Human Papillomavirus (HPV) Infection and Risk Behavior in Vaccinated and Non-Vaccinated Paraguayan Young Women.

Cervical cancer is a global health concern and ranks fourth among the most prevalent cancers in women worldwide. Human papillomavirus (HPV) infection is a known precursor of cervical cancer and preventive measures include prophylactic vaccines. This study focused on sexually active Paraguayan women aged 18-25 years, exploring the intersection of HPV vaccination and sexual behavior. Among 254 participants, 40.9% received the Gardasil-4 vaccine, with no significant differences in sexual behavior between the vaccinated and unvaccinated sexually active groups. However, a notable decrease in the prevalence of HPV among the vaccinated women highlights the efficacy of this vaccine in reducing infections. The prevalence of any HPV type was 37.5% in vaccinated participants compared to 56.7% in unvaccinated participants (p = 0.0026). High-risk HPV types showed a significant difference, with a prevalence of 26.0% in vaccinated women compared with 52.7% in unvaccinated women (p < 0.001). Although a potential decline in genital warts was observed among the vaccinated individuals, statistical significance (p = 0.0564) was not reached. Despite the challenges in achieving high vaccination coverage, the observed reduction in HPV prevalence underscores the importance of ongoing monitoring, healthcare professional recommendations, and comprehensive risk management. These findings contribute to dispelling concerns about HPV vaccination influencing sexual behavior, advocating further large-scale research to explore the impact of vaccines on various HPV types and potential cross-protection.

Removal of Chromium (III) and Reduction in Toxicity in a Primary Tannery Effluent Using Two Floating Macrophytes.

Trivalent chromium (Cr(III)) is a contaminant with toxic activity. Its presence in waters and soils is usually related to industrial activities such as tanneries. The aim of this study was to compare the removal of Cr(III) in hydroponic solutions and tannery effluents using two floating macrophytes: Salvinia auriculata and Eichhornia crassipes. First, to determine the chromium removal capacity in solution and the bioaccumulation factor (BAF) in tissues of each plant, experiments were set up with contaminated solutions with Cr(III) concentrations of 2, 5, 10, 20, and 40 mg/L. Subsequently, both plant species were exposed to a primary tannery effluent contaminated with 12 mg/L of Cr(III) in order to study the removal capacity of organic and inorganic matter, as well as the acute toxicity in the water flea (Daphnia magna) and genotoxicity in zebrafish (Danio rerio). Tests carried out on nutrient solutions revealed that both plants have a high capacity for removing Cr(III) in solution. The BAF in tissues was higher in E. crassipes compared to S. auriculata. In the experiments with a tannery effluent, both species presented low nutrient and organic matter removal efficiency, but they showed good Cr(III) removal capacity, with average reduction values of 57% for S. auriculata and 54% for E. crassipes after 72 h of exposure. E. crassipes contributed most to the reduction in acute toxicity in D. magna, while S. auriculata did not show a similar effect. However, both plant species managed to reduce the genotoxicity marker in D. rerio when compared with the initial effluent and the control.

Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study.

Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

High prevalence and co-infection of high-risk Human Papillomavirus genotypes among unvaccinated young women from Paraguay.

Paraguay launched a human papillomavirus (HPV) vaccination program in 2013, so virological surveillance is important for measuring the impact of HPV vaccines. This study aimed to estimate the type-specific HPV frequency in unvaccinated sexually active women aged 18-25 years in the metropolitan area of Asuncion as a baseline for monitoring the HPV vaccination program. This study included 208 women, attending the Central Laboratory of Public Health between May 2020 and December 2021, were invited for testing through social networks and flyers at local health centers and higher education institutes. All participants who agreed to contribute to the study signed a free, prior, and informed consent form and answered a questionnaire that included basic demographic data and determining factors of HPV infection. Human papillomavirus detection and genotyping were conducted using the CLART HPV2 test (Genomica, Madrid, Spain) that allows the individual identification of 35 genotypes. 54.8% women were positive for any HPV type, with 42.3% positive for high-risk HPV (HR-HPV) types. Several factors were associated with HPV detection including the number of sexual partners, new sexual partners, non-use of condoms, and history of other sexual infections. Moreover, multiple infections were identified in 43.0% of the young women. We detected 29 different viral types present in both single and multiple infections. HPV-58 was the most commonly detected HPV type (14.9%), followed by HPV-16, HPV-51, and HPV-66 (12.3%). We estimated the prevalence of bivalent (16/18), quadrivalent (6/11/16/18), and nonavalent (6/11/16/18/31/33/45/52/58) vaccine types to be 8.2%, 13%, and 38%, respectively. These results reinforce the importance of surveillance studies and provide the first data regarding circulating HPV genotypes in the unvaccinated population in Paraguay, thus generating a baseline to compare future changes in the overall and type-specific HPV prevalence after HPV vaccination.

Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study.

BACKGROUND: Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. METHODS: This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. FINDINGS: Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). INTERPRETATION: Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. FUNDING: WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.

Implementing HPV testing in 9 Latin American countries: The laboratory perspective as observed in the ESTAMPA study.

Background: Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings. Methods: We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored (1 = compliant, 0 = not compliant) and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described. Results: Seven of 12 laboratories had high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs. Conclusion: High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a "culture of quality" should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening.

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol.

INTRODUCTION: Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS: Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT01881659.

Caracterización epidemiológica y molecular de la Hepatitis C en la población que acudió al Laboratorio Central de Salud Pública, Paraguay 2013-2018 / Epidemiological and molecular characterization of Hepatitis C in the population that went to the Central Laboratory of Public Health, Paraguay 2013-2018

Introducción: Las hepatitis causadas por el virus de la hepatitis C (VHC) se han transformado en uno de los principales problemas de enfermedades infecciosas emergentes, responsables del 80% de las hepatitis crónicas con posible evolución a cirrosis o carcinoma hepatocelular y ocasionando un alto costo para el sistema de salud. Objetivo: Describir el perfil epidemiológico y los genotipos del VHC en pacientes que acudieron al Laboratorio Central de Salud Pública (LCSP). Materiales y métodos: Estudio descriptivo; se incluyeron 162 pacientes con infección por Hepatitis C referidos al LCSP entre el 2013 y 2018, para seguimiento y/o genotipificación. Se les realizó la amplificación del genoma mediante la técnica reacción en cadena de la polimerasa en tiempo real previa transcripción reversa (RT-PCR). A una submuestra con PCR detectable y carga viral >500 UI/ml se determinó el genotipo(n=52). Resultados: La media de edad fue de 44,2 ±15,6 años, el 52,5% eran hombres. El 8,02% presentaron carga viral alta, 32,09 % baja y 59,87 % indetectable. La distribución de genotipos fue la siguiente: 61,5 % genotipo 1 (28,1% 1a, 53,1% 1b y 18,8% genotipo 1 sin subtipificación), 15,4% genotipo 2, 15,4% genotipo 3 y 7,7% genotipo 4. Conclusiones: El presente trabajo muestra la importancia de la implementación de técnicas moleculares aplicadas a la vigilancia epidemiológica de nuestro país de manera a establecer programas de detección temprana y seguimiento adecuado de los pacientes, ya que la caracterización genotípica ayuda a determinar lasestrategias terapéuticas más adecuadas y predecir la respuesta antiviral. Se confirma que el genotipo 1 es el que circula con mayor frecuencia, con alto predominio del subtipo 1b. Palabras Clave: Biología Molecular, Hepatitis C, Genotipo, Epidemiología Molecular, Paraguay.

Introduction: Hepatitis caused by the hepatitis C virus (HCV) has become one of the main problems of emerging infectious diseases, responsible for 80% of chronic hepatitis with possible evolution to cirrhosis or hepatocellular carcinoma and causing a high cost for the health system. Objective: To describe the epidemiological profile and the genotypes of HCV in patients who attended the Central Public Health Laboratory (LCSP). Materials and methods: Descriptive study; included 162 patients with Hepatitis C infection referred to the LCSP between 2013 and 2018, for follow-up and / or genotyping. Genome amplification was performed using the polymerase chain reaction technique in real time prior to reverse transcription (RT-PCR). To a subsample with detectable PCR and viral load> 500 IU / ml, the genotype was determined (n = 52). Results: The mean age was 44.2 ± 15.6 years, 52.5% were men. The 8.02% had high viral load, 32.09% low and 59.87% undetectable. The genotype distribution was as follows: 61.5% genotype 1 (28.1% 1a, 53.1% 1b and 18.8% genotype 1 without subtyping), 15.4% genotype 2, 15.4% genotype 3 and 7.7% genotype 4. Conclusions: The present work shows the importance of the implementation of molecular techniques applied to the epidemiological surveillance of our country in order to establish programs of early detection and adequate monitoring of patients, since genotypic characterization helps to determine the most appropriate therapeutic strategies and predict the antiviral response. It is confirmed that genotype 1 is the one that circulates more frequently, with a high predominance of subtype 1b. Keywords: Molecular Biology, Hepatitis C, Genotype, Molecular Epidemiology, Paraguay.

