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

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

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

Clinical-epidemiological characterization of human anal papilloma virus infection coloproctology unit: Central University Hospital Dr. "Antonio Maria Pineda"

Human papillomavirus (HPV) infection is one of the most common sexually transmitted viral diseases. A descriptive cross-sectional study was conducted with the purpose of clinically and epidemiologically characterizing anal HPV infection in patients who attended the Benign Orificial Pathology Consultation of the Coloproctological Unit at the Dr. "Antonio María Pineda" Central University Hospital, during the period March 2022 -February 2023, by selecting 288 patients whose average age was 47.09 ± 14.61 years, being the 41-50 years old group (29.17%) and the 51-60 years old group (19.44%) the most affected groups by pathologies of the anal region, with a predominance of male (54.17%). The sociodemographic characteristics with the highest frequency included married (48.61%) and single (47.22%); secondary level of education (44.44%) and traders (18.05%) and housewives (15, 28%) as predominant occupations. The risk factors were represented by onset of sexual intercourse between 16-20 years of age (65.28%), heterosexuality (91.67%), 22.22% reported having anal sex and 5.56% oral sex. Likewise, 5.56% were reported with a history of genital HPV and 4.17% were HIV positive. In addition, 48.61% stated not to use condoms. The initial clinical diagnosis included hemorrhoidal disease (30.55%), anal fistula (25%) and anal fissure (18.05%), and one patient (1.39%) with anal HPV infection. Anal cytology results showed 8.33% flat epithelial cells with cytopathic changes suggestive of HPV infection and 1.39% squamous cells with cytopathic changes suggestive of HPV infection: 50% mild inflammatory negative for malignancy and 33.33% flat epithelial cells without atypia. In conclusion, the anal cytology investigation should continue to determine the actual frequency of anal HPV infection. (AU)

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

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

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

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features / Modelo preditivo para diferenciação entre nódulos malignos e benignos da tireoide com base na idade, sexo e características ultrassonográficas

Abstract Introduction: A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective: The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods: Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results: In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions: The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

Resumo Introdução: Persiste na literatura uma discussão sobre uma ferramenta padronizada de apoio à decisão para o manejo de nódulos tireoidianos. Objetivo: Criar um modelo de previsão estatística para o manejo de nódulos tireoidianos. Método: Foram selecionados 204 casos de nódulos tireoidianos benignos e 57 malignos para o estudo retrospectivo. As variáveis idade, sexo e características ultrassonográficas foram analisadas com modelos univariados e multivariados. Uma fórmula estatística foi usada para calcular o risco de câncer de cada caso. Resultados: Na análise multivariada, a forma irregular, a ausência de halo, menor idadesubp média, ecotextura homogênea, microcalcificações e conteúdo sólido foram associadas ao câncer. Após a aplicação da fórmula, foram encontrados 20 casos (7,6%) com risco calculado de malignidade ≤ 3,0%, todos benignos. Definiu-se o risco calculado em ≥ 80%, 21 casos (8,0%) foram selecionados e em 85,7% deles o câncer foi confirmado pela histopatologia. A precisão interna da fórmula de previsão foi de 92,5%. Conclusões: A fórmula de previsão alcançou alta precisão e pode ser uma opção para outras ferramentas de apoio à decisão para o manejo de nódulos da tireoide.

Relation between anaemia and bone marrow features and serum erythropoietin in dogs with chronic kidney disease / Relação entre anemia e achados de medula óssea e eritropoetina sérica em cães com doença renal crônica

Chronic anaemia is one of the most severe complications of chronic kidney disease, contributing to morbidity and mortality caused by the disease; therefore, bone marrow cytological evaluation is needed to monitor the progression of anaemia. This study aimed to correlate the anaemia in dogs at different stages of chronic kidney disease with their serum biochemistry, myelogram results and serum erythropoietin findings. Sixty-three dogs were grouped according to International Renal Interest Society (IRIS) classification in stages 1, 2, 3 and 4. Haematologic, serum and urinary biochemistry and serum erythropoietin were performed for comparison with the findings of bone marrow cytology obtained by aspiration of the manubrium. Cytological findings for erythroid hypoplasia were described in 93.65% of dogs, and the anaemia was observed in 84.1% of them. The haematological findings were correlated with azotaemia (p<0.05). It was concluded that the erythroid hypoplasia has correlation with persistent anaemia in dogs at all stages of chronic kidney disease, with iron deficiency in dogs in the early stages and with peripheral destruction of erythrocytes caused by azotaemia.(AU)

A anemia crônica é umas das complicações mais graves da doença renal crônica, contribuindo para a morbidade e mortalidade causada pela doença; Portanto, a avaliação citológica da medula óssea é necessária para monitorar a progressão da anemia. Assim, esse estudo objetivou correlacionar a anemia em cães em diferentes estágios da doença renal crônica aos achados de bioquímica sérica, mielograma e concentração sérica de eritropoietina. Sessenta e três cães foram agrupados de acordo com a classificação da International Renal Interest Society (IRIS) em estágios 1, 2, 3 e 4. Foram realizadas análises hematológicas, bioquímicas séricas e urinárias, e dosagem sérica de eritropoetina para comparação com os achados medulares obtidos por citologia aspirativa do manúbrio. Os achados citológicos de hipoplasia eritróide foram descritos em 93,65% dos cães, e a anemia foi observada em 84,1% dos cães. Os resultados hematológicos foram correlacionados com azotemia (p<0,05). Concluiu-se que a hipoplasia eritróide teve associação com a anemia persistente em cães em todas as fases de doença renal crônica, com deficiência de ferro em cães em fases iniciais e com a destruição periférica dos eritrócitos causada pela azotemia.(AU)

Inflammatory and immunological profiles in patients with COPD: relationship with FEV 1 reversibility / Perfil inflamatório e imunológico em pacientes com DPOC: relação com a reversibilidade do VEF 1

ABSTRACT Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.

