Citopatogenicidade de Trichomonas vaginalis: uma via de sinalização carboidrato-dependente / Trichomonas vaginalis' pathogenic effect and cell signaling in a carbohydrate-dependent manner

Trichomonas vaginalis é um agente infectante da microbiota vaginal que vem sendo correlacionado ao câncer cervical. Um receptor denominado alectina-1 (Gal 1) pode ser expresso em células epiteliais cervicais humanas se ligando à glicofosfolipídica (LPG) de T. vaginalis. A interação de T. vaginalis com as células epiteliais é mediada por cadeias galactose e N-acetilglucosamina (LacNac). Gal 1 se liga aos sítios poly-LacNAC e está relacionada com a aderência de T. vaginalis à célula humana. A sinalização ocorre por intermédio de sítios da proteína Src (SH2) que se associam, ocorrendo sob os domínios de PI3K que fosforilam a membrana de lípides fosfatidilinositol (PIP e PIP2). Aderindo-se às membranas citoplasmáticas e secretando enzimas, T. vaginalis pode ocasionar a ruptura do envoltório celular podendo fagocitar células epiteliais em meio vaginal. O núcleo N-acetilactosamina de Gal 1 pode mediar a regulação do crescimento celular com a ajuda da proteína GRB2; entretanto, Gal 1 pode contribuir para a supressão da inflamação por meio da indução de apoptose pelas células T ativadas. (AU)

Trichomonas vaginalis is an infectious agent of the vaginal flora which has been associated with cervical cancer. Galectin-1 (Gal 1) is a cell receptor expressed in cervical epithelial cells binding T. vaginalis? lipophosphoglican (LPG). Interaction between T. vaginalis and the epithelial cell is mediated by poly-LacNac domains (galactoside and acetil-lactosamin) and is related to cell adherence as well. Cell signaling occurs by the time Src (SH2) domains are correlated with this interaction and PI3K phosphorilation brings up phosphatidil inositol lipid membranes (PIP and PIP2). T. vaginalis adheres to cytoplasm membrane and secrets specific enzymes that probably lead to membrane rupture. Moreover this parasite may phagocyte epithelial cells in vaginal discharge. Gal 1 nucleus called N-acetil-lactosamin can mediate growth development through GRB2 protein and may contribute to inflammation suppression owing to apoptosis induction of activated T cells.(AU)

Cobertura de la Citología de Cuello Uterino y Factores Relacionados en Colombia, 2005 / Pap test coverage and related factors in Colombia, 2005

Objetivo: Describir la cobertura de la citología en los últimos tres años y los principales factores relacionados, en la población de mujeres colombianas entre 25 y 69 años de edad. Materiales y métodos: Se analizó la información de la Encuesta Nacional de Demografía y Salud 2005. Se calculó la variable "práctica de la citología en los últimos tres años". La descripción de la cobertura y factores asociados se hizo a través de porcentajes simples y se realizó un análisis multivariado utilizando un modelo de regresión logística incondicional. Resultados: La cobertura de citología reciente en mujeres entre 25 y 69 años de edad para Colombia fue de 76,5 por ciento. Las condiciones asociadas con la ausencia de toma reciente fueron ausencia de afiliación, afiliación al régimen subsidiado, no haber tenido hijos vivos ni una consulta de salud en el último año; las condiciones asociadas con la toma reciente fueron el nivel de riqueza, tener entre 35 y 44 años, tener un nivel educativo universitario o superior y estar en embarazo. Conclusión: Los resultados indican la necesidad de esfuerzos por mejorar las coberturas en la población más pobre, no afiliada y afiliada al régimen subsidiado; la alta mortalidad a pesar de la buena cobertura general sugiere la necesidad de esfuerzos en la oportunidad del diagnóstico definitivo y el manejo de lesiones.

