Conhecimento para apoio aos profissionais responsáveis pelo diagnóstico de citologia anal: revisão narrativa e interpretação de critérios citomorfológicos

Resumo:Introdução:O câncer anal é uma patologia considerada rara, apesar de crescente na população. A citologia anal tem sido uma aposta para diagnosticar as alterações pré-neoplásicas, evitando a evolução ao câncer. Objetivos:I) Abordar aspectos de satisfatoriedade da amostra celular e revisar os critérios citomorfológicos dos achados benignos e malignos nos esfregaços de citologia anal. II) Tornar este artigo um instrumento de suporte aos profissionais de saúde que atuam no setor de Citopatologia vinculados ao Sistema Único de Saúde (SUS) ou à iniciativa privada. Métodos:Revisão narrativa, com busca nas bases PubMed, Science Direct e SciELO, de fevereiro a abril/2023. Desenvolvimento:A análise da literatura aponta para a aplicação da citologia anal para diagnóstico das alterações induzidas pelo Papilomavírus Humano (HPV) no canal anal. O rastreamento se baseia na semelhança ao controle do câncer de colo uterino e à história natural da doença, reconhecendo que as lesões precursoras evoluem ao câncer invasivo. Essa janela entre a lesão e o câncer abre espaço para detecção precoce. Oportunamente, a técnica pode diagnosticar agentes responsáveis por outras Infecções Sexualmente Transmissíveis (IST). Conclusão: Qualificar os laudos de diagnóstico citopatológico pode apoiar o cuidado desde a atenção primária. O intuito deste trabalho foi contribuir com o processo de aprendizagem dos profissionais da saúde e apoiar a saúde pública nas estratégias de garantia de cuidado às pessoas.

Utilidad diagnóstica de citopatología para diagnóstico de nódulos tiroideos malignos en un hospital peruano / Diagnostic utility of cytopathology for the diagnosis of malignant thyroid nodules in a Peruvian hospital

RESUMEN Objetivos: determinar el rendimiento diagnóstico de la biopsia por punción aspiración con aguja fina (PAAF) para el diagnóstico de nódulos tiroideos malignos. Materiales y métodos: estudio retrospectivo que evaluó las PAAF de tiroides realizadas en el Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú, durante un período de tres años. Se categorizó el diagnóstico citopatológico de las biopsias usando el sistema de Bethesda, se consideró las categorías V y VI como malignas y la categoría II como benigna. Se obtuvo solo una biopsia por paciente y se consideró el resultado con la categoría de Bethesda más alta. Todos los pacientes fueron sometidos a tiroidectomía y los resultados histopatológicos se categorizaron como malignos o benignos. Resultados: se incluyó a 173 pacientes con resultados citopatológicos de Bethesda II al VI. El diagnóstico citológico mostró que el 47,4% de los pacientes tenían Bethesda VI. El 59,5% de los nódulos tiroideos fueron malignos en la histopatología, siendo el carcinoma papilar el tipo más frecuente. El rendimiento diagnóstico de la PAAF fue alta cuando considera Bethesda V y VI como malignos, con una sensibilidad 91,92%, especificidad 71,67%, valor predictivo positivo 84,26%, valor predictivo negativo 84,31% y precisión de 84,28%, razón de verosimilitud positiva 3,39; pero mejoró significativamente cuando se consideró solo Bethesda VI como maligno, con sensibilidad del 90,7%, especificidad del 89,58%, precisión 90,3% y razón de verosimilitud positiva 8,71. Conclusiones : la PAAF tiene buen rendimiento. Este estudio demostró ser de gran utilidad en nuestro centro de salud para detectar errores y promover mejoras, así también como modelo para próximas investigaciones en diferentes establecimientos de salud.

ABSTRACT Objectives: To determine the diagnostic performance of fine needle aspiration biopsy (FNAB) for diagnosing malignant thyroid nodules. Methods: This is a retrospective study that assessed thyroid FNABs in Guillermo Almenara-Irigoyen National Hospital in Lima, Peru, during a three-year period. Cytopathologic diagnosis of biopsies was categorized using the Bethesda System, considering categories V and VI as malignant, and category II as benign. A single biopsy per patient was obtained, and results with the highest value in the Bethesda System were considered. All patients underwent thyroidectomy and histopathological results were characterized as malignant or benign. Results: One hundred and seventy-three patients were included in the study. Their cytopathology results were Bethesda II to VI. Cytological diagnosis showed that 47.4% of all patients were Bethesda VI. Nearly sixty percent (59.5%) of thyroid nodules were malignant in histopathology, and papillary carcinoma was the most frequent neoplasm. Diagnostic performance of FNAB was high when considering Bethesda V and VI as malignant, with 91.92% sensitivity, 71.67% specificity, 84.26 positive predictive value, 84.31% negative predictive value, and 84.28% precision. Positive verisimilitude rate was 3.39; but this significantly improved when only Bethesda VI was considered as malignant, with 90.7% sensitivity, 89.58% specificity, 90.3% precision, and 8.71 positive verisimilitude rate. Conclusion: FNAB showed good performance. This study proved to be quite useful in our healthcare facility for detecting errors and promote improvement, as well as a model for future research in different healthcare instances.

Prevalencia y factores de riesgo de la neoplasia intraepitelial anal en pacientes con lesión intraepitelial cervical de alto grado / Prevalence and risk factors for anal intraepithelial neoplasia in patients with high- grade cervical intraepithelial lesion

Resumen OBJETIVO: Determinar la prevalencia de alteraciones en la citología anal, infección anal por virus del papiloma humano y en la neoplasia intraepitelial anal; además, explorar los factores de riesgo y los serotipos asociados en pacientes con lesión intraepitelial cervical de alto grado, a partir de la hipótesis de que esta población tiene mayor riesgo de lesiones precursoras o cáncer anal. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal, con componente analítico, efectuado en pacientes con diagnóstico de lesión intraepitelial cervical de alto grado (LIEAG) en dos instituciones de salud: una privada y otra pública de Bogotá, atendidas entre enero de 2017 y febrero de 2018. Se efectuó un muestreo no probabilístico, por conveniencia. RESULTADOS: Se incluyeron 119 participantes, en 4 de ellas se evidenció, en la citología anal, el hallazgo de células anormales en el tejido que reviste la parte exterior del cuello uterino. Se encontraron 14 anoscopias anormales que dieron una prevalencia de neoplasia intraepitelial anal del 6.7%. Siete eran neoplasia intraepitelial anal de bajo grado y una de alto grado. Se encontró infección por VPH anal en 45 participantes (37.8%) y se detectaron genotipos de VPH-AR en 29 participantes (24.4%). Más de 3 compañeros sexuales, más de 3 hijos y tener menos de 21 años antes del primer embarazo tuvieron un valor de p < 0.05 que confiere mayor riesgo de infección por VPH anal. CONCLUSIÓN: Es importante establecer en Colombia protocolos para la detección de la neoplasia intraepitelial anal en grupos de alto riesgo, como las pacientes con neoplasia intraepitelial cervical o cáncer de cuello uterino, e incentivar el adiestramiento en la anoscopia de alta resolución en especialistas relacionados con el diagnóstico de patología anogenital.

