Bacterial vaginosis and cervical human papillomavirus infection in young and adult women: a systematic review and meta-analysis

OBJECTIVE: To investigate the association between bacterial vaginosis and cervical HPV infection in young and adult women. METHOD: This systematic review and meta-analysis was based on the Prisma methodological guidelines. PubMed and Web of Science were searched using the following descriptors: “bacterial vaginosis and HPV”, in June 2019. Articles published from 2012 to 2019 were included. Inclusion criteria were original studies that investigated the association between bacterial vaginosis and cervical HPV infection; articles published in English, Spanish or Portuguese; studies conducted in young and adult, non-pregnant, non-HIV-infected women; studies that used the Nugent criteria for the diagnosis of bacterial vaginosis and studies in which the detection of HPV used the polymerase chain reaction (PCR) technique. Assembled data, odds ratio (OR) and respective 95% CIs were estimated for the association between bacterial vaginosis and cervical HPV infection using random-effects models. A bilateral value of p < 0.05 was considered statistically significant. RESULT: Six studies were selected for analysis and demonstrated association between bacterial vaginosis and cervical HPV infection (OR = 2.68; 95%CI: 1.64–4.40; p < 0.001). CONCLUSION: Bacterial vaginosis was considered a risk factor for cervical HPV infection, since women with bacterial vaginosis were more likely to be infected with HPV

Informação nutricional complementar em bebidas açucaradas consumidas pelo público adolescente e infantil

Introduction: The labeling has a fundamental role for the consumer, supporting the choice of foods and being able to help in the prevention of obesity and overweight in children and adolescents; which are important public health problems in Brazil and  worldwide. The declaration of nutrients and energy value on food labels is mandatory. The declaration of complementary nutritional properties is optional for the manufacturer, but once declared, it requires compliance with current legislation. Objective: The objective of the study was to evaluate the labels of sugary drinks widely consumed by adolescents and children; analyzed at the Municipal Public Health Laboratory in Rio de Janeiro. Method: The data being extracted and analyzed from the Harpya Sample Management System. The evaluation of the labels considered items of the Collegiate Board Resolution of the National Health Surveillance Agency nº 54/2012. 226 sugary drinks were analyzed: powdered chocolate, soft drinks and tea with lemon, soy-based drink, milk drinks, fruit nectars, powdered drinks, natural guarana drinks, soft drinks, juices and blackcurrant syrup. Results: It was observed that 29.20% of the labels did not meet the criteria established in the legislation, and that the number of unsatisfactory labels was expressive mainly in juices (85.11%), with 97.50% of the non-conformities related to sugar declarations (attributes and expressions used). Conclusions: The work points to the relevance of the continuous monitoring of products on the market, contributing to the promotion of health and to an adequate diet in children and adolescents, in addition to avoiding the dissemination of misleading information to consumers.Introdução: A rotulagem tem papel fundamental para o consumidor, apoiando a escolha  dos alimentos e podendo auxiliar na prevenção da obesidade e sobrepeso em crianças e adolescentes, importantes problemas de saúde pública no Brasil e no mundo. A declaração  de nutrientes e do valor energético nos rótulos dos alimentos é obrigatória. Já a declaração  de propriedades nutricionais complementares é opcional para o fabricante, mas, uma vez declarada, exige cumprimento da legislação vigente. Objetivo: Avaliar rótulos de bebidas açucaradas amplamente consumidas pelo público adolescente e infantil, analisadas no Laboratório Municipal de Saúde Pública do Rio de Janeiro. Método: Os dados foram extraídos e analisados do Sistema de Gerenciamento de Amostras Harpya. A avaliação dos rótulos considerou critérios da Resolução de Diretoria Colegiada da Agência Nacional de Vigilância Sanitária nº 54/2012. Foram analisadas 226 bebidas açucaradas: achocolatados em pó, refrescos e chá com limão, bebida à base de soja, bebidas lácteas, néctares de frutas, refrescos em pó, refrescos de guaraná natural, refrigerantes, sucos e xarope de groselha.  Resultados: Observou-se que 29,20% dos rótulos não cumpriram os critérios estabelecidos  na legislação, e que o número de rótulos inadequados foi expressivo principalmente em sucos (85,11%), sendo 97,50% das não conformidades relacionadas às declarações de açúcares (atributos e expressões utilizadas). Conclusões: O trabalho aponta para a  relevância do monitoramento contínuo dos produtos no mercado, contribuindo para a promoção da saúde e para uma alimentação adequada na idade infantil e da adolescência, além de evitar difusão de informações enganosas ao consumidor

