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.

Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection / 中华妇产科杂志

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ2=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ2=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

Analysis of natural regression and influencing factors of HSIL in the cervix of childbearing age patients / 中华妇产科杂志

Objective: To investigate the natural regression and related factors of high-grade squamous intraepithelial lesion (HSIL) in the cervix of childbearing age women, and to evaluate the applicability of conservative management for future fertility needs. Methods: This study included 275 patients of reproductive age with fertility needs, who were diagnosed as HSIL by biopsy from April 30, 2015 to April 30, 2022, including 229 cases (83.3%) cervical intraepithelial neoplasia (CIN) Ⅱ and 46 cases (16.7%) CIN Ⅱ-Ⅲ. They were followed-up without immediate surgery in the First Affiliated Hospital of Nanjing Medical University. The median follow-up time was 12 months (range: 3-66 months). The regression, persistence and progression of lesions in patients with HSIL were analyzed during the follow-up period, the influencing factors related to regression and the time of regression were analyzed. Results: (1) Of the 275 HSIL patients, 213 cases (77.5%, 213/275) experienced regression of the lesion during the follow-up period. In 229 CIN Ⅱ patients, 180 cases (78.6%) regressed, 21 cases (9.2%) persisted, and 28 cases (12.2%) progressed. In 46 CIN Ⅱ-Ⅲ patients, 33 cases (71.7%) regressed, 12 cases (26.1%) persisted, and 1 case (2.2%) progressed to invasive squamous cell carcinoma stage Ⅰ a1. There was no significant difference in the regression rate between the two groups (χ2=1.03, P=0.309). (2) The average age at diagnosis, age <25 years old at diagnosis were independent influencing factor of HSIL regression in univariate analysis (all P<0.05). There was no significant difference between HSIL regression and pathological grading, the severity of screening results, human papillomavirus (HPV) genotype, colposcopy image characteristics, number of biopsies during follow-up and pregnancy experience (all P>0.05). (3) The median regression times for patients aged ≥25 years and <25 years at diagnosis were 15 and 12 months, respectively. Kaplan-Meier analysis showed that age ≥25 years at diagnosis significantly increased the median regression time compared to <25 years (χ2=6.02, P=0.014). Conclusions: For HSIL patients of childbearing age, conservative management without immediate surgical intervention is preferred if CINⅡ is fully evaluated through colposcopy examination. Age ≥25 years at diagnosis is a risk factor affecting the prognosis of HSIL patients.

The characteristics and correlations of vaginal flora in women with cervical lesions / 中华肿瘤杂志

Objective: To explore the characteristics and correlations of vaginal flora in women with cervical lesions. Methods: A total of 132 women, including 41 women diagnosed with normal cervical (NC), 39 patients with low-grade cervical intraepithelial neoplasia (CIN 1), 37 patients with high-grade cervical intraepithelial neoplasia (CIN 2/3) and 15 patients with cervical squamous cell carcinoma (SCC), who came from the gynecological clinic of Second Hospital of Shanxi Medical University during January 2018 to June 2018, were enrolled in this study according to the inclusive and exclusive criteria strictly. The vaginal flora was detected by 16S rDNA sequencing technology. Co-occurrence network analysis was used to investigate the Spearman correlations between different genera of bacteria. Results: The dominant bacteria in NC, CIN 1 and CIN 2/3 groups were Lactobacillus [constituent ratios 79.4% (1 869 598/2 354 098), 63.6% (1 536 466/2 415 100) and 58.3% (1 342 896/2 301 536), respectively], while Peptophilus [20.4% (246 072/1 205 154) ] was the dominant bacteria in SCC group. With the aggravation of cervical lesions, the diversity of vaginal flora gradually increased (Shannon index: F=6.39, P=0.001; Simpson index: F=3.95, P=0.012). During the cervical lesion progress, the ratio of Lactobacillus gradually decreased, the ratio of other anaerobes such as Peptophilus, Sneathia, Prevotella and etc. gradually increased, and the differential bacteria (LDA score >3.5) gradually evolved from Lactobacillus to other anaerobes. The top 10 relative abundance bacteria, spearman correlation coefficient>0.4 and P<0.05 were selected. Co-occurrence network analysis showed that Prevotella, Peptophilus, Porphyrinomonas, Anaerococcus, Sneathia, Atopobium, Gardnerella and Streptococcus were positively correlated in different stages of cervical lesions, while Lactobacillus was negatively correlated with the above anaerobes. It was found that the relationship between vaginal floras in CIN 1 group was the most complex and only Peptophilus was significantly negatively correlated with Lactobacillus in SCC group. Conclusions: The increased diversity and changed correlations between vaginal floras are closely related to cervical lesions. Peptophilus is of great significance in the diagnosis, prediction and early warning of cervical carcinogenesis.