Abstract OBJECTIVE: To determine the prevalence of alterations in anal cytology, anal human papillomavirus infection, and anal intraepithelial neoplasia, and to explore the risk factors and associated serotypes in patients with high-grade cervical intraepithelial lesion, based on the hypothesis that this population is at higher risk for precancerous lesions or anal cancer. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study, with analytical component, performed in patients diagnosed with high-grade cervical intraepithelial lesion (HG-CIL) in two health institutions: one private and one public in Bogota, visited between January 2017 and February 2018. A non-probabilistic sampling was performed, by convenience, with a sample calculated in 124 patients. RESULTS: 119 participants were included, in 4 of them it was evidenced in the anal cytology, the finding of abnormal cells in the tissue lining the outside of the cervix. Fourteen abnormal anoscopies were found, giving a prevalence of anal intraepithelial neoplasia of 6.7%. Seven were low-grade anal intraepithelial neoplasia and one was high-grade. Anal HPV infection was detected in 45 participants (37.8%) and HR-HPV genotypes were detected in 29 participants (24.4%). More than 3 sexual partners, more than 3 children and being younger than 21 years before first pregnancy had a p-value < 0.05 conferring an increased risk of anal HPV infection. CONCLUSION: It is important to establish protocols in Colombia for the detection of anal intraepithelial neoplasia in high-risk groups, such as patients with cervical intraepithelial neoplasia or cervical cancer, and to promote training in high-resolution anoscopy in specialties related to the diagnosis of anogenital pathology.

Síndrome do ovário remanescente em cadela ­ relato de caso / Ovarian remnant syndrome in bich ­ case report / Síndrome de ovario restante en perra ­ reporte de caso

A síndrome do ovário remanescente é caracterizada pela remoção incompleta do ovário durante o procedimento de castração em fêmeas. O presente trabalho relata o caso de uma cadela, sem raça definida, submetida a ovário-histerectomia há um ano, mas continuava demonstrando sinais de estro pós castração. Foi necessário a realização de exames de exames complementares como ultrassonografia abdominal e citologia vaginal, sendo identificado uma estrutura vascularizada em topografia de ovário e células em fase de estro. A cadela foi submetida a uma laparotomia exploratória para retirada de tecido ovariano remanescente.

Remnant ovary syndrome is characterized by incomplete removal of the ovary during the castration procedure in females. The present work reports the case of a dog, of no defined breed, who underwent ovariosalpingohysterectomy 1 year ago and continued to show signs of heat after castration. It was necessary to perform imaging tests such as abdominal ultrasound, which identified a vascularized structure in ovarian topography and vaginal cytology, which identified cells in the estrus phase. The dog required an exploratory laparotomy to remove remaining ovarian tissue.

El síndrome de ovario remanente se caracteriza por la extirpación incompleta del ovario durante el procedimiento de castración en las mujeres. El presente trabajo reporta el caso de una perra, sin raza definida, a quien se le realizó ovariosalpingohisterectomía hace 1 año y continuó presentando signos de celo luego de la castración. Fue necesario realizar pruebas de imagen como ecografía abdominal, que identificó una estructura vascularizada en la topografía ovárica y citología vaginal, que identificó células en fase de estro. La perra requirió una laparotomía exploratoria para extirpar el tejido ovárico restante.

Efeito do cigarro eletrônico na saliva e no epitélio da mucosa bucal / Effect of electronic cigarettes on saliva and oral mucosal epithelium

A utilização indiscriminada de cigarros eletrônicos (e-cigs) já representa um problema de saúde pública mundial e pouco se sabe quanto aos efeitos de seu uso sobre a saúde bucal. O objetivo deste trabalho foi avaliar o efeito do uso do e-cig na saliva e na mucosa bucal de seus usuários. Foram formados dois grupos: Grupo Cigarro Eletrônico (GE) - 25 usuários regulares e exclusivos de e-cig; Grupo controle (GC) - 25 indivíduos não-fumantes, pareados em sexo e idade ao GE. A saliva não estimulada foi coletada para avaliar o metaboloma e o biofilme microcosmos. Em seguida, esfregaços foram coletados da borda lateral esquerda da língua para a avaliação dos genes IL1B, CXCL8, TNF, KRT1, KRT13, KRT19, TP16, TP21 e TP53, por meio de RT-qPCR. Os dados receberam tratamento estatístico de acordo com teste de Mann-Whitney. A análise discriminante por mínimos quadrados parciais (PLSDA), Heatmap e a análise biomarcadores foram realizados para o metaboloma. Um total de 101 metabólitos foram considerados na análise do metaboloma salivar. O perfil salivar do GE diferiu do GC, evidenciando 10 metabólitos distintos: isoleucina, ácido 2-hidroxiglutárico, ácido 3-fenilláctico, ácido linoleico, ácido 3- hidroxibutirico, 1,6 ­ anidroglucose, ácido glucurônico, valina, ácido esteárico, ácido elaídico. A análise do biofilme microcosmos do GE revelou uma atividade metabólica média aumentada em comparação ao GC. No entanto, nenhuma diferença foi observada entre os grupos quanto à biomassa e à quantificação dos carboidratos salivares. Além disso, o GE apresentou um aumento significativo na contagem total de microrganismos, incluindo Streptococcus mutans e leveduras do gênero Candida. Em contraste, houve uma redução na contagem de Lactobacillus spp. Por fim, no GE, todos os genes encontravam-se regulados negativamente, com exceção do TP53. Frente aos resultados obtidos, conclui-se que o uso de e-cig impacta diretamente o perfil do metaboloma salivar, promove a disbiose da microbiota bucal, favorecendo o aumento de microrganismos cariogênicos e leveduras. Além disso, causa regulação negativa da expressão de genes relacionados a processos de inflamação e queratinização, e positiva do gene de reparo TP53 (AU)

The indiscriminate use of electronic cigarettes (e-cigs) has already become a global public health concern, with limited knowledge about their impact on oral health. This study aimed to evaluate the effects of e-cig use on the saliva and oral mucosa of its users. Two groups were formed: Electronic Cigarette Group (EG) - consisting of 25 regular and exclusive e-cig users, and the Control Group (CG) - consisting of 25 nonsmokers, matched by sex and age to the EG. Unstimulated saliva was collected to evaluate the metabolome and microcosm biofilm. Subsequently, smears were collected from the left lateral border of the tongue for the of gene expression evaluation of IL1B, CXCL8, TNF, KRT1, KRT13, KRT19, TP16, TP21 and TP53, using RT-qPCR. The data were statistically analyzed using the Mann-Whitney test. Partial least squares discriminant analysis (PLS-DA), Heatmap and biomarkers analysis were performed for the metabolome. A total of 101 metabolites were considered in the salivary metabolome analysis. The salivary profile of EG differed from that of CG, highlighting 10 distinct metabolites: isoleucine, 2-hydroxyglutaric acid, 3-phenyllactic acid, linoleic acid, 3 hydroxybutyric acid, 1,6-anhydroglucose, glucuronic acid, valine, stearic acid and elaidic acid. The analysis of the EG microcosm biofilm revealed an increased mean metabolite activity compared to CG. However, no differences were observed between the groups regarding biomass and the quantification of salivary carbohydrates. Furthermore, the EG exhibited a significant increase in the overall count of microorganisms, including Streptococcus mutans and Candida yeasts. Conversely, the Count of Lactobacillus spp, decreased. Finally, in the EG, all genes were downregulated compared to the CG, except for TP53. Based on the obtained results, it is concluded that the e-cig use directly impacts the salivary metabolome profile, promotes dysbiosis of the oral microbiota, and favors the increase of cariogenic microorganisms and yeasts. Additionally, it causes downregulation of gene expression related to inflammation and keratinization processes, and upregulation of the repair gene TP53.(AU)

