Chronic Cervicitis Research Articles

Clinical and laboratory peculiarities in postmenopausal patients with benign ovarian tumors

Objective. To assess clinical and laboratory peculiarities of postmenopausal patients with benign ovarian tumors. Materials and methods. The data of a prospective study of concomitant somatic and gynecological pathology in postmenopausal patients with benign ovarian tumors (basic group, n = 40) and patients without pathologies (comparison group, n = 15) are presented. Clinical and laboratory data were evaluated in both groups as well. Results. Postmenopausal patients with benign ovarian tumors were frequently exposed to myomas, chronic salpingitis and chronic cervicitis, when women with no ovarian neoplasms did not have these pathologies. Patients of the main group had higher levels of FSG, leptin, GBP and lower levels of vitamin D, than patients of the comparison group. Conclusions. Postmenopausal patients with benign ovarian tumors frequently have concomitant gynecological pathology, pronounced vitamin D insufficiency and high levels of FSG, leptin and GBP in serum samples.

Correlation of cervical pap smears with histopathological study of cervical biopsies: A hospital-based study

Background: Cervical cancer is the second commonest cancer among women accounting for 17.7% among all cancers in women. The high incidence of disease in developing countries is mainly due to absence of effective screening programs. The Papanicolaou (Pap) smear is widely employed for initial screening of cervical epithelial changes to detect early precancerous lesions. Objective: To correlate the cervical cytological findings with histopathological diagnosis using PAP and haematoxylin and eosin stains respectively. Methods: A prospective study conducted in tertiary health care centre over a period of 6 months. Out of 680 PAP smears, 100 cases were selected who were above 21 years and corresponding histopathological samples were received in the form of cervical biopsy. The data was collected and compiled in MS Excel and analysed using SPSS (Version 26.0). The variables were expressed as frequency and percentages and p value <0.05 was considered as statistically significant. Results: In this study, most common age was between 41-50 years (30%) and were multiparous (77%). The most common presenting complaint was white discharge per vagina (34%) followed by abnormal uterine bleed (29%). On PAP smear maximum cases were reported as NILM(64%), followed by ASCUS(19%), LSIL(11%), HSIL(4%), SCC(1%) and Adenocarcinoma(1%). On histopathology 45% were diagnosed as chronic cervicitis, chronic cervicitis with squamous metaplasia(32%), CIN I(9%), CIN II(4%), CIN III(8%), SCC(2%) and Adenocarcinoma(1%). Overall sensitivity of Pap smear was 86%, specificity 79%, positive predictive value 55%, negative predictive value 95% and accuracy of 81%. Conclusion: Hence we conclude that, maximum cases diagnosed on PAP smear correlated with histopathological diagnosis from cervical biopsy. Therefore it should be encouraged as effective screening method to reduce incidence and mortality caused by cervical cancer.

The Impact of Tamoxifen Usage in Breast Cancer Patients on the Development of Histopathological Lesions in the Cervix Uteri.

