ABSTRACT
[ABSTRACT]. We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program’s purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization’s (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO’s non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 – 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccina- tion. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/ Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
[RESUMEN]. Se describen los resultados del programa ECHO® (Extension for Community Healthcare Outcomes) para la eliminación del cáncer cervicouterino en las Américas (ECHO-ELA), que se concibió como una coop- eración trilateral entre la Organización Panamericana de la Salud (OPS), el Instituto Nacional del Cáncer de los Estados Unidos (NCI) y el centro contra el cáncer MD Anderson (MD Anderson) de la Universidad de Texas. La finalidad del programa es difundir las estrategias para la prevención del cáncer cervicouterino, y está estructurado en torno a los tres pilares de la estrategia para la eliminación del cáncer cervicouterino de la Organización Mundial de la Salud (OMS) y los objetivos 90-70-90 conexos. El público destinatario com- prende autoridades de salud de países de América Latina y el Caribe, así como los puntos focales de la OPS para las enfermedades no transmisibles en las Representaciones en los países, además de colaboradores en el ámbito clínico y de la salud pública. Las sesiones virtuales se llevan a cabo en español, durante 1,5 horas cada mes, utilizando el formato ECHO®. De mayo del 2020 a junio del 2021 se celebraron 14 sesiones de ECHO, con un promedio de 74 participantes por sesión (límites: 46-142). Se realizaron dos encuestas anónimas (al inicio y de seguimiento) y dos grupos de opinión. Los encuestados declararon que los temas sobre los que más aprendieron fueron la situación de la vacunación contra el VPH en la región y las estrate- gias para poner en marcha la vacunación contra el VPH. Entre las necesidades mencionadas figuraban el apoyo entre las sesiones de ECHO y la asistencia técnica específica para cada país. El programa ECHO-ELA brinda un foro para una mayor colaboración entre los países de América Latina y el Caribe y para difundir las estrategias sobre las mejores prácticas, a fin de alcanzar los objetivos de la OMS de eliminación del cáncer cervicouterino.
[RESUMO]. Este trabalho descreve os resultados do programa Extension for Community Healthcare Outcomes para elimi- nação do câncer do colo do útero nas Américas (ECHO ELA), desenvolvido na forma de cooperação trilateral entre a Organização Pan-Americana da Saúde (OPAS), o Instituto Nacional do Câncer dos Estados Unidos (NCI) e o MD Anderson Cancer Center da Universidade do Texas (MD Anderson). O programa visa a dissem- inar estratégias para a prevenção do câncer do colo do útero e está estruturado em torno dos três pilares da estratégia de eliminação do câncer do colo do útero da Organização Mundial da Saúde (OMS) e das Metas 90-70-90 associadas. O público-alvo inclui autoridades sanitárias de países da América Latina e do Caribe, bem como os pontos focais de doenças não transmissíveis nas representações da OPAS nos países, além de colaboradores clínicos e de saúde pública. Todos os meses, são realizadas sessões virtuais de uma hora e meia em espanhol usando o formato ECHO®. No período de maio de 2020 a junho de 2021, foram realizadas 14 sessões do ECHO, com uma média de 74 participantes por sessão (variação: 46 a 142). Foram realizadas duas enquetes anônimas (linha de base e acompanhamento) e dois grupos focais. Os entrevistados afirma- ram que os tópicos sobre os quais mais aprenderam foram a situação da vacinação contra o HPV na região e as estratégias para implementar a vacinação contra o HPV. As necessidades identificadas incluíam apoio entre as sessões do ECHO e assistência técnica específica para o país. O programa ECHO ELA oferece um fórum para aumentar a colaboração entre os países da América Latina e do Caribe e difundir melhores práti- cas para atingir as metas de eliminação do câncer do colo do útero da OMS.
Subject(s)
Cervix Uteri , Early Detection of Cancer , Public Health , Health Policy , Latin America , Early Detection of Cancer , Uterine Cervical Diseases , Public Health , Health Policy , Latin America , Early Detection of Cancer , Public Health , Health PolicyABSTRACT
PURPOSE: To evaluate recurrence rates and risk factors among women with stage IA1 cervical cancer without lymph vascular space invasion managed conservatively. METHODS: retrospective review of women with stage IA1 squamous cervical cancer who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed. RESULTS: 26 women diagnosed with stage IA1 squamous cervical cancer without lymphovascular space invasion underwent conservative management and had at least 12 months follow-up. The mean follow-up was 44.6 months. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. There was one Human immunodeficiency virus positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort. CONCLUSION: Excellent outcomes were noted in women with stage IA1 cervical cancer without lymphovascular space invasion and with negative margins who were managed conservatively, even in a developing country.
