CIN Extension at Colposcopy: Relation to Treatment and Blood Parameters.

OBJECTIVE: To determine the colposcopic lesion size that predicts the presence of residual lesion in patients with cervical intraepithelial neoplasia (CIN) 2/3, to aid gynaecologists in selecting conservative management. METHODS: Data from 51 patients with low- and high-grade squamous intraepithelial lesions were evaluated. Colposcopic images were captured and lesion areas were calculated. Polymerase chain reaction (PCR) for human papillomavirus was performed. Laboratory parameters were evaluated. Receiver operating characteristic (ROC) curves were used to obtain cut-off values for lesion area. The performance of PCR in the detection of high-grade CIN was assessed. A flowchart was created to compare the costs of related procedures in the Brazilian health system. RESULTS: For CIN 2/3 treated with excisional surgery, the best cut-off value for lesion area below which no residual lesion was present was 21 019 pixels2 (58.87 mm2). The cut-off value that predicted compromised surgical margins was 155 577.65 pixels2 (435.75 mm2). Among all patients with CIN, lesion area correlated inversely with neutrophil/lymphocyte ratio (NLR; r = -0.446, P = 0.001), platelet/lymphocyte ratio (PLR; r = -0.438, P = 0.001), and absolute number of leukocytes (r = -0.351, P = 0.011). Conservative clinical management with semi-annual clinical follow-up was found to reduce direct costs to the Brazilian Health System by R $909.82 (US $169.42). CONCLUSION: CIN reflects systemic alteration, leading to altered NLRs, PLRs, and absolute numbers of leukocytes. Patients with high-grade CIN and colposcopic lesion areas <21 019 pixels2 could benefit from conservative management, which would result in cost savings for the Brazilian health system.

Association of lesion area measured by colposcopy and cervical neoplasia.

Studies have demonstrated that the size of lesion in colposcopic imaging can be associated with the grade of CIN. We evaluated 36 patients and at the time of colposcopy, the images were recorded and analysed for lesion area measurement. A ROC curve was used to obtain the area under the curve and to determine the best cut-off values between area lesion (pixels2) and biopsy result. Fisher's exact test was performed (p < .05). Half of the sample had a cervical biopsy showing HPV or LSIL, and 18 (50%)a biopsy showing HSIL or invasive cancer. HSIL and invasive cancer were associated with a lesion area greater than 30,337.03 pixels2 (cut off) with p = .04. Thus the area of the colposcopic lesion is related to the severity of that; so small lesions can be more conservatively followed.IMPACT STATEMENT:What is already known on this subject? Studies have proposed that the size of lesion in colposcopic imaging can be associated with the grade of CIN, and the size of CIN lesions may be a factor in determining the risk of progression.What do the results of this study add? This is the first study in the literature that uses the measurement of the lesion area in pixels2 in comparison with the severity of the lesion, which provides greater accuracy of the lesion area than the mere measurement of its diameter.What are the implications of these findings for clinical practice and/or further research? The size of the lesion should be considered in the management of cervical intraepithelial lesions. This approach also leads to lower cost and is less invasive. Small lesions will have the best prognosis and would be treated in the way more conservative, bringing to the patients more comfort and less complications with the treatment.

Links between pet ownership and exercise on the mental health of veterinary professionals.

Background: Connections between the effects of pet ownership and exercise on mental health have previously been demonstrated in different populations. However, little is known about the potential effects of pet ownership and exercise on the mental health of veterinary professionals. Since these individuals have a high prevalence of poor mental health and suicide, while they deal with pets professionally, we investigated the impact of pet ownership, exercise and different types of pet ownership on this demographic group. Method: Veterinary professionals over 18 years old answered an online questionnaire about pet ownership, exercise, mental health (including anxiety, depression and suicidal ideation) and mental health correlates. Regression models were used to identify variables significantly related to mental health outcomes. Results: Of 1087 respondents, pet owners were more depressed than non-owners, while anxiety or suicidal ideation was not associated with pet ownership. Dog and horse owners were psychologically healthier (less anxiety, less suicidal ideation) than non-owners of these species. Veterinary professionals who ran regularly had lower anxiety and depression. Those who walked regularly and spent less time sitting experienced fewer depression symptoms. Conclusions: Running, walking and avoiding prolonged sitting might protect the mental health of veterinary professionals. The type of pet owned may be an important factor in the relationship between pet ownership and mental health; however, generally, pet ownership was associated with worse mental health outcomes in this demographic group. Future studies should determine the causal nature of these relationships.

