Prognostic value of Dna and Mrna E6/e7 of human papillomavirus in the evolution of cervical intraepithelial neoplasia grade 2

Objective: This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL).Methods: This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months.Results: Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant.Conclusions: The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution. © the authors.This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL).Methods: This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months.Results: Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant.Conclusions: The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution9152

Why Does The Prevalence Of Cytopathological Results Of Cervical Cancer Screening Can Vary Significantly Between Two Regions Of Brazil? [por Que A Prevalência De Resultados Citopatológicos Do Rastreamento Do Câncer Do Colo Do útero Pode Variar Significativamente Entre Duas Regiões Do Brasil?]

PURPOSE: To analyze the prevalence of cervical cytopathological results for the screening of cervical cancer with regard to women's age and time since the last examination in Maceió and Rio de Janeiro, Brazil, among those assisted by the Brazilian Unified Health System. METHODS: Cervical cytopathological results available in the Information System of Cervical Cancer Screening for the year 2011 were analyzed, corresponding to 206,550 for Rio de Janeiro and 45,243 for Maceió. RESULTS: In Rio de Janeiro, examination at one and two year intervals predominated, while in Maceió examination at one and three year intervals had a higher predominance. Women who underwent cervical smear screening in Maceió were older than those in Rio de Janeiro. The prevalence of invasive squamous cell carcinoma was similar for the two cities, but all the other results presented a higher prevalence in Rio de Janeiro: ASCUS (PR=5.32; 95%CI 4.66-6.07); ASCH (PR=4.27; 95%CI 3.15-5.78); atypical glandular cells (PR=10.02; 95%CI 5.66-17.76); low-grade squamous intraepithelial lesions (PR=6.10; 95%CI 5.27-7.07); high-grade squamous intraepithelial lesions (PR=8.90; 95%CI 6.50-12.18) and adenocarcinoma (PR=3.00; 95%CI 1.21-7.44). The rate of unsatisfactory cervical samples was two times higher in Maceió and that of rejected samples for analysis was five times higher in Maceió when compared to Rio de Janeiro. CONCLUSIONS: The prevalence rates of altered cervical cytopathological results was significantly higher in Rio de Janeiro than in Maceió. There is no objective information that may justify this difference. One hypothesis is that there may be a difference in the diagnostic performance of the cervical cancer screening, which could be related to the quality of the Pap smear. Thus, these findings suggest that it would be necessary to perform this evaluation at national level, with emphasis on the performance of cervical cancer screening in order to improve the effectiveness of cervical cancer control.365192197International Agency For Research On Cancer, , http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx, World Health Organization [Internet], GLOBOCAN 2012: estimated cancer incidence, and mortality and prevalence worldwide in 2012: cancer fact sheets. Lyon: IARC2013 [cited 2014 Apr 22]. Available fromAkinyemiju, T.F., Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: Analysis of the world health survey (2012) PLoS One, 7 (11), pp. e48834Coordenação De Prevenção E Vigilância [Internet], , http://portal.saude.sp.gov.br/resources/ses/perfil/gestor/homepage/estimativas-de-incidencia-de-cancer-2012/estimativas_incidencia_cancer_2012.pdf, Coordenação Geral De Ações Estratégicas Ministério Da Saúde. Instituto Nacional De Câncer José Alencar Gomes Da Silva. Brasil, Estimativa 2012: incidência de câncer no Brasil. Rio de Janeiro: INCA2011 [citado 2013 Ago 12]. Disponível emMathew, A., George, P.S., Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix--worldwide (2009) Asian Pac J Cancer Prev, 10 (4), pp. 645-650DATASUS [Internet], , http://www2.datasus.gov.br/DATASUS/index.php?area=06, Ministério Da Saúde Brasil, Sistemas e aplicativos [citado 2013 Set 20]. Disponível emInstituto Brasileiro De Geografia E Estatística [Internet], , http://www.ibge.gov.br/home/download/estatistica.shtm, Download: estatísticas [citado 2013 Set 20]. Disponível emInstituto Brasileiro De Geografia E Estatística [Internet], , http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/indicadoresminimos/default_minimos.shtm, Indicadores sociais mínimos [citado 2013 Ago 12]. Disponível emDATASUS [Internet], , http://w3.datasus.gov.br/siscam/index.php?area=0403, Ministério Da Saúde Brasil, SISCOLO/SISMAMA: sistema de informação do câncer de colo do útero e sistema de informação do câncer de mama: informações estatísticas: Siscolo 4.00 ou superior [citado 2013 Set 20]. Disponível emInstituto Nacional De Câncer [Internet], , http://mortalidade.inca.gov.br/Mortalidade/prepararModelo04.action, Ministério Da Saúde Brasil, Atlas de mortalidade por câncer [citado 2013 Set 20]. Disponível em(2006) Instituto Nacional De Câncer José Alencar Gomes Da Silva, , Ministério Da Saúde Brasil, Coordenação de Prevenção e Vigilância. Nomenclatura brasileira para laudos cervicais e condutas preconizadas: recomendações para profissionais de saúde. 2a ed. Rio de Janeiro: INCAInstituto Nacional De Câncer José Alencar Gomes Da Silva [Internet], , http://www2.inca.gov.br/wps/wcm/connect/agencianoticias/site/home/noticias/2010/escola_secao_integrada_citopatologia_inca, Ministério Da Saúde Brasil, Novos equipamentos da SITEC vão melhorar qualidade de exames citológicos. 2010 [citado 2013 Maio 9]. Disponível em(2012) Instituto Nacional De Câncer José Alencar Gomes Da Silva, 3 (1). , http://www1.inca.gov.br/inca/Arquivos/informativo_detecprecoce_1.2_2012.pdf, Ministério Da Saúde Brasil, Monitoramento das ações de controle dos cânceres do colo do útero e de mama. Bol Inf Detecção Precoce [Internet], [citado 2013 Maio 9]. Disponível emVale, D.B., Westin, M.C., Zeferino, L.C., High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion (2013) Cancer Cytopathol, 121 (10), pp. 576-581Fahey, M.T., Irwig, L., Macaskill, P., Meta-analysis of Pap test accuracy (1995) Am J Epidemiol, 141 (7), pp. 680-689Nanda, K., McCrory, D.C., Myers, E.R., Bastian, L.A., Hasselblad, V., Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review (2000) Ann Intern Med, 132 (10), pp. 810-819Tavares, S.B., de Alves, S.N.L., Manrique, E.J., de Pinheiro, A.Z.B., Zeferino, L.C., Amaral, R.G., Improvement in the routine screening of cervical smears: A study using rapid prescreening and 100% rapid review as internal quality control methods (2011) Cancer Cytopathol, 119 (6), pp. 367-376Azara, C.Z., Manrique, E.J., de Alves, S.N.L., Rodrigues, A.R., Tavares, S.B., Amaral, R.G., External quality control of cervical cytopathology: Interlaboratory variability (2013) Acta Cytol, 57 (6), pp. 585-590Amaral, R.G., Manrique, J.C., Guimarães, J.V., Sousa, P.J., Mignoli, J.R.Q., Influence of adequacy of the sample on detection of the precursor lesions of the cervical cancer] (2008) Rev Bras Ginecol Obstet, 30 (11), pp. 556-560Franco, F., Amaral, R.G., Montemor, E.B.L., Montis, D.M., Morais, S.S., Zeferino, L.C., Factors associated with false-negative cervical cytopathological results (2006) Rev Bras Ginecol Obstet, 28 (8), pp. 479-485Monitoramento Das Ações Do Controle Do Câncer Do Colo Do Útero E De Mama [Internet], , http://www1.inca.gov.br/inca/Arquivos/inform.deteccaoprecoce.pdf, Ministério Da Saúde. Instituto Nacional De Câncer Brasil, Bol Inf Detecção Precoce. 2010;1 [citado2012 Jul 13]. Disponível e

