Maria Inês da Rosa

Prevalence of human papillomavirus in breast cancer: a systematic review.

Objective We performed a systematic review and meta-analyses to estimate the prevalence of human papillomavirus (HPV) in breast carcinoma and to explore the reasons for the ongoing controversies about this issue. Materials and Methods A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed for papers published from January 1990 to January 2011. The medical subject heading terms were searched for the following: breast neoplasm, breast lesions, breast cancer, and HPV or human papillomavirus. Statistical analysis was performed using REVMAN 5.0. Results Twenty-nine primary studies, including 2211 samples, were analyzed. Overall, HPV prevalence in patients with breast cancer was 23.0% (95% CI, 21.2%–24.8%). The prevalence of HPV ranged from 13.4% (95% CI, 10.2%–16%) in Europe to 42.9% (95% CI, 36.4%–49.4%) in North America and Australia. The prevalence of HPV in controls was 12.9%. Combinations of 9 case-control studies showed that breast cancer was associated with HPV (odds ratio, 5.9; 95% CI, 3.26–10.67). Conclusion We found a high prevalence of HPV DNA in breast cancer. There is strong evidence to suggest that HPV has an important role in the development of breast cancer.

Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis.

ObjectiveTo estimate the accuracy of pelvic magnetic resonance imaging (MRI) in the diagnosis of deeply infiltrating endometriosis (DIE).MethodsA comprehensive search of the Medline, Pubmed, Lilacs, Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, and ISI Web of Science databases was conducted from January 1990 to December 2013. The medical subject headings (MeSHs) and text words “deep endometriosis”, “deeply infiltrating endometriosis”, “DIE”, “magnetic resonance”, and “MRI” were searched. Studies that compared the parameters of pelvic MRIs with those of paraffin-embedded sections for the diagnosis of DIE were included.ResultsTwenty studies were analyzed, which included 1,819 women. Pooled sensitivity and specificity were calculated across eight subgroups: for all sites, these were 0.83 and 0.90, respectively; for the bladder, 0.64 and 0.98, respectively; for the intestine, 0.84 and 0.97, respectively; for the pouch of Douglas, 0.89 and 0.94, respectively; for the rectosigmoid, 0.83 and 0.88, respectively; for the rectovaginal, 0.77 and 0.95, respectively; for the uterosacral ligaments, 0.85 and 0.80, respectively; and for the vagina and the posterior vaginal fornix, 0.82 and 0.82, respectively.ConclusionIn summary, pelvic MRI is a useful preoperative test for predicting the diagnosis of multiple sites of deep infiltrating endometriosis.

Human papillomavirus and cervical neoplasia.

Human papillomavirus (HPV) has been established as an important etiological factor for the development of cervical cancer. This DNA virus primarily infects the epithelium and can induce benign and malignant lesions of the mucous membranes and skin. Some HPVs are considered high risk due to their role in malignant progression of cervical tumors. Genital HPV infections are common and usually transient among young sexually active women. Only a small fraction of infected women develop cervical cancer, implying the involvement of environmental and genetic cofactors in cervical carcinogenesis. Classification, virology, pathology, natural history, epidemiological features of genital HPV infection, and future prospects for cervical cancer prevention with HPV vaccines will be reviewed here.

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.

Prevalência e fatores associados à obesidade em mulheres usuárias de serviços de pronto-atendimento do Sistema Único de Saúde no sul do Brasil

Obesity is currently one of the major epidemics, representing an important public health problem that is associated with an increase in chronic disease. The scope of this study is to investigate the prevalence of excess weight and obesity and associated factors in 20 to 59-year-old women attended at First Aid Units of the Unified Health System. Standardized interviews and anthropometric measurements were conducted with 440 women. Factors associated with the presence of excess weight/obesity were investigated using the Poisson model with robust variance. The prevalence of excess weight and obesity (64.3%) as well as central obesity (44.1%) in women attended at First Aid Units is higher than that in the population in general and is associated with an increased incidence of health problems. Insufficient physical activity (PR=1.44; 95% CI 1.24-1.66), a history of three pregnancies or more (PR=1.45; 95% CI 1.05-2.00), age above 50 (PR=1.34; 95% CI 1.00-1.82) and central obesity (PR=1.92; 95% CI 1.64-2.25) are associated with a higher prevalence of obesity. The implementation of public health polices focused on the prevention of obesity would undoubtedly have a major impact on primary prevention of chronic diseases in the female population.

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.

Fatores associados à osteopenia e osteoporose em mulheres submetidas à densitometria óssea

The aim of this study was to determine the prevalence of osteopenia and osteoporosis in a female population, that had bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) in a specialized clinic in the south of Brazil. We conducted a cross-sectional study including 1,871 women that performed scans between January and December 2012. We conducted a logistic regression analysis with all independent variables and outcomes (osteopenia, osteoporosis and fracture risk). According to DXA results, 36.5% of women had normal BMD, 49.8% were diagnosed with osteopenia and 13.7% with osteoporosis. Menopause and age over 50 years old were risk factors for osteopenia and osteoporosis while prior hysterectomy and BMI greater than 25 were protective factors. For the outcome of fracture at any site the risk factors were age over 50 years old, osteopenia and osteoporosis (OR = 2.09, 95% CI:1,28-3, 40) and (OR = 2.49, 95% CI:1,65-3, 74), respectively.

Malnutrition and associated variables in an elderly population of Criciúma, SC

OBJECTIVE Determining malnutrition and associated variables in the elderly. METHODS A cross-sectional study was conducted among elderly people vaccinated against influenza in order to evaluate their nutritional status. Nutritional assessment was performed with the Mini Nutritional Assessment. To verify association of studied variables with the outcome, odds ratios was estimated using multiple logistic regression. RESULTS A total of 236 elderly patients were recruited. The Mini Nutritional Assessment identified three patients (1.3%) with malnutrition and 59 (25%) at risk of malnutrition. Factors with a positive association to the outcome were psychological stress or acute disease in the past three months, weight loss (< 3 kg) during the last three months and sores or skin ulcers. On the other hand, consuming two or more servings of fruits or vegetables daily, eating meat, fish or poultry every day and drinking more than three cups of fluids per day were negatively associated to malnutrition and risk of malnutrition. CONCLUSION The low prevalence of malnutrition found in this study may be due to the study sample of elderly individuals in good health. Some factors related to a recent health problem (psychological stress or acute disease) seem to be positively associated while regular consumption of fluids and certain foods seem to be negatively associated with malnutrition.

Laparoscopic Approach of a Unicornuate Uterus with Noncommunicating Rudimentary Horns

Background. Müllerian duct malformations delineate a miscellaneous group of congenital anomalies that result from arrested development, abnormal formation, or incomplete fusion of the mesonephric ducts. Case. This paper describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. Conclusion. This condition was diagnosed by laparoscopy and hysteroscopy examination. Operative videolaparoscopy proved to be a successful approach for the treatment of this congenital Müllerian anomaly.