Manejo de la neoplasia ntraepitelial cervical

El 80 % de las mujeres sexualmente activas se infectan por HPV a lo largo de su vida, siendo más frecuente en etapas tempranas. La mayoría de las veces son asintomáticas y más del 90 % se eliminan por el sistema inmunitario del huésped en los primeros dos años; sin embargo, el 10 % persisten y eventualmente culminan en lesiones malignas. Más del 90 % de los cánceres de cuello uterino en el mundo están causados por HPV. El 55 % se asocian a HPV genotipo 16, el 15 % al HPV genotipo 18; seguidos por los genotipos 31, 33, 35, 45, 52 y 58 que engloban el 18 %. Para el manejo adecuado de las lesiones intraepiteliales (LIE) cervicales, es de suma importancia tener en claro la manera correcta y actualizada de cada método, las guías vigentes, y las utilidades de cada uno. El antiguo trípode diagnóstico clásico que consta de citología, colposcopía y biopsia está perdiendo vigencia, ya que a los métodos diagnósticos actualmente se incorporan las técnicas de inmunohistoquímica y biología molecular. El objetivo principal del tratamiento de las lesiones intraepiteliales del cuello uterino es evitar el cáncer, siendo las lesiones de alto grado las de principal relevancia clínica. El cáncer de cuello uterino continúa siendo una causa relevante de muerte en Argentina y Latinoamérica, siendo de vital importancia que los ginecólogos manejen adecuadamente los algoritmos diagnósticos y terapéuticos de las lesiones intraepiteliales del cuello uterino, además de la adecuada implementación de programas nacionales de salud pública.Facultad de Ciencias Médica

nanoparticles production and inclusion in s aureus incubated with polyurethane an electron microscopy analysis

This study shows that submicron/nanoparticles found in bacterial cells (S. aureus) incubated with polyurethane (a material commonly used for prostheses in odontostomatology) are a consequence of biodestruction. The presence of polyurethane nanoparticles into bacterial vesicles suggests that the internalization process occurs through endocytosis. TEM and FIB/SEM are a suitable set of correlated instruments and techniques for this multi facet investigation: polyurethane particles influence the properties of S. aureus from the morpho-functional standpoint that may have undesirable effects on the human body. S. aureus and C. albicans are symbiotic microorganisms; it was observed that C. albicans has a similar interaction with polyurethane and an increment of the biodestruction capacity is expected by its mutual work with S. aureus

Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus : results from the ESTAMPA multicentric screening study

Correspondence to: Dr Joan Valls, Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon 69366, France. [email protected]. Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. Methods. This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30–64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. Findings. Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7–49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9–93·2) for CIN3+, whereas specificity was 50·1% (48·5–51·8) for less than CIN2 and 47·1% (45·5–48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3–95·3] in those aged 30–49 years vs 77·6% [68·6–85·0] in those aged 50–65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8–47·6] vs 61·8% [58·7–64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). Interpretation. Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women.Consejo Nacional de Ciencia y TecnologíaPrograma Paraguayo para el Desarrollo de la Ciencia y Tecnología. Proyectos de investigación y desarrollo14-INV-036PINV18-25

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America : the ESTAMPA screening study protocol

Q1Q1Introduction Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. Methods and analysis Women aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number NCT01881659Revista Internacional - Indexad

Business environment and strategies of woodworking companies in Northwest Russia – results from a pilot study in Leningrad and Vologda regions

Political and economic development in Russia and other Eastern European countries have been the major driving force of the changing European markets for wood products since the early 1990s. However, very little is known about the organizational structure, strategic orientation and future goals of woodworking firms in Russia. Theoretically, an increasing body of literature emphasises the strategic choices of core competencies/capabilities based on resources, and the combination of these with firm-level strategies. This study examines the issue in the case of 18 small/medium-sized wood industry companies in the emerging markets of Northwest Russia using thematic structured interviews. The interviewed Russian woodworking firms emphasised closeness to the markets, good logistic connections and large market size as the main sources of competitive advantage. Therefore, other than raw material based issues appear to provide competitive advantage or disadvantage to the Northwest Russian woodworking companies. High taxation, corruption and lack of capital strongly characterized the problems in their business environment. In the future, these companies wanted to change from commodity products towards more specialised products and focus more on export markets in Europe than the domestic markets. If the results are more generalizable, competition on the European markets for wood products will intensify, extending also to the markets for higher value added wood products

Business environment and strategies of wood industry companies in Leningrad and Vologda regions results from a pilot study

Published jointly with Pellervo Economic Research InstituteThis pilot study examines resources and capabilities and their utilisation to support business and marketing strategies in the case of small/medium-sized wood industry companies in the Leningrad and Vologda regions. An increasing body of literature emphasises the strategic choices of core competencies/capabilities based on resources and the combination of these with marketing strategies. Both competencies and capabilities need to be aligned to the business environment where the company operates. The realisation of the potential that resources and capabilities provide as actual competitive advantages was studied based on managers perceptions on their companies market position. Furthermore, the competitive advantages at the market place were analysed against the competitive environment where the companies operate, and their decisions of the current and future geographical location. The data consists of personal interviews of managers in 12 wood industry case companies operating in Leningrad region and 6 companies in Vologda region. The interviews were conducted between May 2005 and January 2006.The interviewed managers of Russian woodworking companies emphasised closeness to the markets, good logistic connections and large market size as the main sources of their competitive advantage. Forest resources and availability of wood raw material or price of wood raw material were not considered as particularly significant sources of competitive advantage. The overall reliability, good image and reputation of the company and its qualified and skilled personnel were the most important factors in which the interviewed managers of case companies estimated to be in the best competitive position against their rivals. In profit margins, in market share, and in networking with other companies producing similar products, the respondents perceived to be in the weakest competitive position in comparison to their competitors. High taxation, corruption and lack of capital strongly characterised the problems present in their business environment. In the future, these case companies wanted to change from commodity products towards more specialised products, and focus more on export markets in Europe than the domestic markets. If the results are more generalisable, competition in the European markets for wood products will intensify, extending also to the markets for higher value added wood products

Nanoparticles Production and Inclusion in &lt;i&gt;S. aureus&lt;/i&gt; Incubated with Polyurethane: An Electron Microscopy Analysis

This study shows that submicron/nanoparticles found in bacterial cells (S. aureus) incubated with polyurethane (a material commonly used for prostheses in odontostomatology) are a consequence of biodestruction. The presence of polyurethane nanoparticles into bacterial vesicles suggests that the internalization process occurs through endocytosis. TEM and FIB/SEM are a suitable set of correlated instruments and techniques for this multi facet investigation: polyurethane particles influence the properties of S. aureus from the morpho-functional standpoint that may have undesirable effects on the human body. S. aureus and C. albicans are symbiotic microorganisms; it was observed that C. albicans has a similar interaction with polyurethane and an increment of the biodestruction capacity is expected by its mutual work with S. aureus