Hpv infection and cervical neoplasia: associated risk factors

CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOBehavioral risks such as age at first sexual intercourse, number of sexual partners and partner's sexual behavior are associated with an increased risk of HPV infection, persistence of the infection and the development of neoplastic precursor lesions. The objective of this study was to evaluate the risk factors associated with HPV positivity and with a diagnosis of cervical neoplasia in women referred with an abnormal cervical smear. This study evaluated a series of 198 women referred with an abnormal cervical smear. Risk factors for HPV infection were investigated using a questionnaire. All cervical specimens were tested for 27 HPV genotypes using the Roche polymerase chain reaction reverse line blot assay. The overall prevalence of HPV was 87 %. First sexual intercourse before 16 years of age was significantly associated with a positive HPV test (OR 4.41; 95 %CI: 1.20 - 19.33; p = 0.01). A significant association was also found between this risk factor and CIN 1 lesions or worse (OR 2.2; 95 %CI 0.94 - 5.08; p = 0.03). The age at which a woman begins to be sexually active is associated with HPV infection and with a diagnosis of cervical neoplasia.Behavioral risks such as age at first sexual intercourse, number of sexual partners and partner's sexual behavior are associated with an increased risk of HPV infection, persistence of the infection and the development of neoplastic precursor lesions. The objective of this study was to evaluate the risk factors associated with HPV positivity and with a diagnosis of cervical neoplasia in women referred with an abnormal cervical smear. This study evaluated a series of 198 women referred with an abnormal cervical smear. Risk factors for HPV infection were investigated using a questionnaire. All cervical specimens were tested for 27 HPV genotypes using the Roche polymerase chain reaction reverse line blot assay. The overall prevalence of HPV was 87 %. First sexual intercourse before 16 years of age was significantly associated with a positive HPV test (OR 4.41; 95 %CI: 1.20 - 19.33; p = 0.01). A significant association was also found between this risk factor and CIN 1 lesions or worse (OR 2.2; 95 %CI 0.94 - 5.08; p = 0.03). The age at which a woman begins to be sexually active is associated with HPV infection and with a diagnosis of cervical neoplasia1016CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOCNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOsem informaçã

Bacterial vaginosis, cervical Human Papillomavirus infection and cervical cytological abnormalities in adult women in Central Brazil: A cross-sectional study

Introduction: Bacterial vaginosis is the most common cause of vaginal discharge and occurs when there is an imbalance in the vaginal microbiota, predominantly composed of Lactobacillus spp. Human Papillomavirus is the most common sexually transmitted virus in the world. Persistent infection with high-risk Human Papillomavirus genotypes is the main cause of the development of cervical intraepithelial neoplasia and cervical cancer. Objective: To investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection and between bacterial vaginosis and cervical cytological abnormalities in adult women. Methods: Cross-sectional study carried out in a gynecology outpatient clinic of the public health network. A total of 202 women were included in the study and underwent gynecological examination with cervical specimen collection. Cervical cytopathological examinations and bacterioscopy by the Nugent method were performed to identify bacterial vaginosis, and PCR and reverse hybridization were carried out for Human Papillomavirus detection and genotyping. Bivariate analysis was performed to investigate the association between bacterial vaginosis and cervical Human Papillomavirus infection, and between bacterial vaginosis and cervical cytological abnormalities. The odds ratio was calculated, with the respective 95% confidence intervals (95%CI) and 5% significance level (p≤0.05). Results: The prevalence of bacterial vaginosis was 33.2% (67/202), the prevalence of cervical Human Papillomavirus infection was 38.6% (78/202) and the prevalence of cervical cytological abnormalities was 6.0% (12/202). Bivariate analysis showed no significant association between bacterial vaginosis and cervical Human Papillomavirus infection (OR 0.69; 95% CI 0.37–1.27; p=0.23), or between bacterial vaginosis and cervical cytological abnormalities (OR 0.65; 95%CI 0.17–2.50; p=0.54). Conclusion: In this study, bacterial vaginosis did not represent a risk factor for cervical Human Papillomavirus infection or for the presence of cervical cytological abnormalities in the investigated adult women

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

<p>Abstract</p> <p>Background</p> <p>Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.</p> <p>Methods</p> <p>This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.</p> <p>Discussion</p> <p>The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.</p> <p>Trial Registration</p> <p>Clinical Trials <a href="http://www.clinicaltrials.gov/ct2/show/NCT00970931">NCT00970931</a>.</p

Diagnóstico, tratamento e notificação da sífilis durante a gestação em Goiás, de 2007 a 2017

OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments’ percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms’ data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.OBJETIVO Analisar a evolução das notificações da sífilis durante a gestação em relação à classificação clínica, ao diagnóstico e ao tratamento no estado de Goiás, entre 2007 e 2017. MÉTODOS Estudo de série temporal com análise de dados fornecidos pela Secretaria Estadual de Saúde de Goiás. Foram analisadas as variáveis relacionadas ao diagnóstico e tratamento das gestantes e seus parceiros, e sua tendência evolutiva ao longo dos anos. Utilizou-se estatística descritiva, cálculo de porcentagens e verificação das tendências de aumento e diminuição por meio do teste de Cochran-Armitage com nível de significância α = 0,05. RESULTADOS Ao todo, 7.774 casos foram notificados no período. A maior porcentagem das notificações ocorreu no segundo trimestre de gestação (39,8%) e correspondeu à sífilis primária (34,1%). O tratamento prescrito com maior frequência foi a penicilina benzatina em dose de 7,2 milhões (43,8%). Entre 2007 e 2017, observou-se tendência crescente nas porcentagens de notificações de sífilis latente (14,1% para 30,7%), secundária (5,2% para 19%) e terciária (4,4% para 11,4%), assim como no tratamento com penicilina benzatina em dose de 7,2 milhões (19,3% para 59,6%). Tendência decrescente foi observada nas porcentagens de notificação de sífilis primária (43,4% para 22,1%) e nos demais esquemas de tratamento. CONCLUSÕES Houve aumento no número de notificações de sífilis latente em gestantes e no tratamento com penicilina na dose de 7.200.000 UI. Também foi observado aumento na completitude dos dados da ficha de notificação nas variáveis de classificação clínica e tratamento, sugerindo melhora no processo de notificação

Conhecimentos dos estudantes de medicina a respeito da triagem citológica do câncer de colo uterino

Introdução. O câncer do colo uterino, apesar de importante problema de saúde pública, é passível de prevenção. O Ministério da Saúde faz recomendações para o rastreamento citológico, publicadas em 2011 e atualizadas em 2016. Objetivo. Avaliar o conhecimento dos estudantes de medicina sobre a epidemiologia e rastreamento do câncer do colo uterino. Métodos. Estudo de corte transversal, realizado de setembro de 2017 a junho de 2018, envolvendo alunos do curso de medicina da Pontifícia Universidade Católica de Goiás (PUC-GO). Os dados foram obtidos por meio de questionário, contendo 21 questões, com duas alternativas cada, respondido sem consulta. O conhecimento dos alunos foi categorizado em nível 1 quando menos de 50% das respostas corretas, nível 2 com 51% a 70% corretas e nível 3, com 71% a 100% corretas. Analisou-se a diferença entre os níveis de conhecimento considerando, categoria 1 alunos do quinto ano do curso e categoria 2 do sexto ano. Aplicou-se o teste qui-quadrado (X2) para análise comparativa. As diferenças foram consideradas estatisticamente significativas com o valor de p menor que 0,05.  Resultados. A média de acertos acima de 70% foi significativamente maior para alunos do sexto ano (p&lt; 0,001). Das questões sobre a epidemiologia, rastreio de doenças e desempenho da triagem citológica, a frequência de acertos entre alunos do quinto e sexto ano não apresentou diferença significativa. Das dez questões sobre conhecimentos das Diretrizes Brasileiras para Rastreio do Câncer de Colo Uterino, houve diferença estatisticamente significativa nas questões número catorze, dezessete, dezenove e vinte, com valores de p 0,017; 0,017; 0,006; e menor que 0,001, respectivamente. O percentual de acertos para a maioria das questões foi menor que 70%. Conclusão. Alunos do sexto ano apresentaram nível de conhecimento significantemente maior comparado aos alunos do quinto ano, embora insuficiente para ambos. Palavras-chave: câncer de colo de útero. Exame colpocitológico. Estudantes de medicina.

A Portrait Of Single And Multiple Hpv Type Infections In Brazilian Women Of Different Age Strata With Squamous Or Glandular Cervical Lesions.

Cervical cancer ranks third in prevalence and fourth as cause of death in women worldwide. In Brazil, 17,540 women were diagnosed in 2012 with the disease. Persistent infection with high-risk HPV types is a necessary condition for the development of pre-invasive and invasive cervical neoplasia. Currently, over 100 HPV types have been identified, but HPV16 and 18 are recognized as the mayor culprits in cervical carcinogenesis. Our objective was to assess the relationships between single- (ST) and multiple-type (MT) HPV infections with patients' age and lesion pathological status. 328 patients with either squamous or glandular intraepithelial or invasive cervical lesion were selected. All subjects were tested for HPV genotypes with reverse hybridization for 21 high- (hr-HPV) and 16 low-risk (lr-HPV) probes. Prevalence of ST and MT HPV infections was compared across histological types and age strata. 287 (87%) women had at least one HPV type detected and 149 (52%) had MT infections. The most prevalent HPV type was HPV16, present in 142 cases (49% of all HPV-positive cases), followed by HPV58, 52, 31, 35 and 33. HPV18, in single or multiple infections, occurred in 23 cases (8% of hr-HPV cases). Almost all glandular lesions were associated with HPV16 and 18 alone. Multiple infections were significantly more prevalent in squamous than in glandular lesion for HPV16 and 18 (P = 0.04 and 0.03 respectively). The prevalence of MT infections followed a bimodal distribution; peaking in women younger 29 years and in those aged 50 to 59. Our data indicate that prevention strategies for pre-invasive and invasive squamous lesions should be focused on HPV16 and a few alpha-9 HPV types. It is clear to us that in young women, prophylaxis must cover a large amalgam of HPV types beyond classic HPV16 and 18