Use of grape-based stain (Vinatela) on cervical cytology: A Peruvian validation study.

Objectives: The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test. Material and Methods: Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with pre-fermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples. Results: The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10- 20 min × (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045). Conclusion: Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details.

Quality and Performance of Papanicolaou Test using the Clinical and Laboratory Standards Institute (CLSI) EP12-A2 Guidelines: A Single-Center Study in Peru.

Context: Quality assurance in cervical cytology is based on the cyto-histological correlation that is performed in several countries even without standardized protocols. Aims: To evaluate the quality of the Pap smear with the Clinical and Laboratory Standards Institute (CLSI) EP12-A2 guideline in a Peruvian hospital. Settings and Design: This prospective study was carried out at tertiary care national hospital. Methods and Material: The 156 cyto-histological results were collected and coded according to the Bethesda 2014 and FIGO system. The evaluation with the CLSI EP12-A2 guide allowed estimating the performance and quality of the test. Statistical Analysis Used: We performed a descriptive analysis of the cytological and histological data and correlation with the weight Kappa test. From the calculation of the likelihood ratios, the post-test probability was estimated using Bayes' theorem. Results: In cytology, 57 (36.5%) were undetermined abnormalities, 34 (21.8%) low-grade squamous intraepithelial lesion (SIL), and 42 (26.9%) high-grade SIL. Of the total biopsies, 56 (36.9%) were cervical intraepithelial neoplasia (CIN) grade 1, 23 (14.7%) were both CIN grade 2 and 3. We determined sensitivity, specificity, a positive and negative predictive value of 94%, 74.6%, 58%, and 97.1%, respectively. We determined a moderate cyto-histological agreement (κ = 0.57). Atypical squamous cells of undetermined significance (40%), and cannot exclude high-grade squamous intraepithelial lesions (42.1%) that showed higher overdiagnosis results. Conclusions: The quality and performance of the Papanicolaou test show high sensitivity and moderate specificity. The concordance found was moderate and the proportion of underdiagnosis was higher in abnormalities of undetermined significance.

Clinical, Phenotypic, and Demographic Characteristics of Peruvian Children and Neonates with Autosomal and Sex Chromosome Aneuploidies.

OBJECTIVE: Autosomal and sex chromosome aneuploidies are associated with multiple risk factors that determine their frequency and their social and health impact. We aimed to determine the clinical, phenotypic, and demographic characteristics of Peruvian children and neonates with autosomal and sex chromosome aneuploidies. MATERIALS AND METHODS: This was a retrospective study conducted on 510 pediatric patients. We conducted a cytogenetic analysis with G-bands by trypsin using Giemsa (GTG) banding, and the results were reported using the International System for Cytogenetics Nomenclature 2013 system. RESULTS: Of 399 children (mean age 2.1 ± 4 years), 84 (16.47%) had aneuploidies, with 86.90% being autosomal (73.81% trisomies). In autosomal aneuploidies, 67.85% (n = 57) of the children had Down syndrome where the most common cause was free trisomy 21 (52 cases, 61.91%), followed by Robertsonian translocation (4 cases, 4.76%). Edwards and Patau syndrome affected 4 (4.76%) and 1 (1.19%) neonate. The most frequent phenotypic characteristics in children with Down syndrome were Down syndrome-like facies (45.61%) and macroglossia (19.29%). Of sex chromosome aneuploidies, 6/7 were abnormalities of the X chromosome (mainly 45,X). Neonate's age (19 ± 44.9 months), paternal age (49 ± 9 years), height (93.4 ± 176 cm), and gestational age (30 ± 15.4 weeks) were significantly correlated with the presence of sex chromosome and autosomal aneuploidies (P < .001; P = .025; and P = .001). CONCLUSIONS: Down syndrome and Turner's syndrome were the most frequent aneuploidy and sex chromosome aneuploidy, respectively. In addition, some of the clinical, phenotypic, and demographic characteristics, such as newborn's age, paternal age, gestational age, and height, were significantly correlated with the occurrence of aneuploidy. In this sense, these characteristics could be considered risk factors among this population.

Physical Activity and Body Image Perceived by University Students during the COVID-19 Pandemic: A Systematic Review.

Our objective was to assess the perception of body image and physical activity in university students during the COVID-19 pandemic. Of 74,270 papers found on 13 search engines between 12 August 2020, and 2 November 2021, we identified six studies (n = 1392 and 1097 were women). We found several results on the perception of both variables during the pandemic. First, physical activity tended to decrease or have negative changes, either because they dedicated less time to it, decreased the type of intensity or because they dedicated more time to sedentary activities. In addition, women were more physically active than men, since men perceived a decrease in their levels of physical activity. Secondly, there were also slight changes in the perception of body image; several students perceived that they gained weight and others had an increase in their BMI. It is even noted that those who were physically active or who were older in the population studied had a better perception of their actual physical condition. Similarly, we found that a concern for body image and even negative changes in the perception of appearance during confinement were reported. In conclusion, we found changes in the perception of physical activity and body image in college students during the COVID-19 pandemic.

Decline of cytology-based cervical cancer screening for COVID-19: a single-center Peruvian experience. / Declive del cribado de cáncer cervical basado en citología by COVID-19: una experiencia unicéntrica peruana.

