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Copyright of Journal of Ilam University of Medical Sciences is the property of Ilam University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Cervical cancer begins in superficial cells and over time can invade deeper tissues and surrounding tissues. This paper presents a creative idea of using an ensemble classification algorithm that improves the predictive performance of an artificial intelligence system based on cervical cancer screening. This study aimed to classify Pap-smear images by different machine learning methods to achieve high accuracy detection. Methods. This study was performed on 917 Pap-smear images from the Herlev public database. In the feature extraction stage, 20 geometric features and 76 texture features were extracted. After that, using ensemble classification method, the images were classified into two categories (i.e., normal and abnormal) and then into seven categories (i.e., superficial epithelial, intermediate epithelial, columnar epithelial, mild dysplasia, moderate dysplasia, severe dysplasia and carcinoma) and the accuracy of the proposed method was evaluated. Results. The algorithm in the ensemble classification was able to achieve accuracy of 99.9% with a processing time of 0.028 second in the two-class classification and accuracy of 76.5% with a processing time of 0.033 second in the seven-class classification. Conclusion. Based on the results, the designed algorithm can be used as a computer aided diagnostic tool to increase the accuracy and speed of predicting the risk of cervical cancer. Practical Implications. Cervical cancer is one of the most common cancers among women. Early diagnosis of the disease can save various costs and prevent the patients’ frequent visits to medical centers. This research proposed an artificial intelligence method for automatic classification of cervical cells and improving the accuracy of diagnosis. [ABSTRACT FROM AUTHOR]

Background and Objective: A Pap smear test is one of the most effective procedures utilized for cervi cal cancer (CC) screening purposes. Nevertheless, many women do not like to do such a test. The present study aimed to monitor the impact of an educational intervention developed based on the expanded Protection Motivation Theory (PMT) on CC screening behavior. Materials and Methods: A quasi-experiment was conducted on 200 women referred to Karaj health centers, Iran. The participants were randomized into experimental and control groups. The data was collected by a Standardized questionnaire including demographic characteristics, the constructs of the PMT, and a self-administered Emotional Social- Support questionnaire (ESS). They filled the questionnaire before, after, and at 6-months follow-up. Eight educational sessions based on the model were held for the experimental group via lecture, group discussions and role play. The data were analyzed by SPSS (Ver. 24) and repeated measures ANOVA and Chi-square test. Results: In the pre- intervention and post-intervention stages, the mean score of perceived susceptibility from 8.07±3.28 to 11.83±1.99, perceived severity from 12.64±3.46 to 15.19± 2.85, response efficacy from 12.66±5.37 to 16.06±3.6, self-efficacy from 25.94±5.38 to 29.68±4.68, emotional social support from 27.01±7.16 to 31.46±5.76 and intention from 11.01±2.14 to 13.42±1.65 increased and this difference was statistically significant (p<0.05). The mean score of fear from 10.37±2.29 to 5.54±2.76 and response cost from 6.62±2.13 to 3.97 ±1.69 decreased and that was statistically significant (p<0.05). No significant difference was observed in the control group. Besides, the Pap smear test was increased after the educational intervention in the post-test and follow-up in the experimental group (p<0.05). Conclusion: Based on the findings, PMT and ESS can be used as a framework for designing educational programs to promote CC screening behavior. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of this study was to translate and psychometrics the Cervical Cancer Screening Self-Efficacy Scale. Materials and Methods: A standard forward-backward translation method was used to develop the Persian version of the cervical cancer screening self-efficacy scale. The validity of the questionnaire was assessed through face validity (qualitative and quantitative), content validity (qualitative and quantitative) and construct validity (exploratory and confirmatory factor analysis) in 400 women. The reliability of the questionnaire was determined by test-retest method (calculation of intra-class correlation coefficient) and also internal correlation (calculation of Cronbach-alpha coefficient). Statistical analyzes were performed by SPSS24 and lisrel 8.8 software. Results: The range of calculated CVR and CVI of scale items was (0.92-1.00) and (0.92-1.00) impact score of all items was more than 1.5. The range of Cronbach’s alpha and ICC were calculated for the reliability of scale items respectively (0.66 – 0.85) and (0.846- 0.977). The three factors of “Confidence in controlling tangible barriers of Pap Smear test “, “Confidence in following Pap Smear test Instructions” and “Confidence in controlling intangible barriers of PAPS”. In confirmatory factor analysis the fitted model based on these factors explained 58.29%of the self-efficacy in performing Pap Smear test. These factors confirmed by CFA (X2/df =3.3, CFI=0.91, GFI= 0.96, RMESA=0.081). Conclusion: Psychometric of Persian version of the cervical cancer screening self-efficacy scale with 8 items and 3 domains has proper validity and reliability to evaluate the cervical cancer screening self-efficacy in females. [ABSTRACT FROM AUTHOR]