Detección y tipificación del Virus Papiloma Humano en el marco del tamizaje virológico para la detección de lesiones del cuello uterino en Asunción, Paraguay / Detection and typing of Human Papilloma Virus during a virological screening for detection of cervical lesions in Asunción, Paraguay

En Paraguay la incidencia de cáncer de cuello uterino (CCU) es superior a las observadas en otros países de la región. El agente etiológico asociado al CCU es el virus papiloma humano (VPH), esencialmente tipos de alto riesgo oncogénicos. El objetivo es describir aspectos epidemiológicos de la infección genital por el virus papiloma humano de alto riesgo (VPH-AR) en mujeres de 25 a 64 años que consultaron en servicios de Patología Cervical del MSPyBS, de mayo a diciembre de 2013. Se utilizó el Cobas 4800 HPV Test (Roche) que permite la detección individual de VPH-16 y VPH-18 y un pool de otros VPH-AR que incluye 12 genotipos de alto riesgo. Los otros VPH-AR fueron tipificados por hibridación reversa en línea (RLB). Entre las 495 mujeres incluidas, se detectaron 72 casos positivos (14,5%) de VPH-AR. Se identificaron 19 tipos virales; siendo el más frecuente VPH-16 (2,1%), seguido del VPH-31, 33, 58 y 66; el VPH-18 aparece en sexto lugar. Este trabajo aporta los primeros datos sobre la implementación de técnicas moleculares para detección y tipificación de VPH como parte del sistema de salud pública de Paraguay. El predominio de VPH-16, confirma su amplia circulación a nivel mundial y dado su mayor potencial oncogénico, representa una alerta a considerar, en especial en las mujeres mayores de 30 años portadoras de una infección persistente. Estos resultados apoyan la importancia de la implementación criteriosa y la utilización apropiada de las pruebas moleculares actualmente disponibles para la prevención y control del CCU(AU)

Desempeño de una prueba rápida para el diagnóstico de sífilis en mujeres puérperas / Performance of a rapid test for the diagnosis of syphilis inpuerperal women

La sífilis, por su impacto en la salud materno infantil, demanda prevención y tratamiento de calidad. Las pruebas rápidas son herramientas adecuadas de detección con una sensibilidad entre 84% a 97% y especificidad de 84% o más. En Paraguay, las pruebas rápidas han sido validadas e incorporadas a los programas de salud pero no existen estudios que hayan evaluado su desempeño, por lo que este estudio observacional descriptivo tiene por objetivo evaluar el desempeño de una prueba rápida comercial para el diagnóstico de sífilis en comparación a la Hemaglutinación Indirecta del Treponema (TPHA) en muestras de mujeres puérperas remitidas al Laboratorio Central de Salud Pública por hospitales de parto del Municipio Capital, y los departamentos: Central, Concepción y Alto Paraná entre 2011 y 2012. De 334 muestras evaluadas, 108 fueron positivas por las dos pruebas (test rápido y TPHA), y 182 negativas por ambas. En el resto, los resultados fueron discordantes (23 positivos con la prueba rápida y negativos por TPHA y 21 negativos por test rápido y positivos por TPHA). La sensibilidad de la prueba rápida comparada con TPHA fue 83,72% (IC95%: 75,96-89,42%) y la especificidad de 88,78% (IC95%: 83,45-92,61%).

