Doença inflamatória do colo do útero: indicador indireto da saúde reprodutiva da mulher / Inflammatory disease of cervix uteri: indirect indicator of women's reproductive health / Cervicitis: indicador indirecto de la salud reproductiva de las mujeres

Objetivo: analisar as internações por doença inflamatória do colo do útero e os fatores que influenciam a sua ocorrência. Método: estudo seccional, prospectivo, baseado em um inquérito de morbidade hospitalar realizado em 2013, com amostra de 429 mulheres internadas em hospitais no município de Guarapuava. Os dados foram analisados por meio de análise bivariada e regressão logística. O projeto foi aprovado por Comitê de Ética em Pesquisa. Resultados: do total de mulheres internadas, 45 (10,4%) foram por doença inflamatória do colo do útero. Pertencer ao público alvo, ter realizado o exame no mínimo uma vez, procurar o serviço regularmente para o controle de saúde e apresentar o resultado dentro dos limites de normalidade em 1 ano atuaram como fatores de proteção contra a ocorrência dessas internações. Conclusão: o conhecimento dos fatores que se relacionam ao desfecho fornece subsídios para a readequação dos serviços que prestam assistência às mulheres, a fim de prevenir as internações.

Objective: to examine hospital admissions for inflammatory disease of the cervix uteri and the related factors. Method: this prospective, cross-sectional study based on a hospital morbidity survey was conducted in 2013 with a sample of 429 women admitted to hospitals in the city of Guarapuava. Data were analyzed by bivariate analysis and logistic regression. The project was approved by the institution's research ethics committee. Results: 45 (10.4%) of the women were hospitalized for inflammatory disease of the cervix uteri. Protective factors against the occurrence of such hospitalizations included belonging to the target public, having performed the examination at least once, attending the service regularly for a health check and returning a result within normal limits in the prior year. Conclusion: knowledge of the factors relating to the outcome provides input for adjusting women's care services in order to prevent hospitalizations.

Objetivo: analizar las internaciones por cervicitis y los factores que influencian su ocurrencia. Método: estudio seccional, prospectivo basado en una encuesta de morbilidad hospitalaria realizada en 2013, con muestra de 429 mujeres internadas en hospitales en el municipio de Guarapuava. Los datos se analizaron por medio de análisis bivariado y regresión logística. El estudio fue aprobado por Comité de Ética en Investigación. Resultados: del total de mujeres internadas, 45 (10,4%) lo fueron por cervicitis. Pertenecer al público objetivo, haber realizado el examen al menos una vez, buscar el servicio regularmente para el control de salud y presentar el resultado dentro de los límites de la normalidad en 01 año actuaron como factores de protección respecto a la ocurrencia de estas hospitalizaciones. Conclusión: el conocimiento de los factores que se relacionan al desenlace propo

Granulomatosis con poliangeítis de presentación atípica: revisión de la literatura a propósito de un caso de localización ginecológica / Cervicovaginal granuloma as the first manifestation of granulomatosis with polyangiitis

La granulomatosis con poliangeitis (GPA) es una vasculitis sistémica, granulomatosa, con compromiso de pequeños vasos y presencia de anticuerpos c-ANCA. Ocasionalmente es localizada y es rara su manifestación genitourinaria. Se presenta el caso de una mujer de 68 años con sangrado genital causado por una lesión cervicovaginal verrucosa ulcerada, cuya histopatología descartó malignidad, hongos y TBC, con mala respuesta a antibióticos, ácido tricloro acético y crioterapia. Por recidiva al año se practica histerectomía total y colpectomía parcial, pero reincide al mes acompañada de epistaxis, cuyo estudio pornasofibroscopía e imágenes concluye en una lesión de tipo granulomatosa, agregándose anticuerpo anti PR-3 positivo. Se diagnostica GPA y se trata con ciclofosfamida con buena respuesta. La revisión de la literatura permite concluir que la GPA con localización cervicovaginal es muy poco frecuente, especialmente como manifestación inicial, y se debe considerar en el diagnóstico diferencial con cáncer y otras lesiones granulomatosas localizadas.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis, granulomatous, with commitment of small vessels and the presence of c-ANCA antibodies. Occasionally it is located and its genitourinary manifestation is rare. Presented the case of a 68 year old woman with genital bleeding caused by a lesion cervicovaginal ulcerated verrucosa, whose histopathology ruled out fungal, malignancy and TBC, with poor response to antibiotics, acid trichloro acetic and cryotherapy. By relapse a year is practiced total hysterectomy and partial colpectomia, but repeated a month accompanied by epistaxis, whose study by nasofibroscopia and images concludes in a type granulomatous lesion, adding antibody anti PR-3 positive. GPA is diagnosed and treated with cyclophosphamide with good response. Review of the literature leads to th conclusion that the GPA with cervico-vaginal location is very rare, especially as an initial manifestation, and should be considered in the diagnosis diferenttial with cancer and other localized granulomatous lesions.

