Rotation thromboelastometry velocity curve predicts blood loss during liver transplantation.

BACKGROUND: Patients undergoing liver transplantation (LT) have a high risk of bleeding. The goal of this study was to assess whether the first derivative of the velocity waveform (V-curve) generated by whole blood rotation thromboelastometry (ROTEM®) can predict blood loss during LT. METHODS: Preoperative V-curve parameters were retrospectively evaluated in 198 patients. Patients were divided into quartiles based on blood loss: low (LBL) in the first quartile and high (HBL) in the higher quartiles. A subgroup analysis was performed with patients stratified according to cirrhosis aetiology. A logistic regression model and receiver operator characteristics (ROC) curve were used to test the capacity of the V-curve, to discriminate between LBL and HBL. RESULTS: In the HBL group, the V-curve showed a lower maximum velocity of clot generation (MaxVel), a lower area under maximum velocity curve (AUC), and a higher time-to-maximum velocity (t-MaxVel) than in the LBL group. t-MaxVel was the only parameter showing a capacity to discriminate between the two groups, with a ROC area of 0.69 (95% CI; 0.62-0.74). The ROC area was 0.78 (95% CI; 0.75-0.83) for the 148 patients with cirrhosis, 0.73 (0.60-0.82) for patients with viral hepatitis and 0.83 (0.78-0.96) for patients with alcoholic hepatitis, the group that showed the best discriminative capacity. Moderate but significant correlations were found between all parameters of V-curve and BL. CONCLUSIONS: Pre-transplant V-curve obtained from ROTEM is a promising tool for predicting BL risk during LT, particularly in patients with cirrhosis.

[Incidence of cough after desflurane and sevoflurane administration through a laryngeal mask: a controlled clinical trial]. / Comparación de la incidencia de tos entre desflurano y sevoflurano cuando se utiliza la máscara laríngea. Ensayo clínico controlado.

OBJECTIVE: To determine the incidence of cough with the administration of desflurane and sevoflurane through a laryngeal mask. METHODS: A double-blind controlled clinical trial in 90 patients who received general anesthesia for ear, nose and throat surgery outpatient. The experimental group (n = 45) inhaled desflurane and the control group (n = 45) inhaled sevoflurane. Rugloop simulation software was used to assure that each patient was under the effect of the induction agent (propofol). The Gasman program was used to ascertain that a minimum alveolar concentration of 1 had been achieved before the hypnotic effect of propofol was lost. Cough was evaluated on the Shahbaz scale during the 10 minutes following induction and at the end of the procedure. RESULTS: Cough in the first 10 minutes was recorded in 53.6% of patients in the desflurane group and in 2.4% in the sevoflurane group (P < .05). Between-group differences were also evident at the end of surgery (desflurane group, 24%; sevoflurane group, 9.7%; P< .05). CONCLUSION: The patients who inhaled desflurane through a laryngeal mask had a higher incidence of cough than those who inhaled sevoflurane. The mechanism by which cough is being triggered by desflurane should be studied to determine whether the effect is chemical or mechanical and whether it is acting in the larynx or in the distal portion of the lung.

Difficulty in elucidating the male role in cervical cancer in Colombia, a high-risk area for the disease.

BACKGROUND: Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer. PURPOSE: This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer. METHODS: A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed. Questionnaires included detailed information on sexual behavior. Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis. The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes. Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: Limited education (adjusted odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C. trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives. The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3). Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer. CONCLUSIONS: Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes. These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners. HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV. The role of C. trachomatis in cervical carcinogenesis deserves further investigation. IMPLICATIONS: Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer. HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value.

[Characteristics of mistreatment in medical students of a public university in Peru]. / Características del maltrato hacia estudiantes de medicina de una universidad pública del Perú.