Evaluación de la cito-colposcopia e histología para detectar neoplasia cervical intraepitelial de alto grado en el Hospital Materno Infantil German Urquidi

Objetivo: Bolivia enfrenta serios problemas en la prevención secundaria del cáncer cervicouterino. Este estudio tiene por objetivo evaluar la eficacia y concordancia de los métodos de diagnóstico en la prevención secundaria del cáncer de cuello uterino para detectar lesiones cervicales intraepiteliales de alto grado. Métodos: sesenta y dos pacientes con una citología alterada o una prueba VPH-ar positiva complementada obligatoriamente con una citología, fueron sometidas a una colposcopia y biopsia dirigida. Aquellas pacientes con diagnósticos histopatológicos de NIC2+ en la biopsia colposcópica recibieron el tratamiento escisional correspondiente, obteniéndose muestras de tejido para su análisis histopatológico (biopsias escisionales). Los resultados de la citología e impresión colposcópica fueron comparados con los resultados histopatológicos de la biopsia colposcópica. Finalmente, los resultados histopatológicos de NIC2+ de la biopsia colposcópica fueron comparados con los resultados de la biopsia escisional. Resultados: la sensibilidad de la citología y la impresión colposcopia para detectar NIC 2+ fue de 31,43% y 80% respectivamente. La concordancia (Índice Kappa) de los resultados de la citología y la impresión colposcópica comparadas con los resultados NIC 2+ de la biopsia colposcópica fue 0,15 (leve) y 0,43 (moderado) respectivamente. Finalmente, la comparación entre los resultados histopatológicos de la biopsia colposcópica (NIC2+) y de la biopsia escisional dio una coincidencia del 68%. Conclusiones: la citología tuvo una baja eficacia y concordancia para detectar NIC 2+. La colposcopia mejora la identificación de lesiones subyacentes NIC 2+ en pacientes con citologías iguales o menores a LIE-BG.

Objectives: Bolivia faces serious problems in cervical cancer secondary prevention. This study aims to evaluate the effectiveness and concordance of diagnostic methods in the secondary prevention of cervical cancer to detect high-grade cervical intraepithelial lesions. Methods: sixty-two patients with altered cytology or a positive HR-HPV test, compulsorily complemented by cytology, underwent colposcopy and targeted biopsy. Those patients with histopathological diagnoses of CIN2+ in the colposcopic biopsy received the corresponding excisional treatment, obtaining tissue samples for histopathological analysis (excisional biopsies). The results of the cytology and colposcopy impression were compared with the histopathological results of the colposcopic biopsy. Finally, the histopathological results of CIN2+ from the colposcopic biopsy were compared with the results from the excisional biopsy. Results: the sensitivity of cytology and colposcopy impression to detect CIN 2+ was 31.43% and 80% respectively. The agreement (Kappa Index) of the results of cytology and colposcopic impression compared with the CIN 2+ results of colposcopic biopsy was 0.15 (mild) and 0.43 (moderate) respectively. Finally, the comparison between the histopathological result of the colposcopic biopsy and the excisional biopsy gave a simple percentage coincidence of 68%. Conclusions: cytology had low efficacy and concordance to detect CIN 2+. Colposcopy improves the identification of underlying CIN 2+ lesions in patients with cytology equal to or less than LIE-BG.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group? / Câncer cervical subestimado entre mulheres com mais de 65 anos: É hora de rever a faixa etária alvo do rastreamento?

Abstract Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

Resumo Objetivo Comparar os resultados citológicos e histológicos de mulheres > 64 anos que seguiram as diretrizes nacionais brasileiras de rastreamento do câncer do colo do útero com aquelas que não as seguiram. Método O presente estudo observacional retrospectivo analisou 207 resultados anormais de esfregaço cervical de mulheres > 64 anos de idade em uma cidade de médio porte no Brasil durante 14 anos. Todos os resultados foram relatados de acordo com o Sistema Bethesda. As mulheres foram divididas entre as que seguiram as diretrizes de rastreamento e as que não o fizeram. Resultados Resultados citológicos com células escamosas atípicas de significado indeterminado e lesão intraepitelial escamosa de baixo grau foram encontrados em 128 (62,2%) casos. Destes, 112 (87,5%) repetiram a citologia com resultados positivos. Os outros 79 (38,1%) com resultados anormais deveriam ter sido encaminhados para colposcopia e biópsia. Das 41 (51,9%) mulheres biopsiadas, 23 (29,1%) tiveram diagnóstico confirmado de neoplasia ou lesão precursora. Em contrapartida, entre as 78 (37,7%) pacientes biopsiadas, 40 (51,3%) seguiram as recomendações da diretriz, com 9 (22,5%) biópsias positivas. Entre as 38 (48,7%) mulheres que não seguiram as orientações, houve 24 (63,1%) resultados positivos. As mulheres que não seguiram as diretrizes demonstraram maiores chances de câncer e lesões precursoras (odds ratio [OR]: 5,904; intervalo de confiança [IC] de 95%: 2,188-15,932; p = 0,0002). Conclusão Mulheres > 64 anos que não seguiram a diretriz nacional de rastreamento apresentaram diferenças significativas na frequência de resultados anormais e gravidade do diagnóstico em comparação com aquelas que seguiram a diretriz.

Relación entre ausencia de células endocervicales y citología Papanicolaou negativa en portadoras de lesiones escamosas premalignas de cuello uterino

Objetivo : Determinar la relación entre la ausencia de células endocervicales y resultados citológicos Papanicolaou falsos negativos. Material y métodos : Estudio observacional, de enfoque cuantitativo, transversal, relacional y retrospectivo realizado en el Servicio de Anatomía Patológica del Hospital General de Huacho. Se realizó la búsqueda de resultados de biopsias de cuello uterino positivos para lesiones intraepiteliales escamosas y sus respectivos resultados citológicos Papanicolaou previos durante los años 2016 al 2018. Se seleccionó los resultados negativos con ausencia de células endocervicales. Resultados : De los 158 resultados citológicos, 23 mostraron ausencia de células endocervicales y de éstos, sólo dos (8,7%) fueron reportados como negativos. En total 11 (7%) citologías fueron negativas. Conclusiones : No se encontró relación entre la ausencia de células endocervicales y resultados citológicos falsos negativos; por tanto, no influyó de manera significativa en la detección de lesiones escamosas premalignas de cuello uterino.

