RESUMO
OBJECTIVE: To determine the influence on survival from cervical cancer of human papillomaviruses (HPVs) and other factors including age, herpes simplex virus type 2 (HSV-2) antibody status, and number of pregnancies. METHODS: We followed 196 women diagnosed with invasive cervical cancer in Panama for an average of 32 months. Clinical and risk-factor information was obtained from these women through an interview and review of medical records. We assessed HPV DNA status by testing tumor specimens using polymerase chain reaction, Southern blot, and slot blot techniques. Kaplan-Meier survival curves and Cox proportional hazards model were used to assess the risk of mortality associated with selected variables. RESULTS: Eighty-one percent (N = 144) of the women tested for HPV were positive. Absence of HPV DNA was associated with a 1.9-fold excess risk of mortality (95% confidence interval [CI] 1.1-3.3) after controlling for age, clinical stage at diagnosis, number of pregnancies, and HSV-2 seropositivity. Women diagnosed with cervical cancer before the age of 30 had a ninefold excess risk of dying compared with those diagnosed at age 50 or older (relative risk [RR] 9.3, 95% CI 3.4-25.5). Parity was also an independent prognostic factor. Women with six or more pregnancies had a 2.5-fold excess risk of dying compared with women with three or fewer (95% CI 1.2-5.3). Years of education, presence of HSV-2 antibodies, age at first intercourse, number of sexual partners, oral contraceptive use, and cigarette smoking were not significantly associated with prognosis. CONCLUSION: These findings suggest that women negative for HPV DNA, those who are diagnosed at an early age, and those who have multiple pregnancies might have more aggressive tumors.
Assuntos
Papillomaviridae/isolamento & purificação , Neoplasias do Colo do Útero/microbiologia , Neoplasias do Colo do Útero/mortalidade , Adulto , Fatores Etários , Idoso , Anticorpos Antivirais/análise , DNA Viral/análise , Feminino , Humanos , Pessoa de Meia-Idade , Panamá/epidemiologia , Papillomaviridae/genética , Paridade , Prognóstico , Fatores de Risco , Simplexvirus/imunologia , Simplexvirus/isolamento & purificação , Taxa de SobrevidaRESUMO
This cross-sectional study was conducted to describe the epidemiology of epilepsy in Guaymi Indians residing in Changuinola, a small town on Panama's Caribbean coast near Costa Rica. We randomly selected households and attempted to enroll all residents aged less than or equal to 1 year; 337 eligible subjects agreed to participate (93% response rate). We administered a standard neurologic disease screening examination to all subjects and, if any abnormality was found, we administered a standard neurologic evaluation. We detected 19 cases of active epilepsy; the mean age at onset was 12 years, and generalized tonic-clonic seizures were the most common diagnosis (10 of 19, 53%). The prevalence of active epilepsy among Caribbean coastal Guaymi (57/1000) is considerably greater than that in lower class Panama City populations (22/1000) or in other parts of the world. To identify risk factors for epilepsy, we collected epidemiologic data and serum (for Cysticercus antibody) from subjects with active epilepsy and from 44 age/sex-matched controls. Significantly more cases (47%) than controls (6%) had other family members with epilepsy (relative risk, RR = 14); 44% of cases and 13% of controls reported a history of febrile seizures during childhood (RR = 6).
Assuntos
Epilepsia/epidemiologia , Indígenas Centro-Americanos , Adolescente , Adulto , Encefalopatias/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Cisticercose/epidemiologia , Epilepsia/genética , Epilepsia do Lobo Temporal/epidemiologia , Epilepsia do Lobo Temporal/genética , Feminino , Ligação Genética , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Prevalência , Fatores de Risco , Convulsões Febris/epidemiologia , Convulsões Febris/etnologiaRESUMO
Studies of the prevalence of the human T-cell lymphotropic virus (HTLV-1) in 1984 to 1986 in the Republic of Panama revealed a national seroprevalence of 1 to 2%. Since 1985 clinical epidemiological studies of neurological diseases associated to HTLV-1 are being done. Two hundred and fitly six clinical cases of thirty eight different neurological diseases of unknown etiology studied in the Neurology Services of the Santo Tomas Hospital and the Social Security Metropolitan Hospital Complex have been associated in some way to the HTLV-1. Twelve cases of progressive spastic paraparesis were identified and related to HLTV-1 as an etiologic agent. The ratio of men to women was maintained at 1:1 with the average age at onset at 44 years and without racial preference. There are important doubts about the association of this virus to multiple sclerosis. The seroprevalence of the HTLV-1 virus in Panama is found to be similar to that reported in neighboring countries and the association of tropical spastic paraparesis to THLV-1 infection is identified.
