Malvina Páez

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.

Detection of high risk human papillomavirus cervical infections by the hybrid capture in Asunción, Paraguay

Cervical cancer is the most frequent malignant tumour of women in Latin America being human papillomavirus (HPV) the main cause. The aim of this study was to increase the knowledge about the cervical infections with oncogenic HPV types (HR-HPV) in Asuncion, Paraguay. Two hundred and seventy-two cervical samples were analyzed using hybrid capture II assay (HCA II) for HR-HPV. The frequency of HR-HPV in the study group was 44%. HR-HPV was detected in 25% of the women negative for squamous intraepithelial lesions (NSIL), 72% with atypical squamous cells of undetermined significance (ASCUS), 68% with low SIL and 78% with high SIL. A moderate concordance was observed between HCA II assay and cytology (kappa: 0.43 IC(95% 0.3-0.5)). It was detected a high frequency of HR-HPV in women from 11 to 30 years old and in those over 60 years old. The data obtained in this study showed a high frequency of HR-HPV in woman with NSIL and ASCUS, which corroborate that the use of cytology together with HCA II assay for HR-HPV could improve remarkably the efficiency of screening programs of cervical cancer in Paraguay. Furthermore, these findings point out the need for the periodical follow-up of HR-HPV infections in older women.

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.

Evaluación de la Atención Primaria de Salud en un contexto urbano: percepción de actores involucrados - Bañado Sur - Paraguay, 2011

En Paraguay, desde 2008 se procesa la reforma de la Atencion Primaria de Salud, buscando reducir inequidades. Con el objetivo de conocer el rol de la Atencion Primaria de Salud en la reordenacion del sistema de salud, se utilizo la herramienta Primary Care Assessment Tool para estudiar los Equipos de Salud Familiar en Asuncion. Fueron entrevistados 360 usuarios y 36 profesionales. Los resultados cubren las dimensiones acceso, puerta de entrada, vinculo, integralidad, coordinacion, enfoque familiar, orientacion a la comunidad, y formacion profesional. Se observa que usuarios y profesionales tienen percepciones diferentes, pero convergen que el acceso es un punto debil y la formacion profesional uno fuerte. Se concluye que hay una importante inversion en la Atencion Primaria de Salud, pero la poblacion aun no se esta apropiando de toda su potencialidad.

[Monitoring the Paraguayan epidemiological dengue surveillance system (2009-2011) using Benford's law].

INTRODUCTION Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011. OBJECTIVE To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011. MATERIALS AND METHODS We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benfords law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle. RESULTS The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle. CONCLUSION Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff.

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.

P1-104 Community syndromic surveillance system using information and communication technology in Paraguay

The objective of syndromic surveillance is to identify illness clusters early and to mobilise a rapid response, thereby reducing morbidity and mortality. Objective To describe the system named Bonis, which uses Information and Communication Technology to prevent, warn, monitor and control the spread of febrile syndromes and influenza like illness (ILI) at the community level. Methods Bonis has a kernel free software application; Asterisk, a phone center with VoIP service, PHP as Script language and Mysql as data base management. The system was implemented in a primary healthcare. Results The developed system has the ability to record, classify, and prioritise automatically through the Interactive Voice Response the suspected cases. It has been programmed in a PHP language script AGI to improve the functionality of the Asterisk, in a way that during the user call to report a possible case, the system feeds a database, through the manager module based in a web application developed in PHP. The system, to which the users access from a mobile or fixed telephone, automatically receives the call with 9 questions on signs and symptoms. The system is working since May 2010 and records the phone calls correctly; follow-ups of these patients are performed by the teams within a period of 24 h. Conclusion The developed system is allowing the community to notify and register events that require surveillance, and the community health agents is prioritising visits to those homes from where fever cases are reported for sooner and more appropriate interventions.