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Background: Anal cancer prevention has two critical points: the incidence rate is several fold higher for some groups, such as people living with human immunodeficiency virus (HIV) and men who have sex with men (MSM), and there is not a well-defined guideline for its screening. This systematic review evaluates the accuracy of DNA HRHPV (high-risk human papillomavirus), mRNA HPV, DNA HPV16 isolated and p16 staining biomarkers in anal canal smears for identifying anal intraepithelial neoplasia (AIN) 2 or 3, summarised as anal high-grade squamous intraepithelial lesions (aHSIL), and cancer. Methods: We searched the MEDLINE, Cochrane Library and Embase electronic databases as well as Grey literature to identify eligible papers published up to 31st July 2022. This systematic review and meta-analysis included observational studies comparing biomarker tests to histopathology after HRA (High-resolution Anoscopy) as a reference standard. We (ACM, TF) analysed studies in which patients of both sexes were screened for anal cancer using DNA HRHPV, mRNA HPV, DNA HPV16 and/or p16 biomarkers. The analysis was performed in pairs, for instance AIN2 or worse (AIN2+) vs. AIN1, HPV infection and normal (AIN1-). PROSPERO CRD42015024201. Findings: We included 21 studies with 7445 patients. DNA HR HPV showed a higher sensitivity 92.4% (95% CI 84.2-96.5), specificity 41.7% (95% CI 33.9-44.9) and AUC 0.67, followed by the mRNA HPV test, with a sensitivity 77.3% (95% CI 73.2%-80.9%), specificity 61.9% (95% CI 56.6-66.9) and AUC 0.78. DNA HPV16 showed higher specificity 71.7% (95% CI 55.3-83.8), followed by p16 test, 64.1% (95% CI 51.0-75.4); Sensitivity of DNA HPV16 was 53.3% (95% CI 35.4-70.3) and AUC 0.69, while p16 had a sensitivity of 68.8% (95% CI 47.9-84.1) and AUC 0.74. Subgroup analysis of MSM with HIV, with 13 studies and 5123 patients, showed similar accuracy, with a bit higher sensitivities and lower specificities. Considering the measure of the total between-study variability, mRNA HPV tests showed the smallest area of the 95% prediction ellipse, 6.0%, influenced by the low logit sensitivity, 0.011. All other groups of tests exceed 50% prediction ellipse area, which represent a high heterogeneity. Interpretation: Our findings suggested that DNA HR HPV can be a useful tool for screening for aHSIL and anal cancer if followed by biomarker with a higher specificity. As an isolated test, mRNA HPV had better performance. Funding: There was no funding source for this study.
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Abstract Introduction: Anal intraepithelial neoplasia (AIN) is the most likely precursor of squamous cells cancer which represents 90% of anal cancers. The use of biomolecular tests as a screening method has been extended by gynecology. Given the similarities that exist between the HPV disease in the lower genital tract and anorectal sectors, it is expected that HPV tests can provide information for the diagnosis, treatment and follow-up for AIN-affected patients. Objectives: Comparing the performance of anal cytology, PAP and HPV tests (Hybrid Capture and Papillocheck) against the histology of the diagnosis of low- and high-grade AIN in risk groups. Material and methods: A cross-sectional study was carried out to evaluate diagnostic methods for low- and high-grade AIN in 73 patients. Samples for anal PAP, Papillocheck and Hybrid Capture were taken from all patients who then, regardless of the results, underwent magnifying chromoendoscopy (MCE) along with biopsy. Diagnostic test performances and their 95% confidence intervals (CI: 95%) were calculated as well as the likelihood ratio for each test. Results: Of the 73 patients, 49 (67%) were women. The average age of the patients was 38 years. In 38 patients (52%), the histology was positive with 10 (14%) grade II AIN or higher. There were no statistically significant differences in sensitivity nor in specificity for low- and high-grade AINs between any of the tests. Conclusion: Anal PAP, the Hybrid Capture test (HC2, Qiagen) and PapilloCheck (Greiner Bio One) were highly sensitive but not specific for low- and high-grade AINs. Therefore, a biopsy should be conducted against a positive result of any of the tests to confirm AIN and the degree of dysplasia. The screening method selection depend on the availability but also costs of the test should be considered, since all the diagnostic tests have similar performance.