Intervención educativa basada en metodologías B-learning para mejorar las citologías cervicales: experiencias de enfermeras / Intervenção educacional através do B-learning para melhorar a citologia cervical: experiências de enfermeiras / Educational intervention through B-learning to improve cervical cytology: experiences of nurses

Resumen Objetivo analizar las experiencias de enfermeras en la toma de las citologías cervicales y otros factores organizacionales durante una intervención educativa asistida por metodologías B-learning. Método estudio cualitativo realizado en San Luis Potosí, México. Participaron 15 enfermeras. La recolección de datos se hizo a través de entrevistas semiestructuradas con base en una sistematización de experiencias. Para el análisis de la información se utilizó el programa Taguette y como referente teórico las metodologías B-learning. Resultados se identificaron debilidades en factores relacionados con la accesibilidad de las usuarias al servicio, insumos, infraestructura, bioseguridad, capacitación del personal de salud, entrega de resultados a las pacientes y conocimiento del programa por parte de las usuarias. Conclusiones e implicaciones para la práctica el cáncer cervical es un problema de salud pública. La citología cervical es la prueba de tamizaje más utilizada; sin embargo, existen limitantes en la calidad, por lo que se proponen acciones para mejorar los conocimientos y habilidades del personal de enfermería que tiene como función la toma. La intervención educativa fue efectiva para fomentar el aprendizaje integral sobre la toma de las citologías cervicales y permitió al personal de enfermería compartir sus experiencias.

Resumo Objetivo analisar as experiências das enfermeiras na realização de esfregaços cervicais e outros fatores organizacionais durante uma intervenção educacional assistida por metodologias de b-learning. Método estudo qualitativo realizado em San Luis Potosí, México. Participaram 15 enfermeiras. A coleta de dados foi feita por meio de entrevistas semiestruturadas a partir de uma sistematização de experiências. Para a análise das informações, utilizou-se o programa Taguette e metodologias de b-learning como referencial teórico. Resultados foram identificadas fragilidades em fatores relacionados com a acessibilidade dos usuários ao serviço, insumos, infraestrutura, biossegurança, capacitação da equipe de saúde, entrega de resultados aos pacientes e conhecimento do programa pelos usuários. Conclusões e implicações para a prática o câncer do colo do útero é um problema de saúde pública. A citologia cervical é o teste de triagem mais utilizado; no entanto, existem limitações na qualidade, por isso são propostas ações para aprimorar os conhecimentos e habilidades das enfermeiras que estejam desempenhando essa função. A intervenção educacional foi eficaz para promover o aprendizado integral sobre a realização do esfregaço cervical e permitiu que as enfermeiras compartilhassem suas experiências.

Abstract Objective to analyze the nursing staff's experiences in taking cervical smears and other organizational factors during an educational intervention assisted by B-learning methodologies. Method a qualitative study was carried out in San Luis Potosí, Mexico, with 15 nurses. Data collection was done through semi-structured interviews based on a systematization of experiences. The Taguette program and B-learning methodologies as theoretical references were used to analyze the information. Results weaknesses were identified in factors related to the accessibility of users to the service, supplies, infrastructure, biosafety, training of health personnel, delivery of results to patients, and knowledge of the program by the users. Conclusions and implications for practice cervical cancer is a public health problem. Cervical cytology is the most widely used screening test; however, there are limitations in quality, so actions are proposed to improve the knowledge and skills of the nursing staff in their functions. The educational intervention effectively promoted comprehensive learning about taking cervical smears and allowed the nursing staff to share their experiences.

Cobertura e fatores associados à não realização do exame citopatológico do colo do útero entre mulheres brasileiras de 18 a 39 anos / Pap test coverage and factors associated with non-performing among Brazilian women aged 18-39

Objetivos: avaliar a cobertura e os fatores associados à não realização do exame citopatológico do colo do útero entre mulheres de 18 a 39 anos no Brasil. Métodos: estudo transversal, de base populacional, com dados de inquérito domiciliar com 2.002 mulheres alfabetizadas de áreas urbanas, selecionadas por amostragem aleatória por conglomerados em 2016. Foram avaliados a prática do exame nos três anos anteriores e os fatores associados à não realização, com cálculo de razão de prevalência ajustada (RPaj) e intervalos de confiança de 95% (IC95%) por regressão de Poisson. Resultados: a cobertura do exame entre mulheres de 18-39 anos foi de 66,5%, sendo mais elevada naquelas de 35-39 anos (76,8%). Mulheres com renda familiar até 1 salário-mínimo (RPaj=2,08;IC95% 1,72-2,54), que estudaram até a 4a série (RPaj=2,30;IC95% 1,22-2,67), residentes na região Nordeste (RPaj=1,79;IC95% 1,34-2,09) e em municípios com até 20.000 habitantes (RPaj=3,15;IC95% 2,33-3,96) apresentaram maior prevalência de não realização do exame. Conclusão: a cobertura do exame citopatológico esteve abaixo do recomendado, com disparidades socioeconômicas e geográficas. Os dados sugerem necessidade de oportunizar o rastreamento entre mulheres jovens de maior risco para o câncer do colo do útero.

