The occurrence of antimicrobial residues and antimicrobial resistance genes in urban drinking water and sewage in Southern Brazil.

Antimicrobial resistance (AMR) is currently discussed as an important issue worldwide, and the presence of antimicrobial residues (ARs) and antimicrobial resistance genes (ARGs) in the environment, especially in the water sources, is a challenge for public health. This study was conducted to evaluate the occurrence and diversity of AR and ARG in water sources from an urban center, in Southern Brazil. A total of thirty-two water samples from drinking water treatment plants (24) and sewage systems (8) were collected during two annual samplings, winter and summer. The PCR was performed by 18 ARGs, and the detection of 47 ARs was performed by LC-MS/MS. All sewage samples presented carbapenemases, ESBL, and mcr-1 genes as well as quinolones and sulfamethoxazole residues. In drinking water, we just detected blaTEM and tetB genes and doxycycline residues in samples before treatment. This study provides data about AR and ARG in drinking water and sewage systems showing that these sources are important reservoirs of both. The limited effectiveness of wastewater treatment processes to remove mainly AR demonstrates the need to implement better protocols of disinfection, in order to limit the spread of AMR in the environment.

Infecção pelo HPV na região Sul do Brasil: uma revisão integrativa da literatura / HPV infection in southern Brazil: an integrative literature review / Infección por el VPH en el Sur de Brasil: una revisión integradora de la literatura

O papilomavírus humano (HPV) infecta pele e mucosas e causa, na grande maioria dos casos, lesões transitórias que podem evoluir para câncer. O objetivo deste estudo é avaliar, por meio de revisão integrativa, a literatura disponível sobre a frequência da infecção pelo HPV na região Sul do Brasil. Buscou-se nas bases de dados PubMed, Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO) a frequência de HPV na região Sul do Brasil nos últimos dez anos. Foram identificados oito estudos que se enquadraram nos critérios da pesquisa. A prevalência estimada de infecção pelo HPV foi de 46,19%. Os genótipos mais encontrados foram HPV 6, de baixo risco, e os subtipos HPV 16, HPV 18, HPV 31 e HPV 58, de alto risco. Nas amostras classificadas como LSIL/HSIL ou de células escamosas atípicas (ASC), tipos virais de baixo risco HPV 6, HPV 11 e HPV 44 foram os mais prevalentes, enquanto para os de alto risco os subtipos HPV 16, HPV 18 e HPV 58 foram os mais encontrados. Embora tenham sido identificados poucos estudos com essa temática nos últimos anos, a partir dos dados da pesquisa foi possível estimar a prevalência do HPV no Sul do Brasil e seus genótipos mais frequentes. Essa informação é importante para o planejamento das ações de saúde pública e dos serviços de saúde, contribuindo para a elaboração de estratégias de controle e prevenção da infecção.

Human Papillomavirus (HPV) infects skin and mucous membranes, and, in most cases, causes transient lesions that can progress to cancer. Given this scenario, this integrative review sought to evaluate the available literature on the frequency of HPV infection in southern Brazil. Bibliographic search was conducted on the PubMed, Latin American and Caribbean Literature on Health Sciences (Lilacs) and Scientific Electronic Library Online (SciELO) databases for papers on the frequency of HPV in southern Brazil published in the last ten years. Eight studies were identified. Estimate of HPV infection prevalence was 46.19%. Low-risk HPV 6 and high-risk HPV 16 were the most common genotypes, and HPV 18, HPV 31 and HPV 58 the most common subtypes. Risky viral types HPV 6, HPV 11 and HPV 44 were most prevalent in cellular changes classified as LSIL/HSIL or atypical squamous cell (ASC), whereas HPV 16, HPV 18 and HPV 58 prevailed as the high risk subtypes. Despite the small sample size of recent studies, the review was able to identified the prevalence of HPV infection in southern Brazil and its most common genotype, essential information for elaborating public health strategies and preventing infections.

El virus del papiloma humano (VPH) infecta la piel y las mucosas y, en la mayoría de los casos, provoca lesiones transitorias que pueden progresar a cáncer. El objetivo de este estudio es evaluar, a través de una revisión integradora, la literatura disponible sobre la frecuencia de infección por VPH en la región Sur de Brasil. Se realizaron búsquedas en las bases de datos PubMed, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y Scientific Electronic Library Online (SciELO) para determinar la frecuencia del VPH en la región Sur de Brasil en los últimos diez años. Se identificaron ocho estudios que cumplieron con los criterios de búsqueda. La prevalencia estimada de infección por VPH fue del 46,19%. Los genotipos más comunes fueron el VPH 6 de bajo riesgo y los subtipos VPH 16, VPH 18, VPH 31 y VPH 58 de alto riesgo. En muestras clasificadas como LSIL/HSIL o células escamosas atípicas (ASC), los tipos virales de bajo riesgo VPH 6, VPH 11 y VPH 44 fueron los más prevalentes, mientras que para los subtipos de alto riesgo VPH 16, VPH 18 y VPH 58 fueron los más frecuentes. Aunque se identificaron pocos estudios sobre este tema en los últimos años, con base en los datos de la encuesta, fue posible estimar la prevalencia del VPH en el Sur de Brasil y sus genotipos más frecuentes. Esta información es importante para planificar acciones de salud pública y servicios de salud, contribuyendo al desarrollo de estrategias de control y prevención de infecciones.