SUMMARY Objective : To determine the relationship between absence of endocervical cells and false negative Pap smears in patients with squamous premalignant cervix lesions. Methods : A cross sectional study was carried out at Servicio de Anatomía Patológica del Hospital General de Huacho. A search for positive cervix biopsies for squamous intraepithelial lesions and their Pap smears from 2016 to 2018 was done. Negative Pap smears with absence of endocervical cells were investigated. Results : 23 out of 158 cytology results showed absence of endocervical cells, only two (8.7%) were reported negative. Eleven cytologies were negative (7%). Conclusions : No relationship was found between absence of endocervical cells and false negative results at Pap smears. Therefore, no influence in the detection of squamous pre-malignant cells was found.

Cáncer endometrial: hallazgos en la citología cervical. Un caso clínico / Endometrial cancer: findings on cervical cytology. A clinical case

El cáncer endometrial representa la neoplasia ginecológica más frecuente en países desarrollados y la segunda en los países en vía de desarrollo, luego del cáncer cervical. Se ha establecido claramente la sensibilidad y la utilidad de la citología cervical para la detección de cáncer y lesiones precursoras del cuello uterino, especialmente para aquellas de origen escamoso, pero la utilidad de este muestreo para detectar lesiones a nivel de cavidad uterina es limitada debido a la dificultad del muestreo y otros factores de interpretabilidad. Es por eso que se presenta el siguiente caso clínico en el cual se logró establecer una orientación clara y certera de adenocarcinoma endometrial en una muestra tomada de cuello uterino en una paciente posmenopáusica, tras presentar un sangrado vaginal anormal(AU)

Endometrial cancer represents the most common gynecological neoplasm in developed countries and the second in developing countries after cervical cancer. The sensitivity and usefulness of cervical cytology for the detection of cervical cancer and precursor lesions, especially those of squamous origin, has been clearly established, but the usefulness of this sampling to detect lesions at the level of the uterine cavity is limited due to the difficulty of sampling and other interpretability factors. That is why the following clinical case is presented in which a clear and accurate orientation of endometrial adenocarcinoma was established in a sample taken from the cervix in a post-menopausal patient after presenting an abnormal vaginal bleeding(AU)

Patrón inflamatorio de las vías aéreas en pacientes fumadores con enfermedad pulmonar obstructiva crónica / Inflammatory pattern of the airways in COPD smokers

Introducción: La enfermedad pulmonar obstructiva crónica cursa con un patrón inflamatorio en la vía aérea que incluye neutrófilos, macrófagos, linfocitos, los cuales se pueden obtener mediante un cepillado bronquial citológico. Objetivos: Identificar patrón inflamatorio según células inflamatorias presentes en la vía aérea, mediante el cepillado bronquial citológico e índice tabáquico de paquetes/año en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Se realizó un estudio descriptivo transversal en pacientes con enfermedad pulmonar obstructiva crónica, que concurrieron al Hospital Neumológico Benéfico-Jurídico, en el período comprendido de junio de 2018 a junio de 2019, con indicación para la realización de fibrobroncoscopía con cepillado bronquial. Resultados: El 53,1 por ciento de los pacientes corresponden al sexo masculino. Un 46,1 por ciento presentó un índice tabáquico de paquetes/año entre 21-40. Predominaron las criptas y estrías como hallazgos broncoscópicos con un 51 por ciento y 40,8 por ciento respectivamente en pacientes con índice paquetes/año mayor que 40. De los pacientes con índice paquetes/año mayor de 40 (13 para un 26,5 por ciento) presentaron hiperplasia de células basales. El 46,9 por ciento de los pacientes presentaron un patrón inflamatorio neutrofílica. Conclusiones: Se identificaron a los pacientes con EPOC que presentaron patrón inflamatorio neutrofílica en la vía aérea y elevado índice tabáquico y desde el punto de vista broncoscópico tienen varios hallazgos que sugieren cronicidad(AU)

Introduction: Chronic obstructive pulmonary disease presents with an inflammatory pattern in the airway that includes neutrophils, macrophages, and lymphocytes, which can be obtained by cytological bronchial brushing. Objectives: To identify inflammatory pattern according to inflammatory cells present in the airway, through cytological bronchial brushing and smoking rate of packs/year in patients with chronic obstructive pulmonary disease. Methods: A cross-sectional descriptive study was carried out in patients with chronic obstructive pulmonary disease, who attended Benefico-Jurídico Pneumological Hospital, from June 2018 to June 2019, with an indication for fiberoptic bronchoscopy with bronchial brushing. Results: 53.1percent of the patients correspond to the male sex. 46.1percent ad a smoking rate of packs/year between 21-40. Crypts and striae predominated as bronchoscopic findings with 51percent and 40.8percent respectively in patients with a pack/year index greater than 40. Patients with a pack/year index greater than 40 (13 for 26.5percent) showed basal cell hyperplasia. 46.9percent of the patients had a neutrophilic inflammatory pattern. Conclusions: Patients with COPD who had a neutrophilic inflammatory pattern in the airway and high smoking index were identified, and from the bronchoscopic point of view they have several findings that suggest chronicity(AU)

Características microscópicas del cérvix uterino mediante citología líquida

Introducción: La citología líquida es un método que puede contribuir a identificar de manera precoz los cambios microscópicos del cérvix uterino que pudieran progresar a la malignidad, al disminuir el número de muestras insatisfactorias en relación a la citología convencional. Objetivo: Analizar las características microscópicas identificadas mediante la citología de base líquida del cérvix uterino en mujeres atendidas en la Unidad de Bienestar Estudiantil de la Universidad Técnica de Manabí, Ecuador. Métodos : Se realizó un estudio de serie de casos donde se analizaron las características sociodemográficas, microbiológicas e histológicas procedentes de las fichas médicas de 132 mujeres que participaron en la campaña de Papanicolaou realizado durante junio de 2019. Resultados: El rango de edad predominante fue el de 19 a 33 años, residían en área urbana, 64 % de las mujeres inició la vida sexual antes o durante sus 18 años. Los hallazgos microbiológicos mostraron presencia de flora cocoide en 50 % y 100 % de las muestras manifestaron la calidad adecuada. El estudio citológico presentó, según el sistema Bethesda, 75 % de muestras negativas, con 13 % de LIE de bajo grado y 11 % de ASCUS. El fondo del frotis inflamatorio leve se presentó en 52 %, mientras los antecedentes de más de tres citologías anteriores positivas resultaron en 34 % de las féminas. No se encontró relación entre la presencia de lesión intraepitelial y la edad de las pacientes (p=0,3076). Conclusiones: El total de las muestras fueron útiles lo cual puede indicar que la citología de base líquida ofrece una mayor calidad del diagnóstico histológico.

