II.

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Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.

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Introduction. In this population-based register study our objective was to explore the association of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure with preterm birth. Material and methods. Our population consisted of 4759 women diagnosed with cervical intraepithelial neoplasia, grade 1 during 1997-2009 and their 3021 subsequent deliveries analyzed by loop electrosurcigal excision procedure and parity. Hospital Discharge Register was used to identify women diagnosed for cervical intraepithelial neoplasia, grade 1 and these data were linked with the Medical Birth Register data. We calculated odds ratios with 95% confidence intervals. Results. Cervical intraepithelial neoplasia, grade 1 patients with loop electrosurcigal excision procedure had 54 (6.7%) subsequent preterm births and the corresponding figure among cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure was 116 (5.2%). This results in odds ratios 1.31 (95% confidence interval 0.94-1.83). We assessed the risk before and after diagnosis of cervical intraepithelial neoplasia, grade 1 both for patients with loop electrosurcigal excision procedure (odds ratios 1.47, 95% confidence interval 1.05-2.06) and without loop electrosurcigal excision procedure (odds ratios 0.90, 95% confidence interval 0.71-1.13). An increased risk for preterm birth after diagnosis of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure was observed. We also compared both groups to the background population in the Medical Birth Register. For cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure the risk for preterm birth was not increased (odds ratios 0.95, 95% confidence interval 0.76-1.21) whereas for cervical intraepithelial neoplasia, grade 1 patients treated with loop electrosurcigal excision procedure the risk for preterm birth was increased (odds ratios 1.45, 95% confidence interval 1.02-1.92). Conclusions. Loop electrosurcigal excision procedure itself increases the risk for preterm birth. Cervical intraepithelial neoplasia, grade 1 as such does not increase the risk for preterm birth.

BackgroundIn previous observational studies of TNF-inhibitors, the proportion of patients achieving sufficient clinical response (BASDAI 50) after six months of treatment onset has ranged from 52% to 63% while 26% to 37% have discontinued the treatment within 24 months [1–3].ObjectivesThe aim of this research was to describe the effectiveness and drug survival of TNF-inhibitors in the treatment of ankylosing spondylitis (AS) in Finland and to analyze the effect of concomitant treatment with conventional Disease-Modifying Anti-Rheumatic Drugs.MethodsAS patients enrolled in the National Register for Biologic Treatment in Finland (ROB-FIN) starting their first TNF-inhibitor treatment between July 2004 and December 2011 were included. Treatment response was measured as an improvement of 50% (or 20 mm) after 6 months of treatment onset compared to the baseline BASDAI score. Treatment effectiveness and 2 year drug survival were modelled with logistic regression and time-dependent cox-proportional hazard models, respectively. The results are reported either as Odds Ratios (OR) or Hazard Ratios (HR) where appropriate.ResultsThe study comprised 543 patients, of which 123 also commenced a second TNF-inhibitor during the follow-up. Treatment was discontinued within 24 months by 24% and 28% of the users of the first and the second TNF-inhibitors, respectively. BASDAI50 response at 6 months was achieved by 52% and 25% of the users of the first and the second TNF-inhibitors, respectively.Logistic regression analyses revealed no statistically significant differences between TNF-inhibitors or the use of concomitant cDMARDs. Etanercept (HR 0.48, 95% CI 0.31-0.74) and adalimumab (HR 0.52 95% CI 0.30-0.91) were associated with better drug survival in comparison to infliximab. Also, sulfasalazine (HR 0.70 95% CI 0.49-0.99) decreased the hazard for treatment discontinuation.ConclusionsTNF-inhibitors proved equipotent in the treatment of AS, however etanercept and adalimumab were found superior to infliximab in drug survival. Concomitant use of sulfasalazine reduced the hazard for treatment discontinuation possibly by providing a synergistic effectiveness benefit.ReferencesLord P a C, Farragher TM, Lunt M, et al. Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register. Rheumatology 2010;49:563–70.Glintborg B, Ostergaard M, Krogh NS, et al. Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years' surveillance in the Danish nationwide DANBIO registry. Ann Rheum Dis 2010;69:2002–8.Kristensen LE, Karlsson J a, Englund M, et al. Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register. Arthritis Care Res 2010;62:1362–9.AcknowledgementsWe thank all Finnish rheumatologists for their...

HIV in the UK and it is estimated that 15e20% of inmates at HMP Brixton are HIV positive. Methods Staff delivered 26 walk-in clinics at a drug rehabilitation unit in Brixton over 5 months. The testing service was developed in close liaison with the drug and alcohol team and publicised using posters and education of reception staff. Oral swab testing for HIV and HCV was offered. A simple questionnaire was completed by attendees covering testing history and risk practice. Results 35 individuals tested for HIV and HCV and were 80% male, 74.3% UK born, 48.6% white and 77.1% heterosexual. 37.1% were IVDU, median age was 36 (range 22e74). 57.1% individuals had previously tested for HIV, median time since last test was 4 years (range <1e15 years). 54.3% individuals had previously tested for HCV, median time since last test was 3 years (range <1e11 years). Median length of time in prison was 3 months (range <1e48 months). 48.6% and 51.4% had never been offered an HIV or HCV test in prison respectively. Only two individuals had tested for HIV and HCV in Prison. 14.3% individuals were already known to be HCV positive. 5.7% (N¼2) individuals were newly diagnosed HCV positive but none tested HIV positive. 82.9% felt HIV/HCV testing should be offered in Prison. 71.1% felt this should be done using a mouth swab. 35% had no concerns regarding HIV/HCV testing but in those who did, dislike of needles, receiving a positive result and concerns regarding confidentiality were the commonest barriers to testing. Conclusions Prevalence of previously undiagnosed HCV was high in this group but HIV prevalence was zero. Uptake of HIV/HCV testing was very low despite good publicity and support from the drug services. This suggests that this method is not a cost effective approach to HIV testing despite oral swabs representing an acceptable mode of testing. Half of attendees had not been offered an HIV or HCV test in prison which needs to be increased. Testing in drug rehabilitation services does not result in high uptake of testing or detection of undiagnosed HIV. Objectives To study whether the increasing severity of cervical intraepithelial neoplasia (CIN) by LEEP (loop electrosurgical excicion procedure) cone correlates with the risk for preterm birth. We also wanted to study whether the time period from LEEP or repeat LEEP correlates with the risk. Methods Retrospective register-based study from Finland during 1997e2009. We collected data from the Hospital Discharge Register. We linked the data with data from the Finnish Medical Birth Register. The study population consisted of 20 011 women who had LEEP during 1998e2009 and a subsequent delivery during 1997e2009. Controls were women with no previous LEEP (n¼430 975). The main outcome measure was preterm birth (<37 gestational weeks) rate. Results The risk for preterm birth was increased after LEEP (OR 1.82, CI 1.62 to 2.03). In primiparous women this risk was slightly lower OR 1.61 (CI 1.42 to 1.83). Repeat LEEP was associated with almost threefold risk for preterm birth (OR 2.71, CI 1....

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