Paulo Roberto Merçon de Vargas

Sexually transmitted diseases among female prisoners in Brazil: prevalence and risk factors.

BACKGROUND Sexually transmitted diseases (STDs) have become an important medical problem in prisons. GOAL To determine the prevalence of and risk factors for STDs among female inmates in a Brazilian prison. STUDY DESIGN All female prisoners at the Espírito Santo State Prison were offered enrollment in this cross-sectional study. An interview exploring demographics, criminal charges, and risk behavior was conducted. Blood and genital specimens were collected for STD testing. RESULTS Of 122 eligible women, 121 (99%) agreed to participate. Prevalence rates were: HIV 9.9%, human T-cell lymphotrophic virus type I 4.1%, hepatitis B virus 7.4%, hepatitis C virus 19%, syphilis 16%, gonorrhea 7.6%, chlamydial infection 11%, human papillomavirus-related cytologic changes 9.3%, trichomoniasis 30%, and bacterial vaginosis 15%. Previous or current drug abuse (54%), injection drug use (11%), and blood transfusion (16%) were associated with at least one STD. Condom use was infrequent. CONCLUSION The prevalence of STDs and of behaviors leading to ongoing transmission are high among female inmates in Vitória, Brazil, and demonstrate the potential importance of prevention activities targeting this population.

Infecções genitais em mulheres atendidas em Unidade Básica de Saúde: prevalência e fatores de risco

PURPOSE: to describe the prevalence and behavioral profile of genital infections in women attended at a Primary Health Unit in Vitoria, ES. METHODS: a transversal study including 14 to 49-year-old women attended by the Family Health Program (FHP). Exclusion criteria were: having been submitted to gynecological examination in less than one year before, and history of recent treatment (in the last three months) for genital infections. An interview including socio-demographic, clinical and behavioral data was applied. Genital specimens were collected for cytology, GRAM bacterioscopy and culture, and urine sample for molecular biological test for Chlamydia trachomatis. RESULTS: two hundred and ninety-nine women took part in the study. The median age was 30.0 (interquartile interval: 24;38) years old; the average age of the first intercourse was 17.3 (sd=3.6) years old. The first pregnancy average age was 19.2 (3.9) years old. About 70% reported up to 8 years of schooling; 5% reported previous Sexually Transmitted Diseases (STD), and 8%, the use of illicit drugs. Only 23.7% reported consistent use of condoms. Clinical complaints were: genital ulcer (3%); dysuria (7.7%); vaginal discharge (46.6%): pruritus (20%) and pelvic pain (18%). Prevalence rates were: Chlamydia trachomatis 7.4%; gonorrhea 2%; trichomoniasis 2%; bacterial vaginosis 21.3%; candidiasis 9.3%; and cytological changes suggestive of HPV 3.3%. In the final logistic regression model, the factors independently associated to genital infections were: abnormal cervical mucus, OR=9.7 (CI95%=5.6-13.7), previous HIV testing, OR=6.5 (CI95%=4.0-8.9), having more than one partner during the previous year, OR=3.9 (CI95%=2.7-5.0), and having more than one partner in life, OR=4.7 (CI95%=2.4-6.8). CONCLUSIONS: results show a high rate of genital infections and the need of preventive measures, such as STD surveys and risk reduction programs for women that look for routine gynecological service.PURPOSE to describe the prevalence and behavioral profile of genital infections in women attended at a Primary Health Unit in Vitoria, ES. METHODS a transversal study including 14 to 49-year-old women attended by the Family Health Program (FHP). Exclusion criteria were: having been submitted to gynecological examination in less than one year before, and history of recent treatment (in the last three months) for genital infections. An interview including socio-demographic, clinical and behavioral data was applied. Genital specimens were collected for cytology, GRAM bacterioscopy and culture, and urine sample for molecular biological test for Chlamydia trachomatis. RESULTS two hundred and ninety-nine women took part in the study. The median age was 30.0 (interquartile interval: 24;38) years old; the average age of the first intercourse was 17.3 (sd=3.6) years old. The first pregnancy average age was 19.2 (3.9) years old. About 70% reported up to 8 years of schooling; 5% reported previous Sexually Transmitted Diseases (STD), and 8%, the use of illicit drugs. Only 23.7% reported consistent use of condoms. Clinical complaints were: genital ulcer (3%); dysuria (7.7%); vaginal discharge (46.6%): pruritus (20%) and pelvic pain (18%). Prevalence rates were: Chlamydia trachomatis 7.4%; gonorrhea 2%; trichomoniasis 2%; bacterial vaginosis 21.3%; candidiasis 9.3%; and cytological changes suggestive of HPV 3.3%. In the final logistic regression model, the factors independently associated to genital infections were: abnormal cervical mucus, OR=9.7 (CI95%=5.6-13.7), previous HIV testing, OR=6.5 (CI95%=4.0-8.9), having more than one partner during the previous year, OR=3.9 (CI95%=2.7-5.0), and having more than one partner in life, OR=4.7 (CI95%=2.4-6.8). CONCLUSIONS results show a high rate of genital infections and the need of preventive measures, such as STD surveys and risk reduction programs for women that look for routine gynecological service.

