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Background: Cervical cancer, the fourth most frequent cancer in women, is associated with the human papillomavirus (HPV). This study identifies risk factors and clinical findings for abnormal cervical cytology and histopathology in the Trinidad and Tobago populations. Some risk factors include early age of first coitus, a high number of sexual partners, high parity, smoking, and using certain medications, such as oral contraception. This study aims to identify the significance of Papanicolaou (pap) smears and the common risk factors that contribute to the development of premalignant and malignant cervical lesions. Method: A three-year retrospective, descriptive study of cervical cancer was conducted at the Eric Williams Medical Sciences Complex. The subject population included 215 female patients aged 18 years and older with the following documented abnormal cervical cytology: (ASCUS), ASC-H, LSIL, HSIL, Atypical Glandular cells, HPV, Adenocarcinoma, and Invasive Squamous Cell Carcinoma. Histopathology records were analysed for thirty-three of these patients. Patients' information was recorded on data collection sheets adapted from the North Central Regional Health Authority's cytology laboratory standardised reporting format request form. Results and Findings: The data were analysed via Statistical Package for Social Sciences (SPSS) software edition 23 using frequency tables and descriptive analysis. The mean sample age of the population was 36.7 years, the first age of coitus was 18.1 years, the number of sexual partners was 3.8, and the number of live births was 2. LSIL was the most popular abnormal finding, 32.6%, followed by HSIL, 28.8%, and ASCUS, 27.4%. Most histopathological reports resulted in CIN I and II. Conclusions: The significant risk factors observed for cytology abnormalities and premalignant lesions were early age of coitus, a high number of sexual partners, and no use of contraception. Patients mostly presented as asymptomatic despite obtaining abnormal cytology results. Hence, regular pap smear screening should continue to be highly encouraged.

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BACKGROUND: Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions. AIMS: To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region. MATERIALS AND METHODS: Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies. RESULTS: A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%. CONCLUSION: This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

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Resumo Objetivo Avaliar duas técnicas de coleta cervicovaginal à adequabilidade da amostra e aos demais achados do laudo colpocitopatológico. Métodos O estudo foi realizado no período de setembro de 2018 a julho de 2019, em um centro de saúde-escola, localizado no município de Fortaleza - Ceará. A amostra foi composta por 365 mulheres divididas aleatoriamente, sendo 184 participantes no Grupo Controle (técnica na qual o esfregaço da ectocérvice foi disposto na lâmina antes da coleta do material da endocérvice) e 181 no Grupo Comparação (no qual o esfregaço da ectocérvice vaginal foi disposto na lâmina apenas após a coleta do material da endocérvice). Utilizou-se um instrumento contendo variáveis sociodemográficas, clínicas, sexuais, reprodutivas e referentes aos achados no laudo citopatológico. Incluíram-se mulheres na faixa etária de 18 a 64 anos, que já tinham iniciado vida sexual e que realizaram o exame de prevenção do câncer de colo uterino no período da coleta de dados. Os testes do qui-quadrado, Fisher e Kruskal-Wallis foram utilizados. Resultados Não houve associação estatística entre a adequabilidade da amostra citopatológica às duas técnicas de coleta cervicovaginal empregadas e às demais variáveis clínicas, sexuais, reprodutivas e referentes aos demais achados no laudo citopatológico, obtendo-se valor de p>5% em todas as associações realizadas. Conclusão As duas técnicas de coleta de células cervicais descritas em manuais oficiais não diferiram para a obtenção de uma amostra celular adequada, sendo igualmente eficazes e propiciando a garantia de um laudo colpocitopatológico preciso e oportuno. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-2H4MPN.

Resumen Objetivo Evaluar dos técnicas de toma de muestra cervicovaginal con la adecuación de la muestra y con los demás resultados del informe colpocitológico. Métodos El estudio fue realizado durante el período de septiembre de 2018 a julio de 2019, en un centro de salud-escuela, ubicado en el municipio de Fortaleza, estado de Ceará. La muestra estaba compuesta por 365 mujeres divididas aleatoriamente, de las cuales 184 participantes estaban en el Grupo Control (técnica por la que el frotis del ectocérvix fue colocado en la lámina antes de la toma del material del endocérvix) y 181 en el Grupo Comparación (en el que el frotis del ectocérvix vaginal fue colocado sobre la lámina únicamente después de la toma del material del endocérvix). Se utilizó un instrumento con variables sociodemográficas, clínicas, sexuales, reproductivas y relativas a los resultados del informe citológico. Fueron incluidas mujeres del grupo de edad de 18 a 64 años, que ya habían empezado su vida sexual y que realizaron la prueba de prevención de cáncer de cuello uterino durante el período de la recopilación de datos. Se utilizaron las pruebas χ2 de Pearson, Fisher y Kruskal-Wallis. Resultados No hubo asociación estadística entre la adecuación de la muestra citológica con las dos técnicas de toma cervicovaginal utilizadas y con las demás variables clínicas, sexuales, reproductivas y referentes a los demás resultados del informe citológico, y se obtuvo un valor de p>5 % en todas las asociaciones realizadas. Conclusión Las dos técnicas de toma de células cervicales que se describen en manuales oficiales no difirieron en la obtención de una muestra celular adecuada y son igualmente eficaces y favorecen la garantía de un informe colpocitológico preciso y oportuno.