Introduction: Cervical cancer is the second most frequent malignant disease in the Peruvian female population, and the Papanicolaou test is its main screening tool. However, the COVID-19 pandemic can hinder cervical cancer screening, reducing its scope. Objective: To analyze the decline of Papanicolaou-based cervical cancer screening due to COVID-19 in a specialized hospital in Lima. Methods: We designed a retrospective study (from 2015 to 2020) on 355 029 Papanicolaou smears at the Hospital Nacional Madre Niño San Bartolomé. T-test and one-way ANOVA were used to define differences in the study period and Ljung-Box test with ARIMA (1,0,0) model to describe and forecast monthly expected Papanicolaou smears for 2020. Results: Throughout the six years of the study, the average Papanicolaou smears was 59 171.5 ± 8898.7 per year. However, in 2020 only 16 273 (4.58%) Papanicolaou tests were performed with a monthly mean of 1356.1 ± 684.2 (95% confidence interval 149.7 to 2861.9) (p < 0.001). The forecast showed 66 960 Papanicolaou smears for 2020 and a monthly mean of 5580 ± 129.3. Actual screenings during that year were only 16 273 Papanicolaou smears, resulting in a 76.7% reduction in cervical cancer screening during the pandemic. Conclusions: Our results suggest a dramatic decrease in cervical cancer screening based on Papanicolaou smears during 2020 in Peru due to prevention and control measures against COVID-19.

Introducción: El cáncer de cuello uterino es la segunda neoplasia más frecuente en la población femenina peruana y la prueba de Papanicolau es la principal estrategia de cribado. Sin embargo, la pandemia de COVID-19 puede bloquear el tamizaje cervicovaginal pudiendo reducir su alcance. Objetivo: Analizar el declive del cribado de cáncer de cuello uterino basado en la prueba de Papanicolaou, debido a COVID-19 en un hospital especializado de Lima. Métodos: Diseñamos un estudio retrospectivo (de 2015 a 2020) en 355 029 pruebas de Papanicolau en el Hospital Nacional Madre Niño San Bartolomé. Se utilizó la prueba T y ANOVA para definir las diferencias en el periodo del estudio y la prueba de Ljung-Box con modelo ARIMA (1,0,0) para describir y pronosticar mensualmente las pruebas de Papanicolau esperadas para el año 2020. Resultados: Durante los seis años del estudio el promedio fue de 59 171,5 ± 8898,7 pruebas de Papanicolau por año. Sin embargo, en 2020 solo se realizaron 16 273 (4,58%) pruebas de Papanicolau con una media mensual de 1356,1 ± 684,2 (intervalo de confianza 95%: 149,7 a 2861,9) (p < 0,001). El pronóstico mostró 66 960 pruebas de Papanicolau para el año 2020 y una media mensual de 5580 ± 129,3. Los tamizajes reales durante ese año fueron solamente de 16 273 pruebas de Papanicolau , generando un 76,7% de reducción del tamizaje de cáncer de cuello uterino durante la pandemia. Conclusiones: Conclusiones.

Human papillomavirus infections in low-grade squamous intraepithelial lesion in Peruvian pregnant woman: A cross-sectional cytology-based study.

Background and Aims: Low-risk human papillomaviruses (HPV) are important in pregnant women because they are risk factors for Condyloma acuminatum and recurrent respiratory papillomatosis in the newborn. On the other hand, HPV may contribute to the development of preneoplastic lesions such as LSIL in pregnant women. We aimed to assess the frequency of HPV infections in low-grade squamous intraepithelial lesion (LSIL) in Peruvian pregnant women. Methods: A cross-sectional study was conducted from 2011 to 2015 in 84 primiparous- and multiparous pregnant women (mean age: 27 ± 6.3 years). Pregnant women of 18-45 years attending gynecology outpatient department were included for the study. LSIL and HPV (nuclear irregularities, koilocytosis, and cytopathic effect) cellular alterations were reported using the Bethesda System guidelines. Results: Sixty-four percent had cytological HPV infection (koilocytes and/or pathognomonic signs of infection) and more than a half of pregnant women had a previous Pap test. LSIL was more frequent in multiparous (increased by 12%, p = 0.008), in the second and third trimester (60.7%, p = 0.002), and between the ages of 18 and 30 (42 cases (50%), p = 0.110). This proportion was significatively increased in women with ≥2 sexual partners (39.3%), with an early onset of first intercourse, and from the Rímac Municipality (14.3%) (p < 0.05). The rate of pregnant women with HPV infection increased by 39% between 2011 and 2015 (p = 0.001). Conclusion: Peruvian pregnant women with LSIL have a high frequency of HPV infections. These young pregnant women (≤30 years of age), with multiple pregnancy, ≥2 sexual partners, and early onset of sexual intercourse were mainly associated with the third trimester HPV infection and LSIL. To detect early lesions of the cervix, it is key to continue monitoring HPV infections with molecular techniques and screening in pregnant women.

[The importance of Hashime Murayama's illustrations for George Papanicolaou's Atlas of exfoliative cytology]. / Empoderamiento de Hashime Murayama en el Atlas de citología exfoliativa de George Papanicolaou.

