High human papillomavirus (HPV)-35 prevalence among South African women with cervical intraepithelial neoplasia warrants attention.

Human papillomavirus (HPV) prevalence and genotype distribution data is important for HPV vaccine monitoring. This study investigated the prevalence and distribution of HPV genotypes in cervical lesions of unvaccinated women referred to Nelson Mandela Academic Hospital Gynaecology Department due to different abnormal cervical conditions. A total of 459 women referred to the Nelson Mandela Academic Hospital Gynaecology department were recruited. When the cervical biopsy was collected for histopathology, an adjacent biopsy was provided for HPV detection. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection in cervical biopsies. HPV infection was detected in 84.2% (383/455) of participants. The six most dominant HPV types were HPV-16 (34.7%), followed by HPV-35 (17.4%), HPV-58 (12.1%), HPV-45 (11.6%), HPV-18 (11.4%) and HPV-52 (9.7%). HPV-35 was the third most dominant type among women with cervical intraepithelial lesion (CIN)-2 (12.6%; single infection: 5.7% and multiple infection: 6.9%), the second most dominant type among women with CIN3 (22.2%; single infection: 8.0% and multiple infection: 14.2%); and the fourth most dominant type among women with cervical cancer (12.5%; single infection: 7.1% and multiple infection: 5.4%). A proportion of 41.1% (187/455) was positive for HPV types targeted by the Cervarix®, 42.4% (193/455) by Gardasil®4, and 66.6% (303/455) by Gardasil®9. There was a statistically significant increase when the prevalence of women infected with HPV-35 only or with other HPV types other than Gardasil®9 types was included to those infected with Gardasil®9 HPV types (66.6%, 303/455 increase to 76.0%, 346/455, p = 0.002). High HPV-35 prevalence in this population, especially among women with CIN3 warrants attention since it is not included in current commercially available HPV vaccines.

Distribution of Human Papillomavirus (HPV) Genotypes in HIV-Negative and HIV-Positive Women with Cervical Intraepithelial Lesions in the Eastern Cape Province, South Africa.

South African women have a high rate of cervical cancer cases, but there are limited data on human papillomavirus (HPV) genotypes in cervical intraepithelial neoplasia (CIN) in the Eastern Cape province, South Africa. A total of 193 cervical specimens with confirmed CIN from women aged 18 years or older, recruited from a referral hospital, were tested for HPV infection. The cervical specimens, smeared onto FTA cards, were screened for 36 HPV types using an HPV direct flow kit. HPV prevalence was 93.5% (43/46) in CIN2 and 96.6% (142/147) in CIN3. HIV-positive women had a significantly higher HPV prevalence than HIV-negative women (98.0% vs. 89.1%, p = 0.012). The prevalence of multiple types was significantly higher in HIV-positive than HIV-negative women (p = 0.034). The frequently detected genotypes were HPV35 (23.9%), HPV58 (23.9%), HPV45 (19.6%), and HPV16 (17.3%) in CIN2 cases, while in CIN3, HPV35 (22.5%), HPV16 (21.8%), HPV33 (15.6%), and HPV58 (14.3%) were the most common identified HPV types, independent of HIV status. The prevalence of HPV types targeted by the nonavalent HPV vaccine was 60.9% and 68.7% among women with CIN2 and CIN3, respectively, indicating that vaccination would have an impact both in HIV-negative and HIV-positive South African women, although it will not provide full protection in preventing HPV infection and cervical cancer lesions.

Acceptability of self- collection for human papillomavirus detection in the Eastern Cape, South Africa.

Human papillomavirus (HPV) testing on vaginal self-collected and cervical clinician-collected specimens shows comparable performance. Self-sampling on FTA cards is suitable for women residing in rural settings or not attending regular screening and increases participation rate in the cervical cancer screening programme. We aimed to investigate and compare high-risk (HR)-HPV prevalence in clinician-collected and self-collected genital specimens as well as two different HPV tests on the clinician collected samples. A total of 737 women were recruited from two sites, a community health clinic (n = 413) and a referral clinic (n = 324) in the Eastern Cape Province. Cervical clinician-collected (FTA cards and Digene transport medium) and vaginal self-collected specimens were tested for HR-HPV using the hpVIR assay (FTA cards) and Hybrid Capture-2 (Digene transport medium). There was no significant difference in HR-HPV positivity between clinician-collected and self-collected specimens among women from the community-based clinic (26.4% vs 27.9%, p = 0.601) or the referral clinic (83.6% vs 79.9%, p = 0.222). HPV16, HPV35, and HPV33/52/58 group were the most frequently detected genotypes at both study sites. Self-sampling for HPV testing received a high positive response of acceptance (77.2% in the community-based clinic and 83.0% in referral clinic). The overall agreement between hpVIR assay and HC-2 was 87.7% (k = 0.754). The study found good agreement between clinician-collected and self-collected genital specimens. Self-collection can have a positive impact on a cervical screening program in South Africa by increasing coverage of women in rural areas, in particular those unable to visit the clinics and women attending clinics where cytology-based programs are not functioning effectively.

