Agaricus Subrufescens ameliorates ovarian dysfunction and regulates altered biochemical parameters in rats with Letrozole induced polycystic ovarian syndrome.

OBJECTIVE: The objective of this study is to investigate the effects of an ethanolic extract derived from Agaricus subrufescens on rat models exhibiting Polycystic Ovarian Syndrome (PCOS) induced by Letrozole. METHODS: A total of thirty female Wistar rats were divided into five groups, each consisting of six rats. The negative control group was administered a volume of 1 mL of a 0.5% solution of carboxy methylcellulose (CMC). Letrozole (1 mg/kg) was administered to additional groups for a duration of 21 days in order to induce polycystic ovary syndrome (PCOS). Animals designated as positive controls were euthanized on the 22nd day. Both the test group and the standard group were subjected to treatment from the 22nd day to the 36th day. The experimental group was administered ethanolic extract of Agaricus subrufescens at doses of 200 mg/kg and 400 mg/kg p.o, while the control group received clomiphene citrate at a dose of 1 mg/kg. The study observed various physiological markers in individuals with polycystic ovarian disease, including estimated blood glucose levels, total cholesterol levels, triglyceride levels, and hormonal fluctuations such as increased testosterone and estrogen levels, as well as decreased progesterone levels. The presence of menstrual irregularities was confirmed through the examination of vaginal smears and histopathological changes in the ovaries. RESULTS: The consumption of Agaricus subrufescens was found to have a significant impact on various physiological parameters, including blood glucose levels, testosterone levels, anovulation, and menstrual irregularity. All therapeutic interventions significantly normalized the levels of serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT). The rats with polycystic ovary syndrome (PCOS) that were induced by Letrozole exhibited increased levels of urea and creatinine. The findings of this study indicate that the administration of Agaricus subrufescens therapy has a protective effect on renal function, as evidenced by a reduction in serum levels of urea and creatinine. In rats with polycystic ovary syndrome (PCOS) induced by Letrozole, the inhibition of hepatic synthesis, promotion of ovarian follicle immaturity, and elevation of androgen secretions result in an increase in the weight of the liver and ovaries. The weight of endocrine organs exhibited a decrease across all treatment groups. The histopathological examination of PCOS specimens revealed an increased presence of cysts and theca lutein cells. The group of rats with polycystic ovary syndrome (PCOS) that did not receive treatment exhibited a higher number of cysts compared to the groups that received treatment. CONCLUSION: This study demonstrated that the administration of Letrozole orally resulted in the development of polycystic ovarian disease. The results indicated heightened levels of blood glucose, total cholesterol, and triglycerides, as well as alterations in hormone levels such as increased testosterone and estrogen, and decreased progesterone. These hormonal changes were accompanied by menstrual irregularities, which were confirmed through the examination of vaginal smears and histopathological analysis of the ovaries in the control group with polycystic ovarian disease. The treatment groups that received Agaricus subrufescens exhibited a decrease in blood glucose, total cholesterol, and testosterone levels.

Effect of topical oxytocin gel on vaginal mucosa in postmenopausal Egyptian women: a clinical randomized trial.

BACKGROUND: Vaginal atrophy is common after menopause and is often linked to sexual dysfunction, particularly dyspareunia. AIM: The study aimed to investigate the effect of intravaginally applied oxytocin on expressions of vaginal atrophy. METHODS: Fifty postmenopausal women aged 47 to 66 years with vaginal atrophy participated in this double-blinded placebo-controlled study. The women were randomized to intravaginal treatment with either gel with 600 IU/mL of oxytocin (oxytocin group) or gel alone (control group) once daily for 2 weeks. The gel consisted of hypromellose, pH 3.8 (Vagovital). OUTCOMES: The color of the vaginal mucosa, the vaginal pH, and the cytology of vaginal epithelial cells were investigated before and after treatment. RESULTS: The color of the vaginal mucosa shifted from pale to red in all 25 patients treated with oxytocin but only in 4 patients in the control group (P < .001). There was a significant decrease in intravaginal pH in the oxytocin group and the control group, with the delta value being significantly greater in the oxytocin group than in the control group (P < .001). The vaginal maturation index increased significantly (P < .001) in the oxytocin group but not in the control group. CLINICAL IMPLICATIONS: Topical oxytocin gel offers an effective solution to the sexual dysfunction that is related to vaginal atrophy after menopause. STRENGTHS AND LIMITATIONS: Strengths include studying different outcomes of applying the oxytocin gel for vaginal atrophy. Limitations include the small-scale population with a relatively short duration of treatment (2 weeks). CONCLUSION: Intravaginal treatment with a gel containing 600 IU/mL of oxytocin effectively counteracts physical expressions of vaginal atrophy. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05275270; https://clinicaltrials.gov/ct2/show/NCT05275270).

Repeated Collection of Vaginal Smear Causes Stress in Mice.

