Visual inspection with acetic acid and cytology in the early detection of cervical neoplasia in Kolkata, India.

Visual inspection of the cervix after application of 3-5% acetic acid (VIA) is a potential alternative to cytology for screening in low-resource countries. The present study evaluated the performance of VIA, magnified visual inspection after application of acetic acid (VIAM), and cytology in the detection of high-grade cervical cancer precursor lesions in Kolkata (Calcutta) and suburbs in eastern India. Trained health workers with college education concurrently screened 5881 women aged 30-64 years with VIA, VIAM, and conventional cervical cytology. Detection of well-defined, opaque acetowhite lesions close to the squamocolumnar junction; well-defined, circumorificial acetowhite lesions; or dense acetowhitening of ulceroproliferative growth on the cervix constituted a positive VIA or VIAM. Cytology was considered positive if reported as mild dysplasia or worse lesions. All screened women (N = 5881) were evaluated by colposcopy, and biopsies were directed in those with colposcopic abnormalities (N = 1052, 17.9%). The final diagnosis was based on histology (if biopsies had been taken) or colposcopic findings, which allowed direct estimation of sensitivity, specificity, and predictive values. Moderate or severe dysplasia or carcinoma in situ (CIN 2-3 disease) was considered as true positive disease for the calculation of sensitivity, specificity, and predictive values of screening tests. 18.7%, 17.7% and 8.2% of the women tested positive for VIA, VIAM, and cytology. One hundred twenty two women had a final diagnosis of CIN 2-3 lesions. The sensitivities of VIA and VIAM to detect CIN 2-3 lesions were 55.7% and 60.7%, respectively; the specificities were 82.1% and 83.2%, respectively. The sensitivity and specificity of cytology were 29.5% and 92.3%, respectively. All the tests were associated with negative predictive values above 98%. VIA and VIAM had significantly higher sensitivity than cytology in our study; the specificity of cytology was higher than that of VIA and VIAM.

A simple risk estimates study for oral cavity cancer: practical approach in Indian context.

A study was conducted on 131 cases of oral cavity cancer (OCC), 145 cases of oral leucoplakia and 704 subjects without any oral lesions to investigate risk factors associated with the development of carcinoma of oral cavity in a hospital based cancer registry. Personal interviews, as well as physical examinations of the subjects enabled evaluation of a variety of potential risk factors. Potential risk factors like tobacco chewing, tobacco smoking, snuff dipping, alcohol consumption, bad oral and dental hygiene and age were given each certain numerical values. Each subject was first given a scoring and then analysed and correlated with the presenting lesions, when present. The study revealed that tobacco chewing and bad oral and dental hygiene contributed mainly to higher scoring. Among the subjects in high risk group (scoring more than 400) 63% had OCC, 21% had oral leucoplakia and 16% had no clinical oral lesions. Among the medium risk group (scoring between 100 and 400) 6% had OCC, 21% had leucoplakia and 73% had no oral lesions. In low risk group (scoring below 100) 8% had leucoplakia and 92% had no clinical oral lesions. Using the scoring system, it is suggested that the high risk group for OCC could be identified from general population and cancer detection tests could be specially directed towards this target group to detect maximum number of cases with minimum possible resources.

Quantitative evaluation of large granular lymphocytes in mice on ascorbic acid supplement diet.

The mechanism of ascorbic acid as an immunostimulatory agent is still clearly unknown. It is speculated in the present study that the host resistance may be due in part to ascorbic acid potentiation of the host immune system through stimulation and activation large granular lymphocytes.

Cytologic evidence of the association of different infective lesions with dysplastic changes in the uterine cervix.

Cervical smears from 4055 women were examined and classified as per WHO criteria. 873 (21.53%) smears revealed dysplastic changes. The dysplastic smears were further examined cytologically for the presence of Chlamydia trachomatis, Herpes simplex virus type-2, Human papilloma virus, Trichomonas vaginalis and Candida albicans. Chlamydia was found to be the commonest micro-organism associated with cervical dysplasia followed by Herpes simplex virus type-2 and Human papilloma virus. The association of Trichomonas and Candida with cervical dysplasia was found to be insignificant. Cervical dysplasia associated with Herpes simplex virus type-2 commonly occurred in the early reproductive life. The data observed in this study provide useful baseline information for detecting the subjects harbouring the infective microbes in the cervical epithelium.