OBJECTIVES: To determine the characteristics of mistreatment among medical students at a public university in the province Ica, Peru. MATERIALS AND METHODS: This cross-sectional study was performed in 2012, and used a probability sample of medical students (freshman to sixth year) at the Universidad Nacional San Luis Gonzaga. A 23-item survey with a Likert scale was used to measure the students' perceptions of psychological, physical, academic and sexual mistreatment. Univariate and bivariate statistical analysis were performed. RESULTS: A total of 281 students were surveyed. The perception of psychological mistreatment was 96.8%; academic, 86.8%; physical, 62.6% and sexual, 20.6%. Physical abuse increased during the clinical-surgical study cicle (p = 0.001). Medical doctors and residents were the main aggressors. Male students reported of receiving assignments as a punishment, not receiving credits for their work, physical mistreatment, verbal threats, insults, or being teased because of their etnic background. Female students were more likely to have experienced sexual abuse. Report of sexual abuse frequently ocurred at the university (45.3%, p=0.002) and hospital (45.0%, p=0.046). Women frequently reported not knowing to whom or where to denounce the abuse (54.6%, p=0.042) and not reporting it because it stopped (56.9%, p=0.048). CONCLUSIONS: There is a high prevalence of abuse among students in which their characteristics as sex, level of study and aggressor allow to identify the types of abuse that they receive.

Human papillomavirus DNA and antibodies to human papillomaviruses 16 E2, L2, and E7 peptides as predictors of survival in patients with squamous cell cervical cancer.

PURPOSE: To assess whether human papillomavirus (HPV) DNA detection in cervical cancer specimens, or antibodies to selected HPV 16 peptides are predictors of tumor recurrence and long-term survival in patients with squamous cell invasive cervical cancer. SUBJECTS AND METHODS: Four hundred seventy-one cases included in two population-based case-control studies underwent follow-up evaluation. The survival and cause of death were ascertained for 410 cases (87%), with a median follow-up time of 4.6 years after diagnosis. HPV DNA was assessed using an L1 polymerase chain reaction (PCR)-based system and Southern hybridization (SH) on scraped cytologic specimens or biopsies. HPV 16 antibodies to E2, L2, and E7 peptides were detected with enzyme-linked immunosorbent assay (ELISA). RESULTS: Clinical stage was the only independent prognostic factor for recurrence or survival. Although seropositivity to HPV 16 E7/3 peptide predicted a twofold excess risk of mortality (adjusted hazards ratio [HRa] = 2.0; 95% confidence interval [CI], 1.2 to 3.3), the association was restricted to stage I (HRa = 6.6; 95% CI, 1.2 to 37.6) and II (HRa = 5.9; 95% CI, 2.1 to 16.5) patients. The presence of HPV DNA (HRa = 0.9; 95% CI, 0.5 to 1.5), different estimates of the HPV viral load and the HPV type identified were not predictors of tumor recurrence or survival. CONCLUSION: The presence of antibodies to HPV 16 E7 proteins is of prognostic value in early-stage cervical cancer. Our results provide strong evidence that detection and typing of HPV DNA in cervical cells or tissues is not a prognostic factor for recurrence or survival.

Prostitution, HIV, and cervical neoplasia: a survey in Spain and Colombia.

