RESUMO
OBJECTIVE: To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. METHODS: A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. RESULTS: HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. CONCLUSION: Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
OBJETIVO: Avaliar a acurácia e aceitabilidade da auto-coleta utilizando um novo coletor - SelfCervix® - para a detecção de DNA de HPV. MéTODOS: Foram incluídas no estudo 73 mulheres com idade entre 2565 anos que realizaram seu rastreamento regular do câncer de colo do útero entre Março e Outubro de 2016. Estas mulheres realizaram a auto-coleta, seguida de coleta profissional e as amostras foram analisadas para a presença de DNA de HPV. Após, elas responderam um questionário sobre a experiência da auto-coleta. RESULTADOS: As taxas de detecção de DNA de HPV por auto-coleta foram altas e similares as da coleta profissional. Sessenta e quatro (87,7%) pacientes responderam o questionário de experiência. A maioria (89%) considerou a auto-coleta confortável, e 82,5% preferiram o método comparado a coleta profissional. As razões citadas foram economia de tempo e conveniência. Cinquenta e uma (79,7%) mulheres confirmaram que recomendariam a auto-coleta. CONCLUSãO: Auto-coleta utilizando o novo coletor desenvolvido no Brasil não é inferior na detecção de DNA de HPV quando comparada a coleta profissional, e apresenta uma boa aceitabilidade pelas mulheres. Desta maneira, pode ser uma opção para alcançar populações que não realizam o rastreamento padrão.
Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Brasil , Detecção Precoce de Câncer/métodos , Infecções por Papillomavirus/diagnóstico , Esfregaço Vaginal , Autocuidado , Papillomaviridae , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
Abstract Objective To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. Methods A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. Results HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. Conclusion Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
Resumo Objetivo Avaliar a acurácia e aceitabilidade da auto-coleta utilizando um novo coletor - SelfCervix® - para a detecção de DNA de HPV. Métodos Foram incluídas no estudo 73 mulheres com idade entre 25-65 anos que realizaram seu rastreamento regular do câncer de colo do útero entre Março e Outubro de 2016. Estas mulheres realizaram a auto-coleta, seguida de coleta profissional e as amostras foram analisadas paraa presença de DNA de HPV. Após, elas responderam um questionário sobre a experiência da auto-coleta. Resultados As taxas de detecção de DNA de HPV por auto-coleta foram altas e similares as da coleta profissional. Sessenta e quatro (87,7%) pacientes responderam o questionário de experiência. A maioria (89%) considerou a auto-coleta confortável, e 82,5% preferiram o método comparado a coleta profissional. As razões citadas foram economia de tempo e conveniência. Cinquenta e uma (79,7%) mulheres confirmaram que recomendariam a auto-coleta. Conclusão Auto-coleta utilizando o novo coletor desenvolvido no Brasil não é inferior na detecção de DNA de HPV quando comparada a coleta profissional, e apresenta uma boa aceitabilidade pelas mulheres. Desta maneira, pode ser uma opção para alcançar populações que não realizam o rastreamento padrão.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Displasia do Colo do Útero , Programas de Rastreamento , Detecção Precoce de Câncer , PapillomaviridaeRESUMO
INTRODUCTION: Solid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women. METHODS: Cross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck®) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies. RESULTS: 125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent women (29.6% vs. 20.2%, p = 0.112), but this difference was not statistically significant. High-risk (HR)-HPV was significantly more frequent in SOT than in immunocompetent women (19.4% vs. 7.9%, p = 0.014). Simultaneous infection with ≥2 HR-HPV types was found in 3.1% of SOT and 0.9% of immunocompetent women. HPV seropositivity for at least one HPV type was high in both groups: 63.8% of 105 SOT and 69.7% of 119 immunocompetent women (p = 0.524). Low-grade (LSIL) and high-grade SIL (HSIL) were significantly more frequent in SOT (9.7% and 5.3%, respectively) than in immunocompetent women (1.6% and 0.8%, respectively) (p = 0.001). CONCLUSIONS: These results may reflect the increased risk of HPV persistent infection and disease progression in SOT women due to chronic immunosuppression.