Due to its impact on maternal and child health, syphilis demands quality in preventionand treatment. The rapid test is an appropriate screening tool with a sensitivity of 84-97%and specificity from 84%. In Paraguay, rapid tests have been validated and incorporatedinto health programs. The performance of a rapid test for syphilis was evaluated comparedwith Treponema particle agglutination assay (TPHA) in samples of puerperal women sent tothe Central Laboratory of Public Health from birthing hospitals of the Capital City, and threedepartments: Central, Concepción and Alto Paraná between 2011 and 2012. Of the 334samples tested, 108 were positive by both tests (rapid test and TPHA test), and 182 werenegative by both. The rest presented discordant results (23 positive with the rapid test andTPHA negative and 21 negative by rapid test and positive for TPHA). The sensitivity of therapid test compared with the TPHA was 83.72% (95% CI 75.96 to 89.42%) and specificity88.78% (95% CI 83.45 to 92.61).

Detección molecular del papilomavirus humano de alto riesgo en el seguimiento de mujeres tratadas por lesión escamosa intraepitelial / Molecular detection of high risk human papillomavirus in following women treated for squamous intraepithelial lesion

El cáncer de cuello uterino (CCU) es la primera causa de muerte por cáncer en mujeres en países en vías de desarrollo. La infección persistente por el virus papiloma humano (VPH) es un factor necesario en lesiones preneoplásicas y CCU. La citología cervicovaginal es el método mayormente utilizado para detectar el CCU y su uso combinado con la de detección de ADN viral seis meses post-tratamiento aumenta la efectividad para identificar mujeres tratadas con riesgo de lesión residual/recidiva. El objetivo fue describir la frecuencia de VPH de alto riesgo (AR) en mujeres tratadas por lesión escamosa intraepitelial (SIL) que acudieron al Servicio de Patología Cervical del Hospital San Pablo de enero-diciembre/2014. Se realizó un estudio descriptivo de corte transverso, que incluyó 80 pacientes que acudieron al servicio para control post-tratamiento por SIL. Se utilizó Cobas 4800 HPV Test (Roche) para la detección individual de VPH-16 y 18, y un pool de 10 VPH-AR (31,33,35,39,45,51,52,56,58,59) y dos de “probable” alto riesgo (66,68). Se encontró infección viral en el 7,5% (6/80) de las pacientes tratadas; identificándose VPH-16 en 3/6 de los casos positivos. En Paraguay existe alta incidencia de lesiones pre-neoplásicas y CCU siendo un problema de salud pública. Los datos observados sugieren que la utilización de este sistema para la detección viral puede llevar a optimizar el seguimiento post-tratamiento y la identificación de VPH-16 y 18 podría contribuir a la selección de pacientes en mayor riesgo de desarrollar una lesión cervical que deben someterse a una vigilancia frecuente y meticulosa.

Cervical cancer is the leading cause of cancer death in women in developing country.Persistent infection with human papillomavirus (HPV) is a necessary factor in premalignantlesions and cervical cancer. The Pap smear is the method most commonly used to detect thecervical cancer and its combined with the detection of viral DNA six months post-treatment increases effectiveness to identify women treated in risk with residual/recurrent lesion. Theaim was to describe the frequency of high-risk HPV (HR) in treated women for squamousintraepithelial lesion (SIL) who attended the Cervical Pathology Service of Hospital San Pablofrom January to December/2014. It is cross sectional, descriptive study which included 80patients who attended the service for post-treatment control. The 4800 Cobas HPV Test(Roche) was used, which detects HPV-16 and 18, and a pool of 10 HR-HPV(31,33,35,39,45,51,52,56,58,59) and two "probable" high risk (66,68). Viral infection wasfound in 7.5% (6/80) of patients treated; identifying HPV-16 in 3/6 of positive cases. InParaguay there is a high incidence of pre-neoplastic lesions and cervical cáncer remains apublic health problem. The observed data suggest that the use of this system for viraldetection can lead to optimize the post-treatment monitoring and the identification of HPV-16and 18 could contribute to the selection of patients at increased risk of developing cervicalinjury should undergo to frequent and careful monitoring.

