European Journal of Molecular & Clinical Medicine

Background: Cervical cancer is a preventable disease because it has a premalignant stage which may last up to 10-20 years before its progression to invasive carcinoma. The potential role of ROS in DNA damage as well as the nutritional etiology of cervical neoplasia (which include low dietary intake of vitamin C, carotenoids, vitamin E, and folate) has been suggested. Objectives: The objective of this study is to measure the oxidant status. To estimate and compare serum levels of MDA (malondialdehyde) in postmenopausal cervical cancer patients and healthy age matched control. Methodology: This case control study consist of 90 patients of cervical cancer along with 60 healthy subjects of précised matched age within the institution. blood samples was collected from all participants and were analysed for oxidant MDA (malondialdehyde) .Results obtained were analyzed statistically to see the significance of differences. Results: The Mean concentration of S.MDA (nmol/L) in case group was 5.77 ±2.40 while that of control group 2.03±0.70 and the difference among them found to be highly significant. The mean age of cervical cancer group(case) is 51.26 ±5.43 yr while that of control group is 55.60±4.50 year. According to demographic data .Smoking history present in 16% and 11% in case and control group respectively.History of alcohol present in 9.9% and 4.2% in case and control group respectively.Among total 90 patients of cervical cancer 86(95.55%) females were married. Conclusion: In conclusion, this study has shown that the patients with cervical cancer have high lipid peroxidation (MDA), which is a marker of oxidative stress; and this worsened as the disease progressed. There is a need for antioxidant supplementation in these patients to reduce oxidative stress.

Globally, cervical cancer(CC) is the second most common cancer among women, and persistent infection with high-risk human papillomavirus (HPV), is associated with the causes of cervical cancer along with host genetic factors. Methylenetetrahydrofolate reductase is a major enzyme in folate metabolism and is required for several biological processes. The MTHFR gene's mutations may cause the enzyme's activity to decline. The functional single-nucleotide polymorphism (SNP) C677T in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene can reduce enzyme activity and alter the chemosensitivity of tumour cells. The present study aimed to look into the role of MTHFR gene polymorphism in the aetiology of cervical cancer in Eastern Indian women. In a case-control study, biochemical analysis was carried out using a commercially available ELISA kit.
In contrast, genetic analysis (PCR-RFLP of peripheral leucocytes) was carried out on all women with cervical cancer and controls. Statistical analysis was done by using the student "t-test" for quantitative variables and the chi-square test for nominal variables, and the odds ratio & 95% confidence interval was calculated the odds ratio and 95% confidence interval to estimate risk. The frequencies of MTHFR C677C, C677T, and T677T were 27.62, 57.62, and 12% in the cervical cancer subjects and 95, 5, and 0.00% in the controls, respectively.  Folate and homocysteine levels showed statistically significant differences between these two groups; however, an increasing trend of homocysteine levels was associated with an increasing rate of cervical cancer. We found a negative correlation between homocysteine and the biochemical parameter in the cases. In conclusion, our data suggest that the MTHFR C677T polymorphism, low folate, and vitamins B12 and B6 are associated with cervical cancer and act as "risk factors".

More than 70% cases of cervical cancer present in advanced stages of the disease, which are linked to a poor prognosis and significant fatality rates. Since many of them arrive with uremia due to obstructive uropathy, it is challenging to provide a conclusive course of treatment. Percutaneous nephrostomy (PCN) recommendations for patients with advanced cervical carcinoma are not well defined. The results of PCN are unpredictable in terms of recovery of renal function, quality of life, and benefits attained to administer the subsequent palliative care. Thus the aim of present study is to determine the outcome of PCN in cervical cancer patients presented with obstructive nephropathy secondary to malignant ureteral obstruction.
Material and methods: 72 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their management conducted at Urology Unit, Department of General Surgery, Government Medical College, in collaboration with Regional cancer Centre (RCC), Agartala.
Results: PCN was done in 72 patients of advanced cervical cancer. 60 (83%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. 12 (16.6%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.7 mg% to 0.8 mg% over a period of 1-3 weeks was noted post PCN. Out of 60 patient with primary untreated advanced disease, curative treatment was possible in 12, palliative radiotherapy/chemo-therapy in 36 and only symptomatic treatment in 12 cases, after obstructive uropathy was managed with PCN insertion. PCN was done to prevent permanent kidney damage in them.
Conclusion: Despite certain unavoidable, but controllable, challenges, PCN is a straightforward and secure approach. One of the main advantages was that patients may receive either curative/palliative radiation or chemotherapy.  Therefore, it is appropriate to try PCN in carefully chosen cervical cancer patients