The illustrations of Hashime Murayama were vital in enabling the Papanicolaou test to be understood, admired and observed worldwide, making Papanicolaou's Atlas of cytology so fundamental in the detection and prevention of cervical cancer. Murayama was a talented Japanese artist who initially worked for the National Geographic magazine; his figurative watercolours were ideal for portraying the wonders of nature. Later, he collaborated with George Papanicolaou in Cornell University as he was able to improve on the microphotography of the era; an era in which it was not yet understood why cervical cancer caused so many deaths. His illustrations captured the most intricate cellular details and his artistic legacy will always be enlightening in each display of cellular artistry as seen under the microscope.

Empoderamiento de Hashime Murayama en el Atlas de citología exfoliativa de George Papanicolaou / The importance of Hashime Murayama's illustrations for George Papanicolaou's Atlas of exfoliative cytology

Para que la prueba de Papanicolaou pudiera ser vista, comprendida y admirada por el mundo entero, fue necesario plasmar el arte desarrollado por Hashime Murayama en el Atlas que se materializó gracias a sus dibujos ilustrativos en la consolidación de esta como herramienta fundamental en la detección y la prevención del cáncer cervical. Murayama fue un virtuoso japonés con un estilo artístico figurativo que desarrolló su talento, en un principio para National Geographic, en las ilustraciones a base de acuarela que reflejaba las fascinaciones de la naturaleza, y luego, en colaboración con George Papanicolaou, en Cornell University, donde superó la microfotografía de esa época al reflejar en sus dibujos los más refinados detalles celulares, en los tiempos donde no se entendía por qué el cáncer cervical ocasionaba tantas muertes. El legado artística de Murayama estará siempre presente como información en cada visualización de los detalles celulares vistos en el microscopio.(AU)

The illustrations of Hashime Murayama were vital in enabling the Papanicolaou test to be understood, admired and observed worldwide, making Papanicolaou's Atlas of cytology so fundamental in the detection and prevention of cervical cancer. Murayama was a talented Japanese artist who initially worked for the National Geographic magazine; his figurative watercolours were ideal for portraying the wonders of nature. Later, he collaborated with George Papanicolaou in Cornell University as he was able to improve on the microphotography of the era; an era in which it was not yet understood why cervical cancer caused so many deaths. His illustrations captured the most intricate cellular details and his artistic legacy will always be enlightening in each display of cellular artistry as seen under the microscope.(AU)

Deaths, infections, and herd immunity in the COVID-19 pandemic: A comparative study of the strategies for disease containment implemented in Peru and the United Kingdom / Muertes, infecciones e inmunidad de rebaño en la pandemia por COVID-19: un estudio comparativo de las estrategias de control de la pandemia implementadas en Perú y Reino Unido

Abstract Introduction: In light of the threat posed by the COVID-19 pandemic, most countries have implemented several containment and prevention measures to slow down the rapid spread of the disease. Objectives: To compare the COVID-19 pandemic containment strategies implemented in Peru [World Health Organization (WHO) - confinement and social distancing] and the United Kingdom [herd immunity (HI)] in terms of morbidity and mortality, and to simulate the implementation of HI in Peru during the initial stage of the pandemic. Materials and methods: Exploratory study with a simulation model based on official data obtained from both countries at the beginning of the pandemic. Mortality, case fatality, and infection rates documented within the first 55 days after the first COVID-19 case report in the United Kingdom and the start of the WHO-recommended containment and prevention strategy implementation in Peru were evaluated. Additionally, the impact of applying HI, according to WHO guidelines, as the initial strategy in Peru was simulated. The Paired-samples t-test was used to determine the differences between the two strategies at both stages of the study. Results: During the follow-up period, 15 034 and 33 931 COVID-19 cases were reported in the United Kingdom and Peru, respectively. The case fatality rate was higher in the United Kingdom (7.82% vs. 2.74%), while the cumulative mortality rate was higher in Peru (2.89 vs. 1.74x100 000 inhabitants p= 0.0001). Regarding the simulation, a minimum critical population of 60% (>19 million positive cases) was established for Peru to achieve HI, with 1 223 473.1 deaths and a hospitalization rate of 44 770x100 000 patients. Conclusions: During the follow-up period (55 days), the United Kingdom's strategy resulted in a higher case fatality rate, while the Peruvian strategy in over twice as many COVID-19 cases. The HI simulation strategy in Peru showed a sharp increase in all unfavorable indicators of the pandemic.

