Prevalence of sexually transmitted infections and human papillomavirus in cervical samples from incarcerated women in São Paulo, Brazil: a retrospective single-center study.

Introduction: Sexually transmitted infections (STIs) cause considerable morbidity worldwide and, depending on the specific pathogen, may lead to serious complications in the female reproductive tract. Incarcerated women are particularly vulnerable to health problems with a disproportionate high rate of STIs, including infections with human papillomavirus (HPV). Methods: Here, cervical swab samples collected from 299 women (18 to 64 years) living in one of the women's prisons of São Paulo, Brazil were submitted for liquid-based cytology to determine the prevalence of precancerous lesions. Furthermore, direct detection of 30 genital HPV genotypes (18 high-risk and 12 low-risk types) and 11 additional STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium and hominis, Treponema pallidum, Trichomonas vaginalis, Ureaplasma parvum and urealyticum) were performed by molecular typing using two PCR-based DNA microarray systems, i.e., EUROArray HPV and EUROArray STI (EUROIMMUN), respectively. Results: The overall prevalence of cytological abnormalities was 5.8%, including five women with low-grade and five women with high-grade squamous intraepithelial lesions. The overall prevalence of HPV was 62.2, and 87.1% of the HPV-positive women were infected with oncogenic high-risk (HR) HPV types. HPV types 16 (24.1%), 33 and 52 (both 10.4%) were the most frequently detected. The prevalence of the other STIs was 72.8%. Up to four different pathogens were found in the infected women, the most frequent being Ureaplasma parvum (45.3%), Mycoplasma hominis (36.2%) and Trichomonas vaginalis (24.8%). Conclusion: The high number of HR-HPV infections and other STIs described here highlights the fact that the Brazilian female prison population requires more attention in the country's health policies. The implementation of screening programs and treatment measures might contribute to a decrease in the incidence of STIs and cervical cancer in this vulnerable population. However, for such measures to be effective, further studies are needed to investigate the best practice to get more women to engage in in-prison prevention programs, e.g., through offering further sexual health education and self-sampling.

Cytomorphometric Evaluation of Oral Mucosa of Patients with Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is a rare genetic disorder in which patients progressive muscle deterioration and low life expectancy. Since DMD has no cure, treatment slows the deterioration process using corticosteroids and other medications, including oral bisphosphonates (BP). These drugs can lead to toxicities in both soft and hard tissues. The objective of this study was to present cytological changes in DMD patients, comparing to young, healthy individuals. Cytological smears were obtained from buccal mucosa from nine DMD patients and five healthy patients. The Papanicolaou technique was used to stain the slides. Images were captured using a photomicroscope, and 50 clearly defined cells were selected. The size and ratio between the nucleus and cytoplasmic areas (NA/CA) diameter were measured using a computer program. All the DMD patients presented a statistical difference (p < 0.0001) in the size of the cytoplasm (0.60 ± 0.33 µm) and the NA/CA ratio (0.17 ± 0.07 µm) was seen when compared to the control group (cytoplasm 0.60 ± 0.15 µm and nucleus 0.14 ± 0.05 µm). Furthermore, in one DMD in use of BP who presented Medication-Related Osteonecrosis of the Jaw (MRONJ), presented higher differences in the cytoplasmic (1.20 ± 0.65 µm) and nuclear (0.20 ± 0.12 µm) sizes (p < 0.0001) compared with all others DMD patients. These results suggest that the drugs used or the systemic condition of individuals with DMD may contribute to these changes.