A telecitologia na rotina do rastreamento do câncer do colo uterino / The telecithology in the routine of cervical cancer screening

Introdução: A telecitologia ou citologia digital é a interpretação de amostras citológicas à distância. Depende principalmente da conversão da informação óptica obtida da ocular de um microscópio em uma imagem digital, que posteriormente será transmitida remotamente. Possui aplicações em diversas áreas, como as consultas intraoperatórias, propósitos educacionais e para amenizar o problema da indisponibilidade de profissionais citopatologistas. Objetivo: Descrever sobre o uso da telecitologia na rotina do laboratório de citopatologia, seus métodos, aplicações, vantagens e desvantagens. Método: Tratase de um estudo de revisão de literatura. Resultados: O uso da telecitologia no auxílio ao diagnóstico das lesões cérvico-vaginais mostra-se vantajoso, uma vez que a geração das imagens a partir do screening das lâminas possibilita maior discussão de casos duvidosos, mesmo à distância. Além disso, essa tecnologia fornece garantia e segurança dos resultados, possibilidade de revisão de lâminas por outros profissionais e o armazenamento permanente dos resultados. Considerações finais: A citologia digital traz novas possibilidades, pois permite que imagens de espécimes citológicos estejam disponíveis para qualquer pessoa, em qualquer lugar, para uso em diversas áreas. Com o advento das novas tecnologias em saúde, a telecitologia é uma ferramenta extremamente útil que permite auxílio ao diagnóstico, especialmente a longas distâncias.

Introduction: Telecitology, or digital cytology is the interpretation of cytological samples at a distance. It mainly depends on the conversion of the optical information obtained from the eyepiece of a microscope into a digital image, which will subsequently be transmitted remotely. It has applications in several areas, such as intraoperative consultations, educational purposes and to alleviate the problem of the unavailability of cytopathologists. Objective: To describe the use of telecitology in routine laboratory cytopathology, its methods, applications, advantages and disadvantages. Method: This is a literature review. Results: The use of telecitology to aid in the diagnosis of cervicovaginal lesions is advantageous, since the generation of images from the screening of the slides allows a greater discussion of doubtful cases, even at a distance. In addition, this technology provides guarantee and safety of results, possibility of review of slides by other professionals, and the permanent storage of results. Final considerations: Digital cytology brings new possibilities, as it allows images of cytological specimens to be available to anyone, anywhere, for use in a variety of areas. With the advent of new health technologies, telecitology is an extremely useful tool that allows diagnostic assistance, especially at long distances.

Cytomorphological analysis of cervical cytological smears of women aged over 60 years / Análise citomorfológica de esfregaços citológicos cervicais de mulheres com idade superior a 60 anos

ABSTRACT Introduction: Cervicovaginal atrophy is a condition that can affect women after menopause, and cytology is a diagnostic tool useful in such cases. Objective: To evaluate the cytomorphological profile of cervical smears in patients over 60 years old. Methods: Cytopathological examinations of 500 patients over 60 years old were selected consecutively in this cross-sectional, quantitative, retrospective study. Results: Only 114 (22.8%) presented the squamocolumnar junction (SCJ) sampled, and their presence decreased progressively with advancing age (p < 0.001). Most smears (95.6%) were classified as atrophic. Microbiological analysis showed that from the 22 non-atrophic smears, most presented lactobacillus flora. Among the atrophic swabs, the predominant flora was cocci, with 47.2%. Only 4% presented cytological changes: atypical squamous cells of undetermined significance [(ASC-US) - eight cases/40%], atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion [(ASC-H) - five cases/25%], high-grade squamous intraepithelial lesion [(HSIL) - three/15%], low-grade squamous intraepithelial lesion [(LSIL) - two cases/10%] and adenocarcinoma in situ [(ACI) - two cases/10%]. Among the modified smears, four (20%) presented SCJ cells, and four patients (20%) took hormones (from these, two cases of ASC-H (10%) and two cases ASC-US (10%), showing a relationship between the onset of the lesion and the use of hormones (p < 0.05). Conclusion: The absence of SCJ indicates a diagnostic limitation of sample collection. Although the frequency of lesions has been similar to other studies, and the recommended age range for the examination is between 25 and 60 years, it is important to note that many women older than this range should perform the collection of oncology cytology due to existence of elderly women with risk profile for the disease.

RESUMEN Introducción: La atrofia cervicovaginal es una condición que puede afectar a las mujeres después de la menopausia, y la citología es una herramienta diagnóstica útil en esos casos. Objetivo: Evaluar el perfil citomorfológico de frotis citopatológicos cervicales en pacientes mayores de 60 años. Métodos: Un estudio transversal, cuantitativo y retrospectivo, en el que se eligieron consecutivamente pruebas citopatológicas de 500 pacientes con edad superior a 60 años. Resultados: Solo 114 mujeres (22,8%) tuvieron la unión escamo-columnar (UEC) representada; su presencia ha bajado progresivamente con el adelanto de la edad (p < 0,001). Los frotis (95,6%), en su mayoría, fueron clasificados como atróficos. El análisis microbiológico mostró que de los 22 frotis no atróficos, la mayoría tuvo flora lactobacilar. Entre los frotis atróficos, la flora predominante fue cocoide (47,2%). Solamente 4% presentó alteraciones citológicas: células escamosas atípicas de importancia no determinada [(ASC-US) - ocho casos/40%]; células escamosas atípicas, no se descarta una lesión de alto grado [(ASC-H) - cinco casos/25%]; lesión intraepitelial de alto grado [(HSIL) - três casos/15%]; lesión intraepitelial escamosa de bajo grado [(LSIL) - dos casos/10%] y adenocarcinoma in situ [(ACI) - dos casos/10%]. Entre los frotis alterados, cuatro (20%) contenían células de la UEC y cuatro pacientes (20%) estaban recibiendo hormonas [entre ellos, dos casos de ASC-H (10%) y dos casos de ASC-US (10%)]. Conclusión: La ausencia de UEC indica la limitación diagnóstica de la recolección. Aunque la frecuencia de las lesiones haya sido semejante a la de otros trabajos y la franja etaria recomendada para la realización de la prueba sea 25-60 años, es importante señalar que mujeres con edad superior a esa franja deben realizar la recolección citológica debido al perfil de riesgo para la enfermedad.

RESUMO Introdução: A atrofia cervicovaginal é uma condição que pode afetar mulheres após a menopausa, e a citologia é a ferramenta diagnóstica útil nesses casos. Objetivo: Avaliar o perfil citomorfológico de esfregaços citopatológicos cervicais de pacientes com idade superior a 60 anos. Métodos: Trata-se de estudo transversal, quantitativo e retrospectivo, no qual foram selecionados consecutivamente exames citopatológicos de 500 pacientes com idade superior a 60 anos. Resultados: Apenas 114 mulheres (22,8%) tiveram a junção escamocolunar (JEC) representada e sua presença diminuiu progressivamente com o avanço da idade (p < 0,001). Os esfregaços (95,6%), em sua maioria, foram classificados como atróficos. A análise microbiológica mostrou que dos 22 esfregaços não atróficos, a maioria teve flora lactobacilar. Entre os esfregaços atróficos, a flora predominante foi cocoide (47,2%). Somente 4% apresentou alterações citológicas: células escamosas atípicas de significado indeterminado [(ASC-US) - oito casos/40%], células escamosas atípicas, não podendo excluir lesão intraepitelial de alto grau [(ASC-H) - cinco casos/25%], lesão intraepitelial escamosa de alto grau [(HSIL) - três casos/15%], lesão intraepitelial escamosa de baixo grau [(LSIL) - dois casos/10%] e adenocarcinoma in situ [(ACI) - dois casos/10%]. Entre os esfregaços alterados, quatro (20%) continham células da JEC e quatro pacientes (20%) faziam uso de hormônios [destes, dois casos de ASC-H (10%) e dois casos ASC-US (10%)], o que demonstra a relação entre o aparecimento de lesão e o uso de hormônios (p < 0,05). Conclusão: A ausência da JEC indica a limitação diagnóstica da coleta. Embora a frequência das lesões tenha sido semelhante à de outros trabalhos e a faixa etária recomendada para a realização do exame seja entre 25 e 60 anos, é importante ressaltar que mulheres com idade superior a essa faixa devem realizar a coleta de citologia oncológica devido ao perfil de risco para a doença.

Decreased TAp63 and ΔNp63 mRNA Levels in Most Human Pituitary Adenomas Are Correlated with Notch3/Jagged1 Relative Expression.