Resumen Introducción. Ante la amenaza de la pandemia por COVID-19, la mayoría de los países han establecido diversas medidas de control y prevención para disminuir la rápida propagación de esta enfermedad. Objetivos. Comparar las estrategias de control de la pandemia por COVID-19 implementadas en Perú (de confinamiento y distanciamiento social de la Organización Mundial de la Salud (OMS)) y Reino Unido (de inmunidad de rebaño (IR)) en términos de morbimortalidad, y simular la implementación de la IR en Perú durante la etapa inicial de la pandemia. Materiales y métodos. Estudio exploratorio con un modelo de simulación basado en datos oficiales de ambos países registrados al inicio de la pandemia. Se evaluaron las tasas de mortalidad, letalidad e infección en Reino Unido (IR) y Perú (confinamiento y distanciamiento social) dentro de los 55 días posteriores al reporte del primer caso de COVID-19 en Reino Unido y al inicio de la implementación de la estrategia de control y prevención recomendada por la OMS en Perú. Además, se simuló el impacto de haber aplicado la IR, según pautas de la OMS, como estrategia inicial en Perú. Se utilizó la prueba t-Student para muestras relacionadas para determinar las diferencias entre ambas estrategias en las dos etapas del estudio. Resultados. En el periodo de seguimiento se registraron 15 034 y 33 931 casos de COVID-19 en Reino Unido y Perú, respectivamente. La tasa de letalidad fue mayor para Reino Unido (7.82% vs. 2.74%), y la tasa de mortalidad acumulada fue mayor en Perú (2.89 vs. 1.74x100 000 habitantes; p=0.0001). Respecto a la simulación, se estableció una población crítica mínima de 60% (>19 millones de casos positivos) para que Perú logre la IR, con 1 223 473.1 muertes y una tasa de hospitalización de 44 770x100 000 pacientes. Conclusiones. Durante el periodo de seguimiento (55 días), la estrategia de Reino Unido resultó en una mayor letalidad y la peruana, en más del doble de casos de COVID-19. La simulación de la IR en Perú mostró un dramático incremento de todos los indicadores desfavorables de la pandemia.

Alteraciones citogenéticas en pacientes con diagnóstico de infertilidad en Lima, Perú / Cytogenetic abnormalities in patients with infertility diagnosis in Lima, Peru

INTRODUCCIÓN: La infertilidad es una enfermedad multicausal y el componente genético representa uno de sus principales eventos. Si bien la distribución de la infertilidad puede variar entre poblaciones, las parejas de los países con bajos y medianos ingresos pueden verse más afectadas por la infertilidad, con una proporción de alteraciones citogenéticas aún no esclarecidas. OBJETIVO: Evaluar la frecuencia de alteraciones citogenéticas y su correlación con el número de abortos en pacientes peruanas con diagnóstico de infertilidad. MÉTODO: Se realizó un estudio de corte transversal en 400 pacientes de 18 a 60 años, de ambos sexos, con diagnóstico de infertilidad. Se registraron las características clínicas disponibles durante el examen genético y el análisis citogenético convencional fue con bandeo GTG en muestras de sangre periférica. El análisis de correlación se realizó con la prueba de Spearman. RESULTADOS: Del total, 389 pacientes cumplieron los criterios de inclusión, y de estos, 169 (43,44%) tuvieron reportes de abortos (promedio: 2,25, rango: 1-7). Hallamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas (p < 0,000). Reportamos 25/289 (6,43%) alteraciones cromosómicas, de las que 11/25 (44%) fueron heterocromatinas constitutivas y 6/25 (24%) fueron translocaciones reciprocas. Las alteraciones citogenéticas más frecuentes fueron 16qh+ y 9qh+ (ambas con un 16%), y afectaron a 17 (68%) varones. CONCLUSIONES: Existe una moderada frecuencia de alteraciones citogenéticas en pacientes peruanos con diagnóstico de infertilidad, y las alteraciones más frecuentes fueron heterocromatina constitutivas. Además, evidenciamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas.

INTRODUCTION: Infertility is a multicausal disease and the genetic component represents one of its main events. Although the distribution of infertility may vary between populations, couples in low-and-middle-income countries may be more affected by infertility with a proportion of cytogenetic alterations still unclear. OBJECTIVE: To evaluate the frequency of cytogenetic alterations and their correlation with the number of abortions in Peruvian patients with a diagnosis of infertility. METHOD: A cross-sectional study was carried out in 400 patients between 18 and 60 years-old, of both genders with a diagnosis of infertility. The clinical characteristics available during the genetic examination were recorded and the conventional cytogenetic analysis was with GTG banding in peripheral blood samples. The correlation analysis was performed with the Spearman test. RESULTS: Of the total 389 patients who met the inclusion criteria, of these 169 (43.44%) patients had reports of abortions (mean: 2.25, range: 1-7). We found a significant correlation between the number of abortions and cytogenetic alterations (p < 0.000). We report 25/289 (6.43%) chromosomal alterations, where 11/25 (44%) were constitutive heterochromatin, and 6/25 (24%) were reciprocal translocations. The most frequent cytogenetic alterations were 16qh + and 9qh + (both 16%), and affected 17 (68%) men. CONCLUSIONS: There is a moderate frequency of cytogenetic alterations in Peruvian patients diagnosed with infertility, where the most frequent alterations were constitutive heterochromatin. Furthermore, we evidenced a significant correlation between the number of abortions and cytogenetic alterations.

Six-sigma and quality planning of TORCH tests in the Peruvian population: a single-center cross-sectional study.

