Chlamydia trachomatis and human papillomavirus coinfection: association with p16INK4a and Ki67 expression in biopsies of patients with pre-neoplastic and neoplastic lesions

The objective of this study was to identify the frequency of coinfection by human papillomavirus (HPV) and Chlamydia trachomatis (CT) in cervical lesions and relate it with immunohistochemical expression of p16INK4a and Ki67, both oncogenicity markers. A cross-sectional study with 86 women from primary care units in southern Brazil was conducted. Cervical swabs were collected for HPV-DNA and CT-DNA detection, through the polymerase chain reaction technique (PCR). The immunohistochemical analysis was performed on biopsy cervical tissue material to identify the expression of p16INK4a and Ki67 cell cycle markers. About 83 % were positive for HPV-DNA and 19% had coinfection with CT-DNA. Among coinfected women, 56% expressed p16INK4a. There was a statistically significant association between the histological grade of the lesion and Ki67 expression. All high-grade lesions, 50% of low-grade lesions and 31% of negative biopsies expressed Ki67 (p = 0.004). A total of 37% of coinfected women expressed both markers. In conclusion, although more than half of the coinfected patients have expressed p16INK4a and more than one third have expressed both markers, these results suggest no association between those variables. However, other studies involving larger samples are necessary to corroborate such findings

Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01;

Genital human papillomavirus infection identification by molecular biology among asymptomatic women

OBJECTIVE: To evaluate whether epidemiological factors may be associated to genital human papillomavirus (HPV) infection. METHODS: A cross-sectional study was carried out among 975 women seen at a public health service for cervical cancer screening in Porto Alegre, Brazil. Women were considered infected if tested positive to HPV either by Polymerase Chain Reaction (PCR) or Hybrid Capture II (HC-II) methods. Women with genital HPV infection were compared to women without infection drawn from the same population. RESULTS: The study enrolled 975 women. The HPV prevalence (both methods combined) in this population was 27%. However, when each diagnostic method is analyzed separately, HPV prevalence was 15% and 16% for HC-II and PCR, respectively. Unconditional multiple logistic regression was used to correlate disease status to women characteristics. A positive association was found with HPV infection for the following variables: years of schooling (11 years: OR=2.05; 95%CI =1.31; 3.20), married (OR=1.69; 95%CI=0.78; 2.00), number of lifetime sexual partners (2 partners: OR=1.67; 95%CI=1.01; 2.77; 4 or +: OR=2.18; 95%CI=1.15; 4.13), age at first intercourse (15-16 years: OR=4.05; 95%CI=0.89; 18.29). CONCLUSIONS: Various factors may contribute to genital HPV infection, especially those related to sexual behavior (young age at first intercourse, high number of lifetime sexual partners, and marital status), and those related to social and economic status (years of schooling).OBJETIVO: Verificar a associação entre fatores epidemiológicos e infecção genital pelo papilomavírus humano (HPV). MÉTODOS: Realizou-se estudo transversal com 975 mulheres atendidas em um serviço público de rastreamento para o câncer cervical, em Porto Alegre, Brasil. As mulheres foram consideradas infectadas pelo HPV quando apresentaram o teste de DNA positivo para esse vírus, tanto pelo método de captura híbrida II (CH II) como pelo método de reação em cadeia da polimerase (PCR). Mulheres infectadas pelo HPV foram comparadas com mulheres não infectadas oriundas da mesma população. RESULTADOS: Foram estudadas 975 mulheres. A prevalência observada de HPV (pela combinação dos métodos de DNA) foi de 27%. Quando a análise de cada método de DNA foi feito isoladamente, a prevalência de HPV-DNA foi de 15% para a CH II e de 16% para PCR. Regressão logística múltipla incondicional foi utilizada na identificação dos fatores associados à infecção pelo HPV. Foi encontrada associação positiva com as seguintes variáveis: anos de escolaridade (11 anos: OR=2,05; IC95%=1,31; 3,20; referência: até oito anos de escolaridade); ser casada (OR=1,69; IC95%=0,78; 2,00; referência: ser solteira); parceiros sexuais ao longo da vida (dois parceiros: OR=1,67; IC95%=1,01; 2,77; quatro ou mais: OR=2,18; IC95%=1,15; 4,13; referência: um parceiro); idade da primeira relação sexual (15-16 anos: OR=4,05; IC95%=0,89; 18,29; referência: >; ou = 22 anos). CONCLUSÕES: Vários fatores parecem estar associados à presença de infecção genital pelo HPV, especialmente aqueles referentes ao comportamento sexual (idade da primeira relação sexual, número de parceiros sexuais ao longo da vida e estado marital) e aqueles relacionados à situação socioeconômica (escolaridade)