Resumo Introdução: A neoplasia intraepitelial anal é o precursor mais provável do câncer de células escamosas, que representa 90% dos tumores anais. O uso de exames biomoleculares como método de triagem foi ampliado pela ginecologia. Considerando-se as semelhanças entre as apresentações de HPV no trato genital inferior e anorretal, espera-se que os exames de HPV possam fornecer informações para o diagnóstico, tratamento e acompanhamento dos pacientes com neoplasia intraepitelial anal. Objetivo: Comparar o desempenho da citologia anal, Papanicolau, exames para HPV (teste de captura híbrida e Papillocheck) e histologia no diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em grupos de risco. Material e métodos: Foi realizado um estudo transversal para avaliar métodos de diagnóstico de neoplasia intraepitelial anal de baixo e alto grau em 73 pacientes. Amostras para Papanicolau anal, Papillocheck e captura híbrida foram coletadas de todos os pacientes; independentemente dos resultados desses exames, todos foram submetidos a cromoendoscopia de ampliação (CEA) e biópsia. O desempenho dos exames e seus intervalos de confiança de 95% (95% CI) foram calculados, bem como a razão de verossimilhança para cada teste. Resultados: Dos 73 pacientes, 49 (67%) eram mulheres. A idade média dos pacientes foi de 38 anos. A histologia foi positiva em 38 pacientes (52%), dos quais dez (14%) apresentaram neoplasia intraepitelial anal grau II ou superior. Não foram observadas diferenças estatisticamente significativas na sensibilidade ou especificidade para as neoplasias intraepiteliais anal de baixo e alto grau entre qualquer um dos exames. Conclusão: O Papanicolau anal, o teste de captura híbrida (HC2, Qiagen) e o Papillocheck (Greiner Bio One) foram altamente sensíveis, mas não específicos para neoplasia intraepitelial anal de baixo e alto grau. Portanto, uma biópsia deve ser realizada após um resultado positivo em qualquer um dos testes para confirmar o diagnóstico de neoplasia intraepitelial anal e seu grau. A seleção do método de triagem depende da disponibilidade, mas os custos devem ser considerados, uma vez que todos os testes apresentam desempenho semelhante.
Assuntos
Humanos , Masculino , Feminino , Carcinoma in Situ/diagnóstico , Alphapapillomavirus , Teste de Papanicolaou , Neoplasias do Ânus , Biópsia , Carcinoma in Situ/diagnóstico por imagemRESUMO
This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the anus. This article provides overviews of the virology, pathophysiology, nomenclature, classification, historical terms, risk factors, clinical evaluation, differential diagnosis, and treatment of HPV infection and its sequelae.
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Perinatal maternal high-fat diet (HFD) increases susceptibility to obesity and fatty liver diseases in adult offspring, which can be attenuated by the potent hypolipidaemic action of fish oil (FO), an n-3 PUFA source, during adult life. Previously, we described that adolescent HFD offspring showed resistance to FO hypolipidaemic effects, although FO promoted hepatic molecular changes suggestive of reduced lipid accumulation. Here, we investigated whether this FO intervention only during the adolescence period could affect offspring metabolism in adulthood. Then, female Wistar rats received isoenergetic, standard (STD: 9 % fat) or high-fat (HFD: 28·6 % fat) diet before mating, and throughout pregnancy and lactation. After weaning, male offspring received the standard diet; and from 25 to 45 d old they received oral administration of soyabean oil or FO. At 150 d old, serum and hepatic metabolic parameters were evaluated. Maternal HFD adult offspring showed increased body weight, visceral adiposity, hyperleptinaemia and decreased hepatic pSTAT3/STAT3 ratio, suggestive of hepatic leptin resistance. FO intake only during the adolescence period reduced visceral adiposity and serum leptin, regardless of maternal diet. Maternal HFD promoted dyslipidaemia and hepatic TAG accumulation, which was correlated with reduced hepatic carnitine palmitoyl transferase-1a content, suggesting lipid oxidation impairment. FO intake did not change serum lipids; however, it restored hepatic TAG content and hepatic markers of lipid oxidation to STD offspring levels. Therefore, we concluded that FO intake exclusively during adolescence programmed STD offspring and reprogrammed HFD offspring male rats to a healthier metabolic phenotype in adult life, reducing visceral adiposity, serum leptin and hepatic TAG content in offspring adulthood.