Objective: Describing the use of the Papanicolau (Pap) test and the main factors related to using screening amongst Colombian women aged 25 to 69 years. Methods: Information was taken from the 2005 National Health and Demography Survey. The variable "pap test during the last three years" was calculated; coverage and related factors were described using simple percentages and multivariate analysis using conditional logistic regression. Results: Recent Pap test coverage in Colombian women aged 25 to 69 years was 76.5 percent. Factors associated with the absence of recent exam included non-affiliation to the health system, affiliation to the susbsidiary regimen, having no live-born children and no recent medical consultation. Factors associated with recent coverage were income level, being aged 35 to 44, a higher educational level and being pregnant. Conclusions: Results indicated the need for efforts at increasing coverage amongst the poorer population as well as amongst women from the subsidiary regimen and those having no affiliation. Persistence of high mortality in spite of acceptable coverage suggested the need for more efforts regarding definitive diagnosis and opportune treatment.

Motivos de abandono en el proceso de atención médica de lesiones precursoras de cáncer cervicouterino / Medical care abandon factors in precursor lesions of cervical cancer

Objective. To determine factors associated with medical care abandon of women with CIN. Material and methods. A nested case-control study in a cohort was done. Patients referred to clinical Dysplasia of Gyneco-Obstetrician Services in third level Hospitals were considered. Cases: Patients who abandoned medical care. Controls: women who attend their medical appointments during follow-up. All subjects underwent structured interviews focused on social, clinical and health services factors in two different times, applied at the beginning of study and the end of follow-up. Clinical records were reviewed to obtain clinical information. Analysis: Descriptive and inferential statistical was done. Non conditional Logistic Regression analysis was done to obtain adjusted association. Results. Abandon cumulative incidence rate was 108/525 = 20.7% (I.C 95% = 17.2-24.3); 60.2% happened in diagnosis phase, 17.7% ocured during therapeutic phase and 23.1% happened in surveillance phase. We studied 108 cases and 417 controls to analysis. Next adjusted risk factors were obtained: Afraid to death (ORa = 4.2, I.C.95% = 1.8-9.5), long appointments (ORa = 6.6, I.C95% = 3.4-13.0), lack of privacity (ORa = 12.5, I.C.95% = 2.6-59.8), reject to treatment (ORa = 40.4, I.C.95% = 2.1-785.4), lack of information (ORa = 41.9, I.C95% =14.2-124.1) and other factors. Conclusions. Patient perception, access and barriers in health services were the most important factors associated with medical care abandon.

Objetivo. Determinar factores asociados al abandono del proceso de atención de NIC. Material y métodos. Se realizó un estudio de casos y controles anidado en una cohorte de mujeres referidas a las clínicas de displasias de dos hospitales de tercer nivel. Casos: pacientes que abandonaron su atención médica. Controles: pacientes que cumplieron con sus citas médicas. Las pacientes contestaron una entrevista estructurada respecto a variables sociodemográficas y de atención médica al inicio y al final del seguimiento. Los datos clínicos se obtuvieron de la revisión de expedientes. Análisis: Medidas de frecuencia y asociación, ajustando variables con Regresión Logística no Condicionada. Resultados. La tasa de abandono fue de 108/525 = 20.7% (17.2-24.3); 60.2% ocurrieron en la fase diagnóstica, 17.7% durante el tratamiento y 23.1% en la fase de vigilancia y/o control. Un total de 108 casos y 417 controles fueron considerados para el análisis. Los factores de riesgo ajustados fueron: miedo a la muerte (ORa = 4.2, I.C.95% = 1.8-9.5), citas prolongadas (ORa = 6.6, I.C.95% = 3.4-13.0), falta de privacidad (ORa = 12.5, I.C.95% = 2.6-59.8), rechazo al tratamiento propuesto (ORa = 40.4, I.C.95% = 2.1-785.4) y falta de información (ORa = 41.9, I.C.95% = 14.2-124.1) entre otros. Conclusiones. Los factores relacionados con la percepción de gravedad de la enfermedad y las barreras al acceso de los servicios de salud fueron los de mayor importancia para abandonar la atención médica.