OBJECTIVE: To ensure the health of newborns, it is necessary to perform high-quality diagnostic tests. The TORCH panel is a set of tests that identifies infectious pathogens such as Toxoplasma (Toxo) and Cytomegalovirus (CMV) that are common in low-setting populations. We performed TORCH panel quality planning using six sigma in a reference laboratory at Peru. RESULTS: This was a cross-sectional study. TORCH tests include Toxo, Rubella, CMV, and Herpes. We processed all samples by fourth-generation ELISA on the GEMINI XCR200 analyzer (Diatron, Budapest, Hungary). We obtained the imprecision from the annual data of the external quality assessment plan and we used the CLSI EP12-A3 guideline. In a total of 44,788 analyses, the average imprecision was 3.69 ± 1.47%, and CMV had lower imprecision (2.3 and 2.6% for IgM and IgG, respectively). Quality planning of the TORCH panel allowed estimating the sigma value that ranged from 4 to 10 (average 7 ± 2 sigma), where rubella had the highest values (10 for IgM and 8 for IgG) while HSV2 had the lowest values (4 for IgM and 5 for IgG). Our results suggest the optimal performance of half of the markers including Toxoplasma, Rubella, and CMV in the Peruvian population.

Cost and pollution by the use of xylene in cervical cytology in four Peruvian hospitals.

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths  Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015-2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020-2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles).  Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015-2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020-2025.   Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.

Eco-Pap: The Ecological Modification of the Papanicolaou Stain for Sustainable Cervical Cancer Diagnosis.

OBJECTIVES: To validate the ecological modification of the Papanicolaou stain (Eco-Pap) for the diagnosis of cervical cancer. STUDY DESIGN: A prospective study was performed at the Mother and Child "San Bartolomé" Hospital, Lima, Peru. Reagent handling strategies were divided into three phases: we used (1) Harris progressive hematoxylin (for nuclear staining), (2) a polychromatic solution (a mix of EA-36/Orange G-6 to suppress the use of several alcohol baths), and (3) direct mounting (with Entellan® solution). The cellular details were analyzed by the staining quality index, an external quality control, and the Bethesda System 2014. RESULTS: We evaluated 72,901 cervical smears stained with the Eco-Pap. The validation of the Eco-Pap against the conventional Pap stain was optimal (κ = 0.89; 95% CI: 0.87-0.92), showing a sensibility and specificity of 88.3% (95% CI: 85.1-90.0) and 98.7% (95% CI: 98-99.2), respectively. The Eco-Pap dramatically reduced the environmental pollution caused by 72 L of xylene, hydrochloric acid, and ammonia (6 L each) and mercury oxide. CONCLUSION: The Eco-Pap is an innovative and efficient staining method reducing the use of toxic reagents with carcinogenic potential during cervical cancer screening by exfoliative cytology.

The ecologization of the Papanicolaou stain in the diagnosis of cervical cancer / La ecologización de la coloración del Papanicolaou en el diagnóstico del cáncer de cuello uterino

Background: Cervical cancer is the fourth most common cancer worldwide among women. Objective: To evaluate the implementation and efficiency of the Ecological Papanicolaou staining (Eco-Pap) in exfoliative cytology for the diagnosis of cervical cancer. Methods: A prospective, experimental, cross-sectional research was performed at the Hospital Nacional Docente Madre-Niño "San Bartolomé" during 2015. Three strategies for controlling toxic reagents were used: the use of progressive Harris haematoxylin, polychromatic cytoplasmic solution and direct mounting. Cellular details were analyzed by using the Quality Index Staining, the Bethesda system and the Quality Program for External Evaluation of Cytology. Results: We evaluated 72 901 cervical smears stained with Eco-Pap. The validation of Eco-Pap against the standard Papanicolaou staining had very good agreement (kappa = 0.89), showing a sensitivity and specificity of 88.3 and 98.7%, respectively (p < 0.05). The Eco-Pap had a high diagnostic yield and reduced environmental pollution caused by xylene (72 liters), hydrochloric acid and ammonia (each one with six liters), as well as mercury oxide. Conclusions: The Eco-Pap is a new, efficient and innovative method which eliminates the use of toxic-carcinogenic reagents, generating ecological performance in the diagnosis of cervical cancer

Introducción: El cáncer de cuello uterino (CaCu) ocupa la cuarta posición en la lista de los cánceres más comunes que afectan a la población femenina a nivel mundial. Objetivo: Evaluar la aplicación y la eficiencia de la coloración ecológica de Papanicolaou (Eco-Pap) en citología exfoliativa para el diagnóstico de CaCu. Métodos: Se realizó una investigación de tipo experimental prospectiva de corte transversal en el Hospital Nacional Docente Madre-Niño "San Bartolomé" durante el 2015. Se utilizaron tres estrategias de control de reactivos tóxico-cancerígenos: el uso de hematoxilina progresiva de Harris, la solución policromática citoplasmática y el montaje directo. Los detalles celulares se analizaron mediante el Índice de Calidad de Tinción, el sistema Bethesda y el Programa de Evaluación Externa de la Calidad en Citología. Resultados: Se evaluaron 72 901 extendidos cervicales coloreados con Eco-Pap. La validación del Eco-Pap frente a la coloración convencional de Papanicolaou tuvo una concordancia muy buena (kappa = 0.89), lo cual evidenció una sensibilidad y especificidad del método de 88.3% y 98.7%, respectivamente (p < 0.05). El Eco-Pap tuvo un alto rendimiento diagnóstico y redujo la contaminación ambiental producida por el xilol (72 litros), el ácido clorhídrico y el amoniaco (ambos con 6 litros) y del óxido de mercurio. Conclusiones: El Eco-Pap es un método eficiente, nuevo e innovador que elimina el uso de reactivos tóxico-cancerígenos y genera un performance ambiental en el diagnóstico del cáncer cervical.