Human papillomavirus prevalence and risk factors among HIV-negative and HIV-positive women residing in rural Eastern Cape, South Africa.

OBJECTIVES: To investigate the prevalence of high-risk (HR) human papillomavirus (HPV) and factors associated with HR-HPV infection among women from rural Eastern Cape, South Africa. METHODS: HPV prevalence was determined by Hybrid Capture 2 assay in cervical specimens from 417 women aged ≥30 years (median 46 years) recruited from the community health clinic in the Eastern Cape. RESULTS: HR-HPV prevalence was 28.5% (119/417), and HIV-positive women had significantly higher HR-HPV prevalence than HIV-negative women (40.6%, 63/155 vs 21.4%, 56/262, respectively; p = 0.001). HIV-positive status (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.63-3.90), having ≥3 lifetime sexual partners (OR 2.12, 95% CI 1.16-3.89), having ≥1 sexual partner in the last month (OR 1.89, 95% CI 1.21-2.92), ≥4 times frequency of vaginal sex in the past 1 month (OR 2.40, 95% CI 1.32-4.35), and having a vaginal discharge currently/in the previous week (OR 2.13, 95% CI 1.18-3.85) increased the risk of HR-HPV infection. In the multivariate analysis, HIV positivity remained strongly associated with HR-HPV infection (OR 1.94, 95% CI 1.17-3.22). CONCLUSIONS: Risk factors related to sexual behaviors play a significant role in HR-HPV infection in this population. This report will inform health policymakers on HPV prevalence and contribute to discussions on the use of HPV testing as the primary cervical cancer screening test in South Africa.

Gestación gemelar con feto acárdico: Presentación de un caso / Twin pregnancy with acardiac foetus: Case presentation

Introducción: la secuencia de perfusión arterial reversa (secuencia TRAP) o transfusión feto-fetal; se encuentra entre las numerosas peculiaridades de la gestación monocoriónica (univitelina) gemelar. En ella, el gemelo afectado es perfundido de forma reversa mediante anastomosis arterio-arterial y veno-venosa por el otro gemelo; resultando un feto acardio y otro normal, con consecuencias hemodinámicas en este último, debidas a la misma. Objetivo: caso de embarazo gemelar monocigótico con feto acardio-acéfalo diagnosticado por ultrasonido preparto; dada su baja frecuencia. Presentación del caso: gestante de 17 años de edad, primigrávida, con embarazo gemelar de 36.3 semanas, diagnosticado por Ultrasonido (US); con 4 controles prenatales. La misma consultó en trabajo de parto. Se le realizó un US evolutivo que encontró un feto vivo, en presentación cefálica, acompañado de una masa amorfa, que se concluyó como feto malformado en un embarazo gemelar. Se remitió la gestante al Hospital Nacional Regional de Escuintla (HNRE); donde se le practicó una cesárea; se obtuvo un recién nacido femenino de 2.37 kilogramos y una masa deforme (feto malformado). La placenta resultó ser monocoriónica, univitelina, con perfusión sanguínea feto-fetal (de normal a malformado); lo cual permitió la supervivencia del feto amorfo hasta entonces, seguido de muerte fetal intraparto. El gemelo malformado se envió al servicio de anatomía patológica para su estudio; cuyos resultados se presentan en este trabajo. Se revisa la bibliografía hasta el 2013. Conclusiones: el feto acardio-acéfalo por transfusión feto-fetal inversa es poco frecuente en nuestro país, debido al temprano y avanzado control prenatal. El diagnóstico prenatal temprano es un método valioso para evitar el desenlace fatal e incremento de la mortalidad infantil(AU)

Introduction: among several peculiarities of gestation twins (univiteline) monochorionic is sequence of Twin Reverse Arterial Perfusion (TRAP sequence) or fetus-fetal transfusion. TRAP is a serious complication whereby the affected twin is been perfused in a reverse manner through arterio-arterial and veno-venous anastomoses by another twin; resulting in an abnormal acardiac foetus and other normal, but with hemodynamic consequences in the latter, due to this complication. Objective: illustrate a twin pregnancy with an acardius acephalus (parasite) twin diagnosis by antenatal, ante partum ultrasound; since it is seldom reported in our environment. Case Presentation: the results of a 17-year-old primigravida pregnant woman's with a twin pregnancy of 36.3 weeks, diagnosed by Ultra sound (US) are presented in this article. Four previous ante-natal checks up were retrieved before she went into labour. An evaluative US was carried out; showing a live foetus in a cephalic presentation, accompanied by an amorphous mass that was concluded as a malformed foetus in a twin pregnancy. The patient was referred to the National Regional Escuintla Hospital (NREH). A caesarean section was performed. A female newborn of 2.37 kg weight and an amorphous mass - corresponding to a malformed foetus- were found. A uni-chorionic, uni-amniotic placenta was found, as well as a foetus-foetal blood perfusion (from normal to malformed) that kept "alive" the malformed foetus until the delivery. Intra partum foetal death of the second (amorphous) foetus was noticed. The body was sent to the department of pathology for post-mortem study service. The findings of the post-mortem are presented in this report. Conclusions: acardiocephalus twin pregnancy by reverse foetus-fetal transfusion is quite uncommon in our country, due to early and advanced antenatal control and diagnosis. Early detection of such cases provides a good tool to avoid intra partum and postpartum neonatal deaths, thus,.. (AU)