Comparison of conventional Papanicolaou cytology samples with liquid-based cervical cytology samples from women in Pernambuco, Brazil

In the present study, we compared the performance of a ThinPrep cytological method with the conventional Papanicolaou test for diagnosis of cytopathological changes, with regard to unsatisfactory results achieved at the Central Public Health Laboratory of the State of Pernambuco. A population-based, cross-sectional study was performed with women aged 18 to 65 years, who spontaneously sought gynecological services in Public Health Units in the State of Pernambuco, Northeast Brazil, between April and November 2011. All patients in the study were given a standardized questionnaire on sociodemographics, sexual characteristics, reproductive practices, and habits. A total of 525 patients were assessed by the two methods (11.05% were under the age of 25 years, 30.86% were single, 4.4% had had more than 5 sexual partners, 44% were not using contraception, 38.85% were users of alcohol, 24.38% were smokers, 3.24% had consumed drugs previously, 42.01% had gynecological complaints, and 12.19% had an early history of sexually transmitted diseases). The two methods showed poor correlation (k=0.19; 95%CI=0.11–0.26; P<0.001). The ThinPrep method reduced the rate of unsatisfactory results from 4.38% to 1.71% (χ2=5.28; P=0.02), and the number of cytopathological changes diagnosed increased from 2.47% to 3.04%. This study confirmed that adopting the ThinPrep method for diagnosis of cervical cytological samples was an improvement over the conventional method. Furthermore, this method may reduce possible losses from cytological resampling and reduce obstacles to patient follow-up, improving the quality of the public health system in the State of Pernambuco, Northeast Brazil.

Insights into the role of cervical mucus and vaginal pH in unexplained infertility / Sobre o papel do muco cervical e do PH vaginal na gênese da infertilidade inexplicada

Unexplained infertility diagnosis is made in the presence of a normal semen analysis when tubal patency and normal ovulatory function are established. Among several potential causes, unexplained infertility could be attributed to vaginal pH and cervical mucus abnormalities. Although the vaginal canal and the cervix generally function as effective barriers to sperm, and although the production of mucus is essential to transport them from the vagina to the uterine cavity, these factors receive little attention in the investigation of couples with unexplained infertility. A substantial reduction in sperm number occurs as they transverse the cervix. From an average of 200 to 300 million sperm deposited in the vagina, only a few hundred achieve proximity to the oocyte. Given this expected high spermatozoa loss, a slight modification in cervical mucus may rapidly transform the cervix into a "hostile" environment, which, together with changes in vaginal environment and cervix structure, may prevent natural conception and be a cause of infertility. In this review, we discuss the physiological role of the vaginal pH and cervical mucus in fertility, and describe several conditions that can render the cervical mucus hostile to sperm and therefore be implicated in the pathophysiology of unexplained infertility.

RESUMO O diagnóstico de infertilidade inexplicada baseia-se na presença de espermograma normal, constatadas também permeabilidade tubária e função ovulatória normais. Entre as várias causas potenciais de infertilidade inexplicada, a presença de muco cervical e pH vaginal anormais devem ser consideradas. Embora a produção adequada de muco cervical seja essencial para o transporte dos espermatozóides da vagina para a cavidade uterina, e tanto o canal vaginal quanto o colo do útero desempenham função importante como barreira à passagem dos espermatozóides, estes fatores recebem pouca atenção na investigação de casais com infertilidade inexplicada. Uma redução substancial do número de espermatozoides ocorre à medida que estes percorrem o trato reprodutivo feminino. Partindo de cerca de 200 a 300 milhões de espermatozoides depositados na vagina, apenas algumas centenas alcançam a proximidade do oócito. Alteracões do muco cervical podem rapidamente transformar o colo do útero num ambiente hostil, que em conjunto com alterações no ambiente vaginal e da estrutura de colo do útero, podem apresentar-se condicões impedientes para a concepção natural; desse modo, convertem-se em causa de infertilidade. Nesta revisão, discutimos o papel fisiológico do pH vaginal e do muco cervical na fertilidade, descrever várias condicões que podem tornar o muco cervical hostil aos espermatozoides e, por fim analisamos como estes fatores interferem na fisiopatologia da infertilidade inexplicada.