Abstract Objective To assess two cervicovaginal collection techniques to sample suitability and the other findings of Pap smear. Methods The study was conducted from September 2018 to July 2019, in a school health center located in the city of Fortaleza - Ceará. The sample consisted of 365 women randomly divided, with 184 participants in the Control Group (technique in which the ectocervix smear was placed on the slide before endocervical material was collected) and 181 in the Comparison Group (in which the vaginal ectocervix smear was placed on the slide only after collecting the material from the endocervix). An instrument containing sociodemographic, clinical, sexual, reproductive and findings in cytopathological report was used. Women aged between 18 and 64 years, who had already started their sexual life and who underwent the cervical cancer prevention test during the data collection period, were included. Chi-square, Fisher and Kruskal-Wallis tests were used. Results There was no statistical association between cytopathological sample suitability for the two cervicovaginal collection techniques used and for the other clinical, sexual, reproductive and other variables related to the other findings in cytopathological report, obtaining a value of p>5% in all associations performed. Conclusion The two techniques for collecting cervical cells described in official manuals did not differ for obtaining an adequate cell sample, being equally effective and providing the guarantee of an accurate and timely Pap smear. Brazilian Clinical Trial Registry (ReBEC): RBR-2H4MPN.

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RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

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The aim of this study was evaluating the association and correlation between the diagnostics tests used for Leishmania spp. detection in dogs and ticks. We evaluated 99 dogs and 990 Rhipicephalus sanguineus. In dogs, we used bone marrow aspirates and lymph node fine-needle aspiration biopsy (FNAB) for direct parasitological examinations and real time-polymerase chain reaction (RT-PCR) and collected blood samples for enzyme-linked immunosorbent assays (ELISA). In ticks, two laboratory techniques [immunohistochemistry to lipophosphoglycan (IHC) and RT-PCR] were performed in the intestine, ovaries and salivary glands. With respect to the measurement of diagnostic performance in dogs, lymph node RT-PCR proved to be the best test followed by ELISA and bone marrow RT-PCR. In ticks, intestine IHC were considered as a gold standard for diagnosis of leishmaniasis with intestinal RT-PCR being the best diagnostic test. To arrive at the correlation between laboratory techniques for dogs and their ticks, we evaluated the diagnostic test used for dogs with tests performed in R. sanguineus, which used lymph node FNAB as the gold standard. The intestine IHC technique showed strongest association. We demonstrated that the best tissue for Leishmania spp. detection in dogs was the lymph node and the intestine in case of ticks. As for laboratory techniques, the isolated analysis of each species presented a strong agreement between immunohistochemistry and RT-PCR when compared to its gold standard. In addition, we concluded that the immunohistochemistry of ticks' intestines was a better technique for diagnosing Leishmania spp. in R. sanguineus, thereby showing almost perfect correlation with the lymph node FNAB.

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OBJECTIVE: The protective role of Lactobacillus iners in the vaginal microbiota has been questioned. Recent studies have shown that L. iners is the dominating taxon in a large subset of women worldwide. The aim of this study was to identify sociodemographic, behavioural and clinical variables associated with L. iners-dominated community state type (CST) III in Brazilian women of reproductive age. PARTICIPANTS AND METHODS: This study leveraged microbiota compositional data generated by sequencing of the V3-V4 16S rRNA gene from vaginal samples collected from 442 participants enrolled in a previous cross-sectional study that included 609 women in five geographical regions of Brazil. A total of 167 (27.4%) participants were excluded from the current study as they did not present a Lactobacillus-dominated vaginal microbiota. Data on sociodemographic and behavioural characteristics of the study population were obtained through face-to-face interviews. Participants were assigned to two study groups: those with L. iners-dominated CST III (n=222) and those with three distinct CSTs (I, II or V) dominated by another Lactobacillus spp. (n=220). Logistic regression analysis using a stepwise method was performed to test association between CST III and participants' characteristics, considering their OR and 95% CIs. RESULTS: Among the population characteristics assessed, L. iners-dominated CST III was independently associated with having two or more sexual partners (OR 3.27; 95% CI 1.50 to 7.11) and microscopic detection of Candida sp. on vaginal smears (OR 2.24; 95% CI 1.02 to 4.89). Other characteristics were inversely associated with CST III, including condom use (OR 0.59; 95% CI 0.38 to 0.91), higher educational level (OR 0.61; 95% CI 0.41 to 0.91) and diet containing milk/dairy intake (OR 0.43; 95% CI 0.20 to 0.90). CONCLUSION: Unprotected sex practices, number of sexual partners and lower educational levels may be useful for identifying women with L. iners-dominated microbiota and its suboptimal protective properties. L. iners microbiota does not seem to provide optimal protection against Candida sp. colonisation, warranting further investigation.

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INTRODUCTION: Cytology appears to be a viable option to histological samples for proper storage and maintenance of autopsy material for DNA extraction and analysis. In the present study, we tested the feasibility of using archived air-dried smears produced at the time of the autopsy for simple molecular analysis, comparing quantity and quality of the DNA extracted from the smears to that of correspondent histological specimens. METHODS: Air-dried cytological smears were obtained from scrapings of exactly the same areas collected for histological study. DNA was extracted using a commercially available protocol from all samples, with calculation of purity ratio and overall concentration. The integrity of the extracted DNA was also verified through conventional polymerase chain reaction (PCR). RESULTS: Five cases of lung tumours (2 small cell carcinomas and 3 adenocarcinomas) were collected. Percentage of tumour cells and necrosis ranged from 30% to 90% and from 10% to 40%, respectively, in the cytological preparations, and from 50% to 90% and from 10% to 80%, respectively, in the histological preparations. Purity ratio (260/280) had a median of 1.87 in cytology vs 1.94 in histology. Mean DNA concentration among the cytological preparations was 2653 ng/mL (range 1684-3980 ng/mL) vs 757.2 ng/mL among the histological preparations (range 456-1829 ng/mL. DNA from all five cases of cytology was successfully amplified by conventional PCR, in contrast to none from the histology specimens. CONCLUSIONS: Archived air-dried smears scraped from tumoural lesions in autopsies have proven to yield a good concentration of quality DNA for conventional PCR, with better results than formalin-fixed paraffin embedded material.

