Ramona Gabriela Ursu

HPV prevalence and type distribution in women with or without cervical lesions in the Northeast region of Romania

BackgroundCervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania.MethodsHPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit.ResultsIn our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%).ConclusionsInfection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.

The Need for Cervical Cancer Control in HIV-Positive and HIV-Negative Women from Romania by Primary Prevention and by Early Detection Using Clinically Validated HPV/DNA Tests

Background In Romania, a country with no organized national surveillance program regarding cervical cancer, the early diagnosis of HPV (Human Papilloma Virus) infections is a major requirement, especially in HIV-infected women. The objective of this study was to determine the HPV prevalence and type distribution in young HIV-positive women and to assess the difference in the risk factors for developing cervical cancer compared to those of HIV-negative women. Method We conducted one cross-sectional cohort study from June 2013–September 2014, including 1,032 women: 992 HIV- women who were 36.5 years old (limits: 17 ÷ 84) and 40 HIV + women who were 22.9 years old (limits: 17 ÷ 30) with iatrogenic HIV infected. We detected HPV types with the Linear Array HPV Genotyping test (Roche, Romania). Results DNA/HPV was detected in 18/40 (45%) of the HIV+ patients and in 350/992 (35.2%) of the HIV- patients (OR = 1.5, 95%CI 0.76÷2.96). After age adjustment, the overall HPV prevalence was 51.6% in HIV+ versus 63.2% in HIV- women aged under 25, and 22.2% in HPV+ versus 47.2% in HIV- women aged 25–34. We detect HIV being a risk factor for acquiring multiple HPV type infections (OR = 2.30, 95% CI 0.88÷5.97). The eight most common HPV types (high-risk, and low-risk) for women below age 30, HIV+ / - were: HPV 16, 18, 31, 51, 58, 68, and 6 and 82 respectively. To assess the risk factors of HIV-positive women for acquiring HPV infection, we analyzed the CD4/μL, ARN/HIV copies/μL, the age group, the number of sexual partners, smoking, and the type of HPV infection (single versus multiple infections). We found that the number of sexual partners and smoking are statistically significant risk factors. Conclusion Even though there are no significant differences regarding the prevalence of HPV infection in HIV + versus HIV – patients, multiple infections were more frequent in the first group. In our study group young HIV-infected patients under HAART therapy, high number of sexual partners (more than 3) and smoking were detected to be risk factors. Future organized screening for HPV infection using sensitive and specific methods are necessary at the national level in Romania.

Heterogeneous Distribution of Fetal Microchimerism in Local Breast Cancer Environment.

Fetal cells enter maternal circulation during pregnancy and persist in the woman’s body for decades, achieving a form of physiological microchimerism. These cells were also evidenced in tumors. We investigated the frequency and concentration of fetal microchimerism in the local breast cancer environment. From 19 patients with confirmed breast neoplasia, after breast surgical resection, we collected three fresh specimens from the tumor core, breast tissue at tumor periphery, and adjacent normal breast tissue. The presence of male DNA was analyzed with a quantitative PCR assay for the sex determining region gene (SRY) gene. In the group of women who had given birth to at least one son, we detected fetal microchimerism in 100% of samples from tumors and their periphery and in 64% (9 of 14) of those from normal breast tissue. The tissues from the tumor and its periphery carry a significantly increased number of SRY copies compared to its neighboring common breast tissue (p = 0.005). The median of the normalized SRY-signal was about 77 (range, 3.2–21467) and 14-fold (range, 1.3–2690) greater in the tumor and respectively in the periphery than in the normal breast tissue. In addition, the relative expression of the SRY gene had a median 5.5 times larger in the tumor than in its periphery (range, 1.1–389.4). We found a heterogeneous distribution of fetal microchimerism in breast cancer environment. In women with sons, breast neoplasia harbors male cells at significantly higher levels than in peripheral and normal breast tissue.

