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1.
Int J Gynaecol Obstet ; 148(3): 331-337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31778211

RESUMO

OBJECTIVES: To identify factors influencing the long-term prognosis after surgical repair of obstetric fistula, establish a prognosis-based classification system, and examine changes in quality of life after surgery. METHODS: A retrospective study of 308 women who underwent obstetric fistula repair at Saint Jean de Dieu Hospital, Tanguiéta, Benin, between 2008 and 2016, and were supported by a multidisciplinary management model. All participants were from rural areas of Burkina Faso. The women completed interviews before, immediately after, and 2, 4-6, and 12 months after surgery to assess their clinical state and socioeconomic and psychologic status. RESULTS: Overall, the fistulae of 230/274 (83.9%) women were considered to be repaired after 12 months. Factors associated with poor repair outcome included the presence of sclerotic tissue (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.11-0.53) and intraoperative complications (OR, 0.16; 95% CI, 0.07-0.39). Women with successful surgery had a better quality of life as compared with women with an unrepaired fistula (Ditrovie score, 1.1 vs 3.9; P<0.001). CONCLUSION: The multidisciplinary Tanguiéta model for management of obstetric fistula allowed successful fistula closure, thereby facilitating the women's long-term social reintegration, and improved quality of life.

3.
Oncotarget ; 10(57): 5894-5905, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31666922

RESUMO

Ovarian cancer is the fifth leading cause of cancer-related death in the world. Some ovarian cancer patients present large amount of ascites at the time of diagnosis which may play an active role in tumor development. In earlier studies, we demonstrated that the acellular fraction of ascites can induce apoptosis of ovarian cancer cells. The current study identifies pigment epithelium derived factor (PEDF) as the molecule responsible for the apoptotic effect of ascites and evaluates the Sleeping Beauty transposon (SBT) system as a new tool for PEDF gene therapy against ovarian cancer. We utilize gel filtration, mass spectrometry, affinity column, cell viability assay, tumor development on chick chorioallantoic membrane and molecular biology techniques for these purposes. PEDF was thus identified as the agent responsible for the effects of ascites on ovarian cancer cell viability and tumor growth. Interestingly, the PEDF expression is decreased in ovarian cancer cells compared to healthy ovarian cells. However, the level of PEDF is higher in ascites than in serum of ovarian cancer patients suggesting that cells present in the tumor environment are able to secrete PEDF. We then used the SBT system to stably induce PEDF expression in ovarian cancer cells. The overexpression of PEDF significantly reduced the tumor growth derived from these cells. In conclusion, the results presented here establish that PEDF is a therapeutic target and that PEDF from ascites or SBT could be utilized as a therapeutic strategy for the treatment of ovarian cancer.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31650130

RESUMO

Objective: The objective of this study was to review the records of patients with excised abdominal wall endometriosis (AWE) to determine patient characteristics, diagnostic methods, presence of concurrent pelvic endometriosis and type of surgery. Study design: Medical records from an 11-year period were searched to identify histologically confirmed AWE cases. Descriptive data were collected and analyzed. Two subgroups were differentiated: isolated AWE and pelvic endometriosis-associated AWE. Results: Thirty-five women with AWE were included. The most common symptom was cyclic abdominal or parietal pain (68.6%); 17.1% of the women had no symptoms. Twenty-nine women (82.8%) had a history of gynecological or obstetrical surgery, most commonly cesarean section (CS). The mean interval between prior surgery and appearance of symptoms was 5.3 years. Six women (17.1%) had no prior surgery; all six presented with umbilical nodules, nulliparity and confirmed mild to severe pelvic endometriosis. Among all patients, 34.3% had concurrent pelvic endometriosis, 40% presented with isolated AWE and 25.7% had no pelvic exploration. Women with concurrent pelvic endometriosis had significantly lower parity, smaller nodule size and a higher likelihood of umbilical location than those with isolated AWE (p < 0.05). A history of CS was more commonly found in women with isolated AWE. The overall recurrence rate over the study period was 11.4%, with a mean follow-up period of 5.2 years. Conclusions: AWE is an uncommon condition associated with long diagnostic and therapeutic delays. In patients with umbilical AWE and no surgical history, pelvic endometriosis is commonly present and should be highly suspected.