Despite recent advances in molecular genetics, the pituitary adenoma initiation, development, progress, and the molecular basis of their unique features are still poorly understood. In this sense, it is proposed that stem cell could be involved in pituitary adenoma tumorigenesis. It is suggested that TP63 has important functions in stem cells, and it may have interplay of TP63 and Notch and its ligand Jagged in this process. This study aimed to evaluate the distinct expression of TP63 isoforms (TAp63 and ΔNp63), as well as its correlation with Notch3 receptor and its ligand Jagged1 in human pituitary adenomas at the messenger RNA (mRNA) level. We included 77 pituitary adenoma tumor samples from patients who underwent surgical resection. The expression levels of TP63 isoforms (TAp63 and ΔNp63) and Notch3 and its ligand Jagged1 were evaluated by qRT-PCR using isoform-specific primers. We also evaluated proliferation index immunohistochemically using KI-67 antibody. The expression levels were associated with clinical outcomes, as age, gender, tumor size, and tumor subtype. In summary, we found that mRNA expression of both TP63 isoforms decreased in pituitary adenomas compared with normal pituitary control. On the other hand, there was an increase of relative Notch3 and Jagged1 mRNA expression in the majority of examined samples. The mRNA expression of three genes evaluated was correlated and statistically significantly. There was no significant association between gene expression and the analyzed clinical data. The current study has provided the first time evidence that Tap63 and ΔNp63 isoforms are underexpressed in most pituitary adenomas. These results are correlated with Notch3 and its ligand Jagged1 overexpression, corroborating previous studies pointing its antagonistic interactions.

Aromatase P450 expression in human pituitary adenomas.

Estrogen has been shown to play an important role in pituitary tumor pathogenesis. In humans, this biosynthesis is mediated by aromatase, an enzyme that converts androgens to estrogens. Just a few studies about aromatase expression in human pituitary gland, both in normal and pathological ones, are found in the literature. This study aimed to assess aromatase enzyme expression in human pituitary adenomas and associate it with gender, tumor size and tumor subtype. We conducted a cross-sectional study, reviewed clinical data and surgical specimens of consecutive 65 patients (35 women and 30 men) with anatomopathologic diagnosis of pituitary adenoma who underwent adenomectomy at a neurosurgical referral center in southern Brazil. Immunohistochemistry was performed to assess aromatase expression and define tumor subtype, and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) to estimate aromatase gene expression. Mean patient age was 45.6 (±13.3) years (range, 18 to 73 years), 86.2% of our samples were macroadenomas while 13.8% were classified as microadenomas. Based on clinical and immunohistochemical data, 23 (35.4%) patients had non-functioning adenomas, 19 (29.2%) had somatotroph adenomas (acromegaly), 12 (18.5%) had lactotroph adenomas (hyperprolactinemic syndrome), and 11 (16.9%) had corticotroph adenomas (Cushing's disease). Immunohistochemical analysis was performed in 59 cases, and 58 (98.3%) showed no aromatase expression. Quantification by qRT-PCR was performed in 43 samples, and 36 (83.7%) revealed no gene expression. Among tumor specimens examined by both techniques (37 cases), 30 showed no gene or protein expression (concordance index, 0.81). It is possible to mention that aromatase expression was lost in most pituitary adenomas, regardless of gender, tumor subtype, or tumor size.

Expression of cell growth negative regulators MEG3 and GADD45γ is lost in most sporadic human pituitary adenomas.

We aimed at the evaluation of MEG3 and GADD45γ expression in sporadic functioning and clinically non-functioning human pituitary adenomas, morphologically characterized by immunohistochemistry analysis and their association with clinical features. Thirty eight patients who had undergone hypophysectomy at São José Hospital of Irmandade Santa Casa de Misericórdia in Porto Alegre, Brazil, were included in this study. We evaluated tumor-type specific MEG3 and GADD45γ expression by qRT-PCR in the pituitary adenomas, and its association with clinical features, as age, gender and tumor size, obtained from medical records. The patients consisted of 21 males and 17 females and the mean age was 47 ± 14 (mean ± SD), ranging from 18 to 73 years-old. Of these 14 were clinically non-functioning, 10 GH-secreting, 9 PRL-secreting, and 5 ACTH-secreting pituitary adenomas. All samples were macroadenomas, except four ACTH-secreting tumors, which were microadenomas. In summary, MEG3 and GADD45γ expression was significantly lost in most clinically non-functioning adenomas (78 and 92%, respectively). Other assessed pituitary tumor phenotypes expressed both genes at significantly different levels, and, in some cases, with overexpression. There was no significant association between gene expression and the analyzed clinical features. Our results confirm the previous report, which indicated that MEG3 and GADD45γ expression is lost in the majority of human pituitary tumors, mainly in clinically-nonfunctioning adenomas. Functioning tumors had differences of relative expression levels. The two groups of tumors are probably genetically different and may have a different natural history.