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Introdução: A Gardnerella vaginalis facilita a infecção pelo papilomavírus humano (HPV). Objetivo: Verificar a associação entre anormalidades citológicas e presença de Gardnerella vaginalis nos esfregaços cervicovaginais encaminhados ao Laboratório Clínico da Pontifícia Universidade Católica de Goiás (LAC/PUC Goiás) estratificadas por faixa etária. Método: Estudo transversal realizado no LAC/PUC Goiás entre janeiro de 2013 a dezembro de 2015. Para análises estatísticas, a variável idade foi categorizada em ≤39 anos e >40 anos, utilizando o programa IBM SPSS Statistics (Version 2.0, 2011®) para o teste de qui-quadrado (X²), com intervalo de confiança de 95% e valor p<0,05. Resultados: Foram analisados 4.558 exames citopatológicos, a maioria com presença de Lactobacillus spp. (46,97%). A prevalência dos agentes patogênicos foi a Gardnerella vaginalis (79,6%), seguida de Candida spp. (16,8%), Trichomonas vaginalis (2,2%), Herpes simplex (0,4 %) e Chlamydia trachomatis (0,1%). As anormalidades citológicas foram observadas em 9,1%, sendo atypical squamous cells of undetermined significance (ASC-US) 2,57%, low grade squamous intraepithelial lesion (LSIL) 1,78%, atypical squamous cells of undetermined significance cannot exclude high grade squamous intraepithelial lesion (ASC-H) 3,52%, high grade squamous intraepithelial lesion (HSIL) 1,08%, atypical endocervical cells, favor neoplastic (AGC-NEO) 0,22% e carcinoma 0,02%. Houve uma associação significante entre anormalidades citológicas graves e mulheres ≥40 anos, OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Mulheres ≤40 anos mostraram significância à presença de Gardnerella vaginalis (p<0,0004). Conclusão: Uma elevada prevalência de Gardnerella vaginalis foi encontrada associada com as anormalidades citológicas, principalmente em mulheres sexualmente ativas.

Introduction:Gardnerella vaginalis facilitates human papillomavirus (HPV) infection. Objective: To verify the association between cytological abnormalities and the presence of Gardnerella vaginalis in cervicovaginal smears sent to the Clinical Laboratory of the Pontifical Catholic University of Goiás (LAC/PUC Goiás) stratified by age range. Method: Cross-sectional study carried out at LAC/PUC Goiás from January 2013 to December 2015. For statistical analysis, the variable age was categorized as ≤39 years and >40 years, using the IBM SPSS Statistics program (Version 2.0, 2011®) for the chi-square test (X²), with a 95% confidence interval and p<0.05. Results:4,558 cytopathological exams were analyzed, most of them with the presence of Lactobacillus spp (46.97%). The prevalence of pathogens was Gardnerella vaginalis (79.6%), followed by Candida spp. (16.8%), Trichomonas vaginalis (2.2%), Herpes simplex (0.4%) and Chlamydia trachomatis (0.1%). Cytological abnormalities were observed in 9.1%, being atypical squamous cells of undetermined significance (ASC-US) 2.57%, low grade squamous intraepithelial lesion (LSIL) 1.78%, atypical squamous cells of undetermined significance cannot exclude high intraepithelial lesion (ASC-H) 3.52%, high grade squamous intraepithelial lesion (HSIL) 1.08%, atypical endocervical cells, neoplastic favor (AGC-NEO) 0.22% and carcinoma 0.02%. There was a significant association between severe cytological abnormalities and women >40 years old OR 3.01 (95% CI 2.0-4.58) (p<0.0001). Women ≤40 years old showed the presence of Gardnerella vaginalis (p<0.0004). Conclusion:A high prevalence of Gardnerella vaginalis was found and its association with cytological abnormalities, especially in sexually active women.

Introducción:Gardnerella vaginalis facilita la infección por el virus del papiloma humano (VPH). Objetivo: Verificar la asociación entre anormalidades citológicas y la presencia de Gardnerella vaginalis en frotis cervicovaginales enviadas al Laboratorio Clínico de la Pontificia Universidad Católica de Goiás (LAC/PUC Goiás) estratificadas por grupo de edad. Método: Estudio transversal realizado en LAC/PUC Goiás desde enero de 2013 hasta diciembre de 2015. Para el análisis estadístico, la edad variable se clasificó como ≤39 años y >40 años, utilizando el programa IBM SPSS Statistics (Versión 2.0, 2011®) para la prueba de chi-cuadrado (X²), con un intervalo de confianza del 95% y p <0,05. Resultados: Se analizaron 4.558 exámenes citopatológicos. La prevalencia de Lactobacillusspp. con 46,97%. Los patógenos como Gardnerella vaginalis fueron 79,6%, Candidaspp. 16,8%, Trichomonas vaginalis 2,2%, Herpes simplex 0,4%, y Chlamydia trachomatis 0,1%. Se observaron anormalidades citológicas en 9,1%, con células escamosas atípicas de significado indeterminado (ASC-US) 2,57%, lesión intraepitelial escamosa de bajo grado (LSIL) 1,78%, células escamosas atípicas de significación indeterminada no pueden excluir lesión intraepitelial (ASC-H) 3,52%, lesión intraepitelial escamosa de alto grado (HSIL) 1,08%, células endocervicales atípicas, favor neoplásico (AGC-NEO) 0,22% y carcinoma 0,02%. Hubo una asociación significativa entre anormalidades citológicas severas y mujeres >40 años OR 3,01 (IC 95% 2,0-4,58) (p<0,0001). Las mujeres ≤40 años mostraron la presencia de Gardnerella vaginalis (p<0,0004). Conclusión: Se encontró una alta prevalencia de Gardnerella vaginalis y su asociación con anomalías citológicas, especialmente en mujeres sexualmente activas.