RESUMO Objetivo: Determinar se a gravidade da DPOC se correlaciona com a contagem de células no escarro, atopia e asma. Métodos: Estudo transversal com 37 pacientes com DPOC e 22 indivíduos saudáveis com função pulmonar normal (controles). As contagens de células no escarro foram determinadas por microscopia após a centrifugação das amostras. Foram realizados testes cutâneos de puntura, e as citocinas séricas foram determinadas por ELISA. Resultados: Os pacientes foram estratificados pela resposta ao broncodilatador: o grupo de limitação ao fluxo aéreo não reversível (LFAnr) envolveu 24 pacientes sem alteração significativa do VEF1 pós-broncodilatador, e o grupo de limitação ao fluxo aéreo parcialmente reversível (LFApr) envolveu 13 pacientes com reversibilidade do VEF1 (aumento do VEF1 pós-broncodilatador ≥ 12%). A proporção de eosinófilos no escarro foi maior no grupo LFApr do que no LFAnr (p < 0,01), e houve uma correlação inversa entre a proporção de eosinófilos e VEF1 (p < 0,05). Entretanto, nenhum dos pacientes apresentou histórico de asma e os resultados dos testes cutâneos não diferiram entre os dois grupos. Nas amostras de escarro dos pacientes, os neutrófilos predominaram. Os níveis séricos de TNF, IL-6, IL-8 e RANTES (CCL5) foram maiores nos pacientes que nos controles (p < 0,001), mas não diferiram entre os dois grupos de pacientes. Conclusões: Pacientes com DPOC e reversibilidade parcial do VEF1 parecem apresentar maiores contagens de eosinófilos no escarro e maior hiper-responsividade das vias aéreas que aqueles sem reversibilidade do VEF1. Entretanto, a gravidade da DPOC não se correlacionou com atopia ou perfil das citocinas.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure / Relações Neutrófilo-Linfócito e Plaqueta-Linfócito Como Preditores de Insuficiência Cardíaca

Abstract Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up. Methods: This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization. Results: The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average. Conclusion: NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.

Resumo Fundamentos: A obesidade mórbida está diretamente relacionada à deterioração da capacidade cardiorrespiratória, incluindo alterações na modulação autonômica cardiovascular. Objetivo: Este estudo teve por objetivo avaliar a função autonômica cardiovascular de obesos mórbidos. Métodos: Estudo transversal, incluindo dois grupos, Grupo I, composto por 50 obesos mórbidos, e Grupo II, por 30 indivíduos não obesos. A função autonômica foi avaliada pela variabilidade da frequência cardíaca no domínio do tempo [desvio padrão de todos os intervalos R-R normais (SDNN); desvio-padrão de todos os intervalos R-R normais (SDNN); raiz quadrada das médias quadráticas das diferenças dos intervalos R-R sucessivos (RMSSD); e o percentual de diferenças de intervalo intervalos R-R sucessivos maior que 50 milissegundos (pNN50)] em comparação ao adjacente, e no domínio da frequência (HF, do inglês, “high frequency”, e LF, do inglês, “low frequency”: integração da função da densidade espectral de potência para as bandas de alta e baixa frequência, respectivamente). Os grupos foram comparados pelo teste t de Student, considerando-se um nível de significância de 5%. Resultados: Quando comparados aos controles, os indivíduos obesos apresentaram valores menores de SDNN (40,0 ± 18,0 ms vs. 70,0 ± 27,8 ms; p = 0,0004), RMSSD (23,7 ± 13,0 ms vs. 40,3 ± 22,4 ms; p = 0,0030), pNN50 (14,8 ± 10,4 % vs. 25,9 ± 7,2%; p = 0,0061) e HF (30,0 ± 17,5 Hz vs. 51,7 ± 25,5 Hz; p = 0,0023). A relação LF/HF média foi maior no Grupo I (5,0 ± 2,8 vs. 1,0 ± 0,9; p = 0,0189), refletindo alteração no equilíbrio simpato-vagal. Não houve diferença estatística entre os grupos I e II com relação ao índice LF (50,1 ± 30,2 Hz vs. 40,9 ± 23,9 Hz; p = 0,9013). Conclusão: obesos mórbidos apresentam aumento de atividade simpática e redução da atividade parassimpática, caracterizando uma disfunção autonômica cardiovascular.

Comparison of conventional Papanicolaou cytology samples with liquid-based cervical cytology samples from women in Pernambuco, Brazil

In the present study, we compared the performance of a ThinPrep cytological method with the conventional Papanicolaou test for diagnosis of cytopathological changes, with regard to unsatisfactory results achieved at the Central Public Health Laboratory of the State of Pernambuco. A population-based, cross-sectional study was performed with women aged 18 to 65 years, who spontaneously sought gynecological services in Public Health Units in the State of Pernambuco, Northeast Brazil, between April and November 2011. All patients in the study were given a standardized questionnaire on sociodemographics, sexual characteristics, reproductive practices, and habits. A total of 525 patients were assessed by the two methods (11.05% were under the age of 25 years, 30.86% were single, 4.4% had had more than 5 sexual partners, 44% were not using contraception, 38.85% were users of alcohol, 24.38% were smokers, 3.24% had consumed drugs previously, 42.01% had gynecological complaints, and 12.19% had an early history of sexually transmitted diseases). The two methods showed poor correlation (k=0.19; 95%CI=0.11–0.26; P<0.001). The ThinPrep method reduced the rate of unsatisfactory results from 4.38% to 1.71% (χ2=5.28; P=0.02), and the number of cytopathological changes diagnosed increased from 2.47% to 3.04%. This study confirmed that adopting the ThinPrep method for diagnosis of cervical cytological samples was an improvement over the conventional method. Furthermore, this method may reduce possible losses from cytological resampling and reduce obstacles to patient follow-up, improving the quality of the public health system in the State of Pernambuco, Northeast Brazil.