Subtotal splenectomy preserving the lower pole in rats: technical, morphological and functional aspects

PURPOSE To assess the possibility of preserving the lower pole of the spleen, supplied by the inferior lobar vessels and segmental vessels, or by vessels of the gastrosplenic ligament, in subtotal splenectomy; to study the viability and function of the lower pole of the spleen. METHODS Thirty-six male Wistar rats were used in this study. Said animals weighed 273-390 g ( 355.2 +/- 30.5 g ), and were randomly distributed into three groups. Group 1 comprised ten animals which were submitted to exploratory laparotomy with spleen manipulation (sham operation). Group 2 comprised 16 animals which were submitted to total splenectomy. Group 3 comprised ten animals which were submitted to subtotal splenectomy, preserving the lower pole of the spleen. Blood was collected from all animals before and 90 days after surgery to measure the levels of cholesterol and triglycerides. The animals were sacrificed 90 days after surgery. Spleens and remaining spleens were removed for macroscopic and microscopic examination. RESULTS Surgery was performed with no complications in all groups. Six animals died in group 2. Spleens of groups 1 and 2, and lower poles of group 3 were macroscopically viable. Apparent white pulp hyperplasia was observed in group 1. In group 3, slight inflammation and capsular fibrosis were observed at the incision site, as well as diffuse hemosiderosis in the red pulp. Average mass of remaining spleen was 35.84% +/- 4.31%. No significant difference was observed between preoperative and late postoperative lipid levels in groups 1 and 3 (p > 0.05). Late postoperative lipid levels significantly increased in group 2. CONCLUSIONS Preservation of the lower pole of the spleen (supplied by gastrosplenic vessels or inferior lobar vessels and segmental vessels) was possible with subtotal splenectomy. The lower pole was macroscopically and microscopically viable in all cases. Subtotal splenectomy preserving the lower pole prevented changes in lipid levels, which were observed in rats submitted to total splenectomy. Plasma lipid levels in rats submitted to subtotal splenectomy were similar to those observed in sham operated rats.

Níveis de lípides plasmáticos em ratos submetidos à esplenectomia total, ligadura simultânea dos vasos esplênicos e à esplenectomia subtotal com preservação do pólo inferior

