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%.

Age patterns of human papillomavirus infection as primary screening test for cervical cancer and subsequent triage with visual inspection in Honduras / Patrones de edad de infección por el virus del papiloma humano como prueba primaria en el tamizaje de cáncer de cuello uterino y triaje posterior con inspección visual en Honduras

Abstract Objective: To evaluate age patterns in human papillomavirus (HPV) prevalence and visual inspection with acetic acid (VIA) positivity among women participating in cervical cancer screening in Honduras. Materials and methods: Data on the HPV status (careHPV) and subsequent VIA in HPV-positive women were retrieved from three provinces within the Public Health Sector. Results: Between 2015 and 2018, 60 883 women aged 15-85 years were screened. HPV was detected in 15%, with variation by age, peaking at 20-24 years (27.8%) decreasing to 16% at 30-49 years. Differences in point age-specific HPV prevalence were observed between provinces, but with similar age pattern. VIA was positive in 24.5% of the women aged 30-44 years. Conclusions: The age pattern of the HPV prevalence supports starting HPV testing at age 30+. The low positivity of VIA in ages close to menopause suggest underdetection of cervical lesions in this age group.

Resumen Objetivo: Evaluar la prevalencia del virus del papiloma humano (VPH) y la positividad a la inspección visual con ácido acético (IVA) de cáncer cervicouterico, según edad en mujeres tamizadas en Honduras. Material y métodos: Se extrajo información sobre la prueba de VPH (careHPV) y de IVA en tres provincias en el ámbito de la Atención Pública en Salud. Resultados: Durante 2015-2018, 60 883 mujeres de 15-85 años fueron tamizadas, 15% fueron VPH positivas con valores máximos en mujeres de 20-24 años (27.8%), con una disminución a 16% entre 30-49 años. Se observaron diferencias mínimas entre provincias, con un patrón de edad similar. La IVA fue positiva en 24.5% en mujeres de 30-44 años, con una posterior disminución. Conclusiones: La curva de prevalencia del VPH respalda el tamizar con VPH a los 30+ años. La baja positividad de la IVA en edades cercanas a la menopausia sugiere una subdetección de lesiones cervicales en este grupo.

Comparative study of effectiveness of Papanicolaou smear and visual inspection using acetic acid and visual inspection using Lugol’s iodine for screening of premalignant and malignant lesions of cervix

Background: In developing and resource-limited countries alternative screening methods like VIA, VILI, and Pap smear are used in detection of premalignant and malignant lesions of cervix. The aim of our study was to compare the efficacies of VIA, VILI, and Pap smear in detection of premalignant and malignant lesions of cervix.Methods: The study was conducted for a period of one year in the department of obstetrics and gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. Women who attended the outdoor patient department of obstetrics and gynecology were subjected to collection of Pap Smear, VIA followed by VILI and a thorough pelvic examination.Results: Among the 350 women studied, 59 women (16.9%) had abnormal VIA, 64 women (18.2%) had abnormal VILI. On pap smear, 10 women were reported as ASCUS, 11 as L-SIL and 1 as H-SIL. Cervical biopsy was done in 98 women, out of which 70 had one or more abnormality on VIA, VILI, or Pap, and 28 women who had normal results. Sixteen women (16.3%) reported as CIN-1 and 2 women (2.07%) as CIN-3. VIA and VILI had a higher sensitivity as compared to pap. However, pap was more specific. The PPV of pap was also much higher as compared to VIA and VILI, whereas there was no difference in NPV of the three.Conclusions: Authors observed that VIA presented the best sensitivity (88.8%), followed by VILI (83.3%), and Pap (72.2%). Pap smear had the highest specificity of 97.2%. The positive predictive value of Pap was higher as compared to VIA and VILI, whereas there was no difference in NPV of the three. VIA and VILI have good sensitivity, with reasonable specificity and because of their cost effectiveness and ease of availability, these can be an alternative screening modality for cervical cancer screening.