Citologia e histopatologia de pacientes assistidas em um centro de saúde da mulher / Cytology and Histopathology of patients assisted in a woman health center

O carcinoma de colo do útero é o segundo mais frequente em mulheres no Brasil, tendo acometido mais de 18.000 mulheres no ano de 2008. O presente estudo objetivou analisar e correlacionar os resultados obtidos nos laudos citológicos e histopatológicos, conforme a faixa etária das pacientes. Para tanto, metodologicamente foi realizado um estudo observacional transversal retrospectivo por meio de 106 prontuários de pacientes que apresentavam laudos citopatológicos e histopatológicos com atipias cervicais atendidas no período de janeiro de 2007 a dezembro de 2008 no Centro de Saúde da Mulher em Piripiri, Piauí, Brasil. Foram obtidos os seguintes resultados: quanto ao exame citológico os resultados mais frequentes foram os de ASCH e ASC/AG, correspondendo a respectivamente, 39,6% e 30%. Houve maior número de pacientes com laudo de ASC/AG e ASCH no intervalo de 25 a 34 anos, correspondendo a respectivamente, 13,2% e 17,9% destas lesões. Na histopatologia, 44 casos (41,5%) foram considerados LSIL, 53 casos (50%) foram diagnosticados com HSIL e 7 casos (6,6%) foram considerados como neoplasia maligna invasiva. Sendo assim, este estudo confirma a acuidade diagnóstica dos exames citológicos e histopatológicos, tendo em vista o grande número de lesões observadas, especialmente em pacientes jovens, destaca-se a importância de orientar práticas sexuais seguras, melhor controle na frequência de rastreamento e seguimento clínico destas pacientes.

Cervical carcinoma is the second most common carcinomas among women in Brazil, having involved over 18,000 women in 2008. Analyze and correlate the most frequent cervical lesions observed in cytological and histological examinations. A cross -sectional observational study was retrospectively performed with 106 patients from a Woman Health Center in Piripiri, Piaui, Brazil, from January 2007 to December 2008, who presented atypical cytopathologic and histopathologic cervical findings. The cytologic results were more frequent in ASC and ASCH/AG, representing 39.6% and 30%, respectively. There was a greater number of patients with report of ASC/AG and ASCH in the range of 25 to 34, representing respectively 13.2% and 17.9% of these lesions. Histopathologically, 44 cases (41.5%) were considered LSIL, 53 cases (50%) were diagnosed as HSIL and 7 cases (6.6%) were considered invasive malignancy. This study confirms the diagnostic accuracy of Pap smears, colposcopy and histopathology exams. Given the large number of lesions, especially in young patients, it highlights the importance of guidelines for safe sex practices, better control in the screening frequency and follow-up for these patients.

Cytological analysis of epithelial cells in adolescents with type 1 diabetes mellitus / Análise citológica das células epiteliais de adolescentes com diabetes mellitus tipo 1

Type 1 diabetes mellitus is a chronic metabolic disorder condition, which may causes oral mucosa changes in adolescents. The effect of glycemic control on the oral tissues has been scarcely reported as well as the low number of oral mucosal lesions found in this population. The goal of this study is to evaluate cytopathological changes in oral epithelial cells of adolescents with type 1 diabetes mellitus (DM1) and assess the glycemic control. Materials and methods: Oral smears were collected from normal mucosa by exfoliative cytology in 40 healthy adolescents and 40 with DM1. Cell morphology and cellularity were analyzed. Nuclear area (NA) and cytoplasmic area (CA) were measured; nuclear/cytoplasmic area ratio (NA/CA) was calculated. Time elapsed from the diagnosis of diabetes and glycated hemoglobin levels (HbA1c) were recorded. Results: There was no significant difference to NA, CA, NA/CA for both groups and also in relation to HbA1c (P > 0.05). No morphological differences were found among the groups (P > 0.05). There was a predominance of nucleated cells of the superficial layer in smears of both groups. Class I and Class II smears were predominant in both groups. Conclusion: This study revealed that type 1 diabetes mellitus and the glycemic control were unable to induce significant changes on oral epithelial cells in adolescents...

A diabetes mellitus do tipo 1 é uma doença metabólica crônica que pode causar alterações nas células do epitélio da mucosa bucal. O estudo do efeito do controle glicêmico nos tecidos bucais tem sido pouco relatado e o baixo número de lesões da mucosa bucal encontrada nesta população também. O objetivo deste estudo foi avaliar as alterações citológicas nas células epiteliais bucal de adolescentes com diabetes mellitus tipo 1 (DM1) e avaliar o controle glicêmico. Materiais e métodos: Esfregaços da mucosa normal foram coleta¬dos por citologia esfoliativa em 40 adolescentes com DM1 e 40 saudáveis. A morfologia celular e a celularidade foram analisadas. A área nuclear (NA) e área do citoplasma (CA) foram medidas, e a relação de área de núcleo/ citoplasma (NA/CA) foi calculada. O tempo decorrido desde o diagnóstico da diabetes e os níveis de hemoglobina glicada (HbA1c) foram registrados. Resultados: Não houve diferença significativa para NA, CA, NA/CA para ambos os grupos e também em função da HbA1c (P > 0,05). Não foram encontradas diferenças morfológicas entre os grupos (P > 0,05). Houve um predomínio de células nucleadas da camada superficial em esfregaços de ambos os grupos. Esfregaços classe I e classe II foram predominantes em ambos os grupos. Conclusão: Este estudo revelou que o diabetes mellitus tipo 1 e o controle glicêmico não foram capazes de induzir alterações significativas nas células epiteliais da mucosa bucal de adolescentes...

