This study explored histopathological outcomes among women who tested positive for high‐risk human papillomavirus (hrHPV), examined the significance of extended HPV genotyping, and identified predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2 ⁺ ). This retrospective review assessed medical records of women who screened positive for hrHPV between January 1, 2020, and December 31, 2023. Genotyping results, diagnostic procedures, and histopathological findings were collected. Data were analyzed using SPSS, with p < 0.05 considered statistically significant. Among 1981 women, the median age was 40 years (IQR 32.0‒49.0), and the median parity was 1 (IQR 0‒2). Overall, 1223 women (61.7%) had prior screening, 1215 women (61.3%) had previous cytology, and 107 women (5.4%) had prior hrHPV testing. Single‐genotype infection occurred in 1408 women (74.7%), with HPV52, HPV16, and HPV58 identified in 23.7%, 15.6%, and 15.4% of cases, respectively. CIN2 ⁺ was detected in 152 women (7.7%), including 130 with CIN2/CIN3/AIS and 22 with cancer. Detection of HPV16 significantly increased the risk of CIN2 ⁺ (odds ratio [OR] 4.534, 95% CI: 3.197‒6.430), as did multiparity (OR 1.497, 95% CI: 1.070‒2.094). The immediate risk of CIN2 ⁺ for HPV31, HPV39, HPV56, HPV66, and HPV68 was below 4%. Among hrHPV‐positive women, 7.7% had CIN2 ⁺ . Extended hrHPV genotyping may refine risk stratification by highlighting HPV16 and multiparity as significant predictors of CIN2 ⁺ lesions.

Introduction: The World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2 ⁺ ). Methods: Women who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2 ⁺ across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05. Results: Among 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2 ⁺ occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2 ⁺ was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods ( P = .941). Conclusions: VIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.

Purpose: To evaluate whether adding milk of magnesia (MOM) to an enhanced recovery after surgery (ERAS) pathway prevents postoperative ileus (POI) and improves postoperative bowel function. Methods: This randomized controlled trial at the Gynecology Unit, Siriraj Hospital (Bangkok, Thailand) enrolled patients undergoing hysterectomy for benign or malignant indications during September 2023 through February 2024. Participants were randomly assigned to ERAS alone ( n = 80) or ERAS plus MOM ( n = 80). The MOM group received 15 mL on postoperative day 0 and then 30 mL twice daily until first flatus or bowel movement. The primary outcome was the time from surgery to resumption of a well-tolerated solid diet. Secondary outcomes included POI incidence, time to first flatus, patient-reported outcomes, and MOM-related complications. Results: Among 160 patients, 60 (37.5%) had gynecologic malignancies: endometrial cancer ( n = 34), ovarian cancer ( n = 16), cervical cancer ( n = 8), and leiomyosarcoma ( n = 2). Time to well-tolerated solid diet was significantly shorter in the MOM group compared with the control group (20.6 ± 10.9 vs 28.8 ± 16.3 h; P < 0.001). The incidence of POI was also significantly lower (3.8% vs 27.5%; P < 0.001), and time to first flatus was shorter (17.1 ± 7.9 vs 22.3 ± 10.8 h; P < 0.001). Patient-reported outcomes favored the MOM group, with higher eating and daily activity satisfaction scores. No severe adverse events occurred in the MOM group. Conclusion: Adding MOM to ERAS was associated with reduced POI incidence and faster recovery of bowel function in patients undergoing abdominal hysterectomy for benign or malignant conditions. Trial registration: Thai Clinical Trials Registry (TCTR: TCTR20230816005), registered on 16 August 2023.

Aims: To evaluate the proportion of expressed programmed cell death ligands‐1 (PD‐L1) in epithelial ovarian carcinoma patients, and the association with the clinicopathological, surgical outcomes, and oncologic outcomes. To compare PD‐L1 protein expression with messenger ribonucleic acid (mRNA) expression. Methods: The patients who had pathology of epithelial ovarian/tubal/peritoneal carcinoma were enrolled. The demographic data, tumor characteristics, surgical outcomes, treatment details, and treatment response were analyzed by descriptive statistics. Spearman's rank correlation coefficient test was used to determine the correlation between protein expression and mRNA expression. The survival curve was developed utilizing the Kaplan‐Meier method, the log‐rank test was used to compare survival distributions of patients according to the PD‐L1 protein expression. Results: A total of 100 patients, with high‐grade serous carcinoma being the most common subtype (42%). Advanced‐stage disease was present in 49% of patients, and 65% achieved optimal cytoreduction. PD‐L1 protein expression was detected in 23% of tumors, while the median normalized mRNA expression was 0.015 (IQR 0.004–0.037). A moderate positive correlation was observed between PD‐L1 protein and mRNA expression (Spearman's rho = 0.407, p < 0.001). The mean progression‐free survival (PFS) and overall survival (OS) were 44.32 ± 4.04 months and 74.19 ± 3.33 months, respectively. Conclusions: PD‐L1 protein expression was observed in a minority of patients and was not significantly associated with survival outcomes. There was a moderate correlation between PD‐L1 protein and mRNA expressions.