Background. The epidemiology of human papilloma virus (HPV) infection and the pattern of HPV genotype distribution are much-needed parameters to assess the risk of cervical cancer among females. However, due to less availability of data on HPV burden and its genotypes from various geographical regions in India makes cervical cancer screening modalities and vaccination strategies difficult to implement. Objective. The present study was conducted to identify the various genotypes particularly high-risk HPV types in premalignant or malignant cervical lesions. Methods. The study was a hospital-based cross-sectional study wherein 295 symptomatic women were screened by Pap smear and multiplex real-time PCR was performed for HPV genotypes identification in women with abnormal cervical cytology. Results. Out of 295 women, 237 (80.3%), 45 (15.3%), and 13 (4.4%) women had normal Pap smear, squamous cell carcinoma and precancerous cytology, respectively. Among these 58 women having abnormal cervical cytology, HPV was detected in 48 (81.0%) participants. Most common HPV genotypes in our study were HPV 16 ( n = 29 ; 60.4%) followed by mixed infections; i.e., more than one type of HPV was detected ( n = 10 , 20.8%). HPV 18 was detected only in 6.25%, whereas other high-risk HPV genotypes were found to be 12.5%. Conclusion. HPV positivity was >80% in women having abnormal Pap smear. The prevalence of HPV 18 was found to be much less in Central India, compared to other parts of country. HPV 16 was the most common genotype followed by mixed HPV genotype infections. It is evident from our study that symptomatic women even if having normal Pap smear should be screened for HPV and followed up with periodic Pap smears for detecting any change in cervical cytology, thus preventing cervical cancer in women.

Visual inspection with acetic acid (VIA) and cytology form the core of the screening programs across the globe, which aim at early detection of cervical cancer precursors. 1 Low-and middle-income countries however face operative challenges from the outset, as effectuating mass screening requires the active participation of the clients and a robust healthcare infrastructure that can support population-wide pelvic examination, sample collection, analysis, reporting, and follow up. 2 HPV testing in cervical secretions instead of, or in addition to, cervical cytology has emerged as a better alternative to cytology or VIA in cervical cancer screening because HPV infection contributes to almost 99.7% of all cervical cancers worldwide and testing for HPV provides similar efficacy with an advantage of longer screening interval. 3,4 Keeping pace with the evidence, WHO recommends a rapid transition to HPV DNA testing as

Uterine perforation following postplacental intrauterine contraceptive device (PPIUCD) insertion is a rare event with a potential for serious injuries. In the present case, a young lady with a history of PPIUCD insertion presented with a mass having ill-defined margins and restricted mobility palpable in her right iliac region. Examination reported a conglomerated mass in right adnexa with an IUCD surrounded by a heterogeneous inflammatory collection to which omentum and bowel loops adherent to it. Additional imaging reported involvement of right iliac vessels and right ureter with upstream hydroureteronephrosis. Intraoperatively, ureter was found intact and away from the IUCD which was removed with a gentle pull, and a rent in the right posterolateral surface of uterus was repaired with delayed absorbable sutures. With PPIUCD services being provided on an unprecedented scale, it becomes prudent and ethically crucial to create a national repository to document post insertion outcomes and complications. Case report aims to inform and sensitize stakeholders about possible post insertion complications to help improve expansion of the PPIUCD programs.

No abstract

Objective: The objective of our study was to assess whether urinary samples for human papilloma virus (HPV) detection are a good predictive marker of cervical cancerous and precancerous lesions, by comparing against results from cervical scrapings as the gold standard test. Materials and Methods: The study is a hospital-based cross-sectional study wherein symptomatic women were screened at the colposcopy clinic. Paired samples-cervical scrapings/washings and urine samples were tested for hr-HPV for women who were found to harbor premalignant and malignant lesions of the cervix in histopathological lesions, by multiplex real-time polymerase chain reaction and HPV genotyping. Diagnostic accuracy was tested by calculating concordance with Cohen’s kappa with hr-HPV detection in cervical samples as the gold standard. Results: A total of 295 patients undergoing colposcopy were recruited in the study, out of which 54 had histopathological-proven premalignant and malignant lesions of the cervix. Overall, positivity rate in urinary samples for both HPV 16 and 18 combined is 64.81%, whereas for cervical samples is 68.51%. HPV 16 was seen in 30 (55.5%) and 32 (59.3%) cervical and urinary samples, respectively, whereas HPV 18 was seen in 7 (12.9%) and 6 (11.1%) samples, respectively. There was substantial concordance between the cervical samples and first-void urinary samples results with Cohen’s k: 0.6988 (95% confidence interval: From 0.507 to 0.891). There was 85.96% agreement among all the tests that were performed with only 14.04% disagreement. Conclusions: The study showed that HPV DNA detection from the urine and cervical samples showed significant agreeability for the detection of precancerous and cancerous lesions of the cervix among women with abnormal histology results. Thus, urinary sampling can be done as a potential replacement for cervical sampling methods with the added benefit as it can be used in females reluctant to provide cervical samples, if there is no availability of skilled workforce for collecting samples, for mass screening, and for the follow-up of vaccination programs.