A pilot study on salivary HPV DNA detection to monitor active disease from patients with recurrent respiratory papillomatosis.

PURPOSE: Recurrent respiratory papillomatosis (RRP) is a human papillomavirus (HPV)-related disease affecting the upper airway and saliva could be an important non-invasive sampling source for viral screening and clinical monitoring. We investigated whether HPV DNA could be detected in saliva (cellular pellets and supernatant) from RRP patients and influence on clinical manifestation of the disease. MATERIALS AND METHODS: In this pilot study, saliva samples from 14 RRP patients were obtained in preoperative condition (n = 7) and in disease-free interval (DFI; n = 7). Healthy donors (n = 14) were also included. HPV DNA was investigated by polymerase chain reaction (PCR)-based assays. RESULTS: From cellular pellets, HPV-positive saliva was only detected from preoperative collections (5/7; 71.4 %) and showed a mean cycle threshold (Ct) value of 24.33 (±1.25), whereas all patients in DFI were HPV-negative (Ct ≥ 32.16), revealing significant difference between these two clinical moments (p = 0.021). Patients in DFI and healthy donors showed similar Ct values. From saliva supernatant, detectable HPV cell-free DNA (cfDNA) occurred in 42.9 % (3/7) and 57.1 % (4/7) of preoperative collections using the commercial cfDNA kits from Norgen and Qiagen, respectively. Salivary cfDNA size distribution obtained by TapeStation analysis showed a predominant size range of 150 to 400 bp in both patients and healthy controls, corresponding to mononucleosomal and dinucleosomal fragments. CONCLUSIONS: In conclusion, HPV DNA screening in saliva (both cellular pellets and cfDNA) may have clinical utility to monitor active disease of RRP patients.

Prevalence of Epstein-Barr virus infection in recurrent respiratory papillomatosis and the influence on disease severity.

Recurrent respiratory papillomatosis (RRP) is characterized by benign papillomatous lesions in the upper airway associated with human papillomavirus infection. It has been proposed that viral coinfections may contribute to an aggressive clinical course of the disease. For this purpose, we investigated the prevalence of Epstein-Barr virus (EBV) infection among 40 RRP patients by polymerase chain reaction assay. EBV DNA was detected in 11 cases and disease severity was observed in 54.5% of EBV-positive patients. No significant association was found between the RRP severity categories and EBV status (P > 0.05). Regardless EBV status, disease severity showed significant association with RRP diagnosis since childhood (P = 0.009). These findings indicate an absence of direct influence of EBV infection on aggressive course of RRP. However, the development of RRP since childhood increase the susceptibility to disease severity.

Prevalence and clinical implications of low-risk human papillomavirus among patients with recurrent respiratory papillomatosis in Rio de Janeiro, Brazil.

OBJECTIVE: The aim of this study was to investigate the presence of human papillomavirus (HPV) in biopsy specimens from juvenile and adult patients with histopathological diagnosis of recurrent respiratory papillomatosis (RRP) treated in two public hospitals in Rio de Janeiro, Brazil. METHODS: We performed the detection and genotyping of HPV by PCR technique for the types 6, 11, 16, and 18 in biopsy specimens from 41 RRP patients. RESULTS: The juvenile onset RRP (JoRRP) corresponded to 61% and the adult onset RRP (AoRRP) corresponded to 39% of the study group. Prevalence of males was observed in both the adult (81.3%) and the juvenile (56%) groups. Lesions in the larynx were more frequent in the glottis (46%). Genotyping analysis only revealed patients with HPV-6 (34.1%), HPV-11(17.1%), and co-infection HPV-6 and -11 (48.8%). RRP severity was significantly associated with the JoRRP (p<0.001), with extralaryngeal disease and more surgeries. However, no significant association between RRP severity and HPV types was found. One co-infected patient in the JoRRP died due to the evolution of the disease with lung involvement. CONCLUSION: These results show the strong association of HPV-6 and/or HPV-11 types with RRP and could complement the diagnosis, prognosis, and therapies for these patients. In addition, the HPV vaccination should be encouraged to prevent the disease.

Antimaláricos e ototoxicidade / Antimalarials and ototoxicity

Os antimaláricos, como o difosfato de cloroquina, têm sido usados amplamente no tratamento não só da malária, mas também de doenças reumatológicas como a síndrome de Sjõgren (SS), artrite reumatóide (AR) e lúpus eritematoso sistêmico (LES). Essas drogas são usadas cronicamente e, em conseqüência do acúmulo nos melanócitos, podem causar hiperpigmentação cutânea, retinopatia e lesão no ouvido interno. Como o protocolo do uso de antimaláricos só envolve a avaliação oftalmológica e das enzimas hepáticas, esta revisão discute a necessidade de novos estudos da avaliação periódica da audição desses pacientes.

Automedicaçäo na populaçäo idosa do Núcleo de Atençäo ao Idoso da UnATI/UERJ / Self medication of the elderly population from Nucleous of Attention of Old Age - UnATI/UERJ

Aborda variáveis como percepção de morbidade, natureza dos medicamentos ingeridos, motivos para sua ingestão e origem de sua prescrição. Os achados indicam um padrão de consumo de medicamentos substancialmente baixo para a faixa etária estudada, sugerindo uma conduta diferenciada e sóbria por parte da equipe de saúde da UnATI, no que tange à prescrição de medicamentos (Org)

Automedicaçäo na populaçäo idosa do núcleo de atençäo ao idoso da UnATI-UERJ / Self medication of the elderly population from Nucleous of Attention of Old Age, UnATI-UERJ

Realizou-se um inquérito, junto à população do ambulatório do Núcleo de Atenção ao Idoso (NAI) da Universidade Aberta da Terceira Idade (UnATI), da Universidade do Estado do Rio de Janeiro (UERJ), para se conhecer o padrão de automedicação da população idosa ali atendida. Foram colhidos 140 questionários de perguntas fechadas com váriaveis sexo, idade, residência, percepção de morbidade, medicamentos ingeridos na véspera, na última semana e nos últimos 30 dias, motivos para ingestão e origem da prescrição. Encontrou-se uma média de ingestão de medicamentos mais baixa do que a relatada na literatura, de 2,7 por cento por entrevistado, e um índice de automedicação de até 23,3 por cento. Comparados esses dados aos de uma população semelhante, da UnATI como um todo, percebeu-se um índice de uso de medicamentos sensivelmente mais baixo na população do ambulatório, sugerindo que os médicos da Instituição apresentam uma conduta diferenciada e mais sóbria na prescrição.