Monitoreo de anticuerpos anti-HLA en pacientes con insuficiencia renal crónica en lista de espera para trasplante / Anti-hla antibodies monitoring in patients with chronic re- nal failure on waiting list for renal transplant in Paraguay

INTRODUCCIÓN: El estudio de anticuerpos anti-HLA en el suero del paciente en lista de espera para trasplante renal es fundamental para optimizar la elección de un donante así como el esquema de inmunosupresión de inducción y mantenimiento acorde al riesgo inmunológico. Estos anticuerpos pueden Encontrarse de manera preexistente al trasplante como resultado de exposición del individuo a transfusiones sanguíneas, embarazos y trasplantes previos. El objetivo del estudio fue determinar la incidencia de inmunización frente a antígenos de HLA, los factores asociados y su impacto en pacientes en espera de un trasplante renal. MATERIAL Y MÉTODOS: En este estudio, observacional retrospectivo de corte trasversal, fueron incluidos 254 pacientes en lista de espera para trasplante renal que acudieron al Laboratorio Central de Salud Pública en el período comprendido entre julio de 2013 y julio de 2015. RESULTADOS: De los 254 pacientes estudiados, 30% presentaron anticuerpos anti-HLA. El evento sensibilizante más significativo fue la exposición a un trasplante previo, presentando anticuerpos anti-HLA el 84% de los candidatos a retrasplante (p<0,05). En segundo lugar se encontraron las mujeres multíparas, presentando un PRA (Panel Reactivo de Anticuerpos) positivo el 69% de ellas (p<0,05). Por último, el 24% de los pacientes poli-transfundidos presentaron anticuerpos anti HLA (p<0,05). CONCLUSIONES: En el trascurso de los dos años de estudio, 51 pacientes fueron trasplantados, de los cuales un solo paciente presentaba anticuerpos anti-HLA antes del trasplante. Esto indica claramente que la inmunización frente a antígenos de HLA representa una barrera para el acceso al trasplante

INTRODUCTION: Anti-HLA antibodies determination in the serum of patients on a waiting list for renal transplant is essential to optimize donor selection as well as for the induction and maintenance immunosuppression scheme, according to immunological risk. These antibodies could be present before transplantation as a result of being exposed to blood transfusions, pregnancies and previous transplants. The objective of the study was to determine immunization against HLA antigens, associated factors and their impact on the waiting list for a renal transplant. METHODS: In this observational retrospective cross sectional study, 254 patients on the waiting list for renal transplant were included. These patients attended the Public Health central laboratory between July 2013 and July 2015. RESULTS: 30% of the 254 studied patients presented anti-HLA antibodies. The most significant sensitizing event was the exposure to a previous transplant (p=<0.05). Multiparous women were in second place, 69% of them presenting positive PRA (panel reactive antibodies) (p=<0.05). Finally 24% of poly transfused patients presented anti-HLA antibodies (p=<0.05). CONCLUSIONS: During the 2 year of the study, 51 patients were transplanted, presenting only one of them anti-HLA antibodies before transplantation. This results clearly indicate that the immunization against HLA represents a barrier for transplantation access

Serorreactividad al antígeno de superficie del virus de la hepatitis B en mujeres que acudieron al laboratorio central de salud pública. Asunción, Paraguay / Seroreactivity against the hepatitis B virus surface antigen in women who attended the central public health laboratory. Asunción, Paraguay

La hepatitis B es un grave problema de salud pública a nivel mundial, aproximadamente cerca de 2 billones de personas tienen evidencia serológica de infección por el virus de la hepatitis B. El objetivo de este trabajo fue describir la frecuencia de hepatitis B e identificar los factores de riesgo asociados en mujeres en edad fértil que acudieron al Laboratorio Central de Salud Pública entre diciembre de 2013 y junio de 2014. Fue un estudio observacional analítico de corte transverso que, previo consentimiento informado, analizó suero de mujeres entre 15 y 44 años con una edad promedio de 26,6 (±6,8) años. Mediante la detección del antígeno de superficie de la hepatitis B por ELISA se identificaron seis casos positivos (0,4%), indicando una endemicidad baja; cifra que ha variado según perfil socio demográfico: según edad, las de 20 y más años presentaron una frecuencia mayor en comparación a las demás (p>0,05). No se observaron diferencias significativas al evaluar la seropositividad según el estado civil, el nivel de escolaridad, la condición de gravidez, los antecedentes de transfusiones, sin embargo, la seropositividad era mayor en las portadoras de tatuajes/piercing que entre las no portadoras, lo que representaba un riesgo 6,2 veces mayor (OR:6,2 IC95%:1,3-31,3). En conclusión, la frecuencia del HBsAg en nuestra población es baja, y el factor de riesgo asociado a su detección fue la presencia de tatuajes y/o piercing.