Postmortem findings in HIV/AIDS patients in a tertiary care hospital in rural South Africa.

South Africa has the largest number of people living with HIV/AIDS, and various associated infectious and noninfectious conditions contribute towards mortality. The objective of this study was to determine the important post-mortem findings in HIV-infected individuals in a high HIV burden rural area in South Africa. The patient population included HIV patients who died at the tertiary care hospital, from 2000-2008. Autopsies were performed according to standard protocols and diagnoses were made with additional laboratory investigations wherever required. A total of 86 patients were autopsied (30 males, 56 females). The major postmortem findings were related to infections, with 38% of the patients having had some form of tuberculosis, followed by pyogenic infections--pneumonias (21.5%), meningitis (10.1%) and septicemias (5.1%). Other important infections included opportunistic fungi like cryptococcosis (7.6%) and pneumocystis pneumonia (8.9%). Among the noninfectious conditions, the findings seen were predominantly related to liver (10.1%) and cardiac involvement (10.1%).

Paradigma de la enseñanza de anatomia patologica / Paradigm of pathological anatomy teaching

Se realizan algunas consideraciones acerca del paradigma y en general de la enseñanza de las ciencias medicas en nuestro pais, en el momento actual; considerando que se ha dado un vuelco hacia una socializacion cada vez mayor. Se hacen consideraciones acerca de la enseñanza de anatomia patologica, la cual fue una asignatura eminente biologicista hasta hace muy pocos años, por lo que se situa en su justo lugar en fecha relativamente reciente, gracias al desarrollo general de las ciencias medicas en nuestro pais y a la superacion progresiva del claustro que la imparte, tanto en la esfera de las ciencias pedagogicas como en algunas disciplinas sociobiologicas. Se concluye conceptualizar la anatomia patologica como una ciencia sociobiologica (AU)

Paradigma de la enseñanza de anatomia patologica / Paradigm of pathological anatomy teaching

Se realizan algunas consideraciones acerca del paradigma y en general de la enseñanza de las ciencias medicas en nuestro pais, en el momento actual; considerando que se ha dado un vuelco hacia una socializacion cada vez mayor. Se hacen consideraciones acerca de la enseñanza de anatomia patologica, la cual fue una asignatura eminente biologicista hasta hace muy pocos años, por lo que se situa en su justo lugar en fecha relativamente reciente, gracias al desarrollo general de las ciencias medicas en nuestro pais y a la superacion progresiva del claustro que la imparte, tanto en la esfera de las ciencias pedagogicas como en algunas disciplinas sociobiologicas. Se concluye conceptualizar la anatomia patologica como una ciencia sociobiologica

Some considerations about the paradigm, and generally about the current teaching of medical sciences in our country, are made, considering that there has been a turn toward an every time greater socialization. Considerations are also made about the pathological anatomy teaching, which just a few years ago was an eminently biological subject, ad now at recent date it has been placed in its exact site, favored by the general development of medical sciences in our country, and by the advancing upgrading of the staff which imparts it, in the sphere of the pedagogical sciences as well as in several social-biological disciplines. It is concluded that pathological anatomy must be placed under the concept of a social-biological science

Método para el estudio de las áreas de los vermis cerebelosos y datos preliminares en encéfalos controles y de pacientes esquizofrénicos / Method for the study of cerebelous vermis areas and preliminary data in control encephalon and schizophrenic patients

En la bibliografía se ha señalado la presencia de atrofia del vermis cerebeloso en encéfalos de esquizofrénicos. Por tal motivo, se ha desarrollado un método para poder comparar las áreas de los vermis de esquizofrénicos y cotroles, determinar los valores de ambos grupos, y confrontar sus resultados. La técnica consiste, básicamente, en reproducir en papel el perfil del vermis y contar en papel milimetrado el área correspondiente mediante la utilización siempre, de la cara derecha de la estructura. Se determinarán también, para establecer las comparaciones pertinentes, la edad, peso encefálico, y enfermedad asociada que padeciera el individuo