Background and Objectives: The purpose of the present study was to compare the results of colposcopic biopsies in patients with breast cancer and those who tested positive for HPV in cervix uteri cytological screenings, with a control group of HPV-positive individuals without breast cancer. Additionally, through this study, we aimed to investigate the impact of tamoxifen treatment, an anti-oestrogen drug used following breast cancer treatment, on histopathological changes. Breast cancer is the most common type of cancer and cause of death in women worldwide. Cervical cancer ranks as the second most prevalent form of cancer among women globally, with prevalence rates ranking just behind those of breast cancer. Human papillomavirus (HPV) positivity is a requirement for the development of cervical cancer, although it is not the sole factor responsible. Materials and Methods: A comparison was made between the histopathological results of 52 patients diagnosed with breast cancer, who tested positive for HPV in routine cervical cytological screenings and underwent colposcopic biopsy, and 230 cases without any abnormalities. A study was conducted to compare healthy individuals between the ages of 30 and 65 who were diagnosed with breast cancer and those who did not have breast cancer. The participants underwent HPV screening as part of the national cervical cytology screening programme. Results: The average age of those diagnosed with breast cancer was 46.73 ± 7.54; in comparison, the average age of participants in the control group was 47.49 ± 7.95. There was no statistically significant difference in age between the two groups (p: 0.530). A total of 51 cases (98.1%) of breast cancer were found to have actively used the anti-oestrogen drug tamoxifen for a duration ranging from at least 6 months to 5 years. One patient (1.9%) in the breast cancer group did not use tamoxifen. During routine cervical cytological screenings, it was observed that both breast cancer cases and healthy cases tested positive for HPV. The most commonly detected types of HPV in both groups were HPV 16 and 18, with rates of 73.1% noted in the breast cancer group and 92.6% noted in the healthy group, results consistent with the rates found in the general population. HPV 16 was found in 58.7% of participants in the control group and 42.3% of participants in the breast cancer group. There was a statistically significant difference between the two groups (p: 0.032). There was no statistically significant difference observed between the two groups in terms of normal, high-grade cervical intraepithelial lesions (HGSILs); low-grade cervical intraepithelial lesions (LGSILs); and chronic cervicitis histopathological lesions based on colposcopic and endocervical biopsy results, smear cytology, and HPV results (p-values of 0.913 and 0.877, respectively). Conclusions: Our study results indicate that tamoxifen treatment, an anti-oestrogen drug administered for chemoprevention purposes in the management of breast cancer, does not lead to an increase in abnormal histological changes in the cervix uteri. In all cases of breast cancer, gynaecological examination and cervical cytological screening should be advised.

Characterization of chemical constituents and metabolites in rat plasma after oral administration of Ainsliaea fragrans Champ by using UHPLC-QTOF-MS/MS

Ainsliaea fragrans Champ, a strong heat-clearing and detoxifying traditional Chinese medicine, has been effectively used for treating chronic cervicitis, endometritis, pelvic inflammatory diseases, and other conditions caused by damp heat. It shows a good effect in the treatment of cervicitis and has broad clinical application prospects. Nevertheless, there is no comprehensive study on its in vivo and in vitro chemical analysis. UHPLC-QTOF-MS/MS combined with the non-targeted characteristic filter analysis were used to conjecture and characterize the chemical components and in vivo metabolites of rats following oral administration of Ainsliaea fragrans Champ. In this study, A total of 85 compounds were identified in Ainsliaea fragrans Champ, including 29 flavonoids, 14 sesquiterpenoids, 25 chlorogenic acids, and 17 other compounds. In the plasma of rats after administration of Ainsliaea fragrans Champ, 160 compounds were deduced (19 prototype compounds and 141 metabolites). The 141 metabolites consist of 50 flavonoids, 80 phenolic acids and 11 Chlorogenic acids. The related metabolic pathways mainly involved demethylation, reduction, sulfonation, decarboxylation, hydroxylation, methylation, and glucuronide conjunction. In summary, the chemical components and metabolites of Ainsliaea fragrans Champ were comprehensively identified by using a rapid and accurate analysis method, which laid a foundation for dissecting its bioactive substances. In addition, it provides a scientific basis for the in-depth study of the material basis of Ainsliaea fragrans Champ efficacy and theoretical support for illustrating the mechanism of medical action and its clinical application.

Immediate risk of cervical intraepithelial neoplasia and diagnostic value of colposcopy among cytology-negative women with oncogenic HPV: a retrospective study