Normalización de un método inmunoquímico para detectar Papilomavirus humano tipo 16 en lesiones cérvico-uterinas / Standardization of immunochemical method for detection of type 16 human papilomavirus in cervix uterine lesions

Introducción: la infección por Papilomavirus Humano (PVH) es la condición necesaria para la aparición y desarrollo del cáncer cérvico-uterino. Los genotipos de alto riesgo oncogénico son los causantes de este tipo de neoplasia y dentro de ellos el más frecuente es el PVH 16, que se encuentra aproximadamente en el 60 % de los casos. Los métodos de diagnóstico comerciales resultan costosos para países con escasos recursos económicos, lo que sugiere la búsqueda de alternativas empleando protocolos sencillos y baratos. Objetivos: normalizar un método inmunoquímico para la detección del antígeno L1 de PVH tipo 16 en muestras cérvico-uterinas de pacientes con lesiones intraepiteliales escamosas y determinar la coincidencia entre el método normalizado y la Reacción en Cadena de la Polimerasa en Tiempo Real (RCP-TR), como técnica de referencia, para estimar la utilidad de dicho método en el diagnóstico de la infección por este genotipo viral. Métodos: se compararon tres procedimientos de inmunotinción (Indirecto de inmunoperoxidasa en dos pasos, Estreptavidina-Biotina y Amplificación por polímero) respecto a sensibilidad analítica, tinción inespecífica de fondo y tiempo de terminación, para la detección de la proteína L1 de PVH 16 en líneas celulares derivadas de carcinomas cervicales humanos y en muestras cérvico-uterinas utilizadas como controles. El protocolo normalizado se aplicó a muestras cérvico-uterinas de mujeres entre 30 y 59 años, 82 con lesiones intraepiteliales cervicales y 10 sin antecedentes de alteraciones citológicas, a las que además se les determinó PVH 16 mediante RCP-TR. Resultados: el procedimiento de Estreptavidina-Biotina resultó el más sensible y específico. La coincidencia entre el método inmunoquímico y la RCP-TR fue de un 98,6 por ciento, la sensibilidad fue de un 98,57 por ciento y la especificidad de un 91,67 por ciento, con valores predictivos negativo y positivo por encima del 90 por ciento. Conclusiones: se demostró la validez del método inmunoquímico como prueba confirmatoria de la infección por PVH 16. Dicho método probó ser sensible, sencillo y no requiere de una compleja infraestructura para detectar PVH 16 en muestras cervicales. Además, esta técnica permite obtener información rápidamente y evita el uso de métodos invasivos(AU)

Introduction: Human Papillomavirus (HPV) infection is the necessary condition for the occurernce and development of cervical cancer. The high oncogenic risk genotypes are the responsible for this type of neoplasia and the most frequent is HPV 16 that affects roughly 60 percent of cases. Commercial kits for HPV detection are expensive for resource-poor countries, which suggests the search for alternative throguh non-expensive simple protocoles. Objectives: to standardize an immunochemical method for the detection of HPV 16 L1 antigen in cervical samples of patients with squamous intraepithelial lesions and to determine the diagnostic coincidence between the immunochemical method and the real-time polymerase chain reaction to estimate the usefulness of this method for the detection of cervical infection with this viral genotype. Methods: three immunostaining methods (Two-Step Indirect Immunoperoxidase, Labelled Streptavidin-Biotin and Enhanced Polymer) were compared in terms of analytical sensitivity, nonspecific background staining and time of completion, for the detection of protein L1 of HPV-16 in a cell line derived from human cervical carcinoma and clinical samples from uterine cervix. The optimized protocol was applied to 82 cervical samples from women aged 30-59 years with squamous intraepithelial lesions and to 10 samples of sexually active women without previous signals of positive cytology. The presence of type 16 HPV was also detected with the aid of RT-PCR. Results: the Streptavidin-Biotin system was the most sensitive and specific. The diagnostic agreement between the immunochemical method and the real-time polymerase chain reaction reached 98.6 percent, sensitivity was 98.57 percent and specificity was 91.67 %, with positive and negative predictive values above 90 percent. Conclusions: the validity of the immunochemical method as a confirmatory test for infection by HPV-16 has been demonstrated. The normalized immunochemical method proved to be a sensitive, simple, relatively fast method to detect HPV from clinical samples of cervical cells. Furthermore, this method provides information quickly, avoiding the use of invasive methods in patients(AU)

