a prevalence of chronic esophagitis (48.4 %) and chronic esophagitis with dysplasia (17.1 %). Conclusions: The identification of patients with esophagus premalignant lesions constitutes the starting point for future preventive and interventionists actions, aimed at diminishing the incidence of esophagus cancer.

Differential expression profile of circRNAs in oral leukoplakia / 口腔疾病防治

Objective@#To investigate the differences and clinical significance of circRNA expression profiles in oral leukoplakia (OLK) tissues and normal oral mucosal (NOM) tissues.@*Methods@# High-throughput sequencing was used to detect differentially expressed circRNAs in 6 pairs of OLK and NOM tissues, and qRT-PCR was used to verify the expression of 10 circRNAs screened in 6 pairs of OLK and NOM tissues. The ring formation of circRNA was verified by RNase R digestion and Sanger sequencing, and the target circHLA-C was further verified by qRT-PCR in 20 pairs of OLK and NOM tissues. CircHLA-C was visualized using the UCSC genome browser (genome.ucsc.edu). The function of differentially expressed circRNAs was analyzed by GO and KEGG enrichment analyses. TargetScan and miRanda predicted the downstream miRNAs and mRNAs of the target circRNAs, and a ceRNA network related to the identified circRNAs was constructed in Cytoscape.@* Results@#Sequencing analysis showed that 366 circRNAs were significantly differentially expressed in OLK tissues, including 65 upregulated and 301 downregulated circRNAs. After qRT-PCR verification, 7 of the 10 screened circRNAs were expressed consistent with the sequencing results. The upregulated circHLA-C was confirmed to be a real circRNA with back-splice junction sites by RNase R digestion and Sanger sequencing. Correlation analysis showed a positive correlation between circHLA-C and the degree of OLK dysplasia. ROC curve analysis suggested that circHLA-C had potential value in diagnosing OLK with high accuracy and specificity.@*Conclusion@#CircRNA was significantly abnormally expressed in OLK tissues, and the upregulation of circHLA-C may be related to the degree of OLK dysplasia, providing guiding value for the diagnosis of OLK in the future.

E s t a n d a r i z a c i ó n d e n u e v o p r o t o c o l o Inmunohistoquímico para identificar Helicobacter pylori de biopsias gástricas y valoración frente a la tinción Hematoxilina-Eosina / Standardization of the new immunohistochemical protocol to identify Helicobacter pylori from gastric biopsies and contrast against Hematoxylin-Eosin staining

Objetivo. Estandarizar un nuevo protocolo de inmunohistoquímica para identificar Helicobacter pylori, en biopsias gástricas. Material y Métodos: el trabajo se realizó en tres fases. La primera fase hace uso de anticuerpos policlonales de conejo Anti-H. pylori como anticuerpo primario para la marcación de dicha bacteria, además de un polímero EnVision FLEX/HRP para la marcación en biopsias gástricas. En la segunda se modificó el contraste de la inmunotinción con los colorantes Hematoxilina de Harris y Eosina Y, con la finalidad de apreciar con más claridad la citomorfología del tejido gástrico a examinar y a los posibles cambios histológicos pre malignos. Por último se procedió a valorar los resultados frente a la tinción Hematoxilina y Eosina (H&E). Resultados y Discusión: Demostramos que al realizar el nuevo protocolo de inmunohistoquímica facilita la identificación de H. pylori y a su vez permite evaluar los cambios citomorfológicos en las biopsias gástricas. El establecimiento de este protocolo permitirá estudiar adecuadamente la asociación de la infección por H. pylori y los cambios histológicos pre-malignos en el tejido gástrico.

Objetive. Standardize a new immunohistochemical protocol to identify Helicobacter pylori in gastric biopsies. Materials and Methods: the work was carried out in three phases. The first phase makes use of polyclonal rabbit Anti-H. pylori antibodies as a primary antibody for the labeling of said bacteria, in addition to an EnVision FLEX / HRP polymer for labeling in gastric biopsies. In the second, the immunostaining contrast was modified with the Harris Hematoxylin and Eosin Y dyes, in order to more clearly appreciate the cytomorphology of the gastric tissue to be examined and the possible pre-malignant histological changes. Finally, the results were evaluated against Hematoxylin and Eosin (H&E) staining. Results and Discussion: We s h o w t h a t b y c a r r y i n g o u t t h e n e w immunohistochemistry protocol, it facilitates the identification of H. pylori and, in turn, allows the evaluation of cytomorphological changes in gastric biopsies. The establishment of this protocol will allow an adequate study of the association of H. pylori infection and pre-malignant histological changes in gastric tissue.

