Laura Mendoza

Type-specific human papillomavirus distribution in invasive cervical carcinomas in Paraguay. A study of 432 cases

Cervical carcinoma is the most common malignant tumor among woman in Paraguay. Cytological screening programs have not been successful and a plan for human papillomavirus (HPV) based‐screening program and/or vaccination is under evaluation. This study aimed to identify the contribution of HPV genotypes in invasive cervical cancer in Paraguay to provide essential background data to guide and assess the introduction and impact of new preventive strategies based on HPV. Four hundred thirty two histologically confirmed cases (1960–2004) were analyzed. HPV detection in paraffin blocks was performed at the Catalan Institute of Oncology using PCR with SPF‐10 broad spectrum primers followed by DNA enzyme immunoassay and genotyping with a reverse hybridization line probe analysis. The majority of cases were squamous cell carcinoma (92.8%). Mean patients age was 48 years old. HPV DNA was detected in 73.1% of the cases and single infections were predominant (97.8%). The most common HPV single types were 16, 18, 45, 33, 31, 52, 35, and 39. 73.1% of HPV positive cases had an HPV 16, 18 as single infection. HPV16 was frequent in SCC whereas HPV 18 and 45 were prevalent in glandular tumors. Significant decrease of HPV 16 with age groups (P‐trend = 0.022) and increase in other HPV types (P‐trend > 0.001) were observed. The potential impact of HPV 16 and 18 for a vaccination program was 73.1%. The study provide a profile of the HPV situation in the country, with robust clinical, pathological and virological data which would permit a better cervical cancer screening and vaccination programs. J. Med. Virol. 84:1628–1635, 2012.

Distribution of human papillomavirus genotypes in Paraguayan women according to the severity of the cervical lesion.

The incidence of cervical cancer in Paraguay is among the highest in the world. This study aimed to determine the distribution of human papillomavirus (HPV) genotypes in Paraguayan women, according to the severity of the cervical lesion. This cross‐sectional study included 207 women without a squamous intraepithelial lesion, 164 with low‐grade squamous intraepithelial lesions, 74 with high‐grade squamous intraepithelial lesions, and 41 with cervical cancer. Type‐specific HPV was determined by the polymerase chain reaction with MY9/11 L1 and GP5+/GP6+ L1 primers, followed by restriction fragment length polymorphism and reverse line blotting hybridization, respectively. In total, 12 high‐risk and 24 low‐risk HPVs types were detected. HPV 16 was the most prevalent, followed by HPV 18 in cervical cancer (14.6%), HPV 31 in high‐grade squamous intraepithelial lesions (14.9%), HPVs 58/42 in low‐grade squamous intraepithelial lesions (9.1% each), and HPVs 31/58 (2.4% each) in women without squamous intraepithelial lesions. Among 285 positive samples, 24.2% harbored multiple HPV types, being this more prevalent in women with squamous intraepithelial lesions (30.8% in low‐grade squamous intraepithelial lesions, 22.5% in high‐grade squamous intraepithelial lesions, and 22.0% in cervical cancer) than in women without lesions (9.3%). The higher prevalence of HPV 16 and other high‐risk HPVs in women both with and without cervical lesions may explain the high incidence of cervical cancer in Paraguay. This information may be of importance for local decision makers to improve prevention strategies. In addition, these results may be useful as baseline pre‐vaccination data for a future virological surveillance in Paraguay. J. Med. Virol. 83:1351–1357, 2011.

Distribution of HPV-16 variants among isolates from Paraguayan women with different grades of cervical lesion

To determine the distribution of HPV‐16 variants among Paraguayan women with different grades of cervical lesions.