Prevalencia de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en el Cauca, Colombia / The prevalence of abnormal cytology and inflammation and their association with risk factors for uterine cervical neoplasms in Cauca, Colombia

Objetivos Establecer la prevalencia del resultado de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en mujeres del departamento del Cauca, Colombia. Metodología Después de la Arma voluntaria del consentimiento informado, las mujeres fueron entrevistadas a través de un cuestionario para colectar variables de tipo sociodemográfico y clínico, incluyendo historia reproductiva, actividad sexual, historia de citología y hábito de fumar. Posteriormente, se procedió a la toma de la citología para su análisis y clasificación según el sistema Bethesda 2001. Un total de 1735 mujeres fueron reclutadas para este estudio. Resultados Acorde con el resultado de citología, 1061 mujeres presentaron citología normal (61 %), 36 citología anormal (2 %) y 638 cambios celulares reactivos asociados a inflamación (37 %). Los resultados indican que tener relaciones sexuales a temprana edad, la multiparidad, el uso de anticonceptivos hormonales y no realizarse la citología anualmente fueron factores de riesgo asociados a citología anormal. Conclusiones Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de cribado para la prevención de neoplasias del cuello uterino en mujeres de la región y el país.

Objectives Establishing the prevalence of abnormal and inflammation cytology reports and its association with risks factors for uterine cervical neoplasms amongst females from the Cauca department in Colombia. Methodology After signing a consent-form, females were interviewed using a questionnaire to collect socio-demographic and clinical data, including reproductive history, sexual activity, cytology history and smoking habits. Cytology was then taken for analysis and classification according to the 2001 Bethesda System. A total of 1,735 females were recruited for the study. Results According to the cytology report, 1061 women had normal cytology (61 %), 36 abnormal cytology (2 %) and 638 reactive cellular changes associated with inflammation (37 %). The results indicated that having sexual intercourse at an early age, multiparity, using hormonal contraceptives and not having annual cytology screening were associated with abnormal cytology reports. Conclusions These results provided valuable information for public health institutions for developing better screening programmes to prevent risks of uterine cervical neoplasms amongst females from our region and throughout Colombia.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A blastomicose sul americana, paracoccidiodomicose (Pb micose) ou doença de Lutz é uma infecção fúngica endêmica na América Latina. É causada pelo fungo dimórfico Paracoccidiodes brasiliensis, e pode causar lesões na mucosa oral. Nós avaliamos a incidência de lesões orais de Pb micose nos pacientes atendidos em um Centro Especializado em Diagnóstico Oral com foco principal nas diferentes formas clinicas das lesões, suas localidades, ocupação dos pacientes, hábitos deletérios e diagnóstico e metodologia, e foram detectados 31 casos (18 pacientes). Os resultados mostraram que 88,8% dos pacientes eram do sexo masculino com idade média de 50 anos de idade, e 39% trabalham, ou trabalhavam, com atividades relacionadas à agricultura. Observou-se que 88,9% eram fumantes e 72,2% ingeriam álcool. Citologia esfoliativa foi feita em 66,6%. Mucosa jugal foi acometida em 30%, gengiva, e lábios 16% (cada um) foram os locais mais comuns de lesões orais da Pb micose. Comparando o diagnóstico inicial com o definitivo feito pelos profissionais, a acurácia foi de 33%; o diagnóstico dos estudantes foi mais preciso demonstrando 72,5% do diagnóstico inicial correto com diferença estatística significante (p=0,25) através do teste ANOVA do SPSS WIN com nível de significância de 5%. Biópsia incisonal e citologia esfoliativa são eficientes para um diagnóstico precoce desta doença na boca; o treinamento dos estudantes em diagnóstico para reconhecer as patologias orais é urgente para melhorar a saúde pública.

Comprehensive evaluation of cervical cancer screening programs: the case of Colombia

OBJECTIVE: To identify critical screening program factors for reducing cervical cancer mortality in Colombia. MATERIAL AND METHODS: Coverage, quality, and screening follow-up were evaluated in four Colombian states with different mortality rates. A case-control study (invasive cancer and healthy controls) evaluating screening history was performed. RESULTS: 3-year cytology coverage was 72.7 percent, false negative rate 49 percent, positive cytology follow-up 64.2 percent. There was no association between screening history and invasive cancer in two states having high cytology coverage but high false negative rates. Two states revealed association between deficient screening history and invasive cancer as well as lower positive-cytology follow-up. CONCLUSIONS: Reduced number of visits between screening and treatment is more relevant when low access to health care is present. Improved quality is a priority if access to screening is available. Suitable interventions for specific scenarios and proper appraisal of new technologies are compulsory to improve cervical cancer screening. Comprehensive process-failure audits among invasive cancer cases could improve program evaluation since mortality is a late outcome.