OBJETIVO: Avaliar recidiva e seus fatores de risco em mulheres com câncer do colo do útero estádio IA1 sem invasão do espaço linfovascular tratadas conservadoramente. MéTODOS:: Estudo de coorte retrospectivo de pacientes com câncer do colo do útero IA1 escamoso submetidas a cone do colo do útero, entre 1994 e 2015, em um centro de ginecologia oncológica do sul do Brasil. Foram revisados e analisados idade no diagnóstico, achados pré-conização, método de conização, margens, doença residual, recorrência e sobrevida. RESULTADOS: 26 mulheres diagnosticadas com câncer do colo do útero estádio escamoso sem invasão do espaço linfovascular foram submetidas a tratamento conservador, com seguimento mínimo de 12 meses. O tempo médio de seguimento foi 44,6 meses. A média de idade no diagnóstico foi 40,9 anos. A primeira relação sexual ocorreu aos 16 anos (mediana), 11,5% eram nulíparas e 30,8% eram tabagistas atuais ou passadas. Houve um caso de recidiva de neoplasia intraepitelial cervical grau 2 aos 30 meses em uma paciente com vírus da imunodeficiência humana. Não houve pacientes diagnosticados com câncer de colo do útero invasor recorrente, e não houve mortes por câncer do colo do útero ou outras causas. CONCLUSãO:: Os resultados observados após tratamento conservador em mulheres com câncer cervical escamoso IA1 sem invasão do espaço linfovascular com margens negativas foram excelentes, mesmo em um país em desenvolvimento.
Subject(s)
Carcinoma, Squamous Cell , Uterine Cervical Neoplasms , Adolescent , Adult , Female , Humans , Brazil , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Conservative Treatment , Retrospective Studies , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Neoplasm Recurrence, LocalABSTRACT
ABSTRACT We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program's purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization's (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO's non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 - 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
RESUMEN Se describen los resultados del programa ECHO® (Extension for Community Healthcare Outcomes) para la eliminación del cáncer cervicouterino en las Américas (ECHO-ELA), que se concibió como una cooperación trilateral entre la Organización Panamericana de la Salud (OPS), el Instituto Nacional del Cáncer de los Estados Unidos (NCI) y el centro contra el cáncer MD Anderson (MD Anderson) de la Universidad de Texas. La finalidad del programa es difundir las estrategias para la prevención del cáncer cervicouterino, y está estructurado en torno a los tres pilares de la estrategia para la eliminación del cáncer cervicouterino de la Organización Mundial de la Salud (OMS) y los objetivos 90-70-90 conexos. El público destinatario comprende autoridades de salud de países de América Latina y el Caribe, así como los puntos focales de la OPS para las enfermedades no transmisibles en las Representaciones en los países, además de colaboradores en el ámbito clínico y de la salud pública. Las sesiones virtuales se llevan a cabo en español, durante 1,5 horas cada mes, utilizando el formato ECHO®. De mayo del 2020 a junio del 2021 se celebraron 14 sesiones de ECHO, con un promedio de 74 participantes por sesión (límites: 46-142). Se realizaron dos encuestas anónimas (al inicio y de seguimiento) y dos grupos de opinión. Los encuestados declararon que los temas sobre los que más aprendieron fueron la situación de la vacunación contra el VPH en la región y las estrategias para poner en marcha la vacunación contra el VPH. Entre las necesidades mencionadas figuraban el apoyo entre las sesiones de ECHO y la asistencia técnica específica para cada país. El programa ECHO-ELA brinda un foro para una mayor colaboración entre los países de América Latina y el Caribe y para difundir las estrategias sobre las mejores prácticas, a fin de alcanzar los objetivos de la OMS de eliminación del cáncer cervicouterino.