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We report the first detection of Trypanosoma vivax in Bahia state based on blood smear and PCR analyses. A total of 623 bovine blood samples were collected over two years. Parasitological analysis by smear technique detected the presence of T. vivax in 0.3%, while molecular analysis by PCR showed a prevalence in 18.9% of the samples. This study demonstrated the higher sensitivity of molecular analysis in the diagnosis of hemoparasitosis caused by T. vivax in dairy cattle herds.(AU)

Relatamos a primeira detecção de T. vivax no estado da Bahia baseada em esfregaços sanguíneos e PCR. Foram coletadas 623 amostras de sangue de bovinos ao longo de dois anos. An análise dos esfregaços detectou a presença do T. vivax em 0,3% delas, enquanto a detecção molecular por PCR mostrou uma prevalência em 18,9%. Este estudo evidenciou a maior sensibilidade da análise molecular no diagnóstico da hemoparasitose causada pelo T. vivax, em rebanhos bovinos leiteiros.(AU)

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We report the first detection of Trypanosoma vivax in Bahia state based on blood smear and PCR analyses. A total of 623 bovine blood samples were collected over two years. Parasitological analysis by smear technique detected the presence of T. vivax in 0.3%, while molecular analysis by PCR showed a prevalence in 18.9% of the samples. This study demonstrated the higher sensitivity of molecular analysis in the diagnosis of hemoparasitosis caused by T. vivax in dairy cattle herds.

Relatamos a primeira detecção de T. vivax no estado da Bahia baseada em esfregaços sanguíneos e PCR. Foram coletadas 623 amostras de sangue de bovinos ao longo de dois anos. An análise dos esfregaços detectou a presença do T. vivax em 0,3% delas, enquanto a detecção molecular por PCR mostrou uma prevalência em 18,9%. Este estudo evidenciou a maior sensibilidade da análise molecular no diagnóstico da hemoparasitose causada pelo T. vivax, em rebanhos bovinos leiteiros.

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BACKGROUND: Studies have indicated that bacterial vaginosis (BV) might be a cofactor for the acquisition and persistence of high-risk papillomavirus, enabling the development of cytological abnormalities. The presence of endocervical and metaplastic cells makes the smear more adequate for the detection of these abnormalities once these cell types are representative of the transformation zone, a site of increased susceptibility to viral infection. METHODS: The purpose of this study was to evaluate the patterns of vaginal microbiota, the representation of endocervical and/or metaplastic cells, and the detection of cytological abnormalities in cervical smears from women 15 to 64 years old. Results from satisfactory cytological smears performed in a laboratory school from the Federal University of Goiás were analyzed. The degree of association between the categorical variables was evaluated by the χ2 test, Fisher's Exact test, and stratified analysis through the estimation of the prevalence ratio, with 95% confidence intervals and 5% statistical significance level (P < .05). RESULTS: The global prevalence of BV and cytological abnormalities was 22.02% and 8.21%, respectively. BV and the representation of endocervical and/or metaplastic cells were independently associated with the detection of high-grade cytological abnormalities in the cervical smears of women between 25 and 64 years old. CONCLUSIONS: BV and representation of endocervical and/or metaplastic cells were independently associated with the detection of high-grade cytological abnormalities reinforcing the importance of specimen adequacy and microbiota in the cervical microenvironment.

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Introducción: La citología cervical constituye la principal herramienta para la detección y tratamiento del cáncer de cérvix. Algunos estudios llevados a cabo en población urbana han relacionado la realización y adherencia con los conocimientos, las actitudes y las prácticas favorables de las mujeres con respecto a esta prueba. Objetivo: evaluar los conocimientos, actitudes y prácticas con respecto a la citología cervical en mujeres pertenecientes a un grupo poblacional del ámbito rural. Material y Métodos: estudio de corte transversal-analítico en una población de aproximadamente 3148 mujeres en edad fértil, de ellas se obtuvo una muestra representativa. Se utilizó una encuesta anónima, validada, dirigida, y aplicada por personal de salud capacitado que labora en centros de salud del primer nivel de atención de los distritos de la provincia de Bolívar, La Libertad. Resultados: El 80 por ciento de las mujeres encuestadas tuvo un nivel de conocimiento alto e intermedio, el 70 por ciento una actitud favorable, mientras que el 44 por ciento reportó prácticas correctas en relación con la prueba de citología cervical. El nivel de conocimiento alto e intermedio estuvo asociado a la edad mayor de 30 años (p:0.02), estado civil casada (p:0.05), el mayor grado de instrucción (p:0.00) y el uso de métodos anticonceptivos (p:0.01); no se encontró relación con la edad de inicio de relaciones sexuales (p:0.98). Conclusiones: Existe un alto nivel de conocimientos, actitudes y prácticas correctas hacia la citología cervical en la población rural de la provincia de Bolívar, pero una baja adherencia hacia la misma(AU)