Aims and Objectives: Our goals are to determine how well educated female medical professionals are on HPV infections and vaccination.
Materials and Methods- An observational research was done to study the level of familiarity physicians have with HPV infection and vaccination. In order to study people's openness to and perspective on vaccination, as well as their familiarity with the illness and its symptoms, a survey was done.
Results: Three hundred doctors agreed to take part in the study. They're among the age group of 25 and 40, with an average age of 35.78. The fact that HPV is an STD is common knowledge among 201 professionals. About two-thirds (291) of doctors have cited HPV as a possible reason for cervical cancer. In fact, just 93 people (31% of the total) know that vaginal infections may raise the probability of developing cervical cancer. Only 70 of the doctors and nurses tested positive for Pap smears or HPV, and only 25 had ever been vaccinated against the virus.
Conclusion: Insufficient medical education could have negative effects on the health of the general public, as stated in the conclusion. Aspiring health educators must therefore be well-versed on HPV, cervical cancer, and preventative strategies.

Background: Among Indian women, cervical cancer is the most common form of genital malignancy. Cytology (conventional or liquid-based) & HPV DNA used for diagnostis of cervical cancer. Present study was aimed to compare liquid-based cytology versus HPV DNA for screening of cervical cancer at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted women between the ages of 21 - 65 years, with white discharge per vaginum, post coital bleeding or irregular bleeding, unhealthy cervix on speculum examination.
Results: In present study, 220 women were evaluated for LBC & HPV DNA testing. Mean age of women was 42.91 ± 6.19 year, mean age at marriage was 17.41 ± 3.63 years & mean duration of sexual life was 26.81 ± 8.63 years. Majority were from lower socioeconomic status (57.27 %). Common chief-complaint was white PV discharge (64.55 %), Post coital bleeding PV (19.55 %) & intermenstrual bleeding PV (15.91 %). On per-speculum examination cervical erosion (40.45 %) was common finding. Common mode of contraception used was tubectomy (49.55 %), while 28.64 % women were not using any contraceptive. In present study, common LBC findings were Inflammatory / reactive changes (48.18 %), Non-specific inflammation (10.91 %), Candida (5.45 %), Trichomonas vaginalis (3.64 %), Bacterial vaginosis (0.91 %), Atrophy (1.36 %). Pathological findings were ASCUS  (5.00 %), ASC-H (0.91 %), LSIL (0.45 %), HSIL  (0.91 %), HSIL with suspicious of invasion (0.45 %) & Squamous Cell Carcinoma (2.27 %). Normal findings were noted in 18.64 % women while 2 smears were labelled as unsatisfactory smear. HPV DNA was positive in 15.45 % women.  HPV DNA was significantly associated with pathological LBC report (low grade, high grade & neoplasia).
Conclusion: HPV testing in comparison to LBC was more effective, but it is costlier for application as population screening tool.