Introduction: Women are more likely to be misdiagnosed in many neuropsychiatric disorders than men. One of the possible underlying reasons for this disparity may be more frequent use of male mice than female mice in neuroscience studies. With the increasing realization of the shortcomings of this approach in understanding the neurobiological basis of these disorders, many funding agencies mandate the inclusion of both male and female subjects in study design. As the behaviors vary with the stage of the estrous cycle, the collection of vaginal smears to identify the estrous stage becomes a widely used procedure. Here we tested whether vaginal smear collection causes similar effects to that of stress by evaluating an increase in depression-like behavior and impairment in memory. Method: Vaginal smear was collected from Swiss albino mice twice a day for 10 days. In order to test depression-like behavior tail suspension, sucrose preference and splash tests were conducted. Novel object recognition and novel object location tests were performed 1 hour and 24 hours after training to evaluate short-and long-term memory respectively. Results: The female mice whose vaginal smears were collected demonstrated increased behavioral despair and anhedonia. Vaginal smear group showed deficits in both short-term and long-term memory when compared to the control group. Conclusion: Our results indicate that the collection of vaginal smear not only increased depression-like behaviors in mice, but also impaired short-term and long-term memory, indicating that the procedure of vaginal smear collection was stressful. We recommend to consider other ways of estrous cycle staging when studying behavior.

Canine Vaginal Cytology: A Revised Definition of Exfoliated Vaginal Cells.

Vaginal cytology is an important examination method in the context of gynecological disorders and cycle staging in the bitch. While collection and preparation of samples are easy, the evaluation appears to be challenging. Inconsistent definitions of cell attributes such as size, cornification and the appearance of the nucleus have been published. The aim of the project was to develop a tutorial for vaginal cell determination. To get a deeper insight into the use of cytology in practice, an online survey was distributed to veterinarians interested in small animal reproduction. Participants were asked to define eight cells and answer questions. The agreement of the 16 participants, working in eight different countries, determining the cells was poor (κ = 0.412). Eleven respondents stated that vaginal cytology has a low reliability. Nevertheless, 13 participants use this tool regularly. The tutorial was developed as a flowchart based on the survey results, scientific literature and own measurements. It guides the user systematically through the evaluation of specific cell characteristics. An evaluation of the results of five raters with difference experience levels led to a high agreement (κ = 0.858). Vaginal cytology is a useful diagnostic tool, but it seems helpful to standardize the determination of cell types.

The effects of intrauterine device on cervico-vaginal smears with liquid-based cytology technique: A North-Eastern Anatolia region study in Turkey.

Intrauterine device (IUD), is one of the most efficient methods of contraception. The aim of study to investigate the effects of intrauterine device in cervicovaginal smears with liquid based cytology technique in our patient population. Cervicovaginal smears of 5492 patients who sought the services of the pathology department in a sixmonth period were reviewed retrospectively. Samples were prepared with liquid based cytology technique. The patients using IUD as contraceptive method (n= 562 cases) were included in the study. The samples taken with the conventional method were excluded from the study. The results were categorized according to the Bethesda system. The age range of the patients was 18-61 years (mean age: 34.6). The most common diagnosis was "negative for intraepithelial lesion or malignancy" (97.2%). In 307 patients (54.6%) there were infection and only in 93 out of them (30.2%) a specific agent was detected. Actinomyces (11%) were recorded as the most common infectious agent, followed by Gardnerella vaginalis (2.8%) and Candida species (2.4%). There were reactive changes in 134 cases (23.8%). In 13 cases (2.3%) epithelial cell abnormalities were detected. The most common cytopathologic diagnosis was ASC-US (atypical squamous cells of undetermined significance) in patients who had epithelial cell abnormalities (2.1%). In conclusion, IUDs increase the frequency of genital infection by disrupting the genital flora. In our study the most frequent agent was Actinomyces, and this rate was higher than some studies. This high rate for Actinomyces may be associated with IUDs that are frequently used for contraception in Erzurum province with long term uses.

Epidemiological profile and factors associated with cervicalvaginal infections in quilombola women submitted to preventive examination / Perfil epidemiológico e fatores associados às infecções cérvico-vaginais em mulheres quilombolas submetidas ao exame preventivo / Perfil epidemiológico y factores asociados a infecciones cérvico-vaginales en mujeres quilombolas sometidas a examen preventivo

Background and Objectives: reproductive tract infections are considered an important demand for women's health, due to their high prevalence in the population and the consequences they can cause, such as premature birth, infertility and cervical cancer. There are still women who do not undergo cytopathological examination, capable of preventing these infections, either due to lack of guidance or opportunity, such as quilombola women. This study aimed to identify factors associated with cervicovaginal infections in quilombola women from Feira de Santana, Bahia. Methods: a descriptive study, carried out in a transversal way and with a quantitative approach. Data collection was carried out from November 2019 to January 2020, with the application of an anamnesis form prepared by the team, with variables used in other studies, such as risk factors. Bivariate analysis was performed to obtain prevalence ratios (PR) between infections and the characteristics found. Results: a total of 82 women were studied, with an average age of 45.3 years. The main vaginal infections were caused by Gardnerella vaginalis (17.1%), Trichomonas vaginalis (8.5%), Cocci (8.5%), Candida spp. (6.2%) and Fusobacterium spp. (1.2%). In 88.2% of infected women, inflammation was present. Conclusion: the results obtained in this study showed a correlation between the inflammatory process in women and the presence of some infection. With regard to infections, there was a higher prevalence in women with low education, without a steady partner and who did not undergo regular preventive examination.(AU)