Efeitos de exercícios físicos sobre fatores de risco cardiovascular em idosos hipertensos / Efectos de los ejercicios físicos en los factores de riesgo cardiovascular de mayores hipertensos / Effects of physical exercise on cardiovascular risk factors in hypertensive older adults

OBJETIVO: Avaliar os efeitos de um programa de exercícios na redução dos fatores de risco cardiovascular em idosos sedentários e hipertensos. MÉTODOS: Trata-se de ensaio clínico não randomizado, realizado em uma clínica escola de fisioterapia em São Paulo, em 2016, com amostra de 34 idosos que realizaram um programa de exercícios de noventa minutos, duas vezes por semana, durante o período de três meses. As variáveis avaliadas foram: pressão arterial, índice de massa corporal, frações de colesterol, colesterol total e triglicérides. Houve comparação dos dados em dois momentos, antes do início e ao término do programa de exercícios, considerando-se p<0,0001 em todos os casos pelo teste de Wilcoxon. RESULTADOS: Encontrou-se idade mediana dos avaliados (intervalo interquartis) de 63 (61-66) anos, sendo 25 (74%) do sexo feminino. Após três meses, houve redução estatisticamente significativa do peso, índice de massa corpórea, pressão arterial sistólica (PAS) e diastólica (PAD) dos idosos avaliados (p < 0,0001 em todos os casos). CONCLUSÃO: O efeito do programa de exercícios foi eficaz na redução dos fatores de risco cardiovascular dos idosos sedentários e hipertensos estudados. (AU)

OBJECTIVE: To assess the effects of an exercise program on the reduction of cardiovascular risk factors in sedentary hypertensive older adults. METHODS: This is a nonrandomized clinical trial carried out in a physical therapy teaching clinic in São Paulo in 2016 with a sample of 34 older adults who performed a ninety-minute exercise program twice a week for three months. The analyzed variables were: blood pressure, body mass index, cholesterol fractions, total cholesterol and triglycerides. Data were compared in two stages, before and after the exercise program, with p<0.0001 in all cases using the Wilcoxon test. RESULTS: The median age of the participants (interquartile range) was 63 (61-66) years, with 25 (74%) women. After three months, there was a statistically significant reduction in weight, body mass index, systolic (SBP) and diastolic blood pressure (DBP) in the analyzed older adults (p<0.0001 in all cases). CONCLUSION: The exercise program was effective in reducing cardiovascular risk factors in the sedentary hypertensive older adults analyzed. (AU)

OBJETIVO: Evaluar los efectos de un programa de ejercicios para la disminución de los factores de riesgo cardiovascular de mayores sedentarios e hipertensos. MÉTODOS: Se trata de un ensayo clínico no randomizado realizado en una clínica escuela de fisioterapia de São Paulo, en 2016, con una muestra de 34 mayores que realizaron un programa de ejercicios de noventa minutos, dos veces a la semana durante el período de tres meses. Las variables evaluadas fueron: la presión arterial, el índice de masa corporal, las fracciones de colesterol, el colesterol total y los triglicéridos. La comparación de los datos se dio en dos momentos: antes del inicio y al final del programa de ejercicios con p<0,0001 para todos los casos a través del test de Wilcoxon. RESULTADOS: La edad mediana de los evaluados (intervalo intercuartil) fue de 63 (61-66) años y 25 (74%) años para el sexo femenino. Tras tres meses hubo reducción estadísticamente significativa del peso, el índice de masa corporal y la presión arterial sistólica (PAS) y diastólica (PAD) de los mayores evaluados (p < 0,0001 para todos los casos). CONCLUSIÓN: El efecto del programa de ejercicios ha sido eficaz para la reducción de los factores de riesgo cardiovascular de los mayores sedentarios e hipertensos estudiados. (AU)

Frequência e genotipagem do papilomavírus humano em mulheres submetidas à citologia oncótica / Frequency and genotyping of human papillomavirus in women submitted to citology