Introduction: Cervical cytology is the main tool for the detection and treatment of cervical cancer. Some studies carried out in the urban population have associated the realization and adherence with knowledge, attitudes and favorable practices of women with respect to this test. Objective: The aim of this study was to determine the level of knowledge, attitudes and practices towards cervical cytology in women of childbearing age in a rural Peruvian province. Material and Methods: A cross-sectional analytical study was conducted in a population of approximately 3148 women of childbearing age, a representative sample was obtained. An anonymous, validated, directed survey was used; it was applied by trained health personnel working in health centers of the primary care level in the districts of the province of Bolívar, La Libertad. Results: A total of 400 surveys were carried out. The results showed that 80 percent of the women surveyed had high and intermediate levels of knowledge, 70 percent had a favorable attitude, while 44 percent reported correct practices related to the cervical cytology test. The high and intermediate levels of knowledge were associated with age over 30 years (p: 0.02), married marital status (p: 0.05), the highest level of instruction (p: 0.00) and the use of contraceptive methods (p: 0.01); no relationship was found with the age of onset of sexual intercourse (p: 0.98). Conclusions: There is a high level of knowledge, attitudes and correct practices towards cervical cytology in the rural population of the province of Bolívar, but a low adherence to it(AU)

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ABSTRACT Introduction: Liquid-based solution for cytology has been developed to improve Pap test. Some liquid media are commercially available, however, due to the high cost there are difficulties in implementing it in the public health programs of many countries. Objectives: To study the suitability of alternative liquid media for the collection and preservation of samples for cytologic examinations, comparing the results with the conventional Papanicolaou methodology. Material and methods: In this study, 127 different compositions of alternative liquid-based solutions were tested with samples from 10 volunteers for oral cytology and 20 samples from volunteers for cervical cytology. Formaldehyde-isopropanol-phosphate (FIPLIQ) was used to preserve cervical samples prepared and analyzed on the same day and 3, 7, and 15 days after collection, compared with Pap smear. Evaluations on quality and adequacy of cell types, microorganisms or their cytopathic effects, reactive, degenerative and dysplastic cell alterations were performed. Results: Samples processed with FIPLIQ showed results similar to those of conventional Pap smear when analyzing staining cytoplasm with indistinct cytoplasm borders, chromatin structure, presence or absence of different types of cell and microorganisms, reparative process, preneoplastic, and neoplastic cell changes; the samples were stored for up to 15 days after collection. Conclusion: Preliminary results suggest that FIPLIQ is suitable for the preparation and preservation of cytology specimens for up to 15 days.

RESUMEN Introducción: La citología en medio líquido fue desarrollada para mejorar la prueba de Papanicolaou. Algunos medios líquidos son comercialmente disponibles; no obstante, debido al costo elevado, hay dificultades para su implementación en programas de salud pública en muchos países. Objetivos: Estudiar la adecuación de medios líquidos alternativos para recolecta y la preservación de muestras para exámenes citológicos, comparando los resultados con la metodología convencional de Papanicolaou. Material y métodos: En este estudio, 127 diferentes composiciones de soluciones alternativas de medios líquidos fueron testadas con muestras de 10 voluntarios para citología oral y 20 muestras de voluntarias para citología cervical. El fosfato de formaldehído- isopropanol (FIPLIQ) fue usado para preservación de muestras cervicales preparadas y analizadas en el mismo día, y tres, siete y 15 días después de la recolecta, en comparación con la citología convencional. Se hicieron evaluaciones de calidad y adecuación de los tipos celulares, microorganismos o sus efectos citopáticos, cambios celulares reactivos, degenerativos y displásicos. Resultados: Las muestras procesadas con FIPLIQ presentaron resultados similares a los de la prueba convencional de Papanicolaou cuando analizados color y bordes citoplasmáticos mal definidos, estructura de cromatina, presencia o ausencia de diferentes tipos de células y microorganismos, proceso reparativo, pre-neoplásico y alteraciones celulares neoplásicas; las muestras se conservaron hasta 15 días después de la recolección. Conclusión: Los resultados preliminares sugieren que el FIPLIQ es adecuado para preparación y preservación de especímenes citológicos hasta 15 días.

RESUMO Introdução: A citologia em meio líquido foi desenvolvida para melhorar o teste de Papanicolaou. Alguns meios líquidos são comercialmente disponíveis, no entanto, devido ao alto custo, há dificuldades para sua implementação em programas de saúde pública em muitos países. Objetivos: Estudar a adequabilidade de meios líquidos alternativos para a coleta e a preservação de amostras para exames citológicos, comparando os resultados com a metodologia convencional de Papanicolaou. Material e métodos: Neste estudo, 127 diferentes composições de soluções alternativas de meios líquidos foram testadas com amostras de 10 voluntários para citologia oral e 20 amostras de voluntárias para citologia cervical. O fosfato de formaldeído-isopropanol (FIPLIQ) foi utilizado para preservar amostras cervicais preparadas e analisadas no mesmo dia e três, sete e 15 dias após coleta, em comparação com a citologia convencional. Avaliações de qualidade e adequação dos tipos celulares, de microrganismos ou seus efeitos citopáticos, de alterações celulares reativas, degenerativas e displásicas foram realizadas. Resultados: As amostras processadas com FIPLIQ apresentaram resultados semelhantes aos do teste convencional de Papanicolaou quando analisados coloração e apagamento de bordas citoplasmáticas, estrutura de cromatina, presença ou ausência de diferentes tipos de células e microrganismos, processo reparativo, pré-neoplásico e alterações celulares neoplásicas; as amostras foram conservadas por até 15 dias após a coleta. TOPICO Conclusão: Os resultados preliminares sugerem que o FIPLIQ é adequado para a preparação e a preservação de espécimes citológicos por até 15 dias.