The prevalence of cervical intraepithelial neoplasia (CIN) and the association of CIN with prostitution was examined in Oviedo, a region in Spain with low incidence of cervical cancer, and in Cali, Colombia, where the incidence of cervical cancer is 6-10 times higher. In Oviedo, the study included 758 prostitutes attending a sexually transmitted diseases clinic and 1203 nonprostitutes attending a family-planning clinic. In Cali, 775 prostitutes and 1795 nonprostitutes attending health centers were included. Seropositivity to common sexually transmitted agents was investigated in Spanish prostitutes. No significant difference was found in the prevalence of CIN between Oviedo and Cali in both prostitutes (2.5 versus 1.8%) and nonprostitutes (1.2 versus 1.1%). Prostitutes had a 2-fold increased risk of CIN as compared to nonprostitutes; in Spain, the prevalence odds ratio (POR) was 2.3 and the 95% confidence interval (CI) was 1.1-4.5, and, in Colombia, POR was 1.8 and the 95% CI was 0.9-3.5. Among prostitutes in Oviedo, human immunodeficiency virus (HIV) prevalence was 4.9% and HIV-positive prostitutes showed a high risk of CIN as compared to HIV-negative prostitutes (POR, 12.7; 95% CI, 3.9-40.9); 76% of HIV-positive prostitutes were i.v. drug users and showed an increased seroprevalence of other sexually transmitted diseases. HIV-negative prostitutes did not show any increased risk of CIN (POR, 1.2; 95% CI, 0.5-2.8). These results show that among nonprostitutes the prevalence of CIN was not statistically different between the two cities in Spain and Colombia; prostitutes were at moderate increased risk compared to nonprostitutes in both cities.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for cervical intraepithelial neoplasia grade III/carcinoma in situ in Spain and Colombia.

A case-control study of 525 histologically confirmed cases of cervical intraepithelial neoplasia grade III and 512 controls was done in Spain and Colombia to assess the role of various risk factors taking into account the effect of human papillomavirus (HPV). The presence of HPV DNA, assessed by a polymerase chain reaction-based method, was the strongest risk factor identified. In Spain the adjusted odds ratio (OR) and 95% confidence interval (CI) (numbers in parentheses) were 56.9 (24.8-130.6) and, in Colombia, were 15.5 (8.2-29.4). In addition to HPV, the multivariate analysis revealed independent effects of early age at first intercourse (in Spain ORa, 4.3; 95% CI, 2.0-9.3 for ages < 17 versus 20+ years and in Colombia ORa, 9.0; 95% CI, 2.6-30.9 for ages < 14 versus 20+ years), and antibodies to Chlamydia trachomatis (in Spain ORa, 2.3; 95% CI, 1.1-4.5; and in Colombia ORa, 1.7; 95% CI, 1.1-2.7). High parity showed a significant effect only in Colombia (ORa, 2.0; 95% CI, 1.0-5.0 for > or = 6 versus 1) while number of partners of the woman and specially of her husband showed a strong effect in Spain only (ORa, 6.9; 95% CI, 3.1-15.3 for partners of the husband > or = 21 versus 1-5). Smoking and use of oral contraceptives did not show significant or consistent associations. Among HPV-DNA positive women early age at first intercourse and high parity increased the risk of cervical intraepithelial neoplasia III but the effect was statistically significant only for the former.(ABSTRACT TRUNCATED AT 250 WORDS)

Human papillomavirus and cervical intraepithelial neoplasia grade III/carcinoma in situ: a case-control study in Spain and Colombia.

A case-control study of 525 cases of cervical intraepithelial neoplasia grade III (CIN III) and 512 controls was conducted in Spain and Colombia between 1985 and 1988 to assess the role of human papillomavirus (HPV) in the etiology of CIN III. HPV DNA in cytological scrapes from the cervix was assessed by Virapap and by polymerase chain reaction (PCR) based on the L1 consensus primers. A subsample of 268 specimens was also tested for HPV DNA using Southern hybridization. In Spain, the PCR-based prevalences of HPV DNA were 70.7% among cases and 4.7% among controls. Odds ratio (OR) and 95% confidence interval (numbers in parentheses) for HPV DNA were 56.9 (24.8-130.6). In Columbia HPV DNA was detected by PCR in 63.2% of the cases and in 10.5% of the controls. The OR was 15.5 (8.2-29.4). The estimated fractions of CIN III attributable to HPV were 72.4% in Spain and 60.3% in Colombia. HPV 16 was the predominant viral type and showed the strongest association with CIN III; in Spain the OR was 295.5 (44.8-1946.4) and in Colombia the OR was 27.1 (10.6-69.5). HPV DNA of unknown type was frequent in HPV-positive cases (18.3% in Spain and 38.0% in Colombia) and controls (66.7% in Spain and 47.4% in Colombia). The comparison of results from Virapap and PCR indicated that PCR is the method of choice for epidemiological studies. These data strongly support the hypothesis of the viral origin of CIN III, the common etiology of CIN III and invasive cervical cancer, and the causal nature of the association between HPV and CIN III.