6.
Rev Med Suisse ; 15(668): 1934-1939, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643154

RESUMO

Venous thromboembolic events (VTE), defined by deep vein thrombosis or pulmonary embolism, are potentially serious complications after gynecologic surgery. Without thromboprophylaxis, they are common and can lead to significant morbidity and mortality. Conversely, poorly adapted prophylaxis can be hazardous. Risk factors related to the patients and to the types of surgery have been identified and can be used to adapt the prophylaxis. Several recommendations have been proposed; however, no clear consensus exists. This article reviews the pathophysiology and specific risk factors of post-gynecologic surgical VTE and provides comprehensive and practical recommendations for perioperative thromboprophylaxis in gynecology, based on various international recommendations.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Assistência Perioperatória/métodos , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/prevenção & controle , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Feminino , Humanos , Fatores de Risco
7.
Vaccines (Basel) ; 7(4)2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31561629

RESUMO

Abstract: Background: Human Papillomavirus is a common sexually transmitted infection, representing the main cause of genital warts and cervical cancer. The objective of this study was to evaluate basic knowledge and beliefs regarding HPV infection and HPV vaccine among undergraduate healthcare men and women students, as well as their attitudes towards HPV vaccine. METHODS: Undergraduate women and men (nursing and midwifery curses) attending three Schools of Health Sciences located in Switzerland. A total of 427 women and 223 men have completed the web questionnaire, which included questions on their socio-demographic background and about basic knowledge and attitudes toward the HPV infection and vaccination. RESULTS: Women undergraduate students have a better knowledge of HPV infection than their men counterparts, although there was a significant gap in knowledge of the disease's mode of transmission and prevention. Among women, 72.6% of respondents reported having received at least one dose of HPV vaccines versus 31.4% for men respondents. CONCLUSION: The results of this study revealed a poor understanding among undergraduate healthcare men and women students about the HPV infection, its mode of transmission and its prevention. Our findings highlight the need to improve education on HPV for undergraduate healthcare students in order to increase the awareness of the disease.

8.
PLoS One ; 14(8): e0220632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408474

RESUMO

OBJECTIVE: To assess triage compliance and the effect of the time from screening to triage on follow-up among HPV-positive women. METHODS: We recruited 1232 women in a screening campaign in Madagascar from February to October 2015. In the first period (February-May), HPV tests were performed remotely using the cobas test. In the second period (May-October), testing was performed on-site using the Xpert HPV assay. HPV-positive women were invited for triage with visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). Systematic biopsy and endocervical brushing were performed on all HPV-positive women for quality control. Three groups were defined according to time from HPV testing to triage invitation for HPV-positive women-Group I: delayed (> 3 months), Group II: prompt (24-48 hours), and Group III: immediate (< 24 hours). RESULTS: A total 1232 self-sampled HPV tests were performed in the study period (496 in Group I, 512 in Group II, and 224 in Group III). Participants' mean age was 43.2 ± 9.3 years. Mean time from screening to VIA/VILI testing was 103.5 ± 43.6 days. Overall HPV prevalence was 28.0%. HPV prevalence was 27.2% in Group I (cobas test), 29.2% in Group 2 (Xpert test), and 26,7% in Group III (Xpert test). The VIA/VILI compliance rate was 77.8% for Group I, 82.7% for Group II, and 95.0% for Group III. Of women undergoing VIA/VILI, 56.3% in Group I and 43.5% in Groups II/III had positive results. Prevalence of cervical intraepithelial neoplasia grade 2 or worse among HPV-positive women was 9.8% for Group I and 6.8% for Groups II/III. Non-adherence was higher among rural women, uneducated women, and women in Group I. CONCLUSION: HPV-positive women with immediate VIA/VILI triage invitation had the best triage compliance. A single-day test and triage strategy is preferred for low-resource settings.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Infecções por Papillomavirus/complicações , Cooperação do Paciente/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biópsia , Colo do Útero/patologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Madagáscar/epidemiologia , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Autocuidado/psicologia , Triagem , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
9.
Arch Public Health ; 77: 29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236272

