INTRODUÇÃO: A punção aspirativa por agulha fina guiada por ecoendoscopia (PAAF-EE) é método consagrado para o diagnóstico de lesões sólidas de pâncreas. A aplicação de pressão negativa (PN) durante a PAAF-EE tem objetivo de manter o tecido junto à ponta cortante da agulha durante sua passagem através da lesão, resultando no desprendimento e retenção de células. A capilaridade (CP) é outra técnica que utiliza a retirada gradual do estilete durante a PAAF-EE e parece ser igualmente eficaz, além de evitar aspiração indesejada de hemácias e coágulos. OBJETIVO: Analisar o rendimento da ecopunção de lesões sólidas pancreáticas utilizando PN versus (vs) CP e os aspectos citológicos qualitativos e semiquantitativos da celularidade e contaminação por sangue dos grupos estudados. MÉTODO: No estudo, foram randomizados 50 pacientes com lesões sólidas de pâncreas para realização de PAAF-EE. Cada paciente foi submetido a quatro punções, intercalando as duas técnicas. A ordem das punções foi randomizada por computador. O grupo A (PN, CP, PN, CP) e o grupo B (CP, PN, CP, PN). RESULTADOS: As sensibilidade, especificidade e acurácia da PN vs CP foram 95,2% vs 92,3%; 100% vs 100%; 95,7% vs 93%, respectivamente. Quando foi considerada a associação das duas técnicas (PN+CP), os resultados da sensibilidade, especificidade e acurácia foram 95,6%, 100% e 96%. O valor preditivo positivo (VPP) foi alto para todas técnicas (100%) e os valores preditivos negativos (VPN) para PN, CP e associação dos métodos foram de 66,7% vs 57,1% vs 66,7%, respectivamente. Não houve diferença estatística no rendimento diagnóstico entre a PN e CP: 88% vs 80% (p=0,344), entretanto as técnicas somadas (PN+CP) foi superior à CP isolada: 94% vs 80% (p=0,016). A avaliação citológica qualitativa e semi-quantitativa de celularidade e contaminação por sangue no esfregaço e emblocado pelas técnicas de PN e CP não apresentou diferença estatística (p>0,05). CONCLUSÃO: O rendimento diagnóstico da PAAF-EE pela técnica de PN versus CP de massas sólidas de pâncreas não apresenta diferença estatística, entretanto a utilização das técnicas combinadas é superior, particularmente em relação à CP isolada. A celularidade e contaminação por sangue é semelhante independente da técnica utilizada (PN ou CP) ou do tipo de preparação citológica (esfregaço ou emblocado) / BACKGROUND: Endoscopic ultrasound fine needle aspiration (EUS-FNA) is an established diagnostic method for solid pancreatic masses. Application of negative pressure (NP) during EUS-FNA has the purpose of holding tissue against the cutting edge of the needle as it is moved through the lesion leading to cell detachment and drawing them up. Capillary (CP) sampling is another technique that removes the needle stylet gradually and continuously during the EUS-FNA and seems to have comparable results with less blood and clot aspiration. AIM: Analyze diagnostic yield of EUS-FNA of pancreatic solid mass using NP versus CP and evaluate cytological qualitative and semi-quantitative features of cellularity and blood contamination of each group. METHOD: A total of 50 patients were randomized for NP or CP EUSFNA with a standard 22G needle. Each patient had four passes using NP and CP in an alternate fashion. Computer randomization generated two groups. Group A (NP, CP, NP, CP) and group B (CP, NP, CP, NP). RESULTS: Diagnostic yield of NP versus CP had no statistical difference (p=0.344). Both techniques (NP+CP) was superior to CP alone (p=0.016), but not to NP alone (p=0.25). Sensitivity, specificity and accuracy of NP vs CP were 95.2% vs 92.3%; 100% vs 100%; 95.7% vs 93%, respectively. Results for sensitivity, specificity and accuracy of both NP+CP were 95.6%, 100% and 96%. Positive predictive value was high for all techniques (100%) and Negative predictive value for NP, CP and both techniques were 66.7%, 57.1% and 66.7%, respectively. NP and CP smears and cell blocks had no statistical differences in qualitative and semi-quantitative citological evaluation for cellularity and bloodiness (p > 0.05). CONCLUSIONS: NP versus CP in EUS-FNA of solid pancreatic mass yielded similar overall outcomes in terms of diagnostic performance, however the combination of both techniques is superior, particularly compared to CP alone. Cellularity and bloodiness are equivalent no matter which technique (NP or CP) or type of cytological preparation (smear or cell block) is used

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening. The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm. A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.