Risk factors for progression of cervical intraepithelial neoplasm grade III to invasive cervical cancer.

Data from four case-control studies on invasive cervical cancer and on cervical intraepithelial neoplasia grade III (CIN III) that were concurrently conducted in Spain and Colombia were used to look for factors that might favor the progression from CIN III to the invasive stage. These studies were compared in two ways; a case-case comparison and an estimation of the ratio of odds ratios with the use of of special logistic regression model that took into account the different design of each study and possible confounding factors. Variables studied were human papillomavirus status, viral load, viral types, sexual behavior, sexually transmitted diseases, reproductive patterns, oral contraceptives, and smoking. Both CIN III and invasive cervical cancer have a very similar profile of risk factors and none of them was different in a consistent way to suggest a role in the progression from CIN III to invasive cervical cancer. Some methodological problems such as cohort-specific differences and some selection biases could be adjusted for with a careful statistical analysis. Other problems derived from the cross-sectional nature of the design are unavoidable and should be considered in the interpretation of the results.

Características del maltrato hacia estudiantes de medicina de una universidad pública del Perú / Characteristics of mistreatment in medical students of a public university in Peru

Determinar las características del maltrato hacia estudiantes de Medicina de una universidad pública en la provincia de Ica, Perú. Materiales y métodos. Investigación transversal realizada el 2012 en una muestra probabilística de estudiantes de Medicina de primer a sexto año de la Universidad Nacional San Luis Gonzaga. Se elaboró una encuesta con un total de 23 ítems en una escala likert, para medir la percepción de maltrato de tipo psicológico, físico, académico y sexual; se usaron análisis estadísticos univariados y bivariados. Resultados. Se encuestaron 281 estudiantes. La percepción de maltrato psicológico fue 96,8%, académico 86,8%, físico 62,6% y sexual 20,6%; el maltrato físico se incrementó durante el ciclo de estudio clínico-quirúrgico (p=0,001). Los médicos docentes y médicos residentes fueron los principales agresores. Estudiantes hombres reportaron con mayor frecuencia haber recibido tareas como castigo, no recibir los créditos por su trabajo, maltrato físico, amenazas verbales, insultos o recibir burlas con respecto a su etnia; mientras que el maltrato sexual fue mayor en mujeres. El reporte de maltrato sexual fue más frecuente en la universidad (45,3%, p=0,002) y el hospital (45,0%, p=0,046). Las mujeres reportaron con mayor frecuencia no saber a quién o dónde acudir para denunciar el maltrato (54,6%, p=0,042) y no denunciarlo porque se detuvo el maltrato (56,9%, p=0,048). Conclusiones. Existe una alta prevalencia de maltrato, donde las características de los estudiantes según el sexo, los ciclos de estudio y el agresor permiten identificar los tipos de maltrato que reciben los estudiantes de medicina...

To determine the characteristics of mistreatment among medical students at a public university in the province Ica, Peru. Materials and methods. This cross-sectional study was performed in 2012, and used a probability sample of medical students (freshman to sixth year) at the Universidad Nacional San Luis Gonzaga. A 23-item survey with a Likert scale was used to measure the students' perceptions of psychological, physical, academic and sexual mistreatment. Univariate and bivariate statistical analysis were performed. Results. A total of 281 students were surveyed. The perception of psychological mistreatment was 96.8%; academic, 86.8%; physical, 62.6% and sexual, 20.6%. Physical abuse increased during the clinical-surgical study cicle (p = 0.001). Medical doctors and residents were the main aggressors. Male students reported of receiving assignments as a punishment, not receiving credits for their work, physical mistreatment, verbal threats, insults, or being teased because of their etnic background. Female students were more likely to have experienced sexual abuse. Report of sexual abuse frequently ocurred at the university (45.3%, p=0.002) and hospital (45.0%, p=0.046). Women frequently reported not knowing to whom or where to denounce the abuse (54.6%, p=0.042) and not reporting it because it stopped (56.9%, p=0.048). Conclusions. There is a high prevalence of abuse among students in which their characteristics as sex, level of study and aggressor allow to identify the types of abuse that they receive...