Background and objective: Cervical cancer is one of the most prevalent cancers among women. Although Pap smear test is an effective screening program, it is not conducted very frequently. This study aimed to recognize the determinants affecting women's participation in Pap smear test screening, with a qualitative approach, based on the health belief model (HBM). Materials and methods: This was a qualitative research, based on thematic analysis, conducted in 2015. Participants were 30 rural women who participated in this study voluntarily in Sarvabad County in Kurdestan Province in Iran. Purposive sampling was used to recruit participants and sampling continued until data saturation. Semi-structured interviews were used to collect the data. Data were analyzed using thematic analysis. Results: Based on participants’ perception, more of the women believed that they were not at risk for cervical cancer; however, they perceived the severity of the disease. Some of them did not have an adequate understanding of the test benefits. They pointed to financial difficulties, fear of test result and lack of awareness are the main barriers in taking Pap smear test. Conclusion: Several factors affect women's participation in screening and Pap smear test. These factors include the components of social, economic, cultural, attitudes, individual beliefs, lack of awareness, fear, etc. Findings of this study could help health administers and planners in designing and implementing interventional programs such as theory-based educational programs, face-to-face educational classes, expert advice and speech of clergy people and influential community people to increase women’s participation in Pap smear test screening program. Paper Type: Research Article.

Background and Aims: Endometriosis is considered to be one of the most common women's diseases in the world. The exact cause of endometriosis is unknown. In this study, the bacterial agents were considered as the probable factors influencing this disease and the frequency of two bacteria U. urealyticum and C. trachomatis was studied in this disease. Materials and Methods: This study was performed on Pap smear samples of 50 women with endometriosis, 48 healthy women referred to hospitals in north of Tehran. The recommend samples were transferred to the laboratory, their DNA was extracted, and PCR method was performed. They were analyzed by descriptive statistics. Results: Performing PCR test for U. urealyticum detection among the pap smears of people with endometriosis and non_endometriosis, 27 samples (54%) and 25 samples (52%) were positive respectively but none of the samples had contamination with C. trachomatis. The highest prevalence of U. urealyticum in both endometriosis and healthy subjects was observed in the age group of 30-35 years. Conclusion: The prevalence of U. urealyticum in patients with endometriosis and healthy subjects (non_endometriosis) was relatively similar and the same as normal flora. There was no infection with C. trachomatis in these individuals, therefore there was no significant association between these bacteria and endometriosis. For more accurate results such studies should be done in a higher statistical society. [ABSTRACT FROM AUTHOR]

Background and Aims: Infertility rate has increased by 50% during the last two decades in Iran. There are several factors affecting infertility among women and men, amongst which infections have gained a lot of attentions recently. Given the high percentage of infertility in Iran, the present study has aimed to investigate the prevalence of Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhea amongst infertile women referring to a hospital in Tehran, Iran. Materials and Methods: In the current descriptive study, 65 infertile women referring to Mahdieh Hospital in Tehran during 2016-2017 were included and two vaginal swabs and a questionnaire were taken for each patient. In the laboratory, DNA extraction using kit and PCR using specific primers were carried out. Results: Of the 65 vaginal swab specimens, 21 (32%) had bacterial infection and 44 (68%) had no bacterial infections, and 2 (3%) had the mixed infection. The prevalence of C. trachomatis, M. genitalium and N. gonorrhea were 9 (13.8%), 11 (16.9%) and 4 (6.2%) isolates, respectively. There was no relationship between history of abortion, use of oral contraceptive pills, education or age, with the prevalence of bacterial infections. Conclusions: Based on the results of this study, M. genitalium, N.gonorrhea, and C.trachomatis were quite prevalent among infertile females and it can, therefore, be concluded that on-time control and treatment of infections caused by these organisms, together with other factors, could be important in prevention and treatment of women's infertility and the community's health. [ABSTRACT FROM AUTHOR]