RESUMO Este trabalho descreve os resultados do programa Extension for Community Healthcare Outcomes para eliminação do câncer do colo do útero nas Américas (ECHO ELA), desenvolvido na forma de cooperação trilateral entre a Organização Pan-Americana da Saúde (OPAS), o Instituto Nacional do Câncer dos Estados Unidos (NCI) e o MD Anderson Cancer Center da Universidade do Texas (MD Anderson). O programa visa a disseminar estratégias para a prevenção do câncer do colo do útero e está estruturado em torno dos três pilares da estratégia de eliminação do câncer do colo do útero da Organização Mundial da Saúde (OMS) e das Metas 90-70-90 associadas. O público-alvo inclui autoridades sanitárias de países da América Latina e do Caribe, bem como os pontos focais de doenças não transmissíveis nas representações da OPAS nos países, além de colaboradores clínicos e de saúde pública. Todos os meses, são realizadas sessões virtuais de uma hora e meia em espanhol usando o formato ECHO®. No período de maio de 2020 a junho de 2021, foram realizadas 14 sessões do ECHO, com uma média de 74 participantes por sessão (variação: 46 a 142). Foram realizadas duas enquetes anônimas (linha de base e acompanhamento) e dois grupos focais. Os entrevistados afirmaram que os tópicos sobre os quais mais aprenderam foram a situação da vacinação contra o HPV na região e as estratégias para implementar a vacinação contra o HPV. As necessidades identificadas incluíam apoio entre as sessões do ECHO e assistência técnica específica para o país. O programa ECHO ELA oferece um fórum para aumentar a colaboração entre os países da América Latina e do Caribe e difundir melhores práticas para atingir as metas de eliminação do câncer do colo do útero da OMS.
ABSTRACT
Abstract Purpose: To evaluate recurrence rates and risk factors among women with stage IA1 cervical cancer without lymph vascular space invasion managed conservatively. Methods: retrospective review of women with stage IA1 squamous cervical cancer who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed. Results: 26 women diagnosed with stage IA1 squamous cervical cancer without lymphovascular space invasion underwent conservative management and had at least 12 months follow-up. The mean follow-up was 44.6 months. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. There was one Human immunodeficiency virus positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort. Conclusion: Excellent outcomes were noted in women with stage IA1 cervical cancer without lymphovascular space invasion and with negative margins who were managed conservatively, even in a developing country.
Resumo Objetivo: Avaliar recidiva e seus fatores de risco em mulheres com câncer do colo do útero estádio IA1 sem invasão do espaço linfovascular tratadas conservadoramente. Métodos: Estudo de coorte retrospectivo de pacientes com câncer do colo do útero IA1 escamoso submetidas a cone do colo do útero, entre 1994 e 2015, em um centro de ginecologia oncológica do sul do Brasil. Foram revisados e analisados idade no diagnóstico, achados pré-conização, método de conização, margens, doença residual, recorrência e sobrevida. Resultados: 26 mulheres diagnosticadas com câncer do colo do útero estádio escamoso sem invasão do espaço linfovascular foram submetidas a tratamento conservador, com seguimento mínimo de 12 meses. O tempo médio de seguimento foi 44,6 meses. A média de idade no diagnóstico foi 40,9 anos. A primeira relação sexual ocorreu aos 16 anos (mediana), 11,5% eram nulíparas e 30,8% eram tabagistas atuais ou passadas. Houve um caso de recidiva de neoplasia intraepitelial cervical grau 2 aos 30 meses em uma paciente com vírus da imunodeficiência humana. Não houve pacientes diagnosticados com câncer de colo do útero invasor recorrente, e não houve mortes por câncer do colo do útero ou outras causas. Conclusão: Os resultados observados após tratamento conservador em mulheres com câncer cervical escamoso IA1 sem invasão do espaço linfovascular com margens negativas foram excelentes, mesmo em um país em desenvolvimento.