Accuracy of visual inspection with acetic acid for cervical pathology screening in low cost setup

Background: Cancer cervix, a preventable disease continues to be a cause of great concern to women’s health, being associated with agonizing morbidity and high mortality. Approximately 493,100 new cases and more than 273,000 deaths occur each year, among women worldwide.IN India the screening is largely based on pap smear, which is cumbersome procedure due to transportation of samples and follow up of patients are not usually feasible. Visual inspection with Acetic acid (VIA) is simple and easy to teach procedure. Follow-up of patients usually doesn’t require.Methods: This study includes a total of 1000 patients who attended OPD of gynecology. Each patient is subjected to VIA examination. Biopsy is taken from women with abnormal findings on VIA. The objectives of this study were to evaluate the sensitivity and specificity and positive predictive value of inspection of cervix with acetic acid in precancerous lesions of cervix.Results: When biopsy is taken as reference standard, VIA has sensitivity of 97.7%, specificity of 76.6%, PPV of 62.9% and NPV of 98.5%. The accuracy rate for VIA is 84.8%.Conclusions: VIA is highly sensitive for diagnosis and treatment of cervical pathology at the same sitting. It can be done cost effectively in low resource set up.

Comparison of methods to determine the lactate threshold during leg press exercise in long-distance runners

Abstract Aims: To determine lactate threshold (LT) by three different methods (visual inspection, algorithmic adjustment, and Dmax) during an incremental protocol performed in the leg press 45° and to evaluate correlation and agreement among these different methods. Methods: Twenty male long-distance runners participated in this study. Firstly, participants performed the dynamic force tests in one-repetition maximum (1RM). In the next session, completed an incremental protocol consisted of progressive stages of 1 min or 20 repetitions with increments of 10, 20, 25, 30, 35, and 40% 1RM. From 40% 1RM, increments corresponding to 10% 1RM were performed until a load in which the participants could not complete the 20 repetitions. A rest interval of 2 min was observed between each stage for blood collection and adjustment of the workloads for the next stage. Results: Our results showed no significant difference in relative load (% 1RM), good correlations, and high intraclass correlation coefficients (ICC) between algorithmic adjustment and Dmax (p = 0.680, r = 0.92; ICC = 0.959), algorithmic adjustment and visual inspection (p = 0.266, r = 0.91; ICC = 0.948), and Dmax and visual inspection (p = 1.000, r = 0.88; ICC = 0.940). In addition, the Bland-Altman plot and linear regression showed agreement between algorithmic adjustment and Dmax (r2 = 0.855), algorithmic adjustment and visual inspection (r2 = 0.834), and Dmax and visual inspection (r2 = 0.781). Conclusion: The good correlation and high agreement among three methods suggest their applicability to determine LT during an incremental protocol performed in the leg press 45°. However, the best agreement found between mathematical methods suggests better accuracy.

A study of visual inspection of cervix under acetic acid and visual inspection of cervix under Lugol's iodine for screening of carcinoma cervix

Background: Carcinoma cervix is the most common cancer among women in developing countries. The objectives of the study were to study the sensitivity and specificity of visual inspection of  the cervix with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening. To study the correlation of demographic data like age, socioeconomic status, education residential area, parity, age at marriage in premalignant lesion of  the cervix.Methods: The present study was conducted in the department of Obstetrics and Gynecology  at a Tertiary Medical Care Center over a period of two years. Five hundred fifty women between 20-65 years of age who fulfilled the selection criteria were enrolled in our study. Positive tests for VIA was opaque aceto white lesion on applying 5% acetic acid or detection of definite yellow iodine non uptake areas with Lugol's iodine in the transformation zone or close to touching the squamocolumnar junction. Positive cases were scheduled for cervical biopsy. Ethical approval of the study protocol was obtained from the ethics committee of the institute.Results: On down staging 7.2% (40/550) of cases  had an unhealthy cervix and 0.36% (2/550) with a suspicious cervix. VIA positive in 4.55% (25/550), VILI positive in 2.73% (15/550). Biopsy was taken from positive with VIA and VILI. On histology 2.9% (16) were chronic cervicitis, CIN I had (1), 0.2%, CIN II (2) 0.4%, CIN III (4) 0.7% and squamous cell carcinoma (2) 0.4% VIA sensitivity 72.22%, specificity 97.74%. VILI sensitivity 100%, specificity 98.89%.Conclusions: VIA and VILI are simple, inexpensive, low resources technique. Both have high sensitivity and specificity.