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Dieta Hiperlipídica/efeitos adversos , Suplementos Nutricionais , Dislipidemias/prevenção & controle , Óleos de Peixe/administração & dosagem , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Animais , Dislipidemias/etiologia , Ácidos Graxos Ômega-3/metabolismo , Feminino , Gordura Intra-Abdominal/metabolismo , Leptina/sangue , Fígado/metabolismo , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Ratos , Ratos Wistar , Triglicerídeos/metabolismoRESUMO
Although obesity is well established in hamsters, studies using diets with high levels of simple carbohydrate associated with lipids are necessary to assess the impact of this type of food in the body. In this study a high sugar and butter diet (HSB) and high temperature were employed towards this end. Obesity was successfully induced at a temperature of 30.3°C to 30.9°C after 38 days feeding the animals an HSB diet. It was shown that although diet is important for the induction of obesity, temperature is also essential because at a temperature slightly below the one required, obesity was not induced, even when the animals were fed for a longer period (150 days).The obese clinical condition was accompanied by biochemical and hematological changes, as increased cholesterol and triglyceride levels and increased leukocyte numbers, similar to alterations observed in obese humans. Furthermore, it was demonstrated that increasing the intake of simple carbohydrates associated with lipids provided evidence of inflammation in obese animals.
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Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/efeitos adversos , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/efeitos adversos , Obesidade/etiologia , Animais , Manteiga , Colesterol/sangue , Cricetinae , Modelos Animais de Doenças , Feminino , Humanos , Gordura Intra-Abdominal/metabolismo , Contagem de Leucócitos , Obesidade/sangue , Obesidade/metabolismo , Temperatura , Fatores de Tempo , Triglicerídeos/sangueRESUMO
Resumen: Antecedentes: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. Métodos y resultados: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. Conclusión: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.
Abstract: Background: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. Methods and results: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. Conclusion: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.
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Humanos , Nervo Ulnar/cirurgia , Nervo Ulnar/lesões , Transferência de Nervo , Recuperação de Função Fisiológica , Antebraço , MúsculosRESUMO
OBJETIVO: Caracterizar a la niñez menor de 2 años, integrados a la estrategia de AIN-C delproyecto descentralizado ChildFund en el municipio de Curaren, del área sur de Francisco Morazán, Honduras, Febrero 2016. Problema: Cómo se caracteriza la niñez menor de 2 años, integrada en la estrategia de AIN-Cdel proyecto descentralizado Child Fund en el municipio de Curaren, del área sur de Francisco Morazán, Honduras, febrero2016. MÉTODO: Se tomó una muestra de 134 niños beneficiarios de la estrategia de AIN-C, en elmunicipio de Curaren; a los cuales se les tomo talla y peso durante la visita de seguimiento enel mes de febrero, para realizar la valoración de desnutrición aguda, crónica y global, setomaron muestras de exámenes de laboratorio para detección de anemia 73 muestras y 56para detección de parasitismo intestinal y también se interrogó sobre el patrón alimentario,todo la información se procesó en una base de datos; la cual se analizó por el programa deEpiInfo 7. RESULTADOS: De los 134 niños 74(55%) mujeres y 60(45%) hombres. Índice antropométricoP/L-T: normal un 90%, 8% sobrepeso y 3% Emaciado. Índice antropométrico L-T/E: normal81%, baja talla 13%, baja talla severa 4.5% y muy alto para la edad 1.5%.Indice antropométrico P/E: 96% crecimiento adecuado y 4% crecimiento inadecuado. El 96% y 86%de la muestras de Hemoglobina (Hb)y heces fecales estaban en valores normales,respectivamente. En el patrón alimentario, el 84% de los niños recibió lactancia materna exclusiva y el 81% inicio su ablactación a los 6 meses. CONCLUSIÓN: Se realizó la clasificación de en base al índice antropométrico peso para la talla, talla para la edad y peso para la edad; en las tres mediciones la mayoría de los niños se encuentran dentro de los límites de referencia normal de acuerdo a las gráficas y concrecimiento adecuado; siendo la desnutrición global en donde salen mejor evaluados y la desnutrición crónica donde hay más problemas con los niños.
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Humanos , Nutrição da Criança , Saúde da Criança , Dissertações Acadêmicas como Assunto , Teses EletrônicasRESUMO
BACKGROUND: The peripheral nerve injuries are devastating for the patient; the classic reconstructive options are the Nerve Graft and Tendon Transfers. Lately the Nerve Transfers are being used more and more broadly. They are an excellent option on early injuries and when the motor plate is still alive. The advantages are numerous, because the functional recovery is much better. METHODS AND RESULTS: We report the case of a patient who sustained and injury on the median and ulnar nerve, so the EDQ and ECU branches were used to restore the Ulnar Intrinsic Function. The 4-year follow-up showed good results. CONCLUSION: The ulnar intrinsic innervations provide dexterity; fine motor function and pinch, which is essential for a functioning hand. The most popular donor to restore the function of the motor branch of the ulnar nerve is the anterior interosseous nerve. When this is unavailable the use of the redundant branches of the EDQ and ECU must be considered.