Subject(s)
Humans , Female , Pregnancy , Recurrence , Carcinoma, Squamous Cell , Uterine Cervical Neoplasms , Conization , Conservative TreatmentABSTRACT
We conducted a prospective evaluation of the diagnostic performance of high-resolution microendoscopy (HRME) to detect cervical intraepithelial neoplasia (CIN) in women with abnormal screening tests. Study participants underwent colposcopy, HRME and cervical biopsy. The prospective diagnostic performance of HRME using an automated morphologic image analysis algorithm was compared to that of colposcopy using histopathologic detection of CIN as the gold standard. To assess the potential to further improve performance of HRME image analysis, we also conducted a retrospective analysis assessing performance of a multi-task convolutional neural network to segment and classify HRME images. One thousand four hundred eighty-six subjects completed the study; 435 (29%) subjects had CIN Grade 2 or more severe (CIN2+) diagnosis. HRME with morphologic image analysis for detection of CIN Grade 3 or more severe diagnoses (CIN3+) was similarly sensitive (95.6% vs 96.2%, P = .81) and specific (56.6% vs 58.7%, P = .18) as colposcopy. HRME with morphologic image analysis for detection of CIN2+ was slightly less sensitive (91.7% vs 95.6%, P < .01) and specific (59.7% vs 63.4%, P = .02) than colposcopy. Images from 870 subjects were used to train a multi-task convolutional neural network-based algorithm and images from the remaining 616 were used to validate its performance. There were no significant differences in the sensitivity and specificity of HRME with neural network analysis vs colposcopy for detection of CIN2+ or CIN3+. Using a neural network-based algorithm, HRME has comparable sensitivity and specificity to colposcopy for detection of CIN2+. HRME could provide a low-cost, point-of-care alternative to colposcopy and biopsy in the prevention of cervical cancer.
Subject(s)
Hysteroscopy/instrumentation , Radiographic Image Interpretation, Computer-Assisted/methods , Uterine Cervical Dysplasia/diagnostic imaging , Adult , Aged , Brazil , Colposcopy , Computer Systems , Female , Humans , Microtechnology , Middle Aged , Neural Networks, Computer , Point-of-Care Systems , Prospective Studies , Sensitivity and Specificity , Young AdultSubject(s)
COVID-19 , Capacity Building , Clinical Competence , Developing Countries , Health Personnel/education , Pandemics , Uterine Cervical Neoplasms/prevention & control , Curriculum , Delivery of Health Care , Education, Distance , Female , Humans , Mozambique , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapyABSTRACT
BACKGROUND: Cervical cancer is the leading cause of cancer and related deaths among women in Mozambique. There is limited access to screening and few trained personnel to manage women with abnormal results. Our objective was to implement cervical cancer screening with human papillomavirus (HPV) testing, with navigation of women with abnormal results to appropriate diagnostic and treatment services. METHODS: We prospectively enrolled women aged 30-49 years living in Maputo, Mozambique, from April 2018 to September 2019. All participants underwent a pelvic examination by a nurse, and a cervical sample was collected and tested for HPV using the careHPV test (Qiagen, Gaithersburg, Maryland, USA). HPV positive women were referred for cryotherapy or, if ineligible for cryotherapy, a loop electrosurgical excision procedure. Women with findings concerning for cancer were referred to the gynecologic oncology service. RESULTS: Participants (n=898) had a median age of 38 years and 20.3% were women living with the human immunodeficiency virus. HPV positivity was 23.7% (95% confidence interval 21.0% to 26.6%); women living with human immunodeficiency virus were twice as likely to test positive for HPV as human immunodeficiency virus negative women (39.2% vs 19.9%, p<0.001). Most HPV positive women (194 of 213, 91.1%) completed all steps of their diagnostic work-up and treatment. Treatment included cryotherapy (n=158, 77.5%), loop electrosurgical excision procedure (n=30, 14.7%), or referral to a gynecologist or gynecologic oncologist (n=5, 2.5%). Of eight invasive cervical cancers, 5 (2.8%) were diagnosed in women living with human immunodeficiency virus and 3 (0.4%) in human immunodeficiency virus negative women (p=0.01). CONCLUSION: Cervical cancer screening with HPV testing, including appropriate follow-up and treatment, was feasible in our study cohort in Mozambique. Women living with human immunodeficiency virus appear to be at a significantly higher risk for HPV infection and the development of invasive cervical cancer than human immunodeficiency virus negative women.