Introduction: Liquid-based cytology is a method that can contribute to the early identification of microscopic changes in the uterine cervix that can progress to malignancy, by reducing the number of unsatisfactory samples compared to conventional cytology. Objective: To analyze the microscopic characteristics identified by liquid-based cytology of the uterine cervix in women treated at the Student Welfare Unit of the Technical University of Manabí, Ecuador. Methods: A descriptive, cross-sectional, retrospective and quantitative study was carried out where the sociodemographic, microbiological and histological characteristics collected in the medical records of 132 women who participated in the Pap smear campaign carried out during June 2019 were analyzed. Results: The age range that prevailed was 19 to 33 years who lived in urban areas, 64% of women began their sexual life before or at 18 years of age. The microbiological findings showed the presence of coccoid flora in 50% and 100% of the samples showed adequate quality. The cytological study presented, according to the Bethesda system, 75% of negative samples, with 13% low-grade IEL and 11% ASCUS. The background of the mild inflammatory smears was present in 52%, the history of previous positive cytology in 34% was more than three. All of the samples were useful. No relationship was found between the presence of intraepithelial lesion and the age of the patients (p=0.3076). Conclusions: CBL can ensure a higher quality of histological diagnosis by guaranteeing a greater number of useful samples.

Effect of Lubricant Use on Cervicovaginal Cytology - What's the Evidence? / Efeito do uso de lubrificante na citologia cervicovaginal - Qual a evidência?

Abstract Objective To determine if the use of lubricating gel on the speculum during the cervicovaginal cytology examination interferes with the results obtained, as well as whether it reduces reported discomfort in patients. Data sources A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, with a search in the Pubmed/Medline, Scielo, Cochrane Library, Embase databases of articles published between January 2011 and May 2022. The keywords used were cytology, speculum, lubricant, result, and pain. Selection of studies The initial search resulted in 306 articles, of which were excluded three because they were duplicates, 257 after reading the title and abstract and 41 after reading the full text. Thus, five articles were selected for the study: four randomized clinical trials and one metanalysis. Data collection The selection of articles was performed by two investigators. The 5 selected articles were read in full and submitted to a comparative analysis. Data synthesis Screening through cervicovaginal cytology allows for early diagnosis and reduction of associated mortality, but the procedure can be associated with pain. A small amount of aqueous lubricating gel in the speculum can be used to reduce the discomfort associated with performing cervicovaginal cytology. Conclusion The use of lubricating gel in the speculum does not seem to be associated with a change in the cytology result and reduces the discomfort associated with its insertion into the vagina.

Resumo Objetivo Determinar se o uso de gel lubrificante no espéculo durante o exame de citologia cervicovaginal interfere com os resultados obtidos e se diminui o desconforto relatado por pacientes. Fontes de dados Foi realizada uma revisão sistemática segundo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), com pesquisa nas bases de dados Pubmed/Medline, Scielo, Cochrane Library, Embase, de artigos publicados entre janeiro de 2011 e julho de 2022. Utilizaram-se as palavras-chave citologia, espéculo, lubrificante, resultado e dor. Seleção dos estudos A pesquisa inicial resultou em 306 artigos, dos quais foram excluídos três por se encontrarem duplicados, 257 após a leitura do título e do resumo e 41 após a leitura integral. Assim, foram selecionados cinco artigos para o estudo: quatro ensaios clínicos aleatorizados e uma metanálise. Coleta de dados A seleção dos artigos foi realizada por dois investigadores. Os cinco artigos selecionados foram lidos na íntegra e submetidos a uma análise comparativa. Síntese dos dados O rastreio através da citologia cervicovaginal permite um diagnóstico precoce e redução da mortalidade associada, mas a sua realização pode estar associada a dor. Uma pequena quantidade de gel lubrificante aquoso pode ser utilizada no espéculo para diminuir o desconforto associado à realização da citologia cervicovaginal. Conclusão A utilização de gel lubrificante não está associada a alteração do resultado da citologia e diminui o desconforto associado à sua introdução na vagina.

Concordancia de los hallazgos citológicos, colposcópicos e histológicos en lesiones premalignas del cuello uterino / Concordance in cytological, colposcopic and histological findings in premalignant lesions of the cervix

Resumen OBJETIVO: Determinar la concordancia de los hallazgos citológicos, colposcópicos e histopatológicos en lesiones premalignas del cuello uterino. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo y comparativo, efectuado en la Clínica de Displasias del Hospital General Regional 1 del estado de Querétaro, México, del 1 de enero a diciembre del 2020, con base en la información de los expedientes de mujeres con reporte citológico, colposcópico e histopatológico (biopsia) de lesión intraepitelial de bajo y alto grado. El plan de análisis estadístico incluyó intervalos de confianza para promedios y porcentajes. Se utilizó el Índice de Kappa ponderado para conocer el nivel de concordancia. RESULTADOS: Se analizaron 290 expedientes. La edad promedio de las pacientes fue 36 años, el índice de kappa ponderado fue k = 0.41 (IC95%: 0.33-0.53) para la citología y la colposcopia con un valor moderado (regular). Para la citología y la biopsia fue de k= 0.33 (IC95%: 0.22-0.49) con un valor escaso (medio). En cuanto a la colposcopia y la biopsia fue de k = 0.61 (IC95%: 0.49-0.72) con un valor de buena (sustancial) concordancia. CONCLUSIÓN: Entre la citología y la colposcopia el coeficiente de concordancia fue moderado, para la citología y la biopsia fue escaso, mientras que para la colposcopia y la biopsia fue un sustancial.

Abstract OBJECTIVE: To determine the concordance in cytologic, colposcopic and histopathologic findings in premalignant lesions of the uterine cervix. MATERIALS AND METHODS: Cross-sectional, retrospective and comparative study, carried out in the dysplasia clinic of the Hospital General Regional 1 of the state of Querétaro, Mexico, from January 1 to December 2020, based on information from the records of women with cytology, colposcopy and histopathology (biopsy) report with low- and high-grade intraepithelial lesion. The statistical analysis plan included confidence intervals for averages and percentages. The weighted Kappa Index was used to determine the level of concordance. RESULTS: Two hundred and ninety records were analyzed. The mean age of the patients was 36 years, the weighted kappa index was k = 0.41 (95%CI: 0.33-0.53) for cytology and colposcopy with a moderate value (fair). For cytology and biopsy, it was k= 0.33 (95%CI: 0.22-0.49) with a poor value (medium). For colposcopy and biopsy, it was k = 0.61 (95%CI: 0.49-0.72) with a value of good (substantial) agreement. CONCLUSION: Between cytology and colposcopy the concordance coefficient was moderate, for cytology and biopsy it was poor, while for colposcopy and biopsy it was a substantial.