A Comparative Study Between Pap Smear And Visual Inspection With Acetic Acid (VIA) In Screening Of Cin And Early Cervical Cancer

Introduction: Present study was conducted to detect the specificity and sensitivity of each test for identifying cervical intraepithelial neoplasm (CIN) and cervical cancer by compå with the histology from positively screened women. Methodology: A prospective study was conducted in the department of obstetrics and Gynecology S.P. Medical College Bikaner on 500 gynecological cases. The PAP was evaluated by the Bethesda system and VIA was performed. All positive cases of VIA and pap‘s smear were scheduled for biopsy and histological evaluation. Statistically analysis was done. Results: The sensitivity of VIA was higher (63.16%) than that of Pap smear (52.63%). The specificity of VIA was lower (97.62%) as compared to Pap smear (99.13%). The positive predictive value of Pap smear was 83.33% and that of VIA was 68.57%. The negative predictive value of Pap smear was 96.22% and that of VIA was 96.99%. The diagnostic accuracy of VIA was 95.0% which was comparable to that of Pap smear (95.6%). Conclusion: VIA may be considered as an alternative to Pap smear in resource poor settings. However, in areas where cytology based screening is available, VIA may be useful as an adjunct to improve the sensitivity of cervical cytology.

A comparison of cervical cancer screening methods: pap smear, liquid based cytology and VIA VILI

Background: There are multiple screening methods available for screening cervical cancer with their advantages and disadvantages, researches that compare the sensitivity, specificity, positive and negative predictive values of these tests in a low-cost setting specific to a geographical area is lacking and has to be enhanced. The objective of this study was to determine and compare the agreement, sensitivity, specificity and predictive values of conventional Pap smear cytology, liquid-based cytology and VIA/VILI with cervix biopsy.Methods: This cross sectional study was conducted on women of >35 years of age. Pap smear specimen was collected followed by Liquid Base Cytology (LBC) using cytobrush specimen after which visual inspection with 5% acetic acid (VIA) and visual inspection with Lugol’s Iodine (VILI) procedure was carried out and followed by cervix biopsy. All methods were analyzed for accuracy.Results: Sensitivity was lowest for PAP smear (39.1%, 95% CI 19.18% to 59.1%), followed by VIA VILI (95.7%, 95% CI 87.32% to 100%), and highest for LBC (100.0%). The negative predictive value was lowest for PAP smear (87.4%, 95% CI 81.21% to 93.6%), followed by VIA VILI (99.0%, 95% CI 96.99% to 100.0%) and highest for LBC (100%). The overall diagnostic accuracy was lowest for PAP smear (88.3%) followed by VIA/VILLI (99.2%) and highest for LBC (100%).Conclusions: Treatment decisions based on findings of the PAP smear have to be taken with caution, considering the lower sensitivity. Wherever resources are available more accurate screening methods like liquid-based cytology must be used.

Comparison Of Visual Inspection With Acetic Acid And Pap Smear In Detecting Premalignant Lesions Of Cervix

Background: Worldwide cervical cancer comprises approximately 12% of all cancers in women with 122,844 new casesreported annually in India. Cervical cancer progresses slowly for a decade as it is preceded by intraepithelial histologicalchanges, visual inspection aided by acetic acid test (VIA), Pap smear, and colposcopy can be utilized as a tool for cytologicalanalysis of cervix, early identification of risk factors and preinvasive lesions of cervix and hence early diagnosis and treatmentof cervical cancer even in rural areas.Objectives: The objectives are as follows: (1) To compare VIA with Pap smear in detecting premalignant lesions of cervix,(2) to correlate VIA and Pap smear findings with colposcopic findings, and (3) to localize the lesion by colposcopy and obtainbiopsy wherever necessary.Materials and Methods: A prospective study of 200 women attending the Gynecology Outpatient Department at BLDE (deemedto be university) Shri B. M. Patil Medical College Hospital and Research Center, Vijayapura, between October 2016 and August2018 was included in the study.Results: The incidence of premalignant and malignant lesions of the cervix was 7%. Cervical cytology was normal in 16%,inflammatory in 77.5%, ASCUS in 4%, LSIL in 1.5%, HSIL in 0.5%, and squamous cell carcinoma in 0.5%. XII Maximum numberof patients with ASCUS and LSIL was in the age group of 35–39 years and 40–44 years and HSIL and squamous cell carcinomaoccurred in the age group of 25–29 years and 30–34 years, respectively. ASCUS, LSIL, and HSIL were seen in parity 3–5 andmalignancy in parity >3 observed mostly in low socioeconomic status. All abnormal Pap smears mainly presented with whitedischarge PV, pain abdomen and with irregular PV bleeding as the second most common and erosion and cervicitis as themost common clinical picture. Cervical biopsy confirmed HSIL and invasive carcinoma cytology.Conclusion: In India, cytology, a low cost and easily accessible test, is the most logical screening modality although it has verylow sensitivity, detection rates could be further improved using liquid-based cytology and the use of endocervical cytobrush.

