Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil.

Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N = 160), (ii) "Self&HPV" (self-collection for HPV testing) (N = 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N = 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) who selected Pap] in the Choice arm, and 100% in the Self&HPV arm completed screening. By the second invitation to choose a method of screening in the Choice arm, 100% completed screening. After three invitations, 75.0% of women in the Pap arm completed screening. Adherence to screening differed by study arm (P < 0.001). In conclusion, Self&HPV testing is a promising strategy for unscreened/underscreened women who are recalcitrant or unable to undergo clinic-based cervical screening to complement the screening modality used in the general population. In Brazil, where Pap testing is recommended for routine cervical screening, training CHWs in behavior change strategies and offering Self&HPV or Choice could greatly improve screening population coverage by reaching the unscreened/underscreened populations.

Detection of Human Papillomavirus among Women with Atypical Squamous Cells of Undetermined Significance Referred to Colposcopy: Implications for Clinical Management in Low and MiddleIncome Countries.

To determine the prevalence of human papillomavirus (HPV) among women with atypical squamous cells of undetermined significance (ASC-US) referred to colposcopy and the implications for clinical management in low- and middle-income countries (LMIC), the present study was conducted. We included 200 women living in Maringa÷Brazil referred to colposcopy service between August 2012 and March 2013 due to an abnormal cytology from ASC-US until high-grade intraepithelial lesion (HSIL). HPV was detected and genotyped by polymerase chain reaction (PCR). The mean age was 36.8±10.5 years, and women with and without ASC-US had similar mean ages (37.4±11.5 and 36.4±9.96 years, respectively). The highest prevalence of ASC-US occurred at 20-24 years (40%). HPV-DNA was positive in 164 (82.0%) women.Of the 57 women with ASC-US, 30 (52.6%) were HPV-DNA-positive and 21 (70%) were high-risk HPV-positive (HR-HPV); the latter was similar to women without ASC-US (76.9%) but with other abnormal cytological findings present. Our data demonstrated that performing tests for HR-HPV can be used for management of women with ASC-US to support the decision of which women should be referred for an immediate or later colposcopy. The same conclusions can be applied to other LMICs for which HPV testing for primary screening has not been adopted.

Association of human papillomavirus, Neisseria gonorrhoeae and Chlamydia trachomatis co-infections on the risk of high-grade squamous intraepithelial cervical lesion.

The link between high-risk human Papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) in the risk of developing cervical cancer still unclear. Thus, in this report we investigated the rates of co-infections between HPV and other important non-HPV STDs in different cervical findings using a multiplex polymerase chain reaction (M-PCR) to simultaneously detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, HSV-1 and -2, and Treponema pallidum. A total of 838 women aged 18 to 68 years were screened using Papanicolaou smears for cervical abnormalities, HPV and non-HPV STDs using PCR and M-PCR methods. A total of 614 (73.3%) of the women had normal cytology (NILM) and 224 (26.7%) women exhibited abnormal cytology (≥ ASC-US). HPV-DNA prevalence was 33.9%, and HPV-16 was the most prevalent genotype in women with NILM and ≥ ASC-US cytology. Non-HPV STDs were detected in 30.4% women and T. vaginalis was the most prevalent one (11.6%). A higher increased risk of ≥ ASC-US and HSIL occurred in co-infections of HR-HPV with C. trachomatis and N. gonorrhoeae. Co-infections of HPV-DNA and HR-HPV with HSV-2 exhibited a similar increased risk but only with ≥ ASC-US. Co-infections of HPV-DNA and HR-HPV with T. vaginalis demonstrated a similar increased risk of ≥ ASC-US and HSIL. We found that C. trachomatis and N. gonorrhoeae were the primary pathogens associated with HR-HPV for the increased risk for all grades of cervical abnormalities but mainly for HSIL, suggesting a possible synergistic action in cervical lesions progression. Our results reinforce the hypothesis that some non-HPV STDs might play a role as co-factors in HPV-mediated cervical carcinogenesis. These data improve our understanding of the etiology of SCC and may also be useful for disease prevention.

