Efficacy in treatment of subclinical cervical HPV infection without intraepithelial neoplasia: systematic review.

CONTEXT: The treatment of the subclinical Human papillomavirus (HPV) infection of the uterine cervix is controversial. OBJECTIVE: To assess the efficacy of any therapy for subclinical HPV infection of the cervix without intraepithelial neoplasia, via a search in the medical literature. METHOD: We performed a systematic review with a comprehensive reference search in Medline, LILACS, Excerpta Medica, AIDSLINE, Popline, Cochrane Library and other authors' reference lists to identify experimental studies of therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. In order to identify unpublished studies, we also contacted experts in the area, clinical trial registries, pharmaceutical industries, government and research institutions. We also searched on the Internet and in the book-of-abstracts of some medical conferences. The studies identified were masked and selected by inclusion criteria to help ascertain their internal validity. The data about regression or progression of HPV infection were extracted from the studies included. RESULTS: We identified 67 studies related to the treatment of subclinical HPV infection without intraepithelial neoplasia of the uterine cervix. Only five clinical trials matched the inclusion criteria and none demonstrated significant differences between the experimental group and the control group concerning regression of HPV infection (with or without CIN I) or progression to higher grades of CIN. CONCLUSION: The evidence we found in the medical literature regarding the efficacy of any therapy for subclinical HPV infection without intraepithelial neoplasia of the uterine cervix was unsatisfactory.

[Normal neonatal cerebral ultrasonography in preterm infants - Is it possible to calm down the parents?] / Ultra-sonografia cerebral neonatal normal no prematuro - é possível tranqüilizar os pais?

OBJECTIVE: To verify the predictive values of neonatal cerebral ultrasonography for motor and cognitive development of very low birth weight preterm babies after twelve months correct age. METHODS: The population studied was a cohort of preterm babies with birth weight less than 1,500g, who had been admitted in the Neonatal Intensive Care Unit of Instituto Fernandes Figueira, and were followed to 12-30 months corrected age for prematurity. A cerebral ultrasonography was performed before discharge. The results were classified as normal and abnormal (parenchymal hemorrhage, porencephaly, periventricular leucomalacia, ventricular dilatation). The babies were followed in the Follow-up Clinic and between 12-30 months correct age they underwent a neurological assessment with observation of the acquisition of motor milestones and submitted to Bayley Scales of Development. RESULTS: We studied 83 babies. Cerebral ultrasonography was normal in 68 babies (81.9%) and abnormal in 15 (18.8%). With a mean age of 21 months, 63 children (75.9%) had normal motor development and 20 (24.0%) had motor abnormalities. The cognitive development was normal in 68 children (81.9%). The negative predictive value of the cerebral ultrasonography for motor development was 85.3%, and for cognitive development, 86.8%. The positive predictive value of the cerebral ultrasonography for motor development was 66.7% and for cognitive development, 42.9%. CONCLUSIONS: The negative predictive values were greater than the positive predictive values in both areas of development. The probability for children with normal neonatal ultrasonography to have normal motor and cognitive development is greater than 85%.

[The predictive value of neonatal neurological assessment and neonatal cranial ultrasonography with respect to the development of very low birth weight premature infants]. / Valores de predição da avaliação neurológica e ultra-sonográfica cerebral neonatal em relação ao desenvolvimento de prematuros de muito baixo peso.

OBJECTIVE: To verify the predictive value of two tests (neurological assessment and ultrasonography) performed at the time of discharge, with respect to the neuromotor and cognitive development of premature infants. METHODS: Seventy very low birth weight premature infants (below 1,500 g), admitted to the Neonatal Department between 1992 and 1994 were studied. The average birth weight and gestation age were, respectively, 1,185 g (SD: 180 g) and 32.2 weeks (SD: 1.4). At the term correct age, neurological assessment by the Dubowitz & Dubowitz method and cerebral ultrasonography were carried out. After discharge, the development was monitored at the follow up clinic. RESULTS: At 21 months correct age (SD: 4.9), neuromotor and cognitive abnormalities were observed, respectively, in 25.7% and 20.3% of the infants evaluated. The neonatal neurological assessment was found to be more sensitive than those specific for neuromotor (sensibility: 77.7%, specificity: 57.6%) and cognitive (sensibility: 78.5%, specificity: 56.4%) abnormalities, and exhibited low predictive value for both neuromotor and cognitive abnormality. Ultrasonography exhibited high specificity with respect to both neuromotor and cognitive development. The cerebral ultrasonography has also a reasonable predictive value for neuromotor abnormality. CONCLUSION: The combination of both tests yielded higher predictive values.