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ABSTRACT Introduction: Cervicovaginal atrophy is a condition that can affect women after menopause, and cytology is a diagnostic tool useful in such cases. Objective: To evaluate the cytomorphological profile of cervical smears in patients over 60 years old. Methods: Cytopathological examinations of 500 patients over 60 years old were selected consecutively in this cross-sectional, quantitative, retrospective study. Results: Only 114 (22.8%) presented the squamocolumnar junction (SCJ) sampled, and their presence decreased progressively with advancing age (p < 0.001). Most smears (95.6%) were classified as atrophic. Microbiological analysis showed that from the 22 non-atrophic smears, most presented lactobacillus flora. Among the atrophic swabs, the predominant flora was cocci, with 47.2%. Only 4% presented cytological changes: atypical squamous cells of undetermined significance [(ASC-US) - eight cases/40%], atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion [(ASC-H) - five cases/25%], high-grade squamous intraepithelial lesion [(HSIL) - three/15%], low-grade squamous intraepithelial lesion [(LSIL) - two cases/10%] and adenocarcinoma in situ [(ACI) - two cases/10%]. Among the modified smears, four (20%) presented SCJ cells, and four patients (20%) took hormones (from these, two cases of ASC-H (10%) and two cases ASC-US (10%), showing a relationship between the onset of the lesion and the use of hormones (p < 0.05). Conclusion: The absence of SCJ indicates a diagnostic limitation of sample collection. Although the frequency of lesions has been similar to other studies, and the recommended age range for the examination is between 25 and 60 years, it is important to note that many women older than this range should perform the collection of oncology cytology due to existence of elderly women with risk profile for the disease.

RESUMEN Introducción: La atrofia cervicovaginal es una condición que puede afectar a las mujeres después de la menopausia, y la citología es una herramienta diagnóstica útil en esos casos. Objetivo: Evaluar el perfil citomorfológico de frotis citopatológicos cervicales en pacientes mayores de 60 años. Métodos: Un estudio transversal, cuantitativo y retrospectivo, en el que se eligieron consecutivamente pruebas citopatológicas de 500 pacientes con edad superior a 60 años. Resultados: Solo 114 mujeres (22,8%) tuvieron la unión escamo-columnar (UEC) representada; su presencia ha bajado progresivamente con el adelanto de la edad (p < 0,001). Los frotis (95,6%), en su mayoría, fueron clasificados como atróficos. El análisis microbiológico mostró que de los 22 frotis no atróficos, la mayoría tuvo flora lactobacilar. Entre los frotis atróficos, la flora predominante fue cocoide (47,2%). Solamente 4% presentó alteraciones citológicas: células escamosas atípicas de importancia no determinada [(ASC-US) - ocho casos/40%]; células escamosas atípicas, no se descarta una lesión de alto grado [(ASC-H) - cinco casos/25%]; lesión intraepitelial de alto grado [(HSIL) - três casos/15%]; lesión intraepitelial escamosa de bajo grado [(LSIL) - dos casos/10%] y adenocarcinoma in situ [(ACI) - dos casos/10%]. Entre los frotis alterados, cuatro (20%) contenían células de la UEC y cuatro pacientes (20%) estaban recibiendo hormonas [entre ellos, dos casos de ASC-H (10%) y dos casos de ASC-US (10%)]. Conclusión: La ausencia de UEC indica la limitación diagnóstica de la recolección. Aunque la frecuencia de las lesiones haya sido semejante a la de otros trabajos y la franja etaria recomendada para la realización de la prueba sea 25-60 años, es importante señalar que mujeres con edad superior a esa franja deben realizar la recolección citológica debido al perfil de riesgo para la enfermedad.

RESUMO Introdução: A atrofia cervicovaginal é uma condição que pode afetar mulheres após a menopausa, e a citologia é a ferramenta diagnóstica útil nesses casos. Objetivo: Avaliar o perfil citomorfológico de esfregaços citopatológicos cervicais de pacientes com idade superior a 60 anos. Métodos: Trata-se de estudo transversal, quantitativo e retrospectivo, no qual foram selecionados consecutivamente exames citopatológicos de 500 pacientes com idade superior a 60 anos. Resultados: Apenas 114 mulheres (22,8%) tiveram a junção escamocolunar (JEC) representada e sua presença diminuiu progressivamente com o avanço da idade (p < 0,001). Os esfregaços (95,6%), em sua maioria, foram classificados como atróficos. A análise microbiológica mostrou que dos 22 esfregaços não atróficos, a maioria teve flora lactobacilar. Entre os esfregaços atróficos, a flora predominante foi cocoide (47,2%). Somente 4% apresentou alterações citológicas: células escamosas atípicas de significado indeterminado [(ASC-US) - oito casos/40%], células escamosas atípicas, não podendo excluir lesão intraepitelial de alto grau [(ASC-H) - cinco casos/25%], lesão intraepitelial escamosa de alto grau [(HSIL) - três casos/15%], lesão intraepitelial escamosa de baixo grau [(LSIL) - dois casos/10%] e adenocarcinoma in situ [(ACI) - dois casos/10%]. Entre os esfregaços alterados, quatro (20%) continham células da JEC e quatro pacientes (20%) faziam uso de hormônios [destes, dois casos de ASC-H (10%) e dois casos ASC-US (10%)], o que demonstra a relação entre o aparecimento de lesão e o uso de hormônios (p < 0,05). Conclusão: A ausência da JEC indica a limitação diagnóstica da coleta. Embora a frequência das lesões tenha sido semelhante à de outros trabalhos e a faixa etária recomendada para a realização do exame seja entre 25 e 60 anos, é importante ressaltar que mulheres com idade superior a essa faixa devem realizar a coleta de citologia oncológica devido ao perfil de risco para a doença.