Assuntos
Anticorpos Anti-HTLV-I/sangue , Doenças do Sistema Nervoso/sangue , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Panamá/epidemiologia , Estudos SoroepidemiológicosRESUMO
Little is known of the natural history of genital human papillomavirus (HPV) infections in women from high-risk populations. Samples were collected from 183 Panama City prostitutes and assessed for HPV (filter in situ DNA hybridization) and for sexually transmitted agents. The cohort was followed for 8 mo; 51% of subjects completed four monthly return visits and 16% were sampled eight times. The proportion of women found infected with HPV increased significantly with increasing numbers of consecutive samples tested; 38 (21%) of 183 women were positive after one visit and 46 (82%) of 56 who completed six visits were infected. The pattern of viral detection over time was not random, which implied that most prostitutes were persistently infected with genital HPVs and that either scattered foci of infection or periodic reactivation of latent virus occurred. Our findings suggest that multiple sampling is necessary to accurately estimate HPV infection rates and to define whether patterns of DNA expression are present.
Assuntos
Papillomaviridae/isolamento & purificação , Trabalho Sexual , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Adolescente , Adulto , Estudos de Coortes , DNA Viral/análise , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Panamá/epidemiologia , Papillomaviridae/genética , Recidiva , Fatores de Risco , Comportamento Sexual , Infecções Tumorais por Vírus/etiologia , Doenças do Colo do Útero/etiologiaRESUMO
Thirty-one documented acquired immune deficiency syndrome (AIDS) cases occurred in Panama during 1984-1987. Twenty-three (74%) patients were homosexual males and all but 2 patients recognized prior to June 1987 have died. To identify risk factors for human immunodeficiency virus infection, 287 male homosexual residents of Panama City were enrolled in a cross-sectional study. Nine had human immunodeficiency virus (HIV) antibody. Travel to the United States, homosexual relations with United States nationals in Panama, and sexual contacts in Panamanian clubs and bars were associated with human immunodeficiency virus infection by logistic regression analysis. Number of different male sex partners per year was identified but did not enter the logistic model at a significant level. To estimate seroprevalence in other high risk populations, 183 Panama City female prostitutes and 55 homosexual males from the rural Azuero peninsula were screened; none were seropositive. Eighty-four percent of Panamanian hemophiliacs had antibody; infection was related to factor VIII transfusions. Two of 182 sickle cell anemia patients and 15 of 7,720 volunteer blood donors were positive.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Transfusão de Sangue , Feminino , Anticorpos Anti-HIV/análise , Hemofilia A/complicações , Homossexualidade , Humanos , Masculino , Panamá , Análise de Regressão , Fatores de Risco , Trabalho Sexual , Transtornos Relacionados ao Uso de Substâncias/complicações , Viagem , Estados UnidosAssuntos
Infecções Tumorais por Vírus/diagnóstico , Neoplasias Uterinas/microbiologia , Adolescente , Adulto , Idoso , Colômbia , Costa Rica , DNA Viral/análise , Feminino , Humanos , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Panamá , Papillomaviridae/genética , Projetos Piloto , Fatores de Risco , Parceiros Sexuais , Fumar , Infecções Tumorais por Vírus/epidemiologia , Neoplasias Uterinas/etiologiaAssuntos
Biometria , Epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Humanos , Fatores de RiscoRESUMO
Human papillomavirus (HPV) types 16 and 18 have been implicated as risk factors for cervical dysplasia and neoplasia. However, most studies have been observational, uncontrolled and conducted in populations at low risk for invasive cancer. We report a pilot case-control study of incident invasive cervical cancer in Panama, Costa Rica and Bogota, Colombia. Between July and September 1985 we enrolled 46 consecutive newly diagnosed invasive cervical cancer cases and 51 age-matched control women. Subjects were interviewed and samples collected for HPV DNA assays. HPV infection was defined by a filter in situ DNA hybridization technique under non-stringent and stringent conditions against HPV-6/11, 16 and 18 DNA probes. More cases (91%) than controls (63%) had HPV DNA detected (non-stringent) and more cases than controls had HPV-16 or 18 DNA (67% vs. 43%, p = 0.02). Age at first intercourse was the most significant risk factor for HPV 16/18 infection in all subjects. Smoking was significantly associated with cervical cancer (52% of cases vs. 27% controls) but was not associated with HPV infection.