Justificativa e Objetivos: as infecções do trato reprodutivo são consideradas uma demanda importante para a saúde da mulher, devido à sua alta prevalência na população e às consequências que podem causar, como parto prematuro, infertilidade e câncer do colo do útero. Ainda há mulheres que não realizam exame citopatológico, capaz de prevenir essas infecções, seja por falta de orientação ou oportunidade, como as mulheres quilombolas. Este estudo teve como objetivo identificar fatores associados a infecções cervicovaginais em mulheres quilombolas de Feira de Santana, Bahia. Métodos: estudo descritivo, realizado de forma transversal e com abordagem quantitativa. A coleta de dados foi realizada no período de novembro de 2019 a janeiro de 2020, com a aplicação de uma ficha de anamnese elaborada pela equipe, com variáveis utilizadas em outros estudos, como fatores de risco. A análise bivariada foi realizada para obter razões de prevalência (RP) entre as infecções e as características encontradas. Resultados: foram estudadas 82 mulheres, com média de idade de 45,3 anos. As principais infecções vaginais foram causadas por Gardnerella vaginalis (17,1%), Trichomonas vaginalis (8,5%), Cocci (8,5%), Candida spp. (6,2%) e Fusobacterium spp. (1,2%). Em 88,2% das mulheres infectadas, a inflamação estava presente. Conclusão: os resultados obtidos neste estudo mostraram uma correlação entre o processo inflamatório em mulheres e a presença de alguma infecção. No que se refere às infecções, houve maior prevalência em mulheres com baixa escolaridade, sem companheiro fixo e que não realizavam exame preventivo regular.(AU)

Justificación y Objetivos: las infecciones del aparato reproductor son consideradas una demanda importante para la salud de la mujer, por su alta prevalencia en la población y las consecuencias que pueden ocasionar, como parto prematuro, infertilidad y cáncer de cuello uterino. Todavía hay mujeres que no se hacen un examen citopatológico, capaz de prevenir estas infecciones, ya sea por falta de orientación o de oportunidad, como las mujeres quilombolas. Este estudio tuvo como objetivo identificar los factores asociados a las infecciones cervicovaginales en mujeres quilombolas de Feira de Santana, Bahia. Métodos: estudio descriptivo, realizado de forma transversal y con enfoque cuantitativo. La recolección de datos se realizó de noviembre de 2019 a enero de 2020, con la aplicación de un formulario de anamnesis elaborado por el equipo, con variables utilizadas en otros estudios, como los factores de riesgo. Se realizó análisis bivariado para obtener razones de prevalencia (RP) entre las infecciones y las características encontradas. Resultados: se estudiaron un total de 82 mujeres, con una edad promedio de 45,3 años. Las principales infecciones vaginales fueron causadas por Gardnerella vaginalis (17,1%), Trichomonas vaginalis (8,5%), Cocci (8,5%), Candida spp. (6,2%) y Fusobacterium spp. (1,2%). En el 88,2% de las mujeres infectadas hubo inflamación. Conclusión: los resultados obtenidos en este estudio mostraron una correlación entre el proceso inflamatorio en la mujer y la presencia de alguna infección. En cuanto a las infecciones, hubo mayor prevalencia en mujeres con baja escolaridad, sin pareja estable y que no realizaban examen preventivo periódico.(AU)

Cytological features of a complete hydatidiform mole in a cervicovaginal smear: A case report.

Exfoliated trophoblastic cells can be seen in a cervicovaginal smear in cases of normal pregnancy or gestational trophoblastic disease (GTD) and can mimic high-grade squamous intraepithelial lesion (HSIL) or malignancy. Although they appear highly anaplastic, cytological features such as high nuclear to cytoplasmic ratio, irregular nuclear contours and scanty basophilic cytoplasm admixed with cytologically benign squamoid and endocervical cells can aid in differentiating them from malignant cells. We present a case of a 37-year-old woman with abnormal uterine bleeding for 3-months. There was no history of recent pregnancy or previous GTD. Her cervicovaginal smear showed a hypercellular smear exhibiting cytologically benign superficial and intermediate squamous cells along with clusters of benign endocervical cells with interspersed mononucleate cells. These mononucleate cells were large, with a hyperchromatic, pleomorphic nuclei, and scant basophilic cytoplasm. Cytological features were suggestive of trophoblastic cells and workup for pregnancy and GTD was advised. Her laboratory investigations showed markedly raised levels of ß human chorionic gonadotropins (ß-HCG) and ultrasound showed a uterine mass with snowstorm appearance. A uterine evacuation was performed after which histopathological examination showed microscopic features consistent with a complete hydatidiform mole. The rare presence of trophoblastic cells in a cervicovaginal smear can easily be confused with malignant cells and can be misleading to the pathologist. Trophoblastic cells should always be kept in mind when evaluating a cytology smear of a young patient irrespective of gestational status.

Direct and Indirect Measurements of Sex Hormones in Rodents During Fear Conditioning.

