Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Lower accuracy of cytological screening for high-grade squamous intraepithelial neoplasia in women over 50 years of age in Japan

Background As the population ages in developed countries, the number of Pap smears for cervical cancer screening of older women is increasing. There is concern that cervical atrophy may cause misinterpretation of results for this segment of the population. The present study evaluated the accuracy of screening for high-grade intraepithelial lesions (HSILs) in women younger or older than 50 years, to determine whether aging affects cytological interpretation. Methods Patients with HSIL cytology (N = 1565) were dichotomized into those aged 20–49 years or aged ≥ 50 years. Association between histology results and age was examined. Pearson’s chi-squared test and Cochran-Armitage trend test were used for statistical analysis. Results The positive predictive value (PPV) for cervical intraepithelial neoplasia (CIN)2 and worse was 65.2% (62/95) in older women but 87.3% (482/552) in younger women (p < 0.001). Older patients had a significantly lower PPV (p = 1.69 × 10–8). Separately analyzing chronic cervicitis, CIN1 and overt cancer grouped together, compared with another group composed of CIN2 and CIN3, we found that the PPV for CIN2 and CIN3 was lower in older than in younger women [44.2% (42/95)-vs-82.4% (455/552), p < 0.001], respectively. Conclusions HSILs are associated with a wide range of disease categories as age increases, and the accuracy of HSIL interpretation is lower in older women.

Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors’ perspective

Background Healthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting. Methods A cross-sectional questionnaire-based survey was carried out among 43 PHC physicians from the Malopolska region in Poland. Barriers and attitudes towards cytology in a PHC setting were evaluated. Results Approximately 35% of surveyed physicians reported having experience in performing cytology. Almost 75% of PHC physicians lacked the necessary equipment in their office to perform the screening. None of the studied physicians performed Pap smears in their office at the time. The reasons included: shortage of competence (78.57%) and time (69.05%), the perception of Pap smears as a task for gynecologists (69.05%), the lack of financial incentives (61.90%), and the belief that their patients would be unwilling to undergo the test in their PHC physician’s office (33.33%). More than three quarters (76.74%) declared they would be ready to perform Pap smears if the tests were additionally paid. No significant associations between PHC physicians’ characteristics and their willingness to perform cytology screening were found. Conclusion The primary barrier to perform Pap smears by PHC physicians does not lie in their personal reluctance but in the organization of the healthcare system. Provision of required training and proper funding allocation can likely improve the screening rate of cervical cancer in Poland.

Correlation of cervical pap smears with histopathological diagnosis in cervical lesions

Background: Cervical cancer is the most common genital cancer in India. In India alone,almost,130000 new cases occur with the death toll of 70000 everywhere. Objective of current study was correlation of pap smear with histopathological diagnosis.Methods: A retrospective study was conducted in tertiary care hospital in 130 sexually active women. Pap smears were taken and histopathological diagnosis was performed in all such patientsResults: From pap smear findings, out of 130 patients, maximum number of cases, 74 (56.9%) were categorized as. Out of epithelial cell abnormality, ASCUS was seen in 25 patients (10.2%), LSIL in 17 patients (13.1%), HSIL in 11 patients (8.5%). SCC was seen in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). From cervical biopsy reports, 51 cases(39.2%) were diagnosed as chronic cervicitis, 34 cases (26.2%) were diagnosed as chronic cervicitis with squamous metaplasia, CIN I in 31 patients (23.8%), CIN II in 8 patients (6.2%) and CIN III in 3 patients (2.3%), squamous cell carcinoma in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear test was 91.1%, 82.4%,73.2%, 94.6% and 85.4%, respectively.Conclusions: Pap smear has excellent correlation with histopathological diagnosis. Therefore it should be encouraged as effective tool for cervical cancer screening program to reduce incidence and mortality caused by cervical cancer.

STUDY AND ANALYSIS OF CERVICAL PAP SMEARS IN A MEDICAL COLLEGE HOSPITAL

Introduction: Cervical cancer is the second most common gynaecological cancer worldwide and the third leading cause of cancer-related mortality in the less developed countries. Cervical cancer may be prevented or diagnosed at early stages due to the easy accessibility and clinical evaluation of the cervix. A pap test is a simple, easy, painless procedure which can be carried out as an outpatient procedure to detect specic, nonspecic inammations, precancerous and cancerous lesions In our study we have analysed the results of PAP smears of women in all age groups and have tried to evaluate the prevalence of cervical lesions and the importance of cervical cancer screening. Material And Methods: Our study was conducted between October 2020 to JULY 2021 and patients who have visited the Gynaec OP during this period were included for this study. We received Pap smears from the Department of Obstetrics and Gynecology, stained the slides with Pap stain and studied the smears according to the new Bethesda System for Reporting Cervical Cytology 2014. Results: In our study, majority of the patients were in the age group of 41-50 years. Smears showing ASCUS were 14 , LSIL reports were 5, HSIL reports were 4. No Smears showed squamous cell carcinoma in our study. Reports in our study like many other studies has shown the importance of Pap smear test in screening cervical cancer. By conducting health camps, increasing health awareness and performing Pap smear screening programmes the incidence of cervical carcinoma can be decreased.