[Laparoscopic treatment of hydatid liver cysts]. / Tratamiento laparoscópico de los quistes hidatidicos hepáticos.

In the treatment of the liver hydatid cyst, many surgical techniques have been used, from aspiration, drainage, marsupialization to the complete excision of the cyst with segmentary liver resection. With the appearance of laparoscopic surgery, new chances for the treatment of liver hydatidoses come to us in this frequent pathology in our country. In this paper we show the laparoscopic technique used in some patients seen by us in the last years. After we made the diagnosis, we gave medical treatment with albendazol 400 mg per day during 90 days, prior to surgery. We also used antibiotic prophylaxis with wide spectrum antibiotics. Surgery was performed with the patient in dorsal decubitus with ports: umbilical; 10 mm for angled optics (30-45 ), epigastric;10 mm, for right subcostal in the mid collar bone position. 5 mm for aspiration and forceps and right subcostal and front axillar line. We performed a diagnostic laparoscopy to visualize the cyst. We introduced soaked gauzes with ClNa 21% surrounding the cyst specially in the more protruded zone. Afterwards we punctured the cyst and took laboratory samples searching for the scolex in the direct exam, then we injected ClNa 21% in the cyst. It stay for 5 minutes and we made rechanges for 4-5 times. We take a piece of the wall cyst and adventicy for pathological examination. We take out the germinative layer and the daughter s hydatides with care to put them in extraction bags to leave out their content in a ClNa 21% recipient. Finally we retrieved the gauzes previously introduced, we suck the remaining fluid and introduce a piece of epiplon inside the residual cavity, fixed with suture points to the border and left a 16F fenestrated probe that is left outside by a lateral port. The postoperative management is the same as the laparoscopic colecystectomy. The oral route begins when the postoperative ileum is over (12 to 24 hours), treatment of the pain, prompt deambulation and discharge in relation of the external drainage (on average after 48 to 72 hours).

The causal link between human papillomavirus and invasive cervical cancer: a population-based case-control study in Colombia and Spain.

To evaluate the association between human papillomavirus (HPV) and cervical cancer, we performed a population-based case-control study in Columbia and Spain, the former country having an incidence rate of cervical cancer about 8 times higher than the latter. It included 436 cases of histologically confirmed invasive cervical cancer and 387 randomly selected population controls. Information on demographic variables, sexual behaviour and other risk factors was obtained by interview. HPV-DNA was measured in cervical-swab specimens with 3 hybridization assays: ViraPap, Southern hybridization (SH) and polymerase chain reaction (PCR). The presence of HPV-DNA and detection of types 16, 18, 31, 33 and 35 were strongly associated with cervical cancer in each country regardless of the assay used. For both countries combined the adjusted odds ratios and 95% confidence intervals were: ViraPap OR = 25.9 (10.0-66.7); SH OR = 6.8 (3.4-13.4); and PCR OR = 28.8 (15.7-52.6). HPV-16 was the most common type detected in both cases and controls. Our results indicate that there is a very strong association between HPV 16, 18, 31, 33 and 35 and invasive cervical cancer and that this association is probably causal.

Cervical cancer and herpes simplex virus type 2: case-control studies in Spain and Colombia, with special reference to immunoglobulin-G sub-classes.