BackgroundCervical cancer screening results that are negative for cytology but positive for high-risk human papillomavirus (HR-HPV) are not uncommon. One-year follow-up is suggested for patients with no history of HPV positivity under the most recent American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines (2019). The aim of this study was to evaluate the immediate risk of cervical intraepithelial neoplasia (CIN) among cytology-negative patients positive for HR-HPV. The diagnostic accuracy of colposcopy in these patients was investigated.MethodsA retrospective study was conducted in patients who were cytology negative but HR-HPV positive and referred for colposcopy from January 2022 to August 2023. Patients were compared in terms of the immediate rate of CIN lesions among the HPV16-positive group, the HPV18-positive group and the non-16/18 HR-HPV-positive group. The distribution of CIN2 + lesions according to age was evaluated. The factors associated with the accuracy of colposcopy were evaluated using univariate and multivariate logistic regression.ResultsAmong the 372 patients, 195 had chronic cervicitis, 131 had CIN1, 37 had CIN2/3, and nine had carcinoma. The immediate rates of CIN2 + lesions and CIN3 + lesions in patients who were not HR-HPV16/18-positive were comparable to those in patients who were HPV16/18-positive (P = 0.699). In addition, among patients diagnosed with CIN2 + lesions, 8 (17.39%) patients were women aged < 30 years. When pathological results were used as a reference, the consistency rate of colposcopy was 61.0% (227/372). Multivariate analyses revealed that age and the type of cervical transformation zone were independent factors affecting the accuracy of colposcopy (P < 0.001).ConclusionsIn countries with limited resources, immediate colposcopy referral should be recommended for patients who are cytology negative but HR-HPV-positive (including non-16/18 HR-HPV-positive), and cervical cancer screening via cotesting should be suggested for women aged < 30 years. Colposcopy has moderate diagnostic value and can be affected by age and the type of cervical transformation zone.

The predictive value of serum inflammatory markers for the severity of cervical lesions

ObjectiveExploring the predictive value of NLR, PLR, MLR, and SII for the severity of cervical cancer screening abnormalities in patients.MethodsA retrospective analysis was conducted on the data of 324 patients suspected of cervical lesions due to abnormal TCT and/or HPV in our hospital from January 2023 to December 2023, who underwent colposcopy. The pathological results of colposcopic biopsy confirmed that there were 140 cases of chronic cervicitis, which classified as the group without cervical lesions. The cervical lesion group included 184 cases, including 91 cases of LSIL, 71 cases of HSIL, and 22 cases of cervical cancer. Compared the differences in preoperative peripheral blood NLR, PLR, MLR, and SII among different groups of patients, and evaluated their predictive value for the severity of cervical lesions using Receiver Operating Characteristic (ROC) curves.ResultsThe levels of NLR, PLR, and SII in the group without cervical lesions were lower than those in the group with cervical lesions (p < 0.05), and there was no statistically significant difference in MLR (p > 0.05). The comparison of NLR among LSIL, HSIL, and cervical cancer groups showed statistically significant differences (p < 0.05), while PLR, MLR, and SII showed no statistically significant differences (p > 0.05). The AUC of peripheral blood NLR, PLR, and SII for predicting cervical lesions were 0.569, 0.582, and 0.572, respectively. The optimal cutoff values were 2.3,176.48, and 603.56. The sensitivity and specificity were 38.6% and 73.6%, 28.8% and 85.7%, 37.5% and 76.4%, respectively. At the same time, the joint testing of the three had the highest efficiency, with sensitivity of 69% and specificity of 45%.ConclusionAlthough the peripheral blood NLR, PLR, and SII of the cervical lesions patients were higher than those without cervical lesions in cervical cancer screening abnormal patients, the predictive ROC curve discrimination was low. Therefore, it is not recommended to use preoperative peripheral blood inflammatory markers as markers for cervical cancer screening abnormal patient diversion.