Background: Cervical cancer is the most prevalent malignancy in women that occurs in the cervix, considered as 2^nd common cancer that affects the women after most common breast cancer. Pap smear is a simple, cost effective, non-invasive and OPD method for early diagnosis of cervical cancer and pre-cancerous cervical lesions.
Purpose: The purpose of this study was to examine the evidence for the support of patterns of different kinds of cervical lesions and prevalence of epithelial cell abnormalities in our study populations.
Materials and Methods: This retrospective study was carried out in the department of Pathology in collaboration with the department of Gynaecology at ESIC hospital, Lucknow, Uttar Pradesh, India from 01/03/2021 to 30/12/2021 with the duration of 10 months. All Pap smears were taken of women between the age group of 20-70 years in this study. A total of 150 smears were stained with Pap stain and reported by following the New Bethesda system for Reporting Cervical Cytology, 2014.
Results: Out of 150 cases, 17 (11.33%) Pap smears were reported as unsatisfactory or inadequate, 126 (84%) were NILM (negative for intraepithelial lesion or malignancy). Non-specific inflammatory smears were found to be more predominant among NILM. Epithelial cell abnormalities were reported in 07 (4.66%) pap smears examinations. Atypical squamous cells of undetermined significance (ASC-US) in 03(2%) cases, Low grade squamous intraepithelial lesion (LSIL) in 01(0.66%) case, high grade squamous intraepithelial lesion (HSIL) in 01(0.66%) case and squamous cell carcinoma (SCC) were also found in 01(0.66%) case. The most prevalent age group for epithelial cell abnormalities was 40-50 years.
Conclusion: Pap smears is an effective, non-invasive modality and useful in the detection of early diagnosis of cervical cancer and pre-cancerous cervical lesions. 

Background: Cervical cancer is the third most common cancer among women worldwide, with 85% of its global burden occurring in less-developed countries. The present study was conducted to evaluate the pattern of cervical Pap smear cytology and to correlate it with histopathological findings.
Materials & Methods: 360 females of age ranged 18-60 years were enrolled. Cervical smears were taken with the help of Ayer’s spatula and cyto brush to collect specimen from thesquamocolumnar junction. Thesmears were stained with Papanicolaou stain(PAP stain) and slides wereexamined under light microscope following 2001 Bethesda system.
Results: Age group 18- 30 years had 68 patients, 31-40 years had 112, 41-50 years had 120 and 51-60 years had 60 patients. The difference was significant (P< 0.05). Maximum number of cases 160 were categorized as negative for intraepithelial lesion or malignancy (NILM). Atypical squamous cells of undetermined significance (ASCUS) seen in 54 followed by followed by low gradesquamous intraepithelial lesion (LSIL) in 50 and high gradesquamous intraepithelial lesion (HSIL) in 30, squamous cell carcinoma 4 and cases of adenocarcinoma 2. 88%diagnosed on Pap smears correlated on histopathology findings.
Conclusion: Pap smears found to be effective in screening for earlydetection of premalignant and malignant lesionsof cervix.

Introduction: Cervical carcinoma (Ca Cx) is a high incidence malignancy in India (6–29% of all cancers in women). The Pap smear test is a proven effective measure for reducing cervical carcinoma incidence. Lack of population level screening program in India corresponds with the detection of most cervical lesions at a late stage of disease (stage II or stage III) with consequent high mortality and morbidity. The hospital where this study was conducted offers Pap smear free of cost.
Aims & Objectives:

1.      To study the spectrum of cervical lesions by analyzing the results of Pap smear tests -for a period of one year.
2.      To evaluate clinical utility of Pap smear testing by studying histopathological correlation- wherever feasible, for the same one-year period.