Fear conditioning (FC) is a widely accepted tool for the assessment of learning and memory processes in rodents related to normal and dysregulated acquired fear. The study of sex differences in fear learning and memory is vast and currently increasing. Sex hormones have proven to be crucial for fear memory formation in males and females, and several methods have been developed to assess this hormonal state in rats and mice. Herein, we explain a routine FC and extinction protocol, together with the evaluation of sex hormonal state in male and female rodents. We explain three protocols for the evaluation of this hormonal state directly from blood samples extracted during the procedure or indirectly through histological verification of the estrous cycle for females or behavioral assessment of social hierarchies in males. Although females have typically been considered to present great variability in sex hormones, it is highlighted that sex hormone assessment in males is as variable as in females and equally important for fear memory formation. The readout of these protocols has had a great impact on different fields of fear learning and memory study and appears essential when studying FC. The proven interaction with drugs involved in the modulation of these processes makes sex hormone assessment during FC a valuable tool for the development of effective treatments for fear-related disorders in men and women. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Fear conditioning and fear extinction Basic Protocol 2: Blood collection for direct measurement of sex hormone levels in fear conditioning Basic Protocol 3: Indirect measurement of sex hormones in females during fear conditioning Basic Protocol 4: Assessment of dominance status in males before a fear conditioning protocol Support Protocol: Construction of a confrontation tube.

Reproductive cycle stage assessment using vaginal cytology evaluation in African lions (Panthera leo).

Vaginal cytology evaluation is an economic, non-invasive technique for indirect monitoring of fluctuations in estrogen concentrations, and thus progression of the estrous cycle. This technique is widely used in domestic dogs for determining timing of artificial insemination. There, however, are only a few reports on the vaginal cytology of non-domestic felids, including lions. This study was conducted, therefore, to describe the vaginal epithelial changes throughout the reproductive cycle of African lions, and to investigate the efficacy of vaginal cytology assessments for predicting reproductive stages. During a 12-month period, reproductive behavioral data and vaginal swabs were collected daily from five lionesses. In total, 541 vaginal smears were evaluated for the proportion of mucosal epithelial cells, neutrophils, bacterial cells, and amount of mucous, cellular debris. One single swab with a large proportion of superficial cells, absence of neutrophils, large number of bacteria, without cellular debris was sufficient for detecting lionesses in estrus. Likewise, one cytology sample with a large proportion of parabasal and intermediate cells, few neutrophils, few bacteria, and large amount of mucous, cellular debris enabled detection of females in advanced diestrus or gestation. To distinguish lionesses in early diestrus from those in an inter-estrous period, at least two consecutive swabs were necessary for satisfactory classification. Overall, evaluation of vaginal cytology samples was an effective technique for differentiation among different stages of the reproductive cycle, confirmation of estrus, and pregnancy diagnosis in lionesses. This technique, therefore, has the potential for application in classifying different stages of the reproductive cycle in other feline species.

Análise comparativa dos resultados de exames colpocitológicos realizados em Governador Valadares-MG com aqueles realizados no país, região sudeste e Minas Gerais / Comparative analysis of the cervical cytopathological examination results carried out in Governador Valadares-MG with those conducted in the country, southeast region and Minas Gerais state

Objetivo: O objetivo desse estudo foi comparar resultados de exames colpocitológicos realizados em âmbito nacional, na região sudeste e em Minas Gerais com aqueles obtidos no município de Governador Valadares (GV). Métodos: As informações sobre exames colpocitológicos, realizados nas quatro esferas, de janeiro/2006 a dezembro/2014, foram obtidas na consulta ao Sistema de Informação do Câncer do Colo do Útero ­ Siscolo. Resultados: A taxa de exames alterados foi de 2,8%, 3,3%, 2,2% e 2,7% [Brasil, Sudeste, Minas Gerais (MG) e GV, respectivamente]. Essa taxa foi significativamente mais alta em GV quando comparada com MG e significativamente mais baixa que a da região sudeste e do Brasil. As principais alterações, em todas as esferas, foram: atipias em células escamosas de significado indeterminado possivelmente não neoplásicas, lesão intraepitelial escamosa de baixo grau e lesão intraepitelial escamosa de alto grau. As taxas de incidência de câncer do colo do útero foram: 27,03; 28,02; 16,99 e 23,16 casos por 100 mil habitantes no país, região sudeste, MG e GV, respectivamente. Governador Valadares apresentou uma taxa significativamente mais alta apenas quando comparada com dados de Minas Gerais. Conclusão: Concluindo, os exames realizados em GV mostram algumas diferenças significativas em relação às outras esferas. É necessário implementar uma política de monitoramento interno da qualidade para aumentar a sensibilidade do exame, além de maior investimento na educação continuada do profissional que faz a leitura das lâminas.

