CERVICAL CYTOLOGY AND THE USE OF LUBRICANTS: AN EVIDENCE BASED REVIEW Objectives: To review recent evidence on the effect of lubricant on the cytological result obtained from cervical smears. Data sources: Evidence-based medicine websites and Índex de Revistas Médicas Portuguesas. Methods: A search for articles using the MeSH terms vaginal smears and lubricants published between January 2000 and January 2011 was conducted. Citations were also searched. The Oxford Centre for Evidence-based Medicine-Levels of Evidence was used to assess the quality of studies, the levels of evidence and the strength of recommendations. Results: Of the 41 articles identified, eight were selected for this review. These included seven randomized controlled trials (RCT) and one retrospective study. Six of them (three with evidence level 1b and three with level 2b) conclude that lubricant does not affect the quality of the cytological samples obtained. The remaining two articles (level 2b) found interference with the cytological result by lubricant. Discussion: The use of lubricant in obtaining cervical smears is controversial and is usually not advised. Current knowledge in this area is limited. Clinical trials are heterogeneous with regard to design and techniques used. Trials with protocols that most resemble current clinical practice demonstrate no interference by lubricant with the quality of cytological samples. There is evidence that a small amount of water-based lubricant does not compromise the quality of cervical cytology results (Strength of recommendation A).

Introduction: Urinary tract infections (UTIs) are an important health problem, both in terms of morbidity and economic impact. Emerging antibiotic resistance increases the need for alternative preventive approaches. Aim: To review the available evidence on the efficacy of cranberries in preventing recurrent uncomplicated UTIs in adult women. Sources: MEDLINE database and the following evidence based medical sites: UpToDate, Clinical Evidence, Bandolier, EBM Online, ACP Journal Club, TRIP, InfoPOEMs, The Cochrane Library, DARE, Guidelines Finder, National Guideline Clearinghouse, Canadian Medical Association Infobase, USPSTF, NIC and Canadian Task Force on Preventive Health Care. Methods: Search for systematic reviews, meta-analyses, clinical guidelines and randomized clinical trials published between January 2000 and December 2010 in English, Portuguese and Spanish. We used the MeSH terms: Vaccinium macrocarpon and UTI and the word cranberry. The American Family Physician`s Strength of Recommendation Taxonomy was used to establish the quality of the studies and define the strength of the recommendation. Results: Of the 127 articles found, only nine fulfilled the inclusion criteria and were selected. These included one clinical decision support system, three systematic reviews, four clinical guidelines and one clinical trial. In its various forms, cranberries seem to effectively decrease the recurrence of UTIs in adult women without associated comorbidities Discussion: Available evidence shows that cranberries are beneficial in preventing recurrent urinary infections (Strength of Recommendation B). However, this recommendation is limited by the heterogeneity of studies and lack of agreement concerning dosage and presentation. Better studies are needed to establish safety and tolerability as well as the adequate dosage, presentation and duration of the treatment.

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