Dog owner mental health is associated with dog behavioural problems, dog care and dog-facilitated social interaction: a prospective cohort study.

Despite numerous qualitative and cross-sectional studies investigating how dog-related factors may impact owners' well-being, empirical studies to test these causal effects are lacking. This prospective cohort study examined the correlation and potential causal effect of 17 dog-related factors with six well-being outcomes (depression, anxiety, loneliness, suicidal ideation, hedonic well-being and eudaimonic well-being) in dog owners. Over a four-week period, 709 adult dog owners reported their weekly well-being and occurrence of each dog-related factor (e.g. how many times they ran with their dogs). A random intercept cross-lagged panel model (RI-CLPM) with significance threshold set at 0.001 was used. Six factors correlated with poorer owner well-being (i.e. aggressive dog behaviour, fearful dog behaviour, poor dog health, failure to provide for the dog, lack of control over the dog, and dog presence). Only 'friendly conversation with others due to the dog' correlated with better well-being. Purposeful reductions in the frequency of dog behavioural and health-related issues are likely to improve owner well-being, as well as greater consistency in dog care (i.e. provide for the dog) and more engagement in friendly dog-facilitated social interactions. No potential causal effects were significant. Further studies investigating causal relationships are essential to improve people's well-being through dog ownership.

Black skin color but not VDR gene represent a risk factor for low serum levels of vitamin D in self-declared black individuals.

BACKGROUND: The absorption of vitamin D occurs via two main pathways: first, through the biosynthesis in the skin under the exposure of UV from sunlight; and second, through the intake of certain foods. However, its levels can be influenced by both genetic and environmental factors, which can generate changes such as vitamin D deficiency (hypovitaminosis D), a condition that black adults have a high potential to suffer from. OBJECTIVE: The aim of this work is to study the association of skin color (self-reported: black, brown and white), food consumption, and the BsmI polymorphism in the vitamin D receptor gene (VDR) on serum levels of vitamin D in a group of adults. METHODS: This was a cross-sectional analytical study. Individuals in the community were invited to participate in the research and, After signing the informed consent, a structured questionnaire was applied containing identification data, self-declaration of race/color, and nutritional data (Food frequency questionnaire (FFQ) and 24 h); afterwards, blood was collected for biochemical analysis, vitamin D was measured by Chemiluminescence and RT-PCR was used to evaluate the BsmI polymorphism of the VDR gene. Data was analyzed using a statistical program (SPSS 20.0) and differences between groups using p < 0.05. RESULTS: A total of 114 persons was evaluated between black, brown and white individuals. It was found that a large part of the sample presents hypovitaminosis D, and blacks stand out with an average serum vitamin D level of 15.9 ng/dL. The group demonstrated that dietary intake of vitamin D is low, with the present study is a pioneer in associating the polymorphism of the VDR gene (BsmI) with the consumption of foods that are considered to have a higher content of vitamin D in their composition. CONCLUSION: The VDR gene does not represent a risk factor for the consumption of vitamin D in this sample, and it was found that the self-declaration of "black" skin color was an independent risk factor for low serum levels of vitamin D.

VDR, SOD-2, and CYP24A1 Gene Expression in Different Genotypes of BsmI SNP of the Vitamin D Receptor Gene in Individuals with Hypovitaminosis.

