Cervical Squamous Intraepithelial Lesions Are Associated with Differences in the Vaginal Microbiota of Mexican Women.

Cervical cancer is an important health concern worldwide and is one of the leading causes of death in Mexican women. Previous studies have shown changes in the female genital tract microbe community related to human papillomavirus (HPV) infection and cervical cancer; yet, this link remains unexplored in many human populations. This study evaluated the vaginal bacterial community among Mexican women with precancerous squamous intraepithelial lesions (SIL). We sequenced the V3 region of the 16S rRNA gene in cervical samples from 228 Mexican women, including 121 participants with SIL, most of which were HPV positive, and 107 healthy women without HPV infection or SIL. The presence of SIL was associated with changes in composition (beta diversity) and with a higher species richness (Chao1). A comparison of HPV-positive women with and without SIL showed that microbiota changes occurred even in the absence of SIL. Multivariate association with linear models (MaAsLin) analysis yielded independent associations between HPV infection and an increase in the relative abundance of Brachybacterium conglomeratum and Brevibacterium aureum as well as a decrease in two Lactobacillus iners operational taxonomic units (OTUs). We also identified a positive independent association between HPV-16, the most common HPV subtype linked to SIL, and Brachybacterium conglomeratum. Our work indicates that HPV infection leading to SIL is primarily associated with shifts in vaginal microbiota composition, some of which may be specific to this human population. IMPORTANCE Human papillomavirus (HPV) plays a critical role in cervical carcinogenesis but is not sufficient for cervical cancer development, indicating the involvement of other factors. The vaginal microbiota is an important factor in controlling infections caused by HPV, and, depending on its composition, it can modulate the microenvironment in vaginal mucosa against viral infections. Ethnic and sociodemographic factors influence differences in vaginal microbiome composition, which underlies the dysbiotic patterns linked to HPV infection and cervical cancer across different populations of women. Here, we provide evidence for associations between vaginal microbiota patterns and HPV infection linked to ethnic and sociodemographic factors. To our knowledge, this is the first report of the species Brevibacterium aureum and Brachybacterium conglomeratum linked to HPV infection or squamous intraepithelial lesions (SIL).

[Adverse reactions to drugs in a health center]. / Reacciones adversas a medicamentos en un centro de salud.

OBJECTIVE: To study the adverse side-effects to medication and define their principle characteristics. DESIGN: A descriptive, crossover, observation study with no random distribution. SETTING: The population cared for at a Health Centre in Toledo. PATIENTS: Those over 15 years old during a 6-month period. MEASUREMENTS AND MAIN RESULTS: 64 adverse side-effects were detected, classified as follows: definite, 10.9%; probable, 68.7%; possible, 20.3%. The rate of adverse side-effects was 2.67 per thousand prescriptions and 2.22 per thousand consultations. Distribution by gender was 62.5% women and 37.5% men. The 35-45 age group was the one with most adverse side-effects. The most affected systems were the digestive apparatus (46.50%), followed by the nervous system (27.50%) and the skin (16.22%). The most commonly involved pharmacological groups were: analgesics and non-steroid anti-inflammatories (34.37%) and drugs for the cardiovascular system (26.56%). 98.43% were trivial and none serious. Evolution was: 59.37% recovered on stopping the drug and 23.43% with the help of treatment. CONCLUSIONS: The number of suspected adverse side-effects in the Centre is high, but they were trivial. It was confirmed that adverse side-effects suppose a frequent medical problem in Primary Care. It is important to make health professionals aware so that, when prescribing, they bear in mind the drug risk/benefit relationship. The identification and communication of adverse side-effects, especially of medicines newly on the market, is also important.

[Adolescents' reasons for visiting a doctor]. / Motivos de consulta en adolescentes.

OBJECTIVE: To discover what use adolescents make of the medical services in a Health Area and why they attend. DESIGN: A descriptive epidemiological study of a crossover type. SETTING: Santa Maria de Benquerencia Health Centre, Toledo. PATIENTS AND OTHER PARTICIPANTS: Between July 1992 and June 1993, 717 clinical records selected by means of systematic sampling out of 2127 records of 14 to 18 year old adolescents were examined. MEASUREMENTS AND MAIN RESULTS: Frequency of attendance was 2.15 per adolescent per year, with a standard error of 0.096. Significantly less males than females attended (p < 0.05). 66.53% attended at least once a year. The CIPSAP-2 groups most commonly found were: Respiratory System diseases (433 attendances), Supplementary Classification (231) and Dermatological diseases (177). We found a significantly higher attendance (p < 0.05) in males in the groups for Endocrino-metabolic illnesses and injuries/side-effects, and in females (p < 0.05) in illnesses of the Locomotive System. The commonest individual reasons for attendance were: Respiratory Infection of the upper passages, Prescriptions/Forms/Letters, Tonsillitis and Acne. CONCLUSIONS: Adolescents use the health services less than the rest of the population. Out of the pathologies giving rise to their attendance, the problems arising from the physiological changes and physical activity inherent to this age-group have great specific weight. However such important problems as those arising from so-called "life-style risks" do not appear to be common causes of adolescents seeking health care. We conclude with the need to devote greater and better Primary Health Care to this age-group in order to tackle this situation.