Paulo Roberto Medeiros de Azevedo

Prevalence of HPV infection by cervical cytologic status in Brazil

To assess the prevalence of human papillomavirus (HPV) infection according to cervical cytologic status in northeastern Brazil; identify other risk factors for low‐ and high‐grade squamous intraepithelial lesions (LSILs and HSILs); and identify the most prevalent HPV genotypes associated with the lesions.

Prevalência de transtornos mentais comuns e avaliação da qualidade de vida no climatério

OBJECTIVE: To evaluate prevalence of mental distress and health-related quality of life (HRQoL) in climacteric women. METHODS: A total of 191 women (45 to 65 years of age) were included in this cross-sectional study. A questionnaire about personal information, habits/health, and demographic data was administered in association with the two validated instruments to measure HRQoL, SF-36, Medical Outcomes Study 36-item Short-Form Health Survey and to estimate prevalence of common mental distress (20-item SRQ, Self Reporting Questionnaire). RESULTS: By using the 20-item SRQ for assessing mental distress, and establishing a cut-off level of at least 8 items, 39.8% of the women were categorized as having mental distress. A higher prevalence of mental distress and lower SF-36 scores were found in women in the perimenopause, particularly those with poor education and low family income who did not work outside the home. All SF-36 domains were significantly lower in women with mental distress than those in women without mental distress. CONCLUSION: Prevalence of mental distress is high in this sample of climacteric women and is associated with negative repercussions on the quality of life. This shows that psychosocial factors are significantly involved and psychological support strategies should be instituted in the form of health policies for climacteric women.

Conhecimentos, atitudes e prática do exame de Papanicolaou por mulheres, Nordeste do Brasil

OBJECTIVE To assess the knowledge, attitudes and practices of women related to the Pap test and the association between these behaviors and sociodemographic characteristics. METHODS A household survey with quantitative approach was conducted. A total of 267 women aged 15 to 69 years, randomly selected in a stratified manner, living in the city of São José de Mipibu, Northeastern Brazil, were interviewed in 2007. A questionnaire consisting of pre-coded open questions was administered and answers were described and analyzed, as for adequacy of knowledge, attitudes, and practices of women regarding the Pap test. Tests of association were carried out between sociodemographic characteristics and behaviors studied at a 5% significance level. RESULTS Although 46.1% of the women interviewed showed adequate knowledge about the Pap test, a significantly higher proportion of adequacy was seen regarding attitudes and practices, 63.3% and 64.4%, respectively. Higher schooling was associated with adequacy of knowledge, attitudes, and practices. The main barriers to the Pap test were negligence, non-requesting by their physicians, and shame. CONCLUSIONS The physician is the main source of information about the Pap test. However, women who more often attend medical visits, despite their good practice, show low adequacy of knowledge and attitudes related to the Pap test, which indicates that they are not receiving appropriate information on the tests purpose, advantages and benefits to womens health.OBJETIVO: Analisar conhecimentos, atitudes e praticas das mulheres em relacao ao exame citologico de Papanicolaou e a associacao entre esses comportamentos e caracteristicas sociodemograficas METODOS: Inquerito domiciliar com abordagem quantitativa. Foram entrevistadas 267 mulheres com idade de 15 a 69 anos, selecionadas de forma estratificada aleatoria, residentes no municipio de Sao Jose do Mipibu, RN, em 2007. Utilizou-se questionario com perguntas pre-codificadas e abertas, cujas respostas foram descritas e analisadas quanto a adequacao dos conhecimentos, atitudes e pratica das mulheres em relacao ao exame preventivo de Papanicolaou. Foram realizados testes de associacao entre as caracteristicas sociodemograficas e os comportamentos estudados, com nivel de significância de 5%. RESULTADOS: Apesar de 46,1% das mulheres entrevistadas terem mostrado conhecimento adequado, proporcoes de adequacao significativamente maiores foram observadas em relacao as atitudes e pratica quanto ao exame: 63,3% e 64,4%, respectivamente. O maior grau de escolaridade apresentou associacao com adequacao dos conhecimentos, atitudes e pratica, enquanto as principais barreiras para a realizacao do exame relatadas foram descuido, falta de solicitacao do exame pelo medico e vergonha. CONCLUSOES: O medico e a principal fonte de informacao sobre o exame de Papanicolau. Entretanto, mulheres que vao a consultas com maior frequencia, embora apresentem pratica mais adequada do exame, possuem baixa adequacao de conhecimento e atitude frente ao procedimento, sugerindo que nao estejam recebendo as informacoes adequadas sobre o objetivo do exame, suas vantagens e beneficios para sua saude.OBJETIVO: Analizar conocimientos, actitudes y practicas de las mujeres con relacion al examen citologico de Papanicolaou y su asociacion entre comportamientos y caracteristicas sociodemograficas. METODOS: Pesquisa domiciliar con abordaje cuantitativo. Fueron entrevistadas 267 mujeres con edad de 15 a 69 anos, seleccionadas de forma estratificada aleatoria, residentes en el municipio de Sao Jose do Mipibu, Noreste de Brasil, en 2007. Se utilizo cuestionario con preguntas pre-codificadas y abiertas, cuyas respuestas fueron descritas y analizadas con relacion a la adecuacion de los conocimientos, actitudes y practica de las mujeres con relacion al examen preventivo de Papanicolaou. Fueron realizadas examenes de asociacion entre las caracteristicas sociodemograficas y los comportamientos estudiados, con nivel de significancia de 5%. RESULTADOS: A pesar de 46,1% de las mujeres entrevistadas haber mostrado conocimiento adecuado, proporciones de adecuacion significativamente mayores fueron observadas con relacion a las actitudes y practica con respecto al examen: 63,3% y 64,4%, respectivamente. El mayor grado de escolaridad presento asociacion con adecuacion de los conocimientos, actitudes y practica, con relacion a las principales barreras para la realizacion del examen relatadas fueron descuido, falta de solicitud del examen por el medico y verguenza. CONCLUSIONES: El medico es la principal fuente de informacion sobre el examen de Papanicolaou. Mientras tanto, mujeres que van a consultas con mayor frecuencia, a pesar de presentar practica mas adecuada del examen, poseen baja adecuacion del conocimiento y actitud frente al procedimiento, sugiriendo que no estan recibiendo las informaciones adecuadas sobre el objetivo del examen, sus ventajas y beneficios para su salud.

