RESUMEN

Objectives: To evaluate the outcomes of conservative management in young women with high-grade squamous intraepithelial lesion (HSIL). Methods: A retrospective cohort study included women younger than 30 years referred with HSIL (cytology or biopsy) managed conservatively from 2012 to 2019, in Campinas/Brazil. Regression was the outcome when no evidence of HSIL was observed in at least two consecutive follow-ups. Kaplan-Meyer method was used to determine regression probabilities. Other tests were chi-square or Fisher, Mann-Whitney and COX regression. Results: During the study period, 89 patients were included. No progression to microinvasive or invasive cancer was observed. Sixty-one (69%) patients were younger than 25 years, and 28 (31%) were aged 25-30 years. Spontaneous regression was seen in 64 (72%) and persistence in 25 (28%) of the overall sample. The average time to regression was 15.4 months (standard deviation [SD] = 7.7), and the follow-up time was 31.6 months (SD 19.0). Age, parity, first sexual intercourse, smoking, hormonal contraception, and colposcopy impression were not different among women with regression or persistence. Regression probabilities were, respectively, 28.9%, 60.2%, and 78.1% after 12, 18, and 24 months. Most of the events happened between 12 and 18 months of follow-up. Conclusions: Conservative management in women younger than 30 years was safe: spontaneous regression was observed in 72% of all women younger than 30 with HSIL managed conservatively. No clinical variable was relevant, influencing regression. In 2 years the regression probability was 78%.

RESUMEN

BACKGROUND: The dominant effect of age on COVID-19 mortality obscures the impact of other risk factors. Although the elderly is at a greater risk of severe disease and death due to COVID-19, the interaction of obesity and age was not carefully assessed. This analysis is especially critical for prioritizing groups to receive COVID-19 vaccination. METHODS: Starting with 1,120,767 unvaccinated individuals registered in a Brazilian surveillance system, we selected 313,898 hospitalized COVID-19 patients aged 20 to 89 who had a BMI ≥ 25 kg/m2 and cardiovascular diseases (CVD) or diabetes, as well as individuals with no risk factors associated with severe COVID-19. Patient data were stratified by age, obesity, BMI, and comorbidities, and subsequently, subjected to crude and adjusted odds ratio, hazard ratio, and Kaplan-Meier curves. Disease outcomes were invasive and non-invasive ventilatory support, intensive care unit (ICU) admission, and death. FINDINGS: Obesity alone is a risk factor for in-hospital mortality and is more significant than cardiovascular disease and diabetes. Furthermore, obesity, cardiovascular disease, and diabetes increase the risk of severity and death by COVID-19 more significantly in young adults than in the elderly. When categorizing patients by obesity classes, the severity of obesity was found to be associated with a higher risk of admission to the ICU and death from COVID-19 than the non-obese young adults or elderly population. INTERPRETATION: Our findings highlight the increased risk of severe COVID-19 on the Brazilian obese youth. As SARS-CoV-2 may become a recurrent seasonal infection, future vaccination campaigns against COVID-19 should prioritize obese young individuals. FUNDINGS: This work was supported by the Brazilian National Council for Scientific and Technological Development (grant number 313662/2017-7 and 307356/2017-5; the São Paulo Research Foundation (grant numbers 2018/14933-2); and CAPES.

RESUMEN

OBJECTIVE: To estimate fatality rates due to severe acute respiratory distress syndrome (ARDS) related to COVID-19 in Brazilian women, comparing pregnant and postpartum women with nonpregnant women. METHODS: A cross-sectional study of 12 566 pregnant and postpartum women (obstetric group) and 90 025 nonpregnant women (nonobstetric group) aged 15-49 years reported with severe ARDS in 2020. The Brazilian ARDS Surveillance System was used to compare the outcome (death or cure) between the groups, considering age, race, or comorbidities. RESULTS: The mortality rate related to ARDS/COVID-19 in the obstetric group was 7.8% (377/4853) compared with 13.9% (5946/42 915) in the nonobstetric group. Comorbidity was associated with increased fatality cases for both groups, but higher in the nonobstetric group (22.8% vs 13.3%). In the obstetric group, deaths related to COVID-19 were concentrated in the third trimester or postpartum period. If comorbidity was present, deaths by COVID-19 were 4.4 times higher than ARDS due to other etiologies, and twice higher in women who self-reported as black (13.7%) than white women (6.7%). Considering ADRS etiology, deaths by COVID-19 were 3.4-6.7 times higher than any other etiology. CONCLUSION: ARDS related to COVID-19 in obstetric patients was an important factor for worse clinical outcomes, with 3-6 times higher death rates than other ARDS etiologies. Pregnant and postpartum women with severe ARDS related to COVID-19 had a lower fatality rate than nonpregnant women, even with associated comorbidity.