Prevalence and Management of CIN by Colposcopy among VIA Positive Cases in a Tertiary Level Hospital of Bangladesh

Background: Cervical cancer is the second most commoncancer among women in Bangladesh where CIN is theforerunner. Visual inspection of cervix with acetic acid (VIA) isadopted as national cervical cancer screening programme inBangladesh. All positive VIA cases are evaluated bycolposcopy.Objective: This population-based study was conducted inFaridpur Medical College Hospital for 6 years (2013 - 2018) toevaluate the prevalence of CIN among the VIA positive casesand performance of the clinic for colposcopic management ofCIN.Materials and Methods: A total of 2102 VIA positive caseswere evaluated by colposcopy during the study period.International Federation of Cervical Pathology and Colposcopy(IFCPC) 2011 nomenclature was used for colposcopicdiagnosis. Diagnosed CIN were treated accordingly.Results: During the study period, 548 (26.1%) cases werecolposcopically diagnosed as CIN. Among them, 370 (65.5%)were low grade squamous intraepithelial lesion (CIN-I) and 178(32.5%) were high grade squamous intraepithelial lesion (CINII and III). Colposcopicaly diagnosed 237 (64.1%) of low gradesquamous intraepithelial lesion (LSIL) and 132 (74.2 %) of highgrade squamous intraepithelial lesion (HSIL) casesreceived treatment and histopathological confirmation.Treatment produces were used like thermocoagulation, LoopElectrosurgical Excision Procedure (LEEP), biopsy,hysterectomy and post treatment follow up.Conclusion: From this study, we got information about thedemography and prevalence of CIN among VIA positive casesat the same time management of CIN to prevent invasivecervical cancer. We adopted ‘See and treat’ protocol formanagement, which is well accepted, feasible and useful inBangladesh.

Role of obstetricians and gynecologists in cervical cancer screening / 中华预防医学杂志

Cervical cancer is the second leading cause of death due to gynecological malignancy in female patients. If obstetrician and gynecologists could master the mechanisms involved in the development of cell mutation and new tissue, the effectiveness of cervical cancer screening could be greatly increased. In the process of cervical cancer screening, if cervical tissue hyperplasia accompanied by bleeding could be identified by visual inspection and also in line with the conditions of abnormal cells and vascular proliferation, the cervical cancer would be highly suspicious at this time. Taking the tissue of the abnormal part of the cervix should be immediately conducted when conditions are available. If not, the colposcopy and following biopsy should be immediately performed. After these actions, if no cervical abnormalities are found, the visual inspection of cervix should be performed using cervical cytology (Pap smear test) or a human papillomavirus (HPV) test, or a combination of two tests. When the risk of cervical precancerous lesions predicted by screening results is greater than 5%, colposcopy should be required which is unconditional on the screening methods used before. In the area of abnormal cell proliferation and angiogenesis, 5% acetic acid should be applied to observe whether there is acetowhite epithelium. If yes, the cervical precancerous lesions is highly suspicious in the area of acetowhite epithelium and biopsy should be performed. Even if there is no acetowhite epithelium in the blood vessel-rich area, cervical precancerous lesion could not be excluded and the cervical detachment cell diagnosis results could be used. If the results prompt abnormalities, biopsy could be taken continuously in the red area, including the endocervical curettage in the red area of endocervical tissue. Following the above three-step process of cervical cancer screening, obstetricians and gynecologists could easily, accurately and quickly detect the cervical cancer and cervical precancerous lesions, and complete the goal of cervical cancer screening.