Comparative immunohistochemical expression of RANK, RANKL and OPG in radicular and dentigerous cysts

OBJECTIVE Receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) are members of the superfamily of ligands and receptors of tumour necrosis factor family involved in bone metabolism. The formation, differentiation and activity of osteoclasts are regulated by these proteins. To clarify the roles of osteoclast regulatory factors in cystic expansion of odontogenic cysts, expression of these proteins were analysed in radicular and dentigerous cysts. DESIGN The immunohistochemistry expression of these biomarkers were evaluated and measured in lining epithelium and fibrous capsule of the radicular (n=20) and dentigerous cysts (n=20). RESULTS A similar expression in lining epithelium was observed in the lesions. The fibrous capsule of dentigerous cyst showed a higher content of RANK-positive and RANKL-positive cells than fibrous capsule of radicular cyst. In the lining epithelium the RANKL/OPG ratio showed higher numbers of OPG-positive than RANKL-positive cells, whereas fibrous capsule of the cysts had a tendency to present a similar expression (OPG=RANKL). CONCLUSION Ours findings indicate the presence of RANK, RANKL and OPG in cysts. Moreover, increased expression of OPG compared to RANKL in the lining epithelium could contribute to the differential bone resorption activity in theses lesions.

Human papillomavirus infection in women attended at a cervical cancer screening service in Natal, Brazil

We analyzed cervical specimens of 202 women, aged 15 to 64 years, attended at Luis Antonio Hospital, Natal, Brazil, to determine the prevalence of HPV and identify the more frequent genotypes and risk factors for HPV infection in women attended at a cervical cancer screening service. Two specimens were collected from each patient: one for cytological examination and the other to detect HPV DNA by PCR, and typing by dot blot hybridization. A total of 54.5% of the sample had normal cytology and 45.5% had cytological alterations. HPV was detected in 24.5% of the cytologically normal women and in 59.8% of those with altered cytology. Both single and double HPV infection increased the likelihood of cytological alterations. Thirteen types of HPV were identified, most of which were high risk. HPV 16 was the most prevalent single-type infection, followed by HPV 58. The most frequent double infection was the association between HPV 56 and 57. The prevalence of HPV in cytologically normal women was greater than that reported for countries on all the continents except Africa. The inverse was observed in women with cytological alterations. The distribution of HPV types was similar to that described for the Americas, with some differences. Multiple sexual partners was the only risk factor showing an association with the presence of HPV infection.