Esquistossomose endocervical: relato de caso / Endocervical schistosomiasis: case report

A esquistossomose mansoni, endemia encontrada em diferentes áreas do território brasileiro, constitui um grave problema de saúde pública no Brasil e no mundo. Formas ectópicas da doença podem acometer o sistema reprodutor feminino, constituindo um tipo raro de infecção pelo S. mansoni. Paciente com 26 anos queixava-se de corrimento vaginal, dispareunia e dor à palpação do hipogástrio. No exame ginecológico foi observado pólipo endocervical, que foi biopsiado. O exame histológico evidenciou vários granulomas envolvendo ovos degenerados e viáveis de Schistosoma mansoni. Tratada com praziquantel, retornou assintomática após quatro semanas do tratamento. Corrimento vaginal e dispareunia podem ser causas secundárias de cervicite por Schistosoma mansoni. Pesquisa de ovos em esfregaço vaginal de rotina ou exame histológico devem fazer parte da avaliação ginecológica de pacientes de área endêmica, com o objetivo de rastrear forma ectópica da esquistossomose do trato genital feminino.

Schistosomiasis mansoni is found in different endemic areas of Brazil. It is a serious public health problem in Brazil and worldwide. Ectopic forms of the disease may affect the female reproductive system, representing a rare type of Schistosoma mansoni infection. A 26-year-old patient complained of vaginal discharge, dyspareunia and pain on palpation of the hypogastrium. Gynecological examination revealed an endocervical polyp. A biopsy was performed. Under microscopy, several granulomas surrounding degenerate and viable eggs of Schistosoma mansoni were seen. Treated with praziquantel, she was asymptomatic after four weeks of treatment. Vaginal discharge and dyspareunia may be secondary causes of cervicitis caused by Schistosoma mansoni. The search for eggs in routine vaginal smear or histological examination should be part of the gynecologic evaluation of patients from endemic areas, with the purpose of tracking ectopic schistosomiasis of the female genital tract.

The importance of immediate verification of a cervical cytological abnormality with histology.

Background: A serious proportion of the patients with invasive cervical cancer can be women who have had abnormal smear findings known for at least 6 months. Aims: The aims of the study were to evaluate the cervical cytohistopathologic correlation in the population studied, and to discuss the acceptability of immediate histological verification for minor Papanicolaou smear abnormalities. Materials and Methods: A total of 443 patients who were admitted with abnormal smear results and had undergone immediate colposcopy, cervical biopsy and endocervical curretage in the gynecologic oncology clinic between the years of 2003-2009 were enrolled into the present retrospective study. One-way analysis of variance and independent t-tests were used to study the results. Results: The distribution of abnormal smear results were documented as 46.27%, 29.57%, 13.76%, 7.67%, 1.58%, 0.67%, and 0.45% for atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), squamous cell carcinoma (SCC), atypical glandular cell (AGC), and adenocarcinoma, respectively. The percentages of cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) and greater lesions were 70.49%, 35.29%, 15.26%, and 9.75% for HSIL, ASC-H, LSIL, and ASC-US, respectively. Moreover, 38.36% of all the CIN 2-3 or cancer (n = 104) cases originated from those with low grade referral diagnosis (ASC-US and LSIL). Conclusions: The majority of cases in the study were predominantly ASC-US and LSIL and approximately 40% of all the high grade lesions came from those with low grade referral diagnosis. This shows poor cytohistopathological correlation and calls the triage of minor cytological abnormalities into question.

Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section / Achados histeroscópicos em pacientes com sangramento pós-menstrual tipo escape com cesárea anterior

Objective: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.