OBJETIVO: Identificar factores críticos para reducir la mortalidad por cáncer cervical en Colombia. MATERIAL Y MÉTODOS: Se evaluó cobertura, calidad y seguimiento del tamizaje en cuatro departamentos con tasas de mortalidad diferenciales. Un estudio de casos (cáncer invasor) y controles (sanos) evaluó historia de tamizaje. RESULTADOS: Cobertura 72,7 por ciento; falsos negativos 49 por ciento; acceso a diagnóstico-tratamiento de HSIL 64,2 por ciento. La historia de tamizaje no se asoció con cáncer invasor en dos departamentos con elevada cobertura pero elevada proporción de falsos negativos. Dos departamentos con asociación entre historia de tamizaje deficiente y cáncer invasor tuvieron cobertura aceptable pero bajo acceso a diagnóstico-tratamiento. No hubo relación entre mortalidad y desempeño del programa. CONCLUSIONES: Reducir visitas entre tamizaje y tratamiento es prioritario ante bajo acceso a los servicios. Incrementar calidad es prioritario si hay adecuado acceso al tamizaje. Intervenciones y tecnologías apropiadas a cada contexto son indispensables para obtener mejores resultados. Vigilar integralmente el cáncer invasor contribuye a la evaluación de los programas por ser un desenlace más temprano que la mortalidad.

Avaliação de métodos diagnósticos, morfológicos e biomoleculares em mulheres encaminhadas com citologia alterada / The diagnostic efficacy of morphologic and molecular methods in women with abnormal citology

Introdução: o câncer do colo uterino é a neoplasia mais frequente em mulheres de países em desenvolvimento. Doença causada pela infecção persistente com diferentes tipos de papilomavírus humano (HPV) classificados em baixo e alto risco, de acordo com o potencial oncogênico. Objetivo: em mulheres com diagnóstico citopatológico anormal por ocasião de exame de rastreamento do câncer cervical, encaminhadas por diferentes postos de atendimento do Sistema Único de Saúde para serviço universitário de referência e com diagnóstico definitivo de lesão intraepitelial de alto grau ou câncer cervical, avaliara eficácia diagnóstica de métodos morfológicos e biomoleculares utilizados de maneira isolada ou em associação; e a prevalência, estratificada em duasfaixas etárias, abaixo de 30 e igual ou superior a 30 anos, do HPV tipos 16, 18 e 45. Métodos: estudaram-se 167 mulheres encaminhadas ao Ambulatório de Patologia Cervical e Colposcopia do Hospital Universitário da Universidade Federal de Juiz de Fora, no período de novembro de 2002 e dezembro de 2003,com colo uterino íntegro, não grávidas e sem história de câncer no trato genital inferior. Coletaram-se, de todas as mulheres, amostras para estudo citológico,convencional e em meio líquido, e para os testes de DNA-HPV. Considerou-se como diagnóstico histopatológico final a avaliação mais grave dentre ospossíveis espécimes, biópsia, conização ou peça cirúrgica, que a paciente pudesse ter. Resultados: não há qualquer diferença no tocante à sensibilidade,ao valor preditivo positivo e negativo e à acurácia dentre os métodos diagnósticos estudados, porém a associação da citologia com o teste DNA-HPV tem menor especificidade que o exame citológico isolado, quer convencional ou em meio líquido. A prevalência do HPV 16, 18 e 45 cai de 88,9% para 50,0%nas mulheres com 30 anos ou mais (p = 0,02). Conclusão: nas mulheres encaminhadas ao ambulatório de PTGIC do HU-UFJF com colpocitologia alteradanão se justifica a realização de qualquer exame confirmatório, devendo realizar-se imediatamente a colposcopia para se ter o desfecho diagnóstico.

Introduction: cervical cancer is the most frequent neoplasia among the women of countries in development. Great part of these cases is caused by persistent infection with different types of human papilomavirus (HPV) classified as low and high risk, according to the risk of cervical cancer development. Objectives:based on women with abnormal cytology when screening for cervical cancer who were led from different units of the Public Health System to the reference university service and with a definite diagnosis of high cervical intraepithelial neoplasia or cancer, was to evaluate the diagnostic efficacy of morphologicand molecular methods used alone or together and the prevalence of HPV types 16, 18, 45, stratified into two age brackets. Methods: 167 women went to the Cervical Pathology and colposcopy clinic of the University Hospital of the Universidade Federal de Juiz de Fora, during the period from November 2002 to December 2003, with intact uterine cervix, not pregnant and without previous chemical and/or radiotherapy treatment for the inferior genital tract.Samples for cytology study were collected from all women, with conventional and liquid-based preparations, for CH2 for high risk virus, for DNA PAP andfor Probe Pack test. The worst histologic diagnosis among the possible histologic studies through biopsy, conization or cirurgic pieces was considered as "gold standard". Results: there is no difference regarding sensibility, positive predict value and negative predict value for all methods studied, However, the DNA PAP method has less specificities than the citology exam, either with conventional or based-liquid preparation. The prevalence of HPV 16, 18, 45 decreases from 88,9% to 50% in women of 30 years old or more, being this decrease statistically significant. Conclusion: in those women led to the PTGIC of the HUUFJF with abnormal cytology it is not necessary to repeat any tests, just colposcopy in order to reach the final diagnosis.