Objective: Cervical cancer is one of the leading causes of cancer death in women and can be prevented by the early detection of precursor lesions by cytological techniques. The objective of this study was to compare the results of colpocytological exams performed at national, regional and state level with those obtained at Governador Valadares (GV). Methods: Information was obtained on colpocytological exams performed in the four spheres, from January / 2006 to December / 2014, from the Cervical Cancer Information System ­ Siscolo. Results: The rate of altered exams was 2.8%, 3.3%, 2.2% and 2.7% [Brazil, Southeast, Minas Gerais (MG) and GV, respectively]. This rate was significantly higher in GV when compared to MG and significantly lower than that in the Southeast and Brazil. The main injuries in all spheres were: atypical squamous cells of undetermined significance, possibly non-neoplastic, low grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion. The incidence rates of cervical cancer were: 27.03; 28.02; 16.99 and 23.16 cases per 100,000 inhabitants in the country, southeast region, MG and GV, respectively. GV showed a significantly higher rate only when compared with MG data. Conclusion: Concluding, the exams carried out in GV show some significant differences in relation to the other spheres. It is necessary to implement an internal quality monitoring policy to improve the quality of the exam, besides greater investment in the continuing education of the professional who does the scrutiny of the blades.

Comparison of urine, self-collected vaginal swab, and cervical swab samples for detecting human papillomavirus (HPV) with Roche Cobas HPV, Anyplex II HPV, and RealTime HR-S HPV assay.

BACKGROUND: Human papillomavirus (HPV) is well established as the main cause of cervical cancer. Non-invasive self-collected urine and vaginal sampling have the potential advantage of increasing patient compliance with cervical cancer screening. METHODS: Self-collected vaginal and urine samples and clinician-collected cervical samples were collected from 101 patients, including 84 patients with high grade squamous intraepithelial lesion and 17 patients with benign ovarian disease. Each sample was evaluated with RealTime HR-S HPV, Anyplex™ II HPV, and Cobas® HPV assays. The concordance of urine and of self-collected vaginal samples with cervical samples was assessed using the kappa (k) statistic. RESULTS: In any high-risk HPV (hrHPV), the concordance of self-collected vaginal and urine samples compared to cervical samples was moderate (k 0.49-0.58) and fair to moderate (k 0.33-0.51), respectively. In HPV 16/18, the concordance of vaginal and urine samples compared to cervical samples was almost perfect (k 0.81-0.86) and moderate to substantial (k 0.59-0.63), respectively. Among the three methods for HPV detection, RealTime HR-S showed the highest concordance with vaginal (k: any hrHPV 0.58, HPV 16/18 0.86) and urine samples (k: any hrHPV 0.51, HPV 16/18 0.63) compared to cervical samples. CONCLUSION: HPV tests using self-collected vaginal samples and urine showed substantial and moderate agreement compared with cervical samples, respectively, although HPV tests using these samples were still inferior to clinician-collected cervical samples. Further research is needed on the clinical performance of HPV testing using urine and self-collected vaginal samples as the screening method.

Regulation of estrous cycle by Cynodon dactylon in letrozole induced polycystic ovarian syndrome in Wistars albino rats.

Menstrual cycle is controlled by luteinizing hormone (LH) and follicle-stimulating hormone of anterior pituitary and regulated by gonadotropin-releasing hormone of hypothalamus. Any disturbance to this regulatory mechanism alters the pulsatile release of these hormones, especially LH; leads to polycystic ovarian syndrome (PCOS). Changes in vaginal cytology are used to interpret the changes in hormonal levels and modifications in estrous cycle. The aim of this study is to compare the pattern of vaginal cytology and body mass among PCOS rats which are treated with metformin and Cynodon dactylon. Twenty-four Wistar rats were selected and divided into four groups: control, induced, treatment, and referral. PCOS was induced in all groups except controls by giving letrozole through oral gavage for 21 days. After inducing PCOS, the referral and treatment group were treated for PCOS with metformin and C. dactylon respectively for next 21 days. Vaginal smear of all the groups were taken every day from day one and screened for estrous cycle. The body mass of the animals was measured on days 1, 21, and 42. Animals were sacrificed after 24 hours of the last dose and the reproductive organs were dissected out and weighed. Results of the study show the estrous cycle begins to revert after 1-week administration of C. dactylon; while the changes were slower in referral group. There was a rapid decrease in the body mass as well as reproductive organs among the treatment and referral group compared to that of induced and control. Finding of this study suggests that C. dactylon treats PCOS better than metformin.

Regulation of estrous cycle by Cynodon dactylon in letrozole induced polycystic ovarian syndrome in Wistars albino rats / 대한해부학회지

Evaluation of the usefulness of a device for Human Papilloma Virus DNA collection and reservation in self-collected cervicovaginal samples stored dry in women with cervical dysplasia, Bogotá, Colombia / Evaluación de la utilidad de un dispositivo para toma y preservación del ADN del virus del papiloma humano de muestras cérvico-vaginales autorrecolectadas y almacenadas en seco en mujeres con displasia cervical, Bogotá, Colombia