Assuntos
Alphapapillomavirus/isolamento & purificação , Colo do Útero/patologia , Infecções por Papillomavirus/epidemiologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adolescente , Adulto , Alphapapillomavirus/genética , Brasil , Colo do Útero/virologia , Estudos Transversais , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , Neoplasias do Colo do Útero/virologia , Adulto Jovem , Displasia do Colo do Útero/virologiaRESUMO
BACKGROUND: The development of efficient strategies for managing high-risk human papillomavirus (HR-HPV)-positive women is a major challenge when human papillomavirus-based primary screening is being performed. The objectives of this study were to evaluate the comparative effectiveness of HR-HPV testing based on self-collection (SC) and HR-HPV testing based on collection by a health professional (HP) and to assess the potential usefulness of HR-HPV testing combined with testing with the biomarkers p16/Ki-67, α-mannosidase, and superoxide dismutase 2 (SOD2). METHODS: This was a cross-sectional study of 232 women admitted for colposcopy because of an abnormal Papanicolaou smear. The collected material underwent liquid-based cytology, HR-HPV detection, and immunocytochemical testing (p16/Ki-67, α-mannosidase, and SOD2). The gold standard was the histopathological result; the positive reference was CIN2+. RESULTS: The overall accuracy of HR-HPV testing was 76.6%; the results for the SC group (78.1%) and the HP group (75.2%) were similar. The positive predictive values (HP, 76.5%; SC, 80.0%), the negative predictive values (HP, 66.7%; SC, 64.3%), the positive likelihood values (HP, 1.35; SC, 1.36), and the negative likelihood values (HP, 0.21; SC, 0.19) were also similar. p16/Ki-67 showed higher sensitivity than the other 2 biomarkers: 78.1% versus 45.8% for α-mannosidase and 44.5% for SOD2. The specificities of the biomarkers were equivalent: 71.4% for p16/Ki-67, 77.8% for α-mannosidase, and 71.2% for SOD2. In the HP group, accuracy also leaned more heavily toward the final score (using α-mannosidase and SOD2) without statistical significance (80.8% vs 77.9%). The contrast with the SC group yielded the same level of accuracy. CONCLUSIONS: SC, when associated with testing with biomarkers, is as accurate as collection by HPs in the detection of women at risk for cervical cancer.
Assuntos
Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Estudos Transversais , Inibidor p16 de Quinase Dependente de Ciclina , Feminino , Humanos , Antígeno Ki-67/análise , Masculino , Sensibilidade e Especificidade , Coloração e Rotulagem , Esfregaço Vaginal , alfa-ManosidaseRESUMO
This study characterized and related yeasts of the genus Candida isolated from vaginal mucous membranes of women with lesions caused by high-risk HPV for cervical cancer. Forty-two women treated at the Lower Genital Tract Pathology Clinic of the University of São Paulo Medical School Hospital of Clinics were examined, with 30 high-grade (G1) uterine lesions with a mean age of 36.5 years ± 11. 1 and 12 with low grade (G2) uterine lesions with a mean age of 34.7 years ± 15.5. Clinical conditions and laboratory data on HPV were collected from patients' medical records; the socio-demographic data obtained from an appropriate questionnaire. For the study of association between the variables, Odds Ratio analysis was used from the STATA 13.1 program. Patients G1 had a higher prevalence for diabetes and the results indicated 27% prevalence of Candida spp. in vaginal mucosa, in G2 this was 33% in vaginal mucosa. Among the species found in vaginal mucosa of patients, Candida albicans was the most isolated with 88%, followed by C. tropicalis (8%) and C. glabrata (4%). The strains of C. albicans isolated from mucosa presented sensitivity to all antifungal agents tested, unlike the C. tropicalis strain isolated in G2 in vaginal mucosa, which presented a resistance profile to fluconazole. Thus, monitoring and supervision through clinical and laboratory testing of HPV patients is important, reinforcing the need for care, treatment and prevention of HPV-related infections and Candida spp.
Assuntos
Humanos , Feminino , Papillomaviridae , Candida albicans , Neoplasias do Colo do Útero , Mucosa , AntifúngicosRESUMO
OBJECTIVE: To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS: There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION: The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.
Assuntos
Glândulas Vestibulares Maiores/cirurgia , Cistos/cirurgia , Eletrocirurgia/métodos , Adolescente , Adulto , Fatores Etários , Glândulas Vestibulares Maiores/patologia , Cistos/patologia , Eletrocirurgia/efeitos adversos , Feminino , Humanos , Complicações Intraoperatórias , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
SUMMARY OBJECTIVE To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. DESIGN Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.
