Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26 and 97, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions. © 2005 IGCS

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health

Determining the Midwifery Staff in the Maternity Ward of Hospitals Using the Birthrate Plus Model

BACKGROUND AND OBJECTIVE: In addition to reducing the costs in hospitals, manpower planning can ensure the quality of patient care. Therefore, this study, which is part of a comprehensive study, was conducted with the aim of applying the birth rate method to estimate the number of midwives required in the maternity ward. METHODS: In this analytical study, 334 patients who referred to the delivery ward of two hospitals affiliated to the Social Security Organization in Khorasan Razavi province were selected by systematic random sampling. Retrospective data were collected from patients' medical records using the Birthrate Plus (BR+) model questionnaire consisting of 34 items related to maternal and neonatal clinical factors based on scores obtained in five groups (score 6 in group one, score 7-9 in group two, score 10-13 in group three, score 14-18 in group four, and score 19 and above in group five). Then, the data were analyzed. FINDINGS: The results showed that the duration of stay in the maternity wards of the province and district hospitals was 12.07±5.18 and 7.17±4.22 hours, respectively (p<0.001). The mean duration of midwife's care in the two hospitals was significantly different (p<0.001). The results indicated more patients with complex conditions in the maternity ward of the province hospital. According to the "BR+" model, about 60% of patients in the province hospital were in groups 4 and 5, while it was 18% in another hospital. The number of midwives required in district and province hospitals was 27 and 72, respectively, based on full-time equivalent (FTE), which was obtained by converting it into an index equivalent to one midwife for 142 and 95 annual deliveries in the mentioned hospitals. CONCLUSION: The results of the study showed that the use of the BR+ model, considering the length of stay and the severity of clients' symptoms, is a suitable model for determining the midwifery staff in the maternity ward

Ovarian hormones prevent methamphetamine-induced anxiety-related behaviors and neuronal damage in ovariectomized rats

Methamphetamine (METH) may cause long�lasting neurotoxic effects and cognitive impairment. On the other hand, the ovarian hormones estrogen and progesterone have neuroprotective effects. In the current study, we aimed to examine the effects of estrogen and progesterone on anxiety�like behavior and neuronal damage in METH�exposed ovariectomized (OVX) rats. Three weeks after ovariectomy, the animals received estrogen (1 mg/kg, i.p.), or progesterone (8 mg/kg, i.p.), or estrogen plus progesterone (with the same doses), or vehicle during 7 consecutive days (days 22�28). On day 28, OVX rats were exposed to a single�day METH regimen (6 mg/kg, four s.c. Injections, with 2 h interval) 30 min after the hormone treatment. The next day (on day 29), the animals were assessed for anxiety�related behaviors using the open field and elevated plus�maze tasks. The animals were then sacrificed and brain water content, cell apoptosis and expression of IL-1β were evaluated. The findings showed that treatment with estrogen or progesterone alone in METH�exposed rats significantly improved hyperthermia, anxiety�like behavior, neuronal damage, and inflammation in the CA1 area. Also, treatment with estrogen plus progesterone improved hyperthermia and brain edema. Taken together, the findings suggest that treatment with ovarian hormones can partially prevent hyperthermia and anxiety�related behaviors induced by METH in OVX rats, which could be accompanied by their neuroprotective effects in the hippocampus. © 202