Método para el estudio de las áreas de los vermis cerebelosos y datos preliminares en encéfalos controles y de pacientes esquizofrénicos / Method for the study of cerebelous vermis areas and preliminary data in control encephalon and schizophrenic patients

En la bibliografía se ha señalado la presencia de atrofia del vermis cerebeloso en encéfalos de esquizofrénicos. Por tal motivo, se ha desarrollado un método para poder comparar las áreas de los vermis de esquizofrénicos y cotroles, determinar los valores de ambos grupos, y confrontar sus resultados. La técnica consiste, básicamente, en reproducir en papel el perfil del vermis y contar en papel milimetrado el área correspondiente mediante la utilización siempre, de la cara derecha de la estructura. Se determinarán también, para establecer las comparaciones pertinentes, la edad, peso encefálico, y enfermedad asociada que padeciera el individuo

Estudio anatómico-comparativo del área de broca en encéfalos controles y de pacientes esquizofrénicos / Anatomical comparative study of broca's area on control encephalons and schizophrenic patients

Se hace un análisis de varios encéfalos de sujetos esquizofrénicos, se les compara con los controles y se determina la densidad, área total y áreas relativas de sustancias gris y blanca de las regiones operculares frontales de cada hemisferio cerebral. Los valores obtenidos fueron comparados, y se encontró marcada atrofia de dicha región en ambos hemisferios, en mayor grado, al parecer, en la sustancia gris, lo que pudiera indicar que el proceso atrófico en la esquizofrenia estuviera vinculado con atrofia marcada de áreas específicas corticales, en este caso de zonas relacionadas con el centro cortical del lenguaje oral (área de Brocá)

Estudio anatómico-comparativo del área de broca en encéfalos controles y de pacientes esquizofrénicos / Anatomical comparative study of broca's area on control encephalons and schizophrenic patients

Se hace un análisis de varios encéfalos de sujetos esquizofrénicos, se les compara con los controles y se determina la densidad, área total y áreas relativas de sustancias gris y blanca de las regiones operculares frontales de cada hemisferio cerebral. Los valores obtenidos fueron comparados, y se encontró marcada atrofia de dicha región en ambos hemisferios, en mayor grado, al parecer, en la sustancia gris, lo que pudiera indicar que el proceso atrófico en la esquizofrenia estuviera vinculado con atrofia marcada de áreas específicas corticales, en este caso de zonas relacionadas con el centro cortical del lenguaje oral (área de Brocá)

Variaciones del peso encefálico en enfermedades mentales de larga duración / Encephalic weight variations in long-lasting mental disease

Se estudiaron los datos obtenidos de 519 informes de necropsias de los hospitales "Salvador Allende" y Psiquiátrico de la Habana, analizándose el peso encefálico, cerebral, edad, sexo y causa de muerte. Se agruparon los datos en cuatro poblaciones que incluían esquizofrénicos, psicosis maniacodepresiva, retraso mental y el grupo control (sin patología psiquiátrica, neurológica o traumatismo craneoencefálico), calculándose los valores promedios de sus pesos encefálicos y cerebrales. Los resultados obtenidos permiten concluir que la esquizofrenia y retraso mental disminuyen significativamente ambos pesos, no así la psicosis maniacodepresiva; además, que los valores promedios de estos pesos son dependientes entre sí y descienden con el incremento de la edad, no existiendo correlación con el sexo

Linfadenopatía angioinmunoblástica con disproteinemia. Presentación de un caso y revisión de la literatura / Angioimmunoblastic lymphadenopathy with dysproteinemia. Presentation of a case and review of the literature

Se comunica el primer caso de linfadenopatía angioinmunoblástica con disproteinemia en nuestro país y se hace una revisión de la literatura. Se informa que el cuadro clínico tenía como datos más notables un síndrome general asociado con adenopatías y hepatoesplenomegalia y desde el punto de vista inmunológico, una hipergammaglobulinemia ganglionar con proliferación de vasos sanguíneos e inmunoblastos y presencia de sustancia acidófila PAS positiva. Se señala que estas alteraciones en su conjunto hacen el diagnóstico de la enfermedad. Se informa que el paciente falleció después del tratamiento citotóxico por una sepsis por hongo (mucormicosis)(AU)

Degeneración basófila (Mucinosa) del miocardio. Presentación de un caso y revisión de la literatura / Basophilic degeneration (mucinous) of the myocardium. Presentation of a case and review of literature

Se presentan los hallazgos morfológicos en un paciente fallecido por una miocardiopatía primaria tipo enfermedad cardíaca familiar idiopática con degeneración basófila (mucoide) del miocardio asociada. Se señalan las características estructurales e histoquímicas de la sustancia basófila encontrada, lo que concuerda con lo que aparece informado sobre la misma(AU)