FIPLIQ: an alternative solution for gynecological and oral cytology / FIPLIQ: uma solução alternativa para exames citológicos ginecológicos e bucais

ABSTRACT Introduction: Liquid-based solution for cytology has been developed to improve Pap test. Some liquid media are commercially available, however, due to the high cost there are difficulties in implementing it in the public health programs of many countries. Objectives: To study the suitability of alternative liquid media for the collection and preservation of samples for cytologic examinations, comparing the results with the conventional Papanicolaou methodology. Material and methods: In this study, 127 different compositions of alternative liquid-based solutions were tested with samples from 10 volunteers for oral cytology and 20 samples from volunteers for cervical cytology. Formaldehyde-isopropanol-phosphate (FIPLIQ) was used to preserve cervical samples prepared and analyzed on the same day and 3, 7, and 15 days after collection, compared with Pap smear. Evaluations on quality and adequacy of cell types, microorganisms or their cytopathic effects, reactive, degenerative and dysplastic cell alterations were performed. Results: Samples processed with FIPLIQ showed results similar to those of conventional Pap smear when analyzing staining cytoplasm with indistinct cytoplasm borders, chromatin structure, presence or absence of different types of cell and microorganisms, reparative process, preneoplastic, and neoplastic cell changes; the samples were stored for up to 15 days after collection. Conclusion: Preliminary results suggest that FIPLIQ is suitable for the preparation and preservation of cytology specimens for up to 15 days.

RESUMEN Introducción: La citología en medio líquido fue desarrollada para mejorar la prueba de Papanicolaou. Algunos medios líquidos son comercialmente disponibles; no obstante, debido al costo elevado, hay dificultades para su implementación en programas de salud pública en muchos países. Objetivos: Estudiar la adecuación de medios líquidos alternativos para recolecta y la preservación de muestras para exámenes citológicos, comparando los resultados con la metodología convencional de Papanicolaou. Material y métodos: En este estudio, 127 diferentes composiciones de soluciones alternativas de medios líquidos fueron testadas con muestras de 10 voluntarios para citología oral y 20 muestras de voluntarias para citología cervical. El fosfato de formaldehído- isopropanol (FIPLIQ) fue usado para preservación de muestras cervicales preparadas y analizadas en el mismo día, y tres, siete y 15 días después de la recolecta, en comparación con la citología convencional. Se hicieron evaluaciones de calidad y adecuación de los tipos celulares, microorganismos o sus efectos citopáticos, cambios celulares reactivos, degenerativos y displásicos. Resultados: Las muestras procesadas con FIPLIQ presentaron resultados similares a los de la prueba convencional de Papanicolaou cuando analizados color y bordes citoplasmáticos mal definidos, estructura de cromatina, presencia o ausencia de diferentes tipos de células y microorganismos, proceso reparativo, pre-neoplásico y alteraciones celulares neoplásicas; las muestras se conservaron hasta 15 días después de la recolección. Conclusión: Los resultados preliminares sugieren que el FIPLIQ es adecuado para preparación y preservación de especímenes citológicos hasta 15 días.

RESUMO Introdução: A citologia em meio líquido foi desenvolvida para melhorar o teste de Papanicolaou. Alguns meios líquidos são comercialmente disponíveis, no entanto, devido ao alto custo, há dificuldades para sua implementação em programas de saúde pública em muitos países. Objetivos: Estudar a adequabilidade de meios líquidos alternativos para a coleta e a preservação de amostras para exames citológicos, comparando os resultados com a metodologia convencional de Papanicolaou. Material e métodos: Neste estudo, 127 diferentes composições de soluções alternativas de meios líquidos foram testadas com amostras de 10 voluntários para citologia oral e 20 amostras de voluntárias para citologia cervical. O fosfato de formaldeído-isopropanol (FIPLIQ) foi utilizado para preservar amostras cervicais preparadas e analisadas no mesmo dia e três, sete e 15 dias após coleta, em comparação com a citologia convencional. Avaliações de qualidade e adequação dos tipos celulares, de microrganismos ou seus efeitos citopáticos, de alterações celulares reativas, degenerativas e displásicas foram realizadas. Resultados: As amostras processadas com FIPLIQ apresentaram resultados semelhantes aos do teste convencional de Papanicolaou quando analisados coloração e apagamento de bordas citoplasmáticas, estrutura de cromatina, presença ou ausência de diferentes tipos de células e microrganismos, processo reparativo, pré-neoplásico e alterações celulares neoplásicas; as amostras foram conservadas por até 15 dias após a coleta. TOPICO Conclusão: Os resultados preliminares sugerem que o FIPLIQ é adequado para a preparação e a preservação de espécimes citológicos por até 15 dias.