Two case-control studies, including 449 histologically confirmed cases of cervical intra-epithelial neoplasia (CIN) III and 425 controls, and 2 studies on invasive cervical cancer, involving 316 histologically confirmed cases and 330 population controls, were conducted in Colombia and Spain to assess the role of herpes simplex virus type 2 (HSV-2) in cervical neoplasia. Antibodies to this virus were also measured in the sera of 931 husbands of cases and controls. A serological assay using type-specific antigens, glycoprotein C for type I (gC-I) and glycoprotein G for type 2 (gG-2) was employed. Immunoglobulin-G (IgG) sub-classes, IgG1 and IgG3, were measured in women positive for HSV-2 antibodies. No increase in risk of CIN III or invasive cancer was found in women whose sera or whose husbands' sera were positive to HSV-2. However, compared with women negative to HSV-2, the risk of CIN III progressively increased with increasing levels of IgG1. The trend was statistically significant in Colombia. There was also a statistically significant increasing trend in risk of invasive cancer with levels of IgG1 in Spain. The levels of IgG3 and its ratio to IgG1, which may indicate recurrent infections, were not associated with the risk of either type of cancer. When the association with IgG1 was analyzed by human papillomavirus (HPV) DNA status, as determined by polymerase chain reaction, the trend was clearer in women whose HPV status was not determined or in those with negative HPV DNA. These results suggest that the role of HSV-2 is merely marginal and do not support the hypothesis that recurrent HSV-2 infections are of importance for cervical neoplasia.

[Human papilloma virus in the etiology of cervicouterine cancer]. / El virus del papiloma humano en la etiología del cáncer cervicouterino.

The objectives of this study were to confirm the hypothesis that invasive carcinoma of the uterine cervix and the precursors of that condition are most often caused by human papilloma virus (HPV) infections, and to determine whether or not other risk factors are involved in the neoplastic process. For this purpose, four concurrent case-control studies were carried out. Two included cases of invasive cervical cancer and population-based controls. The other two included cases of in situ carcinoma and controls. Research was carried out in nine provinces of Spain and in Cali, Colombia. The identification of cases took place between June 1985 and June 1988. The studies included 436 incident cases of invasive carcinoma and 387 controls, selected at random from the corresponding populations, and 525 cases of in situ carcinoma and 512 controls paired by age, place of recruitment, and date that cytological specimens were taken from the women participating in cytological screening programs. Exposure to HPV was detected through hybridization tests after amplification by polymerase chain reaction (PCR) in exfoliated cervical cells from cases and controls. Exposure to HPV was the principal risk factor in the four studies. For invasive carcinoma, the relative risk and 95% confidence interval were 46.2 (18.5-115.1) in Spain and 15.6 (6.9-34.7) in Colombia. For in situ carcinoma, the figures were 56.9 (24.8-130.6) in Spain and 15.5 (8.2-29.4) in Colombia. This strong association was specific for types 16, 18, 31, 33, and 35 as well as still-unclassified HPV types.(ABSTRACT TRUNCATED AT 250 WORDS)

Adeno-associated virus seropositivity and HPV-induced cervical cancer in Spain and Colombia.

Extensive experimental and limited epidemiologic data suggest that adeno-associated viruses (AAV) can have antioncogenic activity and may be protective factors for the development of cervical cancer. To examine the association between AAV-2 IgG antibodies and cervical neoplasia in Spain and Colombia, we tested for AAV-2 antibodies using an ELISA assay for 109 women with invasive cervical cancer, 100 population-based controls age-matched to the invasive cases, 77 women with carcinoma in situ (CIN III) and 100 clinic-based controls age-matched to the CIN III cases. Human papillomavirus (HPV) DNA was detected in cervical exfoliated cells by polymerase chain reaction using HPV-L1 and GP5+/6+ consensus primers. The prevalence of AAV-2 antibody titers >100 was significantly lower in invasive cervical cancer cases than control participants. When comparing women with invasive cancer with controls or with CIN III cases, a pattern of decreasing cervical cancer risk with increasing AAV-2 titers was observed. Elevated AAV antibody titers (>100) were inversely associated with invasive cervical cancer (OR 0.3; 95% CI 0.1-0.7), although results were not statistically significant after controlling for HPV (OR 0.4; 95% CI 0.1-1.6). In contrast, AAV-2 antibodies were not significantly associated with the risk of CIN III (OR 1.4; 95% CI 0.3-6.8). These results provide supportive evidence that AAV infection may be a protective factor for the development of invasive cervical cancer. Alternatively, the lower AAV-2 seroprevalence in invasive cervical cancer cases may be due to an immunosuppressive effect of cervical cancer on AAV antibody response. To investigate whether a direct viral interaction is occurring, future studies should aim to resolve at what frequency AAV is found in the genital tract and to clarify further whether AAV may infect the same HPV-positive cells in the cervix.