PREVENTION OF HYSTERECTOMY BY AYURVEDIC MANAGEMENT OF ASRUGDARA WITH CYSTIC GLANDULAR HYPERPLASIA: A CASE REPORT

Asrugdara is a condition where there is an occurrence of heavy menstrual bleeding. Excess intake of food, which are excessive Lavana(salty), Amla(sour), Guru(heavy), Katu(hot), Vidahi (producing a burning sensation) and Snigdha (unctuous) etc. leads to this condition. This condition can be correlated with abnormal uterine bleeding (AUB). Abnormal uterine bleeding is defined as any uterine bleeding outside the normal volume, dura-tion, regularity or frequency is considered as abnormal uterine bleeding (AUB). This is a case report of a 41-year-old female patient having complaint of heavy menstrual bleeding with passing of clots for 11 days and ir-regular and early menses for three months. Her ultrasonography report was suggestive of thickened endometrial thickness with chronic cervicitis and a left ovarian simple cyst. She underwent conventional treatment of heavy bleeding, including Dilatation and Curettage (D&amp;C), but was unsuccessful. The histopathology report suggested glandular cystic hyperplasia without atypia. In the allopathic system of medicine, hysterectomy is advised. The patient is diagnosed with Kapha Vataja Asrugadara as per the symptoms. The objective of the present treatment included Ayurvedic management of Asrugadara, ensuring a decrease in the menstrual blood flow and regulariza-tion of the cycle, thereby improving the patient's general condition. The treatment plan included Shamana Chikitsa along with Basti Chikitsa. The treatment outcome was completely relieved of the symptoms with a reg-ular ultrasonography report.

CO2 Cryotherapy Combined with Kushen Gel for the Treatment of Chronic Cervicitis: A Real-World Study

CO2 Cryotherapy Combined with Kushen Gel for the Treatment of Chronic Cervicitis: A Real-World Study

Clinical Efficacy of Microwave Combined with Sophora flavescens Gel in Treating HPV Infection Complicated with Chronic Cervicitis and its Influence on Vaginal Microecology of Patients

Objective: To analyze the effect of microwave combined with Sophora flavescens gel in patients with HPV infection and chronic cervicitis (CC). Methods: From May 2022 to May 2023, 65 patients with HPV infection complicated with CC were randomly selected and divided into group A (31 cases, microwave) and group B (34 cases, microwave + Sophora flavescens gel) by numerical numbering envelope method, and the effects of the two groups were compared. Results: The positive rate of vaginal microenvironment factors, inflammatory factor indexes, immune function indexes, and HPV-DNA viral load in group B were better than those in group A in the following month after treatment (P &lt; 0.05). Conclusion: Combined use of microwave and Sophora flavescens gel in patients with HPV infection and CC can better improve the vaginal microenvironment and inflammatory reaction, boost the body’s immune function, and reduce HPV-DNA viral load.

A multicenter study on the accuracy of PAX1/JAM3 dual genes methylation testing for screening cervical cancer

Objective: To explore the value of cervical cytologic DNA methylation for screening cervical cancer. Methods: This study was a prospective multicenter study conducted from May to October 2022 in Peking Union Medical College Hospital, Zhejiang Provincial People's Hospital, and the Second Affiliated Hospital of Zhejiang University School of Medicine. Women who accepted opportunistic cervical cancer screening in gynecological outpatient clinics were subjected to liquid-based thin-layer cytology testing (TCT), high-risk human papillomavirus (hrHPV) DNA testing and PAX1/JAM3 dual-genes methylation testing (PAX1m/JAM3m). Colposcopy evaluation and biopsy were offered to women according to current guidelines. The accuracies of various testing methods and their combinations were compared based on histological diagnosis. Results: A total of 1 184 samples diagnosed by histopathology were included in this study, consisting of 541 cases (45.7%) of benign cervical tissue or chronic cervicitis, 273 (23.1%) of cervical intraepithelial neoplasia (CIN) 1, 168 (14.2%) of CIN2, 140 (11.8%) of CIN3, and 62 (5.2%) of cervical cancer. The sensitivity and specificity of PAX1m/JAM3m testing for detecting CIN2 or more severe lesions (CIN2+) were 74.1% and 95.9%, respectively. The sensitivity and specificity of PAX1m/JAM3m testing for detecting CIN3+were 87.6% and 86.8%, respectively. Receiver operating characteristic curve analysis showed that, for detecting CIN3+, the area under curve of PAX1m/JAM3m testing (0.872, 95%CI: 0.847-0.897) was significantly superior to TCT testing (0.580, 95%CI: 0.551-0.610) or hrHPV testing (0.503, 95%CI: 0.479-0.515) (all P values<0.05). Conclusions: The PAX1m/JAM3m test in cervical exfoliated cells has excellent accuracy for the diagnosis of both CIN2+and CIN3+, which is superior to traditional screening protocols and screening strategies.