Tamizaje con citología anal en mujeres con lesiones premalignas del cuello uterino / Anal cytology screening in women with premalignant lesions of the uterine cervix / Rastreamento de citologia anal em mulheres com lesões pré-malignas do colo do útero

Objetivo: nuestro objetivo principal fue evaluar la prevalencia de citología anal patológica en mujeres con antecedentes de neoplasia intraepitelial cervical. Métodos: se trata de un estudio de cohorte transversal desde mayo de 2018 a agosto de 2020 en el Centro Hospitalario Pereira Rossell. Se estudiaron dos cohortes: una de mujeres que tenían diagnóstico de neoplasia intraepitelial cervical y otra de control de mujeres sanas que asistieron al control, con una proporción de 2:1. Se calculó un tamaño muestral total de 205 pacientes, siendo 135 pacientes con NIC con un IC del 95%, suponiendo una prevalencia del 10% de lesiones preneoplásicas anales. El tamaño muestral de la cohorte control fue de 70 pacientes según la relación preestablecida. Resultados: se encontró asociación entre la presencia de lesiones premalignas cervicales y anomalías epiteliales detectadas en la citología anal, con un cociente de prevalencia de 1,77 (IC del 95%: 1,19-2,62) y un odds ratio de 2,69 (1,36-5,30). No se encontraron diferencias significativas en las variables de raza, tipo de relación sexual o tabaquismo. Conclusiones: nuestro estudio concluye que existe una asociación entre la neoplasia intraepitelial cervical relacionada con el VPH y la citología anal patológica.

Objective: the main objective of the study was to assess the prevalence of anal cytology in women with a history of cervical intraepithelial neoplasia. Method: cohort transversal study conducted from May, 2018 until August, 2020 at Pereira Rossell Hospital. Two cohorts were studied, one of which included women with a diagnosis of cervical intraepithelial neoplasia and the other one included healthy women who attended their routine follow up, in a 2:1 ratio. The total size of the sample was 205 patients, 135 of which were patients with cervical intraepithelial neoplasia (confidence interval being 95%), presuming a 10% prevalence of anal pre-neoplasic lesions. The sample size of the control cohort was 70 patients as per the pre-defined ratio. Results: a association was found between the presence of malignant lesions of the cervix and epithelial anomalies detected in the anal cytology, with a prevalence coefficient of 1.77 (CI: 95%: 1,19 - 2,62) and odds ratio of 2,69 (1,36 - 5,30). No significant differences were found between race, type of sexual relationships or smoking variables. Conclusions: our study concludes there is an association between cervical intraepithelial neoplasia related to HPV and pathological anal screening.

Objetivo: Avaliar a prevalência de citologia anal patológica em mulheres com história de neoplasia intraepitelial cervical. Métodos: Trata-se de um estudo de coorte transversal de maio de 2018 a agosto de 2020, no Hospital Pereira Rossell. Foram estudadas duas coortes, uma de mulheres com diagnóstico de neoplasia intraepitelial cervical e outra de controle de mulheres saudáveis que compareceram ao controle na proporção de 2:1. Foi calculada uma amostra total de 205 pacientes, 135 pacientes com NIC com um IC de 95%, assumindo uma prevalência de 10% de lesões pré-neoplásicas anais. O tamanho da amostra da coorte controle foi de 70 pacientes de acordo com a relação pré-estabelecida. Resultados: Foi encontrada associação entre a presença de lesões pré-malignas cervicais e anormalidades epiteliais detectadas na citologia anal, com razão de prevalência de 1,77 (IC 95%: 1,19 - 2,62) e odds ratio 2,69 (1,36-5,30). Não foram encontradas diferenças significativas nas variáveis raça, tipo de relação sexual ou tabagismo. Conclusões: Nossos resultados mostram uma associação entre neoplasia intraepitelial cervical relacionada ao HPV e citologia anal patológica.

Asociación entre el inicio de la vida sexual y las lesiones intraepiteliales / Association between age at onset of active sexual life and intraepithelial lesion

Introducción: El cáncer cervicouterino inicia con una lesión precancerosa llamada displasia, pudiendo ser de bajo grado o alto grado; uno de los factores más importantes en este sentido es la edad de inicio de la vida sexual activa (IVSA). Objetivo: Conocer si existe asociación entre la edad de inicio de la vida sexual activa y la lesión intraepitelial escamosa de alto grado (LIEAG). Material y métodos: Estudio descriptivo, retrospectivo, observacional, en 52 expedientes de mujeres de 15 a 60 años, con Papanicolaou en el HGZ MF No. 1, previa autorización del CLIS 301 y el CEI 3018, con folio R-2022-301-021. Se recolectaron los datos de expedientes que cumplieron los criterios de inclusión; se realizó un análisis estadístico con frecuencias, porcentajes para variables cualitativas nominales, con medidas de tendencia central y dispersión en variables cuantitativas, con determinación de chi2 y prueba de Kruskal-Wallis, respetándose los principios de Belmont en consideración a la Justicia y Beneficencia, los principios éticos de la Declaración de Helsinki 1964 y la Ley General de Salud en México. Resultado: Al evaluar 52 expedientes de pacientes, la edad fue de 37.81 ± 9.949 años; se encontró asociación entre el IVSA y la LIEAG, sin significación estadística, de acuerdo con la prueba de chi2, con un valor de p = 0.538 (IC 95%: 0.403-0.674), y una asociación significativa por la prueba de Kruskal-Wallis entre la LIEAG y la edad de la paciente, con un valor de p = 0.019 (IC 95%: 0.000-0.057). Conclusión: El IVSA no se correlaciona con el tipo de LIEAG.

Introduction: Cervical cancer begins with a precancerous lesion called dysplasia, which can be low grade or high grade. One of the most important factors is the age at which an active sexual life begins. Objective: To know if there is an association between the age of beginning of active sexual life (BASL) and high-grade squamous intraepithelial lesions (HGSIEL). Material and methods: Descriptive, retrospective, observational study, in 52 files of women aged 15 to 60 years with Pap smear at HGZ MF No. 1, prior authorization from CLIS 301 and CEI 3018 with folio R-2022-301-021. Data were collected from files that met the inclusion criteria, a statistical analysis was carried out with frequencies, percentages for nominal qualitative variables, with measures of central tendency and dispersion in quantitative variables, with determination of chi2 and Kruskal-Wallis, respecting the principles of Belmont in consideration of Justice and Beneficence, the ethical principles of the Declaration of Helsinki 1964, the General Health Law in México. Result: When evaluating 52 patient records, the age was 37.81 ± 9.949 years, the association of BASL and HGSIEL was found without statistical significance according to the chi2 with a p = 0.538 (95% CI, 0.403-0.674) and a significant association by Kruskal-Wallis between HGSIEL and patient age, with p = 0.019 (95% CI, 0.000-0.057). Conclusion: The beginning of an active sexual life has no association with the type of high-grade squamous intraepithelial lesions.

