RÉSUMÉ
Background: Cervical cancer is the second most common cancer in women in India. So, detection of its premalignant lesions is of utmost importance, which can be easily done by screening methods. Screening programmes for cervical cancer using the conventional pap smear (CPS) technique have been in place since decades. However, CPS technique has many limitations. To overcome these limitations liquid-based cytology (LBC) was introduced in the mid 1990 as a better tool for processing cervical samples. The aim of present study is to compare CPS with LBC and to assess the diagnostic accuracy and cost effectiveness of LBC in rural tertiary care centre.Methods: The study was conducted over a period of 2 years at Rama medical college, Mandhana, Kanpur. All women presenting to gynaecological OPD with symptoms and signs suspicious of cervical malignancy were selected for paired samples of conventional pap and LBC. Colposcopy and biopsy were sought which correlated with cytologic findings.燫esults: A maximum number of cases were in the reproductive age group, most common age of presentation being 40-49 years (27.3%) followed by 30-39 years (25.3%). A majority of patients were presented with a complaint of discharge per vagina 176 (58.7%), followed by pelvic pain 154 (51.3%). Only 4 patients were found to have unsatisfactory smear in LBC (1.33%) while 22 patients had unsatisfactory smear in conventional PAP (7.33%). LBC showed presence of endocervical cells in almost all patients 290 (97.97%). Candida bodies were not evident in LBC smears while the CPS showed presence candida bodies in 4 cases.Conclusions: Both the screening methods are very effective and sensitive in the detection of premalignant lesions with slight discordance of grade on histology. Thus, we conclude that cervical cytology is very effective in the detection of premalignant lesions with the sensitivity of almost 100%. In developing countries such as India, where finances pose a major problem, conventional method is as good as LBC.
RÉSUMÉ
Background: Clomiphene citrate was considered as first line of treatment for ovulation and induction in patients with unexplained infertility, but there are differences in results which can be explained by anti-estrogenic effect of CC resulting in estrogen receptor depletion. Letrozole is potent non-steroidal aromatase inhibitor which increases gonadotrophin secretion with ovarian follicle stimulation. Research question was that which drug is more efficacious for ovulation and induction in patients with unexplained infertility.Methods: This comparative study was conducted at OBGYN OPD of RMCH and RC, Kanpur. Patients were 50 females with unexplained infertility randomly divided into 2 groups. Group A received letrozole 2.5 mg from D3-D7 of menstruation. Group B received CC 50 mg from D3-D7 plus 2 mg estradiol valerate BD on D8-D14 of menstruation. Female aged 18-35 years with complete fertility workup i.e. D3 FSH, LH, prolactin, serum TSH, HSG, USG-pelvis, mid luteal phase progesterone, semen analysis within normal limits are included in study. Patients with male infertility, hyperprolactinemia, thyroid disorders and BMI>30 kg/m2 were excluded.Results: There was statistically significant difference in endometrial thickness (ET) between two groups, (p value <0.03) as mean ET was 9.3�7 in group A (L) and 8.3�5 in group B (CC+E). The number of follicles after stimulation were better with CC+E 2.9�1 and L 2.1�2 showing statistically significant difference with p value <0.01 but clinical pregnancy rate was higher with letrozole as compared to CC-E without statistically significant difference.Conclusions: Letrozole has better effect on endometrial thickness with statistically significant difference. CC+E had advantage towards multifollicular development with statistically significant difference, but there was no significant difference in case of clinical pregnancy rate, abortion, ectopic, multiple gestation.