Subject(s)
Papillomaviridae/pathogenicity , Uterine Cervical Neoplasms/diagnosis , Adult , Female , Humans , Middle Aged , Mozambique , Prospective Studies , Uterine Cervical Neoplasms/pathologyABSTRACT
PURPOSE: To evaluate the prevalence of cervical pre-malignancies in the cervical cytology of female renal transplant recipients (RTR) and compare to immunocompetent patients. METHODS: A prospective case-control study of 165 RTR (cases) and 372 immunocompetent women (controls) was carried out from May 2015 to August 2016. The participants completed a questionnaire with demographic characteristics, habits, reproductive history, and information about the renal transplant. Cervical cytology samples were collected at their visit for cervical cancer screening. Relevant medical history was obtained from medical records and previous cervical cytology results were retrieved: from the time of kidney transplantation to the beginning of this study for RTR and all collected throughout life for controls. RESULTS: The mean age was similar between groups (42.6 ± 11.4 vs. 41.8.2 ± 11.1 years, p = 0.447). Considering cervical cytology collected since the kidney transplant, RTR had three times higher rates of abnormal cervical cytology test (24.8% of RTR vs. 6.3% for controls), and the abnormalities were more frequent (p < 0.001) for low squamous intraepithelial lesion (LSIL) (n = 23, 13.9%) and high squamous intraepithelial lesion (HSIL) (n = 9, 5.5%). Cervical cytology collected during the study had normal results in 152 RTR (92.1%) vs. 326 controls (93.9%) (p > 0.05). When the altered results were broken down, a higher frequency of LSIL could be seen in RTR (3.6% vs 0.0%, p = 0.008). CONCLUSION: RTR had significantly higher rates of cervical cytology abnormalities comparing to the control group and most of it was composed of LSIL.
Subject(s)
Cervix Uteri/pathology , Immunocompromised Host , Kidney Transplantation/adverse effects , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears/methods , Adult , Brazil , Case-Control Studies , Early Detection of Cancer , Female , Humans , Immunocompetence , Middle Aged , Papillomaviridae , Papillomavirus Infections , Prospective Studies , Uterine Cervical Neoplasms/parasitology , Vagina/pathology , Young Adult , Uterine Cervical Dysplasia/pathologySubject(s)
Humans , Female , Pregnancy , Avitaminosis/diet therapy , Prenatal Nutritional Physiological Phenomena , Prenatal Nutrition , Recommended Dietary Allowances , Anemia/diagnosis , Anemia/diet therapy , Anemia/etiology , Dietary Vitamins , Nutrition Assessment , Clinical Protocols , Dietary SupplementsABSTRACT
BACKGROUND: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. METHODS: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. RESULTS: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. CONCLUSIONS: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.
Subject(s)
Bone Density , Fractures, Bone/epidemiology , Genital Neoplasms, Female/radiotherapy , Pelvic Bones/injuries , Adult , Aged , Aged, 80 and over , Chemoradiotherapy/adverse effects , Endometrial Neoplasms/radiotherapy , Female , Humans , Middle Aged , Osteoporosis/complications , Proportional Hazards Models , Prospective Studies , Radiotherapy, Intensity-Modulated/adverse effects , Uterine Cervical Neoplasms/radiotherapy , Vaginal Neoplasms/radiotherapy , Young AdultABSTRACT
OBJECTIVE: To ascertain whether placement of the etonogestrel contraceptive implant induces significant changes in carbohydrate and lipid metabolism, as reflected by metabolic parameters, in healthy women. STUDY DESIGN: Prospective cohort study of 213 healthy patients who received etonogestrel implants. Weight, BMI, blood pressure and a comprehensive metabolic profile were assessed at baseline, 1, 2 and 3 years. In 21 of the 213 participants, AUC for glucose levels, fasting insulin levels at baseline and year 3 (immediately before implant removal), HOMA-IR score, and the QUICK index were assessed. Parameters were expressed as median and interquartile range. The Wilcoxon test and ANOVA were used for comparison of measurements after implant placement (significance level p<0.05). RESULTS: Median age was 26 years (range, 22-31.5). Results showed a trend toward increase of the variables weight (63.3-66.1) and BMI (24.7-25.7) and a decrease in TC (172-161.5), TG (75-69.5), and LDL (100.5-98.5) (p>0.05). Of the metabolic variables, FBG (85-88) and HDL (53-46) had significant differences (p<0.002). In the subgroup of 21 patients, there were reductions in insulin levels (9.65 vs. 8.4mU/dL, p=0.03), HOMA scores (2.06 vs. 1.75, p=0.02), QUICK index (0.34 vs. 0.35, p=0.03), TC (178 vs. 160mg/dL, p=0.001), HDL (51 vs. 46mg/dL, p=0.009), and LDL (110 vs. 100mg/dL, p=0.035). CONCLUSION: These results provide evidence of the metabolic safety of the ENG implant in healthy women over a 3-year period. Indeed, implant placement induces changes consistent with a lower risk of insulin resistance and dyslipidemia.