Anti-inflammatory properties and characterization of water extracts obtained from Callicarpa kwangtungensis Chun using in vitro and in vivo rat models

Callicarpa kwangtungensis Chun (CK) is a common remedy exhibits anti-inflammatory properties and has been used in Chinese herbal formulations, such as KangGongYan tablets. It is the main component of KangGongYan tablets, which has been used to treat chronic cervicitis caused by damp heat, red and white bands, cervical erosion, and bleeding. However, the anti-inflammatory effects of CK water extract remains unknown. This study assessed the anti-inflammatory effects of CK in vivo and in vitro, characterized its main components in the serum of rats and verified the anti-inflammatory effects of serum containing CK. Nitric oxide (NO), tumour necrosis factor α (TNF-α) and interleukin-6 (IL-6) release by RAW264.7 cells was examined by ELISA and Griess reagents. Inflammation-related protein expression in LPS-stimulated RAW264.7 cells was measured by western blotting. Furthermore, rat model of foot swelling induced by λ-carrageenan and a collagen-induced arthritis (CIA) rat model were used to explore the anti-inflammatory effects of CK. The components of CK were characterized by LC–MS, and the effects of CK-containing serum on proinflammatory factors levels and the expression of inflammation-related proteins were examined by ELISA, Griess reagents and Western blotting. CK suppressed IL-6, TNF-α, and NO production, and iNOS protein expression in LPS-stimulated RAW264.7 cells. Mechanistic studies showed that CK inhibited the phosphorylation of ERK, P38 and JNK in the MAPK signaling pathway, promoted the expression of IκBα in the NF-κB signaling pathway, and subsequently inhibited the expression of iNOS, thereby exerting anti-inflammatory effects. Moreover, CK reduced the swelling rates with λ-carrageenan induced foot swelling, and reduced the arthritis score and incidence in the collagen-induced arthritis (CIA) rat model. A total of 68 compounds in CK water extract and 31 components in rat serum after intragastric administration of CK were characterized. Serum pharmacological analysis showed that CK-containing serum suppressed iNOS protein expression and NO, TNF-α, and IL-6 release. CK may be an anti-inflammatory agent with therapeutic potential for acute and chronic inflammatory diseases, especially inflammatory diseases associated with MAPK activation.

Chronic cervicitis: a gynecologist and cytologist’s view of the problem

Chronic cervicitis: a gynecologist and cytologist’s view of the problem

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

AbstractBackgroundCervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps.MethodsThis descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma.ResultsThe mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%.ConclusionGiven the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines.

Histological manifestations of the Cervix with Chronic Cystic Cervicitis and Nabothian Cyst: Case Report

Nabothian cysts are non-malignant lesions that occur on the cervix and affect a large percentage of reproductive aged women. They usually occur because of childbirth or minor trauma; most of the time, they are small and asymptomatic and require no treatment. However, large nabothian cysts may vary in appearance and even resemble malignant tumors. Consequently, in order to rule out malignancy, a biopsy is advised. The greatest valuable imaging modalities for cervical cystic lesions are MRI and transvaginal ultrasonography. Nabothian cysts usually don't need any treatment, but if the lesion's nature is unclear and it hurts, surgery may be necessary. In this case study, chronic pelvic pain is described and abnormal uterine bleeding needed surgical intervention because of chronic cystic cervicitis and multiple nabothian cysts accompanied with Leiomyoma accompanied with adenomyosis and endometrial hyperplasia without atypia.