Asunto(s)

COVID-19 , Complicaciones Infecciosas del Embarazo , Síndrome de Dificultad Respiratoria , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Periodo Posparto , Embarazo , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/etiología , SARS-CoV-2

RESUMEN

BACKGROUND: Matrix metalloproteinases (MMP) are important enzymes in the tumor microenvironment associated with progression of cervical intraepithelial neoplasia (CIN) toward squamous cell carcinoma (SCC) of the cervix. However, the role of MMPs in the inflammatory process associated with Chlamydia trachomatis infection concomitant with the carcinogenic process driven by HPV has not yet been addressed. In the present study, we analyzed the state of the MMP-9-RECK axis in cervical carcinogenesis. METHODS: The levels of MMP-9 and RECK expression were analyzed by immunocytochemistry in liquid-based cytology samples from 136 women with high-grade cervical lesions (CIN2/CIN3) and cervical SCC diagnosed by LLETZ, and in 196 women without cervical neoplasia or CIN1. Real-time qPCR was performed to analyze expression of MMP-9 and RECK in 15 cervical samples. The presence of HPV-DNA and other genital pathogens was evaluated by PCR. RESULTS: We found a higher expression of MMP-9 [OR, 4.2; 95% confidence interval (CI), 2.2-7.8] and lower expression of RECK (OR, 0.4; 95% CI, 0.2-0.7) in women with CIN2/CIN3/SCC when compared with women from the control group (no neoplasia/CIN1). A statistically significant association was also found between MMP-9/RECK imbalance and infection by alpha-9 HPV and C. trachomatis. The prevalence of C. trachomatis infection was significantly higher in women with high-grade cervical disease (OR, 3.7; 95% CI, 1.3-11.3). CONCLUSIONS: MMP-9/RECK imbalance in cervical smears is significantly associated with high-grade cervical diseases and infection by alpha-9 HPV and C. trachomatis. IMPACT: MMP-9/RECK imbalance during cervical inflammation induced by C. trachomatis might play a role in HPV-mediated cervical carcinogenesis.

Asunto(s)

Infecciones por Chlamydia/genética , Proteínas Ligadas a GPI/genética , Regulación Neoplásica de la Expresión Génica , Metaloproteinasa 9 de la Matriz/genética , Infecciones por Papillomavirus/genética , Neoplasias del Cuello Uterino/genética , Cervicitis Uterina/genética , Adulto , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/virología , Cuello del Útero/metabolismo , Cuello del Útero/patología , Infecciones por Chlamydia/metabolismo , Infecciones por Chlamydia/patología , Chlamydia trachomatis/genética , Estudios Transversales , ADN Bacteriano/genética , ADN de Neoplasias/genética , ADN Viral/genética , Femenino , Proteínas Ligadas a GPI/biosíntesis , Regulación Bacteriana de la Expresión Génica , Genotipo , Papillomavirus Humano 16/genética , Humanos , Inmunohistoquímica , Metaloproteinasa 9 de la Matriz/biosíntesis , Prueba de Papanicolaou , Infecciones por Papillomavirus/metabolismo , Infecciones por Papillomavirus/virología , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Neoplasias del Cuello Uterino/metabolismo , Neoplasias del Cuello Uterino/virología , Cervicitis Uterina/metabolismo , Cervicitis Uterina/microbiología , Frotis Vaginal

RESUMEN

OBJECTIVE: This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL). METHODS: This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months. RESULTS: Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant. CONCLUSIONS: The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution.