Materials and Methods: Retrospective observational study conducted by retrieving data for 1 year, pertaining to conventional Pap smear tests and related histopathological examination reports.
Results ^([1]): Of 808 Pap smear tests done, 788 (97.5%) were satisfactory for evaluation. These were reported using, “The Bethesda system for evaluation of cervical pathology (2014)”. Results were divided into: i) Inflammatory (70.56%), ii) NILM (23.60%), iii) Atrophic (3.42%) and iv) Epithelial cell abnormalities [ECA] (2.41%). The ECAs included ASCUS, LSIL, HSIL and SCC. The inflammatory Pap smears included 28 cases of Trichomonas vaginalis, 7 cases of Yeast, (likely Candida) infection, and 2 cases with presence of blue wool like microorganisms morphologically resembling Actinomyces. Histopathological report association was done for 118 (14.97%) cases. Of these, 112 (94.91%) cases were reported as inflammatory pathology and 6 (5.08%) cases as ECAs. The ECAs included 3 HSILs, 2 LSIL/inflammatory changes and 1 case of SCC. All 118 cases were reported with 100% concurrence rate for cytopathology –histopathology correlation.
Conclusions: 1) Pap smear is a good screening as well as diagnostic test. 2)However more significant yield towards prevention of Ca Cx will be achieved by adding supplemental testing e.g., HPV DNA testing.3) Concentrated efforts need to be made to target screening efforts towards older age group women and also towards follow up and treatment of the Positive Pap smear cases

Objective: To evaluate the use of Pap smear screening method for detection of precancerous
lesions.
Methods: Women working in police department and female family members of men working
in police department were screened for Ca cervix. A total of 67 women were recruited for the
study. A clinical examination per speculum and per vaginal examination were performed and
a history taken for all women. A pap smear was used for all women to see for cervical cancer.
The smear was obtained using Ayer’s spatula and spread over a marked glass slide which was
placed in 95% ethyl alcohol and sent to department of Pathology for cytopathological
examination. All data were recorded using a predesigned proforma.
Results: Most women were in age range of 30-50 years. The common complaint was white
discharge per vagina occurring in about 30% of individuals, abdominal pain was in 8.95% of
them, irregular menstrual cycle in 12.78% and 40.29% of them did not have any complaints.
Out of 67 ladies 61 (92.1%) pap smears were taken and 6 were not taken due to post
hysterectomy status or because they were menstruating. The test was negative for malignancy
in 68.6% of individuals and 11% of individuals had inflammatory smear due to infections
with trichomoniasis, bacterial vaginosis or candidiasis. Atypical cells were detected in 2.98%
women and they were advised colposcopy and guided biopsy. 5% of individuals had
unsatisfactory smear due to inadequate sample.
Conclusion: A Pap smear is simple, noninvasive, cost-effective, and easy to perform for
detection of precancerous lesions in a gynecological patient. Awareness about screening in
general population is needed. Women with an abnormal Pap test should undergo a
colposcopy and guided biopsy.

Background: Cervical cancer is the second most common cancer among women
globally. There are different methods for control and prevention of cervical cancer
which include conventional cytology (Pap smear), liquid-based cytology, human
papillomavirus (HPV) screening, and vaccination against HPV. The aim of this study to
evaluate the pap smear and acetic acid test as cervical cancer screening tools with
histopathological correlation.
Material & Methods: The present study was carried out in department of pathology at
SMS Medical College, Jaipur, Rajasthan, India for one year period. A total of 150
patients attending the gynecology OPD were enrolled in the study. All the patients in the
study were subjected to colposcopy. The cervix was inspected with the naked eye than
with a colposcope. After taking the Pap smear with Ayre’s spatula and cytobrush and
was evaluated by the Bethesda system and then cervix was washed with normal saline
and visualized, followed by application of 3% acetic acid and visualization by
colposcope. Collected data was statistically analyzed to determine specificity and
sensitivity, PPV, NPV of Pap smear, VIA.
Results: Our study shows that majority of cases were seen in 40-50 years of age
group.Sensitivity of VIA was found to be 90% (versus Pap smear, which had 40%) and
specificity of VIA was 87.85% (versus Pap smear, which had specificity of 96.42%).
Conclusion: PAP smear screening needs good infrastructure, trained manpower to
make & interpret the slides which is not feasible considering the facilities available in
the periphery. However, VIA can be done even by sisters in the remotest place with
minimum facilities & patient is diagnosed.