Dentre os vírus de transmissão sexual, o papilomavírus humano (HPV) é o mais prevalente, podendo ser detectado em considerável número de mulheres sexualmente ativas. Ele é considerado o principal agente causador do câncer do colo do útero. Portanto, a identificação do HPV de alto risco pode auxiliar na prevenção de lesões do colo uterino. Objetivo: Avaliar a ocorrência de infecções pelo HPV, comparando diferentes metodologias, assim como alguns fatores de risco e seu potencial de associação no desenvolvimento do câncer do colo uterino em mulheres submetidas à citopatologia atendidas nos ambulatórios da Unidade de Saúde Familiar e Comunitária (USFC) da Universidade do Vale do Itajaí (UNIVALI). Métodos: Foram avaliadas 118 amostras de mulheres sexualmente ativas que buscaram atendimento para rastreio do câncer cervical na USFC e da UNIVALI. Todas as amostras foram submetidas à reação em cadeia da polimerase (PCR) e às citologias líquida e convencional. Entretanto, apenas 64 mulheres foram submetidas à metodologia de captura híbrida (CH2). Resultados: A prevalência do HPV foi de 43,22% pela técnica de PCR e de 25% pela CH2; na análise dos resultados observou-se associação do HPV com as seguintes variáveis: etnia (p<0,016), escolaridade (p<0,012), vírus da imunodeficiência humana (HIV) (p<0,008), preservativo (p<0,02),anticoncepcional (p<0,03), início da atividade sexual (p<0,07), citologia convencional (p<0,002) e citologia líquida (p<0,029). Conclusão: A ocorrência de infecção pelo HPV é elevada e o HPV de alto risco foi principalmente associado ao início precoce da atividade sexual

Among the sexually transmitted virus, the human papilloma virus (HPV) is the most prevalent and may be detected a considerable number o fsexually active women. He is considered the main agent of cervical cancer. Therefore, the high-risk HPV identification can aid in the prevention of cervical lesions. Objective: To evaluate the occurrence of HPV infections, comparing different methodologies, as well as some risk factors and their potential association in the development of cervical cancer in women submitted to cytopathology treated in ambulatory Unit Family and Community Health (USFC) ofthe University of Vale do Itajaí (UNIVALI). Methods: 118 samples were evaluated sexually active women who sought care for screening of cervical cancerin USFC and UNIVALI. All samples were subjected to polymerase chain reaction (PCR) and the liquid and conventional cytology. However, only 64 women were subjected to hybrid capture methodology (CH2). Results: The prevalence of HPV was 43.22% by PCR and 25% for CH2; analysis of the results was observed association between HPV and the following variables: ethnicity (p<0.016), scholarity (p<0.012), human immunodeficiency virus (HIV) (p<0.008),preservative (p<0.02), oral contraceptives (p<0.03), younger age at first sexual intercourse (p<0.07), conventional cytology (p<0.002) and liquid cytology(p<0.029). Conclusion: The incidence of HPV infection is high and the high-risk HPV was primarily associated with the younger age at first sexual intercourse.

MMP-9/RECK Imbalance: A Mechanism Associated with High-Grade Cervical Lesions and Genital Infection by Human Papillomavirus and Chlamydia trachomatis.

BACKGROUND: Matrix metalloproteinases (MMP) are important enzymes in the tumor microenvironment associated with progression of cervical intraepithelial neoplasia (CIN) toward squamous cell carcinoma (SCC) of the cervix. However, the role of MMPs in the inflammatory process associated with Chlamydia trachomatis infection concomitant with the carcinogenic process driven by HPV has not yet been addressed. In the present study, we analyzed the state of the MMP-9-RECK axis in cervical carcinogenesis. METHODS: The levels of MMP-9 and RECK expression were analyzed by immunocytochemistry in liquid-based cytology samples from 136 women with high-grade cervical lesions (CIN2/CIN3) and cervical SCC diagnosed by LLETZ, and in 196 women without cervical neoplasia or CIN1. Real-time qPCR was performed to analyze expression of MMP-9 and RECK in 15 cervical samples. The presence of HPV-DNA and other genital pathogens was evaluated by PCR. RESULTS: We found a higher expression of MMP-9 [OR, 4.2; 95% confidence interval (CI), 2.2-7.8] and lower expression of RECK (OR, 0.4; 95% CI, 0.2-0.7) in women with CIN2/CIN3/SCC when compared with women from the control group (no neoplasia/CIN1). A statistically significant association was also found between MMP-9/RECK imbalance and infection by alpha-9 HPV and C. trachomatis. The prevalence of C. trachomatis infection was significantly higher in women with high-grade cervical disease (OR, 3.7; 95% CI, 1.3-11.3). CONCLUSIONS: MMP-9/RECK imbalance in cervical smears is significantly associated with high-grade cervical diseases and infection by alpha-9 HPV and C. trachomatis. IMPACT: MMP-9/RECK imbalance during cervical inflammation induced by C. trachomatis might play a role in HPV-mediated cervical carcinogenesis.

