Background. Sickle cell anaemia (SCA) is the most prevalent monogenic disease in Brazil. In SCA, haemoglobin S (HbS) is formed, which modifies red blood cell morphology. Intravascular haemolysis occurs, in which free Hb and free radicals degrade nitric oxide (NO) and release arginase, which reduces arginine levels. Because arginine is a substrate for NO formation, this decrease leads to reduced NO (vasodilator) synthesis. SCA treatment uses hydroxyurea (HU) to maintain high foetal haemoglobin (HbF) levels and reduces HbS to avoid haemolytic episodes. Objective. To analyse the efficacy of L-arginine as an adjuvant in the treatment of SCA patients. Setting. The State Blood Centre of Ceará, Brazil. Methods. This was a randomized double-blind clinical study of adults with SCA with continuous use of HU at the State Blood Centre of Ceará. The clinical study enrolled 25 patients receiving HU + L-arginine (500 mg) and 25 patients receiving HU + placebo. The treatment was carried out over four months. Laboratory tests were performed to determine the levels of the following: (1) complete blood count; (2) nitrite + nitrate; (3) HbF; and (4) reticulocytes. The clinical experiments were performed by a haematologist. The main outcome measures were nitrite and pain. Results. Statistical analysis showed that the levels of NO were increased in the study group, and there was also a reduction in pain frequency using a pain frequency scale by day, week, and month. The levels of nitrite plus nitrate in the group receiving placebo plus HU did not change among the times evaluated (38.27 ± 17.27 mg/L, 39.49 ± 12.84 mg/L, 34.45 ± 11.25 mg/L, p >0.05), but in the patients who received supplementation with L-arginine plus HU, a significant increase in nitrite plus nitrate levels was observed between M0 and M4 (36.55 ± 20.23 mg/L versus 48.64 ± 20.63 mg/L, p =0.001) and M2 and M4 (35.71 ± 15.11 mg/L versus 48.64 ± 20.63 mg/L, p <0.001). It is important to note that the increase in nitrite plus nitrate levels occurred only in the fourth month of follow-up of patients in the treatment group, showing that at least 4 months of supplementation with L-arginine is necessary to show an increase in these metabolites in the serum. Conclusion. The use of L-arginine as a coadjuvant in the treatment of sickle cell anaemia may function as a potential tool for pain relief, consequently improving the life of patients.
Based on the results, liquid-based cytology may be used to detect intra-anal lesions, especially among women who have a history of anal intercourse or who have genital HPV-associated lesions at multiple sites.
Background: There is a high frequency of human papillomavirus (HPV)-induced lesions in cervix and anus of immunosuppressed patients. However, few studies have evaluated these lesions in kidney-transplanted women.Methods: This cross-sectional study examined 31 kidney-transplanted women receiving immunosuppressive therapy at the General Hospital of Fortaleza in Brazil. Cervical and anal samples were collected and preserved in order to perform liquid-based cytology and a real-time polymerase chain reaction assay detecting high-risk HPV. Results: The patients' ages ranged from 31 to 70 years (mean: 42.6 ± 10.4). The age of sexual debut varied from 14 to 30 years (mean: 19.7 ± 3.8). Cervical cytology was diagnosed as atypical in 25.8% of cases (atypical squamous cells of undetermined significance [ASC-US] in 2 [6.2%], atypical squamous cells, but unable to exclude a high-grade squamous intraepithelial lesion in 1 [3.1%], low-grade squamous intraepithelial lesion [LSIL] in 4 [12.4%], and squamous cell carcinoma in 1 [3.1%]). Anal cytology was atypical in 35.4% of cases (ASC-US in 1 [3.2%]and LSIL in 7 [21.7%]). The presence of cervical HPV was confirmed in 22.5% of patients, and anal HPV was found in 48.8% of the cases. The relative risk of atypical anal cytology in cases of atypical cervical cytology was 4.37 (1. 35-14.20). High-risk cervical HPV did not significantly increase the risk of having atypical anal cytology. However, for HPV in the anus, this was associated with a relative risk of 10.18 (1.45-71.54).Conclusion: High-risk HPV and atypical cytology are very common in the cervix and anus of kidney-transplanted women. Furthermore, the presence of HPV in an anal sample correlates with an increased risk of atypical anal cytology. HPV tests could be useful tools for identifying patients who require anal cytology.