ABSTRACT Objective: To evaluate the usefulness of a device for collecting and preserving human papilloma virus (HPV) DNA in self-collected vaginal samples stored dry during 14 days. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Materials and methods: Diagnostic concordance pilot study that included non-pregnant women over 25 years of age with a biopsy-confirmed result of cervical intraepithelial neoplasia (CIN) grade 1 or more, coming to two referral centres in Bogotá, Colombia. Women with a history of total hysterectomy were excluded. Convenience sampling was used. The device uses real-time PCR (polymerase chain reaction) for DNA detection. Sociodemographic and clinical variables were measured, as well as the results of the test when the sample was collected by the patient and when it was collected by the physician, and the amount of DNA in the samples taken and processed on day 1, and in those processed on day 14, using Ct thresholds. Descriptive statistics were applied. Overall concordance was estimated by means of the kappa coefficient and mean differences in DNA amount. Results: A kappa coefficient of 0.84 (95% CI: 0.71-0.96) was found for concordance in high-risk HPV detection between the self-collected cervicovaginal sample and the sample taken by the clinician. There were no differences in terms of the amount of viral DNA between day 1 and day 14 (DM -0.34 cycles; 95% CI: - 2.29 to 1.61). Conclusion: Self-collected vaginal samples using the storage device are reliable for high-risk HPV detection in patients with cervical dysplasia, and preserve viral DNA for 14 days if stored dry at room temperature. Confirmation studies in the general population are required.

RESUMEN Objetivo: Evaluar la utilidad de un dispositivo para toma y preservación del DNA del virus del papiloma humano (VPH) de muestras vaginales recolectadas por autotoma y almacenadas en seco durante 14 días. Materiales y métodos: Estudio piloto de concordancia diagnóstica. Se incluyeron mujeres mayores de 24 años no gestantes con un resultado de neoplasia intraepitelial cervical (NIC) grado 1 o más, confirmado por biopsia en dos instituciones de referencia en Bogotá, Colombia. Se excluyeron mujeres con antecedente de histerectomía total. Se realizó un muestreo por conveniencia. El dispositivo utiliza PCR (reacción en cadena de la polimerasa) en tiempo real para detección del ADN. Se midieron variables sociodemográficas y clínicas, así como el resultado de la prueba por autotoma y tomada por el médico, y la cantidad de ADN de las muestras tomadas el día 1 procesadas ese día, y el día 14, por medio del Ct umbral. Se realizó estadística descriptiva. Se calculó la concordancia global por medio del índice de kappa ponderado y la diferencia de medias de la cantidad de ADN. Resultados: La concordancia en la detección de VPH de alto riesgo mostró un kappa = 0,84 (IC 95 %: 0,71-0,96) entre la muestra cervicovaginal recolectada por autotoma frente a la muestra cervical recolectada por el médico. No hubo diferencias en la cantidad de ADN viral entre el día 1 y el 14 (DM -0,34 ciclos; IC 95 %: -2,29 a 1,61). Conclusión: Las muestras vaginales recolectadas por autotoma usando el dispositivo de almacenamiento son confiables para la detección de VPH de alto riesgo en pacientes con displasia cervical, y preservan el ADN viral por 14 días si se almacenan en seco a temperatura ambiente. Se requieren estudios en población general para poder confirmar.

Experimental validation of a rapid staining method and digital cytology for cervical and anal cancer / Validação experimental de um método de coloração rápida e citologia digital para cancro ginecológico e anal

ABSTRACT Cytology is used as detection and screening method of malignant and pre-malignant lesions showing their potential since the original works of Papanicolaou. The cytological smears are usually stained with the Pap staining, although this method is time consuming and requires different reagents. The aim of this study is to assess the quality of an original Blue staining in exfoliative smears comparing it with the standard Papanicolaou staining. The new Blue staining allows staining gynecological cytology with high quality standards at reduced cost and time when compared to the Papanicolaou method.

RESUMO A citologia é utilizada como método de detecção e rastreio de lesões malignas e pré-malignas e mostra seu potencial desde os trabalhos originais de Papanicolaou. Geralmente, os esfregaços citológicos são corados com a coloração de Papanicolaou, apesar desse método exigir muito tempo e vários reagentes. O objetivo deste estudo é avaliar a qualidade de uma coloração original Blue Stain em esfregaços esfoliativos comparando-a com a coloração standard de Papanicolaou. O novo método de coloração Blue Stain permite corar citologias ginecológicas com elevados padrões de qualidade a um custo e tempo reduzidos quando comparado com o método de Papanicolaou.

Dificuldades enfrentadas pelas mulheres para realizar o exame papanicolau: revisão integrativa / Difficulties faced by women to perform the pap smear examination: integrative review

Objetivo: buscar as evidencias cientificas das principais dificuldades enfrentadas pelas mulheres, para realizar o exame Papanicolau. Método: Revisão integrativa, realizada nos meses de abril e maio de 2017 nas bases de dados on-line Scielo e LILACS no período de 2006 a 2016. Para a pesquisa, utilizou-se o cruzamento do descritor “esfregaço vaginal” com a palavra-chave “câncer”,utilizando o boleando “and” entre as palavras. Foram encontrados 573 artigos, 51 do Scielo e 523 do Lilacs, sendo selecionados 25 e excluídos 549, com a associação dos descritores. Resultados: Percebeu-se que muitas mulheres ainda são resistentes em realizar esse tipo de exame por conceitos e valores culturais que foram absorvidos por toda a vida. Conclusão: Portanto, a partir do conhecimento desses fatores de dificuldade na realização do exame preventivo, considera-se essencial para as mulheres a adoção de uma nova postura para prevenção de doenças.