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Objetivo: estimar a prevalência de exame citopatológico não realizado nos últimos três anos e de nunca realizado em mulheres, e analisar fatores associados. Métodos: estudo transversal, com mulheres de 20 a 69 anos de idade, em São Leopoldo, RS, Brasil, em 2015; calcularam-se as razões de prevalência (RP) por regressão de Poisson. Resultados: entre 919 mulheres, a prevalência de exame atrasado foi 17,8% (intervalo de confiança de 95% [IC95%15,4;20,3), e de nunca realizado, 8,1% (IC95%6,3;9,8); na análise ajustada, o aumento na prevalência de exame atrasado mostrou-se associado à classe econômica D/E (RP=2,1 - IC95%1,3;3,5), idade de 20-29 anos (RP=3,2 - IC95%2,1;4,9) e nenhuma consulta realizada (RP=3,0 - IC95%2,1;4,1); nunca ter realizado exame associou-se com classe econômica D/E (RP=2,6 - IC95%1,4;5,0), idade de 20-29 anos (RP=24,1 - IC95%6,4;90,9) e nenhuma consulta (RP=2,9 - IC95%1,7;4,8). Conclusão: a cobertura de exame foi alta e com iniquidade.

Objetivo: estimar la prevalencia de examen en mujeres, no realizado en los últimos tres años y de nunca realizado, y analizar factores asociados. Métodos: estudio transversal con mujeres de 20 a 69 años de edad de São Leopoldo, RS, Brasil, en 2015; se calcularon las razones de prevalencia (RP) por la regresión de Poisson. Resultados: entre 919 mujeres, la prevalencia de examen retrasado fue 17,8% (intervalo de confianza del 95% [IC95%]15,4;20,3) y de nunca realizado fue del 8,1% (IC95%6,3;9,8); en el análisis ajustado, el aumento en la prevalencia de examen retrasado se asoció con clase económica D/E (RP=2,1 - IC95%1,3;3,5), a edad entre 20-29 años (RP=3,2 - IC95%2,1;4,9) y ninguna consulta (RP=3,0 - IC95%2,1;4,1); nunca haber realizado examen se asoció con clase D/E (RP=2,6 - IC95%1,4;5,0), a 20-29 años de edad (RP=24,1 - IC95%6,4;90,9) y ninguna consulta (RP=2,9 - IC95%1,7;4,8). Conclusión: la cobertura de examen fue alta y con inequidad.

Objective: to estimate the prevalence of Pap tests not performed in the last three years and never performed in women and to analyze factors. Methods: this was a cross-sectional study with women aged 20 to 69 years living in São Leopoldo, RS, Brazil, in 2015; prevalence ratios (PR) were calculated using Poisson regression. Results: among 919 women, prevalence of delayed testing was 17.8% (95% confidence interval [95%CI]15.4;20.3) and never tested prevalence was 8.1% (95%CI6.3%;9.8%); in the adjusted analysis, the increase in the prevalence of delayed testing was associated with economic class D/E (PR=2.1 - 95%CI1.3;3.5), being aged 20-29 years (PR=3.2 - 95%CI2.1;4.9) and not having had a medical appointment (PR=3.0 - 95%CI2.1;4.1); never having tested was associated with economic class D/E (PR=2.6 - 95%CI1.4;5.0), being aged 20-29 years (PR=24.1 - 95%CI6.4;90.9), and not having had a medical appointment (PR=2.9 - 95%CI1.7;4.8). Conclusion: coverage of the test was high but characterized by social inequality.

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The morphometric parameters of erythrocytes in Mandarin ducks- Aix galericulata have never been subjected to study even though this species is common in aviculture. The aim of this study is to investigate the morphometric parameters of erythrocytes in juvenile Mandarin ducks. A total of 1500 erythrocytes obtained from thirty Mandarin ducks were analysed. The smears of the peripheral blood were stained using Diff-Quik® stain method, and the length and width of erythrocytes were measured using ImageJ program. The average length of the measured erythrocytes was 11.879 µm. The maximal measured length of the erythrocytes was 16.049 µm, and the minimal measured length was 5.668 µm. The average width of the measured erythrocytes was 6.160 µm. The maximal measured width of the erythrocytes was 10.115 µm and the minimal measured width was 3.750 µm. In conclusion, knowing morphometric parameters of Mandarin duck erythrocytes is the first step in evaluation process of erythrocytes functional state and health condition of an individual.

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The morphometric parameters of erythrocytes in Mandarin ducks- Aix galericulata have never been subjected to study even though this species is common in aviculture. The aim of this study is to investigate the morphometric parameters of erythrocytes in juvenile Mandarin ducks. A total of 1500 erythrocytes obtained from thirty Mandarin ducks were analysed. The smears of the peripheral blood were stained using Diff-Quik® stain method, and the length and width of erythrocytes were measured using ImageJ program. The average length of the measured erythrocytes was 11.879 µm. The maximal measured length of the erythrocytes was 16.049 µm, and the minimal measured length was 5.668 µm. The average width of the measured erythrocytes was 6.160 µm. The maximal measured width of the erythrocytes was 10.115 µm and the minimal measured width was 3.750 µm. In conclusion, knowing morphometric parameters of Mandarin duck erythrocytes is the first step in evaluation process of erythrocytes functional state and health condition of an individual.(AU)