Cytopathological diagnosis of herpes simplex virus infection causing oral aphthous ulcers in a patient with acute lymphocytic leukemia: case report / Diagnóstico citopatológico de infecção pelo vírus herpes simples causando úlceras aftosas orais em paciente com leucemia linfocítica aguda: relato de caso

Aim:This paper aims to report an atypical oral HSV infection diagnosed by cytopathological examination in a patient with acute lymphocytic leukemia. Case report: A nine-year-old white female was admitted with acute lymphocytic leukemia, presenting ulcers covered with pseudomembrane and spontaneous bleeding on the left soft palate, measuring approximately 2 cm, as well as other ulcers measuring 1 cm on the left lateral border of the tongue. Exfoliative cytopathology revealed neutrophils and cytopathic effects of HSV in the keratinocytes in a fibrin background. Based on the exfoliative examination, the diagnosis of HSV infection was obtained. Conclusion: Oral HSV infection can be atypical in immunocompromised patients and can cause high morbidity and mortality. Healthcare professionals, especially those working in a hospital environment, should be aware of the possibility of HSV infection in atypical lesions in these patients and evaluate the need to include antiviral prophylactic therapy.

Objetivo:Este trabalho tem como objetivo relatar uma infecção oral atípica por HSV diagnosticada por exame citopatológico em um paciente com leucemia linfocítica aguda. Relato de caso:Paciente do sexo feminino, nove anos, branca, portadora de leucemia linfocítica aguda, apresentando úlceras recobertas por pseudomembrana e sangramento espontâneo em palato mole esquerdo medindo aproximadamente 2 cm, além de outras úlceras medindo 1 cm na borda lateral esquerda da língua. A citopatologia esfoliativa revelou neutrófilos e efeitos citopáticos do HSV nos ceratinócitos em um fundo de fibrina. Com base no exame esfoliativo, foi obtido o diagnóstico de infecção por HSV. Conclusão: A infecção oral por HSV pode ser atípica em pacientes imunocomprometidos e pode causar alta morbidade e mortalidade. Os profissionais de saúde, principalmente os que atuam em ambiente hospitalar, devem estar atentos à possibilidade de infecção pelo HSV em lesões atípicas nesses pacientes e avaliar a necessidade de inclusão de terapia antiviral profilática.

Metodología para la evaluación automatizada de la expresión del receptor de vitamina D mediante técnica inmunocitoquímica / Methodology of automated Vitamin D receptor immunocytochemical expression análisis

Introducción: la citología permite examinar células de un tejido de manera mínimamente invasiva, sin embargo, la capacidad de realizar técnicas complementarias como la inmunocitoquímica (ICQ) no está exenta de dificultades. Es el objetivo de nuestro trabajo presentar una metodología que permita la utilización de ICQ automatizada asociada a un análisis automatizado mediante técnica de patología digital. Métodos: se incluyeron 5 sujetos sanos y se obtuvieron muestras de superficie ocular utilizando un citocepillo. La muestra fue procesada de manera automatizada mediante citología en fase líquida. Posteriormente se realizó ICQ automatizada para detectar la positividad nuclear del receptor de vitamina D. Para la evaluación, se utilizaron dos métodos: cuantificación directa bajo microscopio de luz y análisis automatizado usando analizador de imágenes en las diapositivas digitales obtenidas con un Scanner. El porcentaje de positividad encontrado con ambos métodos fueron comparados utilizando la prueba de Kappa. Resultados: todas las muestras presentaron una celularidad adecuada. En todos los casos fue posible realizar ICQ automatizada, más aún, todas las muestras presentaron una calidad óptima. Al comparar ambos métodos (manual versus automatizado) se observó un nivel de acuerdo sustancial (Kappa=0,69). Conclusiones: la metodología presentada en este manuscrito permite la evaluación automatizada de marcadores inmunohistoquímicos de la superficie ocular de manera mínimamente invasiva, siendo similar al conteo manual, pero más objetivo y reproducible. Esta técnica podría ser útil para el estudio proteómico en patologías como la enfermedad por ojo seco.

Introduction: Cytology tests use small amounts of tissue samples for diagnosis as a minimally invasive technique; however, the ability to perform complementary methods such as immunocytochemistry (ICC) is not without difficulties. The aim of our work is to present a method that allows the use of automated ICC associated with an automated image analysis using digital pathology. Methods: Five healthy subjects were included, and ocular surface samples were obtained using a cytobrush. The sample was processed as liquid-based cytology. Automated ICC was subsequently performed to detect vitamin D receptor nuclear positivity. Two methods were used for evaluation: manual counting under a light microscope and automated analysis using an image analyzer on digitized slides. The percentage of positivity found in both methods was compared using the Kappa test. Results: All samples presented adequate cellularity. In all cases, it was possible to perform automated ICC; moreover, all samples presented optimal quality. When comparing both methods (manual versus automated), a substantial level of agreement was seen (Kappa=0.69). Conclusions. The method presented in this manuscript allows the minimally invasive automated evaluation of ocular surface ICC markers, being like manual counting but more objective and reproducible. This technique could be useful for proteomic study in pathologies such as dry eye disease.

Comportamiento de las alteraciones citológicas en mujeres atendidas en una IPS de la ciudad de Medellín / Behavior of cytological alterations in women treated at an IPS in the city of Medellín

Resumen Objetivo: Analizar las características relacionadas con el diagnóstico de cáncer de las pacientes que consultan una IPS de la ciudad de Medellín. Metodología: Estudio observacional analítico. La población fueron todas las mujeres atendidas en la IPS Unidad Video Diagnóstica de la Mujer, institución que se dedica a realizar confirmación diagnóstica de mujeres con citologías alteradas. Se analizaron todos los registros de la base de datos de la institución correspondientes a las mujeres que consultaron durante el período 2012- 2017, un total de 55655 mujeres. Resultados: Se analizaron los registros de 55655 usuarias, la mediana de edad fue de 40 años (RIQ 19) y el 66.1% (36812) pertenecen al régimen subsidiado. La principal indicación para la realización de la colposcopia fueron las alteraciones citológicas con un 89.8% (49984) y más frecuente fue el LIEBG 35.3% (19649). El principal cáncer diagnosticado fue el escamocelular con 0.5% (284) y los factores asociados fueron residir en el Valle de Aburrá (OR 0.60 IC 0.42-0.84) y el resultado de citología LIEAG (OR 3.31 IC 2.22-4.94). Conclusiones: Se encontró una prevalencia de cáncer de cérvix de 7.8 por cada 1000 pacientes que consultan en la IPS.

Abstract Objective: To analyze the characteristics related to the diagnosis of cancer of the patients who consult an IPS in the city of Medellín. Methodology: Analytical observational study. The population consisted of all the women treated at the IPS Unidad Video Diagnóstica de la Mujer, an institution dedicated to performing diagnostic confirmation of women with altered cytologies. All the records of the institution's database corresponding to the women who consulted during the period 2012-2017 were analyzed, a total of 55,655 women. Results: The records of 55,655 users were analyzed, the median age was 40 years (RIQ 19) and 66.1% (36,812) belonged to the subsidized regime. The main indication for performing colposcopy was cytological alterations with 89.8% (49984) and the most frequent was LIEBG 35.3% (19649). The main cancer diagnosed was squamous cells with 0.5% (284) and the associated factors were residing in the Valle de Aburrá (OR 0.60 IC 0.42-0.84) and the LIEAG cytology result (OR 3.31 IC 2.22-4.94). Conclusions: A cervical cancer prevalence of 7.8 was found for every 1000 patients who consulted the IPS.