Deficiencia de vitamina A en adolescentes no gestantes y gestantes de Maracaibo, Venezuela / Vitamin A deficiency in non pregnant and pregnant adolescents from Maracaibo, Venezuela

Antecedentes: La deficiencia de vitamina A (DVA) es un problema nutricional de salud pública en el mundo. Durante el embarazo se ha asociado con incremento en la morbilidad y mortalidad materno-infantil. Objetivo: Determinar en adolescentes no gestantes y gestantes venezolanas, el estado nutricional de la vitamina A (ENVA). Método: Se realizó un estudio transversal, descriptivo y controlado, en 235 adolescentes mujeres (edad: 16,76 +/- 1,48 años); 75 no gestantes y 160 gestantes. El ENVA fue evaluado según valores de retinol sérico (RS) por cromatografía líquida de alta eficacia (HPLC) y citología de impresión conjuntival (CIC). Resultados: En gestantes y no gestantes la prevalencia de CIC anormal (37,5 por ciento vs 48 por ciento; p>0,05) y afectación del ENVA (41,24 por ciento vs 13,34 por ciento; p=0,0001) fue alta; significativamente mayor durante el segundo y tercer trimestre de gestación (p<0,0002). Las gestantes mostraron una disminución significativa de los valores promedio RS (p<0,0001), una correlación inversa no significativa con la edad gestacional y 4,56 veces mayor probabilidad de presentar afectación del ENVA (OR=4,56; IC95 por ciento: 2,0-10,23) que las no gestantes. Conclusión: La alta prevalencia de DVA observada en este trabajo, representa un problema de salud pública en adolescentes venezolanas, por lo que este grupo vulnerable requiere intervención inmediata.

Background: Vitamin A deficiency (VAD) is a public health nutrition problem in the developing world. VAD had been associated with increased risk of maternal and childhood mortality and morbidity. Objective: To determine vitamin A status (VAS) between non pregnant and pregnant adolescents from Maracaibo-Vene-zuela. Methods: A cross-sectional and descriptive study was conducted in 235 female adolescents (16.76 +/- 1.48y old); non pregnant (n=75) and pregnant (n=160). Vitamin A status was assessed by using serum retinol concentrations (SRC) and conjuctival impression cytology (CIC). SRC were measured by high-performance liquid chromatography and CIC. Results: In pregnant and non pregnant adolescents the prevalence of CIC abnormal (37.50 percent vs 48 percent) and non normal VAS (41.24 percent vs 13.34 percent; p=0.0001) were high, predominantly in the second and third trimester of pregnancy (p<0.0002). Pregnant adolescents showed significative reduction of the mean SRC values (p<0.0001), while gestational age had a negative and no significant relationship with SRC. The odds ratio for pregnant adolescents with non normal VAS was 4.56 (95 percentIC: 2.0-10.23), resulting significantly more frecuent non normal VAS in pregnant adolescents than non pregnant adolescents. Conclusions: The high prevalence of VAD found in this work, is a public health problem in venezuelan female adolescents and this vulnerable group require immediate interventions.

Comparação entre a citologia em base líquida e a citologia esfoliativa convencional no diagnóstico da candidose bucal / Comparison between liquid based cytology and conventional exfoliative cytology in the diagnosis of oral candidoses

Objetivo: O objetivo deste estudo foi comparar a eficácia da citologia esfoliativa em base-líquida (CBL) e da citologia esfoliativa convencional (CEC) no diagnóstico da candidose bucal. Material e método: a amostra foi dividida em dois grupos: a) grupo experimental - formado por 27 indivíduos com candidose bucal (submetidos a CBL e CEC) e b) grupo controle - composto por 30 indivíduos sem nenhuma lesão bucal (submetidos a CBL). Além de avaliar a eficácia dos métodos no diagnóstico de candidose bucal, procurou-se comparar a qualidade das imagens microscópicas, a associação da presença de hifas e/ou pseudohifas com o tipo de célula epitelial e a eficácia de aplicação dos dois métodos após o tratamento com antifúngico. Os esfregaços foram processados em laboratório, analisados por microscopia de luz e submetidos à análise estatística por meio do teste do Qui-quadrado (p < 0,05). Resultado: Os resultados mostraram que a CBL foi mais eficaz do que a CEC devido ao maior número de lâminas contendo hifas e/ou pseudohifas, bem como pela quantidade e dispersão mais uniformes das células epiteliais, o que caracterizou a qualidade superior das imagens neste método. Ao se avaliar a associação de hifas e/ou pseudohifas com o tipo de célula epitelial mais encontrado, observou-se que tanto na CBL quanto na CEC as referidas estruturas estavam mais associadas com células das camadas superficial nucleada e intermediária. Conclusão: embora a citologia em base líquida tenha sido tecnicamente superior à citologia esfoliativa convencional na confecção de lâminas com melhor qualidade e favorecendo a detecção de hifas e pseudohifas, a CBL não demonstrou resultados satisfatórios como um método seguro para o diagnóstico da candidose oral.

Objective: The aim of this study was to compare the efficiency of the liquid based cytology (LBC) and conventional exfoliative cytology (CEC) in the diagnosis of oral candidosis. Material and method: The sample was divided in two groups: a) experimental group - composed by 27 individuals with oral candidosis (submitted to LBC and CEC) and b) control group - composed by 30 individuals with no oral lesion (submitted to LBC). Besides, the quality of the cytological smears; the association between hyphae and/or pseudohyphae with the type of epithelial cell; and the efficacy of the two methods after the treatment with antifungal medication were evaluated. The smears were processed in the laboratory, analyzed by light microscopy and submitted to statistical analysis using Chi-square test (P < 0.05). Result: There were more smears exhibiting hyphaes and/or pseudohyphaes in LBC than CEC. Besides, the quantity and the more uniform dispersion of the epithelial cells on the slide were more present. Thus, this method showed the best quality of the cytological smears. When the association between hyphae and/or pseudohyphae with the type of epithelial cell was analyzed, both LBC (experimental and control groups) and CEC demonstrated that these structures were more associated with nucleated superficial and intermediary epithelial cells. Conclusion: Even so LBC has been technically superior than CEC to the preparing of best quality slides and favoring to the detection of hyphae and/or pseudohyphae. Nevertheless, it did not show satisfactory results as a safe method to the diagnosis of oral candidosis.