Smokeless tobacco and premalignant and malignant lesions of the oral cavity.

The paper compares the prevalence of oral carcinoma and dysplasia in smokeless tobacco users and non users. A total of 3205 subjects were studied. Of the smokeless tobacco users, 1.96 percent had oral carcinoma compared with 0.36 percent of non-users. The prevalence of oral dysplasia in the users' group was 14.4 percent as compared with 6.85 percent in the group of non-users.

Immunobiological studies on experimental visceral leishmaniasis. I. Changes in lymphoid organs and their possible role in pathogenesis.

Studies were carried out to determine changes in lymphoid organs i.e. spleen, lymph node and bone marrow (BM) in progressive experimental visceral leishmaniasis. Mononuclear phagocytes in the BM were increased; spleens showed a hypercellularity coupled with a rise in parasite burden while secondary follicles with no apparent depletion of paracortex were seen in the lymph node. This enhanced proliferation of mononuclear phagocytes in the BM and probably their subsequent recruitment in the spleen could be induced in naive recipients by injecting nylon wool-purified lymph node cells derived from infected mice together with sonicated leishmanial antigen(s). Similar changes could also be induced in the BM of naive recipients by injecting serum of infected mice. In control experiments where both donor and recipients were uninfected such changes were not apparent. A working hypothesis is proposed to delineate the role of lymphoid organs in the pathogenesis of experimental visceral leishmaniasis.

Uterine cervical dysplasia with reference to the betel quid chewing habit.

Systemic effects of betel quid are poorly documented compared to its local effects on the mucosa of the oral cavity and pharynx. In the present study dysplastic activity of the betel quid on exfoliated uterine cervical cells was studied and compared with women addicted to other habits or nothing. That the mutagenic changes at cellular level are associated with prolonged use of betel quid is suggested.

Micronuclei test in routine smears from uterine cervix.

Micronuclei are intracytoplasmatic inclusion bodies formed from chromatin fragments or whole chromosomes. Their presence in cells is a reflection of chromosomal aberrations during cellular mitosis. The micronuclei in exfoliated cells of the cervix have been suggested to represent a marker of their malignant potential. The Authors present a study with a micronuclei test carried out on cervical smears. Moderate and severe dysplasia revealed a slightly higher frequency of micronuclei than the inflammatory and mild dysplasia. The Author suggest that the rising frequency of micronuclei in exfoliated cervical cells reflects a sustained mutagenesis in cervical epithelium.

Evaluation of colposcopy in the screening of pre-malignant and malignant lesions of uterine cervix.

In an attempt to evaluate the effectiveness of colposcopy in screening pre-malignant and malignant lesions of uterine cervix, one hundred cases of atypical colposcopical findings were cytologically and histologically analysed along with one hundred individuals with typical colposcopical appearance. It was observed that moderate dysplasia, severe dysplasia and malignant lesions of uterine cervix reveal certain distinct changes in the colposcopic "Transformation Zone" which are well related to the cytological and histological findings. The results suggested that colposcopy might be undertaken as a rapid, reliable and complementary tool for cancer screening in a vastly populated country like India.

Detection of human papilloma virus infection in routine Papanicolaou-stained cervical smears.

Women at reproductive age were investigated cytologically for the presence of koilocytes in cervical scrapings to study the frequency of Human Papilloma Virus infections. Out of 2275 cervical smears, 51 (2.24%) revealed koilocytes. Koilocytes were more frequently associated with dysplasia and neoplasia than inflammation and negative smears. Higher frequency of HPV infection was observed in Hindu women as compared to Muslims. Blood stained or white discharge per vaginum is the commonest presenting symptom of the patients with HPV cervical lesions. The data observed in this study provide useful baseline information.