Subject(s)
Body Weight/drug effects , Contraceptive Agents, Female/adverse effects , Desogestrel/adverse effects , Adult , Body Mass Index , Contraceptive Agents, Female/pharmacology , Contraceptive Agents, Female/therapeutic use , Desogestrel/pharmacology , Desogestrel/therapeutic use , Female , Humans , Insulin/blood , Insulin Resistance/physiology , Prospective Studies , Women's Health , Young AdultABSTRACT
INTRODUCTION: The standard treatment for locally advanced cervical cancer is chemoradiation, with the majority of patients having a complete response to the therapy. The current surveillance recommendations from the Society of Gynecologic Oncology include annual cytology, with a small proportion of patients subsequently diagnosed with high-grade cervical dysplasia (CIN 2/3). To date, there is limited information regarding the optimal treatment and outcome for patients diagnosed with CIN 2/3. The current report describes the diagnosis, management and outcome of 4 patients diagnosed with CIN 2/3 following chemoradiation. CASE DESCRIPTION: We describe 4 patients who developed CIN 2/3 seven months to 8 years following radiation therapy for locally advanced cervical cancer. All 4 patients were asymptomatic and the abnormalities were first detected by a Pap test. Three of the patients were managed conservatively with observation, and the CIN 2/3 resolved without intervention. One patient underwent 2 cervical conizations followed by a hysterectomy with no residual dysplasia noted on the hysterectomy specimen. CONCLUSION: The majority of patients with recurrent cervical cancer after chemoradiation are symptomatic, and most cases are detected by a physical examination. The role of cytology, colposcopy and biopsies may be of limited value. Furthermore, the significance of the diagnosis of CIN 2/3 in patients previously treated with radiation therapy was not associated with recurrent disease in the 4 patients described. Our results suggest that cytology may be of limited value in detecting recurrence in patients following radiation therapy, even when CIN 2/3 is detected.
ABSTRACT
PURPOSE: To investigate the prevalence of human papillomavirus (HPV) in cervical samples of pregnant and non-pregnant women in South-Brazil. METHODS: A prospective study of 91 pregnant and 92 non-pregnant women with no previous history of cervical dysplasia or cancer was carried out. Cervical samples for HPV testing and cytology were collected in each trimester of pregnancy and in the puerperium for pregnant women and at matched intervals for the non-pregnant women. All samples were analyzed through PCR with consensus primers GP5+/GP6+. Genotyping was performed using specific primers. To control for confounding factors, the analysis of multivariate logistic regression was applied. The measure of odds ratio (OR) and the 95 % confidence interval (95 % CI) were used. The level of statistical significance was set at 5 % (P ≤ 0.05). RESULTS: HPV DNA was detected in 23/91 (25.3 %) cervical samples from the pregnant women and in 12/92 (13 %) cervical samples from non-pregnant women (P = 0.035). There was a significant association among cervical HPV infection and young age, number of lifetime sexual partners, and the presence of abnormal cervical cytology. HPV16 and HPV18 were the viral types more frequently detected. Out of the 23 HPV-positive pregnant women, 17 (73.9 %) had normal cervical cytology. CONCLUSION: Our results suggest a higher prevalence of HPV infection in pregnant vs. non-pregnant women. This finding may be related to the relative immunosuppression observed in pregnant women, outlining the importance of the appropriate monitoring of the viral infection in this specific population.
Subject(s)
DNA, Viral/analysis , Papillomaviridae/genetics , Papillomavirus Infections/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , Brazil/epidemiology , Female , Genotype , Human papillomavirus 16/genetics , Humans , Logistic Models , Middle Aged , Multivariate Analysis , Papillomaviridae/isolation & purification , Papillomavirus Infections/genetics , Polymerase Chain Reaction , Pregnancy , Pregnancy Complications, Infectious/microbiology , Pregnant Women , Prevalence , Prospective Studies , Vaginal Smears , Young AdultABSTRACT
A literatura obstétrica atual sugere a existência de impacto da obesidade sobre os desfechos maternos e perinatais à medida que inúmeros relatos demonstram implicações críticas aos períodos anteparto, intraparto e pós-parto. Apesar dessas publicações, a extensão desse impacto permanece controversa. Dada a crescente prevalência de obesidade entre mulheres em idade fértil e considerando-se o fato de que o peso materno acima do ideal é um dos poucos fatores de risco potencialmente modificáveis e, provavelmente, relacionados a um desfecho gestacional desfavorável, estratégias que incluam a prevenção da obesidade gestacional fornecidas ainda no período periconcepcional se tornam atualmente importantes ações de saúde pública. No presente estudo, os autores realizam uma atualização sobre o assunto, focalizando na interface dos efeitos da obesidade materna sobre o prognóstico gestacional e perinatal.