SONOGRAPHIC PARAMETERS IN THE DIAGNOSIS OF CHRONIC CERVICITIS

Introduction. Inflammatory diseases of the pelvic organs (IDPO) remain the most relevant issue in contemporary gynecology. In modern diagnostics of reproductive organ pathologies, a highly effective and accessible method is ultrasound examination. Recent studies in this field, conducted using high-frequency digital transvaginal echography, have significantly contributed to reevaluating the potential of ultrasonographic diagnosis of the cervix; however, further research is warranted.&#x0D; The aim of this research is to enhance the diagnosis of cervical changes in cervicitis.&#x0D; Materials and methods. The study included 68 women with chronic cervicitis. The diagnosis was established based on clinical, colposcopy, and bacterioscopist examinations. During transvaginal ultrasound examinations, the cervix was visualized in both longitudinal and transverse projections for all patients. The patients with chronic cervicitis were divided into two groups: Group I consisted of 37 patients with visual changes in the cervix, while Group II comprised 31 women without any changes. A comparison group included 35 healthy women.&#x0D; Results. Chronic cervicitis is characterized by an increase in the thickness and volume of the cervix, as well as the heterogeneity of the stroma due to cystic cavities, with elevated ratios of cervix thickness to length and endocervix thickness to cervix thickness. Significant sonographic signs of the inflammatory process in the endocervix also include certain structural features, such as indistinct contours, increased echogenicity, small cysts, and multiple microcalcifications in the endocervix, uneven dilation of the cervical canal, and an area of reduced echogenicity.&#x0D; Conclusions. Therefore, a thorough ultrasound examination to determine the condition of the cervix, thickness, and structure of the endocervix can be a valuable adjunct non-invasive tool in the diagnosis of chronic cervicitis and can assist clinicians in diagnosing this pathology even in cases where there are no visual changes in the cervix during an examination.

A Rare Case of Xanthogranulomatous Salpingo-oophoritis

Background: Xanthogranulomatous salpingo-oophoritis is an infrequent and challenging diagnosis of the female genital tract. It involves the destruction of the fallopian tube and ovarian tissue by infiltrating inflammatory cells comprising lipid laden macrophages, lymphocytes, plasma cells, and multinucleated giant cells. While more commonly found in gall bladder and kidney, its occurence in female genital tract is rare. This is a case of Xanthogranulomatous salphingo-oophoritis in a 48 year woman who presented with chronic lower abdomen pain and frequent heavy menses for two months. On per abdomen examination a non tender 24 weeks size mass was felt and on vaginal examination the same mass was appreciated, seperate from the uterus. PAP was reported NILM. Ultrasound revealed uterine adenomyoma with bilateral endometrioma of ovaries and associated left hydrosalphinx. Patient underwent hysterectomy with bilateral salphingo-oopherectomy. Histopathological examination revealed uterine adenomyosis, chronic cervicitis with xanthogranulomatous salpingo-oophoritis. The patient recovered well and doing good on follow-up. Conclusion: Xanthogranulomatous salpingo-oophoritis, though rare is a significant entity because clinically it can mimic chronic pelvic inflammatory disease or endometrioma and even in some cases malignancy. Even clinical examination and imaging might not help much. Therefore, knowledge and awareness about the condition with the help of histopathology can clinch the diagnosis and also prevent radical cancer surgery

A randomized, double-blind, positive-controlled, Phase-II clinical trial to evaluate efficacy and safety of Fuke Qianjin capsule in Pakistani patients with pelvic inflammatory disease.