Distribution of human papillomavirus (HPV) genotypes and bacterial vaginosis presence in cervical samples from Paraguayan indigenous

OBJECTIVE To determine the frequency of human papillomavirus (HPV) types and to assess bacterial vaginosis (BV) possible associations with cervical infections in indigenous Paraguayan women of the Department of Presidente Hayes. METHODS This study included 181 sexually active women without cervical lesions. HPV typing was performed by polymerase chain reaction with primers PGMY 09/11 followed by reverse line hybridization. BV was diagnosed by the Nugent criteria using the results from a Gram stain smear. RESULTS Sixteen percent of women were positive for at least one high risk HPV type (HR-HPV). The most frequent genotypes were HPV 16 (4.4%), followed by HPV 58 (3.3%), HPV 45 (3.3%), HPV 53 (2.8%) and HPV 11 (2.8%). A significant association between HR-HPV and BV was observed (p=0.01). In addition, women with BV had a higher frequency of Chlamydia trachomatis (p=0.0007), Trichomonas vaginalis (p=0.00009), Mycoplasma hominis (p=0.001). CONCLUSIONS A large variety of HPV genotypes was detected and showed a slightly different pattern from previous studies on urban women in Paraguay, with the predominance of HR-HPV. Furthermore, the information of co-infections involved in BV could be useful for the improvement of national prevention programs, as well as for laboratory surveillance of these genital infections.

Deteccion del virus del papiloma humano de alto riesgo por captura hibrida II segun hallazgos citologicos en mujeres tratadas por lesiones escamosas intraepiteliales de cuello uterino, periodo 2006/2010

OBJECTIVE: To determinate the frequency of high risk human papillomavirus (HR-HPV) by hybrid capture II (r) (CH II(r)), according cytology results in women treated for squamous intraepithelial lesions of the cervix (SIL). MATERIAL AND METHODS: A descriptive cross-sectional study of a series of cases that included 122 women treated, 79 (75%) for low grade SIL (LSIL) and 43 (35%) for high grade SIL (HSIL) attending at the HPV Laboratory at the Health Sciences Research Institute (IICS), National University of Asuncion (UNA), for post-treatment control during period 2006/2010. RESULTS: A total of 28% (34/122) of women treated for SIL were positive for HR-HPV, detecting viral infection in 20% of women with no SIL (NSIL) (22/108), in 83% of women with LSIL (10/12) and in 100% of women with HSIL (2/2). Of 34 women positive for HR-HPV, 10 women (29%) had high values (100 pg / mL or more) of relative viral load, detecting an increase of positive cases with severity of the lesion (28% NSIL, 30% LSIL, 50% HSIL). CONCLUSION: HR-HPV detection by CH II(r) and high relative viral load values especially in women with NSIL could help to identify treated women at risk of developing recurrence, thereby contributing to strengthening the cervical cancer prevention program.

Anemia y deficiencia de hierro en mujeres indígenas del Departamento de Presidente Hayes, Paraguay, 2010-2011

Segun datos de la UNICEF, entre 4 mil y 5 mil millones de personas en el mundo padecen carencia de hierro, y se calcula que 2 mil millones sufren de anemia. La mujer puede presentar diversos tipos de anemia, ya sea por menstruaciones abundantes o por deficiencia de aporte de hierro. El objetivo de este trabajo fue evaluar los parametros hematologicos e indicadores quimicos de la anemia y carencia de hierro en las mujeres indigenas del Departamento de Presidente Hayes, Paraguay, realizado de octubre de 2010 a octubre de 2011. En este estudio observacional descriptivo de corte transverso, se incluyeron 222 mujeres de 12 a 60 anos de edad de las etnias maka, nivacle, sanapana, enxet y tobaqom. Se determino la concentracion de la hemoglobina e indices hematimetricos: VCM, HCM y CHCM mediante un contador hematologico. El hierro serico y transferrina se determino por metodo enzimatico colorimetrico y la saturacion de la transferrina por calculo manual. En el 40% (88/222) de las mujeres se observo hemoglobina por debajo de 12 g/dL. Con respecto a los indices hematimetricos, presentaron valores inferiores al punto de corte, siendo el 33% para VCM, 22% HCM y el 16% para CHCM. Estos resultados indican una deficiencia de hierro en diferentes fases, lo que tendria consecuencias negativas como la anemia, baja resistencia a infecciones, retraso en el desarrollo psicomotor y funcion cognoscitiva de los ninos, bajo rendimiento academico, fatiga, entre otras patologias en una poblacion vulnerable donde la mayoria de las mujeres estudiadas son de edad fertil.