Background and objective: Cervical cancer is one of the most prevalent cancers among women. Although Pap smear test is an effective screening program, it is not conducted very frequently. This study aimed to recognize the determinants affecting women's participation in Pap smear test screening, with a qualitative approach, based on the health belief model (HBM). Materials and methods: This was a qualitative research, based on thematic analysis, conducted in 2015. Participants were 30 rural women who participated in this study voluntarily in Sarvabad County in Kurdestan Province in Iran. Purposive sampling was used to recruit participants and sampling continued until data saturation. Semi-structured interviews were used to collect the data. Data were analyzed using thematic analysis. Results: Based on participants' perception, more of the women believed that they were not at risk for cervical cancer; however, they perceived the severity of the disease. Some of them did not have an adequate understanding of the test benefits. They pointed to financial difficulties, fear of test result and lack of awareness are the main barriers in taking Pap smear test. Conclusion: Several factors affect women's participation in screening and Pap smear test. These factors include the components of social, economic, cultural, attitudes, individual beliefs, lack of awareness, fear, etc. Findings of this study could help health administers and planners in designing and implementing interventional programs such as theory-based educational programs, face-toface educational classes, expert advice and speech of clergy people and influential community people to increase women's participation in Pap smear test screening program [ABSTRACT FROM AUTHOR]

Background: Ureaplasma and M. genitalium species belong to a kind of bacteria that are sexually transmitted and are the possible cause of pelvic inflammatory disease and nongonococcal urethritis, and et al. The aim of this study was to determine the urea plasma and Mycoplasma genitalium species frequency in women with vaginal infection and various sexual partners who referred to women, s health promotion and treatment center in Arak. Materials and Methods: Endocervical swab samples from 110 women with vaginal infections referred to women' s health promotion and treatment center in Arak, were prepared. Patients' personal information and identities during reception process were registered. The samples were transferred to the laboratory in the transport environment and after DNA extraction, were evaluated according to Real-time PCR assay. Results: Urea plasma and Mycoplasma genitalium bacteria existed in 96(87.27%) and 4(3.63%) of patients, respectively. Among them, 4 cases had both bacteria infections. The amount of isolation in young women between 30-39 years old was more than others. Conclusion: The results show that the colonization of urea plasma species in adult women is 40-80% and in studied group is 87.27%. These results indicate that with due attention to the increasing number of sexual partners and the increase of sexual activity, the urea plasma colonization of women will increase. In view of the potential influence of mycoplasma species on side effects resulted from pregnancy infection of mothers and mortality, on-time diagnosis and treatment will be increasingly essential. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cervical cancer is the most prevalent cancer and leading cause of death among women in most developing countries. Pap smear has been recognized as a simple screening for diagnosis of infections and pre-cancerous changes. This study intends to evaluate the level of awareness and knowledge of Herisian females regarding the cervical cancer and Pap smear. Materials and Methods: The present descriptive study was conducted on 333 married women, visiting the health treatment centers of Heris, East Azarbayjan. Data were obtained through a questionnaire that was made up and its validity and reliability was assessed. Results: One hundred and twenty eight of women with the age of 15< years old were aware of cervical cancer (38.4%) and 203 were unaware (61%). The percent of women referring for pap smear test was 49.8 (half of participants) and the other half didn't get this test. Conclusion: Regarding the low level of awareness (61%) about the cervical cancer among women in this region and the appropriate performance, it seems that vast educational programs are required to be run in order to promote the level of awareness and knowledge in women and their performance in order to prevent the cervical cancer. [ABSTRACT FROM AUTHOR]