Evaluation of a training workshop on the use of visual inspection with acetic acid in cervical cancer screening / Philippine Journal of Obstetrics and Gynecology

Objective@#The Department of Health developed a program for Cervical Cancer Prevention and Control in the Philippines and this involves training of health care providers on Visual Inspection with Acetic Acid (VIA). The evaluation of this training program aims to determine the effectivity of the training workshop in increasing the knowledge and skills of healthcare providers in VIA and whether this would translate to practice in their workplaces. @*Method@#The first run of the training program was evaluated and the approach used was Kirkpatrick’s model. Participants were asked to complete an evaluation questionnaire for Level 1 evaluation. A pre-test, post-test and performance checklist were accomplished for Level 2 evaluation. For Level 3 evaluation, randomly selected participants were interviewed via mobile phone. Data analysis involved descriptive methods and inferential statistics (T-test and McNemar test) for Level 2. @*Results@#Level 1 evaluation demonstrated a high over-all satisfaction rating from the participants (x ?=4.59) and the training workshop was found to be relevant and useful to their practice. Level 2 evaluation showed a significant increase in the knowledge of the participants (P=.001) particularly in the core topics of cervical cancer epidemiology (P=.001) and VIA (P=.006). There was likewise a significant improvement in the performance of VIA from the first to the last patient encounter (P=.000). Level 3 evaluation showed that the participants interviewed have realized the importance of VIA @*Conclusion@#The training workshop was effective in increasing the knowledge base and clinical skills required of health care professionals who will provide cervical cancer screening services using visual inspection with acetic acid. As a direct effect of the increase in knowledge and skills, the participants have started to incorporate their new learnings into their practice.

Diagnostic accuracy of Conventional Cervical Cytology (papanicolau smear), Liquid Based Cytology (LBC) and Visual Inspection with Acetic Acid (VIA) in detecting premalignant and malignant cervical lesions among Filipino women in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#Cervical cancer screening can reduce both the incidence and mortality rates of the disease. This study aimed to assess the diagnostic accuracy of conventional cytology, liquid based cytology and visual inspection with acetic acid in detecting pre-malignant and malignant cervical lesions. @*Methods@#There were 249 patients who participated in the study. Of these, 6/249 (2.4%) turned out positive in papsmear, 7/249 (2.8%) turned out positive in liquid based cytology while 23/249 (9.2%) turned out positive in visual inspection with acetic acid. Colposcopic guided cervical biopsy was done on all 249 patients to confirm the results. @*Results@#Fourteen turned out positive for cervical intraepthelial neoplasia, 1 patient had carcinoma in situ and 1 was positive for squamous cell carcinoma. @*Conclusion@#Among the three screening tests, VIA appears to be the most accurate, followed by liquid based cytology as compared to the conventional papsmear.

Analysis of Factors Affecting Women of Childbearing Age to Screen Using Visual Inspection with Acetic Acid

OBJECTIVES: The purpose of this study was to evaluate patient factors such as knowledge, attitude, motivation, perception, socio-economic status and travel time to health facilities and assess how these factors affected patients' decision to pursue cervical cancer screening with visual inspection with acetic acid (VIA). METHODS: A total of 80 women of childbearing age who visited Kenjeran and Balongsari Public Health Centers for health assessments were involved in this study. Patients who agreed to participate in the study underwent a verbal questionnaire to evaluate various factors. RESULTS: Bivariate analysis concluded that knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities were significantly different between women who received VIA screening and women who did not receive VIA screening (p < 0.05). The factors of knowledge, attitudes, motivation, perception, socio-economic status, and the travel time to health facilities accounted for 2.920-fold, 2.043-fold, 3.704-fold, 2.965-fold, 3.198-fold and 2.386-fold possibility, respectively, of patients to pursue cervical cancer screening with VIA. Multivariate analysis showed that perception, socio-economic status, and travel time to health facilities were the most important factors influencing whether or not women pursued VIA screening. CONCLUSION: Knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities appears to affect women’s’ decision to pursue cervical cancer screening with VIA, with the largest intake being the motivational factor.

Sensibilidad y especificidad de la prueba ivaa en area rural de bolivia - gestiones 2012 a 2014 / Ivaa sensitivityand specificity of the test in rural area in bolivia gestiones 2012 2014