Objetivo: Identificar os achados histeroscópicos uterino em grupo de pacientes com operação cesariana anterior e sangramento pós-menstrual tipo escape. Métodos: Foi realizado um estudo descritivo e prospectivo, com mulheres que compareceram em consultório em Ji-Paraná (RO), entre junho de 2008 e dezembro de 2009, com queixa de sangramento genital prolongado tipo escape após período menstrual. Destas, foram selecionadas 20 mulheres que apresentavam, simultaneamente, as seguintes características: ao menos uma cesárea prévia; idade entre 18 e 45 anos; sem uso de método anticoncepcional hormonal; e ausência de qualquer outra cirurgia uterina capaz de alterar a anatomia da cavidade. As pacientes selecionadas foram submetidas a exame histeroscópico. Resultados: À histeroscopia, em 90% das pacientes, observou-se, no terço final do colo, a presença da cicatriz de cesárea. Essa cicatriz causa, no interior da cavidade uterina, uma anomalia em sua anatomia, caracterizada pela visualização, na parede anterior, de uma dilatação seguida de retração, que proporciona a presença de pseudocavidade com profundidade e oclusão da luz em graus variáveis. Já em duas pacientes, não foi detectada a pseudocavidade. Conclusão: A pseudocavidade na cicatriz da cesariana é o achado mais freqüente à observação histeroscópica em pacientes com cesárea prévia e sangramento uterino anormal pós-menstrual tipo escape.

Uso de la electrocirugía en gestantes portadoras de patología premaligna del cérvix uterino, 1998-2008: Hospital Docente Ginecoobstétrico de Guanabacoa / Use of electrosurgery in pregnant women with uterine cervical premalignant disease, 1998-2008: teaching Hospital of Guanabacoa Ginecoobstétrico

Objetivo: Determinar la eficacia de la electrocirugía como medio diagnóstico y de tratamiento en las lesiones premalignas de alto grado (LIE-AG) de las gestantes que acudieron a la consulta de patología de cuello del Hospital docente Ginecoobstétrico de Guanabacoa en el período de enero 1998 a diciembre 2008...

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Cervical stenosis following electrosurgical conization / Estenose cervical após conização eletrocirúrgica

CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING: Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS:This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confidence intervals (95 percent). Levels of 5 percent were considered significant. RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66 percent and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS: We did not find associations between the variables for stenosis. However, we observed borderline significance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

CONTEXTO E OBJETIVO: A estenose cervical é uma complicação pós-operatória dos procedimentos para tratamento das lesões pré-invasivas do colo uterino e assume importância particular tanto pelas repercussões clínicas associadas como pela limitação causada nos acompanhamentos citológico e colposcópico. O objetivo foi verificar a incidência da estenose cervical em uma coorte de pacientes submetidas a conização eletrocirúrgica do colo uterino e apontar possíveis fatores prognósticos associados. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, observacional realizado no Instituto Fernandes Figueira, Departamento de Ginecologia, Rio de Janeiro, Brasil. MÉTODOS: Estudo observacional em uma coorte de pacientes submetidas à conização eletrocirúrgica do colo uterino. As variáveis possivelmente preditoras foram analisadas de forma bivariada entre os grupos com e sem estenose. Calculou-se também a razão de taxas de incidência-densidade da estenose cervical para cada variável possivelmente preditora e os respectivos intervalos de confiança (95 por cento). O nível de significância considerado foi de 5 por cento. RESULTADOS: Foram incluídas 274 pacientes submetidas a conização eletrocirúrgica do colo uterino com um tempo mínimo de seis meses de acompanhamento após o procedimento. A incidência bruta de estenose cervical foi de 7,66 por cento e a incidência-densidade foi de 3,3/1000 pacientes-mês. Não houve diferença estatisticamente significativa entre as características clínico-demográficas dos grupos. CONCLUSÃO: Não se encontrou associação entre as variáveis e a estenose, porém observou-se um nível de significância limítrofe em relação às complicações hemorrágicas do peri e pós-operatório (p = 0,089).

Gérmenes patógenos más frecuentes encontrados en tracto genital de embarazadas en trabajo de parto, entre 35 y 40 semanas de gestación y sus complicaciones materno fetales atendidas en el Hospital Fernando Vélez Paiz: noviembre- diciembre 2007 / Pathogen most frequently found in genital tract of pregnant women in labor, between 35 and 40 weeks of pregnancy and its complications maternal fetal served at the Hospital Fernando Velez Paiz: November-December 2007

El presente estudio realizado, es descriptivo corte transversal, en el periodo de noviembre a diciembre del 2007, con un universo de 601, tomando una muestra por conveniencia de 106 personas que cumplia con los criterios de inclusión y exclusión, que acudieron en trabajo de parto al hospital Fernando Vélez Paíz. Se utilizo el programa estadístico para ciencias sociales (SPSS) 12.0 de Windows para el cálculo de frecuencias simples de las variables cuantitativas, tales como; promedio, desviación estándar. La asociación entre las variables cualitativas se determino a través de pruebas de significancia estadísticas de Chi cuadrado con su estimador Odds Ratio (OR), valor de p, con un intervalo de confianza del 95 por ciento. Se realizó un análisis multivariado de regresión logística para determinar el valor real de los factores y controlar los probables factores de confusión asociados al proceso de infección...

