ABSTRACT
La vacuna contra el virus del papiloma humano (HPV) se presenta como una medida de prevención primaria del cáncer de cuello de útero (CCU), segunda causa de muerte de las mujeres a nivel mundial. Esta vacuna genera una dicotomía a nivel social que obliga a pensar si verdaderamente es necesario administrarla. En este artículo se desarrollan las posibles causas de esta contrariedad con la finalidad de colaborar en la toma de decisión informada sobre la administración de la misma. Se revisan las vacunas disponibles, las recomendaciones para su uso y las controversias en cuanto a eficacia, seguridad, número de dosis requeridas, eficiencia en la prevención y participación ciudadana. Las vacunas contra el HPV ofrecen un enfoque prometedor para la prevención del CCU y las afecciones asociadas a estos virus, pero no reemplazan a otras estrategias de prevención debido a que no protegen contra todos los tipos de virus de HPV.
The Human Papillomavirus (HPV) vaccine is presented as a primary preventive measure of cervical cancer (CC), the second cause of women deaths in the world. This vaccine generates such social dichotomy that makes us consider whether its administration is really necessary. The possible causes of this controversy are developed in this article, with the aim of helping to make an informed decision about its administration. Available vaccines are reviewed, as well as use recommendations and controversy regarding effectiveness, security, required doses, prevention efficiency and peoples participation. HPV vaccines offer a promising approach to prevent cervical cancer and conditions associated with these viruses, but they do not replace other prevention strategies since they do not protect against all HPV types.
A vacina contra o vírus do papiloma humano (HPV) é apresentada como uma medida de prevenção primária do câncer do colo do útero (CCU), a segunda principal causa de morte entre as mulheres em todo o mundo. Esta vacina gera tal dicotomia ao nível social que obriga a pensar se é realmente necessário administrá-la. Neste artigo discutem-se as possíveis causas desta controvérsia, a fim de ajudar na tomada de decisões informadas sobre a sua administração. Consideram-se as vacinas disponíveis, as recomendações para seu uso e a polêmica sobre a sua eficácia, segurança, número de doses necessárias, a eficiência na prevenção e a participação cidadã. As vacinas contra o HPV oferecem uma abordagem promissória para a prevenção do CCU e das doenças associadas a estes vírus, mas não substituem outras estratégias de prevenção, por não protegerem contra todos os tipos de vírus do HPV.
Subject(s)
Humans , Female , Uterine Cervical Neoplasms/prevention & control , Papillomavirus Vaccines/administration & dosage , Papillomavirus Vaccines , Papillomavirus Vaccines/adverse effects , Papillomavirus Vaccines/standards , Papillomavirus Vaccines/therapeutic useABSTRACT
Introducción: Algunos estudios atribuyen a la tiroiditis linfocitaria crónica (TLC) asociada al carcinoma papilar de tiroides (CPT) un efecto protector o de buen pronóstico; otros sugieren que sería un factor de riesgo para el desarrollo de recurrencias. Objetivo: Determinar la influencia de la TLC en el pronóstico de pacientes con CPT. Métodos: De un total de 406 CPT operados por un mismo cirujano (JLN), se seleccionaron 140 CPT que cumplieron los siguientes criterios de inclusión: pacientes operados con tiroidectomía total con criterio curativo y diagnóstico histológico de CPT variedad usual, sin tratamientos quirúrgicos previos y con seguimiento mínimo de 5 años. El diagnóstico de CPT y TLC lo realizó un mismo anatomopatólogo. Se definieron como factores de mal pronóstico, la edad ?45 años, el sexo masculino, los tumores grandes (>40 mm), los ganglios metastásicos al momento del diagnóstico de CPT, la multifocalidad tumoral y la invasión extratiroidea. Resultados: Se diagnosticaron histológicamente 51 (36.4%) CPT asociados con TLC y 89 (63.6%) sin TLC. Ninguno de los factores considerados mostró diferencias estadísticamente significativas entre los pacientes con y sin TLC (P=NS). Las tasas de recurrencia (3.6%) y muerte (2.1%) también fueron similares en ambos grupos (P=NS). Conclusión: La coexistencia de CPT y TLC es elevada y concordante con algunas publicaciones, pero la TLC no produjo ningún impacto sobre el pronóstico (recurrencia) de los pacientes. Aquellos que recurrieron y fallecieron presentaron 3 o más factores de mal pronóstico, sin que la TLC fuese un factor determinante del pronóstico.
Introduction: Some articles attribute a protect effect of chronic lymphocytic thyroiditis (CLT) on the prognostic outcome of patients with papillary thyroid carcinoma (PTC); others suggest it as a risk factor of PTC recurrences. Objective: To determine the influence of CLT on the prognostic outcome of patients with PTC. Methods: From 406 PTC patients surgically treated by a same surgeon (JLN), which received radioactive iodine ablative dosis, 140 PTC patients were selected that followed the following criteria: patients who underwent a total thyroidectomy for curative purpose, with histological diagnosis of pure PTC, without previous related surgeries, with a minimal 5-year follow-up. PTC and CLT histological diagnosis were performed by a same pathologist. Bad prognosis factors were defined: ?45 years old, male sex, big tumors (>40 mm), metastatic nodes at PTC diagnosis, multifocality and extrathyroideal extension. Results: 51 (36.4%) were found associated with CLT and 89 (63.6%) showed only pure PTC. No factors showed significantly statistical differences between patients with and without CLT (P=NS). Recurrence (3.6%) and death (2.1%) rates were similar in both groups, too (P=NS). Conclusion: Coexistence of CLT and PTC is high and it coincides with other experiences, but CLT did not cause any impact on the prognostic outcome (recurrence and/or death) of patients with PTC. Patients who had recurrence or died showed at least three risk factors, but CLT did not a bad prognosis factor.