BACKGROUND: To verify the effect on plasmatic lipid level of rats feed with control diet and diet added with 2.5% pure cholesterol after total splenectomy, ligature of the splenic vessels and partial splenectomy with preservation of the inferior pole. METHODS: One hundred and eleven male Wistar rats weighting between 273 and 427g aged 12 weeks, were randomly divided into 5 groups. Group 1 (N = 20) control group was not submitted to surgery; Group 2 (N = 20) submitted to manipulation of the spleen; Group 3 (N = 31) total splenectomy; Group 4 (N = 20) simultaneous ligature of the splenic artery and vein; Group 5 (N = 20) partial splenectomy with preservation of the inferior pole. Plasmatic lipids levels were measured and the animals divided in two subgroups according to the type of diet: subgroup A control diet, subgroup B had a 2.5% pure cholesterol added to the control diet. All animals were killed ninety days after the beginning of the experiment, following a new dosage of plasmatic lipids. RESULTS: Animals submitted to total splenectomy, independently of any diet, showed significant increase (p < 0.05) in total cholesterol, LDL, VLDL and triglycerides. The increase of HDL was significant in the rats fed with control diet (p < 0.05) and non significant in the rats submitted to the diet with pure cholesterol (p = 0.29). The animals submitted to simultaneous ligature of vein and artery and to control diet did not show significant alteration of the plasmatic lipids. In the group submitted to diet added with pure cholesterol, we observed a significant increase (p < 0.05) in total cholesterol, VLDL and triglycerides, although the levels of HDL were the same. Animals submitted to partial splenectomy with preservation of the inferior pole and to control diet, did not show significant alterations (p < 0.05) in total cholesterol, LDL, VLDL and triglycerides, but did in HDL (p < 0.05). In those with diet with cholesterol we observed an increase in total cholesterol, LDL, VLDL and triglycerides but not in HDL. CONCLUSIONS: Total splenectomy leads to a significant increase of total cholesterol, LDL, VLDL and triglycerides, independently of the type of diet. The increase is more significant in the animals that received their diet with a 2.5% pure cholesterol. Simultaneous ligature of splenic artery and vein, partial splenectomy with preservation of the inferior pole protect against the alterations in the levels of plasmatic lipids observed in rats submitted to total splenectomy in both types of diet.

Cytomegalovirus in human abortion in Espírito Santo, Brazil

BACKGROUND Despite the established implication of human cytomegalovirus (HCMV) in congenital infection, there are still conflicting reports regarding the association of HCMV with spontaneous abortion. Viral antigens and nucleic acid were already described in tissues from abortions cases, but did not indicate HCMV pathogenical role. OBJECTIVES (1) To access viral seroprevalence (total and IgM antibodies) in pregnant, non-pregnant and in women in abortion process, (2) to evaluate if antigenemia assay can detect active infection in these populations, (3) to detect viral DNA in peripheral leukocytes, and (4) in abortion tissues. STUDY DESIGN Blood samples from 95 patients in abortion process and from two control groups (40 pregnant and 60 non-pregnant women) were obtained for determination of viral seroprevalence, for detection of antigen and viral DNA by PCR from peripheral leukocytes. Specimens obtained from 88 patients in abortion process, spontaneous or induced, were submitted to gB gene amplification (PCR and nested-PCR). RESULTS Viral seroprevalence were found in 97.3 with 2.5% of IgM positive cases. Antigenemia assay were negative in all cases, however, viral nucleic acid were found in 6.3 and in 6.0% of the patients in abortion and in control groups, respectively. Nucleic acid in conception tissue was present in 6.6%. CONCLUSION This high seroprevalence observed is according to previous surveys in Brazil. If active infection due to viral reactivation occurred during the abortion process, it cannot be accessed by antigenemia or anti-IgM assays. Nucleic acid found by PCR in peripheral blood cells enriched with polymorphonuclear cells (PMN) corresponds to viral circulation in immunocompetent person, as similar results were found for the three groups. Although viral DNA had been found in 6.6% from abortion tissues, this result does not support HCMV as a major abortion-related factor as we could not found any correlation between abortion and active HCMV infection.

Prevalência de HIV em gestantes e transmissão vertical segundo perfil socioeconômico, Vitória, ES