RESUMO OBJETIVO Avaliar a eficácia da fulguração da eletrocirurgia como tratamento para os cistos da glândula de Bartholin. MÉTODOS Estudo retrospectivo, grupo controle comparativo realizado no Hospital Brigadeiro e disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de fevereiro de 2005 a março de 2009. Pacientes com cisto de glândula de Bartholin foram divididos em três grupos de tratamento: grupo 1 - eletrocirurgia (n = 169 casos); grupo 2 - excisão da glândula com técnica convencional utilizando bisturi frio (n = 51 casos); grupo 3 - marsupialização (n = 11 casos). Revisamos a história clínica e cirúrgica, o exame físico, a descrição da técnica cirúrgica, os resultados pós-operatórios (sucesso e complicações) e os dados de acompanhamento. RESULTADOS Não há diferença entre os grupos em relação ao sangramento intraoperatório, hematoma e cicatrização completa em uma única sessão de tratamento. No entanto, a eletrocirurgia mostrou o percentual mínimo de recidivas, 18 (10,7%), em relação à técnica de marsupialização (grupo 3, p = 0,031). Recorrências ocorreram em 18 (10,7%), três (5,9%) e quatro (36,4%) casos. Após o retratamento pela mesma técnica, houve taxa de cura completa: 90% (152/169) para o grupo 1 e 98% (50/51) para o grupo 2. O custo do grupo 1 foi menor do que os dos outros grupos. CONCLUSÃO A fulguração com eletrocirurgia da cápsula do cisto de Bartholin é um método efetivo de tratamento, mas o custo dessa técnica é menor do que a técnica de convenção e a marsupialização.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Glândulas Vestibulares Maiores/cirurgia , Cistos/cirurgia , Eletrocirurgia/métodos , Complicações Pós-Operatórias , Recidiva , Fatores de Tempo , Glândulas Vestibulares Maiores/patologia , Estudos Retrospectivos , Fatores Etários , Resultado do Tratamento , Estatísticas não Paramétricas , Cistos/patologia , Eletrocirurgia/efeitos adversos , Complicações Intraoperatórias , Pessoa de Meia-IdadeRESUMO
BACKGROUND: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. METHODS: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. RESULTS: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p = 0.206) and biological agent use (p = 0.238) were similar in both JIA groups. CONCLUSIONS: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.
Assuntos
Artrite Juvenil/epidemiologia , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por Papillomavirus/epidemiologia , Infecções do Sistema Genital/epidemiologia , Adaptação Biológica , Adolescente , Artrite Juvenil/tratamento farmacológico , Estudos de Casos e Controles , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis , Coito , Feminino , Gonorreia/diagnóstico , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Vacinas contra Papillomavirus/administração & dosagem , Infecções do Sistema Genital/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto JovemRESUMO
BACKGROUND: To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. METHODS: This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush®), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. RESULTS: The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. CONCLUSIONS: The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.
Assuntos
Fatores Etários , Detecção Precoce de Câncer/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado/psicologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/psicologia , Adulto , Estudos Transversais , Detecção Precoce de Câncer/métodos , Feminino , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Projetos Piloto , Autocuidado/métodos , Inquéritos e Questionários , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/métodos , Adulto JovemRESUMO
Cervical cancer continues to be a public health problem in developing countries. Previous studies have shown that cervical cancer cells display markers of aerobic glycolysis, indicating that these tumors are likely to secrete lactate. Mostly, lactate is recognized as a molecule capable of suppressing immune responses, through inhibition of T cells, MÏs, and dendritic cells. We and others have previously shown that MÏs are frequent cells infiltrating cervical cancers with the ability to inhibit antitumor immune responses and promote tumor growth through angiogenesis. Here, we have tested the hypothesis that lactate, secreted by cervical cancer cells, can modulate MÏ phenotype. First, we showed higher lactate plasma concentrations in patients with increasing cervical lesion grades, with maximum concentration in the plasma of cancer patients, which supported our hypothesis. We then inhibited lactate production in tumor cell spheroids established from cervical cancer derived cell lines, using the lactate dehydrogenase inhibitor, oxamate, prior to co-culture with monocytes. Lactate mediated part of the crosstalk between tumor cells and MÏs, promoting secretion of IL-1ß, IL-10, IL-6, and up-regulation of hypoxia induced factor-1α expression, and down-regulation of p65-NFκB phosphorylation in MÏs. We also showed that MÏs from co-cultures treated with oxamate were better inducers of T cell activation. Of note, experiments performed with inhibition of the monocarboxylate transporters rendered similar results. Our data confirms the hypothesis that lactate, secreted by cervical tumor cells, influences the phenotype of tumor MÏs, promoting a suppressive phenotype.