RESUMEN
BACKGROUND: Cervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples. PURPOSE: To compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation. METHODS: Paired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay. RESULTS: The prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49 %, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90 % (κ = 0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97 % (κ = 0.95 for HR-HPV and κ = 0.97 for LR-HPV). CONCLUSIONS: High concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.
Asunto(s)
Cuello del Útero/virología , ADN Viral/análisis , ADN Viral/orina , Pruebas de ADN del Papillomavirus Humano/métodos , Papillomaviridae/genética , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Adolescente , Adulto , Anciano , Femenino , Francia/epidemiología , Genotipo , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/epidemiología , Embarazo , Prevalencia , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa , Sensibilidad y Especificidad , Frotis Vaginal , Carga ViralRESUMEN
The nephrology-dialysis department of the Havre's hospital has launched a project of certification ISO 9002 in 1996, based on reflections from the centers of dialysis Upper Normandy. The problems encountered were mainly the lack of ways, a bad documentary structure, false ideas on the quality and a bad perception from the client. With the help of a quality manager, il has enable the project to advance and finalized, obtaining the certification of activity. In june 2000 "Procedure of taking in charge all the patient's medical and para-medical cost in the center of the Nephrology-Dialysis service" of the GHH (Hospital Group of the Havre) has brought not only the certificate but notable improvements on the level of documentary management, the errors, relationship clients-suppliers and projects of collaboration with the other services of nephrology dialysis of France.
Asunto(s)
Certificación , Administración Hospitalaria , Departamentos de Hospitales/normas , Nefrología/normas , Garantía de la Calidad de Atención de Salud/organización & administración , Certificación/legislación & jurisprudencia , Predicción , Control de Formularios y Registros , Francia , Relaciones Interinstitucionales , Aceptación de la Atención de Salud , Solución de Problemas , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Control de Calidad , Diálisis Renal/normasRESUMEN
UNLABELLED: We report two cases of nephrotic syndrome with minimal glomerular change complicating alpha-interferon therapy. CASE REPORTS: The first patient was a 60-year-old man with Waldenström's disease who was given 1 million units of alpha-interferon three times a week for 22 months. Acute renal failure developed when a second protocol was started. Renal biopsy revealed intraglomerular deposits and no cellular proliferation. Total remission could not be achieved with corticosteroids. The second case was a 46-year-old man given high dose alpha-interferon (15 million units 3 times a week) for lymph node metastasis of a malignant melanoma. A nephrotic syndrome without renal failure developed during the third month of treatment. Minimal glomerular involvement was seen. Symptomatic treatment led to resolution of the nephrotic syndrome. DISCUSSION: Nine other cases of nephrotic syndrome complicating alpha-interferon therapy have been reported in the literature.