Juliana Barroso Zimmermmann

Associação entre a contagem de linfócitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical diagnosticada pela histopatologia em mulheres infectadas pelo HIV

OBJETIVO: avaliar a associacao entre a contagem de linfocitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical em pacientes HIV positivas. METODOS: estudo transversal no qual foram incluidas 87 pacientes infectadas pelo HIV, confirmado por testes sorologicos previos. Todas eram portadoras do HPV cervical, diagnosticado por meio da reacao em cadeia da polimerase. Foram realizados anamnese, exame fisico e colposcopia de todas em pacientes. A biopsia do colo uterino foi realizada quando indicada pelo exame colposcopico. Os resultados histopatologicos foram classificados com neoplasia intra-epitelial de baixo grau (NIC I) ou de alto grau (NIC II e II). A associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao foi verificada por meio da comparacao de medias utilizando a analise da variância (ANOVA). RESULTADOS: entre as 60 pacientes biopsiadas foram encontrados 24 casos (40,0%) com NIC I, oito (13,3%) NIC II, tres (5%) NIC III, 14 (23,3%) pacientes somente com cervicite cronica e 11 (18,3%) apresentando efeito citopatico produzido pelo HPV, mas sem perda da polaridade celular. Isso equivale a 35 mulheres com lesao intra-epitelial de baixo grau (NIC I + HPV) (58,3%) e 11 (18,3%) com lesao intra-epitelial de alto grau (NIC II + NIC III). A associacao entre a media da contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial cervical nao foi significativa (p=0,901). CONCLUSOES: nao houve associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial do colo uterino, diagnosticada pelo exame histopatologico.

Langerhans cell density in cervical intraepithelial neoplasia associated with human papillomavirus infection in HIV-infected and HIV-noninfected Brazilian women.

Objective Local immunity plays an important role in the cervical defense mechanisms that prevent the development of cervical intraepithelial neoplasia. The objective of this study was to determine the involvement of local immunity by evaluating Langerhans cell (LC) density in cervical biopsies of human immunodeficiency virus (HIV)-positive and HIV-negative women. Materials and Methods A cross-sectional study was developed by including HIV-positive and HIV-negative women. All patients presented human papillomavirus DNA from the uterine cervix, which was detected by polymerase chain reaction or hybrid capture II. Cervical biopsies were assessed for LC density and cervical intraepithelial neoplasia. Langerhans cells were identified by immunohistochemistry using anti-CD1a and anti-S100 antibodies. Associations among cervical LC density, the type of cervical lesion, CD4+ lymphocyte count, and HIV viral load were analyzed using logistic regression (SPSS, version 12.0). Results Seventy-seven women (40 seropositive and 37 seronegative) were enrolled. The mean ± SD LC density identified with the anti-CD1a antibody was 0.80 ± 0.7 cells versus 2.6 ± 1.6 cells (P < 0.0001), whereas the mean ± SD LC density identified by the anti-S100 antibody was 1.3 ± 1.0 cells versus 3.6 ± 1.7 cells (P < 0.0001) among the HIV-positive and HIV-negative women, respectively. There were no associations between LC density and HIV viral load, CD4+ lymphocyte count, or human papillomavirus genotype (P > 0.05). In a logistic regression model, HIV infection was the only factor independently associated with a decrease in LC density. Conclusions Human immunodeficiency virus infection was found to be an independent factor that explains the decrease in local immunity in the uterine cervix, which could allow the development of cervical lesions. This effect was not associated with CD4+ lymphocyte count or HIV viral load.