Background: Cervical cancer is among the most frequent cancer types in women worldwide. Radiotherapy, including external beam radiation and brachytherapy, is one of the commonly used treatment options for cervical cancer. However, the response and adverse effects of radiation therapy on cervical cancer survival have been poorly investigated with inconclusive result. Therefore, the aim of this study was possibly to explore the potential factors that might affect the response to radiotherapy in patients affected with cervical cancer and thus providing information for an eminent decision making in a way to a better therapy.
Materials and Methodology: This study included 150 cases for the effective analysis. The data of the all the subject analysed were diagnosed with cervical cancer based on histopathology examination where a complete standard-protocol radiotherapy [external curative dose of 46–50 Gy (25 fractions) using Photon on LINAC with 6-10 Mega Volt energy, continued to brachytherapy using the after loading method HDR microselectron unit of ¹²⁹Ir, dose 700cGy, three times to A-point week apart].
Results: Of the total of 150 cases, 102 cases (68.29%) showed a complete response, 37 cases (24.39%) developed a partial response, seven cases (4.88%) had a stable response, and four cases (2.44%) were progressive. There were no observed gastrointestinal side effects (grade 0) for 121 cases (80.49%), 24 cases were grade 1 (16.26%), five cases were from grade 2 (3.25%), and no cases were seen grade 3.
Conclusion: Most of definitive-curative radiotherapy responses for patients with stage IIA-IIIB cervical cancer were complete (68.29%). Partial response was seen in 24.49%, stable response in 4.88% and progressive response in 2.44%. The clinical characteristics that are significantly associated with the complete response to radiotherapy was seen in the largest tumour diameter. Clinicopathological factors like age, BMI, blood haemoglobin level, blood leucocyte count, serum albumin level, FIGO stage, histopathology and tissue differentiation were not statistically significant.

Malignancy or carcinoma is the unrestrained development of cells. There are numerous kinds of malignancies. In this, we are concentrating on one of the normal tumor of females is malignant growth of the cervix. Cervical cancer is the second most kind of malignant growth found in females, apart from the breast cancer which is first existence. There are abundant quantities of screening tests for Cervical cancer in which Pap smear has done. Pap smear is a virtuous device for first screening of this cancer yet it has constraints as there are consistently odds of blunder due to human perceptions. The main aim of this research is to preclude failures by utilizing computerized methods for identifying the cervical cell. Here, the image of Pap smear has been improved by utilizing Kaun Filter. The weight factor in kaun filter is resolved using an optimization technique called Bayesian Optimization Algorithm. Thus it tends to be an upgraded KF. The reformed picture has been segmented by Active Contour model. In this, the weight upgrade issue has been rectified using Analytic Hierarchy Process optimization technique. Hereafter, the solid features are eliminated from the segmented region which is most significant for identifying the cancer by utilizing ELMCSA (Extreme Learning machine with Crow Search optimization) classifier. Experimental results for the cervical cancer identification by the proposed ELM-CSA outperforms 93.5% of accuracy, 88.7% of specificity,79.21% of precision,92.25% of recall and 79.26% of F-measure than the existing classifiers such as ELM, ENN-TLBO, SVM and RBFN

Objective. To determine the relationship between knowledge and the practice of preventive control of cervical cancer. Methods. A correlational study was carried out with 120 housewives attending the CLAS Pillcomarca in Huánuco 2017. In the data collection a knowledge questionnaire and a practice questionnaire were used. For the inferential analysis of the results, the Chi Square Test of independence was used. Results. 50.0% (60 housewives) presented regular knowledge about cervical cancer and 90.8% (109 housewives) had preventive cervical cancer control practices. On the other hand, a significant relationship was found between the knowledge about cervical cancer and preventive control practices (p 0,000). And, the general knowledge of the disease and knowledge about the prevention of the disease relate to the preventive control practices of cervical cancer (p 0.000). Conclusions. There is a significant relationship between the knowledge about cervical cancer and the preventive control practices of cervical cancer of housewives attending the CLAS Pillcomarca - Huánuco.

