Distribution of high-risk types of human papillomavirus compared to histopathological findings in cervical biopsies in women

Introduction: In over of 99% cases of cervical cancer its appearing is preceded by persistent cervical epithelium infection caused by high-risk oncogenic types of human papillomavirus (HPV). The aim of the study was to examine the distribution of high-risk oncogenic HPV types compared to patohistological diagnoses of cervical diseases in women. Materials and methods: The study included 56 women with suspected premalignant and malignant cervical lesions, due to suspected colposcopic and cytological findings (Papanicolaou test). The HPV typing by 'in situ' hybridization method on high-risk HPV types 16, 18, 31 and 33 was performed in all patients from cervical smear as well as cervical biopsy. Histological findings of cervical biopsy was a 'gold standard' in the analysis of materials. Results: Histologically detected premalignant or malignant changes of the cervix were found at 34 (60.7%) of all 56 examined women: 17 of them had LSIL, 13 of them had HSIL, while 4 had squamous cell carcinoma. A positive HPV test had a 47 (84%) of them with a prove of the presence of one or more types of HPV. The most common type of virus was HPV 16 and it was detected in 27 (48.2%) women, followed by HPV 31 that was detected in 26 (46.4%) women, HPV 18 in 18 (32.1%) of women and HPV 33 in 4 (7.1%) women. The infection caused by oncogenic type HPV16 was significantly more frequent in patients with HSIL and cervical cancer (p<0,001), while the infection caused by oncogenic type HPV 31 was significantly more frequent in patients with LSIL and cervicitis (p=0,003). The distribution of HPV 18 and HPV 33 types was not statistically significantly different in patients with different histological findings (HPV 18, p = 0.41; HPV 33, p = 1.0). Conclusion: Based on our results we can conclude that there is a good correlation of HPV infection with pre-malignant cervical lesions and cervical cancer. The incidence of HPV type 16 infection increased with severity of cervical lesions and it is usually detected high-risk oncogenic type virus in women with severe cervical lesions type like HSIL and cancer are. HPV 31 is the most common high-risk type of HPV of mild type lesions, like LSIL and cervicitis are. We believe that women infected by high-risk oncogenic HPV types, although without histologically diagnose of cervical lesion, should be more frequent control by colposcopy and cytology (Papanicolaou) test, because of possible disease progression to a more advanced level

Histological-cytological reports correlation and reliability of papanicolau test for the detection of malignant changes in the cervix

The incidence rate of cervical cancer in Serbia is among the highest in Europe and is 23.8 in 100.000. Papanicolaou test, colposcopy and pathohistology report are the basic method of secondary prevention of cervical cancer. The aim of the study was to examine the correlation between histological-cytological findings and reliability of the Papanicolaou test in detection of cervical lesions. We analyzed cervical smears (Papanicolaou test) in 3868 women. Among them 190 women had suspect finding and because of that they were underwent to cervical biopsy. We detected premalignant or malignant changes of the cervix in 77 women. LSIL was found at 43 (22.6%), HSIL at 25 (13.2%) and carcinoma planocellulare at 9 (4.7%) women. There is a statistically significant positive correlation (Spearman=0.829; p<0,001) between histological and cytological findings of the respondents. Most estimates of diagnostic performance of Papanicolaou test in discrimination of LSIL, HSIL and carcinoma planocellulare in accordance with cervicitis are for cytological findings of ASCH (PA IIIa) (Sp=90.6% and Sn=100% for carcinoma planocellulare; Sn = 96% for HSIL and Sn=86% for LSIL). In discrimination HSIL from LSIL the best discrimination is achieved by finding LSIL (PAIIIb) Papanicolaou test (Sn=72.0%, Sp=67.4%), and in discrimination carcinoma planocellulare from LSIL best discrimination is achieved by finding HSIL (PA IIIb/IV) Papanicolaou test (Sn=77.8%, Sp=97.7%). Based on our results we can conclude that there is a positive correlation between histological-cytological findings and that the Papanicolaou test more reliable in detecting severe premalignant lesions. Cytological diagnosis of ASCH (PAIIIa) and LSIL (PAIIIb) can reliably indicate the presence of premalignant cervical lesions in women, and patients with these findings must be more controlled and treated

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged &gt;= 18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARR(adj)). This study is registered with ClinicalTrials. gov, number NCT01865513.Findings Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7.6%] of 21 694); ORadj 1.86, 95% CI 1.53-2.26; ARR(adj) -4.4%, 95% CI -5.5 to -3.2). Only 2.3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1.31, 95% CI 1.15-1.49; ARR(adj) -2.6%, 95% CI -3.9 to -1.4) and the administration of reversal agents (1.23, 1.07-1.41; -1.9%, -3.2 to -0.7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1.03, 95% CI 0.85-1 center dot 25; ARR(adj) -0.3%, 95% CI -2.4 to 1.5) nor extubation at a train-of-four ratio of 0.9 or more (1.03, 0.82-1.31; -0.4%, -3.5 to 2.2) was associated with better pulmonary outcomes.Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications