A novel next generation sequencing assay as an alternative to currently available methods for hepatitis C virus genotyping.

Chronic HCV infection is one of the leading causes of liver-related death and in many countries it is a primary reason for having a liver transplant. HCV genotype identification has long been used in the clinical practice, since different genotypes have different response rates and required different doses and durations of IFN/RBV treatment; moreover both the frequency and the pattern of resistance to different Direct-Acting Antivirals (DAAs) classes are subtype specific. Hence the necessity to make an accurate HCV subtyping becomes a fundamental tool to optimize current and future clinical management of HCV infected subjects. In the present study the performance of a next generation sequencing (NGS: based on the Ion Torrent Platform-Vela Sentosa SQ 301 sequencer) HCV genotyping assay has been evaluated. The current method targets a region of the NS5B gene and it is the unique NGS based market CE-IVD assay. As a comparative method a commercial method based on the detection via reverse hybridization of 5'UTR and core regions (Versant HCV Genotype 2.0 Assay, LiPA, Siemens) was selected. A total 207 plasma samples from HCV infected individuals were used. No selection was made for these samples that were submitted for routine HCV genotyping. The results show Vela NGS assay assigns major number of HCV subtypes with respect LiPA. Concerning genotype 1 and 3, the discrepancy of assigned subtypes for LiPA with respect to Vela NGS assay is not relevant (1.8% and 2%, respectively); in contrast, the difference of assigned subtypes for genotypes 2 and 4 is very high (96.6% and 100%, respectively). The resistance mutations data, except for 1a and 1b subtypes, remain scarce; the future relevant challenge will be to identify subtypes-specific drug resistance mutations, which are essential to create highly personalized therapeutic pathways.

Câncer de pênis em jovem de 23 anos associado a infecção por HPV 62 - relato de caso / Penile cancer in a 23-year-old ossociated with HPV 62 infection - Case Report

Introdução: o câncer de pênis é uma doença maligna rara, de alta morbidade e mortalidade, que acomete principalmente homens com idade avançada. Tem pico de incidência na sétima década de vida, muito raro em jovens. Em alguns países da África, da Ásia e da América do Sul, representa cerca de 10% das doenças malignas que acometem homens. No Brasil, o câncer de pênis representa 2% do total de cânceres em homens e é mais frequente nas regiões Norte e Nordeste do país, onde a taxa de incidência varia entre 1,3 a 2,7 por 100.000. Má higiene peniana, retenção de esmegma, e fimose são consideradas fatores de risco para câncer de pênis.Em populações que praticam circuncisão, a incidência de câncer de pênis é baixa mesmo em países pouco desenvolvidos como Nigéria e Índia. Há muitos estudos na literatura apontando como provável causa a infecção pelo HPV, tendo como provável precursor inicial a lesão verrucosa inicial. Relato de caso: paciente E.G.S.,masculino, 23 anos, branco, católico, não estuda, trabalha com telefonia, natural de Osasco (SP) e procedente de Barueri (SP). É casado e não tem filhos. O paciente relata que possuía fimose desde a infância, que impossibilitava a exposição completa da glande. Em novembro de 2010 relata surgimento de nódulo de 1 cm de diâmetro no pênis. Foi realizada postectomia em 24 de fevereiro de 2011 para tratamento de fimose, durante a qual se realizou biópsia da lesão, diagnosticada como carcinoma epidermoide grau III. Estudo biomolecular apontou infecção por HPV 62. Foi realizada penectomia parcial para retirada da lesão em 21/03/2011. No momento da cirurgia, a lesão já se apresentava com 7 x 5 x 4 cm, com lesão úlcero-infiltrativa de 3 x 5 cm, distante 1 cm do óstio uretral. Discussão: nosso paciente apresentava fimose que impossibilitava a exposição completa da glande desde a infância, prejudicando a higiene peniana. A fimose predispõe à retenção de células descamativas e resíduos da urina (esmegma) que podem causar irritação crônica com ou sem infecção bacteriana da glande ou do prepúcio. A circuncisão diminui achance de contrair doenças venéreas, infecções do trato urinário e possibilita melhor higiene. Além disso, está associada a menor incidência de HPV, que se mostra como importante fator de risco para o desenvolvimento do câncer peniano. Observou-se profunda redução na persistência do vírus entre pacientes circuncidados, de até 90%, sendo importante na resolução da infecção e proteção contra a malignização. O HPV 62 foi encontrado em pacientes do sexo feminino, causando lesõeses camosas intraepiteliais de alto grau, compatíveis com lesões dos subtipos mais oncogênicos de HPV.

Introduction: cancer of the penis is a rare malignant disease, causing high morbidity and mortality, which mostly affects elderly men. It has a peak incidence in the seventh decade of life, very rare in young people. In some countries in Africa, Asia and South America represents about 10% of the malignancies that affect men. In Brazil, penile cancer represents 2% of all cancers in men and is most common in the north and northeast of the country,where the incidence rate varies from 1.3 to 2.7 per 100.000. Poor penile hygiene, smegma retention, and phimosis are considered risk factors for penile cancer. In populations that practice circumcision, the incidence of penile cancer is low, even in underdeveloped countries like Nigeria and India. There aremany studies in the literature pointing HPV infection as the probable cause, with the probable initial precursor the initial verrucosa. Case report: patient E.G.S., male, 23 years, white, catholic, without studying, working with telephony, native from Osasco (SP), born in Barueri (SP). He is married and has nochildren. The patient reports that he had had phimosis since childhood, which precluded complete exposure of the glans. In November 2010 reported the appearance of a nodule with 1 cm in diameter in the penis. Circumcision was performed on February 24, 2011 for the treatment of phimosis, and a biopsy was performed during the treatment, diagnosed as squamous cell carcinoma grade III. Biomolecular study showed HPV 62 infection. Partial penectomy was performed to remove the injury on 21/03/2011. At surgery, the injury already had with 7 x 5 x 4 cm, ulcerative-infiltrative lesion of 3 x 5 cm, 1 cm away fromthe urethral orifice. Discussion: our patient had phimosis which precluded complete exposure of the glans in childhood, affecting penile hygiene. Phimos is predisposes to squamous cell and urine and waste (smegma) retention, that can cause chronic irritation with or without bacterial infection of the glans orforeskin. Circumcision decreases the chance of contracting sexually transmitted diseases, urinary tract infections and provides better hygiene. It is also associated with lower incidence of HPV, which shows it self as an important risk factor for the development of penile cancer. There was dramatic reductionin the persistence of the virus among circumcised patients, up to 90%, being important in the resolution of infection and protection against malignancy. The HPV 62 was found in female patients, causing squamous intraepithelial lesions of high degree, compatible with lesions of more oncogenic subtypes of HPV.

Urethral vs suprapubic catheter following open prostatectomy: surgeon's choice / Catéter uretral vs suprapúbico después de prostatectomía abierta: la elección del cirujano

Objectives: Following suprapubic prostatectomy, a suprapubic tube and/or an urethral catheter are generally placed to allow bladder irrigation. The aim of the present study was to assess the urological and wound complications associated to the suprapubic prostatectomy, comparing the maintenance of urethral Vs suprapubic catheters after patients’ discharge. Methods: Between 2000 and 2004, 59 patients with indication of an open prostatectomy for BPH at a single institution were prospectively randomized in two groups. One group was discharged with urethral catheter (urethral group, n=29), while the other was discharged with a suprapubic tube (suprapubic group, n =30). Data regarding early and late complications in the different groups were compared. Results: Mean follow up period was 20 months. Overall death rate was zero. There was no diference in the overall complication rate nor in the occurrence of wound infection, urinary tract infection, urethral stricture, meatal stenosis and bladder neck contracture occurred between both groups. Conclusions: In conclusion, there was no statistically significant difference in the post-prostatectomy complication rate in patients left with a suprapubic or urethral catheter. Even with the laparoscopic techniques, a urinary diversion is generally used during early post-operatory time. The form of diversion (suprapubic or urethral catheter) seems to be more a preference of the surgeon, and it doesn’t seem to interfere with the surgical outcomes. Moreover, suprapubic prostatectomy can still be considered an effective and low morbidity procedure for BPH.

Objetivos: Después de una prostatectomía suprapúbica, se utiliza generalmente un tubo suprapúbico y/o un catéter uretral para permitir la irrigación de vejiga. El objetivo del presente estudio fue evaluar las complicaciones urológicas y de la herida asociadas a la prostatectomía suprapúbica, comparando el mantenimiento de catéteres uretrales vs. suprapúbicos después del alta del paciente. Métodos: Entre el 2000 y 2004, 59 pacientes con indicación de prostatectomía abierta por hiperplasia benigna de próstata (HBP) fueron prospectivamente aleatorizados en dos grupos en una única institución. Un grupo fue de alta con catéter uretral (grupo uretral, n = 29), mientras que el otro fue dado de alta con un tubo suprapúbico (grupo suprapúbico, n = 30). Se compararon los resultados relativos a las complicaciones tempranas y tardías en los diferentes grupos. Resultados: La media de período de seguimiento fue 20 meses. La tasa de mortalidad fue cero. No hubo diferencia entre ambos grupos en la tasa global de complicaciones ni en la incidencia de infección de herida operatoria, infección del tracto urinario, estenosis uretral, estenosis meatal, contractura de cuello vesical. Conclusiones: No hubo diferencias estadísticamente significativas en el período posterior a la prostatectomía en la tasa de complicaciones en pacientes con catéter uretral o suprapúbico. Incluso con las técnicas laparoscópicas, una derivación urinaria se utiliza generalmente durante las primeras etapas del post-operatorio. La forma de desviación (catéter uretral o suprapúbico) parece ser más una preferencia del cirujano y no parece interferir con el resultado quirúrgico. Además, la prostatectomía suprapúbica puede considerarse de baja morbilidad y un eficaz procedimiento para tratar la HBP.