RESUMEN

Studies about cervical carcinogenesis have demonstrated the increased expression of matrix-metalloproteinase (MMP) according to the grade of cervical intraepithelial lesions. Considering the importance of innovative techniques to introduce noninvasive and rapid diagnoses for patients, this study aimed to perform MMP-9 immunocytochemistry in cervical smears according to the cytopathological diagnoses, in order to monitor MMP activity in cervical smears. This cross-sectional study investigated the expression of MMP-9 in normal cervical smears, inflammatory cervical smears, squamous intraepithelial lesions, and cervical carcinoma. Cervical smears from 630 women were collected for cytopathological diagnoses and immunocytochemistry. Women with squamous intraepithelial lesions showed an increase in MMP-9 expression, with moderate to intense staining occurring with increasing cervical lesion grade. The prevalence of moderate to intense MMP-9 staining was 9% in normal cervical smears, 12% in cervical inflammation, 24% in low-grade squamous intraepithelial lesion (LSIL), 92% in high-grade squamous intraepithelial lesions (HSIL) and 100% in cervical carcinoma cases. In the specific case of LSIL, we found that association with MMP-9 is more evident when there is the simultaneous presence of an infectious agent. Thus, the expression of MMP-9 in cervical smears increases according to the grade of cervical lesion and LSIL in the presence of infectious agents showed higher MMP-9 expression than women with LSIL without infectious agents.

Asunto(s)

Metaloproteinasa 9 de la Matriz/metabolismo , Lesiones Intraepiteliales Escamosas de Cuello Uterino/metabolismo , Frotis Vaginal , Adolescente , Adulto , Femenino , Humanos , Metaloproteinasa 9 de la Matriz/genética , Persona de Mediana Edad , Clasificación del Tumor , Lesiones Intraepiteliales Escamosas de Cuello Uterino/diagnóstico , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología

RESUMEN

OBJECTIVE: To evaluate the outcome of CIN 2 diagnosed by colposcopy-directed biopsy in women followed without treatment for 12 months and to verify whether the regression and progression of this lesion are associated with the woman's age at diagnosis and age at first sexual intercourse. STUDY DESIGN: Women diagnosed with CIN 2 by biopsy and with previous cervical smear showing LSIL were included in this cohort study and followed up for one year with cervical smear and colposcopy every three months. The rates of progression, persistence and regression of the CIN 2 were evaluated. The Kruskal-Wallis test was used to analyze the woman's age at diagnosis, age at first sexual intercourse and interval since the first sexual intercourse according to the CIN 2 outcome, assuming a significance level of 5%. RESULTS: At the end of 12 months of follow-up the CIN 2 regression rate was 74% (31/42), progression rate to CIN 3 was 24% (10/42) and in one case CIN 2 persisted (2%). Among women who had regression, this event was detected in the first six months of follow-up in 26 of the 31 cases. There was no statistically significant association between the evolution of CIN 2 and the woman's age at diagnosis, age at first sexual intercourse and interval since first sexual intercourse. Women whose lesions were restricted to one quadrant were more likely to have CIN 2 regression at three-month follow-up compared with women with a lesion extending to one or more quadrants (OR: 6.50; 95% CI: 1.20-35.23). CONCLUSIONS: The results of this study indicate that the majority of CIN 2 diagnosed by biopsy in women with previous Pap smear showing LSIL will regress in 12 months and therefore an expectant approach could be considered in these cases, not only for young women. Nevertheless these findings are not conclusive, and larger studies are required in order to certify when it is safe to adopt expectant management for CIN 2.

