Jenner Chrystian Veríssimo de Azevedo

Link between chronic inflammation and human papillomavirus-induced carcinogenesis (Review)

Inflammation is a defense strategy against invading agents and harmful molecules that is activated immediately following a stimulus, and involves the release of cytokines and chemokines, which activate the innate immune response. These mediators act together to increase blood flow and vascular permeability, facilitating recruitment of effector cells to the site of injury. Following resolution of the injury and removal of the stimulus, inflammation is disabled, but if the stimulus persists, inflammation becomes chronic and is strongly associated with cancer. This is likely to be due to the fact that the inflammation leads to a wound that does not heal, requiring a constant renewal of cells, which increases the risk of neoplastic transformation. Debris from phagocytosis, including the reactive species of oxygen and nitrogen that cause damage to DNA already damaged by the leukotrienes and prostaglandins, has an impact on inflammation and various carcinogenic routes. There is an association between chronic inflammation, persistent infection and cancer, where oncogenic action is mediated by autocrine and paracrine signals, causing changes in somatic cells under the influence of the microbial genome or of epigenetic factors. Among the infectious agents associated with cancer, certain genotypes of human papillomavirus (HPV) stand out. HPV is responsible for virtually all cases of cervical cancer and a lower proportion of cancers of the vagina, vulva, anus, penis and a number of extragenital cancers. In the present review, recent advances in the mechanisms involved in the inflammatory response are presented with their participation in the process of carcinogenesis, emphasizing the role of chronic inflammation in the development of HPV-induced cervical cancer.

Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents

OBJECTIVE To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings. METHODS Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value <5%was established as statistically significant. RESULTS No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001). CONCLUSIONS In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.

Comparação entre avaliação objetiva e autoavaliação da maturação sexual em crianças e adolescentes

OBJECTIVE: To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings. METHODS: Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value < 5% was established as statistically significant. RESULTS: No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001). CONCLUSIONS: In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.

Knowledge about HPV and Screening of Cervical Cancer among Women from the Metropolitan Region of Natal, Brazil

Objective. The purpose of this study was to assess the knowledge level about HPV and screening of cervical cancer in women from the metropolitan region of Natal, Brazil. Materials and Methods. A descriptive cross-sectional study involving sexually active women was conducted. The participants were submitted to a face-to-face interview, using a structured questionnaire that permitted the quantification of data and opinions of the respondents. Results. Most participants (70.9%) had poor knowledge about HPV and also the Pap test (53.0%). The high level of knowledge about HPV was associated with age, education, marital status, household income, and pregnancy, while the high level of knowledge about the Pap test proved to be associated only with education and household income. Conclusion. The results highlight the need for performing educational campaigns emphasizing the role of HPV in the etiology of cervical lesions of different degrees, including cervical cancer, as well as the importance of having a Pap test regularly to prevent these diseases.

Contribuição das características antropométricas na predição dos estádios de maturação puberal de jovens do sexo masculino

Objetivo:Identificar a contribuicao de variaveis antropometricas para a predicao do estadio maturacional em jovens do sexo masculino.Metodos:Estudo transversal, sendo investigados 190 sujeitos do sexo masculino, com idades entre 8 e 18 anos, selecionados aleatoriamente em escolas publicas e privadas de Natal. Foram selecionadas 32 variaveis antropometricas, todas avaliadas de acordo com as recomendacoes da International Society for the Advancement of Kineanthropometry (ISAK). A avaliacao da maturacao sexual se baseou na observacao de dois especialistas experientes, que identificaram o desenvolvimento da genitalia, segundo as recomendacoes propostas por Tanner (1962).Resultados:As variaveis antropometricas apresentaram um aumento significativo no decorrer do avanco do desenvolvimento puberal (p<0,05). As variaveis de altura troncocefalica, diâmetro biepicondilo femural, perimetro de antebraco, dobra cutânea de triceps, alturas osseas tibial e acromio-radial apresentaram a melhor relacao para predicao dos grupos maturacionais, sendo responsaveis por estimar os estadios puberais com indice de 76,3% de chance de acerto.Conclusao:As caracteristicas antropometricas apresentaram diferencas significativas entre os momentos dos estadios maturacionais, sendo encontradas, de forma representativa, sete variaveis que melhor predizem os estadios de maturacao sexual.Objective: To identify the contribution of anthropometric variables to predict the maturational stage in young males. Methods: Cross-sectional study that enrolled 190 male subjects aged between eight and 18 years, randomly selected from public and private schools in Natal, Northeast Brazil. Thirtytwo anthropometric variables were measured following the recommendations of the International Society for the Advancement of Kineanthropometry (ISAK). The assessment of sexual maturation was based on the observation of two experienced experts, who identified the pubertal development according to Tanner guidelines (1962). Results: The anthropometric variables showed a significant increase of their values during the advancement of pubertal development (p<0.05). The following variables showed the best value for prediction of maturational groups: sitting height, femoral biepicondylar diameter, forearm girth, triceps skinfold, tibiale laterale and acromiale-radiale bonelenghts. These variables were able to estimate the pubertal stages in 76.3% of the sujects. Conclusion: The anthropometric characteristics showed significant differences between the moments of maturational stages, being found, representatively, seven variables that best predict the stages of sexual maturation.