Subject(s)
Humans , Female , Pregnancy , Maternal Welfare , Pregnancy , Obesity/complications , Public Health , PrognosisABSTRACT
OBJECTIVE: To study the epidemiologic characteristics and underlying conditions that place pregnant women infected with H1N1 virus at increased risk for being admitted to the intensive care unit (ICU). METHODS: In this cross-sectional study conducted in Porto Alegre, Brazil, with 57 pregnant women hospitalized with the H1N1 influenza during the 2009 pandemic, we collected epidemiologic characteristics and assessed the rates of ICU admission according to pregnancy duration and the presence or absence of comorbidities. RESULTS: The median (range) of maternal age was 26 years (15-41 years), the pregnancy duration at the time of infection was 29 weeks (8-41 weeks), and the birth weight was 3180 g (740-3900 g). Five patients (8.8%) were in the first, 22 (38.6%) in the second, and 30 (52.6%) in the third trimester, and (22.8%) had comorbidities. Antiviral drugs were administered to all, and 46 (80.7%) patients received an early treatment. There were no maternal, fetal, or neonatal deaths. Eight patients (14%) required ICU admission and 15 (50%) of the patients who gave birth during their hospitalization underwent a cesarean delivery. The risk of being treated at the ICU did not increase for patients with comorbidities (P=0.22) or an advanced pregnancy (P=0.31). The study revealed a relationship between early initiation of an antiviral treatment and a lower mortality rate. CONCLUSION: Neither an advanced pregnancy nor comorbidities increased the risk of being admitted to the ICU but, compared with the results of other studies, a prompt treatment lowered mortality.
Subject(s)
Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/epidemiology , Pandemics/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Adolescent , Adult , Antiviral Agents/therapeutic use , Birth Weight , Brazil/epidemiology , Cesarean Section/statistics & numerical data , Female , Gestational Age , Hospitalization/statistics & numerical data , Humans , Influenza A Virus, H1N1 Subtype/drug effects , Influenza, Human/drug therapy , Influenza, Human/virology , Intensive Care Units/statistics & numerical data , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Treatment Outcome , Young AdultABSTRACT
A infecção do trato urinário (ITU) é uma complicação comum na gestação. Escherichia coli é o uropatógeno mais comum, encontrado em aproximadamente 80% das pacientes infectadas. Prematuridade, baixo peso ao nascer e até morte fetal podem estar associadas à ITU na gestação. O objetivo dessa atualização é discutir a antibioticoterapia para o tratamento da infecção do trato urinário baixo (cistite aguda) nos diferentes trimestres da gestação. A ampicilina é segura em qualquer etapa da gestação contudo a Escherichia coli apresenta altos índices de resistência a essa droga. Cefalexina parece ser uma droga segura em todos os estágios da gestação. Nitrofurantoína deve ser evitada no final da gestação pelo risco de hemólise neonatal. As complicações diminuem com investigação e tratamento adequados. O rastreamento precoce da bacteriúria na gestação, mesmo que assintomática, tem benefícios maternos e fetais.
ABSTRACT
A infecção pela Chlamydia trachomatis é uma das mais freqüentes e curáveis doenças bacterianas de transmissão sexual, constatação que traz consigo sérias conseqüências para a saúde reprodutiva da mulher. A prevalência da infecção do trato genital inferior pela C. trachomatis varia, conforme dados obtidos na literatura, entre 2 e 25 porcento, sendo mais prevalente em adultos jovens. A infecção é assintomática em 75 porcento das mulheres e em pelo menos 50 porcento dos homens, portanto, a infecção do trato genital inferior por esse agente permanece indetectável em sua grande maioria. Essa infecção situa-se entre as causas mais comuns de doença inflamatória pélvica (DIP), gravidez ectópica e infertilidade. Há aumento de evidências de que a infecção por C. trachomatis pode acarretar desfechos adversos na gestação, como abortamento, infecção intra-uterina, natimorto, prematuridade e ruptura prematura e membranas. Essa atualização focalizará a epidemiologia, características clínicas, fisiopatologia e seqüelas reprodutivas da infecção por esse agente, abordando de modo geral os métodos de triagem e o tratamento clínico preconizado.