BACKGROUND: Hypovitaminosis D is a public health problem due to its implications for various diseases. Vitamin D has numerous functions, such as modulating the metabolism of cellular tissues, and it is expressed through the vitamin D receptor (VDR) gene that may influence gene expression modulation, which plays an important role in vitamin D metabolism. OBJECTIVE: To evaluate the effect of the genotypes of BsmI single nucleotide polymorphism (SNP) of the VDR gene on VDR, SOD2, and CYP24A1 gene expression in individuals with low serum vitamin D levels. METHODS: This was a cross-sectional analytical study. After signing the informed consent form, individuals were invited to participate and answered a structured questionnaire with identification data. Blood was collected for biochemical analysis, and vitamin D was measured by chemiluminescence; BsmI polymorphism was determined using real-time polymerase chain reaction (PCR) assays with TaqMan allelic discrimination, and gene expression was conducted by qRT-PCR using QuantiFast SYBR® Green PCR Master Mix. Data were analyzed using the SPSS 20.0 software, and differences were considered significant at p < 0.05. RESULTS: 98 individuals with vitamin D ≤ 20 ng/dL were evaluated, and the BsmI SNP of the VDR gene showed CYP24A1 overexpression and low SOD2 expression. CONCLUSION: BsmI SNP of the VDR gene can modulate the expression of the genes evaluated without interfering with serum levels.

Atypical squamous cells of undetermined significance: Bethesda classification and association with Human Papillomavirus.

INTRODUCTION: To analyze patients with atypical squamous cells of undetermined significance (ASCUS) through a cytology review and the presence of microbiological agents, with consideration of colposcopy and semiannual tracking. METHODS: 103 women with ASCUS were reviewed and reclassified: normal/inflammatory, ASCUS, low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). If ASCUS confirmed, it was subclassified in reactive or neoplastic ASCUS, ASC-US, or ASC-H; and Regione Emilia Romagna Screening Protocol. Patients underwent a colposcopic examination, and test for Candida sp., bacterial vaginosis, Trichomonas vaginalis, and human papillomavirus (HPV) were performed. RESULTS: Upon review, ASCUS was diagnosis in 70/103 (67.9%), being 38 (54.2%) reactive ASCUS and 32 (45.71%) neoplastic ASCUS; 62 (88.5%) ASC-US and 8 (11.41%) ASC-H. ASCUS (Regione Protocol), respectively 1-5: 15 (21.4%), 19 (27.1%), 3 (27.1%), 16 (22.8%), and 1 (1.4%). A higher number of cases of cervical intraepithelial neoplasia (CIN) II/III in the biopsies of patients with ASC-H compared to ASC-US (P = .0021). High-risk HPV test and presence of CIN II/III are more frequent in ASC-H than ASC-US (P = .031). CONCLUSIONS: ASC-H is associated with clinically significant disease. High-risk HPV-positive status in the triage for colposcopy of patients with ASC-US is associated with increased of CIN.

Understanding the impact of dog ownership on autistic adults: implications for mental health and suicide prevention.

Mental health problems and suicide are more frequent in autistic adults than general population. Dog ownership can improve human well-being. This study aimed to generate a framework of well-being outcomes for dog-related activities in autistic adults and compare it to the framework generated for a general adult population. Thirty-six autistic dog owners (18-74 years old, 18 males) from diverse UK regions were interviewed and transcripts thematically analysed. 16.7% reported that their dogs prevented them from taking their own lives, mainly due to the dog's affection and the need to care for the animal. Close dog-owner interactions (e.g., cuddling, walking, dog's presence) were the most frequent activities improving emotions/moods and life functioning, whereas routine-like activities (e.g., feeding the animal) particularly enhanced life functioning. Well-being worsening was mainly linked to dog behaviour problems, dog poor health/death and obligations to the dog. Despite some negatives associated with ownership, having a dog could improve the well-being of many autistic adults and assist suicide prevention strategies in this high-risk group. The framework was consistent with that generated previously, indicating its robustness and the potential opportunity to focus on dog-related activities rather than the vague concept of "ownership" when considering the impact of ownership on well-being.

Dog-related activities and human well-being in Brazilian dog owners: A framework and cross-cultural comparison with a British study.