ANTECEDENTES: Las lesiones de nervio periférico, principalmente las traumáticas, tienen efectos devastadores para la función. Tradicionalmente las opciones eran en forma temprana el injerto nervioso y en forma tardía la transferencia tendinosa. Durante los últimos años se han venido realizando transferencias nerviosas cuando la lesión es temprana y la placa motora aún es viable. Los resultados en su mayoría son superiores a los injertos nerviosos y a las transferencias tendinosas. MÉTODOS Y RESULTADOS: Se presenta el caso de una paciente que sufrió lesión de nervio mediano y cubital en el antebrazo y se utilizaron las ramas redundantes de los músculos extensor carpi ulnaris y extensor digiti quinti. Los resultados fueron buenos a los cuatro años. CONCLUSIÓN: Cuando existe un déficit de la musculatura intrínseca cubital de la mano, el donador favorito es la rama terminal del nervio interóseo anterior. Cuando éste no se encuentra, debemos tener opciones para restaurar esta función.
Assuntos
Transferência de Nervo , Nervo Ulnar , Antebraço , Humanos , Músculos , Recuperação de Função Fisiológica , Nervo Ulnar/lesões , Nervo Ulnar/cirurgiaRESUMO
This study assessed the utility and limitations of anal cytology as a screening method for women infected with human papilloma virus (HPV) in the lower genital tract. Furthermore, this study aimed to establish risk factors for pathological anal cytology/biopsy findings, the prevalence of anatomopathological lesions associated with positive anal brushings, and the frequency of concomitant lesions of the lower genital tract. A cross-sectional, retrospective, descriptive study in 207 women with HPV-associated lesions of the lower genital tract and 25 women with immunosuppression was carried out. Anal cytology, high resolution anoscopy, and biopsy of suspicious lesions were performed. In total, 232 anal brushings were performed: 184 (79.3%) were negative, 24 (10.34%) showed atypical squamous cells of undeterminated significance, 18 (7.7%) showed low-grade squamous intraepithelial lesions, and 6 (2.6%) showed high-grade squamous intraepithelial lesion. Cytohistological correlation was obtained for 70 cases. The sensitivity of anal cytology in detecting intraepithelial lesions was 70%, whereas the specificity was 93%. The sensitivity of the method for detecting high-grade lesions (84%) was higher, than that for detecting low-grade lesions (66%). The most frequently associated pathology was vulvar lesion. It is important to perform anal brushings in women who have had lower genital tract biopsies for HPV-associated lesions due to the high prevalence of anal lesions in such patients. Anal cytology is useful for detecting high-grade lesions but the sensitivity for detecting low-grade lesions is low. It is of the utmost importance to perform high-resolution anoscopy and biopsy in women with suspicious lesions in order to confirm the pathology.
Assuntos
Neoplasias do Ânus/diagnóstico , Imuno-Histoquímica/estatística & dados numéricos , Neoplasias de Células Escamosas/diagnóstico , Infecções por Papillomavirus/diagnóstico , Neoplasias Vulvares/diagnóstico , Adolescente , Adulto , Idoso , Canal Anal/imunologia , Canal Anal/patologia , Neoplasias do Ânus/imunologia , Neoplasias do Ânus/patologia , Células Escamosas Atípicas do Colo do Útero , Biópsia , Estudos Transversais , Feminino , Humanos , Terapia de Imunossupressão , Pessoa de Meia-Idade , Neoplasias de Células Escamosas/imunologia , Neoplasias de Células Escamosas/patologia , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Vulvares/imunologia , Neoplasias Vulvares/patologiaRESUMO
This pilot study introduces the aerosolized route for midazolam as an option for infant and pediatric sedation for computed tomography imaging. This technique produced predictable and effective sedation for quality computed tomography imaging studies with minimal artifact and no significant adverse events.