Background and purpose: Sexually transmitted diseases (STD) are very common throughout the world. In this study the prevalence of vaginitis caused by Trichomonas vaginalis, Candida albicans and pathogenic bacteria was investigated in women referring for Pap smear to Imam Khomeini and Boalicina hospitals in Sari, 2008-9. Materials and methods: In this descriptive retrospective study, a total of 1832 files archive were randomly selected and examined for presence of Trichomonas vaginalis, Candida albicans and pathogenic bacteria. The data was analyzed by chi-square test using SPSS software. Results: The results indicated, 191 cases (10.42%) of vaginitis, where the rates of trichomoniasis, candidaiasis and bacterial infections were 14 (7.3%), 89 (46.6%) and 88 (46.1%), respectively. There was a significant difference between different age groups and vaginitis (P = 0.008) caused by Trichomonas vaginalis, Candida albicans and pathogenic bacteria. Conclusion: Sexually transmitted diseases as part of health problems affect communities at different ages, therefore, high risk individuals should receive more attention to gain immediate help. [ABSTRACT FROM AUTHOR]

Background: Continuous evaluation of screening programs in different parts of the country can provide appropriate feedbacks for the health system to adopt training programs and modify existing protocols. We studied the current status of cervical cancer screening in women referred to health centers in Isfahan, Iran. Methods: This cross-sectional study was conducted in women aged 35 to 60 years old covered by health centers in Isfahan city for one year starting from the beginning of 2011. Patients were selected by clustered random sampling method. Data were gathered by telephone or in-person interviews and also by the review of medical records. Findings: From 324 patients studied, 284 patients (87.7%) had at least one Pap smear test, of whom, 10.5% had one test and 89.4% had several tests (38.7% had the test done every three years and 50.7% irregularly). The associations of age and education with performing Pap smear test was not statistically significant (P = 0.062), but being employed outside home was associated with less frequent Pap smear tests (P < 0.001). No relationship was found between the family history of cancer and the frequency of Pap smear tests (P = 0.288). Conclusion: Based on our results, there is a need to improve women's participation rates in cervical cancer screening by primary health care providers. Promoting awareness through high schools and higher education institutions seems necessary. [ABSTRACT FROM AUTHOR]

Background: Pap smear is an easy and cost-effective screening method for cervical carcinoma and its precursors. The Bethesda system 2001 for reporting cervicovaginal cytology provides valuable information about specimen adequacy. In the present study, we investigated the status of specimen adequacy in Pap smears taken from women who had referred to Beheshti Hospital in Isfahan, Iran. Methods: In this cross-sectional study, all women with Pap smears in Beheshti Hospital in a 6-month period were evaluated. Exclusion criteria were the history of previous cervical cone biopsy or total hysterectomy. The specimens were studied by the investigators using a two-headed microscope and their adequacy was classified according to the Bethesda system 2001. Findings: Overall, 99.1% of the 1420 investigated specimens were satisfactory. Moreover, 66.1% of partially obscured and 46.2% of unsatisfactory specimens had been obscured by excessive thickness. Conclusion: The results of this study showed that a considerable percentage of Pap tests are satisfactory for evaluation. Excessive thickness was found to be the most frequent obscuring factor in this study. Since this obscuring factor happens during smear preparation, training is helpful in reducing its frequency. [ABSTRACT FROM AUTHOR]

Introduction: Pursuing the purpose of promoting students' potentials for learning practical skills, medical universities have tried to create a suitable environment in clinical skills centers for the practice of medicine in a simulated environment to prevent possible mistakes in real-life situations. This study aims to determine the effect of basic gynecological clinical skills on students' performance in Guilan University of Medical Sciences. Methods: This quasi-experimental study with a single before-and-after-training group conducted in April 2009 in the Clinical Skills Center of Guilan University of Medical Sciences. Through census sampling 25 clerckship students taking the basic gynecological clinical skills course were studied. Data collection was done through 8 researcher-built checklists. Their validity and reliability were confirmed. Descriptive (mean and standard deviation) and inferential (paired t-test) statistics were applied for data analysis using SPSS. Results: There was a significant difference between the students' performance on basic gynecological clinical skills before and after training; the mean of the students' total scores on all eight skills showed a significant increase after the training course. The highest mean scores before the training belonged to pop smear sampling skill (7.12w±2.42) and IUD insertion skill (5.8±2.41), while the lowest belonged to the management of third stage of labor skill (1.33±0.57) and bimanual examination skill (1.8±0.18). Skills which showed the highest mean scores after the training were IUD Insertion skill (13.52 ± 1.29) and Pap smear sampling skill (12± 1.08). Conclusion: Before the skills training, the students' mean scores on most procedures were not satisfactory, but after the training course, they increased significantly. Therefore, it is suggested that clinical skills centers and objective assessment methods be used both to meet students' needs and preserve patients' rights. [ABSTRACT FROM AUTHOR]