Objectives: to evaluate the coverage and factors associated with non-performing Pap smear test among women aged 18-39 years in Brazil. Methods: cross-sectional, population-based study with household survey data with 2,002 literate women from urban areas, selected by random sampling by clusters in 2016. The practice of Pap test in the previous three years and associated factors with non-participation were evaluated, with calculation of adjusted prevalence ratio (PRad) and 95% confidence intervals (95%CI) by Poisson regression. Results: coverage of Pap tests among women 18-39 years was 66.5%, being higher in those aged 35-39 years (76.8%). Women with a family income up to 01 minimum wage (PRad=2.08; 95%CI 1.72-2.54), who studied up to 4th grade (PRad=2.30; 95%CI 1.22-2.67) and residents in the Northeast region (PRad=1.79; 95%CI 1.34-2.09) and in municipalities up to 20,000 inhabitants (PRad=3.15; 95%CI 2.33-3.96) had a higher prevalence of non-participation in screening. Conclusions: the coverage of the Pap smear test was below recommended, with socioeconomic and geographical disparities. The data suggest the need to provide screening among young women at higher risk for cervical cancer.

Repercussões da braquiterapia na qualidade de vida e funcionalidade no tratamento do câncer de colo uterino / Effects of brachytherapy on quality of life and functionality in the treatment of cervix cancer / Efectos de la braquiterapia sobre la calidad de vida y la funcionalidad en el tratamiento del cáncer de cuello uterino

RESUMO Objetivo: avaliar a repercussão da braquiterapia sobre funcionalidade e qualidade de vida de mulheres com câncer de colo uterino. Método: estudo transversal descritivo, desenvolvido entre dezembro de 2019 e fevereiro de 2020, com 33 mulheres com neoplasia uterina em tratamento braquiterápico, acompanhadas no Centro Oncológico do Nordeste - Brasil. Foi aplicado o instrumento Funtional Assessment of Cancer Theraphy - Cervix Cancer. Foram comparadas as médias das subescalas e analisada a correlação entre elas por meio da aplicação dos testes ANOVA e t de Student. Resultados: foram evidenciadas demandas voltadas para a autoimagem, sexualidade e queixas urinárias. A média de preocupações adicionais foi menor na faixa de 50-59 quando comparada com a média da faixa de 31-49 (p=0,004) e com a de 60-75 (p=0,002). Conclusão: abordar assuntos voltados para sexualidade e queixas urinárias contribuem para a identificação precoce dos sintomas ocasionados pela braquiterapia, assim como implementação de medidas, proporcionando qualidade de vida à paciente.

ABSTRACT Objective: to assess the effect of brachytherapy on functionality and quality of life of women with cervix cancer. Method: a descriptive and cross-sectional study carried out between December 2019 and February 2020 with 33 women with uterine neoplasia undergoing brachytherapy, followed up at Centro Oncológico do Nordeste - Brazil. The Funtional Assessment of Cancer Therapy - Cervix Cancer instrument was applied. The means of the subscales were compared and their mutual correlation was analyzed by applying the ANOVA and Student's t tests. Results: requirements focused on self-image, sexuality and urinary complaints were evidenced. The mean of additional concerns was lower in the age group from 50 to 59 years old, when compared to the mean values in the age groups from 31 to 49 years old (p=0.004) and from 60 to 75 years old (p=0.002). Conclusion: addressing issues related to sexuality and urinary complaints contribute to early identification of the symptoms caused by brachytherapy, as well as the implementation of measures, providing quality of life for the patient.

RESUMEN Objetivo: evaluar el efecto de la braquiterapia sobre la funcionalidad y la calidad de vida de mujeres con cáncer de cuello uterino. Método: estudio transversal y descriptivo realizado entre diciembre de 2019 y febrero de 2020 con 33 mujeres con neoplasia uterina en tratamiento de braquiterapia, monitoreadas en el Centro Oncológico do Nordeste - Brasil. Se aplicó el instrumento Funtional Assessment of Cancer Therapy - Cervix Cancer. Se compararon las medias de las subescalas y se analizó la correlación entre ellas por medio de las pruebas ANOVA y t de Student. Resultados: se evidenciaron requerimientos centrados en la autoimagen, la sexualidad y las quejas urinarias. La media de preocupaciones adicionales fue menor en los grupos etarios de 31 a 49 años (p=0.004) y de 60 a 75 (p=0.002). Conclusión: abordar cuestiones relacionadas con la sexualidad y las molestias urinarias contribuyen a la identificación precoz de los síntomas causados por la braquiterapia, así como a la implementación de medidas, proporcionando calidad de vida a la paciente.

Presentación inusual de compromiso metastásico cutáneo por carcinoma escamocelular de cuello uterino / Unusual presentation of metastatic skin involvement in a patient with squamous cell carcinoma of the cervix: Case report

Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.

Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.

Mortality by colon, lung, esophagus, prostate, cervix and breast cancers in Brazilian capitals, 2000-2015: a multilevel analysis / Mortalidade por câncer de cólon, pulmão, esôfago, próstata, colo do útero e mama nas capitais brasileiras, 2000-2015: uma análise multinível

Abstract This study aimed to analyze the role of period, geographic and socio demographic factors in cancer-related mortality by prostate, breast, cervix, colon, lung and esophagus cancer in Brazilians capitals (2000-2015). Ecological study using data of Brazilian Mortality Information. Multilevel Poisson models were used to estimate the adjusted risk of cancer mortality. Mortality rate levels were higher in males for colon, lung and esophageal cancers. Mortality rates were highest in the older. Our results showed an increased risk of colon cancer mortality in both sexes from 2000 to 2015, which was also evidenced for breast and lung cancers in women. In both genders, the highest mortality risk for lung and esophageal cancers was observed in Southern capitals. Midwestern, Southern and Southeastern capitals showed the highest mortality risk for colon cancer both for males and females. Colon cancer mortality rate increased for both genders, while breast and lung cancers mortality increased only for women. The North region showed the lowest mortality rate for breast, cervical, colon and esophageal cancers. The Midwest and Northeast regions showed the highest mortality rates for prostate cancer.

Resumo Este estudo teve como objetivo analisar o papel de fatores temporais, geográficos e sociodemográficos na mortalidade por câncer de próstata, mama, colo do útero, cólon, pulmão e esôfago nas capitais brasileiras (2000-2015). Estudo ecológico utilizando informações brasileiras de mortalidade. Modelos de Poisson multinível foram usados ​​para estimar o risco ajustado de mortalidade por câncer. Os níveis de mortalidade foram maiores em homens para câncer de cólon, pulmão e esôfago. As taxas de mortalidade foram mais altas nos idosos. Nossos resultados mostraram risco aumentado de mortalidade por câncer de cólon em ambos os sexos de 2000 a 2015, o que também foi evidenciado para câncer de mama e de pulmão em mulheres. Em ambos os sexos, o maior risco de mortalidade para câncer de pulmão e esôfago foi observado nas capitais do Sul. As capitais do Centro-Oeste, Sul e Sudeste apresentaram o maior risco de mortalidade por câncer de cólon tanto para homens quanto para mulheres. A taxa de mortalidade por câncer de cólon aumentou para ambos os sexos, enquanto a mortalidade por câncer de mama e de pulmão aumentou apenas para as mulheres. A região Norte apresentou a menor taxa de mortalidade por câncer de mama, colo do útero, cólon e esôfago. As regiões Centro-Oeste e Nordeste apresentaram as maiores taxas de mortalidade por câncer de próstata.

Prevalência de alterações de exame citopatológico e sua relação com lesões compatíveis com a infecção pelo Papiloma Vírus Humano e as neoplasias do colo uterino / Prevalence of changes on cytopathological exams and their relationship with injuries compatible with human papilloma virus infection and uterine cervical neoplasms

Introdução: O objetivo deste estudo é identificar a frequência de exames citológicos de colo uterino alterados e sua relação com a infecção pelo Papiloma Vírus Humano (HPV) e neoplasias. Métodos: Foram estudadas mulheres residentes em zona urbana, que fizeram exame citopatológico entre 2015 e 2017, com registros no Sistema de Informações do Câncer. Resultados: Foram realizados 25.323 exames citopatológicos, reunindo 815 alterações (3,2%). A faixa etária mais acometida foi entre 30-40 anos. A principal alteração encontrada foi "ASC-US" (431 casos ­ 52,8%). A Lesão Intraepitelial de Baixo Grau, que compreende o efeito citopático pelo HPV e neoplasia intraepitelial cervical Grau I, foi encontrada em 164 casos (20,1%). Após exame de colposcopia, 181 pacientes realizaram biópsia, sendo mais prevalente "NIC I com Alterações Compatíveis com Ação pelo HPV" (21,5%). Conclusão: Elevada prevalência de alterações que podem evoluir para neoplasias de colo uterino, com ênfase naquelas sugestivas da presença de HPV em pacientes abaixo de 25 anos.

Introduction: This study aimed to identify the frequency of changes on cervix cytopathological exams and its relationship with Human Papilloma Virus (HPV) infection and neoplasms. Methods: Women living in the urban area who underwent cytopathological examination from 2015 to 2017 were assessed, based on records from the Cancer Information System. Results: A total of 25,323 cytopathological exams were performed, reporting 815 changes (3.2%). The most affected age group was from 30 to 40 years. The most frequent change was "ASC-US" (431 cases ­ 52.8%). Low-grade intraepithelial lesion, which encompasses the cytopathic effect of HPV and cervical intraepithelial neoplasm grade I, was found in 164 cases (20.1%). After being examined by colposcopy, 181 patients underwent biopsy, whose most prevalent finding was "grade I CIN with Changes Compatible With HPV Action" (21.5%). Conclusion: There was a high prevalence of changes that can evolve to uterine cervical neoplasms, with emphasis on those suggestive of presence of HPV in patients younger than 25 years.