Knowledge, attitudes, and practices related to Pap test by women, Northeastern Brazil

OBJECTIVE To assess the knowledge, attitudes and practices of women related to the Pap test and the association between these behaviors and sociodemographic characteristics. METHODS A household survey with quantitative approach was conducted. A total of 267 women aged 15 to 69 years, randomly selected in a stratified manner, living in the city of São José de Mipibu, Northeastern Brazil, were interviewed in 2007. A questionnaire consisting of pre-coded open questions was administered and answers were described and analyzed, as for adequacy of knowledge, attitudes, and practices of women regarding the Pap test. Tests of association were carried out between sociodemographic characteristics and behaviors studied at a 5% significance level. RESULTS Although 46.1% of the women interviewed showed adequate knowledge about the Pap test, a significantly higher proportion of adequacy was seen regarding attitudes and practices, 63.3% and 64.4%, respectively. Higher schooling was associated with adequacy of knowledge, attitudes, and practices. The main barriers to the Pap test were negligence, non-requesting by their physicians, and shame. CONCLUSIONS The physician is the main source of information about the Pap test. However, women who more often attend medical visits, despite their good practice, show low adequacy of knowledge and attitudes related to the Pap test, which indicates that they are not receiving appropriate information on the tests purpose, advantages and benefits to womens health.OBJETIVO: Analisar conhecimentos, atitudes e praticas das mulheres em relacao ao exame citologico de Papanicolaou e a associacao entre esses comportamentos e caracteristicas sociodemograficas METODOS: Inquerito domiciliar com abordagem quantitativa. Foram entrevistadas 267 mulheres com idade de 15 a 69 anos, selecionadas de forma estratificada aleatoria, residentes no municipio de Sao Jose do Mipibu, RN, em 2007. Utilizou-se questionario com perguntas pre-codificadas e abertas, cujas respostas foram descritas e analisadas quanto a adequacao dos conhecimentos, atitudes e pratica das mulheres em relacao ao exame preventivo de Papanicolaou. Foram realizados testes de associacao entre as caracteristicas sociodemograficas e os comportamentos estudados, com nivel de significância de 5%. RESULTADOS: Apesar de 46,1% das mulheres entrevistadas terem mostrado conhecimento adequado, proporcoes de adequacao significativamente maiores foram observadas em relacao as atitudes e pratica quanto ao exame: 63,3% e 64,4%, respectivamente. O maior grau de escolaridade apresentou associacao com adequacao dos conhecimentos, atitudes e pratica, enquanto as principais barreiras para a realizacao do exame relatadas foram descuido, falta de solicitacao do exame pelo medico e vergonha. CONCLUSOES: O medico e a principal fonte de informacao sobre o exame de Papanicolau. Entretanto, mulheres que vao a consultas com maior frequencia, embora apresentem pratica mais adequada do exame, possuem baixa adequacao de conhecimento e atitude frente ao procedimento, sugerindo que nao estejam recebendo as informacoes adequadas sobre o objetivo do exame, suas vantagens e beneficios para sua saude.OBJETIVO: Analizar conocimientos, actitudes y practicas de las mujeres con relacion al examen citologico de Papanicolaou y su asociacion entre comportamientos y caracteristicas sociodemograficas. METODOS: Pesquisa domiciliar con abordaje cuantitativo. Fueron entrevistadas 267 mujeres con edad de 15 a 69 anos, seleccionadas de forma estratificada aleatoria, residentes en el municipio de Sao Jose do Mipibu, Noreste de Brasil, en 2007. Se utilizo cuestionario con preguntas pre-codificadas y abiertas, cuyas respuestas fueron descritas y analizadas con relacion a la adecuacion de los conocimientos, actitudes y practica de las mujeres con relacion al examen preventivo de Papanicolaou. Fueron realizadas examenes de asociacion entre las caracteristicas sociodemograficas y los comportamientos estudiados, con nivel de significancia de 5%. RESULTADOS: A pesar de 46,1% de las mujeres entrevistadas haber mostrado conocimiento adecuado, proporciones de adecuacion significativamente mayores fueron observadas con relacion a las actitudes y practica con respecto al examen: 63,3% y 64,4%, respectivamente. El mayor grado de escolaridad presento asociacion con adecuacion de los conocimientos, actitudes y practica, con relacion a las principales barreras para la realizacion del examen relatadas fueron descuido, falta de solicitud del examen por el medico y verguenza. CONCLUSIONES: El medico es la principal fuente de informacion sobre el examen de Papanicolaou. Mientras tanto, mujeres que van a consultas con mayor frecuencia, a pesar de presentar practica mas adecuada del examen, poseen baja adecuacion del conocimiento y actitud frente al procedimiento, sugiriendo que no estan recibiendo las informaciones adecuadas sobre el objetivo del examen, sus ventajas y beneficios para su salud.

Ecological interactions among phlebotomines (Diptera: Psychodidae) in an agroforestry environment of northeast Brazil.