Background: Cancer of uterine cervix is the second cause of death in women in the world and the most common cause in developing countries. Because the majority of women with invasive cervical cancer of the uterine have not previously undergone screening, many clinicians assume that Pap smear has a high degree of accuracy; but problems such as false positive and false negative interpretations, as well as interobserver variability have questioned its validity. Methods: We retrieved 162 positive cervical smears that had been originally interpreted as ASC-US, ASC-H, LSIL, HSIL, SCC, AGC and adenocarcinoma from the cytology archives of Women's Hospital in Tehran, Iran. The slides were rescreened by an experienced pathologist and reclassified in the mentioned categories. All the 162 slides were reviewed by three more pathologists in a blind study using interpretative criteria utilized in their daily routine to evaluate interobserver reproducibility. To increase the level of interobserver agreement, the diagnostic categories were reduced to squamous Vs. glandular abnormalities and invasive (SCC and adenocarcinoma) Vs. non-invasive abnormalities. Results: The results obtained in this study indicated slight interobserver agreement (k=0.26). The most reproducible category was the invasive category (SCC in addition to adenocarcinoma) and the least agreement was seen for HSIL (k=0.19). Conclusion: This study showed that reproducibility of cytological interpretation of conventional Pap smears varies among interpretive categories and the overall interobserver agreement is slight. Since convening on the reduction of interobserver discrepancy in Pap smear interpretations necessitates more reliable information of interpretative variability, larger studies need to be undertaken. [ABSTRACT FROM AUTHOR]

Background: Cervical (uterine) carcinoma is the second most frequent type of women cancer. Success in early diagnosis of this disease is due to the use of pap-smear test. However, this test has both false-positive and false-negative results. P16 protein is a Cyclin-dependent Kinase inhibitor supposed to be overexpressed in cervical dysplasia and cancer. Our study was about correlation between P16 and cervical dysplasia. Methods: In this study 45 patients with dysplastic abnormalities in cervix (including Ascus-H) were sampled for papsmear (by Liquid-base method). Two smears were stained, one with papanicolau and the other (by IHC) for P16. The results were compared using t-test via SPSS15 software. Finding: Pap-stain revealed 13 ASCUS (29%), 18 LSIL (40%), 11 HSIL (24%), and 3 S.C.C (7%). Immunostaining of P16 protein was observed in ASCUS (3/13, 23%), LSIL (12/18, 67%), HSIL (11/11, 100%), and S.C.C (3/3, 100%). P16 had significant correlation with degree of cervical dysplasia in Liquid-base pap-smear (P < 0.0001). Conclusion: We suggest the usage of P16-test as an optional test for cervical dysplasia according to our study. [ABSTRACT FROM AUTHOR]

Background: Primary clear cell adenocarcinoma of cervix (CCAC) is usually seen in women with a history of in utero exposure to diethyl acetyl bestrol (DES). We report two cases of clear cell adenocarcinoma of cervix with no history of exposure to DES in embryonic period. Case presentation: The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic lymphadenectomy and for the another one external beam radiotherapy and brachytherapy was performed. There was no any recurrence or metastasis after an 18-24 months follow-up Conclusions: Primary clear cell carcinoma of cervix could be unrelated to HPV infection or exposure to DES during embryonic period and in approach to these patients this subject should be considered. [ABSTRACT FROM AUTHOR]