Hepatitis B is a serious public health problem worldwide; approximately about 2 billionpeople have serologic evidence of infection with hepatitis B virus. The aim of this analyticcross-sectional study was to describe the frequency of hepatitis B and identify risk factorsin women of child bearing age who attended the Central Public Health Laboratory in theperiod 2013 to 2014. Prior informed consent, antigen detection of hepatitis B surface wasperformed by ELISA in women between 15 and 44 years with a mean age of 26.6 (±6.8)years. The identification of six serologic positive cases (0.4%) indicates low endemicity.This figure varied according to socio-demographic profile: according to age, those whowere 20 years old or older had an increased frequency compared to the others (p> 0.05). No significant differences were observed in seropositivity by marital status, level ofeducation, pregnancy, history of transfusion, while seropositivity was higher amongcarriers of tattoos/piercing than among non-carriers, which represented a 6.2 times higherrisk (OR 6.2 95% CI 1.3 to 31.3). In conclusion, the frequency of HBsAg in our populationwas low. The risk factor associated with its detection was the presence of tattoos and / or piercings.

Existe concordancia entre los criterios de ECG de agrandamiento de cavidades izquierdas y los hallazgos ecocardiogramas? / Exists agreement between the criteria of ECG of enlargement of left cavities and the findings ecocardiogramas?

Este trabajo busca comprobar si los criterios de agrandamiento de cavidades izquierdas encontrados por el ecocardiograma. Objetivos: idnetificar los criterios de diagnósticos por electrocardiograma de hipertrofia ventricular izquierda y o dilaciónventricular izquierda y dilación auricular izquierda. Estabelcer la concordancia auricular izquierda. Materiales: estudio analítico de corte transversal. Se incluyeron pacientes de ambos sexos (54% femenino y 46% masculino). Reclutados desde el 1-05-05 al 10-07-05. Resultados: se incluyeron 150 pacientes, todos fueron estudiados con electrocardiograma y ecocardiograma con el mismo aparato y observador. Conclusiones: el hallasgo de agrandamiento de aurícula izquierda por electrocardiograma nos permite hacer el diagnóstico exacto solo ene un 75% y su ausencia no la descarta. Entre los criterios de agrandamiento de ventriculo izquierdo por electrocardiograma la mayoría de los criterios revelo una mayor concordancia con la hipertrofia ventricular izquierda, siendo el criterio de voltaje el demás elevado VP+ de hasta el 100%, contrariamente el análisis entre dichos criterios y la dilatación ventricular izquierda revelo un VP-mayor a 80 o sea que en ausencia de dichos criterios podemos afirmar que la mayoría de los pacientes no tienen dilatación ventricular izquierda con un VP-del 22%. La ausencia de criterios por electrocardiograma no presentó concordancia con ausencia de hipertrofia ventricular izquierda o dilatación ventricular izquierda por ecocardio. Teniendo en cuenta la escasa sensibilidad del electrocardiograma para captar hipertrofia ventricular izquierda y/o dilatación ventricular izquierda consideramos importante concluir que es conveniente completar el chequeo del paciente con ecocardiograma cuando la clínica nos hace sospechar que puede tener hipertrofia ventricular izquierda y/o dilatación ventricular izquierda.

Programa de evaluación externa de calidad química clínica en Paraguay. Periodo 1991-1994 / Annual reports 1995 / Program of external quality evaluation of clinical chemistry in Paraguay. Period of 1991-1994