RESUMO

Background: Human Papillomavirus (HPV) vaccination, intended for young women aged 11-14 years old, has been introduced in Switzerland in 2007. Ten years after its introduction, only a few studies have explored the reasons associated with uptake and non-uptake of the vaccination. Our objective was to identify the sociodemographic characteristics of a population of vaccinated and unvaccinated undergraduate healthcare female students, to define the reasons of non-uptake of vaccination, and compare our findings with those found in other Swiss cantons. Methods: Between January and November 2017, women studying in Health Sciences School and Medical School in Geneva, aged 18-31 years old, were recruited in a large trial assessing HPV prevalence. As part of a smaller, observational study nested in this larger trial, women were invited to complete a questionnaire. Self-reported HPV vaccination uptake or non-uptake, as well as knowledge and attitude about HPV vaccination were assessed. T-Test and Chi square test were used to compare characteristics of vaccinated and unvaccinated women. Results: Overall, 409 women were recruited in the study. The majority of them (69.1%) reported having been vaccinated for HPV, while 30.9% of them had never received any dose of the HPV vaccine. The only factor associated with a higher vaccination rate was the participants' origin, as women from Geneva were more represented in the vaccinated group than women from other Swiss regions or countries. Unvaccinated women were more likely to consider HPV vaccination as less important than the vaccinated ones (50.4% vs 3.5% p < 0.001). Conclusion: Although no typical profile can be established in this studied population of unvaccinated women, a lack of information was a major reason of non-uptake of vaccination among the study participants. An effort by health authorities and carefully designed messages are essential to increase the population's awareness over cervical cancer and its prevention. Trial registration: The trial was registered under cliniclatrials.gov with the identifier: NCT03474211.

10.
JMIR Cancer ; 5(1): e9798, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31094335

RESUMO

BACKGROUND: Women undergoing pelvic examination for cervical cancer screening can experience periprocedural anxiety. OBJECTIVE: The aim of this study was to assess the anxiety level experienced by women undergoing a visual inspection with acetic acid and Lugol iodine (VIA and VILI) examination, with or without watching the procedure on a digital screen. METHODS: This prospective randomized study took place in the district of Dschang, Cameroon. A previous cervical cancer screening campaign tested women aged between 30 and 49 years for human papillomavirus (HPV). HPV-positive women were invited for the 12-month follow-up control visit, including a VIA/VILI examination. During that visit, we recruited women to participate in this study. Before the examination, participants were randomized in a 1:1 ratio to a control group (CG) and an intervention group (IG). Women in both groups underwent a pelvic examination and were verbally informed about the steps undertaken during the gynecological examination. The IG could also watch it live on a tablet screen. Women's anxiety was assessed before and immediately after the examination, using the Spielberger State-Trait Anxiety Inventory (STAI). A paired t test was used to compare the mean STAI score for each question before and after VIA/VILI while a nonpaired, 2-sided t test was used to compare the mean differences of the STAI score between the 2 study groups. RESULTS: A total of 122 women were randomized in the study; 4 of them were excluded as they did not undergo the pelvic examination, did not answer to the second STAI questionnaire because of personal reasons, or the cervix could not be properly visualized. Thus, the final sample size consisted of 118 patients of whom 58 women were assigned to the CG and 60 to the IG. The mean age was 39.1 (SD 5.2) years. Before the examination, the mean (SD) STAI score was 33.6 (SD 10.9) in the CG and 36.4 (SD 11.8) in the IG (P=.17). The STAI score after pelvic examination was significantly reduced for both groups (CG: 29.3 [SD 11.2]; IG: 28.5 [SD 12.0]). Overall, the difference of the STAI scores before and after the pelvic examination was lower in the CG (4.2 [SD 9.0]) than in the IG (7.9 [SD 14.3]), although the difference was not significant (P=.10). However, the women's emotional state, such as I feel secure and I feel strained, was improved in the IG as compared with the CG (CG: P=.01; IG: P=.007). CONCLUSIONS: Watching the VIA/VILI procedure in real time improved the women's emotional state but did not reduce the periprocedural anxiety measured by the STAI score. Furthermore, larger studies should assess women's satisfaction with watching their pelvic examination in real time to determine whether this tool could be included in VIA/VILI routine practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT02945111; http://clinicaltrials.gov/ct2/show/NCT02945111.