Despite the abundance of studies investigating the benefits of having a dog, the specific aspects of dog ownership that impacts human well-being are not well understood. This study used a qualitative approach to create a framework of the main dog-related activities perceived by Brazilian owners to impact their well-being and compared the findings with those of a similar study in England. Thirty-two Brazilian dog owners from the five regions of the country were remotely interviewed. The thematic analysis of the transcripts generated a total of 58 dog-related activities, organised into 13 themes. Most activities were reported to have a positive effect on participants' well-being, accounting for 76.8% of the total number of mentions in the interviews. 'Playing with dog' and 'Dog presence' were the themes most frequently associated with positive well-being outcomes, whereas 'Unwanted behaviours' and 'Failing to meet dog's needs' were the most commonly associated with negative outcomes. The dog-related activities reported by Brazilian dog owners and the well-being outcomes linked to those activities were consistent with the previous British sample in the framework that emerged. These findings suggest reliability between the two methods used to gather data (remote interview versus focus group) and, most importantly, provide consistent cross-cultural evidence for how certain activities impact dog owner's well-being.

Theoretical Foundations to the Impact of Dog-Related Activities on Human Hedonic Well-Being, Life Satisfaction and Eudaimonic Well-Being.

Cross-sectional comparisons of well-being between dog owners and non-owners commonly generate inconsistent results. Focusing on the uniqueness of the relationship might help address this issue and provide a stronger foundation for dog-related psychotherapeutic interventions. This study aims to evaluate the impact of dog-related activities (e.g., exercising the dog) on owner hedonic well-being, life satisfaction and eudaimonic well-being. It was also hypothesised that psychological closeness to the dog would affect these well-being outcomes. For this study, 1030 dog owners aged over 18 years old answered an online questionnaire about the impact of 15 groups of dog-related activities on their well-being. Ordinal regressions were used to estimate the mean response (and its uncertainty) for each outcome, while conditioning for psychological closeness to the dog and controlling for several key covariates. Tactile interactions and dog playing were significantly more beneficial than other activities for hedonic well-being, and dog training and dog presence for eudaimonic well-being. In contrast, dog health issues and behavioural problems were linked to decrements in these well-being outcomes. Higher psychological closeness to the dog predicted greater improvement in well-being in positive dog-related activities. Our quantitative study validates the general findings of previous qualitative work and lays the groundwork for future longitudinal studies.

A framework for understanding how activities associated with dog ownership relate to human well-being.

There is notorious inconsistency regarding mental health benefits of dog ownership, partially due to repeated cross-sectional studies comparing dog owners and non-owners, without taking into account the heterogeneity of dog-owner dyads, especially the activities with which the owners are involved. This study aimed to develop a comprehensive framework of the most important dog human related activities and their impact on owner well-being. Six focus groups with 35 dog owners were conducted, and their audio transcripts thematically analysed. Dog human related activities and themes of activities were linked to their reported changes in well-being through matrix coding. A framework of 58 dog human related activities linked with their specific hedonic well-being, life satisfaction and eudaimonic well-being outcomes was generated. Most activities were reported to improve owner's well-being, (e.g. human-dog tactile interaction increases owner's self-esteem), and a minority was mainly associated with negative outcomes. The richness of the framework presented in this study reinforces the importance of assessing dog ownership well-being outcomes based on specific dog human related activities with which dog owners are involved. This new and systematic investigative approach should decrease inconsistencies in the field and facilitate mental health interventions and study designs of a higher level of evidence.

Pain and Problem Behavior in Cats and Dogs.

We argue that there is currently an under-reporting of the ways in which pain can be associated with problem behavior, which is seriously limiting the recognition of this welfare problem. A review of the caseloads of 100 recent dog cases of several authors indicates that a conservative estimate of around a third of referred cases involve some form of painful condition, and in some instances, the figure may be nearly 80%. The relationship is often complex but always logical. Musculoskeletal but also painful gastro-intestinal and dermatological conditions are commonly recognized as significant to the animal's problem behavior. The potential importance of clinical abnormalities such as an unusual gait or unexplained behavioral signs should not be dismissed by clinicians in general practice, even when they are common within a given breed. In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient's response to trial analgesia, even if a specific physical lesion has not been identified.