Rastreio da infecção pelo vírus da imunodeficiência humana no momento do parto

PURPOSE to evaluate the frequency of HIV tests performed during prenatal care and rapid tests ordered for pregnant women admitted at the time of delivery. METHOD this was a cross-sectional study with 711 pregnant women at delivery during the period from January to July 2010. Women admitted for clinical control and those that did not allow their clinical data to be included in the study were excluded. The χ² test or the Fishers Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%. RESULTS the mean age of the patients was 25.77 ±6.7 years and the maximum and minimum age was 44 and 12 years, respectively. The average gestational age at the time of attendance was 38.41 ±6.7 weeks. Of these patients, 96.3% (n=685) had prenatal care and 11.1% (n=79) received prenatal care at our facility. The average number of prenatal care visits was 6.85 ±2.88, but 28.1% had less than six visits. We identified 10 HIV-positive pregnant women (1.4%) and two patients were known to be HIV positive. The others (n=8) were screened at birth and therefore did not receive ARV prophylaxis during the prenatal period. Three patients were admitted during the expulsion period and also did not receive intrapartum antibiotic prophylaxis. However, all newborns were evaluated, with lactation being suppressed and artificial milk being used. CONCLUSIONS despite the measures established by the Ministry of Health, there are still flaws in the approach to these patients. Only with the participation of managers and professionals involved in care it will be possible to correct the direct actions that enable the effective prevention of vertical transmission of HIV.

Aspectos ginecológicos e obstétricos de pacientes atendidas nos serviços público e privado de saúde: há diferenças?

PURPOSE To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. METHODS In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5% level of significance. RESULTS The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. CONCLUSIONS Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.

Associação entre cultura de secreção vaginal, características sociodemográficas e manifestações clínicas de pacientes com diagnóstico de candidíase vulvovaginal

PURPOSE To investigate the etiology and the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors. METHODS Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by Polymerase Chain Reaction (PCR). Demographic and clinical data were obtained with a questionnaire. For statistical analysis, the Students t-test, the χ² and Fischer tests were applied as needed using the Statistical Package for Social Sciences (SPSS) software, with the level of significance set at 5%. RESULTS Sixty-nine patients aged from 15 to 52 years were evaluated. They were predominantly white (79.7%), with higher education (58%), married (56.5%) and sexually active (97.1%). Among them, 34.8% were pregnant, 7.2% diabetic, 1.4% seropositive for AIDS, and 36.2% were using oral contraceptives. Recent antibiotic therapy was mentioned by 13% of the patients, and antifungal or anti-trichomonas therapy was mentioned by 5.8 and 1.4% of the patients, respectively. Corticosteroid use was reported by 2.9% and antineoplastic by 1.4%. Vaginal discharge and itching were the main complaints (97.1 and 73.9%), followed by burning (63.8%) and erythema (63.8%). When present, the vaginal flow was predominantly white (88.1%) or lumpy (86.6%). The diagnosis was confirmed by culture in 55 (79.7%) patients, with mixed infections in 4 patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). CONCLUSION Despite the high culture positivity and clinical data characteristic of VVC, the symptoms were not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in VVC etiology, such as the emergence of C. lusitaniae.

Hormonal contraception: a comparison between patients of the private and public health network

The aim of this paper is to assess the profile of patients using hormonal contraceptives in the public health network and a comparison with the private health service, as well as the frequency of side effects and adherence to treatment. A cross-sectional study was conducted with 240 patients, namely 120 patients from the private health service and 120 patients from the public health network. The most commonly prescribed hormonal dosage on the private group (36.7%) was 15 or 20 micrograms of ethinyl estradiol (EE), associated with gestodene, desogestrel or levonorgestrel. On the other hand, the prescribed hormonal dosage in the public group was a combination of 30 micrograms of EE associated with gestodene, levonorgestrel or desogestrel (48.3%). There was no difference between the frequency of side effects in both groups surveyed (p>0.05). Meanwhile, adherence to treatment was higher in patients of the private group. The authors concluded that the most widely used contraceptive method was a low oral dose of ethinyl estradiol and there is no difference between the frequency of side effects. However, adherence to treatment was higher in the private group, which may be associated with social and cultural aspects of the patients surveyed.

