RESUMO
This study estimated the frequency and assessed the clinical value of nine primitive reflexes (PR) in 78 AIDS cases, comparing them with 81 matched, seronegative controls. All subjects were evaluated with a standardized neurologic examination that included a Mini-Mental State Exam (MMSE). Fifty-six percent had cognitive impairment and PR. Overall, PR were 2-36 times more frequent in cases. Such association was univariately stronger for the glabellar, snout, and Rossolimo signs. Ninety-two percent of cases had > or = 2 PR vs. 8% of controls, who had up to 2 PR (p < 0.0001; 95 CI: 68% to 100%). We were able isolate or show opportunistic pathogens in CSF of 4 out of 43 cases. This study supports the association of PR to cognitive decline in patients with AIDS. Larger, long term follow-up studies with multivariate analysis in Latin America are needed to identify the PR that can serve as reliable indicators of human immunodeficiency virus type 1 (HIV-1)-associated cognitive/motor complex.
Assuntos
Síndrome da Imunodeficiência Adquirida/fisiopatologia , Transtornos Cognitivos/etiologia , Reflexo/fisiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Interpretação Estatística de Dados , Feminino , Soropositividade para HIV , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Exame Neurológico , Reflexo Anormal/fisiologia , Reflexo de Babinski/fisiologiaRESUMO
We measured serum levels of anti-Gal(alpha 1-->3)Gal and anti-Gal(alpha 1-->2)Gal antibodies in 89 and 91 women, respectively, by using ELISA. These patients had cervical intraepithelial neoplasia (CIN) grades 1 to 3 and early invasive cervical carcinoma (ICC). Our objective was to compare anti-alpha-galactosyl antibody levels among them and with those of normal controls. High levels of anti-Gal(alpha 1-->2)Gal antibodies were detected in 22% of patients (P = 0.006). The mean level was 1.6 times greater than that of controls, without difference among subgroups. Thirty percent of patients had abnormally high anti-Gal levels (P = 0.001). Mean levels were twofold greater than the mean control value. Subsets with human papillomavirus/CIN 1 and CIN 2-3 had high immunoreactivity (P = 0.004). Both antibodies showed a significant correlation (r = 0.53, P < 0.00001). We conclude that 22 to 30% of patients with CIN 1-3 showed significantly high levels of anti-alpha-galactosyl antibodies. This seroreactivity might be related to the abnormal expression of alpha-galactosyl residues at some point of the natural history of human papillomavirus infection of the uterine cervix, suggesting an active immune response by natural antibodies against this virus. Further studies are needed to determine whether anti-alpha-galactosyl antibodies confer protection in human papillomavirus infection.
Assuntos
Anticorpos/sangue , Carcinoma in Situ/sangue , Carcinoma de Células Escamosas/sangue , Dissacarídeos/imunologia , Epitopos/sangue , Neoplasias do Colo do Útero/sangue , Adulto , Análise de Variância , Feminino , Humanos , Invasividade Neoplásica , Papillomaviridae , Infecções por Papillomavirus/sangue , Estudos Prospectivos , Infecções Tumorais por Vírus/sangue , Neoplasias do Colo do Útero/patologiaRESUMO
To assess the validity of colposcopy to correctly detect and grade squamous intraepithelial lesions (SIL) in Venezuelan women, we did a prospective, nonrandomized and cross sectional study on patients referred with low-grade and high-grade SIL. After a second cervical smear, they were colposcopically evaluated and biopsied. The outcome measures were interobserver variation, sensitivity, specificity, and predictive values. Ninety-nine patients were evaluable. Colposcopy had poor agreement with repeat cervical smears, and moderate to good agreement with conization biopsy (kappa = 0.55; 95% C.I.: 0.45 to 0.65), with a sensitivity of 0.87, a specificity of 0.69, a positive predictive value of 0.85 and a negative predictive value of 0.71 for high-grade SIL. The criterion of colposcopic vascular atypias was accurate enough to detect and grade SIL, showing good agreement with histopathology. Because of the disparity of results in previous reports, only a carefully designed, randomized study will settle this question.