Lídia Rf Medeiros

Persistence and clearance of human papillomavirus infection: a prospective cohort study.

OBJECTIVE The objective of the study was to identify epidemiological correlates for persistence and clearance of human papillomavirus (HPV) infection. STUDY DESIGN Cervical smears collected in a prospective cohort study to perform Papanicoloau cytology and HPV deoxyribonucleic acid (DNA) detection at baseline and during the follow-up. Outcomes analyzed were: (1) persistence of HPV DNA; (2) conversion; and (3) clearance of HPV. RESULTS Among 501 women the incidence of HPV was 12.3%. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse and 4 or more sexual partners during their lifetime. In a median of 19 months, 80.7% of women had clearance of HPV, which was associated with black race, coinfection with Chlamydia trachomatis at baseline, and a history of previous Papanicoloau smear. CONCLUSION Strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Papanicolaou smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynecological infections with HPV clearance are needed.

Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review

OBJECTIVE To estimate the diagnostic accuracy of magnetic resonance in ovarian tumors. STUDY DESIGN A quantitative systematic review was performed. Studies that compared magnetic resonance and paraffin sections within subjects for diagnosis of ovarian tumors were included. RESULTS Fifteen primary studies were analyzed, which included 1267 ovarian masses. For borderline or malignant ovarian cancer vs benign ovarian lesions, the pooled likelihood ratio for the occurrence of a positive magnetic resonance result was 6.6 (95% confidence interval, 4.7-9.2) and the posttest probability for borderline or malignant diagnosis was 77% (95% confidence interval, 70-82). Because specificity and likelihood ratio positive were heterogeneous, a random effect model was used and a summary receiver operating characteristic curve was generated. For borderline or malignant ovarian cancer vs benign ovarian lesions, the area under curve was 0.9526. CONCLUSION Magnetic resonance seems to be a useful preoperative test for predicting the diagnosis of pelvic masses.

Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis.

OBJECTIVE To investigate the efficacy, compared to placebo, of fluconazole 150 mg weekly, given for six months as prophylaxis against recurrent vulvovaginal candidiasis (RVVC). STUDY DESIGN A quantitative systematic review was performed, and randomized controlled trials were included. We conducted searches at Medline, EMBASE, Lilacs, Cochrane Library and ICI Web of Science from 1980 to March 2012. We used the odds ratio (OR) with confidence intervals (CI) of 95% using a random effects model of Mantel-Haenszel. The software used was Review Manager version 5.0. RESULTS Through the search strategies we identified 249 articles, of which only two were part of the meta-analysis. Fluconazole was more effective than placebo in reducing symptomatic episodes of VVC, immediately after treatment (OR 0.10, 95% CI 0.03-0.34), 3 months after treatment (OR 0.23, 95% CI 0.07-0.74) and 6 months after treatment (OR 0.39, 95% CI 0.24-0.64). CONCLUSION Weekly treatment with fluconazole (150 mg) for six months is effective against RVVC.

Accuracy of telomerase in estimating breast cancer risk: A systematic review and meta-analysis

OBJECTIVE To determine the accuracy of telomerase activity in predicting a higher risk for breast cancer. STUDY DESIGN A quantitative systematic review was performed. Studies that detected telomerase activities in breast tissue were included. RESULTS Twenty-five primary studies were analyzed, which included 2395 breast lesions. The proportion of breast cancer was 60.8%. Eighty-two percent (1193/1455) of breast cancer cases and 18% (169/940) of benign lesions cases were positive for telomerase activity. For breast cancer vs benign or normal breast tissue, the pooled likelihood ratio for the presence of telomerase activity was 4.5 (95% confidence interval [CI], 3.1-6.5) and the post-test probability was 88% (95% CI, 83-91). For breast cancer vs benign or normal tissue, the area under the summary receiver operating characteristic (SROC) curve was 0.89 with the Q* point value of 0.82. CONCLUSION Our systematic review showed that telomerase activity was significantly present in breast cancer when compared with normal breast tissue or benign breast lesions.

Corticóide inalatório: efeitos no crescimento e na supressão adrenal

This is a review of the medical literature regarding inhaled corticosteroids and their effects on growth and adrenal suppression in children and adolescents. A review of the literature, principally that published over the last five years, was conducted using Medline and searching indexes of articles published in national and international scientific journals. There is considerable controversy regarding the side effects of inhaled corticosteroids. In 21 studies evaluating the effect that inhaled corticosteroids have on growth, a statistically significant reduction (growth retarded by 1-1.5 cm) was observed within the first year of treatment with Beclomethasone or Budesonide inhalers. However, in studies of longer duration, no significant difference was found between final adult height and adult height of the parents. However, in ten studies of the use of inhaled corticosteroids and their effect on adrenal suppression, hypoglycemia and arrested development (no height or weight gains), as well as changes in morning serum levels and 24-h urinary levels of cortisol, were reported, especially when high doses of inhaled corticosteroids were used. Inhaled corticosteroids can reduce growth during the first year of use but do not affect adult height. However, further long-term studies are needed in order to determine the full impact of inhaled corticosteroids on final adult height. Height measures are a means of evaluating the safety and efficacy of the use of inhaled corticosteroids in children. Tests that evaluate the hypothalamic-pituitary-adrenal axis and adrenal insufficiency should be correlated with clinical symptoms and side effects.

Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis

The objective of the study was to verify the accuracy of hyperbilirubinaemia as a marker for acute perforated appendicitis.