Local immune response to HPV-induced lesions of the uterine cervix in patients infected or not with human immunodeficiency virus

Objetivando avaliar a contagem de celulas de Langerhans na mucosa cervical de pacientes soropositivas e soronegativas para o HIV foi realizado um estudo com 77 pacientes, sendo 40 soropositivas e 37 soronegativas para o HIV que foram submetidas a colposcopia e biopsia de colo uterino. O material obtido atraves da biopsia de colo uterino foi encaminhado para estudo histopatologico e imunohistoquimico,utilizando-se os anticorpos CD1a (1:200), S100 (1:1200) e Ecaderina(1:400), todos da marca DAKO. O sistema de deteccao utilizado foi oNovolink (Novocastra). Nas pacientes soropositivas para o HIV, considerando ao longo do epitelio, a marcacao pelo anticorpo CD1a, a media de celulas/campo foi de 0,80 + 0,7 celulas e pelo anticorpo S100 a media de celulas/campo foi de 1,3 + 1,0 celulas. Nas pacientes soronegativas para o HIV, considerando-se ao longo do epitelio, pelo marcador CD1a, a media de celulas/campo foi de 2,6 + 1,6 celulas epelo marcador S100 verificou-se contagem de 3,6 + 1,7 celulas, o que determinou para o CD1a (p 0,05). A analise multivariada identificou como responsavel pela reducao do numero de celulas de Langerhans apenas a infeccao pelo HIV. Conclui-se que as pacientes soropositivas apresentam menor quantidade de celulas de Langerhans na mucosa cervical, quando comparadas com assoronegativas, mas este efeito nao esta associado a contagem de linfocitos TCD4+ e a carga viral do HIV.

5. Hypertensive disorders of pregnancy and trombophilia association

Introduction Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the national high blood pressure education program working group on high blood pressure in pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension and 4) gestational hypertension (transient hypertension of pregnancy or chronic hypertension identified in the latter half of pregnancy). The role of thrombophilia in the pathogenesis of preeclampsia is controversial, and it’s possible the thrombophilia increases the risk of preeclampsia or interferes with its clinical course. Methods We study 79 pregnancy patients with a poor obstetrics results. All those patients were submitted to trombofilia research (Leiden V factor, mutation of prothrombin, SAAF, MTHFR, S protein, C protein, antithrombin ) and mutation of PAI (4G/5G). Results We identificated 38% of pacients with preeclampsia, and there was association between SAAF and preeclampsia (p  Conclusions SAAF and PAI 4G/5G mutation are important trombophilia for the adverse outcome of pregnancy.

Frequência de sífilis em gestantes

O cuidado primario tem um papel importante na prevencao e no tratamento de doencas infecciosas, pois no contexto gestacional algumas dessas doencas podem causar complicacoes graves ao recem-nascido, levando inclusive a morte fetal. Os autores apresentam um estudo transversal em que participaram 299 gestantes no Servico Pre-natal em Juiz de Fora e 66 gestantes oriundas do servico de obstetricia da Faculdade de Medicina de Barbacena. A idade media foi de 24,60 anos. Houve sifilis em ambos os grupos, mas nao houve casos de sifilis congenita. Os autores concluiram que a frequencia de sifilis apresentou distribuicao uniforme em ambos os servicos e sugerem medidas adequadas de controle e tratamento de gestantes. Palavras-chave: Sifilis congenita; vaginose bacteriana; candidiase; infeccoes por tricomonas; mulheres gravidas

Avaliação temporal da frequência da infecção do HIV em gestantes

Com a evolucao da epidemia de AIDS nas ultimas decadas, houve um aumento expressivo do numero de casos entre heterossexuais. A feminizacao da epidemia acelerou a disseminacao geografica do virus da imunodeficiencia humana (HIV) em todo o territorio nacional, determinando tambem o aumento de criancas infectadas pela transmissao materno-infantil. A frequencia da infeccao pelo HIV em gestantes atendidas pelo Servico de Obstetricia da Universidade Federal de Juiz de Fora, nos periodos de 2009-2015 (grupo 1) foi avaliada e comparada com a frequencia da infeccao pelo HIV no mesmo servico no periodo de 1998-2002 (grupo 2). A comparacao dos dados revelou uma menor frequencia da infeccao pelo HIV no grupo 1. Os autores identificaram queda da frequencia da infeccao pelo HIV ao longo do tempo, com estabilizacao nos ultimos anos. Palavras-chave: Infeccao pelo HIV; gravidez; cuidado pre-natal