Sexually transmitted agents and cervical neoplasia in Colombia and Spain.

Case-control studies of cervical intra-epithelial neoplasia grade III (CIN III) and of invasive cervical cancer were carried out in Spain and Colombia to assess the relationship between cervical cancer and 6 common sexually transmitted agents (STAs). The CIN-III studies included 525 cases and 512 controls matched for age and for the place of recruitment; the invasive-cancer studies included 373 histologically confirmed cases of squamous-cell carcinoma and 387 age-stratified controls selected randomly from the populations that generated the cases. Antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus type II (HSV-2) and cytomegalovirus (CMV) were tested in 88% of the women. Cervical scrapes were examined for HPV DNA in 63% of the women using a polymerase-chain-reaction assay (PCR). Among controls, the highest antibody prevalence was to CMV (96.5%), followed by HSV-2 (31.4%) and C. trachomatis (23.3%). For all STAs, the sero-prevalence was markedly higher in Colombia than in Spain both for cases and for controls. After adjustment for the presence of HPV DNA, C. trachomatis was the only STA associated with CIN III in both countries; Spain and Colombia. In both countries, the risk of CIN III increased with increasing of C. trachomatis antibody titers. Among Spanish women, an increase in risk of invasive carcinoma was found for those with antibodies to N. gonorrhoeae; those with antibodies to HSV-2 and those with antibodies to C. trachomatis. These associations were present only in HPV-DNA-negative women. Among HPV-DNA-positive women, none of the STAs considered were associated with cervical neoplasia. Our findings could be interpreted as indicating that past infections with HSV-2, N. gonorrhoeae and C. trachomatis are surrogate markers of HPV, but because HPV DNA may have escaped detection, we cannot exclude that these STAs are also of separate etiological significance.

Serological response to HPV16 in CIN-III and cervical cancer patients. Case-control studies in Spain and Colombia.

This study evaluates the association of antibodies against HPV-16-derived peptides with cervical cancer and estimates the sensitivity and specificity of the serological assays in relation to HPV DNA detection in cervical cells by PCR. Study subjects were derived from 4 case-control studies carried out in Spain and Colombia. Sera from 544 cases of CIN III and invasive cancer and of 543 age-matched controls were tested for antibodies to 5 peptides derived from E2, E7 (3 partially overlapping frames of HPV 16 denoted E7/ 1, E7/2, E7/3) and L2 open reading frames of HPV 16. HPV DNA was detected using a L1-PCR based method. Among cancer controls, antibody response to E2 and E7/1, E7/2, E7/3 was higher in Colombia (22.5%,7.2%,11.7%,12.6% respectively) than in Spain (17.1 %, 4.7%, 5.9%, 5.9%). E7 antibodies were related to stage, particularly in CIN III vs. invasive stages and less markedly within invasive stages. Detection of antibodies to the E7/1 was associated to CIN III (OR = 1.8). The risk of invasive cervical cancer was increased among those with antibodies to E2 (OR = 2.2), to E7/1 (OR = 4.2), to E7/2 (OR = 4.3), and to E7/3 (OR = 2.5). Presence of antibodies to all the 3 E7 peptides increased the risk of CIN III (OR = 5.6) and that of invasive cancer (OR = 17.5). High levels of antibodies to E7/1 or E7/2 or E7/3 increased the risk of invasive cervical cancer (OR for high levels of antibodies vs. negatives to E7/1 OR = 22.6; E7/2 OR = 7.5, E7/3 OR = 3.4). In the present analysis, antibodies to L2 were not associated with either CIN III or cervical cancer. Serological markers of HPV 16 detected less than half of the HPV-16-DNA-positive cases. It is concluded that antibodies to E2 and particularly E7 antigens are strongly associated with cervical cancer. Antibodies to E7 seem to be a moderate marker of tumor burden.