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Descrever a prevalencia de infeccao por HIV em gestantes e a taxa de transmissao vertical, segundo o perfil socioeconomico dos bairros de residencia das maes. METODOS: Estudo ecologico exploratorio utilizando a base de dados do Sistema de Informacao de Agravos de Notificacao de gestantes HIV-positivas e aids em criancas notificadas entre 2000 e 2006 em Vitoria, ES. Para analise das informacoes socioeconomicas foi utilizado o Indice de Qualidade Urbana. A prevalencia de HIV em gestantes e a taxa de transmissao vertical foram calculadas. A distribuicao espacial dos casos foi realizada no programa Terraview 3.2.0. Para verificar a associacao entre a qualidade urbana e a prevalencia de HIV em gestantes utilizou-se o modelo de regressao de Poisson. RESULTADOS: Um total de 137 gestantes e 14 criancas infectadas por transmissao vertical foi notificado no periodo. Sete criancas correspondiam a maes HIV-positivas sem notificacao de caso no periodo analisado. A prevalencia de infeccao em gestantes no periodo foi de 0,44% e a taxa de transmissao vertical foi de 9,7%. CONCLUSOES: A prevalencia de infeccao por HIV em gestantes e a transmissao vertical associam-se a qualidade urbana do bairro de residencia, indicando que os bairros com menor qualidade urbana devem ser priorizados quanto as acoes para reducao da transmissao vertical.OBJECTIVE To describe HIV prevalence in pregnant women and the rate of vertical transmission according to socioeconomic status of residential neighborhoods. METHODS Ecological exploratory study, which used the Information System of Notifiable Diseases database on HIV-positive pregnant women and AIDS in children, reported from 2000 to 2006, in Vitória, Southeastern Brazil. For analysis of socioeconomic data the Urban Quality Index was utilized The HIV prevalence rate in pregnant women and vertical transmission rate were calculated. Spatial distribution was carried out by Terraview 3.2.0. To verify the association between urban quality and HIV prevalence in pregnant women, Poisson regression was used. RESULTS A total of 137 HIV-positive women and 14 children infected by vertical transmission was reported. Seven children matched to HIV-positive mothers without notification in the period analyzed. HIV prevalence among pregnant women in the period was 0.44%, and the vertical transmission rate was 9.7%. CONCLUSIONS The prevalence of HIV infection among pregnant women and vertical transmission were associated with the urban quality of residential neighborhood. Neighborhoods with lower urban quality should be prioritized in actions to reduce vertical transmission.

Molecular detection of adeno-associated virus in cases of spontaneous and intentional human abortion.

Pregnancy failure is a common event and often of unknown cause. Some viruses are thought to cause abortions including the adeno‐associated viruses (AAV), viruses which are regarded as being without any definitive association to any human disease. This study investigated AAV infection in 81 human abortions, both spontaneous and intentional that occurred up to the 23rd week of gestation. Nucleic acid of AAV‐2, 3, and 5 types from 118 decidual and chorionic tissues, collected from the patients in this study, was amplified by nested‐PCR. In situ hybridization (ISH) was developed with a digoxigenin‐labeled AAV probe in paraffin embedded tissues from the AAV positive cases. AAV was observed in 28.4% (23/81) of the cases, of which, 78.3% (18/23) were in the decidua and 21.7% (5/23) in the extravillous trophoblast, the chorionic plate, or chorionic villi fragments. AAV‐2, the only type detected, occurred in 32.3% (22/68) and in 7.7% (1/13) of the spontaneous and intentional abortions, respectively. ISH revealed AAV in the decidua, chorionic tissue or chorionic plate and extravillous trophoblast. The detection of only AAV‐2 type indicates that it is the most frequent in the population studied and/or shows tissue tropism. The presence of AAV in decidual or trophoblastic cells in cases of abortion, as observed by ISH, implies that the virus could jeopardize the pregnancy. The significant predominance in spontaneous cases suggests possibly a causal association between AAV and abortion. J. Med. Virol. 82:1689–1693, 2010.

HIV prevalence in pregnant women and vertical transmission in according to socioeconomic status, Southeastern Brazil