Asunto(s)

Progresión de la Enfermedad , Regresión Neoplásica Espontánea , Displasia del Cuello del Útero/fisiopatología , Adolescente , Adulto , Factores de Edad , Biopsia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/fisiopatología , Coito , Colposcopía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Prueba de Papanicolaou , Estadísticas no Paramétricas , Factores de Tiempo , Carga Tumoral , Frotis Vaginal , Adulto Joven , Displasia del Cuello del Útero/diagnóstico

RESUMEN

PURPOSE: To evaluate vaginal microflora and interleukin-1ß (IL-ß), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) concentrations in the cervicovaginal fluid of a group of pregnant women in preterm labor when compared with a group of full-term pregnant women not yet in labor. METHOD: Case-control study performed in a University tertiary referral maternity in Campinas, Brazil with 45 pregnant women in preterm labor and 45 full-term pregnant women not in labor. All patients underwent speculum examination for the collection of cervicovaginal fluid. Bacterial vaginosis (BV) was diagnosed according to the criteria of Amsel and Nugent. Culture was performed for group B streptococcus (GBS) and lactobacilli, and hybrid capture assay for screening for chlamydial and gonococcal infection. Cytokine concentrations were measured using ELISA technique. Statistical analysis was performed using χ(2), Fisher's exact, and crude and adjusted odds ratios. Significance level was defined at 5%. The main outcome measures were cervicovaginal cytokines in preterm labor. RESULTS: IL-6 and IL-8 were significantly associated with preterm labor. The changes in vaginal microflora, as well as BV and GBS, were more frequent in women in preterm labor, although BV and GBS showed no statistical significance. The presence of Candida sp., absence of lactobacilli, positive screening for chlamydial and gonococcal infection and the presence of IL-1ß and TNF-α were not associated with preterm labor. CONCLUSIONS: IL-6 and IL-8 and the presence of any type of vaginal infection were the factors that were significantly associated with preterm labor.

Asunto(s)

Líquidos Corporales/inmunología , Citocinas/inmunología , Trabajo de Parto Prematuro/inmunología , Trabajo de Parto Prematuro/microbiología , Complicaciones Infecciosas del Embarazo/microbiología , Vagina/inmunología , Vagina/microbiología , Adolescente , Adulto , Líquidos Corporales/química , Brasil , Estudios de Casos y Controles , Citocinas/análisis , Femenino , Humanos , Inflamación/microbiología , Interleucina-1beta/análisis , Interleucina-1beta/inmunología , Interleucina-6/análisis , Interleucina-6/inmunología , Interleucina-8/análisis , Interleucina-8/inmunología , Embarazo , Factor de Necrosis Tumoral alfa/análisis , Factor de Necrosis Tumoral alfa/inmunología , Vaginosis Bacteriana/diagnóstico , Adulto Joven

RESUMEN

BACKGROUND: The study was conducted to evaluate the cytopathological findings and vaginal flora in cervical smear samples from women using the levonorgestrel-releasing intrauterine system (LNG-IUS) for a period of up to 7 years. STUDY DESIGN: Postinsertion cytology examinations were conducted on 187 women who had an LNG-IUS inserted between April and September 1998 in the family planning clinic of the Universidade Estadual de Campinas. RESULTS: During the 7 years of follow-up, a high frequency of candidiasis was found from the fourth through the seventh year of use in comparison to the first year of use. No significant results were found with respect to cytopathological abnormalities or other microbiological alterations following insertion of the LNG-IUS. CONCLUSION: Use of the LNG-IUS had no effect on cervical smears over the 7-year follow-up period; however, an increase occurred in the frequency of candidiasis.

Asunto(s)

Cuello del Útero/citología , Dispositivos Intrauterinos Medicados/microbiología , Vagina/microbiología , Vaginitis , Adolescente , Adulto , Brasil , Anticonceptivos Femeninos/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Levonorgestrel/administración & dosificación , Estudios Longitudinales , Frotis Vaginal

RESUMEN

The objective of this study was to analyze the association between bacterial vaginosis (BV) and squamous intraepithelial lesion (SIL). Pap smears were analyzed to verify the presence of BV and SIL. One hundred and ten women with SIL comprised the study group, while 110 women with no cytological abnormalities served as controls. BV was similarly present in women of both groups: 18% of women with SIL and 12% of women without SIL. Results were also similar when the grade of SIL was taken into consideration. BV was detected in 16% of women with low-grade SIL and in 12% of women in the control group, while a higher rate of BV (33%) was found among women with high-grade SIL in comparison to the controls (12%). This difference, however, was not statistically significant. BV tended to be more common among women with high-grade SIL than in women with no cytological abnormalities.