Prevalence of Oral mucosal lesions and their association with Pattern of tobacco use among patients visiting a dental institution

Background: Oral mucous membrane is an integral part of the complex oral cavity which is associated with maintenance of oral as well as general body health. Oral mucosal lesion (OML) is one of the most prevalent diseases in India, which is caused by consumption of smokeless and smoked forms of tobacco. Aim: To assess the prevalence of OMLs and their association with pattern of tobacco use among patients visiting dental institution in Bhilai. Materials and Methods: This descriptive cross-sectional study included 872 participants who visited the Department of Oral Medicine and Radiology, Rungta College of Dental Science and Research, and fulfilled the inclusion criteria, and the study was carried out from July to September 2016. Self-designed proforma was used for recording demographic details, and WHO Assessment Form for Oral Mucosal Diseases was used to record the tobacco use status and findings of the clinical and laboratory investigation. Statistical analysis was performed using IBM SPSS version 23, and the mean, frequency, and percentage were calculated. Results: Among the 872 participants, 69.26% were male and 30.74% were female. The mean age of the study population was 46.19 ± 12.33 years. The prevalence of tobacco use among study participants was 51.26% and that of the OML was 36.36%. Aphthous ulcer was the most prevalent OML followed by oral submucous fibrosis and leukoplakia. Conclusion: The study emphasizes the harmful effects of tobacco use toward oral mucous membrane and also serves as a path for future tobacco cessation programs that would be helpful to prevent OML.

Resultados de la conización por radiocirugía en pacientesatendidas en consulta de patología de cuello uterino / Results of Conization by Radiosurgery in patients treated in a Cervical Pathology Clinic

Introducción: La radiocirugía tiene como objetivo proporcionar una herramienta de diagnóstico y tratamiento. Objetivos: Describir los resultados de la conización por radiocirugía en pacientes atendidas en la consulta de patología de cuello uterino de la institución. Métodos: Se realizó una investigación descriptiva de corte transversal en el Hospital General Docente Mártires del 9 de Abril de Sagua la Grande, Villa Clara, Cuba. La población de estudio estuvo conformada por la totalidad de 256 pacientes atendidas en la consulta de patología de cuello uterino que fueron sometidas a conización por radiocirugía, entre enero 2013 y diciembre 2015. Para la recogida de la información se empleó la revisión de documentos y se confeccionó un modelo de recogida de datos. Resultados: El diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa) (78 casos; 30,5 por ciento). Conclusiones: Las lesiones premalignas en el presente estudio comenzaron a aparecer con marcada incidencia a partir de los 20 años y hasta los 49, sobresaliendo el grupo de 30 - 39 años. El aumento en el número de parejas sexuales, así como el comienzo temprano de las relaciones sexuales incrementan el riesgo de padecer lesiones intraepiteliales en el cuello del útero. A partir de los cinco años de iniciada las relaciones sexuales comienzan a aparecer las lesiones intraepiteliales cervicales, el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa). En los diagnósticos histológicos por sacabocado y cono existió correspondencia en todos los casos(AU)