Genital infection by Human Papillomavirus (HPV) in women from Santa Catarina/Brazil / Infecção genital pelo Papilomavírus Humano (HPV) em mulheres de Santa Catarina/Brasil

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some point in their lives. Most infections will be transient, but when the infection becomes persistent and associated with a high oncogenic risk of Human Papillomavirus, there may be progression to cancer, especially cervical cancer. The best way to prevent Human Papillomavirus infection is through the use of vaccines, which have been available to the public in Brazil since 2014. Objective: This study aimed to assess the most prevalent types of Human Papillomavirus in the state of Santa Catarina, Brazil, and its mesoregions and if the majority of diagnosed types are contained in the Human Papillomavirus vaccines currently available on the market. Methods: A total of 20,000 Human Papillomavirus tests were evaluated for the diagnosis of genital Human Papillomavirus infection in women from the state of Santa Catarina, Brazil. The prevalence of infection was evaluated according to age and the city of origin of the exams. Human Papillomavirus detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the Human Papillomavirus group, high or low oncogenic risk) and polymerase chain reaction (viral genotyping) techniques. Results: The diagnosis of Human Papillomavirus infection was performed on women between 1 and 102 years of age. The age with the highest Human Papillomavirus positivity, as expected, was 20­25 years (45.6%) and the lowest after 70 years (7.1%). The highest Human Papillomavirus positivity of the exams was observed in the Serrana region of Santa Catarina state (58.9% of the exams). A high-oncogenic-risk Human Papillomavirus was detected in 93% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk Human Papillomavirus) was more prevalent in the 66­70 age group (29.3%) and in the Southern Region of Santa Catarina (26.4%). The most frequent genotypes in the state of Santa Catarina were non-16/18 high oncogenic risk Human Papillomavirus (76.9% of positive cases). Human Papillomavirus 16 was found in 17.1% of positive cases and Human Papillomavirus 18 in 6.6%. Conclusion: The most prevalent types of Human Papillomavirus in the state of Santa Catarina in the past 6 years are the non-16/18 high oncogenic risk Human Papillomavirus types, which are viral types not covered by the current Human Papillomavirus vaccines available in Brazil.

A infecção por Papilomavírus Humano é a infecção sexualmente transmissível mais frequente na mulher. Cerca de 80% das mulheres sexualmente ativas entrarão em contato com esse vírus em algum momento. A maioria das infecções será transitória, mas quando ela é persistente, associada aos Papilomavírus Humano de alto risco oncogênico, poderá progredir para câncer, principalmente de colo de útero. A melhor forma de se prevenir da contaminação pelo vírus é por meio de vacina, disponível no sistema público do Brasil desde 2014. Objetivo: Avaliar os tipos de Papilomavírus Humano mais prevalentes no estado de Santa Catarina e suas mesorregiões, e se a maioria dos tipos diagnosticados estão contidos nas vacinas contra o Papilomavírus Humano atualmente disponíveis no mercado. Métodos: Foram avaliados 20 mil exames para diagnóstico da infecção genital pelo Papilomavírus Humano em mulheres de todo o estado. A prevalência da infecção foi comparada de acordo com a idade e a procedência dos exames. A detecção do Papilomavírus Humano deu-se pelos exames de biologia molecular pelas técnicas de captura híbrida (para diagnóstico do grupo de Papilomavírus Humano, alto ou baixo riscos oncogênicos) e de PCR (genotipagem viral). Resultados: Foram avaliados exames para diagnóstico da infecção de mulheres entre um e 102 anos de idade. A faixa etária de maior positividade, como era de ser esperado, foi dos 20 aos 25 anos (45.6%) e a menor depois dos 70 anos (7.1%). A maior positividade dos exames foi observada na região Serrana do estado (58.9% dos exames). O Papilomavírus Humano de alto risco oncogênico foi detectado em 93% dos casos positivos e foi o mais frequente em todas as faixas etárias. A infecção mista (Papilomavírus Humano de alto e baixo riscos) foi mais prevalente na faixa etária dos 66 aos 70 anos (29.3%) e na região Sul Catarinense (26.4%). Os genótipos mais frequentes no estado foram os Papilomavírus Humano de alto risco oncogênico não 16/18 (76.9% dos casos positivos). O Papilomavírus Humano 16 foi encontrado em 17.1% dos casos positivos e o Papilomavírus Humano 18 em 6.6%. Conclusão:Os tipos de Papilomavírus Humano mais prevalentes no estado de Santa Catarina, nos últimos seis anos, são os Papilomavírus Humano de alto risco oncogênico não 16/18, tipos virais não cobertos pelas atuais vacinas contra o Papilomavírus Humano disponíveis no Brasil.