Asunto(s)

Carcinoma de Células Escamosas/complicaciones , Displasia del Cuello del Útero/complicaciones , Neoplasias del Cuello Uterino/complicaciones , Vaginosis Bacteriana/complicaciones , Brasil/epidemiología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Prueba de Papanicolaou , Factores de Riesgo , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Frotis Vaginal , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/patología , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/patología

RESUMEN

A study was carried out in 135 women of reproductive age to evaluate the role of the Papanicolaou smear performed in cervical and vaginal samples for the diagnosis of bacterial vaginosis (BV), to validate the method for this diagnosis and to evaluate the reproducibility of the criterion used. The cervical and vaginal smears were stained using the Papanicolaou method and evaluated by two separate observers. The finding of 20% or more clue cells was considered positive for the presence of BV. This diagnostic criterion presented a sensitivity of 87%, specificity of 94%, a positive predictive value of 81%, and a negative predictive value of 96%, both in cervical and vaginal samples. There was excellent agreement in the diagnosis of BV between the two observers (kappa, 0.87) and between cervical and vaginal samples (kappa, 0.92). Therefore, the presence of 20% or more clue cells in the Papanicolaou smear is an accurate and reproducible criterion for the diagnosis of BV and may be used in screening for this infection, eliminating the need for further vaginal sample collection.

Asunto(s)

Prueba de Papanicolaou , Frotis Vaginal/métodos , Vaginosis Bacteriana/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad

RESUMEN

Introdução: vaginose bacteriana é a mais freqüente causa de descarga vaginal em mulheres na idade reprodutiva. Entretanto, ainda não são totalmente conhecidas as causas que levam a esta desordem da flora vaginal. Objetivo: avaliar a prevalência de vaginose bacteriana em profissionais do sexo e não-profissionais do sexo e avaliar os fatores comportamentais e características da microbiota vaginal envolvidos na instalação da vaginose bacteriana nesta população. Métodos: este estudo de corte transversal envolveu 68 mulheres, sendo 20 profissionais do sexo e 48 não-profissionais do sexo (grupo-controle). As participantes foram submetidas a um exame ginecológico, no qual foram coletadas amostras cérvico-vaginais para medição do pH, teste do KOH, bacterioscopia corada pelo Gram e culturas para Gardnerella vaginalis, lactobacilos e bacteriófagos. As análises estatísticas foram expressas por meio do valor p e Odds ratio com intervalo de confiança de 95 por cento. Resultados: a prevalência de vaginose bacteriana foi 60 por cento entre as profissionais do sexo e 27 por cento no grupo controle e esta diferença foi estatisticamente significativa (OR=4.04, IC 95 por cento 1.19- 14.11). Variáveis como o hábito de realizar ducha vaginal, uso de preservativo e prática de sexo oral e anal foram significativamente mais freqüentes entre as profissionais do sexo (p<0.001). A freqüência de Gardnerella vaginalis foi maior entre as profissionais do sexo. Por outro lado, uma menor recuperação de lactobacilos e bacteriófagos foi encontrada entre as profissionais do sexo quando comparadas ao grupo controle. Conclusão: alguns fatores comportamentais e características da microbiota vaginal podem estar associados com a maior prevalência de vaginose bacteriana entre as profissionais do sexo

Asunto(s)

Humanos , Femenino , Adulto , Persona de Mediana Edad , Conducta Sexual , Enfermedades de Transmisión Sexual , Vagina , Vaginosis Bacteriana

RESUMEN

Estudo de caso controle no qual os esfregaços cervicais de 104 mulheres usuárias de DIU foram comparados aos esfregaços de 104 mulheres não-usuárias de DIU. Estes esfregaços foram corados pelo método de Papanicolaou e analisados segundo critérios microbiológicos e citopatológicos padronizados

Asunto(s)

Humanos , Femenino , Adulto , Dispositivos Intrauterinos , Frotis Vaginal