Human Papillomavirus Infections and Associated Cancers

Human papillomavirus types are the main tumor viruses in humans. High-risk human papillomavirus types, also called oncogenic human papillomaviruses, have been shown to be associated with cervical cancer, which is the leading cause of cancer mortality among women worldwide. High-risk human papillomavirus types are also associated with other anogenital cancers, and a subgroup of head and neck cancers. In addition, several studies have reported human papillomavirus types to be associated with some of the breast, lung, skin, and colon cancers. The proof that human papillomaviruses have a role in human oncogenesis has allowed the development of preventative and therapeutic strategies purposed at reducing the incidence and mortality rate of associated cancers. This article summarizes the main steps of the human papillomavirus life cycle and the functions of the viral proteins, and draws attention to carcinogenic mechanisms. In addition, this study presents a brief analysis of researches on cancer that were definitely or possibly associated with human papillomavirus and current information on prophylactic and therapeutic vaccine strategies against human papillomavirus infections and related cancers

Choosing Wisely in Immunology Laboratory: Reviewing of Antinuclear Antibody (ANA) Test Requests and Results Together with Other Tests

<p><strong>Özet</strong></p><p>Bu çalışmada bir üçüncü basamak eğitim ve araştırma hastanesinin tıbbi immünoloji laboratuvarında çalışılan testlerin dağılımını ve pozitiflik oranlarını incelemek ve iş yükünün önemli bir bölümünü oluşturan antinükleer antikor (ANA) testi istemlerinin hastalık tanı/ön tanılarına ve klinik birimlere göre dağılımını belirlemek, hatalı-uygunsuz test istemlerinin olası nedenlerini ve maliyetini incelemek ve etkin ve uygulanabilir çözüm önerilerini ele almak amaçlanmıştır. Çalışmada, Eylül 2016 tarihinden itibaren yaklaşık üç yıllık bir dönemde çalışılan tüm immünoseroloji testlerine (n=94.954 ayrı parametre) ait verilerin retrospektif bir incelemesi sunulmuştur. Testler üç ana gruba ayrılarak ele alındığında; tüm test parametreleri arasında %20.3'lük (n=19.248) bir oran ile ilk sırada ANA testleri yer almaktadır. Çalışmamızda indirekt immünfloresan antikor (IFA) yöntemi ile değerlendirilen ANA testlerinin pozitiflik oranı %23.1 (n=4446) olarak bulundu. Çok sayıda farklı testi içeren (IFA, ELISA ve immunoblot temelli) spesifik otoantikor testlerinin raporlanan parametre sayısı ise 67.976 olup ikinci grupta yer alan bu testlerin genel pozitiflik oranı %2.96 idi ve antikor tipine göre %0.8 ve %12.7 arasında değişmekte idi. Üçüncü grupta yer alan ELISA temelli brusella ve antiviral (herpes simplex virus 1 ve 2, varicella virus, measles virus, mumps virus, parvovirus B19) IgM ve IgG antikor testlerinde ise istenilen test sayısına göre en yüksek pozitiflik oranı (%30.1, 2324/7730) gözlemlendi. ANA pozitif hastalarda ANA ile ilişkili otoantikorlardan en sık saptananlar anti-dsDNA (%9.2) ve anti-SS-A (%8.2) olarak bulundu. Eş zamanlı test istemi yapılan ANA ilişkili otoantikorlar için, ANA negatif hastalarda anti-dsDNA pozitifliği %3.3 olarak bulunurken, ANA ilişkili diğer spesifik otoantikorlar için pozitiflik oranları %0.0-0.31 aralığında değişmekte idi. ANA testleri için en çok istem yapılan (%34.2) ve en yüksek ANA pozitiflik oranının (%28) görüldüğü birim romatoloji idi. Gereksiz test istemi nedenleri arasında en dikkat çekeni, aynı hasta için farklı hekimlerin yaptıkları test istemleri idi. ANA testlerinin 1:100 dilüsyonda çalışılmasının düşük pozitif sonuçlar nedeni ile gereksiz ikinci basamak test (spesifik otoantikor) çalışılmasına neden olabileceğini ve dar kapsamlı ikinci basamak otoantikor test panellerinin laboratuvar verimliliği üzerine olumsuz etkileri olacağını değerlendirmekteyiz.</p><p><strong>Abstract</strong></p><p>In this study, it was aimed to examine the distribution and positivity rates of the tests reported in the medical immunology laboratory of a tertiary education and research hospital, and to determine the distribution of antinuclear antibody (ANA) test requests, which constitute a significant part of the workload, according to disease diagnosis/preliminary diagnoses and clinical departments, and to examine the possible causes and costs of incorrect-inappropriate test orders, and to consider effective and applicable solution suggestions. In the study, a retrospective review of data on all immunoserology tests (n=94,954 individual parameters) reported approximately over a three-year period starting from September 2016 was presented. When the tests are divided into three main groups; among all test parameters, ANA tests ranked first with a rate of 20.3% (n=19,248). In our study, the positivity rate of ANA tests evaluated by the indirect immunofluorescence antibody (IFA) method was found as 23.1% (n=4,446). The number of reported parameters of specific autoantibody tests (second group), which include many different tests (IFA, ELISA, and immunoblot based), was 67,976, and the overall positivity was 2.96%, varies between 0.8% and 12.7%, depending on the antibody type. In the ELISA-based brucella and antiviral (herpes simplex virus 1 and 2, varicella virus, measles virus, mumps virus, parvovirus B19) IgM and IgG antibody tests in the third group, the highest positivity rate was observed according to the number of tests requested (30.1%, 2,324/7,730). In ANA-positive patients, the most frequently detected ANA-related autoantibodies were anti-dsDNA (9.2%) and anti-SS-A (8.2%). In ANA-negative patients, in simultaneously ordered tests, anti-dsDNA positivity was found to be 3.3%, while positivity rates for other ANA-related specific autoantibodies were in the range of 0.0-0.31%. ANA tests were most frequently ordered from the rheumatology department (34.2%), and also the highest ANA positivity rate (28%) was observed in this unit. The most notable reason for unnecessary test ordering was the test requests by different physicians for the same patient. We consider that evaluation of ANA tests at a dilution of 1:100 may lead to unnecessary second-step testing (specific autoantibodies) due to the low positive results, and that narrow-scope second-step autoantibody test panels will have negative effects on laboratory efficiency.</p><p><strong>İmmünoloji Laboratuvarında Akılcı Test Seçimi: Antinükleer Antikor (ANA) İstemlerinin ve Sonuçlarının Diğer Testler ile Birlikte İncelenmesi</strong></p&gt