Cáncer de cérvix: una mirada práctica / Cervical cancer, a practical view

Resumen Introducción: El cáncer de cérvix (CC) es un problema de salud pública en países desarrollados y no desarrollados; esta patología tiene repercusiones socioeconómicas en mujeres en edad reproductiva. Objetivo: Describir las características sobre métodos de prevención, tamizaje, diagnóstico y tratamiento del cáncer de cérvix. Método: Se realizó una búsqueda bibliográfica exhaustiva en un período de seis años (2016-2021) en la base de datos de la Fundación Universitaria del Área Andina, utilizando motores de búsqueda como Dialnet, Science Direct, Medline, LIlacs, Scopus para revisar los conceptos generales sobre cáncer de cérvix. Resultados: El CC es el segundo cáncer más frecuente en Colombia, la principal etiología del cáncer de cérvix es el virus del papiloma humano (VPH), el cual es un virus prevenible mediante la adecuada educación e información y seguimiento a sus lesiones precancerosas. Conclusión: El CC es una patología con altas tasas de mortalidad, especialmente en países en vía de desarrollo y en las infecciones asociadas a VPH de alto riesgo, afectando principalmente a mujeres en edad reproductiva y estratos socioeconómicos bajos. Los principales pilares para el manejo de esta patología siguen siendo las estrategias de salud pública, como la vacunación y realización de las pruebas de tamizaje.

Abstract Introduction: Cervical cancer (CC) is a public health problem in both developed and undeveloped countries; besides it has socio-economic repercussions in women of reproductive age. Objective: To describe the characteristics of cervical cancer prevention, screening, diagnosis, and treatment methods. Method: An exhaustive bibliographic search was carried out within a period of 6 years (2016-2021) in the database of the Fundación Universitaria del Área Andina, using search engines such as Dialnet, Science Direct, Medline, Lilacs, and Scopus to review the concepts general information about cervical cancer. Results: The main etiology of cervical cancer is the human papillomavirus (HPV) which is a preventable virus through adequate education and information and follow-up of its precancerous lesions. It is the second most frequent cancer in Colombia. Conclusion: CC is a pathology that mainly affects women of reproductive age belonging to low socioeconomic strata. This type of cancer has high mortality rates, especially in developing countries and in high-risk HPV infections. Regarding the management of this pathology, public health strategies, such as vaccination and conducting screening tests continue being the fundamental pillars.

A Relação entre Compartimentos de Volume Extracelular e Matriz Metaloproteinase 2 na Remodelação do Ventrículo Esquerdo após o Infarto do Miocárdio / The Relationship between Extracellular Volume Compartments and Matrix Metalloproteinases-2 in Left Ventricular Remodeling after Myocardial Infarction

Resumo Fundamento: As matrizes metaloproteinases (MMPs) podem afetar o volume extracelular (VEC) e seus compartimentos, e isso pode oferecer informações mais detalhadas sobre o mecanismo de remodelação adversa (RA) do ventrículo esquerdo (VE) após o infarto agudo do miocárdio (IM). Objetivos: Investigar o papel que as alterações (Δ) nos compartimentos de VEC (volume matriz (MVi) e volume celular (CVi)) desempenham no desenvolvimento de RA após o IM, e sua relação com as expressões de MMP-2. Métodos: Um total de noventa e dois pacientes com primeiro IM passaram por exames de imagens por ressonância magnética cardiovascular 3 Tesla realizados 2 semanas (linha de base) e 6 meses após o IM. Medimos o mapeamento T1 com sequências MOLLI. O VEC foi obtido após o realce pelo gadolínio. O VEC e a massa do VE foram usados para calcular o MVi e o CVi. A RA foi definida como um aumento de ≥ 12% no volume diastólico final do VE em 6 meses. As MMPs foram medidas usando-se um sistema de imunoensaio multiplex em grânulos no primeiro dia (linha de base) e 2 semanas após o IM. Um P valor <0,05 foi aceito como estatisticamente significativo. Resultados: Os níveis de linha de base de MVi média e VEC médio foram mais altos no grupo com RA em comparação com o grupo sem RA (42,9±6,4 vs. 39,3±8,2 %, p= 0,037; 65,2±13,7 vs. 56,7±14,7 mL/m2, p=0,010; respectivamente). Os níveis de CVi eram semelhantes entre os grupos. Foi encontrada uma correlação positiva entre os níveis de linha de base de MMP-2 e os níveis de linha de base de VEC (r=0,535, p<0,001) e MVi (r=0,549, p<0,001). O aumento dos níveis de ΔMVi foi um preditor independente da RA (RC=1,03, p=0,010). O ΔMVi teve um desempenho diagnóstico superior quando comparado ao ΔVEC na previsão do (ΔAUC: 0,215±0,07, p<0,001). Conclusão: Níveis altos de MVi estão associados à RA, e o ΔMVi foi um preditor independente de RA. Isso pode estar associado à liberação de MMP-2 devido ao aumento da resposta inflamatória.

Abstract Background: Matrix metalloproteinases (MMPs) can affect myocardial extracellular volume (ECV) and its compartments, and this can provide more detailed information about the mechanism of adverse left ventricular (LV) remodeling (AR) after acute myocardial infarction (MI). Objectives: To investigate the role of changes (Δ) in ECV compartments (matrix volume (MVi) and cell volume (CVi)) in the development of AR after MI, and their relationship with MMP-2 expressions. Methods: Ninety-two first MI patients who underwent 3 Tesla cardiovascular magnetic resonance imaging performed 2 weeks (baseline) and 6 months post-MI. We measured T1 mapping with MOLLI sequences. ECV was performed post-gadolinium enhancement. ECV and LV mass were used to calculate MVi and CVi. AR was defined as an increase of ≥ 12% in LV end-diastolic volume in 6 months. MMPs were measured using a bead-based multiplex immunoassay system at first day (baseline) and 2 weeks post-MI. P <0.05 was accepted as statistically significant. Results: Mean ECV and mean MVi baseline levels were higher in AR group compared to without AR group (42.9±6.4 vs 39.3±8.2%, p= 0.037; 65.2±13.7 vs 56.7±14.7 mL/m2, p=0.010; respectively). CVi levels was similar between groups. A positive correlation was found between baseline levels of MMP-2 and baseline levels of ECV (r=0.535, p<0.001) and MVi (r=0.549, p<0.001). Increased ΔMVi levels was independently predictor of AR (OR=1.03, p=0.010). ΔMVi had superior diagnostic performance compared to ΔECV in predicting AR (ΔAUC: 0.215±0.07, p<0.001). Conclusion: High MVi levels are associated with AR, and ΔMVi was independently predictor of AR. This may be associated with MMP-2 release due to increased inflammatory response.