Objective: to search the scientific evidences of the main difficulties faced by women, to perform the Papanicolau exam. Method: Integrative review, carried out in the months of April and May 2017 in the online databases Scielo and LILACS from 2006 to2016. For the research, the cross-reference of the descriptor "vaginal smear" key "cancer", using the "and" between the words. Wefound 573 articles, 51 of Scielo and 523 of Lilacs, being selected 25 and excluded 549, with the association of the descriptors. Results: It was noticed that many women are still resistant to this type of examination by cultural concepts and values that have been absorbedthroughout life. Conclusion: Therefore, considering the knowledge of these factors of difficulty in performing the preventive examination,it is considered essential for women to adopt a new posture for disease prevention.

Objetivo: Buscar las evidencias científicas de las principales dificultades enfrentadas por las mujeres, para realizar el examen Papanicolau. Método: Revisión integrativa, realizada en los meses de abril y mayo de 2017 en las bases de datos en línea Scielo y LILACSen el período de 2006 a 2016. Para la investigación, se utilizó el cruce del descriptor "frotis vaginal" con la palabra- clave "cáncer",utilizando el boleando "and" entre las palabras. Se encontraron 573 artículos, 51 del Scielo y 523 del Lilacs, siendo seleccionados 25y excluidos 549, con la asociación de los descriptores. Resultados: Se percibió que muchas mujeres todavía son resistentes en realizarese tipo de examen por conceptos y valores culturales que fueron absorbidos por toda la vida. Conclusión: Por lo tanto, a partir del conocimiento de estos factores de dificultad en la realización del examen preventivo, se considera esencial para las mujeres la adopción de una nueva postura para la prevención de enfermedades.

Self-sampling with HPV mRNA analyses from vagina and urine compared with cervical samples.

BACKGROUND: In order to increase coverage in the organized cervical screening program, self-sampling with HPV analyses has been suggested. OBJECTIVES: The aim was to compare human papillomavirus (HPV) mRNA detection in vaginal and urine self-collected samples with clinician-taken cervical samples and the corresponding clinician-taken histological specimens. STUDY DESIGN: Self-collected vaginal, urine and clinician-taken cervical samples were analyzed from 209 women with the Aptima mRNA assay (Hologic Inc, MA, USA). Cervical cytology, colposcopy, biopsy and/or the loop electrosurgical excision procedure (LEEP) were performed in every examination. RESULTS: The sensitivity of the HPV mRNA test in detecting high-grade squamous intraepithelial lesions (HSIL)/adenocarcinoma in situ (AIS)/cancer cases was as follows: for the vaginal self-samples 85.5% (95% CI; 75.0-92.8), the urinary samples 44.8% (95% CI; 32.6-57.4), and for routine cytology 81.7% (95% CI; 70.7-89.9). For the clinician-taken cervical HPV samples the sensitivity of the HPV mRNA test in detecting HSIL/AIS/cancer was 100.0% (95% CI; 94.9-100.0). The specificity of the HPV mRNA was similar for the clinician-taken cervical HPV samples and the self-samples: 49.0% vs. 48.1%. The urinary HPV samples had a specificity of 61.9% and cytology had a specificity of 93.3%. CONCLUSION: The sensitivity of the Aptima HPV mRNA test in detecting HSIL/AIS/cancer from vaginal self-samples was similar to that of routine cytology. The Aptima HPV mRNA vaginal self-sampling analysis may serve as a complement in screening programs.

Safety and acceptability of human papillomavirus testing of self-collected specimens: A methodologic study of the impact of collection devices and HPV assays on sensitivity for cervical cancer and high-grade lesions.

BACKGROUND: Comparative data on different self-collection methods is limited. OBJECTIVES: To assess the impact of hrHPV testing of two self-collection devices for detection of cervical carcinoma and high-grade lesions. STUDY DESIGN: Three hundred ten patients collected two cervicovaginal specimens using a brush (Evalyn®Brush) and a swab (FLOQSwabs™), and filled a questionnaire at home. Then, a physician at the clinic took a cervical specimen into PreservCyt® buffer for hrHPV testing and cytology. All specimens were tested using Anyplex™ II HPV28, Cobas® 4800 HPV Test and Xpert®HPV. RESULTS: Performance comparison included 45 cervical carcinomas and 187 patients with premalignant lesions. Compared to the physician-specimen, hrHPV testing of Evalyn®Brush showed non-inferior sensitivity for CIN3+ (relative sensitivity of Anyplex™ 0.99; Cobas® 0.96; Xpert®HPV 0.97) while hrHPV testing of FLOQSwabs™ showed inferior sensitivity (relative sensitivity of Anyplex™ 0.91; Cobas® 0.92; Xpert®HPV 0.93). Similar results were observed for invasive carcinomas albeit that FLOQSwabs™ was statistically non-inferior to the physician-specimen. Self-collection by either Evalyn®Brush or FLOQSwabs™ was more sensitive for CIN3+ than LSIL or worse cytology. Significant decrease in sensitivity for CIN3+ were observed for FLOQSwabs™ when specimens were preprocessed for hrHPV testing after 28 days. Both devices were well accepted, but patients considered Evalyn®Brush easier and more comfortable than FLOQSwabs™. CONCLUSIONS: Self-collection is comparable to current screening practice for detecting cervical carcinoma and CIN3+ but device and specimen processing effects exist. Only validated procedure including collection device, hrHPV assay and specimen preparation should be used.