Terapia de balón para manejo del dolor y sus efectos en el parto / Balloon therapy for pain management and its effects in childbirth

La terapia de balón, también conocida como esferodinamia, es un ejercicio que estira y relaja los músculos pélvicos al usar una pelota suiza, que, al ser incorporada al trabajo de parto, reduce la duración de su primera fase y disminuye el dolor. El objetivo de la revisión es describir su aplicación como medida no farmacológica para el manejo del dolor y sus efectos en la evolución del trabajo de parto. Para alcanzar esto, se realizó una revisión bibliográfica basándose en artículos científicos publicados en los últimos cinco años. Esta técnica no farmacológica ha demostrado beneficios en el manejo del dolor y la ansiedad materna. Durante el embarazo y el trabajo de parto, esta terapia promueve la corrección postural, la relajación y el estiramiento de los músculos del piso pélvico. Además, ayuda en el descenso y rotación de la cabeza fetal y aumenta la dilatación del cuello uterino, facilitando el parto natural. La terapia de balón reduce el tiempo de trabajo de parto y es una medida eficaz no farmacológica para el manejo del dolor. Así mismo, ayuda a corregir la presentación fetal y evita procedimientos obstétricos

Ball therapy, also known as spherodynamics, is an exercise that stretches and relaxes the pelvic muscles using a Swiss ball, which, when incorporated into labor, reduces the duration of its first phase and decreases pain. The objective of the review is to describe its application as a non-pharmacological measure for pain management and its effects on the evolution of labor. To achieve this, a bibliographic review was carried out based on scientific articles published in the last five years. This non-pharmacological technique has shown benefits in the management of maternal pain and anxiety. During pregnancy and labor, this therapy promotes postural correction, relaxation, and stretching of the pelvic floor muscles. In addition, it helps in the descent and rotation of the fetal head and increases the dilation of the cervix, facilitating natural childbirth. Balloon therapy reduces the time of labor and is an effective non-pharmacological measure for pain management. Likewise, it helps correct fetal presentation and avoids obstetric procedures

Adénocarcinome du col utérin au Gabon caractéristiques clinico-pathologiques d'une série des cas

Contexte et objectifs. L'adénocarcinome du col utérin a fait l'objet de peu de publications notamment en Afrique. L'objectif de la présente étude était de décrire les aspects cliniques, pathologiques et évolutifs de ce cancer au Gabon puis d'évaluer la reproductibilité du pattern d'invasion (PI) afin d'améliorer le choix thérapeutique. Méthodes. Il s'agissait d'une série des cas d'adénocarcinomes du col utérin confirmés histologiquement en 8 ans. Les données clinico-pathologiques et le suivi ont été enregistrés à partir des dossiers médicaux. 3 pathologistes ont évalué le PI de chaque cas puis, la reproductibilité a été réalisée. Résultats.Sur les 378 cas recensés, 16 ont été retenus. Leur âge moyen était de 57 ans. Les femmes étaient de grandes multipares (68,7 %) et ayant consulté pour des métrorragies (87,5 %). Elles étaient récués à un stade clinique avancé (62,5 %) et l'évolution était défavorable dans 81,25 % des cas. Le type endocervical et le grade intermédiaire étaient les plus fréquents. Le niveau de concordance du PI était faible (28,6 %). Conclusion. L'adénocarcinome du col utérin au Gabon survient chez la femme d'âge jeune, grande multipare, est de diagnostic tardif et d'évolution péjorative d'où l'intérêt d'assurer un dépistage précoce et une prévention. Par ailleurs, la reproductibilité du PI devrait être réévaluée par des études supplémentaires.

Cervical Primary Ewing's Sarcoma:Report of One Case / 中国医学科学院学报

Ewing's sarcoma in the cervix is characterized by extremely rare occurrence,high degree of malignancy,and rapid progression.The diagnosis of this disease is based on pathology and immunohistochemistry. The main image of the case reported in this paper showed the cervical cyst with solid mass,large volume,and uneven density and signal,and the solid part can be strengthened in enhanced scanning.Because of the rapid growth,the lesion is prone to liquefaction necrosis and bleeding.Since the metastasis occurs early,timely diagnosis is essential.