ABSTRACT: Phlebotomine vectors transmit parasites and can cause visceral leishmaniasis (VL) or cutaneous leishmaniasis (TL). Phlebotomine females are hematophagous but need to ingest carbohydrates, possibly promoting the development of protozoan parasites in their digestive tract. The present study evaluated the species composition and abundance across several habitats in a metropolitan landscape, as well as associations among phlebotomines, plants, and local climatic parameters. Three consecutive monthly collections were carried out in an Atlantic Forest fragment, using CDC light traps in peridomestic areas and cashew, coconut, and mango tree.plantations. Eight species of phlebotomine were captured: Evandromyia evandroi, Lutzomyia longipalpis, Psathyromyia shannoni, Sciopemyia sordellii, Evandromyia walkeri, Psychodopygus wellcomei, Nyssomyia whitmani, and Nyssomyia intermedia, primarily from the forest environment. L. longipalpis was confirmed as a species adapted to anthropic environments, while P. wellcomei was shown to be predominately forest-dwelling. Phlebotomines exhibited diversified food consumption patterns in relation to carbohydrate sources. They fed on both native and exotic species of arboreal and shrubby vegetables and gramineous plants.

Seroepidemiology of Trypanosoma cruzi infection in the semiarid rural zone of the State of Rio Grande do Norte, Brazil

INTRODUCTION A seroepidemiological survey was carried out to evaluate Trypanosoma cruzi infection in an endemic area of the State of Rio Grande do Norte, Brazil, involving rural residents. METHODS Sixteen municipalities were randomly selected, 15 from the west mesoregion and one from the central, with an estimated population of 83,852 individuals. A total of 1,950 blood samples were collected in the west mesoregion and 390 in Caicó. Anti-T. cruzi antibodies were detected using the Chagatest® ELISA HAI-hemagglutination kits and indirect immunofluorescence. As sera presented indeterminate results, TESAcruzi® western blot was performed to confirm reactivity. RESULTS An estimated seroprevalence of 6.5% was determined for the west mesoregion and 3.3% for Caicó. Seropositivity rises progressively with the age of individuals, up to 40 years in Caicó and up to 50 years in the west mesoregion. Only educational level and knowledge regarding the triatomine were associated with seropositivity. No seroreactive individuals under 18 years of age were identified. CONCLUSIONS Infection by T. cruzi remains high and is concentrated in municipalities in the central western area of the west mesoregion; however, evidence suggests a decline in vector transmission in this mesoregion and in Caicó. Epidemiological variables appear not to influence seropositivity, with the exception of education and knowledge concerning the triatomine, among seroreactive individuals from the west mesoregion.

Seasonal Variation of Potential Flavivirus Vectors in an Urban Biological Reserve in Northeastern Brazil

ABSTRACT Although yellow fever (YF) has not been reported on the eastern coast of Brazil since 1942, there was a reemergence of dengue fever in Rrazil in 1987 due to the reintroduction of Aedes aegypti (L.). To assess areas of potential risk for transmission of vector-borne diseases, a surveillance system was placed in a large Atlantic Forest reserve in Natal, Rio Grande do Norte, Brazil, where in 2004 unexplained epizootics were reported among marmosets. The etiologic agent causing the mortality in marmosets has not been identified. Wyeomyia bourrouli Lutz, Haemagogus leucocelaenus Dyar & Shannon, Ae. aegypti, Aedes albopictus (Skuse), Ochlerotatus scapularis Rondani, Ochlerotatus serratus Theobald, Ochlerotatus taeniorhynchus Wiedemann, Culex quinquefasciatus Say, and Limatus durhami Theobald were collected in the park and in the proximity of the households adjacent to the park. Seasonal abundance fluctuation was significant for Ae. aegypti, Ae. albopictus, Ochlerotatus scapularis (Rondani), and Hg. leucocelaenus. Eggs of Ae. aegypti, Ae. albopictus, and Hg. leucocelaenus were more frequently found at the conclusion of the rainy season. A significant negative correlation between the number of Ae. albopictus collected and temperature was observed (r = -0.50), i.e., for each 1°C increase in temperature, the number of specimens collected decreased eight-fold. The findings reported herein reinforce the need for a sustainable arboviral surveillance program in this area to decrease the potential risk of emergence of vector borne diseases as YF.

Clinicopathological study of salivary gland tumors: an assessment of 303 patients

Salivary gland neoplasms are remarkable for their histological diversity and several studies point to their varied occurrence in the population. Clinical aspects were histologically assessed to determine possible associations and define parameters to differentiate benign and malignant neoplasms. The case files of patients diagnosed with epithelial salivary gland tumors between 1989 and 2005 were reviewed. A majority (71%) of the 303 salivary gland tumors studied were benign and pleomorphic adenoma were found to be most common. Mean ages for patients with benign and malignant tumors were 49.2 and 58.5 years, respectively. A statistically significant difference between these tumors was observed for the following variables: mean age, tumor size and disease duration. A correlation was found between histological diagnosis and tumor consistency. The data presented here corroborate a number of previous studies and are therefore relevant in understanding the diverse characteristics exhibited by these tumors.