[Anemia and birthweight]. / Anemia e peso ao nascer.

OBJECTIVE: To verify the influence of Low Birthweight (LBW) on child anemia and malnutrition during the first year of life. METHODS: Sample population included all children under one year seen at Health Units of the municipality of Maringá, southern Brazil, in 1998. Total sample size was 587 children. LBW was defined as birthweight below 2 500 g. The analysis of growth for the weigh-for-age and height-for-age indicators was based on National Center for Health Statistics standards. For anemia diagnosis, a biochemical hemoglobin concentration dosage, using HemoCue direct colorimetric method was employed. Children with [Hb] <11,0 g/dL were considered as anemic. RESULTS: Fifty-eight percent of the studied population were anemic, and 37 children (6.3%) presented LBW. Anemia was more prevalent during the second semester of life (p=0.0093). Undernutrition, as indicated by the height-for-age indicator, was high especially for children aged 0-3 months with LBW. CONCLUSIONS: Although LBW rates among the studied population were similar to those of developed countries, we suggest the implementation of specific antenatal care for high-risk women, aiming at reducing LBW, an event that affects the child, hampering its growth and increasing the risk of anemia and its countless deleterious consequences.

Molecular detection of HPV and Chlamydia trachomatis infections in Brazilian women with abnormal cervical cytology.

The question of whether Chlamydia trachomatis (Ct) is a cofactor for human Papillomavirus (HPV) in cervical carcinogenesis is still controversial. We conducted a molecular detection study of both infections in 622 Brazilian women, including 252 women with different grades of abnormal cervical cytology and cervical cancer (CC; cases) and 370 women with normal cytology (controls). Although Ct infection did not seem related to CC carcinogenicity, women with abnormal cytology had a significant high rate of Ct infection. Therefore, it is important to adopt protocols for diagnosis and treatment of this bacterium in conjunction with screening for CC in this population.

Anemia e peso ao nascer / Anemia and birthweight

OBJETIVO: Verificar a influência do baixo peso ao nascer (BPN) na anemia e desnutriçäo da criança, ao longo do primeiro ano de vida. MÉTODOS: A populaçäo amostral foi constituída por todas as crianças menores de um ano de idade atendidas nas unidades de saúde do Município de Maringá, PR, em 1998, num total de 587. Considerou-se baixo peso ao nascer, todas as crianças com peso <2.500 g. O estudo do crescimento para o indicador peso/idade e altura/idade teve como referência o padräo NCHS (National Center for Health Statistics). Para o diagnóstico da anemia, utilizou-se a dosagem bioquímica da concentraçäo de hemoglobina pelo método colorimétrico direto, HemoCue. Foi considerada anêmica toda a criança com [Hb] <11,0 g/dL. RESULTADOS: Da populaçäo total, 58por cento eram crianças anêmicas e 37 (6,3por cento) apresentaram baixo peso ao nascer; a anemia foi mais prevalente no segundo semestre de vida (p=0,0093). A desnutriçäo identificada pelo índice altura/idade apresentou-se elevada especialmente para as crianças de zero a três meses nascidas de baixo peso. CONCLUSOES: O índice de baixo peso ao nascer na populaçäo estudada apresenta um percentual semelhante ao de países desenvolvidos. Sugere-se a implementaçäo de um serviço de pré-natal para as mulheres de risco visando à reduçäo desse evento que afeta a criança, dificultando o seu crescimento e aumentando o risco de anemia e suas inúmeras conseqüências deletérias

Adenocarcinoma endocervical in situ: relato de caso / Adenocarcinoma endocervical in situ: a case report

Os casos de neoplasia glandular endocervical têm sido pouco relatados, descrevendo principalmente as características histopatológicas. Pouca atençao tem sido dada aos aspectos citopatológicos. De todos os cânceres de colo uterino, a incidência de adenocarcinoma, conforme a literartura, varia de 5,5 por cento a 25 por cento. Foi detectado, pelo exame colpocitológico de rotina, um caso de adenocarcinoma in situ. No presente relato as características citológicas foram correlacionadas com os aspectos clínicos e histopatológicos.