Avaliação das taxas de adequabilidade dos laudos citopatológicos de mulheres atendidas pelo SUS no município de Anápolis-GO / Evaluation of suitability rates of the women's cytopathology reports attended by the SUS on the Anapolis-GO

O exame citopatológico é o método mais difundido mundialmente para o rastreamento do câncer do colo do útero e suas lesões precursoras, sua vulnerabilidade aos erros de coleta e de preparação da lâmina. A subjetividade na interpretação dos resultados pode comprometer sua sensibilidade e especificidade. Este trabalho teve como objetivo avaliar as taxas de adequabilidade dos laudos citopatológicos de cérvice uterina em exames realizados pelo Sistema Único de Saúde (SUS) na cidade de Anápolis-GO em dois anos, bem como especificar os principais fatores obscurecedores de amostra. A amostra foi composta pelo levantamento de laudos citopatológicos de cérvice uterina em pacientes atendidas pelo SUS no município de Anápolis-GO nos anos de 2012 e 2013 nas bases de dados do Data-SUS e do Programa Siscolo. A taxa de laudos insatisfatórios foi de 3,4/1000 laudos (IC 95% 2,4 - 4,6) e 4,9/1000 laudos (IC 95% 3,9 - 6,1) para os anos de 2012 e 2013, respectivamente. A taxa geral do estudo para laudos insatisfatórios foi de 4,3/1000 laudos (IC 95% 3,5 - 5,1). O principal fator responsável pelos laudos insatisfatórios foi a presença de artefatos de dessecamento tanto na taxa geral, com 2,1/1000 laudos (IC 95% 1,7 ­ 2,8), quanto na estratificação anual, com 1,8/1000 laudos (IC 95% 1,2 ­ 2,7) em 2012 e 2,4/1000 laudos (IC 95% 1,7 ­ 3,3) em 2013. Estes achados indicam que as ações de educação continuada com os profissionais que realizam a coleta do exame preventivo são de fundamental importância, já que os fatores mais visualizados são passíveis de correção.(AU)

The cytopathological exam is the most used method around the globe in screening for cancer of the cervix and its precursor lesions. The vulnerability to collection errors, preparation of the glass and the subjectivity in the interpretation of the results can impact the sensibility and specificity of the exam. This article aims to avaliate the adequacy rates of cytopathological reports in uterine cervix by the Health Unic System (HUS) in Anapolis-GO in two years, as well as specify the main obscuring factors of the sample. The sample was taken by the cytopathological reports in uterine cervix treated by HUS in the city of Anapolis-GO between 2012 and 2013 on HUS database and Siscolo Program. The rate on unsatisfying reports was 3,4/1000 reports (IC 95% 2,4 ­ 4,6) and 4,9/1000 reports (IC 95% 3,9 ­ 6,1) between 2012 e 2013. The general rate on unsatisfying reports was 4,3/1000 reports (IC 95% 3,5 ­ 5,1). The main factor responsible for inadequate reports was the presence of artifacts from desiccation on the general rate at 2,1/1000 reports (IC 95% 1,7 ­ 2,8), as well on the annual stratification at 1,8/1000 reports (IC 95% 1,2 ­ 2,7) in 2012 and 2,4/1000 reports (IC 95% 1,7 ­ 3,3) in 2013. These findings reveal that continuing education activities with the professionals who perform the collection of the screening test are highly important, once that the findings are likely to correct.(AU)

Inflammatory cells in liquid-based cytology smears classified as bacterial vaginosis.

BACKGROUND: Bacterial vaginosis (BV) remains an enigmatic question. The term "osis" instead of "itis" is used because commonly, there are no inflammatory process associated with BV. However, leukocytes are often observed in it. METHODS: In a transversal study, we evaluated 1178 cases with diagnosis of BV by liquid-based cytology (more than 20% of clue cells), attended in general gynecologic private clinic. Depending of the presence of more than five leukocytes on average per field in immersion objective (1000×), the cases were divided in two groups: few or no leukocytes (< 5 leukocytes per field) (BV) and with leukocytes (≥ 5 leukocytes per field) (BV-L). The Fisher exact and Student t tests was applied to a confidence interval of 95%. The project was approved by the Ethic Committee of Federal University of Ceará, Brazil. RESULTS: The age between the groups was the only different socio-demographic variable. The assessment of vaginal discharge aspect had no characteristic aspect. Colposcopy findings suggesting colpitis and ectopy were more frequent in the group of BV-L, 7.1% and 6.9%, respectively. The study of the microbiology demonstrated in the BV-L group, more frequently co-occurrence of Candida sp (15.1%) than in BV group (1.5%) (P < .0001). The cellular atypia was present more frequently in the BV-L (9.6%) than in BV (5.7%) (P = .0116). CONCLUSION: The presence of leukocytes in BV (or BV-L) may suggest a mixed infection, ectopy influencing the vaginal milieu and even epithelial atypia.