Chlamydia trachomatis is the most common and curable bacterial disease sexually transmitted, in many countries, a fact that has serious consequences for the reproductive women's health. The prevalence of the lower tract infection with C. trachomatis varies from 2 percent to 25 percent and is higher among young people. The infection is asymptomatic in 75 percent of women and at least 50 percent of men, thus the lower genital tract infection remains largely undetected. It is a major cause of pelvic inflammatory disease (PID), which in turn is a major cause of infertility and ectopic pregnancy. It has been also demonstrated that the infection for C. trachomatis can cause adverse outcomes for the pregnancy, as abortion, intrauterine infection, stillborn, prematurity and premature rupture of membranes. This updating highlights the epidemiology, pathophysiology, clinical features and reproductive sequelae of the infection. Current screening and management methods are outlined.(au)
Subject(s)
Female , Pregnancy , Chlamydia trachomatis/isolation & purification , Pregnancy Complications, Infectious/epidemiology , Erythromycin/therapeutic use , Chlamydia Infections/epidemiology , Chlamydia Infections/transmission , Mass Screening , Risk Factors , PrognosisABSTRACT
OBJETIVO: demonstrar a expressão de biomarcadores, detectados por técnicas de imunohistoquímica, em tecidos sadios, lesões pré-neoplásicas e neoplásicas do colo do útero. MÉTODOS: para avaliação da reatividade imunohistoquímica de tecidos do colo do útero ao p16 e ao herpes simples vírus tipo 2 (HSV-2), foram avaliadas 187 amostras de lesões intra-epiteliais de baixo grau (LIE-BG) e lesões intra-epiteliais de alto grau (LIE-AG) e carcinoma do colo do útero, e comparadas com grupo de pacientes sem lesões no colo uterino. A análise estatística foi realizada pelo teste do chi2 para tendências. O nível de significância foi de alfa=0,05. RESULTADOS: foi avaliada a reatividade ao p16 com a seguinte distribuição: grupo sem lesão no colo do útero: 56 por cento (24/43), LIE-BG: 92 por cento (43/47), LIE-AG: 94 por cento (43/46) e câncer: 98 por cento (46/47) (p<0,001, tendência linear). Com relação ao HSV-2: grupo sem lesão no colo do útero: 27 por cento (12/45), LIE-BG: 58 por cento (22/38), LIE-AG: 78 por cento (35/45) e câncer: 59 por cento (29/49) (p<0,001, tendência linear). Foi observado aumento na proporção de reatividade para os dois marcadores entre os grupos controle, LIE-BG, LIE-AG e câncer do colo do útero (p<0,001). Não houve diferença significativa, quando comparamos apenas os grupos LIE-BG e LIE-AG entre si. CONCLUSÕES: FOI VErificado um aumento progressivo nas taxas de reatividade aos marcadores de imunohistoquímica estudados, com a severidade das lesões.
PURPOSE: to demonstrate the expression of biomarkers, detected by immunohistochemical techniques in healthy tissues, as well as in preneoplastic and neoplastic lesions of the uterine cervix. METHODS: in order to evaluate the immunohistochemical reactivity of tissues from the uterine cervix to p16 and to type 2 herpes simplex virus (HSV-2), 187 samples of low-grade intraepithelial lesions (LG-IEL) and high-grade intraepithelial lesions (HG-IEL), and of uterine cervix carcinoma were compared with a group of patients without uterine cervix lesions. Statistical analysis was done by the chi2 test for trends. The significance level was alpha=0.05. RESULTS: the reactivity to p16 was assessed showing the following distribution: group without uterine cervix lesions: 56 percent (24/43), LG-IEL: 92 percent (43/47), HG-IEL: 94 percent (43/46), and cancer: 98 percent (46/47) (p<0.001, linear trend). Concerning the HSV-2: group without uterine cervix lesions: 27 percent (12/45), LG-IEL: 58 percent (22/38), HG-IEL: 78 percent (35/45), and cancer: 59 percent (29/49) (p<0.001, linear trend). There was an increase in the reactivity ratio for the two markers in the pathological groups (LG-IEL, HG-IEL and uterine cervix cancer, at p<0.001) compared to controls. There was no significant difference between the LG-IEL and the HG-IEL groups. CONCLUSIONS: a progressive increase of reactivity ratios of the studied immunohistochemical markers as a function of lesion severity was observed.