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Abstract: Objective: To describe the methods of a study aimed at evaluating high risk-HPV (hrHPV)-based screening and cervical cytology as triage compared to conventional cervical cytology as primary screening in the detection of grade 2+ cervical intraepithelial neoplasia in the National Cancer Screening Program (NCSP) of Mexico. Materials and methods: We will use information originated from the Womens Cancer Information System of Mexico regarding cervical cancer from 2008 to 2018. The database includes cytology results, diagnostic confirmation by histopathology and/or treatment colposcopy. We will then carry out statistical analyses on approximately 15 million hrHPV. Results: We will evaluate the overall performance of hrHPV-based screening as part of the NCSP and compare hrHPV-based to cytology-based screening under real-life conditions. To guarantee an unbiased comparison between hrHPV with cytology triage and conventional cytology we will use propensity score matching. Conclusion: Decision makers may use our results to identify areas of opportunity for improvement in NCSP processes.

Resumen: Objetivo: Describir los métodos de un estudio que busca comparar el beneficio de la introducción de la prueba de VPH de alto riesgo como prueba primaria frente a la citología convencional para la detección de la neoplasia intraepitelial cervical grado 2 o mayor, dentro del Programa de Prevención y Control del Cáncer de la Mujer, para el periodo de 2008 a 2018. Material y métodos: Se utilizarán los registros del Sistema de Información de Cáncer de la Mujer, se realizarán los análisis estadísticos con aproximadamente 15 millones de resultados de VPH-alto riesgo, además se utilizarán los resultados de citología, colposcopia, histología y los casos referenciados al centro oncológico para tratamiento. Para comparar ambos grupos usaremos "propensity score matching". Resultados: Se evaluará el desempeño general de la prueba de VPH-alto riesgo, en condiciones reales dentro del Programa Nacional de Prevención y Control de la Mujer y su tendencia en el tiempo. Conclusiones: Los resultados de estudio ayudarán a los tomadores de decisiones a identificar áreas de oportunidad para mejorar el programa en México.

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INTRODUCTION: To evaluate the internal quality control indicators and quality management programme in a university cytopathology laboratory. METHODS: All results of conventional cervical smears tests (taken from the SISCAN, the Brazilian cervical cancer screening system) of women aged ≥15 years at the time of Papanicolaou smear specimen collection during January 2007-December 2014 were included. The final results of the cytopathology were classified in accordance with the Bethesda System. The variables included in the database were the woman's name, date of birth, and age at the time of sampling (15-30, 31-40 and older than 40 years). RESULTS: In this period, 50 286 cytopathology examinations were carried out. Of these, 44 386 (91.34%) were negative for malignancy or unsatisfactory and 4209 (8.66%) presented epithelial abnormalities. The percentage of the tests consistent with atypical squamous cells (ASC) between satisfactory examinations was 4.12%; the percentage of tests compatible with ASC among abnormal examinations was 47.87%; the ASC/squamous intraepithelial lesion) ratio was 0.97 and the percentage of high-grade squamous intraepithelial lesion among satisfactory tests was 2.21%, and the 5-year retrospective review identified 4.97% of false-negative results. CONCLUSION: All rates obtained were consistent over the years and within the recommended values by Federal Regulation of Brazil. This demonstrates the efficacy of our established internal quality monitoring and continuing education, reflecting the commitment of the team involved in the release of smear reports.

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Introducción: la tuberculosis es la más antigua de las pandemias y causa alrededor de 1,7 millones de muertes y 9 millones de casos nuevos cada año. Objetivo: determinar el comportamiento epidemiológico de la tuberculosis en el municipio Matanzas. Materiales y métodos: se realizó un estudio observacional descriptivo retrospectivo en el período comprendido entre enero 2010 a diciembre del 2014. Se tomó como universo el total de 42 pacientes con diagnóstico de tuberculosis en todas sus formas. Se trabajó con el total del universo. Resultados: en cuanto a incidencia existió una tendencia a su disminución en el municipio de Matanzas, siendo el área de salud más afectada el área de Contreras con 11 casos para un 53,8 %. El mayor número de sintomáticos respiratorios de más de 14 días se encontró en el año 2011 con 2739 pacientes, el mayor número de ellos del área de salud de Policlínico Docente "José Jacinto Milanés" con 814. Conclusiones: predominó del número de casos de tuberculosis con baciloscopía positiva con un 61 %, de ellos más de la mitad fue diagnosticado en la atención secundaria, traduciendo una falla del programa. El 89,8 % de los pacientes presentó localización pulmonar con amplio predominio de la misma (AU).

Introduction: tuberculosis is the eldest of the pandemic diseases and causes almost 1.7 million deaths and nine millions of new cases every year. Objective: to determine the epidemiologic behavior of tuberculosis in the municipality of Matanzas. Materials and methods: a retrospective, descriptive, observational study was carried out in the period from January 2010 to December 2014. The universe were the total of 42 patients with diagnosis of tuberculosis in all its forms. All of them were included in the study. Results: It was found a tendency to a decrease of tuberculosis in the municipality of Matanzas, being the most affected health area the Contreras one, with 11 cases, for 52.8 %. The highest number of symptomatic patients of more than 14 days was found in 2011, with 2 739, most of them from the health area of the Teaching Policlinic "José Jacinto Milanés", with 814 patients. Conclusions: the number of tuberculosis cases with positive sputum smears predominated for 61 %. More than half of them were diagnosed in the secondary health care, showing a program failure. 89.8 % of the patients had pulmonary location with a wide predominance of it (AU).

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