Factores de riesgo de alteraciones citológicas del cuello uterino en mujeres chilenas: Un estudio de casos y controles / Risk factors associated with abnormal cervical cytology among Chilean women: A case control study

Background: Cervical cancer is the third cause of cancer death among Chilean women, affecting mainly women from low socioeconomic status. Aim: To determine main risk factors (RF) including human papilomavirus (HPV) types associated with abnormal cervical cytology (Atypical Squamous Cells of Undetermined Significance or ASCUS) among Chilean women from low socioeconomic status in Santiago, Chile. Material and Methods: A random population based sample of616 women from La Pintana (a low-income district in Santiago) participated in 2001 in a HPV prevalence study and were re-evaluated in 2006 through a risk factors questionnaire, Papanicolaou test and DNA detection for HPV. The Papanicolaou test was analyzed in Santiago and HPV analysis (PCR_GP5+/GP6+) was conducted in Vrije University, Amsterdam. Cases included 42 women with cervical lesions and controls included 574 women with normal cytology during the period 2001-2006. Logistic regression with uni and multivariate analysis was performed to identify RF for cervical lesions. Results: During the study period, there was a significant increase in the proportion of single women, from 8.3 to 14.8 percent (p < 0.05), of women with 3 or more sexual partners from 8.9 to 13.3 and of women high risk HPV, from 9.1 to 14.3 percent. The proportion of abnormal Papanicolaou tests remained stable (3.08 and 3.9 percent > ASCUS). High risk HPV was the most significant factor associated with cervical lesions (odds ratio (OR) = 9.695 percent> confidence intervals (CI) = 4.4-21.1) followed by oral contraceptive use (OR = 2.58 95 percent> CI= 1.2-5.7). Among women infected by high risk HPV, the use of oral contraceptives was a risk factor while compliance with screening was protective for cervical lesions. Conclusions: From 2001 to 2006, there was an increase in the proportion of women with high-risk HPV infections.

Avaliação da adequabilidade das amostras de examescitopatológicos realizados em um laboratório de Porto Alegre – RS no ano de 2005 / Adequateness evaluation of cytopatology smears samples in a laboratory in

O exame citologico e um dos mais apropriados metodos de deteccao de lesoes pre-cancerosas e cancer de colo uterino. Porem, uma das criticas mais frequentes a este exame e a alta taxa de falsos negativos que sao atribuidos principalmente a erros de coleta,no escrutinio do esfregaco e na interpretacao do diagnostico. O presente trabalho teve por objetivo avaliar a adequabilidade de amostras de exames citopatologicos realizados no Laboratorio Marques Pereira em Porto Alegre, RS no periodo de janeiro a marco de 2005, de pacientes atendidas pelo Sistema Unico de Saude. Dos 1570 laudos de exames citologicos analisados, 71,40% eram esfregacossatisfatorios, 26,56% satisfatorios, mas limitados por ausencia de celulas glandulares endocervicais, 0,64% satisfatorios, mas limitados pela presenca de sangue, 0,51% satisfatorios, mas limitados por material purulento, 0,38% satisfatorios, mas limitados por areas espessas, 0,19% limitados por dessecamento e 0,32% de material insatisfatorio por lamina danificada ou ausente. Dos 3,24% deexames citologicos que apresentaram algum tipo de alteracoes nas celulas escamosas e glandulares endocervicais, o maior indice foi de LSIL em 1,59% das amostras prevalecendo na faixa etaria dos 21 aos 30 anos. Com referencia a analise microbiologica dos exames citopatologicos, foi verificada uma colonizacao cervico-vaginal predominante de lactobacilos (49,36%).

The cytologic smear is one of the most appropriate methods of pre-cancerous and cervical cancer detection. However,one of the most frequent critics to this examination is the high rate of false negatives that are attributed to the errors of collection mainly, in the scrutiny of smears and in the interpretation of the diagnosis.The purpose of this study was to evaluate the adequateness of citopatological samples, in public health patients, whose examination was realized in Marques Pereira Laboratory in Porto Alegre, RS between january and march of 2005. Of the 1570 exams analyzed, 71.40% were satisfactory smears, 26.56% satisfactory, but limited for absence of endocervical cells, 0.64% satisfactory, but limited forthe presence of blood, 0.51% satisfactory but limited by material with excess of inflammatory cells, 0.38% satisfactory but limited by thick areas, 0.19% limited by desseccate smears and 0.32% of unsatisfactory material for damaged or slyde glass. Of 3.24% of citopathologic exams that presented some alterations in endocervical and squamous cells, the greater index was of LSIL in 1,59% of samplesprevailing in women with 21 to the 30 years. In relation of microbiological analysis of the citopathologic exams, were observed the predominance of Lactobacillus (49,36%).