Objective: We aimed to assess potential associations between atypical squamous cell (ASC) subgroups: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion), regarding cytomorphological features, high-risk (HR) human papillomavirus (HPV) testing, and histological outcomes in a sample of Brazilian women. Study Design: Cross-sectional study which evaluated 1,346 liquid-based cytologies between January 2010 and July 2016 with ASC results. ASC-US and ASC-H were analyzed for frequency, diagnostic criteria, and cytological findings and compared with HR-HPV tests and histological outcomes. Results: Enlarged nucleus was the most frequent ASC-US criterion, but alternative criteria were present in 20% of the total cases. No ASC-US criteria were associated with histological outcomes or HR-HPV positivity. Parakeratosis, corneal pearl, giant cells, and binucleation were strongly associated with ASC-US while hyperkeratosis was associated with high-grade squamous intraepithelial lesions (HSIL) or a superior outcome. HR-HPV was positive in 64.39% of ASC-US and 65.38% of ASC-H. HSIL or superior outcomes also occurred in 13.33% of ASC-US and 64.71% of ASC-H cases. Conclusion: Alternative criteria for ASC-US were relatively frequent. Reactive cellular changes suggestive of atypias were more abundant in ASC-US. Although ASC-H is associated with worse histological outcomes, no differences in HPV positivity were found in comparison to ASC-US.
INTRODUÇÃOO papilomavírus humano (HPV) é um vírus DNA extremamente prevalente em todo o mundo. Atualmente existem mais de 200 tipos identificados, dos quais cerca de 45 acometem a área anogenital, classificados como de alto e baixo risco, dependendo da sua associação com câncer genital 1 . Sem dúvida, hoje a infecção por HPV é considerada a doença sexualmente transmitida de origem viral mais frequente. Algo em torno de 300 a 400 milhões de novas infecções ocorrem em todo o mundo, na maioria dos casos na forma latente, sem indicativos subclínicos ou clínicos da infecção 2 . Dentre os fatores de risco considerados para infecção pelo vírus estão principalmente idade, maior prevalência entre adolescentes e adultas jovens até 24 anos 3 , início precoce de vida sexual 4,5 , múl-tiplos parceiros sexuais 5,6 , diferença etária em relação ao parceiro, em especial quando superior a 10 anos 7 e outras doenças sexualmente transmissíveis 8 . O HPV tem em sua essência situações ainda não totalmente esclarecidas. A possibilidade de infecção por transmissão não sexual é ainda um ponto não bem definido e alvo de tabus. Há discussão quanto ao papiloma de laringe e a transmissão perinatal 9,10 , assim como infecção através da placenta e do cordão umbilical 11. Além destas, a transmissão por autoinoculação e de mãos para genitais 12 , bem como por fômites 13 estaria associada a possível via não sexual, uma vez que estudos demonstram a possibilidade de manutenção de infecciosidade em temperatura ambiente 14 . Embora se saiba da alta prevalência de infecções pelo HPV entre adolescentes com atividade sexual, onde o ectrópion, ou seja, a presença de epitélio cilíndrico endocervical na ectocérvice, expõe células jovens (células parabasais e de reserva) mais receptivas à infecção pelo vírus, a maioria destas infecções tende a desaparecer espontaneamente, sendo transitória 15,16 . No entanto, poucos estudos têm conseguido demonstrar a presença do vírus entre meninas antes da coitarca sem história de abuso sexual [17][18][19] . ObjeTIvOO objetivo deste estudo é avaliar a frequência de DNA-HPV genital por biologia molecular entre mulheres adolescentes antes da coitarca e sem história de abuso sexual. ReSUMO Introdução: o papilomavírus humano (HPV) é um vírus bastante prevalente no mundo. Atualmente existem em torno de 200 tipos identificados, e destes, aproximadamente 45 acometem a área anogenital. Embora se saiba da alta prevalência de infecções pelo HPV entre adolescentes com atividade sexual, poucos estudos têm conseguido demonstrar a presença do vírus entre meninas antes da coitarca. Objetivo: determinar a prevalência de papilomavírus humano (HPV) em adolescentes e mulheres jovens sem coitarca. Métodos: foram avaliadas 50 mulheres adolescentes atendidas no ambulatório de ginecologia infanto-puberal do Hospital Universitário Pedro Ernesto (HUPE) da Universidade do Estado do Rio de Janeiro com idade até 20 anos, que relatavam não ter tido coitarca e apresentavam hímen íntegro no exame físico feito por ginecologista de larga experiência, e...
Sexually transmitted diseases (STDs) are common worldwide, with especially alarming numbers in Brazil. Among the most common infections is human papillomavirus (HPV). The possibility of the nonsexual transmission of HPV is not well defined and is the subject of debate. This study aimed to identify the prevalence of HPV in adolescents with no history of sexual intercourse compared with a group of similar age with sexual activity. 100 adolescents were evaluated with at least two years after menarche, who attended from January 2007 to January 2009 at the University Hospital Pedro Ernesto, Rio de Janeiro, Brazil. Among the adolescents, 50 had intact hymen and 50 reported regular sexual activity. For patients without sexual intercourse (group 1) we collected material from vestibule and for patients with sexual activity (group 2) we collected material from vagina and endocervix. The search for HPV-DNA 2nd generation hybrid capture (hC2) was performed. In group 1 the test was positive in 3 cases (6%). In the second group, 33 cases (66%) were positive for at least one site. The positivity in girls with sexual activity is high. On the other hand, the HPV infection, although rare, may occur in girls without sexual intercourse.
The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.
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