SENSITIVITY AND SPECIFICITY OF VISUAL INSPECTION WITH LUGOL’S IODINE S(VILI) IN CERVICAL CANCER.

Introduction: Cervical cancer is the second most common gynecologic cancer worldwide, accounting for 13% of all female cancer in developing countries. Cervical cancer is a disease that can be prevented through both primary prevention and early detection. Pap smear is a screening method which has been used for so long. Hence, one simple diagnostic test namely visual inspection with Lugol 's iodine (VILI) which is based on the ability of the trained healthcare personnel to detect yellow non iodine uptake areas in the cervical transformation zone are currently being evaluated in the experimental setting as potential alternative to cervical cytology. Objective: To determine diagnostic accuracy of visual inspection with Lugol's iodine (VILI) taking histopathology as gold standard among patients of cervical cancer. Subjects and methods: A total of 285 women with early marriage, history of post-coital bleeding, history of post- menopausal bleeding and history of per vaginal discharge were included in study. Women with obvious cervical growth and diagnosed cervical cancer were excluded. I put each patient in the  lithotomy  position and insert Cusco's speculum to visualize cervix. I cleaned the cervix with cotton soaked with normal saline. Now applied Jugol 's iodine, to the cervix normal squamous epithelium contain glycogen and stain.  Conversely premalignant and malignant squamous tissue contain no glycogen and does not stain with iodine. This was schillers test and non-staining areas were schiller positive. For further confirmation I took biopsy from schillers positive area and sent for histopathology. Results: Age range in this study was from 21 to 60 years with mean age of 39.393± 6.66 years and mean duration of disease was 6.031±2.09 months. 43.9% patients were belong to rural area and 56.1% belongs to urban area. 25.6% patients have Family History of cervical cancer. Visual inspection with Lugol's iodine (VILI) diagnosed 43(15.1%) patients and Histopathology diagnosed 15.8% patients with Cervical cancer. Visual inspection with Lugol's iodine (VILI) has shown sensitivity of 86.6%, specificity 98.3%, diagnostic accuracy by 96%, PPV 90.6%, NPV 97.5%, (p=0.000) in diagnosis of Cervical cancer.  Conclusion: My study showed VILI good sensitivity and it can therefore be a suitable potential alternative/adjunctive screening test not only in resource-poor settings but also in well-equipped centers. Keywords: Cervical cancer, Visual inspection with Lugol's iodine, Diagnostic accuracy DOI: 10.7176/JMPB/52-0

Prevalence and characteristics of resistant hypertensive patients in an Asian population

Background: Resistant hypertension is a well-recognized clinical challenge yet there are no reported data on its prevalence in Pakistan. These patients are subjected to a higher risk of developing hypertensive complications. The objective of our study was to evaluate the prevalence and determinants of resistant hypertension in an Asian cohort of hypertensive patients.Methods: This cross-sectional study was carried out among hypertensive patients visiting a tertiary care hospital in Karachi from September-December 2015. Patient data and characteristics were recorded using a pre-coded questionnaire. Morisky and Berlin questionnaires were used to assess compliance to medications and determine the risk of developing obstructive sleep apnea, respectively. Pearson\u27s chi-square test was used to analyze statistical differences between hypertensive patients and related factors.Results: A total of 515 patients were included in the study. Overall, 12% of the total patients (n=62) were resistant hypertensives and 25% (n=129) had pseudo-resistant hypertension. Resistant patients were more often females, older and had a higher body mass index (all P\u3c0.001). Use of painkillers and noncompliance to dietary recommendations were found to be significant determinants of resistant hypertension. Prevalence of comorbid conditions, including diabetes (p=0.33), hyperlipidemia (p=0.46), and chronic kidney disease (p=0.23), was not significantly higher in patients with resistant hypertension.Conclusion: Nearly one in ten hypertensive patients had true resistant hypertension, and twenty-five percent of patients had pseudo-resistance. Resistance hypertensions is significantly associated with female gender, older age, obesity, dietary noncompliance and increased use of NSAIDs