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Descrever a prevalencia de infeccao por HIV em gestantes e a taxa de transmissao vertical, segundo o perfil socioeconomico dos bairros de residencia das maes. METODOS: Estudo ecologico exploratorio utilizando a base de dados do Sistema de Informacao de Agravos de Notificacao de gestantes HIV-positivas e aids em criancas notificadas entre 2000 e 2006 em Vitoria, ES. Para analise das informacoes socioeconomicas foi utilizado o Indice de Qualidade Urbana. A prevalencia de HIV em gestantes e a taxa de transmissao vertical foram calculadas. A distribuicao espacial dos casos foi realizada no programa Terraview 3.2.0. Para verificar a associacao entre a qualidade urbana e a prevalencia de HIV em gestantes utilizou-se o modelo de regressao de Poisson. RESULTADOS: Um total de 137 gestantes e 14 criancas infectadas por transmissao vertical foi notificado no periodo. Sete criancas correspondiam a maes HIV-positivas sem notificacao de caso no periodo analisado. A prevalencia de infeccao em gestantes no periodo foi de 0,44% e a taxa de transmissao vertical foi de 9,7%. CONCLUSOES: A prevalencia de infeccao por HIV em gestantes e a transmissao vertical associam-se a qualidade urbana do bairro de residencia, indicando que os bairros com menor qualidade urbana devem ser priorizados quanto as acoes para reducao da transmissao vertical.OBJECTIVE To describe HIV prevalence in pregnant women and the rate of vertical transmission according to socioeconomic status of residential neighborhoods. METHODS Ecological exploratory study, which used the Information System of Notifiable Diseases database on HIV-positive pregnant women and AIDS in children, reported from 2000 to 2006, in Vitória, Southeastern Brazil. For analysis of socioeconomic data the Urban Quality Index was utilized The HIV prevalence rate in pregnant women and vertical transmission rate were calculated. Spatial distribution was carried out by Terraview 3.2.0. To verify the association between urban quality and HIV prevalence in pregnant women, Poisson regression was used. RESULTS A total of 137 HIV-positive women and 14 children infected by vertical transmission was reported. Seven children matched to HIV-positive mothers without notification in the period analyzed. HIV prevalence among pregnant women in the period was 0.44%, and the vertical transmission rate was 9.7%. CONCLUSIONS The prevalence of HIV infection among pregnant women and vertical transmission were associated with the urban quality of residential neighborhood. Neighborhoods with lower urban quality should be prioritized in actions to reduce vertical transmission.

Anal HPV infection and correlates in HIV-infected patients attending a Sexually Transmitted Infection clinic in Brazil

Objective To estimate the prevalence of anal HPV infection, genotype distribution, intraepithelial neoplasia (AIN) and correlates in a cohort of HIV-infected patients attending at Sexually Transmitted Infections (STI) clinic in Brazil. Study design A descriptive analysis was performed which includes, demographic, behavioral and clinical data. Anal specimens from HIV-positive men and women were collected during a regular visit and they were used for cytology and histopathology tests, as well as for HPV molecular identification. Results A total of 223 patients (143 females and 80 males) were enrolled in the study and, HPV was identified in 68.6% of the sample. The frequency of HR-HPV, HPV16/18 and multiple HPV infection were similar in both groups. The upstream regulatory region (URR) sequencing was carried out in 38 samples identified as HPV16-positive, and European variants were the most frequent (69.2%), followed by Africans (25.6%) and Asiatic-Americans (5.1%). Having more than 20 sexual partners was associated with multiple HPV infection (p = 0.000) while, anal sex and the first intercourse before 15 years of age was a risk factor for any HPV infection (p = 0.001). Being MSM (men who have sex with men) was a risk factor for any HPV and multiple infections (p = 0.002). The CD4 count >500 cells/mm3 was a protective factor for the HPV16/18 (p = 0.048) and multiple infections (p = 0.023), and the undetectable viral load and HAART treatment were both protective for any HPV (p = 0.010), HR-HPV (p = 0.091) and multiple infections (p = 0.006). Abnormal anoscopy was found in 23.7% (53/223) of the total number of patients, and this was significantly associated with all types of investigated HPV infections (p<0.0001). Conclusions In this study, anal HPV infection was common among young HIV-positive men and women, particularly in MSM. Anal cancer screening in patients at risk, such as those who are HIV-positive, and mainly those with anal HPV infection and a history of STI, will increase the likelihood of detecting anal intraepithelial neoplasia.

Placental examination: a challenge for pathologists

The importance of the placenta as the organ that provides maternal supplies to the fetus has been recognized since the ancient Egyptians. Experts in placental pathology are unanimous in pointing out the clinical, pathological and epidemiological relevance of the lesions of this unique organ. Little is acknowledged as to the practical contribution of its examination by obstetricians, pediatricians and pathologists. Quite few placentas have been examined by pathologists.