Automated Segmentation of Nucleus And Cytoplasm of Cervical Cells From Pap-Smear Images Using A Quadtree Decomposition Approach.

Background: Digital pathology and microscopy image analysis is widely used for comprehensive studies of cell morphology especially for cervical cancer screening from pap-smears. Manual assessment of pap-smears is labour intensive and prone to interobserver variations. Computer-aided methods, which can significantly improve the objectivity and reproducibility, have attracted a great deal of interest in recent literature. A critical prerequisite in automated analysis of pap-smears is nucleus and cytoplasm segmentation, which is the basis of cervical cancer screening. This paper articulates a potent approach to the segmentation of cervical cells into nucleus and cytoplasm using a quadtree decomposition approach with statistical measures.Results: Choosing an appropriate quadtree decomposition strategy was a great challenge and a novel task in the proposed approach. The image is pre-processed using an enhanced median filter and is decomposed based on the mean, maximum entropy and the variance statistical measures of the pixels in the subtree. As a result, highly efficient and segmentations of acceptable performance were obtained. Comparison of the segmented nucleus and cytoplasm with the ground truth nucleus and cytoplasm segmentations resulted into a Zijdenbos similarity index of greater than 0.9034 and 0.9498 for nucleus and cytoplasm segmentation respectively. Conclusion: Given the accuracy of the classifier in segmenting the nucleus which plays an important role in cervical cancer diagnosis and classification, the classifier can be adapted for automated systems for cervical cancer diagnosis and classification. The method serves as a basis for first level segmentation of cervical cells for diagnosis and classification of cervical cancer from pap-smears.

A Nudge for Health: Using Behavioral Economics to Increase Online Scheduling and Health Maintenance Completion (Preprint)

BACKGROUND Behavioral economics has been an increasingly utilized method in healthcare to “nudge” behavior change through the use of techniques such as choice architecture and framing of words. Patient portals are a key tool for facilitating patient engagement in their health, and deployment of interventions via patient portals have been effective in improving utilization of preventive health services. Our integrated healthcare system was one of the first to employ behavioral economics in health maintenance reminder (HMR) messages sent through the online patient portal to improve patient engagement and preventive service use. OBJECTIVE We examined the impacts of behavioral economics-based nudge HMRs on online scheduling uptake and appointment completion for two preventive services, Medicare wellness visits (MWV) and pap smears. METHODS This was a retrospective observational study using electronic health record data from an integrated healthcare system in Northern California. Nudge HMRs with behavioral economics-based language were implemented in November 2017 to all sites for MWV and selected sites in February 2018 for pap smears. We analyzed 125,369 HMRs for MWV, and 585,358 HMRs for pap smears sent between January 2017 and February 2020. The primary outcomes were online scheduling and appointment completion. The predictor was the receipt of a nudge HMR. We used segmented regression with interrupted time series design to assess the immediate and gradual effect of the nudge for MWV. For Pap smear, we used logistic regression models to assess the association of the nudge HMR on study outcomes, adjusting for the propensity to receive a nudge HMR. RESULTS Rates of online scheduling were higher for nudge HMRs recipients than control HMRs (13.0% nudge vs. 9.7% control for MWV; 1.4% nudge vs. 0.6% control for pap smears; p<0.001 for all comparisons). Rates of appointment completion were higher in nudge HMRs for pap smears (21.4% nudge vs. 15.3% control, p<0.001) but comparable for MWV between the two groups (51.5% nudge vs. 51.8% control, p=0.30). Regression results suggest a marginally gradual effect of nudge on online scheduling for the overall MWV sample (at a monthly rate of 0.26%, p=0.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, p=0.04). For pap smears, nudge HMRs were positively associated with online scheduling (propensity adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.50–1.88 overall sample; propensity adjusted OR 1.65 [1.45–1.87] among scheduled appointments) and appointment completion (propensity adjusted OR 1.07 [1.04–1.10]). CONCLUSIONS Nudge for health, a behavioral economics-based approach to providing HMRs, improves patient online scheduling for Medicare wellness visits and pap smears. Our study demonstrates that a simple approach of framing and modifying language in an electronic message can have a significant and long-term impact on patient engagement and access to care. CLINICALTRIAL No