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Administração Intranasal , Anestésicos Intravenosos/administração & dosagem , Sedação Consciente/métodos , Midazolam/administração & dosagem , Tomografia Computadorizada por Raios X , Aerossóis , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Segurança do Paciente , Projetos PilotoRESUMO
La variada posición anatómica de los terceros molares mandibulares presenta importantes desafíos asociados a su profundidad y grado de inclinación. Las complicaciones más habituales del procedimiento quirúrgico convencional de extracción se relacionan con la extensa osteotomía y poca visualización del sitio quirúrgico, que pueden generar consecuencias post-quirúrgicas como inflamación, dolor, trismus, lesiones reversibles e irreversibles del nervio alveolar inferior (NAI) o nervio lingual, riesgo de fractura y formación de defectos periodontales del segundo molar. La implementación de soportes rígidos en la óptica endoscópica ha permitido utilizar esta tecnología para realizar abordajes mínimamente invasivos para remover terceros molares mediante accesos flapless con una mínima osteotomía de la zona oclusal, conservando la pared bucal y lingual a través de la visualización directa y magnificada del sitio quirúrgico, adaptable a los movimientos del paciente durante la intervención. En este reporte se presenta un nuevo procedimiento quirúrgico mínimamente invasivo a través de asistencia endoscópica para la conservación ósea en la remoción de terceros molares mandibulares con riesgo de lesión del nervio alveolar inferior.
Anatomic variability of the position of mandibular third molars represents significant challenges associated with its depth and angulation. The most common complications of conventional surgical procedure are related to extensive osteotomy and poor visualization, which can cause postsurgical effects such as inflammation, pain, trismus, reversible and irreversible lesions of the inferior alveolar nerve (IAN) or lingual nerve, fracture risk and formation of a deep periodontal defect on the distal aspect of the second molar. The implementation of rigid endoscopy in optics has allowed to use this technology via a minimally invasive approach to remove third molars by a minimally occlusal flapless ostectomy, preserving the buccal and lingual walls through direct and magnified visualization of the surgical site, adaptable to the patients movements during the surgery. In this report, we present a new and minimally invasive procedure through endoscopic assistance for bone conservation in the removal of third molars at risk of inferior alveolar nerve injury.
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Feminino , Complicações Pós-Operatórias/prevenção & controle , Endoscopia/métodos , Extração Dentária/métodos , Dente Serotino/cirurgia , Dente Impactado/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Mandíbula/cirurgia , Osteotomia/métodos , Traumatismos do Nervo Trigêmeo/prevenção & controleRESUMO
A terapia por placa oclusal tem muitas aplicações favoráveis que a torna extremamente útil no tratamento das desordens temporomandibulares. A etiologia destas desordens, na maioria das vezes, é multifatorial, por isto é muito importante que a terapia inicial seja reversível e não invasiva, o que valoriza ainda mais estes aparelhos como tratamento inicial. Diante disto o objetivo deste trabalho foi realizar um estudo piloto para analisar a sensibilidade dolorosa e limiar de dor antes e após placa interoclusal resiliente e rígida de pacientes jovens com apertamento dental e dor muscular. Para isto foram selecionados dez pacientes com dor tensional nos músculos masseter e temporal. Estes pacientes foram analisados por meio de palpação e algometria. Cinco deles foram tratados com placa interoclusal resiliente, e os outros cinco, com placa rígida. Foram novamente avaliados pós uma e duas semanas da instalação do aparelho. Os resultados foram submetidos à Análise de Variância a 5% de significância e demonstraram que não houve diferença estatisticamente significante entre as placas. A comparação dos momentos analisados (S1, S2, S3) mostrou que houve diferença significativa, sendo que todos os momentos foram diferentes entre si, tanto para a sensibilidade à palpação digital quanto para o limiar de dor. Pode-se concluir que no curto período avaliado ambas as placas mostraram resultados semelhantes, entretanto, estudo com amostra maior de pacientes e por um período mais prolongado deve ser realizado
Interocclusal appliances therapy has many favorable applications which turn it useful in temporomandibular disorders treatment. Etiology of these disorders is varied in the most of cases, and thats why it is very important that the initial treatment be reversible and not invasive. It turns this kind of appliances very good as an initial choice of treatment. The aim of this study is do a pilot study to analyses pain before and after a resilient and rigid interocclusal appliance treatment. Ten patients with muscle pain were selected. They were analyzed by digital palpation and algometry, before and after one and two weeks of installation of appliances. Five of them were treated by soft interocclusal appliance and the other five with rigid one. The results were submitted toa variance analysis with 5% of significance e demonstrated that there was no difference between appliances. Comparison of moments demonstrated that they were different palpation and for pressure pain threshold. However, other research may be done in future