Validity and acceptance of self vs conventional sampling for the analysis of human papillomavirus and Pap smear.

The newest high-risk human papillomavirus (HPV) detection techniques were included for cervical cancer primary screening under the Spanish National Health System in 2019. These analyses allow changing population approaches to foster adherence to screening. Therefore, the validity of self versus conventional sampling for HPV and cytology analyses was appraised. Women's preferences concerning samples and devices were also evaluated. This is a diagnostic accuracy cross-sectional study among 120 women recruited from a colposcopy clinic at a general hospital in Illes Balears, Spain. Participants were given written information and asked for a self-sample. One of two sets containing two devices each were handed. One set was transported dry and the second in liquid medium. Next, clinicians collected vaginal samples that were our gold standards. The agreement between both techniques was examined with the Kappa coefficient (κ). Self-sampling evaluation and preferences for different vaginal devices were also surveyed. The agreement between self and conventional samples concerning HPV positivity was very good (κ 0.86 for Mía by XytoTest® and 0.83 for Viba-Brush®) or reasonable (κ 0.73 for Iune and 0.68 for viscose swab). Pap smears from self-samples exhibited moderate agreement (κ 0.41 for Mía® and 0.51 for Viba-Brush® respectively) for negative versus ASC-US and worse results. Most of the participants considered self-sampling as beneficial (110 or 91.7%) and the advantages were, in decreasing order, scheduling, comfort, intimacy and less fear for pain or disturbance. The priority of choice for the devices was Mía® and viscose swab (chosen in first or second place) in opposition to Iune and Viba-Brush® (chosen in third or fourth place). If Viba-Brush® was to collect the best quality samples, 108 women (94.7%) switched their decisions. Our agreement between self and conventional samples was very good or reasonable for HPV, with the best values for devices in a liquid medium, and moderate for cytology. Even so, reflex cytology on self-samples is a valuable tool in promoting adherence. Self-sampling was widely accepted for smooth and thin devices. However, there is no resistance to change to others if a higher quality of the sample is obtained.

Comparing outcomes and costs between contingent and combined first-trimester screening strategies for Down's syndrome.

OBJECTIVE: To compare a contingent strategy with a combined strategy for prenatal detection of Down's syndrome (DS) in terms of cost, outcomes and safety. STUDY DESIGN: The contingent strategy was based on a simulation, removing measurement of the free beta subunit of human chorionic gonadotropin (free ßhCG) and calculating the DS risk retrospectively in 32,371 pregnant women who had been screened with the combined strategy in the first trimester. In the contingent strategy, a risk between 1:31 and 1:1000 in the first trimester indicated further testing in the second trimester (alpha-fetoprotein, inhibin A, unconjugated oestriol and free ßhCG). The cut-off risk values for the contingent and combined strategies in the first trimester were 1:30 and 1:250, respectively, and the cut-off risk value for integrated screening in the second trimester was 1:250. Costs were compared in terms of avoided DS births, and the ratio of loss of healthy fetuses following invasive procedures per avoided DS birth was calculated. RESULTS: The combined strategy had sensitivity of 40/44 (90.9%) and a false-positive rate of 2.8%. Corresponding values for the contingent strategy were 39/44 (88.6%) and 1.3%, respectively. Only 11% of pregnant women required tests in the second trimester, and the approximate cost reduction for each avoided DS birth was 5000€. The ratio of lost healthy fetuses following invasive procedures per avoided DS birth improved by up to 0.65. CONCLUSION: The contingent strategy has similar effectiveness to the combined strategy, but has lower costs and fewer invasive procedures.

Diagnóstico prenatal de dos casos de teratoma cervical fetal / Prenatal diagnosis. Ultrasonography. Prenatal. Teratoma

Presentamos 2 casos de tumoración cervical fetal con sospecha diagnóstica ecográfica de teratoma cervical, con posterior confirmación histológica. En el primer caso, su alto grado de sospecha permitió la intervención inmediata de los neonatólogos mediante intubación orotraqueal por compromiso mecánico de la vía aérea superior. El posterior tratamiento quirúrgico por parte del servicio de cirugía pediátrica permitió una recuperación aceptable del neonato. El segundo caso, al diagnosticarse antes de las 22 semanas, la paciente optó porque se practicara una interrupción legal del embarazo (AU)

Interrupción voluntaria del embarazo por anomalías congénitas en Mallorca en la década de los noventa / Induced abortion due to birth anomalies in Majorca in the 1990s

Objetivos: Calcular la proporción de interrupciones voluntarias del embarazo para ciertas anomalías congénitas con el fin de valorar el acceso al diagnóstico prenatal en Mallorca, y comparar con datos análogos correspondientes a registros españoles de base poblacional. Material y métodos: Se obtuvo información sobre nacidos de madres residentes en Mallorca desde las 20 semanas de gestación y sobre interrupciones voluntarias de embarazo con historia clínica abierta en nuestros hospitales públicos. Resultados: Con relación a los registros poblacionales de malformaciones durante el período 1990-1996, nuestra proporción de interrupciones voluntarias del embarazo es significativamente menor que la de Asturias para defectos del tubo neural y que la del País Vasco para gastrosquisis, y mayor que en Asturias para las cromosomopatías y la trisomía 21. Si comparamos los quinquenios 1990-1994 y 1995-1999 en Mallorca, las proporciones aumentan para las anomalías del tubo neural, las cromosomopatías totales y la trisomía 21.Conclusiones: El incremento evolutivo de interrupciones gestacionales por defectos del tubo neural y aneuploidías podría deberse al cribado bioquímico. El mayor acceso al diagnóstico prenatal no se corresponde con un aumento de interrupciones por gastrosquisis y uropatías obstructivas. Es preceptivo mejorar el diagnóstico prenatal de las cardiopatías (AU)

Stabilization of blood homocysteine in an epidemiological setting.

The major problem in the determination of homocysteine (Hcy), which is thought to be a risk factor in colorectal cancer, is the rise in its concentration if blood is not centrifuged immediately after collection. We assess the interference of 3-deazaadenosine (which inhibits conversion of S-adenosylhomocysteine into Hcy within the erythrocyte), using the fluorescence polarization immunoassay (FPIA) assay, the stabilizing effect of 3-deazaadenosine and the impact of temperature on Hcy stabilization. To assess interference of 3-deazaadenosine, 12 blood samples were extracted; two aliquots were obtained from each and one of them was added 3-deazaadenosine (50 micromol/l). To assess the stabilizing value of 3-deazaadenosine, as well as the effect of temperature, two blood samples were extracted from 24 volunteers. One of the tubes was immediately placed on ice and centrifuged (reference concentration). To the second tube was immediately added 3-deazaadenosine (50 micromol/l), producing six aliquots, three of which were kept at room temperature (25 degrees C) for 1, 4 and 6 hours, the other three kept at 37 degrees C. The mean values (standard deviation) obtained for methodological interference were: 7.32 (3.58) micromol/l without stabilizer, and 7.11 (3.61) micromol/l with stabilizer. There were no statistically significant differences (P = 0.104) and intraclass correlation coefficient was 0.989, suggesting no methodological interference. We did not find any significant differences regarding our reference value in the samples kept at room temperature during the interval studied. A high Pearson correlation coefficient was obtained. Nevertheless, in those samples kept at 37 degrees C, a slight increase was observed in the 4-hour period (P = 0.009). The addition of 3-deazaadenosine may avoid problems in the critical pre-analytical phase in the Hcy measurement. There is no interference with the FPIA assay, nor any dilution effect, and new reference values are not necessary.