Ethnopharmacological relevance: Pelvic inflammatory disease (PID) is a frequently occurring gynecological disorder mainly caused by the inflammation of a woman's upper genital tract. Generally, antibiotics are used for treating PID, but prolonged use poses potential risks of gut bacterial imbalance, bacterial resistance, super bacteria production, and associated adverse reactions. Traditional Chinese medicine (TCM) has shown unique advantages in various ailments and has received widespread clinical research attention. Fuke Qianjin (FUKE) capsule is an approved National Medical Products Administration (NMPA License No. Z20020024) Chinese herbal prescription that has been widely used individually or in combination with other Western medicines for the treatment of various gynecological inflammatory diseases, including chronic cervicitis, endometritis, and chronic PID. Aim: This clinical trial was designed to assess the safety and efficacy of FUKE capsule in mild-to-moderate symptomatic PID patients. Materials and methods: This phase 2, randomized, double-blind, positive controlled clinical trial was conducted in mild-to-moderate symptomatic PID patients at a single center in Pakistan from 21 September 2021 to 11 March 2022. Eligible female participants were randomly assigned to a test and a control group with a ratio of 1:1. The test group subjects received two metronidazole (METRO) tablets and one doxycycline hyclate (DOXY) simulant at a time, twice daily for 14 days, and two Fuke Qianjin (FUKE) capsules, three times a day after a meal for 28 days. Subjects in the control group received two METRO tablets and one DOXY tablet at a time, twice daily for 14 days, and two FUKE simulant capsules, three times a day after meal for 28 days. The primary efficacy outcome was an improvement in pelvic pain symptoms assessed through a visual analog scale (VAS). The secondary outcomes were the improvement in secondary efficacy symptoms like local physical signs, clinical assessment of leucorrhea and cervical secretions through laboratory examination, and improvement in the maximum area of pelvic effusion assessed through gynecological ultrasound after the treatment. The safety outcomes were assessed through vital signs, laboratory tests, electrocardiogram findings, and adverse events/serious adverse events. Results: A total of 198 subjects with active PID were randomly assigned to a test group (n = 99) and a control group (n = 99). The baseline characteristics of the subjects in the two groups were similar. In the intention-to-treat analysis, the primary efficacy was 84.9% for the test group and 71.6% for the control group, with a statistically significant difference (p = 0.0370; 95% CI -0.2568 to -0.0088). The secondary clinical efficacy was 88.4% for the test group and 82.7% for the control group, with no significant difference (p = 0.2977; 95% CI -0.1632 to 0.0501). The improvement in local physical signs was 95.8% for the test group and 76.9% for the control group, with no significant difference (p = 0.0542; 95% CI -0.3697 to -0.0085). The inter-group non-inferiority comparison showed that the upper limit of the 95% CI was less than 0.15 and thus met the non-inferiority requirements of the test group to the control group. The results of clinical signs of leucorrhea and cervical secretions showed that there was no difference in the rate of improvement between the test and control groups, indicating that FUKE was non-inferior to DOXY. A total of 14 adverse events in eight subjects were observed in the trial, with an incidence rate of 4.7%. Four subjects in each group experienced seven adverse events with 4.5% and 4.8% incidence rates of adverse reactions in the test and control groups, with no statistically significant differences (p = 0.2001). No serious adverse events occurred in the trial. Conclusion: The results of this trial indicate that the test drug (Fuke Qianjin capsule) is non-inferior to the control drug (doxycycline hyclate tablet) in treating mild-to-moderate PID patients with comparable efficacy, safety, and tolerability to the control drug. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT04723069.

Diagnostic Performance between Colposcopy Findings and Histopathology Reports

Background: Cervical cancer is the most frequent cancer in women worldwide. With appropriate screening, the condition can be prevented and treated. Colposcopy is a useful tool in the diagnosis and management of precancerous cervical lesions following primary screening. The gold standard for identifying precancerous lesions is histopathology. Objective: The aim of this study is to evaluate the diagnostic performance between colposcopy findings and histopathology reports Methods: The cross-sectional observational study was conducted in the Department of Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to June 2023. A total of 62 subjects were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, the mean age was found to be 36.8±11.9 years, with a range from 20 to &gt;51 years maximum 44 (71.0%) of the patients were within the age group of 20 - 40 years. The majority 37 (59.7%) of patients completed SSC and most of the patients 56 (90.3%) were housewives. Most of the patients 59 (95.2%) were Muslims and about 32 (51.6%) came from middle-income families. About 25 (40.3%) patients were married between the ages of 15-17 years. About 25 (40.3%) were between 16-18 years during their first delivery and about 26 (41.9%) had 3-4 children and 21 (33.9%) had more than 4 children. Most of the patients 43(69.4%) had history of received OCP. Regarding colposcopic diagnosis, 12.9% (n=8) were normal, 69.4% (n=43) were CIN I, 9.7% (n=6) were CIN II and 8.1% (n=5) were CIN III and 30.6% (n=19) chronic cervicitis, 46.8% (n=29) CIN I, 6.5% (n=4) CIN II, 6.5% (n=4) CIN III, 4.8% (n=3) carcinoma in situ and 4.8% (n=3) were invasive squamous cell carcinoma by the histopathological diagnosis. Conclusion: Colposcopy had a rather high diagnostic accuracy for histopathologically verified precancerous cervical lesions. Even if the results of the screening tests are normal, patients who report with postcoital and postmenopausal bleeding should have colposcopies and biopsies. Colposcopy also has a high sensitivity, therefore it is simple to use the "see and treat" approach to lower dropout rates.