MMP-9 expression increases according to the grade of squamous intraepithelial lesion in cervical smears.

Studies about cervical carcinogenesis have demonstrated the increased expression of matrix-metalloproteinase (MMP) according to the grade of cervical intraepithelial lesions. Considering the importance of innovative techniques to introduce noninvasive and rapid diagnoses for patients, this study aimed to perform MMP-9 immunocytochemistry in cervical smears according to the cytopathological diagnoses, in order to monitor MMP activity in cervical smears. This cross-sectional study investigated the expression of MMP-9 in normal cervical smears, inflammatory cervical smears, squamous intraepithelial lesions, and cervical carcinoma. Cervical smears from 630 women were collected for cytopathological diagnoses and immunocytochemistry. Women with squamous intraepithelial lesions showed an increase in MMP-9 expression, with moderate to intense staining occurring with increasing cervical lesion grade. The prevalence of moderate to intense MMP-9 staining was 9% in normal cervical smears, 12% in cervical inflammation, 24% in low-grade squamous intraepithelial lesion (LSIL), 92% in high-grade squamous intraepithelial lesions (HSIL) and 100% in cervical carcinoma cases. In the specific case of LSIL, we found that association with MMP-9 is more evident when there is the simultaneous presence of an infectious agent. Thus, the expression of MMP-9 in cervical smears increases according to the grade of cervical lesion and LSIL in the presence of infectious agents showed higher MMP-9 expression than women with LSIL without infectious agents.

Liquid-Based Medium Used to Prepare Cytological Breast Nipple Fluid Improves the Quality of Cellular Samples Automatic Collection.

BACKGROUND: Breast cancer is the second cause of death in women worldwide. The spontaneous breast nipple discharge may contain cells that can be analyzed for malignancy. Halo® Mamo Cyto Test (HMCT) was recently developed as an automated system indicated to aspirate cells from the breast ducts. The objective of this study was to standardize the methodology of sampling and sample preparation of nipple discharge obtained by the automated method Halo breast test and perform cytological evaluation in samples preserved in liquid medium (SurePath™). METHODS: We analyzed 564 nipple fluid samples, from women between 20 and 85 years old, without history of breast disease and neoplasia, no pregnancy, and without gynecologic medical history, collected by HMCT method and preserved in two different vials with solutions for transport. RESULTS: From 306 nipple fluid samples from method 1, 199 (65%) were classified as unsatisfactory (class 0), 104 (34%) samples were classified as benign findings (class II), and three (1%) were classified as undetermined to neoplastic cells (class III). From 258 samples analyzed in method 2, 127 (49%) were classified as class 0, 124 (48%) were classified as class II, and seven (2%) were classified as class III. CONCLUSION: Our study suggests an improvement in the quality and quantity of cellular samples when the association of the two methodologies is performed, Halo breast test and the method in liquid medium.

Can breast nipple fluid collected with automated aspiration and preserved in based-liquid solution improve the cytological samples?

OBJECTIVE: Samples from breast nipples collected with the automated HALO™ Mamo Cito Test were studied in order to evaluate the cellularity for the diagnosis of breast cancer. STUDY DESIGN: One hundred and fifty-nine asymptomatic women were prospectively examined. Women younger than 18 years, pregnant or lactating women, and women with a history of breast cancer, with previous radio- or chemotherapy and with nipple piercing were excluded from the study. Nipple samples from both breasts were collected. RESULTS: In 107 (34.96%) of the 306 samples of nipple discharge analyzed by optical microscopy, adequate cellularity was observed after the HALO procedure. Cytological findings, previously categorized according to the National Health Service Breast Screening Program (NHSBSP), were grouped as unsatisfactory, benign, suspected for malignancy, and malignant. Of the cellular breast samples, 97.19% (104/107) were classified as benign, and 2.81% (3/107) were classified as suspicious for malignancy. In 199 cases there were samples without cells (65.03%). Most of the cells observed were easily recognized as well-preserved and adequately stained macrophages. None of the women reported discomfort with the nipple aspiration procedure. CONCLUSIONS: The results discussed here encouraged us to use samples collected automatically in routine procedures.