Control de calidad postanalítico en citología exfoliativa cervical en Lima, Perú / Post-analytical quality control in cervical exfoliative cytology to Lima, Peru

Con el objetivo evaluar el desempeño y la calidad de la etapa postanalítica del cribado citológico en el Hospital Nacional Docente Madre Niño «San Bartolomé» se diseñó una investigación de tipo analítico-correlacional con muestreo prospectivo y análisis transversal en todos los frotices referidos de redes y microrredes de salud durante 2016. Se evaluaron 8 parámetros (rotulación de láminas, marcaje de láminas, reporte de resultados, emisión de resultados, archivo de láminas, almacenamiento, sistema informático y errores postanalíticos) (α-Crombach=0,823) en base a la percepción de todos los técnicos, citotecnólogos y citopatólogos del hospital, y a 21 estudiantes de la especialidad de Citología de la Universidad Nacional Federico Villarreal. El procesamiento citológico reportó un rendimiento global adecuado (29 puntos) siendo 18 y 34 el puntaje mínimo y máximo, respectivamente. Esta valoración difiere significativamente en los ítems marcaje de lámina (p=0,722) y archivo de láminas (p=0,503). Se evidenció una diferencia global por grupo de evaluación (p<0,027). Se estableció una correlación directa entre el tipo de evaluador y el total de errores postanalíticos (rho=0,534; p<0,005). Estos procesos deben de tener un cumplimiento de requisitos interrelacionados de manera coordinada y dinámica que permita mantener la identidad de la unidad: muestra-solicitud-usuaria. La evaluación del desempeño y la calidad de la etapa postanalítica para la detección del cáncer de cuello uterino mostro un desempeño «adecuado» que difiere de evaluaciones de otras instituciones. Esta nueva aproximación señala la importancia de los procesos postanalíticos relacionados con rescreening, las necesidades operativas y las metas organizacionales (AU)

In order to evaluate the performance and quality of the post-analysis stage of cervical screening in the "Madre Niño" St Bartholomew's National Teaching Hospital, a correlational analytical study was designed, with prospective sampling and transversal analysis of all the smears referred from the health networks during 2016. Eight criteria were assessed (labelling of slides, marking of slides, reporting of results, sending of results, filing of slides, storage of slides, computer programme and post-analytic errors) (α-Crombach»=»0.823) based on the perception of all the technicians, cytotechincians and cytopathologists in the hospital as well as 21 cytology students at the Federico Villareal National University. Cytology processing reported adequate global efficiency, with an average of 29 points and a range of 18 to 34. This assessment differs significantly in the marking of the slides (P=.722) and filing of slides (P=.503). A global difference was seen per evaluation group (P<.027). A direct correlation was established between the type of assessor and the total number of post-analytical errors (rho=0.534; P<.005). These processes should fulfil certain requirements that are inter-related in a coordinated and dynamic way, in order to maintain the identity of the unit: sample-request-user. The assessment of the performance and quality of the post-analytic phase in the detection of cervical cancer revealed an "adequate" performance which differs from the assessments in other centres. This new approximation points out the importance of the post-analytic processes related to rescreening, the operative needs and the organizational goals (AU)

Tendencias en la investigación del virus de papiloma humano en latinoamérica frente a los países de altos ingresos / Human papillomavirus research trends in Latin American compared to high income countries

RESUMEN Objetivo: Este documento busca hacer una reflexión sobre las tendencias en la investigación del Virus de Papiloma Humano (VPH) en Latinoamérica en comparación con los países de altos-ingresos. Materiales y métodos: Con base en la evaluación de estudios desarrollados en diversos países, discriminados por el grado de desarrollo económico y social, se da respuesta a preguntas relacionadas con el VPH en cuanto a: su frecuencia, las tendencias de investigación, los programas de educación al personal de salud y los pacientes, y las estrategias preventivas. Para esto se realizó una extensa revisión de las investigaciones publicadas y los estudios presentados en el I Encuentro Sudamericano del VPH. Resultados: Los esfuerzos para el desarrollo de investigación sobre VPH se reflejan en estudios básicos y aplicados sobre sobre VPH y cancer cervicouterino (CCU). Existen limitaciones en el desarrollo científico regional comparado con los países de ingresos altos que se evidencian en las tasas de prevalencia y vacunación. Se observan transformaciones lentas en los programas de prevención en cada nivel, con dificultades de índole regional. Conclusión: El impacto del VPH y del CCU es inconmensurable para Latinoamérica, lo que exige el desarrollo de políticas públicas e intervenciones preventivas y organizadas.