Introduction: Radiosurgery aims to provide a diagnostic and treatment tool. Objectives: To describe the results of conization by radiosurgery in patients treated in the cervical pathology clinic of the institution. Methods: A descriptive cross-sectional investigation was carried out at Mártires del 9 de abril General Teaching Hospital, in Sagua la Grande, Villa Clara, Cuba. The study population consisted of 256 patients attended in the cervical pathology clinic who underwent conization by radiosurgery, from January 2013 to December 2015. For the collection of the information, the document review was used and a data collection form was made. Results: The preoperative diagnosis that contributed the greatest number of cases was IAS III (severe dysplasia) (78 cases; 30.5 percent). Conclusions: The premalignant lesions in the present study began to appear with a marked incidence from the age of 20 and up to 49, with the group of 30-39 years standing out. The increase in the number of sexual partners, as well as the early sexual intercourse increase the risk of suffering intraepithelial lesions in the cervix. After five years of beginning sexual intercourse, cervical intraepithelial lesions begin to appear, the preoperative diagnosis that contributed the greatest number of cases was IAS III (severe dysplasia). In histological diagnoses by punch and cone correspondence existed in all cases(AU)

Association of oral pre-malignant lesions with the consumption of tobacco

Background: Tobacco consumption in the form of chewing and smoking is one of the biggest addictions. It causes various oral pre-malignant lesions which mainly include oral sub-mucous fibrosis (OSMF) caused by betel nut consumption and tobacco quid lesion, leukoplakia, erythroplakia and smoker's palate caused by chewing and smoking tobacco. Methods: The data about the past and present consumption of tobacco was collected from 909 individuals. Based on the tobacco habits, the oral cavity findings were assessed and the statistical analysis was carried out to find the significance of associations observed between tobacco consumption and lesions. Results: Out of 909 subjects, 537 were consuming tobacco, out of which 284 were chewers, 65 were smokers and 76 were consuming in both forms. Out of the 284 tobacco chewers, 43% had oral lesions (19.4% had OSMF and 21.5% had tobacco quid) as compared to just 1% of workers having oral lesions (OSMF) amongst those who had no addiction. There was a high prevalence of lesion in tobacco chewers (p<0.005). Out of total smokers, 15.8% had smoker's palate whereas no lesion was seen in the non-addicted workers. The odds of developing oral pre-malignant lesion are 43.62 times higher in exposed individuals. Conclusions: The tobacco consumption in any form is hazardous. Betel nut exposure causes more harmful effect which goes unnoticed. Awareness should be created about various lesions caused by tobacco as well as betel nut and special steps should be taken for early diagnosis and its treatment.

Prospective study of colposcopic screening of unhealthy cervix

Background: The study was conducted to screen women who have abnormal vaginal discharge with Pap smear to do histopathological analysis of colposcopically directed biopsies.Methods: A prospective analytical study carried out in the department of obstetrics and gynaecology. The patients were randomly selected who fulfilled the selection criteria and was carried out to study the correlation of Pap smear and colposcopy in women with unhealthy cervix.   Results: Among all patients 13% were between 20-29 years, 38% were between 30- 39%, 31% belonging to 40-49 years group and 18% was between 50-59%.  Among 100 Women studied, 33% were illiterates, 55% had primary/high school education and 12% had Higher education Majority of the patients (68.7%) of CIN occurred in the age group of 30-49years, 41.7% with CIN were paragrvida 2, 43.8% with CIN were paragravida 3 and 18.6% were greater than paragravida 4 showing high incidence of CIN in multiparity.The incidence of CIN was found to be high among the lower income group 87.5%.The major presenting complains in the study patients were white discharge per vagina.Conclusions: Colposcopy was found to be useful in understanding the morphology of the cervical lesion, both of the neoplastic and nonneoplastic ones and was very helpful in planning their management. Cytology is an accepted method for screening for cervical cancer and the value of colposcopy has been recognized. Hence it may be better to utilize cervical cytology smear with colposcopy should be offered as a diagnostic method in all patients with unhealthy cervix.

A Statistical Study of Cutaneous Malignant Tumors and Premalignant Lesions in Southeastern Gyeonggi-do Province over an 11-year Period (2006~2016) / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors and premalignant lesions has recently increased worldwide. However, studies investigating the incidence and clinical manifestations of cutaneous malignant tumors and premalignant lesions in Korea are rare, especially in southeastern Gyeonggi-do Province. OBJECTIVE: To analyze the recent trends in the incidence of cutaneous malignant tumors and premalignant lesions in southeastern Gyeonggi-do Province. METHODS: We retrospectively reviewed 451 cases of cutaneous malignant tumors and 455 cases of premalignant lesions from 2006 to 2016. RESULTS: The average annual incidence rates of cutaneous malignant tumors and premalignant lesions among the total number of outpatients was 0.84% and 0.85%, respectively, and both these rates increased significantly over time. Basal cell carcinoma was most commonly diagnosed cutaneous malignant tumor (50.8%), followed by squamous cell carcinoma (24.6%), malignant melanoma (8.2%), and metastatic carcinoma (5.1%). The most common premalignant lesion was actinic keratosis (60.0%). The mean age of the patients with cutaneous malignant tumors and premalignant lesions was 68.8 years and 70.8 years, respectively. The ratio of male to female patients was 1 : 1.19 for cutaneous malignant tumors and 1 : 2.01 for premalignant lesions. The face was the most common site for both cutaneous malignant tumors and premalignant lesions (at 71.9% and 75.8%, respectively). CONCLUSION: This retrospective study provided data about the incidence and clinical patterns of cutaneous malignant tumors and premalignant lesions among patients in southeastern Gyeonggi-do Province.