Qualidade e desempenho das colpocitologias na prevenção de câncer de colo uterino / Quality and performance of pap smears in the cervical cancer screening program in a city of southern Brazil

OBJETIVO: Estimar a prevalência e analisar a qualidade e o desempenho das colpocitologias realizadas no Programa de Prevenção de Câncer de Colo Uterino no município de Maringá-PR. MÉTODOS: Estudo retrospectivo dos dados do SIS-Colo do Ministério da Saúde. Foram analisadas as variáveis idade, resultado de colpocitologia e procedência. As idades foram categorizadas em faixas etárias, a procedência distribuída em cinco regionais de saúde do município de Maringá; a colpocitologia foi categorizada conforme o Sistema Bethesda. Calculou-se a cobertura de colpocitologia dividindo-se o número de exames na população de 25 a 59 anos pelo número de mulheres nesta mesma faixa etária. RESULTADOS: As 17.664 colpocitologias coletadas, no ano de 2005, pela rede pública se distribuíram entre as mulheres com idade mínima de 12 e máxima de 82 anos, sendo 12.961 (73,4 por cento) exames na faixa entre 25 e 59 anos, considerada de maior risco para o câncer. Foram negativos para neoplasia 17.458 (98,84 por cento) exames e as alterações celulares (ASCUS/AGUS, LIEBG, LIEAG e câncer invasor) totalizaram 206 (1,16 por cento). Encontrou-se prevalência de ASCUS de 0,85 por cento (151), de atipias celulares 1,14 por cento (203/17.664) e a relação ASCUS/atipias celulares 2,75 por cento (151/55). CONCLUSÃO: A prevalência das alterações colpocitológicas e da ASCUS abaixo dos índices esperados, a relação ASCUS/atipias celulares em níveis elevados, a cobertura populacional insuficiente de colpocitologia compromete o desempenho da prevenção de câncer de colo uterino. A população de baixa condição sócio-econômica requer uma atenção especial e a população mais privilegiada deve ser orientada quanto a periodicidade do exame e faixa etária de maior risco.

OBJECTIVE: To estimate prevalence and analyze quality and performance of colpocytology carried out under the Cervical Cancer Screening Program in Maringá, Paraná, Brazil. METHODS: A retrospective study of the SIS-Colo database of the Brazilian Ministry of Health. Variables such as age, colpocytology result and origin were analyzed. Ages were divided into brackets; origin was distributed in five Regional Health Divisions of the city of Maringá; colpocytology was categorized according to the Bethesda System. Colpocytology, coverage was calculated by dividing the number of exams in the population between 25 and 59 years of age by the number of women in that same age group. RESULTS: The 17,664 colpocytology exams collected in 2005 by the public health system were distributed among women between 12 and 82 years of age, with 12,961 (73.4 percent) examinations in women between the ages of 25 and 59, considered at high risk for cancer. A total of 17,458 (98.84 percent) cytological examinations were negative for malignancy, and atypical results (ASCUS / AGUS, LSIL, HSIL and invasive cancer) totaled 206 (1.16 percent). The study found a prevalence of 0.85 percent (151) for ASCUS / AGUS, 1.14 percent (203/17.664) for atypical cells, and a 2.75 ASCUS / atypical cells ratio (151/55). CONCLUSION: The lower than expected prevalence of colpocytological and ASCUS alterations, the high ASCUS / atypical cells ratio and the insufficient population coverage by colpocytology jeopardized the performance of the cervical cancer prevention program. The low-income population requires special attention, and those more privileged should be advised about the frequency of examination and the age bracket with higher risks.

A vulnerabilidade às DST em região com intensa prostituição e turismo sexual de Natal/RN / The vulnerability to the STD in region with intense prostitution and sexual tourism of Natal/RN

Doenças sexualmente transmissíveis (DST) englobam uma série de doenças infecciosas causadas por microrganismos cuja via preferencial de transmissão é a sexual. Estima-se no mundo aproximadamente 333 milhões de novos casos de DST ao ano, representando a segunda maior causa de perda de vida saudável entre mulheres. Este trabalho teve como objetivo a investigação da prevalência dos principais agentes causadores de DST que podem ser detectados em esfregaços cervicais em duas comunidades com características de comportamento sexual e aspecto sócio-econômico distintos. Para isso, foi realizado um estudo retrospectivo em 4676 mulheres sexualmente ativas de 14 a 70 anos, sendo 1955 do atendimento realizado no bairro de Ponta Negra e 2721 resultantes doatendimento no bairro do Tirol, em Natal-RN, de janeiro de 2003 a dezembro de 2005. A prevalência de DST em Ponta Negra foi a mais elevada, apesar da procura para realização do exame preventivo ter sido menor. Fato que colabora com as características do bairro, que possui uma população mais carente, associada a altos índices de prostituição infanto-juvenil e turismo sexual. Em contrapartida, Tirol apresentou uma população com poder sócio-econômico mais elevado e um grau de esclarecimento maior, justificando, assim, menores índices de DST e maior procura por prevenção.

Sexually Transmitted Diseases (STD) encompass a series of infectious illnesses caused by micro-organisms whose preferential way of transmission is the sexual one. It is estimated in the world about 333 million new cases of STD a year, representing the second bigger cause of loss of healthful life among women. This work aimed at the investigation of the prevalence of the main causing agents of STD that can be detected in cervical smears in two communities with sexual behavior characteristics and distinct socioeconomic aspects. For that, a retrospective study was accomplished in 4676 women sexually active from 14 to 70 years, being 1955 of the attendance carried out in the neighborhood of Ponta Negra and 2721 resultants of the attendance in the neighborhood of Tirol, in Natal-RN, from January of 2003 to December of 2005. The prevalence of STD in Ponta Negra, in spite of the search for accomplishment of the preventive test to have been lesser. Fact that collaborates with the characteristics of the neighborhood, that has a more lacking population, associated to high rates of child prostitution and sexual tourism. On the other hand, Tirol showed a population with higher socio-economic power and a degree of bigger clarification, thus justifying least STD rates and greater search by prevention.