MPH / Department of Public Health / See the attached abstract below

Indiana University-Purdue University Indianapolis (IUPUI) / This in-vitro, prospective, randomized study microscopically compared the debridement efficacy of passive ultrasonic irrigation (PUI) using the Ultrasonic Bypass System and different irrigating protocols. Eighty extracted maxillary anterior teeth were randomly assigned to four groups. Teeth were instrumented using EndoSequence rotary instrument system and treated with passive ultrasonic irrigation with different irrigating regimens for one minute. Group one (control) was treated with hand/rotary instrumentation. Group two was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 6.0-percent NaOCl. Group three was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 17-percent EDTA. Group four was treated with hand/rotary instrumentation followed by a one-minute PUI using the Ultrasonic Bypass System with 30 seconds of 6.0-percent NaOCl and 30 seconds of 17-percent EDTA. Teeth were sectioned longitudinally and each half was divided into three equal parts from the anatomic apex. The half with the most visible part of the apex was used for SEM evaluation. A scoring system for debris and smear layer removal was used. Statistical analysis was performed using a Kruskal-Wallis test, which determines if there are any differences among the four groups. Following this test, a Wilcoxon Rank Sum test was used to compare each pair of groups. The addition of a one-minute PUI with the Ultrasonic Bypass System significantly enhanced the removal of smear layer when compared with the hand/rotary instrumentation with conventional irrigating solutions. The Ultrasonic Bypass System when used with the combination of 6.0-percent NaOCl and 17-percent EDTA after hand/rotary instrumentation significantly removed smear layer at the coronal, middle, and apical areas of a tooth when compared with all other groups. A one-minute PUI with the Ultrasonic Bypass System combined with NaOCl and EDTA is significantly better in smear removal and ultimately will result cleaner canal wall.

Background: Acute promyelocytic leukemia (APL) is considered a hematologic emergency due to high risk of bleeding and fatal hemorrhages being a major cause of death. Despite lower death rates reported from clinical trials, patient registry data suggest an early death rate of 20%, especially for elderly and frail patients. Therefore, reliable diagnosis is required as treatment with differentiation-inducing agents leads to cure in the majority of patients. However, diagnosis commonly relies on cytomorphology and genetic confirmation of the pathognomonic t(15;17). Yet, the latter is more time consuming and in some regions unavailable. - Methods: In recent years, deep learning (DL) has been evaluated for medical image recognition showing outstanding capabilities in analyzing large amounts of image data and provides reliable classification results. We developed a multi-stage DL platform that automatically reads images of bone marrow smears, accurately segments cells, and subsequently predicts APL using image data only. We retrospectively identified 51 APL patients from previous multicenter trials and compared them to 1048 non-APL acute myeloid leukemia (AML) patients and 236 healthy bone marrow donor samples, respectively. - Results: Our DL platform segments bone marrow cells with a mean average precision and a mean average recall of both 0.97. Further, it achieves high accuracy in detecting APL by distinguishing between APL and non-APL AML as well as APL and healthy donors with an area under the receiver operating characteristic of 0.8575 and 0.9585, respectively, using visual image data only. - Conclusions: Our study underlines not only the feasibility of DL to detect distinct morphologies that accompany a cytogenetic aberration like t(15;17) in APL, but also shows the capability of DL to abstract information from a small medical data set, i. e. 51 APL patients, and infer correct predictions. This demonstrates the suitability of DL to assist in the diagnosis of rare cancer entities. As our DL platform predicts APL from bone marrow smear images alone, this may be used to diagnose APL in regions were molecular or cytogenetic subtyping is not routinely available and raise attention to suspected cases of APL for expert evaluation.