OBJETIVO: Se busca establecer la Sensibilidad Especificidad Valor Predictivo Positivo VPP y Valor Predictivo Negativo VPP de la prueba IVAA Inspección visual con ácido acético, en pacientes del Área rural de Bolivia, comparados con el PAP, Papanicolaou, durante las gestiones 2012 a 2014. MATERIAL Y MÉTODOS: Previa capacitación a los operadores. Estudiantes de quinto año de medicina, En base a un diseño de ensayo comunitario, Se procedió a la toma de muestras siguiendo el siguiente protocolo: 1: Toma de muestra de PAP, mediante espátula de Ayre 2: Aplicación del test IVAA 3: Caso IVAA positivo----Colposcopia inmediatamente, por especialista 4: Si COLPOSCOPIA positiva ----BIOPSIA ( Prueba de oro) 4: Caso Negativo---Espera resultado PAP 5: Recopilación de datos: Análisis de la información en base de datos Excel 7: Presentación de resultados. RESULTADOS: 551 pacientes entre 15 y 65 años que residen en área rural de Bolivia fueron estudiadas. La prevalencia de casos verdaderamente positivos fue de 4.11%. La Sensibilidad del IVAA o sea su capacidad para diagnosticar fue de 100% y su Especificidad de 84% Sus valores VPP y VPN para IVAA fueron 25% y 87% respectivamente. En cambio el PAP presenta una Sensibilidad de apenas 16% y una Especificidad de 96% Sus valores VPP y VPN son 13% y 93%. DISCUSION: Una alta prevalencia de casos verdaderamente positivos se encuentra en este estudio Se ratifica la alta sensibilidad para el diagnóstico de verdaderamente enfermos por la prueba IVAA en una sola sesión, factible en áreas rurales.

OBJETIVE: It seeks to establish Sensitivity Specificity positive predictive value VPP and negative predictive value PPV of VIA test visual inspection with acetic acid in patients from rural areas of Bolivia, in the highlands Copacabana, semi plains Coripata, Chulumani and plains, San Borja and Riberalta in the Plurinational State of Bolivia, compared with PAP smear during the steps 2012 to 2014. MATERIAL AND METHODS: After training to operators. Students fifth year of medicine escole, both the PAP sampling, technique and visual inspection with acetic acid and collecting epidemiological information. EMCN design community trial, we proceeded to the sampling in rural areas, in a single session using the following protocol: 1: Sampling of PAP, by Ayre spatula 2: Application of the test VIA (acid application acetic 5% vinegar on a cotton swab for 1 minute and then observing with lighting 100 watt bulb 3: Case VIA positive Colposcopy immediately, Specialist 4: If COLPOSCOPY positive BIOPSY ( Gold standart) 4: If not Wait --- PAP result 5: Collecting data 6: Information analysis in Excel database. 7: Presentation of results. RESULTS: 551 patients between 15 and 65 who live in rural area of Bolivia were student the prevalence of cases truly positives was 4.11%. The sensitivity of VIA or their capacity to diagnose was 100% and specificity of 84% Their PPV and NPV for VIA values were 25% and 87% respectively. In contrast, the PAP has a sensitivity just 16% and a specificity of 96% Their PPV and NPV values are 13% and 93%. DISCUSION: A truly high prevalence of positive cases found in this study in the rural area. High sensitivity for the diagnosis of truly sick is ratified by the VIA test in one session, feasible in rural areas, because the PAP did not match the VIA in most cases, it remains to follow up the second level, colposcopy positive chaos diagnosed by PAP 3.26%, which could increase the prevalence of truly positive cases in the rural area. This study suggests pursue new strategies for the detection, diagnosis and treatment particularly in women living in rural area and do not have easy access to care centers II or III level.

Modified Cervicography and Visual Inspection With Acetic Acid as an Alternative Screening Method for Cervical Precancerous Lesions

BACKGROUND: We compared the diagnostic accuracy between visual inspection with acetic acid (VIA) and modified cervicography as an alternative screening method for cervical precancerous lesions. METHODS: A diagnostic cross-sectional study was performed at the outpatient clinic at an Indonesian national referral hospital from February until April 2015. We collected samples from patients who sequentially underwent VIA examination, modified cervicography, and colposcopy. RESULTS: A total of 185 patients were included in this study. Modified cervicography showed positive results in 7.6% of patients, while 7.0% of patients had a VIA positive result. This is compared to 5.4% of patients showing abnormal colposcopy results. From those results, we obtained that sensitivity and specificity of VIA were 96.0% and 90.9%. Meanwhile, sensitivity and specificity of modified cervicography were 97.7% and 90.9%, respectively, compared to colposcopy as a gold standard. CONCLUSIONS: Modified cervicography and VIA are reliable tools for cervical cancer screening, with comparable sensitivity and specificity. Modified cervicography can be used as a supplementary tool to improve the documentation of VIA and as an alternative to VIA alone.