ABSTRACT Objective: This paper is intended to be a reflection on the trends in Human Papilloma Virus (VPH) research in Latin America, compared to high income countries. Materials and methods: Answers are provided regarding HPV in terms of frequency, research trends, education programmes for patients and healthcare staff, and preventive strategies. An extensive review was conducted of the published research and of the studies presented during the I South American Meeting on HPV. Results: Research work in HPV is focused on basic and applied studies on HVP and cervical cancer (CC). There are limitations to scientific development in our region compared to high income countries, and this is reflected in disease prevalence and vaccination rates. Prevention programs at each level are undergoing slow transformations as the natural hurdles of the region are overcome. Conclusion: The impact of HPV infection and cervical cancer is huge in Latin America, requiring the development of public policy and organized preventive interventions.

Validation of the Modification of the Prolonged Papanicolaou Stain for the Diagnosis of Cervical Cancer.

OBJECTIVES: To validate the modification of the prolonged Papanicolaou stain based on the quality control of time, units and staining stages (micro- and macroscopic), and on the stain reactivation based on the control. STUDY DESIGN: A prospective study was performed on 125,358 cervical smears in Lima (Peru). The microscopic quality control included evaluating the cytological characteristics through the staining quality index (SQI) and the quality criteria for samples described by the Bethesda System (TBS). The macroscopic quality control is based on the interslide staining as a set corresponding to a poststaining vertical angle. The stains were reactivated with the addition of 0.15 and 2 g of phosphotungstic acid for Orange G and EA-50, respectively. RESULTS: Both the nonneoplastic and the neoplastic findings comply with the quality criteria of the TBS (SQI value = 0.94). The yield per battery of staining fluctuated between 5,616 and 17,954 Pap smears, and the reactivation of stains produced a stain yield of up to four times the initial amount of the smears, saving USD 5,598.88 from 2013 to 2014. CONCLUSION: The modification of prolonged Papanicolaou staining is an excellent alternative, with a cost-benefit ratio that generates savings and a higher yield per battery of staining.

Hallazgos no neoplásicos y anormalidades celulares epiteliales en citología cervical / Non Neoplastic Findings and Epithelial Cell Abnormalities in Cervical Cytology

Introducción: el examen citológico de Papanicolaou tiene como objetivo el diagnóstico de lesiones precancerosas o cancerosas del cuello uterino, una evaluación hormonal y de flora bacteriana. Objetivos: determinar la proporción de hallazgos no neoplásicos y las anormalidades epiteliales escamosas y glandulares remitidos al área de Citología del Hospital Nacional Docente Madre Niño San Bartolomé. Métodos: se diseñó una investigación de tipo analítico-correlacional prospectiva de corte transversal en todos los frotices referidos de cinco redes y microredes de salud. El procesamiento citológico se realizó en conformidad con los requerimientos internacionales para citología. La interpretación citológica se realizó según el Sistema Bethesda. Resultados: de 72 644 extendidos cérvicouterinos evaluados mediante sistema de calidad del Sistema Bethesda, la proporción de resultados con alteraciones cérvico-uterinas (prevalencia 6,5 por ciento; IC: 95 por ciento: 6,32 por ciento, 6,68 por ciento), negativos posevaluación y Hallazgos no neoplásicos fue de 4724 (6,5 por ciento), 35 318 (51,7 por ciento) y 32 602 (48,2 por ciento) muestras, respectivamente (p< 0,005). La probabilidad posprueba fue de 89,3 por ciento (IC: 95 por ciento: 87,1 por ciento a 91,1 por ciento; likelihood ratio LR > 10) y se estableció una correlación directa significativa entre los hallazgos/NLIM y las edades de los pacientes (rho= 0,477; p< 0,005). Además, 46,53 por ciento de estos hallazgos corresponden a flora sugestiva de vaginosis bacteriana, 22,5 por ciento a cambios reactivos asociados a inflamación y 21 por ciento a metaplasia escamosa. La asociación más frecuente fue la metaplasia escamosa, vaginosis bacteriana e inflamación severa 5,5 por ciento (1495 resultados). Conclusiones: la proporción de hallazgos no neoplásicos fue considerable y las anormalidades epiteliales escamosas y glandulares estuvieron sobre el promedio estándar(AU)

Introduction: The Pap test aims at diagnosing precancerous or cancerous lesions of the cervix, hormonal evaluation, and bacterial flora. Objectives: Determine the proportion of non-neoplastic findings, squamous and glandular epithelial abnormalities referred to the district ofHospital Nacional Docente Madre Niño San Bartolome. Methods: A prospective, analytical, correlational, cross-sectional research was designedfor all vaginal smear which were referred from five health networks and micro-networks. Cytological processing was carried out in accordance with applicable international requirements. Cytologic interpretation was performed according to Bethesda System. Results: Out of 72,644 cervical smears evaluated by Bethesda quality system, the proportion of results with cervical uterine disorders (prevalence 6.5 percent CI 95 percent: 6.32 percent, 6.68 percent) were 4724 (6.5 percent) samples, negative posevaluación was 35318 (51.7 percent) samples, and nonneoplastic findings 32 602 (48.2 percent) samples, (p< 0.005). Posttest probability was 89.3 percent (CI 95 percent: 87.1 percent to 91.1 percent; likelihood ratio LR > 10) and a significant direct correlation was established between the findings/nLiM and ages of patients (rho= 0.477; p< 0.005). Moreover, 46.53 percent of NIM flora suggestive corresponds to bacterial vaginosis (BV), 22.5 percent to reactive changes associated with inflammation and squamous metaplasia 21 percent (MET). The most frequent association was MET, VB, and severe inflammation 5.5 percent (1495 results). Conclusions: The proportion of non-neoplastic findings was considerable; squamous and glandular epithelial abnormalities were above average standard(AU)