Liposomes are vesicle-shaped particles whose walls are composed of lipid molecules ( the main constituent is a double layer phospholipid which wraps the liquid compartment inside. Liposomes can be made from natural ingredients in the form of natural phospholipid derivatives mixed with fat chains (eg phosphatidylcholine) by dispersing. Liposomes from papaya leaf extract (Carica Papaya Linn) are made with the aim of increasing the effectiveness of the drug and biocompatible work, as well as protecting healthy tissue from the toxic effects of the drug. The process of making liposom papaya leaf extract using the sonication method by mixing soybean lecithin with papaya leaf extract. Then do the heating and sonication. This method is done to reduce particle size. The aim of this study was to produce an extract of liposomes from papaya leaf phospholipid formulations using a combination of heating and sonication. The method to produce liposomes with a size of <150 nm using a combination of heating 40○C for 40 minutes and stirring using ultraturrax at a speed of 15,000 rpm for 30 minutes, then stirring with a sonicator for 30 minutes. The results showed the liposome nano papaya leaf extract formulation from soybean lecithin by the PSA (Particle Size Analyzertype 1090 / Cilas) method. The liposome product was in the form of liquid, light green and milk white and odorless. Particle size distribution is obtained in the range of 0.04 μm - 500.00 μm / 100 Classes and an average pH of 5.45.

Liposomes are vesicle-shaped particles whose walls are composed of lipid molecules ( the main constituent is a double layer phospholipid which wraps the liquid compartment inside. Liposomes can be made from natural ingredients in the form of natural phospholipid derivatives mixed with fat chains (eg phosphatidylcholine) by dispersing. Liposomes from papaya leaf extract (Carica Papaya Linn) are made with the aim of increasing the effectiveness of the drug and biocompatible work, as well as protecting healthy tissue from the toxic effects of the drug. The process of making liposom papaya leaf extract using the sonication method by mixing soybean lecithin with papaya leaf extract. Then do the heating and sonication. This method is done to reduce particle size. The aim of this study was to produce an extract of liposomes from papaya leaf phospholipid formulations using a combination of heating and sonication.The method to produce liposomes with a size of <150 nm using a combination of heating 40○C for 40 minutes and stirring using ultraturrax at a speed of 15,000 rpm for 30 minutes, then stirring with a sonicator for 30 minutes.The results showed the liposome nano papaya leaf extract formulation from soybean lecithin by the PSA (Particle Size Analyzertype 1090 / Cilas) method. The liposome product was in the form of liquid, light green and milk white and odorless. Particle size distribution is obtained in the range of 0.04 μm - 500.00 μm / 100 Classes and an average pH of 5.45.

Background: The present study was conducted to assess utilization pattern of various cervical cancer screening methods and their outcomes among outpatients of tertiary care hospital.
Materials & Methods: 140 women age ranged 20-50 years were recruited. A questionnaire was developed and distributed among all subjects and asked to fill it and return it. Awareness and utilization and pattern of cervical screening was noted.
Results: Age group 20-30 years comprised of 40, 30-40 years had 60 and 40-50 years had 40 subjects. Education level was upto primary in 65, secondary in 45 and no education in 30 subjects. 90 were married, 25 unmarried and 15 were widow. 98 had awareness and 42 had never heard about it. 55 utilized it and 85 never utilized it. The difference was significant (P< 0.05). The type of methods of screening was PAP’s smear in 15, VIA in 35, VILI in 10, frequency of screening was yearly in 35, once in 20 and never in 85. Accessibility to results of screening was 25 received results of screening, 10 not received results of screening and 20 did not indicate receipt of results of screening. The difference was significant (P< 0.05).
Conclusion: Authors found that there was lack of awareness and utilization of cervical screening among subjects. Most commonly used methods was visual inspection with acetic acid.