Colposcopic findings to study cervical changes in reproductive age group women using various contraceptives.

Colposcopy has a key role to play in see-and-treat programs for premalignant cervical lesions. The aim of the study/was to observe cervical changes with a colposcope using the Swede scoring system in fertile age group women using various contraceptives: conventional methods (barrier methods, coitus interruptus), oral contraceptives (OCPs), copper-T and bilateral tubectomy. The aim of the study was to observe and evaluate the colposcopic findings using the Swede scoring system for the diagnosis of premalignant/malignant lesions in reproductive age group women using various contraceptives. This was a prospective observational study, conducted among 200 women of reproductive age group using various contraceptives in a tertiary care institute in North India. PAP smear, direct visual examination, VIA (Visual Inspection with Acetic Acid) examination, colposcopic examination, and (biopsy if indicated) were done. The data were collected, and analysis was done using Microsoft Excel Office Software 2019 version 19.11 and epi info (CDC Atlanta) 7.23.1. Statistical analysis was done using percentages, mean, mode, median, standard deviation, Chi-square, Fisher's Test, and Anova Test. We found positive PAP (Papanicolaou test) smears in 61.50%, positive VIA examination in 9%, and positive findings in colposcopic examination in 28.50%, Swede score of 0-3 in 100% (0-91%, 1-2%, 2-6%, and 3-1%) and positive biopsy in 9% subjects. Malignant findings were observed in 1.00% of PAP smears. Colposcopic findings were CIN 1 (cervical intraepithelial neoplasia 1) in 8.5% and CIN 2 in 0.5% subjects. Swede score was zero in 91%, 1 in 2%, 2 in 6%, and 3 in 1% of subjects. HPE (histopathological examination) was chronic cervicitis in 8.50% and mild dysplasia/CIN 1 in 0.5%. No significant statistical associations between contraceptive choice and false-positive test results or disease prevalence was found in any group except Cu-T users p = 0.0184 (especially for CIN 2; p = 0.0109 and CIN 1 more in all groups than Cu-T users). Colposcopy had sensitivity 100%, specificity 91.46% (0/0 = 0%) PPV = 5.56%, NPV = 100%, Accuracy = 91.5% for detecting mild dysplasia/CIN-non-significant (p = 0.055). Our study had mainly low-grade lesions with 100% NPV. With increase in Swede Score, sensitivity increases but at the expense of specificity but it was statistically non-significant (p = 0.055). Our study may guide the rational use of colposcopy with Swede scoring for see-and-treat lesions, which is easy and with a low learning curve, as a tool for diagnosis but only in cases where indicated like unhealthy cervix because of the high rate of false-positive results. In low-grade lesions, it is highly useful to rule out the disease.

ЛЕЧЕНИЕ ХРОНИЧЕСКОГО ВПЧ-АССОЦИИРОВАННОГО ЦЕРВИЦИТА

Chronic cervicitis is a polyetiological inflammatory disease of the cervix, accompanied by a recurrent course. In the presence of viral agents (especially human papillomavirus), transformation of this disease into neoplastic processes is possible in the absence of timely diagnosis and a lack of comprehensive treatment. Particular attention is drawn to the steady increase in morbidity among women of young reproductive age, peculiarities of immune status, and concomitant gynecological diseases.