Local expression of interferon-alpha and interferon receptors in cervical intraepithelial neoplasia.

PURPOSE: The present study evaluated mRNA expression of interferon-alpha (IFN-alpha), IFN-alpha receptor subunits (IFNAR-1 and IFNAR-2) and an IFN-stimulated gene encoding the enzyme 2',5'-oligoadenylate synthetase (2'5'OAS) in biopsies on patients with varying grades of cervical intraepithelial neoplasia (CIN I, II and III). METHODS: Uterine cervix biopsies were collected from women with CIN I, II and III (n = 28) and controls without CIN lesions or human papilloma virus (HPV) infection (n = 17). The presence of high and low-risk HPV DNA was determined using hybrid capture. The mRNA levels of IFNAR-1, IFNAR-2, IFN-alpha and 2'5'OAS were determined by RT-PCR with specific primers. RESULTS: The control group exhibited a greater frequency of IFNAR-1 expression (10/17; 58.3%) than the CIN samples (4/28; 14.2%) (P = 0.0018), while, the expression of IFNAR-2 was also greater in the control samples (11/17; 64.7%) than in the patients with lesions (2/28; 7.1%) (P = 0.0018). Importantly, simultaneous expression of both receptors was observed only in the control group (8/17; 47.0%) (P = 0.0001). Among the CIN samples, there was one case of low expression of mRNA of IFNAR-1 and IFNAR-2. IFN-alpha was present in 14.2% (4/28) of the CIN samples but was not expressed in the control group. mRNA 2'5'OAS were expressed in 28.5% (8/28) of the CIN samples and 11.7% (2/17) of the control samples (not statistically significant). Fifty percent (14/28) of the CIN samples were positive for HPV DNA. CONCLUSIONS: Cervical biopsy samples from control women or those without neoplasia or HPV infection displayed higher IFN-alpha receptor expression than those with CIN, while simultaneous expression of both IFN-alpha receptor subunits was found only in the control group. There was no significant difference in mRNA expression of IFN-alpha and 2'5'OAS between the control and CIN groups. Then we concluded that the samples obtained from patients with CIN present low levels of the IFN-alpha receptor mRNA.

Association of IL-10 to coronary disease severity in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MetS) is a group of risk factors that increase the risk for heart disease. Little is known about the role of IL-10 in the severity of coronary artery disease (CAD) in patients with MetS. We investigated plasma levels of IL-10 and other pro-inflammatory cytokines in patients with MetS with or without severe CAD. METHODS: Cross-sectional study with healthy and MetS individuals. IL-10 and other pro-inflammatory interleukins were analyzed in 90 subjects divided into 3 groups: group 1 (n = 30), patients with MetS without severe CAD; group 2 (n = 30), patients with MetS and severe CAD (history of myocardial infarction or revascularization performed through surgery or percutaneous transluminal coronary angioplasty with or without stent placement); and group 3 (n = 30), healthy individuals. RESULTS: Levels of IL-12 (p = .018), TNF-α (p = .007) and IL-6 (p = .010) were significantly higher in group 1 when compared to group 3 (p = .003; p = .002; p = .001, respectively). In addition, group 1 presented significantly higher levels of IL-12 (p = .019), TNF-α (p = .026) and IL-6 (p = .020) when compared to group 2. IL-10 levels were significantly higher in group 1 (p = .003) when compared to group 2 (p = .014) and group 3 (p < .001). Only the level of IL-10 was significant to explain the presence of severe CAD, as a protective factor (OR: 0.896; 95%CI: 0.818-0.981) in the logistic regression model. CONCLUSIONS: Higher IL-10 levels in patients with MetS are associated with lower incidence of severe CAD, suggesting a protective effect through its anti-inflammatory activity even in the presence of higher levels of pro-inflammatory cytokines.

Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon.

INTRODUCTION: Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS: Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS: RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS: The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.

Common Risk Factors for Urinary House Soiling (Periuria) in Cats and Its Differentiation: The Sensitivity and Specificity of Common Diagnostic Signs.

Urinary house soiling (periuria) in the home is a common but serious behaviour problem in cats. Although many specific risk factors and triggers have been postulated, their importance is largely unknown. This study assessed: (1) the significance of purported risk factors for periuria as well as specifically marking and latrine behaviour in the home; (2) the specificity and sensitivity of signs commonly used to differentiate latrine and marking behaviour. Owner responses to an internet survey (n = 245) were classified into three groups: control, marking and latrine behaviour, along with 41 potential risk factors and 15 predictors used to diagnose marking and latrine problems. Univariate statistical analyses and non-parametric tests of association were used to determine simple associations. In addition the sensitivity and specificity of four cardinal signs (posture to urinate, attempt to cover soiled area, surface chosen and volume of urine deposited) were calculated. Significant potential risk factors were: age (marking cats were older than the other two groups); multi-cat household (increased risk of marking and latrine behaviours); free outside access and cat flaps in the house (higher frequency of marking); outside access in general (lower prevalence of latrine behaviour); defecation outside the litter box (higher frequency of latrine behaviour); a heavy dependence by the cat on its owner (lower frequency of latrine behaviour) and a relaxed personality (lower risk of marking behaviour). Litterbox attributes and disease related factors were not significant. Individual cardinal signs were generally not good predictors of diagnosis. This study challenges the poor quality of evidence that has underpinned some of the hypotheses concerning the causes of periuria in cats. The results, in particular, highlight the general importance of the social environment, with the presence of other cats in the household, the cat-owner bond and personality related factors, alongside factors like the use of a cat flap which might also alter the social environment, all implicated as significant risk factors. While the physical environment may be important in specific cases, it seems this is less important as a general risk factor. The findings quantify the risk of misdiagnosis if a single sign is considered sufficient for diagnosis.

Utilization of human papillomavirus testing for cervical cancer prevention in a university hospital.

This study aimed to evaluate the performance and cost of using polymerase chain reaction (PCR) and hybrid capture in the detection of cervical intraepithelial neoplasia (CIN) in patients with cytological abnormalities (ASCUS/low-grade squamous intraepithelial lesion--LSIL), and the feasibility of implementing these methods in Brazil's Unified National Health System (SUS). Colposcopy gave a negative predictive value of 92.86% and efficiency of 87.8% for diagnosing CIN. The sensitivity of PCR and hybrid capture for detecting CIN was 83.33% and 66.67%, respectively, and the negative predictive value for diagnosing CIN2/CIN3 was 100% and 94.74%, respectively. The annual cost for 80 patients was lower when all patients with ASCUS/LSIL were referred for colposcopy than when HPV testing was performed and those with positive results were referred for colposcopy. Therefore, at present, it is financially unfeasible for the National Health System to implement HPV testing to screen patients with cytological abnormalities (ASCUS/LSIL). However, considering that large-scale use might make such methods cheaper, PCR should be the chosen method, since it is less expensive, more sensitive, and has a high negative predictive value.

A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation.