Neoplasia intraepitelial escamosa cervical de alto grau: abordagem ambulatorial / High-grade cervical intraepithelial neoplasia: outpatient approach

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Factores que afectan la suficiencia e interpretación de la citología de cuello uterino / Factors affecting cervical cytological sample adequacy and interpretation

Objetivo: evaluar los factores que afectan la suficiencia e interpretación de la citología de cuello uterino. Materiales y métodos: estudio transversal y retrospectivo en el Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela con la revisión de las historias clínicas e informes de las citologías de cuello uterino de la consulta de ginecología y obstetricia de enero a diciembre 2019. Se analizan las características generales y la clasificación de los informes (satisfactorios para la evaluación, satisfactorios pero limitados por y no satisfactorios). Resultados: se seleccionaron 581 informes de los cuales 329 (56,6%) eran muestras satisfactorias, 233 (40,1%) satisfactorias pero limitadas y 19 (3,3%) insatisfactorios. El análisis univariante demostró que la muestra insatisfactoria, la presencia síntomas al momento de la toma y el tipo de método anticonceptivo fueron factores que se asociaron significativamente (p < 0,0001). Los que influyeron para un resultado anormal de la citología cervical fueron frotis satisfactorio (razón de probabilidad, 4,78; intervalo de confianza del 95%, 3,127-8,136) y presencia de síntomas (razón de probabilidad, 11,652; intervalo de confianza del 95%, 2,992-38,55). Esta asociación continuó siendo significativa luego de ajustarlos a los factores de edad, paridad, edad al momento de la toma de la primera citología y método de anticoncepción (p < 0,0001). Conclusión: la suficiencia de la muestra de citología es un factor importante para la detección de anomalías celulares de cuello uterino y evitar resultados falsos negativos, retrasando la detección del cáncer.

Objective: to evaluate factors that affect cervical cytological sample adequacy and interpretation. Materials and methods: a retrospective cross-sectional study conducted at Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela by a review of the gynecology and obstetrics outpatient clinic medical records and cervical smear reports from January to December 2019. The general characteristics and classification of the reports (as, satisfactory, satisfactory but limited by and not satisfactory for cytological evaluation), were analyzed. Results: out of 581 reports selected, 329 (56.6%) were satisfactory, 233 (40.1%) satisfactory but limited and 19 (3.3%) not satisfactory. A univariate analysis showed that not satisfactory samples, presence of symptoms at the time of collection and type of contraceptive method were significantly associated factors (p < 0.0001). Those influencing an abnormal result were satisfactory smears (odds ratio, 4.78; confidence interval 95%, 3.127-8.136) and the presence of symptoms (odds ratio, 11.652; confidence interval 95%, 2.992-38.55). This association remained significant after considering other variables such as age, parity, age at first Pap smear and contraceptive method (p < 0.0001). Conclusion: cytological sample adequacy is an important factor for identifying cell abnormalities and avoiding false negative results which delay cancer detection.

Perfil dos exames citopatológicos do colo do útero de mulheres residentes no estado de Minas Gerais / Profile of cytopathological examinations of the cerever of women resident in the state of Minas Gerais

Introdução: O diagnóstico precoce e referenciamento ao serviço especializado são essenciais para melhorar as taxas de cura e sobrevida das mulheres acometidas pelo câncer de colo de útero. Assim, a realização deste estudo tornará possível o levantamento de informações que serão essenciais para o desenvolvimento de medidas preventivas, que almejam contribuir com o desenvolvimento de ações de educação em saúde e o diagnóstico precoce para reduzir a morbimortalidade dessa enfermidade. Objetivo: Identificar o perfil dos resultados dos exames citopatológicos do colo do útero de mulheres residentes no estado de Minas Gerais a partir dos dados de exames correspondentes ao ano de 2019, utilizando as variáveis disponibilizadas pelo Sistema de Informação do Câncer. Métodos: Trata-se de um estudo retrospectivo, exploratório, quantitativo realizado por meio de base de dados secundários. Os dados foram submetidos à análise no software SPSS, versão 20.0. Realizou-se estatística descritiva (frequência absoluta, porcentagem, média e desvio padrão). Para verificar associação entre variáveis qualitativas foi utilizado teste qui-quadrado (x²) e exato de Fisher. A força das associações entre as variáveis foi aferida pelo risco relativo (RR) e intervalos de confiança (IC 95%). Resultados: As principais alterações presentes nos exames foram: alterações por células escamosas atípicas de significado indeterminado e lesão intraepitelial de baixo grau. Após análises estatísticas, notou-se que algumas alterações possuem risco maior de se desenvolverem no público fora da faixa etária preconizada, ou seja, entre mulheres com idade <25 anos ou >64 anos. Conclusão: O estudo realizado contribui para identificação do perfil atual vivenciado na área da saúde da mulher e possibilita a criação de condutas e ações que visem intervir frente aos resultados obtidos, impactando positivamente na realidade de Minas Gerais