Microbiological Characteristics And Inflammatory Cytokines Associated With Preterm Labor

Purpose: To evaluate vaginal microflora and interleukin-1β (IL-β), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) concentrations in the cervicovaginal fluid of a group of pregnant women in preterm labor when compared with a group of full-term pregnant women not yet in labor. Method: Case-control study performed in a University tertiary referral maternity in Campinas, Brazil with 45 pregnant women in preterm labor and 45 full-term pregnant women not in labor. All patients underwent speculum examination for the collection of cervicovaginal fluid. Bacterial vaginosis (BV) was diagnosed according to the criteria of Amsel and Nugent. Culture was performed for group B streptococcus (GBS) and lactobacilli, and hybrid capture assay for screening for chlamydial and gonococcal infection. Cytokine concentrations were measured using ELISA technique. Statistical analysis was performed using χ2, Fisher's exact, and crude and adjusted odds ratios. Significance level was defined at 5%. The main outcome measures were cervicovaginal cytokines in preterm labor. Results: IL-6 and IL-8 were significantly associated with preterm labor. The changes in vaginal microflora, as well as BV and GBS, were more frequent in women in preterm labor, although BV and GBS showed no statistical significance. The presence of Candida sp., absence of lactobacilli, positive screening for chlamydial and gonococcal infection and the presence of IL-1β and TNF-α were not associated with preterm labor. Conclusions: IL-6 and IL-8 and the presence of any type of vaginal infection were the factors that were significantly associated with preterm labor. © 2010 Springer-Verlag.1

Tinidazole Versus Cefazolin In Antibiotic Prophylaxis Of Vaginal And Abdominal Hysterectomy [tinidazol Versus Cefazolina Na Antibioticoprofilaxia De Histerectomia Vaginal E Abdominal]

PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.3011544549Bratzler, D.W., Houck, P.M., Richards, C., Steele, L., Dellinger, E.P., Fry, D.E., Use of antimicrobial prophylaxis for major surgery: Baseline results from the National Surgical Infection Prevention Project (2005) Arch Surg, 140 (2), pp. 174-182Ferraz, E.M., Ferraz, A.A., Bacelar, T.S., D'Alburquerque, H.S., Vasconcelos, M.D., Leão, C.S., Controle de infecção em cirurgia geral: Resultado de um estudo prospectivo de 23 anos e 42.274 cirurgias. (2001) Rev Col Bras Cir, 28 (1), pp. 17-26Molina-Cabrillana, J., Valle-Morales, L., Hernandez-Vera, J., López-Carrió, I., García-Hernández, J.A., Bolaños-Rivero, M., Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain (2008) Eur J Obstet Gynecol Reprod Biol, 136 (2), pp. 232-238Soper, D.E., Bump, R.C., Hurt, W.G., Wound infection after abdominal hysterectomy: Effect of the depth of subcutaneous tissue (1995) Am J Obstet Gynecol, 173 (2), pp. 465-469Persson, E., Bergstrom, M., Larson, P.G., Moberg, P., Platz-Christensen, J.J., Schedvins, K., Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology (1996) Acta Obstet Gynecol Scand, 75 (8), pp. 757-761Costa, R.J.M., Krauss-Silva, L., Revisão sistemática e meta-análise da antibioticoprofilaxia na histerectomia abdominal. (2004) Cad Saúde Pública, 20 (SUPL 2), pp. 175-189DiLuigi, A.J., Peipert, J.F., Weitzen, S., Jamshidi, R.M., Prophylactic antibiotic administration prior to hysterectomy: A quality improvement initiative (2004) J Repr Med, 49 (12), pp. 949-954Tanos, V., Rojansky, N., Prophylatic antibiotics in abdominal Gynecology (1994) J Am Coll Surg, 179 (5), pp. 593-600Peipert, J.F., Weitzen, S., Cruickshank, C., Story, E., Ethridge, D., Lapane, K., Risk factors for febrile morbidity after hysterectomy (2004) Obstet Gynecol, 103 (1), pp. 86-91Soper, D.E., Bump, R.C., Hurt, W.G., Bacterial vaginosis and trichomoniais vaginistis are risk factors for cuff celullits after abdominal hysterectomy (1990) Am J Obstet Gynecol, 163 (3), pp. 1016-1021Löfgren, M., Poromaa, I.S., Stjerndhal, J.H., Renström, B., Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden: A study by the Swedish National Register for Gynecologic Surgery (2004) Acta Obstet Gynecol Scand, 83 (12), pp. 1202-1207Roumbelaki, M., Kritsotakis, E.I., Tsioutis, C., Tzilepi, P., Gikas, A., Surveillance of surgical site infections at a tertiary care hospital in Greece: Incidence, risk factors, microbiology, and impact (2008) Am J Infect Control, , In pressMatushek, K.J., Rosin, E., Pharmacokinetics of cefazolin applied topically to the surgical wound (1991) Arch Surg, 126 (7), pp. 890-893Mittendorf, R., Aronson, M.P., Berry, R.E., Williams, M.A., Kupelnick, B., Klickstein, A., Avoiding serious infections associated with abdominal hysterectomy: A meta-analysis of antibiotic prophylaxis (1993) Am J Obstet Gynecol, 169 (5), pp. 1119-1124Su, H.Y., Ding, D.C., Chen, D.C., Lu, M.F., Liu, J.Y., Chang, F.Y., Prospective randomized comparison of single-dose versus 1-day cefazolin for prophylaxis in gynecologic surgery (2005) Acta Obstet Gynecol Scand, 84 (4), pp. 384-389Livengood 3rd, C.H., Ferris, D.G., Wiesenfeld, H.C., Hillier, S.L., Soper, D.E., Nyirjesy, P., Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: A randomized controlled trial (2007) Obstet Gynecol, 110 (2 PART 1), pp. 302-309Dhar, K.K., Dhall, G.I., Ayyagari, A., Single dose tinidazole prophylaxis in vaginal hysterectomy (1993) Int J Gynaecol Obstet, 42 (2), pp. 117-120Crosthwaire, A.H., Hurse, A.B., McDonald, I.A., Miles, H.M., Pavillard, E.R., Single dose tinidazole prophylaxis in hyterectomy (1985) Aust N Z Obstet Gynecol, 25 (1), pp. 55-58Amsel, R., Totten, P.A., Spiegel, C.A., Chen, K.C., Eschenbach, D., Holmes, K.K., Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations (1983) Am J Med, 74 (1), pp. 14-22Nugent, R.P., Krohn, M.A., Hillier, S.L., Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation (1991) J Clin Microbiol, 29 (2), pp. 297-301Chongsomchai, C., Lumbiganon, P., Thinkhamrop, J., Ounchai, J., Vudhikamraksa, N., Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy (2002) J Hosp Infect, 52 (4), pp. 302-306Meyer, N.L., Hosier, K.V., Scott, K., Lipscomb, G.H., Cefazolin versus cefazolin plus metronidazole for antibiotic prophylaxis at cesarean section (2003) South Med J, 96 (10), pp. 992-99