BACKGROUND:: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain. OBJECTIVE:: To develop and validate a multivariate model to predict coronary artery disease (CAD) based on variables assessed at admission to the coronary care unit (CCU) due to acute chest pain. METHODS:: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%), while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested. RESULTS:: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC) of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84) in the derivation sample and 0.86 (95%CI = 0.79 - 0.93) in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively). Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002) and validation (p = 0.039) samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001) and validation (p < 0.0015) samples. CONCLUSION:: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain. FUNDAMENTO:: Atualmente, não existe um modelo multivariado validado para predizer a probabilidade de doença coronariana obstrutiva em pacientes com dor torácica aguda. OBJETIVO:: Desenvolver e validar um modelo multivariado para predizer doença arterial coronariana (DAC) com base em variáveis avaliadas à admissão na unidade coronariana (UC) devido a dor torácica aguda. MÉTODOS:: Foram estudados um total de 470 pacientes, 370 utilizados como amostra de derivação e os subsequentes 100 pacientes como amostra de validação. Como padrão de referência, a angiografia foi necessária para descartar DAC (estenose ≥ 70%), enquanto a angiografia ou um teste não invasivo negativo foi utilizado para confirmar a doença. Foram testadas como preditoras 13 variáveis basais relacionadas à história médica, 14 características de desconforto torácico e oito variáveis relacionadas ao exame físico ou testes laboratoriais. RESULTADOS:: A prevalência de DAC foi de 48%. Por regressão logística, seis variáveis permaneceram como preditoras independentes de DAC: idade, gênero masculino, alívio com nitrato, sinais de insuficiência cardíaca, e eletrocardiograma e troponina positivos. A área sob a curva (area under the curve, AUC) deste modelo final foi de 0,80 (intervalo de confiança de 95% [IC95%] = 0,75 - 0,84) na amostra de derivação e 0,86 (IC95% = 0,79 - 0,93) na amostra de validação. O teste de Hosmer-Lemeshow indicou uma boa calibração em ambas as amostras (p = 0,98 e p = 0,23, respectivamente). Em comparação com o modelo básico contendo eletrocardiograma e troponina, o modelo completo ofereceu um incremento na AUC de 0,07 tanto na amostra de derivação (p = 0,0002) quanto na de validação (p = 0,039). A melhoria na discriminação integrada foi de 0,09 nas amostras de derivação (p < 0,001) e validação (p < 0,0015). CONCLUSÃO:: Um modelo multivariado foi derivado e validado como uma ferramenta acurada para estimar a probabilidade pré-teste de DAC em pacientes com dor torácica aguda.

Atypical squamous cells of undetermined significance: analysis of microbiology, cytological criteria and clinical conduct.

AIMS: To differentiate between two types of atypical squamous cells of undetermined significance (ASCUS): probably neoplastic (PN) or probably reactive (PR), and, in accordance with the recommendations on screening protocols of the Emilia-Romagna Region (PSRER), Italy, to define the best management to follow and the prognosis. Furthermore, the associations between ASCUS and infectious agents and human papillomavirus (HPV) were evaluated. METHODS: Fifty-eight ASCUS smears were reviewed and sorted; if a diagnosis of ASCUS was confirmed, the smear was classified as PR or PN, and the PSRER group was identified. Then, colposcopy was performed with checks for infectious agents (culture evaluation with cytological or clinical criteria) and HPV (hybrid capture). RESULTS: The ASCUS frequency was 3.96%. Of the 58 cases, 33 (56.9%) were diagnosed as ASCUS on review, of which 15 cases were PN and 18 were PR, while 23 (39.7%) smears were normal and 2 (3.4%) showed cervical intraepithelial neoplasia (CIN). There was a higher frequency of bacterial vaginosis (BV) and HPV in ASCUS PR patients compared with normal cytology, and a higher frequency of CIN in ASCUS PN patients compared with normal controls (P < 0.05). By grouping ASCUS 1 and 3, we observed a higher frequency of CIN and of high-grade colposcopy findings compared with ASCUS 2 and 4 (P < 0.05). From the 23 cases not found to be ASCUS, 18 (87.5%) had normal cytology and colposcopy results on the first follow-up. CONCLUSIONS: Classification of ASCUS as either PN or PR helps in clinical conduct and prognosis, because a higher frequency of CIN is found in ASCUS PN. ASCUS subdivisions, based on PSRER and colposcopy, may facilitate the clinical conduct because ASCUS 1 and 3 with high-grade colposcopic findings proved to be related to the presence of CIN. We propose that initial ASCUS cytology be reviewed, and if it is confirmed, colposcopy should be performed. For those cases found to be normal on review of the cytology results, it is suggested that a cytological check-up be carried out every 6 months.