Introduction: Early diagnosis and referral to a specialized service are essential to improve the cure and survival rates of women affected by cervical cancer. Thus, carrying out this study will make it possible to collect information that will be essential for the development of preventive measures, which aim to contribute to the development of health education actions and early diagnosis to reduce the morbidity and mortality of this disease. Objective: Identify the profile of the results of cervical cytopathological examinations of women residing in the State of Minas Gerais from the data of examinations corresponding to the year 2019, using the variables made available by the Cancer Information System.Methods: This is a retrospective, exploratory, quantitative study carried out by means of a secondary database. The data were submitted to analysis using the SPSS software, version 20.0. Descriptive statistics (absolute frequency, percentage, mean and standard deviation) were performed. To verify the association between qualitative variables, the chi-square test (x²) and Fisher's exact test were used. The strength of the associations between the variables was measured by the relative risk (RR) and confidence intervals (95% CI). Results: The main alterations present in the cytopathological exams performed were: changes due to atypical squamous cells of undetermined significance and low- grade intraepithelial lesion. After statistical analysis, it was noted that some changes have a higher risk of developing in the public outside the recommended age range, that is, among women aged <25 years or> 64 years. Conclusion: The study carried out contributes to the identification of the current profile experienced in the area of women's health and enables the creation of conducts and actions that aim to intervene in view of the results obtained, positively impacting the reality of Minas Gerais.

Acesso e acessibilidade ao rastreamento de câncer em mulheres brasileiras com lesão medular / Acceso y accesibilidad al rastreo de cáncer en mujeres brasileñas con lesión medular / Access and accessibility to cancer screening for Brazilian women with spinal cord injury

Resumo Objetivo identificar e analisar a acessibilidade e o acesso de mulheres brasileiras com lesão medular para a realização de exames preventivos do câncer de mama e colo de útero. Método estudo quantitativo e transversal desenvolvido em plataforma virtual. Realizadas análises estatísticas descritivas e de associação entre as variáveis qualitativas por meio do teste exato de Fisher. Quando identificada a associação (p<0,05), foi realizada a regressão logística. Resultados participaram 120 mulheres brasileiras com lesão medular com idades entre 25 e 67 anos; 85,83% foram ao ginecologista após a lesão medular, 79,17% realizaram a citologia e 52,50%, a mamografia. Observou-se que as mulheres que utilizavam a saúde suplementar apresentaram maior probabilidade de terem ido ao ginecologista do que as usuárias do serviço público. Aquelas com companheiro e as de maior idade apresentaram maior probabilidade de terem realizado o exame de citologia. Para a mamografia, aquelas de maior idade e que utilizavam a saúde suplementar apresentaram maiores chances de terem realizado o exame de mamografia após a lesão medular. Conclusão mulheres com lesão medular buscam a realização de exames de rastreamento. Entretanto, encontram dificuldades relacionadas à estrutura física, aos equipamentos, transporte, profissionais da saúde, assim como dificuldades sociodemográficas e quanto ao serviço de saúde utilizado.

Resumen Objetivo este estudio tuvo como objetivo identificar y analizar la accesibilidad y el acceso de mujeres brasileñas con lesión medular para la realización de exámenes preventivos de cáncer de mama y de cuello uterino. Método se desarrolló un estudio cuantitativo y transversal, realizado en un entorno virtual. Los análisis estadísticos descriptivos y la asociación entre variables cualitativas se realizaron mediante la prueba exacta de Fisher, cuando se identificó una asociación se realizó una regresión logística. Resultados participaron 120 mujeres brasileñas con lesión medular, la edad de las participantes varió de 25 a 67 años. Con relación al rastreo, el 85,83% de las mujeres acudió al ginecólogo tras la LM, el 79,17% se sometió a citología y el 52,50% a mamografía. Se observó que las mujeres que utilizaban un seguro médico privado tenían más probabilidades de haber visto a un ginecólogo que las usuarias del servicio público. Las que tenían pareja y mayores tenían más probabilidades de someterse a citología oncótica. Para la mamografía, las que eran mayores y que usaban un seguro médico privado tenían más probabilidades de someterse al examen después de la LM. Conclusión las mujeres con LM buscan pruebas de detección. Sin embargo, enfrentan dificultades relacionadas con la estructura física, equipamientos, transporte, profesionales de la salud, así como dificultades sociodemográficas relacionadas con el tipo de servicio de salud utilizado.

Abstract Objective to identify and analyze the accessibility and accessibility of Brazilian women with spinal cord injury to preventive examinations for breast and cervical cancer. Method quantitative and cross-sectional study developed in a virtual platform. Descriptive statistical analysis was performed, as well as association analysis between qualitative variables using Fisher's exact test. When identified the association (p<0.05), logistic regression was performed. Results a total of 120 Brazilian women with spinal cord injury, aged between 25 and 67 years participated in the study; 85.83% visited a gynecologist after the spinal cord injury, 79.17% underwent cytology and 52.50% underwent mammography. It was observed that women who used the supplementary health plan were more likely to have visited a gynecologist than those who used the public service. Those who had a partner and were older were more likely to have undergone the cytology exam. For mammography, those who were older and who used supplementary health care were more likely to have had mammography exams after the spinal cord injury. Conclusion women with spinal cord injury seek screening tests. However, they encounter difficulties related to the physical structure, equipment, transportation, health professionals, as well as socio-demographic difficulties and difficulties regarding the health service used.