Manejo das lesões de colo uterino durante a gestação / Management of cervical lesions during pregancy

Introdução: O câncer de colo de útero é a neoplasia mais comum durante a gestação. A frequência da doença precursora e do câncer do colo estimada em gestantes é de 0,22% e 0,01%, respectivamente. O manejo dessas lesões ainda não está bem estabelecido em virtude da dificuldade de realização de estudos nessa população. Métodos: Revisão de publicações dos últimos 7 anos foi realizada, pelas palavras-chave citadas no banco de dados Pubmed, base de dados do Ministério da Saúde do Brasil, diretrizes brasileiras para rastreio de câncer de colo de útero do INCA e livro "Ginecologia básica e avançada" do Serviço de Ginecologia do Hospital São Lucas da PUCRS. Resultados: De acordo com as evidências analisadas sobre lesões precursoras e câncer de colo de útero invasivo em gestantes observou-se que o diagnóstico, através do exame citopatológico e a colposcopia, é semelhante ao das não grávidas. Em contrapartida o manejo e o tratamento diferem das não gestantes devido ao envolvimento de fatores maternos como religiosidade, crenças e idade gestacional. Conclusão: Alterações na citologia cervical de gestantes devem ser avaliadas individualmente. A grande maioria das lesões sofre regressão no período pós-parto, mas o acompanhamento individualizado das gestantes com diagnóstico de câncer é imprescindível, levando em consideração características pessoais, éticas e religiosas de cada paciente.

Introduction: Cervical cancer is the most common neoplasm during pregnancy. The prevalence of precursor disease and cervical cancer in pregnant women is 0.22% and 0.01%, respectively. The management of these lesions is still not well established due to the difficulty of conducting studies in this population. Methods: Literature from the last 7 years was reviewed, using Pubmed database, database of the Brazilian Ministry of Health, Guidelines Brazilian women for cervical cancer screening at INCA and "Ginecologia Básica e Avançada" ­ book of the Gynecology Departament of the Hospital São Lucas da PUCRS. Results: According to evidence analyzed on precursor lesions and invasive cervical cancer in pregnant women, it was observed that the diagnosis, through cytopathological examination and colposcopy, is similar to that of non-pregnant women. On the other hand, the management and treatment differ from non-pregnant due to the involvement of maternal factors such as religiosity, beliefs and gestational age. Conclusion: Abnormalities in the cervical cytology during pregnancy should be evaluated individually. The vast majority of lesions regress in the postpartum period, but the individualized follow-up of pregnant women diagnosed with cancer is essential, taking into account the personal, ethical and religious characteristics of each patient.

Abnormal Papanicolaou Test: Results and Risk Factors Among Women of Uttarakhand

Background: Cervical cancer is a significant health issue worldwide. About 493 million new cases of cervical cancer are diagnosed each year. About 274 thousand women die from this disease annually and 83% of these cases are in developing countries. The aim of this study was to determine the frequency of abnormal cervical cytology among women attending Gynaecology OPD and to assess the presence of associated risk factors. Methods: This hospital-based cross-sectional study was conducted using a questionnaire involving women attending Gynaecology OPD of HIMS, Dehradun from January to December 2016. All pap smears cytological examination was conducted using Bethesda system of classification. Results: 248 (11.6%) women had abnormal cytological findings with a mean age of 36.84 years. Duration of marriage was found be significantly longer among those with abnormal Pap smear (18.34 years verses 15.72 years (p<0.05). Conclusions: Early marriage, increasing parity and longer duration of marriage are strongly associated with abnormal Pap smear results.