Calidad de los extendidos cervicouterinos dentro de la coloración de Papanicolaou para el cribado de cáncer cervical en Lima, Perú / Quality of Papanicolaou test smears in screening for cervical cancer, Lima, Peru

En el Hospital Nacional Docente Madre Niño San Bartolomé de Lima revisamos y valoramos 72.644 frotis cervicales con el objetivo de determinar la calidad de la muestra coloreada con Papanicolaou. Se diseñó una perspectiva analítica-correlacional y un estudio transversal con las muestras obtenidas de 5 distritos del sistema de salud. El procesamiento citológico era acorde con los requerimientos internacionales para la citopatología. La interpretación citológica se llevó a cabo según el sistema Bethesda. De los 72.644 frotis cervicales valorados con el sistema de calidad de Bethesda, el 3,6 % (2.615 muestras) no eran aptas por ser la muestra inadecuada (MI), debido en gran parte a la presencia de >75% de leucocitos (49 %), poca celularidad (24 %) e insuficiente fijación (20 %). El índice de Youden era de 0,7 para MI con una variación significante del negativo para las lesiones intraepiteliales o malignidad (p = 0,71). Los distritos de salud Rímac, Túpac Amaru, Lima y Puente Piedra aportaron 849 (33 %), 723 (28 %), 675 (25 %) y 365 (14 %) de MI, respectivamente. Se encontró una correlación directa estadísticamente significativa entre el lugar de origen de las muestras y el número de MI (p < 0,005; rho = 0,492). El número de frotis con MI o con mala calidad sobrepasa los límites establecidos por varios organismos internacionales. La proporción de hallazgos no neoplásicos fue considerable y las anomalías epiteliales, escamosas y glandulares estuvieron dentro de la media nacional. Para desarrollar un estudio citológico adecuado se requieren métodos de evaluación de calidad en todas las fases del cribado y de esta forma cumplir con los requisitos internacionales de calidad, adecuarse a la acreditación y conseguir una mejoría continua (AU)

Seventy-two thousand and six hundred and forty-four cervical smears were evaluated in the Hospital Nacional Docente Madre Niño San Bartolomé, Lima, in order to determine the quality of samples stained with PAP. The smears were collected from 5 different healthcare districts and an analytical-correlational prospective and cross-sectional study was designed to assess them. Cytological processing was performed in accordance with international requirements for cytology, and cytological interpretation was performed according to the Bethesda system. Of 72,644 cervical smears evaluated by Bethesda system, 2,615 samples (3.6 %) had inadequate sample (IM > 75 %) mainly due to the presence of leucocytes (49 %), low cellularity (24 %) or insufficient fixation (20 %). The Youden index was 0.7 for IM, varying significantly from the negative for intraepithelial lesions or malignancy (P = .71). Health districts Rímac, Túpac-Amaru, Lima and Puente Piedra accounted for 849 (33 %), 723 (28 %), 675 (25 %) and 365 (14 %) of IM, respectively. A statistically significant direct correlation between the place of origin of the smears and the number of IM was found (P < .005; rho = .492). The quantity of cervical smears with IM or low quality surpassed that established by various international bodies and the proportion of non-neoplastic findings was high whilst squamous epithelial and glandular abnormalities were within average range. Quality assessment is necessary in every phase of cytological screening if it is to prove efficient and comply with international quality requirements and accreditation as well as achieving continuous improvement (AU)

Environmental Performance of Xylene, Hydrochloric Acid and Ammonia Solution During Pap Stain for Diagnosing Cervical Cancer.

BACKGROUND: Little importance has been placed on sustainability of the Papanicolaou (Pap) stain, the gold standard for the diagnosis of cervical cancer, for global environmental health. The standard Pap stain uses environmentally toxic and carcinogenic reactants such as xylene, hydrochloric acid and ammonia solution. OBJECTIVES: To eradicate the use of environmentally toxic and carcinogenic reactants through the validation of the Ecologic Papanicolaou (Eco-Pap) test. METHODS: Reagent handling strategies were divided in three phases: used Harris' progressive hematoxilin, polychromatic solution and direct mounting that were analyzed by PEED-Cytology, Staining Quality Index (ICT) and the Bethesda system 2014. RESULTS: A total of 52,319 Pap smears stained with Eco-Pap were admitted (ICT=0.91). Validation of the Eco-Pap versus conventional staining was optimal (Kappa =0.89) and the sensitivity and specificity of the method were 57% and 98%, respectively. Eco-Pap reduced the environmental contamination produced by xylene (66 liters), hydrochloric acid and ammonia (5.5 liters each) over nine months, and all diagnoses coincided with the cytological details. CONCLUSIONS: The Eco-Pap is an innovative method that transforms Pap testing into a sustainable and supportable technology.