The environmental cofactors in carcinogenesis in high risk HPV/HIV-positive women

The objective of the present study was to assess the presence of human papilloma virus (HPV) in HIV-infected women, with comparison between the Papanicolaou cytologic technique and the molecular PCR technique, as well as to determine the type of HPV, to measure cellular immunocompetence and to identify the presence of risk factors for the acquisition of HPV infection. Thirty HIV-infected women were selected. Vaginal and endocervical samples were collected from 27 of them. The smears were examined by 3 experienced cytologists to diagnose the presence of HPV by the Papanicolaou technique and the results were compared to HPV detection and typing by PCR. HPV-infected patients were interviewed in order to identify the presence of risk factors for the acquisition of the virus. Eight of the 27 patients analyzed (29 percent) presented HPV in endocervical samples submitted to PCR, 6 of them (75 percent) presented HPV involving a high risk of development of cervical cancer. For 5 of these patients, the cytologic diagnosis was not confirmed by PCR. When cellular immunocompetence was related to HPV infection, PCR revealed a diagnosis of HPV in 37.50 percent of the patients at intermediate risk for HPV infection and in 83.33 percent of the patients at high risk for HPV infection. These immunologically compromised HPV-infected patients are at higher risk of developing cervical neoplasia. We showed here that PCR is adequate for HPV detection and that, if only the Papanicolaou method is used for the follow-up of these patients, we will not provide good prevention of cervical cancer.

Analysis of molecular biology techniques for the diagnosis of human papillomavirus infection and cervical cancer prevention

The objective of the present study was to evaluate the usefulness of molecular methodologies to access human papillomavirus genome in the genital tract. Samples from 136 women aged 17 to 52 years old obtained from the Dr. Sérgio Franco Laboratories between 2000 and 2001, were analyzed by the hybrid capture assay and amplified by PCR with generic primers MY09/MY11 and specific primers for types 16, 18, 31, 33, 35, 58. Viral genome was detected in 71.3 percent of the samples by hybrid capture and 75 percent by amplification. When cytopathology was used as a reference method for screening lesions, hybrid capture (p=0) and amplification (p=0.002) presented positive association. The 3 methods showed absolute agreement when cytopathology confirmed papillomavirus infection and high grade intraepithelial lesion. Disagreements occurred for 10 cases: seven inflammatory cases positive by PCR and negative for hybrid capture and 3 low squamous intraepithelial lesions positive for hybrid capture but negative for amplification. In conclusion, hybrid capture was shown to be sensitive and specific enough for use in clinical routines. Moreover, the evaluation of viral load values obtained by this method were shown to be related to the severity of the lesion and merit further studies to analyze the possible association with risk of progression to malignancy.

O objetivo do nosso trabalho foi avaliar o emprego de métodos moleculares para comprovar a presença dos papilomavírus humanos no trato genital. Amostras de 136 pacientes com idades entre 17 e 52 anos, coletadas nos Laboratórios Dr. Sérgio Franco entre 2000 e 2001, foram analisadas pelas técnicas de captura híbrida e amplificação pela reação em cadeia da polimerase com primers genéricos MY09/MY11 e específicos para os tipos 16, 18, 31, 33, 35, 58. O genoma viral foi detectado em 71,3 por cento dessas amostras pela captura híbrida e 75 por cento pela reação em cadeia da polimerase. Quando a citopatologia foi usada como método de referência para rastreamento das lesões, a captura (p=0) e a amplificação (p=0,002) demonstraram associação positiva. Os três testes demonstraram concordância absoluta quando a citopatologia diagnosticou processo compatível com papilomavírus ou lesão intraepitelial de alto grau. Dez casos discordantes ocorreram: sete casos de citologia inflamatório positivos na reação em cadeia da polimerase mas negativos na captura híbrida e 3 casos de lesão de baixo grau positivas na captura híbrida e negativas pela reação em cadeia da polimerase. Concluímos que a captura híbrida apresentou sensibilidade e especificidade adequadas para uso clínico. Avaliação da carga viral obtida por esta metodologia relacionou-se com a severidade da lesão e merece estudos adicionais a fim de determinar seu valor prognóstico para o câncer.