Leucoplasia verrucosa proliferativa: Caso idiopático y revisión de la literatura / Proliferative verrucous leukoplakia: Idiopathic case and review of the literature

La leucoplasia verrucosa proliferativa (LVP) es de etiología multifactorial, en la actualidad aún no se encuentra un agente etiológico direccional, la alta tasa de transformación maligna a un carcinoma verrucoso es la principal preocupación en estos pacientes, con la presencia de una placa blanca irregular de características verrucoides, que se encuentra en diferentes sitios de la economía de la cavidad bucal. Hasta el momento, no se cuenta con un protocolo estandarizado de tratamiento; los retinoides y fármacos tópicos así como la criocirugía, la terapia láser y la cirugía convencional, han fracasado en la mayoría de los casos con una persistencia de la lesión o recurrencia. Presentamos una revisión de la literatura y el caso específico de una paciente femenina, de 70 años de edad, con una LVP en región de maxilar superior izquierdo y de aparición incipiente en maxilar derecho.

Proliferative verrucous leukoplakia (PVL) is of multifactorial etiology; at present there is still no directional etiologic agent; the high rate of malignant transformation to verrucous carcinoma is the main concern in these patients with the presence of a white plaque irregular verrucoid characteristics found in different sites of the economy of the oral cavity, so far no standardized treatment protocol is available for retinoids and topical drugs as well as cryosurgery, laser therapy and conventional surgery have failed. In most cases with a persistent lesion or recurrence, we present a review of the literature and the specific case of a 70-year-old female patient with a PVL in the region of the upper left jaw and incipient right jaw.

Resultados de la conización por radiocirugía en pacientes atendidas en consulta de patología de cuello uterino / Results of conization by radiosurgery in cervical pathology patients

Introducción: la radiocirugía tiene como objetivo proporcionar una herramienta de diagnóstico y tratamiento. Objetivos: describir los resultados de la conización por radiocirugía en pacientes atendidas en la consulta de patología de cuello uterino. Método: se realizó una investigación descriptiva de corte transversal en el Hospital General Docente Mártires del 9 de abril, de Sagua la Grande, Villa Clara, Cuba. La población de estudio estuvo conformada por 256 pacientes atendidas en la consulta de patología de cuello uterino que fueron sometidas a conización por radiocirugía, desde enero de 2013 a diciembre de 2015. Para la recogida de la información se empleó la revisión de documentos mediante la confección de un modelo de recogida de datos. Resultados: el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa) con 78 casos (30,5 por ciento). Conclusiones: en el presente estudio las lesiones premalignas comenzaron a aparecer con notada incidencia desde los 20 años y hasta los 49, con marcada ocurrencia en el grupo de 30 a 39 años. El aumento en el número de parejas, así como el comienzo temprano de las relaciones sexuales incrementan el riesgo de padecer lesiones intraepiteliales en el cuello del útero. A partir de los cinco años de iniciada las relaciones sexuales, comienzan a aparecer las lesiones intraepiteliales cervicales, el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa). Existió correspondencia en todos los casos en los diagnósticos histológicos por sacabocado y cono(AU)

Introduction: radiosurgery aims to provide a diagnostic and treatment tool. Objectives: describe the results of radiosurgery conization in patients treated at the cervical pathology clinic. Method: adescriptive cross-sectional study was carried out at Mártires del 9 de Abril General Teaching Hospital, Sagua la Grande, Villa Clara, Cuba. The study population consisted of 256 patients treated at the cervical pathology clinic, who were submitted to radiosurgery conization, from January 2013 to December 2015. For the collection of the information, a review of documents was done by making a data collection model. Results: CIN III (severe dysplasia was) the preoperative diagnosis that contributed the most cases ( 78 cases (30.5 percent)). Conclusions: in the present study, premalignant lesions began to appear with a marked incidence from the age of 20 to 49, with a distinct occurrence in the group aged 30 to 39 years. The increase number of couples as well as the early beginning of sexual intercourse increase the risk of intraepithelial lesions in the cervix. After five years of sexual intercourse, cervical intraepithelial lesions began to appear, the preoperative diagnosis with the highest number of cases was CIN III (severe dysplasia). There was correspondence in all cases in the histological diagnoses by punch and cone(AU)