Evaluation of Malassezia furfur Biofilm Formation on Polypropylene Membrane

The Malassezia yeast species colonize on the skin immediately after birth and could be found on the healthy skin flora for life. Although they are more frequently involved in the etiology of common skin infections in the community, particularly Malassezia furfur could cause life-threatening infections such as fungemia. Detection of biofilm during the colonization of these yeasts on the skin is an important criterion for its virulence. Since they are lipophilic yeasts, commonly used biofilm detection methods are not applicable to the Malassezia strains. The aim of the study was to describe the growth and measurement of M.furfur isolates on a polypropylene membrane to demonstrate their biofilm-forming capacities. Twenty-seven M.furfur strains colonized in the newborns were included in the study. Basically, sterile polypropylene membranes were placed on different polysorbates (tween 20, 40, and 80) which were spread on Sabouraud dextrose agar. Ten µl saline suspension of M.furfur was dropped on the polypropylene membrane and incubated in standard growth conditions for three days. Later, the visible colony was removed gently by washing with running water and the biofilm structure formed on the membrane was stained with safranin. The stained biofilm was photographed. Performing image analysis, the values obtained against background activity were digitized according to the specified protocol. Moreover, XTT reduction test was performed and the measured metabolic activity results were compared with the safranin-stained biofilm data. The safranin hydrolysis of the strains was measured spectrometrically. Twenty-five (92.6%) of the strains included in the study were stained with safranin, which indicated the presence of biofilm on the polypropylene membrane. The strains grown with tween 20 and tween 80 formed a higher biofilm layer density than those supplied with tween 40. Isolates with low and high biofilm-forming capacity were clearly separated by tween 20 (p 0.05). XTT activity was detected in 26 (96.3%) isolates. No correlation was found between biofilm density obtained by the described method and XTT reduction. It was observed that hydrolysis of safranin did not affect the biofilm evaluation method. In this study, it was shown that as a result of sufficient diffusion through hydrophobic membranes, polysorbate-based growth factors could maintain measurement of the biofilm layer formed by lipophilic M.furfur strains. The best grouping properties for M.furfur were obtained with tween 20 which could determine low and high level of biofilm formation. Image analysis was used with high performance for this method. As conclusion, the utilization of different hydrophobic membranes and dyes would lead to the development of new techniques for the application in other lipophilic yeasts