13.
BMC Cancer ; 19(1): 111, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700274

RESUMO

BACKGROUND: The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. METHODS: We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. RESULTS: We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. CONCLUSIONS: Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.


Assuntos
Neoplasia Intraepitelial Cervical/virologia , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero/virologia , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/patologia , Estudos Transversais , Feminino , Genótipo , Humanos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Vigilância da População , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
14.
Gynecol Oncol ; 153(1): 92-99, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718124

RESUMO

OBJECTIVE: About 30% of women who are eligible for cervical cancer (CC) screening remain un-screened or under-screened in Switzerland. HPV testing on self-collected vaginal samples (Self-HPV) has shown to be more sensitive than cytology while also reaching non-attendees. The objective of this study was to explore the cost-effectiveness of offering Self-HPV to non-attendees in Switzerland. METHODS: A recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: Self-HPV and triage with colposcopy (Self-HPV/colpo), Self-HPV and triage with Pap cytology (Self-HPV/PAP), cytological screening and triage with HPV (PAP/HPV). Sensitivity analyses for the key parameters of the model were conducted to check the robustness of findings. RESULTS: Offering a Self-HPV screening to non-attendees could prevent 90% of CC and 94% of CC-related deaths in the study population. The current cytology-based program could reduce by 83% the number of CC cases and by 88% the number of CC-related deaths over the population's lifetime. Compared to the absence of screening, incremental cost-effectiveness ratios (ICER) were estimated to be, per saved Quality Adjusted Life Year (QALY), 12413US$ for the strategy Self-HPV/colpo, 11138US$ for the strategy Self-HPV/Pap and 22488US$ for the strategy PAP/HPV. CONCLUSIONS: Offering Self-HPV as a CC screening strategy to non-attendees in Switzerland is a cost-effective solution that is associated with a reduction of CC cases and related deaths. Self-HPV is more cost-effective than the currently used cytology-based screening.


Assuntos
Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/virologia , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/economia , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/virologia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Cadeias de Markov , Modelos Econômicos , Teste de Papanicolaou/economia , Teste de Papanicolaou/métodos , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/virologia , Autocuidado/economia , Autocuidado/métodos , Suíça , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/economia , Esfregaço Vaginal/métodos
15.
J Minim Invasive Gynecol ; 26(7): 1351-1356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30710637

RESUMO

STUDY OBJECTIVE: Few reports have investigated the use of endoscopic retrieval bags in the context of laparoscopic myomectomy with electromechanical morcellation. We performed a leak test of a specially designed endoscopic bag system in women undergoing laparoscopic myomectomy with contained electromechanical morcellation. DESIGN CLASSIFICATION: Prospective study. SETTING: University hospital. PATIENTS: Thirty-one women undergoing laparoscopic myomectomy with contained electromechanical morcellation. INTERVENTIONS: Electromechanical morcellation was introduced for large specimen extraction during laparoscopic procedures. Complications such as retained/disseminated parasitic tissue were documented. MEASUREMENTS AND MAIN RESULTS: Systematic peritoneal washings were performed at 3 specific times: at baseline, T1, once the peritoneal cavity was accessed laparoscopically; T2, when the myometrial incision was closed after myomectomy; and T3, after contained electromechanical morcellation. After retrieval of the endoscopic bag from the abdominal cavity, visual inspection and water test on the bag with NaCl infiltration were performed to detect leaks attributed to intraoperative perforations. A pathologist performed cytologic analyses on the 3 washings. The mean endoscopic bag procedure duration was 9 minutes. The use of a specially designed endoscopic bag system was found to be easy in 45% of cases, and no complications were reported. Cytologic washings were positive for smooth muscle cell detection in 8 cases (25.8%) at T2 and 3 cases (9.7%) at T3. All positive cases at T3 already had detectable smooth muscle cells at T2. After retrieval from the abdominal cavity, perforations on the optic access of the endoscopic bag were observed in 3 cases. CONCLUSION: The results from this pilot study are encouraging. The use of a specially designed endoscopic bag system could be an adjuvant to reduce the risk of disseminating cells during myomectomy.