Oral infection by the Human Papilloma Virus in women with cervical lesions at a prison in São Paulo, Brazil.

UNLABELLED: Carcinoma of the head and neck is the 6th cause of death by cancer in the world. In recent decades the human papillomavirus (HPV) has been implicated in the etiology of this disease. OBJECTIVE: To characterize the types of HPV detected in the oral mucosa in women with cytological abnormalities suggesting intraepithelial squamous lesions in the uterine cervix. METHODS: Four-hundred-nine cervical-vaginal and oral pap-smears of women interned in a Female Prison in São Paulo were examined. The relationship between cervical and oral lesion was analyzed by PCR/RFLP and DNA sequencing. RESULTS: Of 27 (6.67%) specimens showing cervical cytological abnormalities suggesting LSIL and HSIL, 22 (81.48%) had oncogenic high-risk HPV infection, of which HPV 59 was the most prevalent. Three (11.1%) samples showed cytological changes suggesting mild dysplasia in the oral cavity. CONCLUSION: Our study suggests an association between carcinoma of the oral cavity and HPV infection, regardless of the virus type.

Infecção oral pelo HPV em mulheres com lesão escamosa de colo uterino no sistema prisional da cidade de São Paulo, Brasil / Oral infection by the Human Papilloma Virus in women with cervical lesions at a prison in São Paulo, Brazil

O carcinoma de cabeça e pescoço é 6ª maior causa de mortes por neoplasia no mundo. Nas últimas décadas, tem-se associado a relação da infecção pelo Papilomavírus Humano (HPV) e seu envolvimento na etiologia desta doença, bem como acontece com o câncer de colo de útero. OBJETIVO: A caracterização molecular dos tipos de HPV diagnosticados na mucosa oral de mulheres que apresentavam alterações citológicas compatíveis com lesão escamosa no colo uterino. MÉTODOS: Foram estudadas 409 amostras cérvico-vaginais e de cavidade oral de mulheres internas no Presídio Feminino da cidade de São Paulo. A correlação entres lesões cervicais e orais foram avaliadas em 27 mulheres que apresentavam lesões pré-malignas e malignas no colo uterino pela caracterização molecular dos tipos de HPV por PCR/ RFLP e Sequenciamento. RESULTADOS: Das 27 (6,67%) amostras compatíveis com LSIL e HSIL no colo uterino, 22 (81,48%) apresentaram infecção pelo HPV de alto risco oncogênico, sendo o HPV 59 o mais prevalente, dentre elas, três amostras (11,1%) evidenciaram alterações celulares compatíveis com displasia leve na cavidade oral. CONCLUSÃO: Nosso estudo sugere uma relação entre o desenvolvimento de lesões da cavidade oral e a infecção pelo HPV, independentemente do tipo viral presente.

Carcinoma of the head and neck is the 6th cause of death by cancer in the world. In recent decades the human papillomavirus (HPV) has been implicated in the etiology of this disease. OBJECTIVE: To characterize the types of HPV detected in the oral mucosa in women with cytological abnormalities suggesting intraepithelial squamous lesions in the uterine cervix. METHODS: four-hundred-nine cervical-vaginal and oral pap-smears of women interned in a Female Prison in São Paulo were examined. The relationship between cervical and oral lesion was analyzed by PCR/RFLP and DNA sequencing. RESULTS: Of 27 (6.67%) specimens showing cervical cytological abnormalities suggesting LSIL and HSIL, 22 (81.48%) had oncogenic high-risk HPV infection, of which HPV 59 was the most prevalent. Three (11.1%) samples showed cytological changes suggesting mild dysplasia in the oral cavity. CONCLUSION: Our study suggests an association between carcinoma of the oral cavity and HPV infection, regardless of the virus type.