Socioeconomic differences in cervical cancer: two case-control studies in Colombia and Spain.

OBJECTIVES: This study examined the causes of socioeconomic differences in invasive cervical cancer in two countries that differ substantially in cervical cancer incidence and economic development. METHODS: Data were derived from two case-control studies carried out in Spain and Colombia; there were 373 case subjects, 387 control subjects, and 425 husbands interviewed with a structured questionnaire. Exfoliated cells were obtained from cervical or penile scrapes and tested for human papillomavirus (HPV) DNA. RESULTS: Relative to better educated women, women with low educational levels in both countries reported fewer Pap smears and had a higher prevalence of HPV DNA. The prevalence ratio of HPV DNA across educational strata was twofold in Spain and fourfold in Colombia. In both countries, husbands of poorly educated women reported higher use of prostitutes than husbands of better educated women. In Colombia, 30% of husbands of poorly educated women harbored HPV DNA, compared with 10% of husbands of better educated women. CONCLUSIONS: Socioeconomic differences in invasive cervical cancer could be partly explained by differences in the prevalence of HPV DNA and by a lower use of preventive care.

Risk factors for HPV DNA detection in middle-aged women.

BACKGROUND AND OBJECTIVES: Strong epidemiologic evidence indicates that human papillomavirus (HPV) is the main etiologic factor of cervical cancer. A few cohort studies suggest that most HPV infections are transient in young women and that persistent HPV infections are more common in older women. Little is known about the determinants of persistent HPV infections. The present study was aimed at increasing our knowledge about these determinants. GOALS: To identify risk factors for genital HPV DNA detection among cytologically normal middle-aged women. STUDY DESIGN: Eight hundred ten women who participated as control subjects in three case-control studies on cervical cancer in Spain, Colombia, and Brazil were included in this study. After an interview, women underwent a gynecologic examination with collection of exfoliated cells for a Papanicolaou smear and HPV DNA detection. Human papilloma virus DNA was detected by polymerase chain reaction (PCR)-based hybridization techniques. RESULTS: The HPV positivity rate was 10.5% in the whole population, but was higher in the areas with high incidence of cervical cancer (17% in Brazil and 13% in Colombia) than in Spain (4.9%), which is a low-risk area for cervical cancer. Age was related to the prevalence of HPV DNA in Brazil, but not in Spain and Colombia. In univariate analyses in all three countries, the prevalence of HPV DNA was positively associated with the number of lifetime sexual partners and inversely associated with the levels of family income and with age at first sexual intercourse. There was four times increase in the odds ratio (OR) of HPV infection in women who had six or more lifetime sexual partners compared with those with one or less. The use of any kind of contraceptive tended to decrease the OR for HPV detection. Their ORs ranged from 0.44 (barrier methods) to 0.48 (oral contraceptives). In Spain and Colombia, antibodies against Chlamydia trachomatis were positively associated with the prevalence of HPV DNA. In a final multivariate model, the positive associations with lifetime number of sexual partners, socioeconomic status, and C. trachomatis persisted. CONCLUSIONS: These results support the sexual transmission of HPV and suggest that socioeconomic status and antibodies to C. trachomatis are independent predictors of HPV detection in middle-aged cytologically normal women.