16.
Womens Health (Lond) ; 14: 1745506518805642, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30353785

RESUMO

OBJECTIVE: Persistent infection with human papillomavirus is the prerequisite for the development of cervical precancerous and cancerous lesions. The aim of this study was to determine the time-to-viral clearance in a population of human papillomavirus-infected Cameroonian women and to examine the possible predictors of viral persistence. METHODS: We conducted a prospective cohort study based on a population of human papillomavirus-positive women having previously been recruited in a self-human papillomavirus-based cervical cancer screening campaign, who were invited for a control visit at 6 and 12 months. We determined human papillomavirus clearance using self-sampling (Self-HPV) and physician-sampling (Dr-HPV), which were analyzed with a point-of-care assay (GeneXpert® IV; Cepheid, Sunnyvale, CA, USA). Logistic regression was performed to assess the relationship between sociodemographic and clinical characteristics with HPV clearance according to the two sampling techniques. RESULTS: A total of 187 participants were included in the study. At the 12 months follow-up, 79.5% (n = 104) and 65.3% (n = 86) had cleared their human papillomavirus infection according to Dr-HPV and self-HPV, respectively (p = 0.001). Only parity (>5 children) was statistically associated with viral persistence (p = 0.033). According to Dr-HPV, clearance of women treated with thermoablation at 12 months was of 84.1% versus 70.2% for non-treated women (p = 0.075). CONCLUSION: The human papillomavirus clearing rates found in our study are close to those found in other studies worldwide. Parity was significantly associated with human papillomavirus persistence. Larger, prospective studies are needed to confirm our results.


Assuntos
Neoplasia Intraepitelial Cervical/virologia , Infecções por Papillomavirus/virologia , Lesões Pré-Cancerosas/virologia , Neoplasias do Colo do Útero/virologia , Adulto , Camarões , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Índice de Gravidade de Doença , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/epidemiologia , Carga Viral , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-29987255

RESUMO

Background: The human papillomavirus (HPV) vaccination program for young girls aged 11⁻26 years was introduced in Switzerland in 2008. The objective of this study was to evaluate the prevalence of high- and low-risk HPV in a population of undergraduate students using self-sampling for monitoring the HPV vaccination program's effect. METHODS: Undergraduate women aged between 18⁻31 years, attending the Medical School and University of Applied Sciences in Geneva, were invited to participate in the study. Included women were asked to perform vaginal self-sampling for HPV testing using a dry cotton swab. RESULTS: A total of 409 students participated in the study-aged 18⁻31 years-of which 69% of the participants were vaccinated with Gardasil HPV vaccine and 31% did not received the vaccine. About HPV prevalence, 7.2% of unvaccinated women were HPV 16 or 18 positive, while 1.1% of vaccinated women were infected by HPV 16 or 18 (p < 0.01). Prevalence of HPV 6 and 11 was 8.3% in non-vaccinated women versus 2.1% in vaccinated women (p < 0.02). We observed no cross-protection for the other HPV genotypes of a low- and high-risk strain. CONCLUSIONS: Prevalence of HPV 6/11/16/18 was lower in vaccinated women versus unvaccinated women. Continued assessment of HPV vaccine effectiveness in real population is needed.


Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Adulto , Feminino , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Humanos , Imunização , Prevalência , Amostragem , Suíça/epidemiologia , Vacinação , Adulto Jovem
18.
Gynecol Obstet Invest ; 83(4): 313-328, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29874641

RESUMO

To confirm the origin of cancer found in both the endometrium and the myometrium is difficult. Cancer may spread from the endometrium into adenomyotic foci or vice versa. Also, premalignant changes may arise at either or both sites. Investigating disease origin enhances our understanding of pathophysiology and prognosis. Additional critical questions are whether women with adenomyosis have a higher risk of endometrial cancer; whether the invasive properties and prognosis of cancer in adenomyosis differ from those arising in the eutopic endometrium and whether the ectopic glandular tissue in adenomyosis becomes altered in the presence of eutopic endometrial cancer. A final question is whether cancer arising within adenomyosis carries a worse prognosis because of its location within the myometrium and the possibility that the presence of adenomyosis facilitates invasion of cancer arising in the eutopic endometrium. The present review explores currently available literature in an attempt to answer these questions and to examine clinical presentations, diagnostic criteria, pathogenesis and prognosis.


Assuntos
Adenomiose/patologia , Neoplasias do Endométrio/patologia , Adenomiose/complicações , Neoplasias do Endométrio/etiologia , Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Miométrio/patologia , Prognóstico
19.
Int J Technol Assess Health Care ; 34(3): 337-342, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29921339

RESUMO

OBJECTIVES: Colposcopes are expensive, heavy, and need specialized technical service, which may outreach the capacity of low-resource settings. Our aim was to assess the performance of smartphone-based digital images for the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS: Human papillomavirus (HPV)-positive women recruited through a cervical cancer screening campaign had VIA/VILI assessment (visual inspection after application of acetic acid/lugol's iodine). Cervical digital images were captured with a smartphone camera, randomly coded with no prior selection and distributed on an online database (Google Forms) for evaluation. Healthcare providers were invited to evaluate the images and identify CIN2+. The gold standard was the histopathological diagnosis. The sensitivity and specificity for the detection of CIN2+ was assessed for each reader and reported with the 95 percent confidence interval (Clopper-Pearson method). RESULTS: One hundred twenty-five consecutive HPV-positive women were included, with 19 CIN2+ (15.2 percent). Forty-five gynecologists completed the assessment, one-third were considered as experts (>50 colposcopies) and two-thirds as novices (<50 colposcopies). The sensitivity and specificity for CIN 2+ detection was 71.3 percent (67.0-75.7 percent) and 62.4 percent (57.5-67.4 percent), respectively. The performance of novices and experts was similar. The readers assessed 73.1 percent of images as acceptable for diagnostic. CONCLUSION: Smartphone-based digital images, with its high portability, have a great potential for the diagnosis of CIN2+ in low-resource context.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Detecção Precoce de Câncer/métodos , Smartphone , Neoplasias do Colo do Útero/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/complicações , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , Madagáscar , Gradação de Tumores , Infecções por Papillomavirus/complicações , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/patologia
20.
Int J Womens Health ; 10: 229-236, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805267

RESUMO

Objective: Vaginal self-sampling for human papillomavirus (HPV) testing has recently been proposed to optimize cervical cancer screening coverage. The objective of this study was to compare the performance of self-taken samples using flocked and cotton swabs for HPV detection and cellular retrieval. Methods: We recruited women aged 21-65 years, referred to colposcopy at the Division of Gynecology of the Geneva University Hospitals between May and September 2016. Each participant collected 2 vaginal samples: 1 with a cotton swab and 1 with a flocked swab. A 1:1 randomization determined the order in which the 2 samples were taken. The swabs were introduced into a 20 mL PreservCyt® vial. Real-time polymerase chain reaction analysis using the Anyplex™ II HPV HR assay, cytofluorometric analysis and cytological cell counting were performed on each sample. Results: A total of 119 participants were recruited in the study. Their mean ± standard deviation age was 35.1±8.9 years. The HPV prevalence was 29.7% and 38.1% according to the cotton and flocked swab, respectively (p=0.006). The mean number of cells collected per milliliter according to cytofluorometry was 96,726.6 with the cotton swab and 425,544.3 with the flocked swab (p<0.001). The mean number of cells detected at cytological cell count was 13,130.42 using the cotton swab and 17,503.6 using the flocked swab (p<0.001). Conclusion: The flocked swab achieved a greater cellular retrieval and showed an improved performance in HPV detection. Further studies are needed to assess the usability and cost-effectiveness of the 2 self-sampling devices.

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