ABSTRACT
"BACKGROUND: It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2-3. METHODS: Guidelines were developed using the WHO Handbook for Guideline Development and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. A multidisciplinary guideline panel was created. Systematic reviews of randomized controlled trials and observational studies were conducted. Evidence tables and Evidence to Recommendations Tables were prepared and presented to the panel. RESULTS: There are nine recommendations for screen-and-treat strategies to prevent cervical cancer, including the HPV test, cytology, and visual inspection with acetic acid. There are seven for treatment of CIN with cryotherapy, loop electrosurgical excision procedure, and cold knife conization. CONCLUSION: Recommendations have been produced on the basis of the best available evidence. However, high-quality evidence was not available. Such evidence is needed, in particular for screen-and-treat strategies that are relevant to low- and middle-income countries."
Subject(s)
Humans , Female , Precancerous Conditions , Uterine Cervical Neoplasms , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , /therapy , ColposcopyABSTRACT
Se examinó un total de 341 muestras de suero para detectar anticuerpos IgA, IgG e IgM anti-Leishmania mediante pruebas de inmunofluorescencia (IF) y ensayos inmunoenzimáticos (ELISA). En conjunto, 292 de los sueros pertenecían a pacientes con diagnósticos clínicos y parasitológicos de leishmaniasis cutánea (resultados positivos en la impronta de lesiones o en la prueba cutánea de Montenegro) y 49, a controles de la misma población. Los índices de rendimiento diagnóstico de los ELISA-IgG e IgM fueron de utilidad diagnóstica y el valor predictivo positivo del ELISA-IgG fue de 94,6. La especificidad de la prueba de IF-IgA fue notablemente alta (100), pero su sensibilidad fue muy baja.
Subject(s)
Leishmaniasis , Fluorescent Antibody Technique , Immunoenzyme Techniques , Enzyme-Linked Immunosorbent Assay , Sensitivity and Specificity , BrazilABSTRACT
Se examinó un total de 341 muestras de suero para detectar anticuerpos IgA, IgG e IgM anti-Leishmania mediante pruebas de inmunofluorescencia (IF) y ensayos inmunoenzimáticos (ELISA). En conjunto, 292 de los sueros pertenecían a pacientes con diagnósticos clínicos y parasitológicos de leishmaniasis cutánea (resultados positivos en la impronta de lesiones o en la prueba cutánea de Montenegro) y 49, a controles de la misma población. Los índices de rendimiento diagnóstico de los ELISA-IgG e IgM fueron de utilidad diagnóstica y el valor predictivo positivo del ELISA-IgG fue de 94,6
. La especificidad de la prueba de IF-IgA fue notablemente alta (100
), pero su sensibilidad fue muy baja
Subject(s)
Leishmaniasis/diagnosis , Fluorescent Antibody Technique/standards , Immunoenzyme Techniques/standards , Enzyme-Linked Immunosorbent Assay/methods , Sensitivity and Specificity , Leishmaniasis/epidemiology , BrazilABSTRACT
A total of 341 sera were screened for anti-Leishmania IgA, IgG, and IgM antibodies by immunofluorescent (IF) tests and enzyme immunoassay (ELISA). Altogether, 292 of the sera originated from patients with clinically as well as parasitologically diagnosed (positive lesion imprint or the Montenegro skin test) cutaneous leishmaniasis; 49 of the sera were from controls from the same base population
In terms of diagnostic performance, the ELISASs for IgG and IgM yielded indices of diagnostic utility, and the positive predictive value for the IgG-ELISA was 94.6 per cent. A remarkably high specificity (100 per cent) was obtained with the IgA-IF test, but its sensitivity was very low(AU)
Subject(s)
Leishmaniasis/diagnosis , Leishmaniasis/epidemiology , Fluorescent Antibody Technique/standards , Immunoenzyme Techniques/standards , BrazilABSTRACT
The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of immunofluorescence (IF) and enzyme-linked immunoassays (ELISA) for IgG, IgM and IgA antibodies were assessed on sera from mucocutaneous lieshmaniasis patients and controls. The sensitivity of the IgG-ELISA test was 93.3 per cent with 95 per cent confidence interval higher than what could be due to a random test not associated with the disease. The specificity of all tests, except the IgM-ELISA, gave indices that could not have been due to chance. The IgG-ELISA and IgG-IF had the highest positive predictive value and the kappa statistic showed that the strength of agreement between the disease and the test was strongest for IgG-ELISA. The IgG-ELISA had a negative predictive value with 95 per cent confidence limits that were not due to chance alone. Efficiency was highest for IgG-ELISA and IgG-IF. These results were obtained using sera from patients with severe or long-standing disease and from controls in whom the disease was ruled out by a negative Montenegro skin test. In field surveys where the differences between cases and controls are less easy to define the diagnostic indices of these tests may vary with the disease prevalence(AU)