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil / Papilomavírus humano e anormalidades cervicais em mulheres do sistema de saúde privado e público no Estado do Rio de Janeiro, Brasil

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4 percent presented HPV and nearly 90 percent of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3 percent. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3 percent), and invasive cervical carcinoma (16.3 percent). HPV infection was found in 93.1 percent and 94.4 percent of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions...

Este artigo analisa a infecção por HPV e anormalidades citológicas cervicais encontradas em pacientes atendidas em serviços ginecológicos dos sistemas de saúde público e privado do estado do Rio de Janeiro. O trabalho também avalia os testes utilizados para detecção de DNA do HPV em cada população estudada. Um grupo de 454 mulheres oriundas de serviços da rede privada de saúde foi testado por Captura do Híbrido II. Destas, 58,4 por cento apresentaram infecção por HPV e cerca de 90 por cento delas estavam infectadas por HPV de alto risco. Este grupo, entretanto, apresentava poucos casos de lesões cervicais pré-malígnas e nenhum caso de câncer. Estudamos, também, 220 mulheres de baixo nível econômico atendidas no serviço de saúde pública que foram testadas para HPV pela reação da polimerase em cadeia utilizando-se os oligonucleotídeos My09/My11. A identificação dos tipos foi efetuada por amplificação com oligonucleotídeos específicos para a região E6 do genoma viral. A prevalência de HPV nesta população foi de 77.3 por cento, observando-se uma alta porcentagem de casos de neoplasias intraepiteliais cervicais de alto grau (26,3 por cento) e de carcinoma cervical invasivo (16,3 por cento). A infecção por HPV foi achada em, respectivamente, 93,1 por cento e 94,4 por cento destes casos. A média de idade em ambos os grupos era de 31,5 e 38 anos, respectivamente. Na série 1, a prevalência da infecção por HPV decresce com a idade, enquanto na série 2 ela não desaparece, dando suporte não só à idéia de persistência viral neste grupo, mas também a variações epidemiológicas na mesma área geográfica. Diferenças significativas foram vistas nos dois grupos. Casos normais e benignos foram incidentes na série 1, enquanto as lesões malígnas predominaram na série 2. Ao contrário, casos normais infectados por HPV eram prevalentes na série 2 (p < 0.001), indicando maior exposição ao vírus. Embora as mulheres de ambos os grupos tenham sido incluídas no estudo por apresentarem citologia anormal, evidências sócio-demográficas demonstram que mulheres da série 1 tem acesso mais fácil e rápido ao tratamento do que as mulheres da série 2 antes que as lesões pré-malígnas se desenvolvam...

Análisis preventivo y formativo para el diagnótico, detección y atención integral del cáncer cérvico-uterino en el Area de Liberia, en el periodo comprendido entre febrero y junio del 2002 / Preventive and formative analysis for the diagnosis, detection and integral attention of cervicouterino cancer in the Area of health Liberia in the period between february and june of the 2002

El cáncer de cuello uterino es un epitelioma originado, por lo general, en la unión del epitelio malpigiano (exocervical) con el epitelio cilíndirico (endocervical). El epitelioma in situ es un cáncer que no ha sobrepasado la membrana basal y se extendida. El cáncer de cuello uterino es una de las principales causas de una alta mortalidad ginecológica, constituye un serio problema de salud pública, por lo tanto este trabajo de investigación es de tipo aplicado ya que pretende concientizar a los médicos de la importancia que significa un papanicolau para su prevención y diagnóstico, también tiene como propósito informar a la población en general las consecuencias que tiene dicha enfermedad, por ello se realizó un estudio comparativo en el cual participaron dos grupos de mujeres, el grupo A (de 15 a 30 años) y el grupo B (de 31 a 50 años) en un taller educativo interactivo que constaba de 3 fases dentro de los cuales se impartieron charlas interactivas referentes al cáncer cérvico-uterino con el fin de aplicar un cuestionario que identificó fortalezas y debilidades referente a los conceptos, prevención, diagnóstico, detección y atención integral del cáncer cérvico - uterino en el área de salud de Liberia en el periodo comprendido entre febrero y junio del 2002.