El presente estudio se realizó con el objetivo de determinar el rendimiento en exactitud de una cohorte de 58 laboratorios de análisis clínicos de Asunción. Los mismo participaron en forma ininterrumpida en programa de Evaluación Externa de la Calidad en Química Clínica de la Asociación de Bioquímicos y el Instituto de Investigaciones Ciencias de la Salud, en los años 1991 a 1994. En ese periódo se llevarón a cabo 9 evaluaciones de exactitud utilizando sueros control a un solo nivel de concentración en los que se midieron 13 analitos. En los primeros años se llevó a cabo un programa de intervención educativa en control de calidad interno en 71 laboratorios en forma confidencial y voluntaria, de los cuales 25 por ciento fueron públicos y 75 por ciento privados. Solo el 35 por ciento(25/71) de los laboratorios tuvo rendimiento satisfactorio, manteniendose este resultado hasta 12 meses después de la intervención. En los años posteriores, 58 laboratorios continuaron participando de la evaluaciones externas y de los cursos de capacitación. En las 9 evaluaciones se empleó el criterio del Colegio de Patólogos Americanos (CAP), que califica un rendimiento como satisfactorio por laboratorio cuando el 80 por ciento de los resultados son buenos o satisfactorios. Al analisar el rendimeinto de los 58 laboratorios que continuaron en forma ininterrumpida el estudio, detectamos un cambio significativo (p=0,002) a los 18 meses post-intervención educativa, con un rendimiento satisfactorio en el 67 por ciento (39/58) de los laboratorios. Dicho rendimiento se mantuvo hasta el final del estudio en el grupo de laboratorios, siendo a los 48 meses de 86 po ciento (50/58). En la comparación de la precisión interlaboratorio de 1991 a 1994, se observó que los coeficientes de variación se mantuvieron en su mayoria por encima de los alcanzados por el United Kigdom national External Quality Assessment Scheme. Los resultados de nuestros estudios sugieren que contínuos y regulares programas de evaluación externa de calidad contribuyen a mejorar el rendimiento de los laboratorios. Sin embargo, en nuestro país los coeficientes de variación continúan elevados, probablemente debido a que son aun pocos los laboratorios que tienen implementado un programa de control interno de claidad.

Programa de evaluación externa de calidad química clínica en Paraguay. Periodo 1991-1994 / Annual reports 1995 / Program of external quality evaluation of clinical chemistry in Paraguay. Period of 1991-1994

El presente estudio se realizó con el objetivo de determinar el rendimiento en exactitud de una cohorte de 58 laboratorios de análisis clínicos de Asunción. Los mismo participaron en forma ininterrumpida en programa de Evaluación Externa de la Calidad en Química Clínica de la Asociación de Bioquímicos y el Instituto de Investigaciones Ciencias de la Salud, en los años 1991 a 1994. En ese periódo se llevarón a cabo 9 evaluaciones de exactitud utilizando sueros control a un solo nivel de concentración en los que se midieron 13 analitos. En los primeros años se llevó a cabo un programa de intervención educativa en control de calidad interno en 71 laboratorios en forma confidencial y voluntaria, de los cuales 25 por ciento fueron públicos y 75 por ciento privados. Solo el 35 por ciento(25/71) de los laboratorios tuvo rendimiento satisfactorio, manteniendose este resultado hasta 12 meses después de la intervención. En los años posteriores, 58 laboratorios continuaron participando de la evaluaciones externas y de los cursos de capacitación. En las 9 evaluaciones se empleó el criterio del Colegio de Patólogos Americanos (CAP), que califica un rendimiento como satisfactorio por laboratorio cuando el 80 por ciento de los resultados son buenos o satisfactorios. Al analisar el rendimeinto de los 58 laboratorios que continuaron en forma ininterrumpida el estudio, detectamos un cambio significativo (p=0,002) a los 18 meses post-intervención educativa, con un rendimiento satisfactorio en el 67 por ciento (39/58) de los laboratorios. Dicho rendimiento se mantuvo hasta el final del estudio en el grupo de laboratorios, siendo a los 48 meses de 86 po ciento (50/58). En la comparación de la precisión interlaboratorio de 1991 a 1994, se observó que los coeficientes de variación se mantuvieron en su mayoria por encima de los alcanzados por el United Kigdom national External Quality Assessment Scheme. Los resultados de nuestros estudios sugieren que contínuos y regulares programas de evaluación externa de calidad contribuyen a mejorar el rendimiento de los laboratorios. Sin embargo, en nuestro país los coeficientes de variación continúan elevados, probablemente debido a que son aun pocos los laboratorios que tienen implementado un programa de control interno de claidad

Control de calidad en el laboratorio de análisis clínico / Annual Reports 1992 / Quality control in the laboratory of clinical analysis

A quality conrol assesssment laboratories of clinical analysis was performed in March 1989. Glucose, urea, bilirubin, and GOT were determined in a sample of the same control serum. Statistical evaluation of the results showed that the coefficient of variation (CV) of each parameter was much higher than the internationally accepted values. A further evaluation included an internal precision control and an interlaboratory control. Urea, glucose and cholesterol were determined in twenty samples of the same serum lot per month by each laboratory. About 61 percent had an acceptable CV for glucose, 74.4 percent for urea and 65,6 percent for cholesterol