Prevalence, Age Distribution, and Risk Factors of Visual Inspection With Acetic Acid-Positive From 2007 to 2011 in Jakarta

BACKGROUND: Cervical cancer is still the second most frequent cancer among Indonesian women, thus screening program is still critically important to prevent it. Visual inspection with acetic acid (VIA) was introduced as a method which is most suitable with Indonesia's condition compared with the other screening methods. The Female Cancer Program from Jakarta Regional collaborated with Leiden University in 2007 to 2011 has done cervical cancer screening using VIA method, involving 25,406 women spreading across several primary health centers in Jakarta. By using these data, we found out the prevalence, age distribution, and risk factor of VIA positive in Jakarta as a basis to predict the budget and logistics for the next cervical cancer screening and to do an advocating to the Jakarta's government. METHODS: A secondary data analysis was conducted from several areas in Jakarta from 2007 to 2011. VIA test was used as the screening method, and performed by doctors and midwives with technical supervision by gynecologists. RESULTS: From 25,406 women, there were 1,192 cases (4.7%) of VIA test positive. The risk factors that can significantly influence the result of VIA positive were number of marriage, parity, smoking habits, and the use of hormonal contraception with OR 1.51, 1.85, 1.95, and 0.68, respectively. CONCLUSIONS: Prevalence of VIA test-positive is 4.7% in Jakarta population. The findings of precancerous lesions and cervical cancers are not only between thirty and fifty years old, but also below the thirty years old and after fifty years old. We suggest that VIA test should be performed to all reproductive age and elder women who are not screened yet.

Comparison of two different methods of detecting residual caries

OBJECTIVES: The aim of this study was to investigate the ability of the fluorescence-aided caries excavation (FACE) device to detect residual caries by comparing conventional methods in vivo. MATERIALS AND METHODS: A total of 301 females and 202 males with carious teeth participated in this study. The cavity preparations were done by grade 4 (Group 1, 154 teeth), grade 5 (Group 2, 176 teeth), and postgraduate (Group 3, 173 teeth) students. After caries excavation using a handpiece and hand instruments, the presence of residual caries was evaluated by 2 investigators who were previously calibrated for visual-tactile assessment with and without magnifying glasses and trained in the use of a FACE device. The tooth number, cavity type, and presence or absence of residual caries were recorded. The data were analyzed using the Chi-square test, the Fisher's Exact test, or the McNemar test as appropriate. Kappa statistics was used for calibration. In all tests, the level of significance was set at p = 0.05. RESULTS: Almost half of the cavities prepared were Class II (Class I, 20.9%; Class II, 48.9%; Class III, 20.1%; Class IV, 3.4%; Class V, 6.8%). Higher numbers of cavities left with caries were observed in Groups 1 and 2 than in Group 3 for all examination methods. Significant differences were found between visual inspection with or without magnifying glasses and inspection with a FACE device for all groups (p < 0.001). More residual caries were detected through inspection with a FACE device (46.5%) than through either visual inspection (31.8%) or inspection with a magnifying glass (37.6%). CONCLUSIONS: Within the limitations of this study, the FACE device may be an effective method for the detection of residual caries.

On hemolysis of extracts of Lonicera Macranthoides flower bud and two saponins / 中国药理学通报

Aim To figure out whether Lonicera mac-ranthoides could induce hemolysis. Methods In vitro, macroscopic observation and spectrophotometry were used to observe whether the solutions of extracts from Lonicera macranthoides, MacranthoidinB and Dipsa-cosideB could induce hemolysis in 2% red cell suspen-sion of New Zealand white rabbits. And the three test-ed materials were prepared in concentration gradient of 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100 mg· L - 1; and in vivo, mice were respectively treated with MacranthoidinB (0. 110 g·kg - 1 , 0. 055 g·kg - 1 ), DipsacosideB(0. 020 g·kg - 1 , 0. 010 g·kg - 1 ), ex-tracts (2. 275 g·kg - 1 , 1. 137 g·kg - 1 , crude drugs) once per day for 7 days, and all of the tested doses de-pended on the clinical doses. Then, RBC, RET and MCHC before and after administration were tested. Re-sults The hemolytic ratio in each treated group was below 5% in vitro. And in vivo, the three materials did not induce hemolysis and had no significant influence on RBC,RET and MCHC(P > 0. 05). Conclusions Extracts from flower bud of Lonicera macranthoides, MacranthoidinB and DipsacosideB, have not caused hemolysis in vivo and in vitro in this research.

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

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