Made available in DSpace on 2011-05-04T12:36:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / O desenvolvimento de vacina contra o Papilomavirus humano (HPV), que se apresenta revolucionária, pelo potencial de prevenção primária do câncer de colo uterino tem suscitado polêmica quanto à incorporação em programas de saúde pública. As evidências de eficácia da vacina se limitam a lesões invasivas pelos principais genótipos doHPV e a vacina tem custo muito mais alto do que outras vacinas do calendário vacinal do Programa Nacional de Imunização do SUS. Este trabalho analisa as possibilidades de utilização da vacina contra o HPV, considerando a efetividade do Programa de Rastreamento do Câncer de Colo Uterino do Brasil e a eficácia da vacina contra o HPV registrada. O estudo foi realizado a partir de revisão das evidências obtidas de dados empíricos, e disponíveis em relatórios, publicações e páginas eletrônicas. A vacina apresentou resultados muito favoráveis para a eficácia e segurança, porém com lacunas importantes no conhecimento sobre seu efeito a longo prazo e correlato sorológico de proteção. Os dados indicam que o programa de prevenção do câncer de colo do Brasil tem baixa efetividade, com grande heterogeneidade de cobertura e qualidade. Foi observada também uma variação muito grande com relação à acurácia do Papanicolaou, com implicações no desempenho do programa. Considerando que o controle de câncer de colo uterino continuará dependendo de rastreamento com o Papanicolaou, e que a efetividade do programa em outras partes do mundo permitiu reduzir a mortalidade, parece mais indicado concentrar esforços e recursos na melhoria do programa de rastreamento e aguardar os resultados de médio prazo da vacinação. / The development of a vaccine against human papillomavirus (HPV), which presents itself revolutionary due to its potential for primary prevention of cervical cancer, has raised controversy over the incorporation into public health programs. Evidence of effectiveness of the vaccine are limited to invasive lesions of the major genotypes of HPV and the vaccine cost is much higher than other vaccines in the immunization calendar of the National Program on Immunization of the Unified Health System (SUS). This study analyzes the potential use of the vaccine against HPV, considering the effectiveness of the Program for Cervical Cancer Control in Brazil and the efficacy of the vaccine against HPV registered. The study was carried out from reviewing the evidence obtained from empirical data, and available in reports, publications and websites. The vaccine showed very favorable safety and efficacy results, but with important gaps in knowledge about their effect in the long term and serological correlate of protection. The data indicate that the program for the prevention of cervical cancer in Brazil has low effectiveness, with great diversity of coverage and quality. There was also a very large variation with respect to the accuracy of Papanicolaou, with implications for the performance of the program. Considering that the control of cervical cancer will continue depending on the Papanicolaou screening, and that the effectiveness of the program in other parts of the world has reduced mortality, it seems more appropriate to concentrate efforts and resources in improving the tracking program and wait for the results medium-term vaccination.

This master’s thesis is focused on automating the process of differential leukocyte count in peripherial blood using image processing. It deals with the design of the processing of digital images - from scanning and image preprocessing, segmentation nucleus and cytoplasm, feature selection and classifier, including testing on a set of images that were scanned in the context of this work. This work introduces used segmentation methods and classification procedures which separate nucleus and the cytoplasm of leukocytes. A statistical analysis is performed on the basis of these structures. Following adequate statistical parameters, a set of features has been chosen. This data then go through a classification process realized by three artificial neural networks. Overall were classified 5 types of leukocytes: neutropfiles, lymphocytes, monocytes, eosinophiles and basophiles. The sensitivity and specificity of the classification made for 4 out of 5 leukocyte types (neutropfiles, lymphocytes, monocytes, eosinophiles) is higher than 90 %. Sensitivity of classiffication basophiles was evaluated at 75 % and specificity at 67 %. The total ability of classification has been tested on 111 leukocytes and was approximately 91% successful. All algorithms were created in the MATLAB program.