The clinical utility of TORCH testing of pregnant women from northeastern Romanian population: Application of electrochemiluminiscence assay

The accurate diagnosis of pregnant women for congenital infections is very important for the health of new-borns. We have used a highly sensitive assay - electrochemiluminiscence (ECLIA), in order to assess the prevalence of antibodies IgM and IgG type against cytomegalovirus, rubella virus and Toxoplasma gondii in pregnant women. None of the tested women were at risk for congenital infections, as we did not detect any IgM antibody present.

Human papillomavirus 52 positive squamous cell carcinoma of the conjunctiva

Human papillomavirus (HPV) infection is strongly associated with several human cancers; the most known genotypes involved being HPV 16 and HPV 18. We report the detection of HPV 52 in a sample taken from a 47-year-old patient with squamous cell carcinoma of the conjunctiva of the left eye. The method used for the detection of HPV was real time polymerase chain reaction. The evolution was favorable after surgical removal of the tumor and the patient was explained that long-term follow-up is essential to avoid recurrence.

Role of mucosal high-risk human papillomavirus types in head and neck cancers in Romania

Background Limited information is available about the involvement of human papillomavirus (HPV) in head and neck squamous cell carcinomas (HNSCCs) in Romanian patients. Objective To evaluate the HPV-attributable fraction in HNSCCs collected in Northeastern Romania. Materials and methods In total, 189 formalin-fixed paraffin-embedded tissue samples (99 oral cavity tumors, 28 oropharynx, 48 pharynx, and 14 larynx/hypopharynx) were analyzed for HPV DNA and RNA using Luminex-based assays, and for overexpression of p16INK4a (p16) by immunohistochemistry. Results Of the 189 cases, 23 (12.2%) were HPV DNA-positive, comprising half of the oropharyngeal cases (14/28, 50.0%) and 9/161 (5.6%) of the non-oropharyngeal cases. HPV16 was the most prevalent HPV type (20/23, 86.9%), followed by HPV18 (5/23, 21.7%) and HPV39 (1/23, 4.3%). Only two (2/189, 1.1%) HNSCC cases were HPV-driven, i.e. positive for both HPV DNA and RNA. Conclusion A very small subset of HNSCC cases within this cohort from Northeastern Romania appeared to be HPV-driven.

Increased Detection Rate of Prevotella Intermedia amongPregnant Periodontitis Patients in Romania

The oral cavity is heavily colonized by more than 700 different microbial species forming a dynamic and complex ecosystem. The members of the ecosystem establish symbiotic relationships with the host which is subjected to continuous variation depending on the diet, lifestyle and general health status of the host [1-3]. There is a thin balance between peaceful coexistence of oral microbial populations on oral epithelia promoting tissue protection from xenobiotics and harmful to the host interactions with the members of oral microbiota. In case of such dysbiotic relationships members of the oral microbiota can lead to activation of immune cells provoking inflammatory chronic oral diseases. Periodontitis is an excellent example of such disease [4,5]. Periodontal disease represents a chronic, inflammatory condition of tooth supporting tissues and the final outcome is the spontaneous avulsion oh the teeth from the dental alveoli if left untreated. A high number of factors are involved in the etiology of periodontitis which are host dependent, oral environment dependent and microbial community dependent [1,6]. Several host dependent factors can influence the transition from healthy mutualist or commensal microbial communities to disease provoking communities which benefits from the subgingival inflammatory microenvironment. Despite the fact that oral microbiome is the most studied microbiome in terms of composition and function, our understanding of periodontitis has not changed significantly in the last years and development of predictable biomarkers for early diagnosis or therapy outcome are still insufficient [7,8]. Several bacterial species, members of Socransky’s red complex are strongly associated with the development of periodontal disease therefore their detection and quantification are used in diagnosis and therapy planning purposes. Prevotella intermedia and Porphyromonas gingivalis are Gram negative, anaerobes and act as pathobionts which although in low abundance in the gingival sulcus but through special synergistic actions can influence negatively the normal microbiome composition and facilitate the development of an dysbiotic inflammation provoking microbiota. Such inflammatory phenomena are amplified by the rise of blood hormones during pregnancy [9,10]. Steroid sex hormones target the gingival and deep periodontal tissues leading to increased vasculature, elevated proinflammatory cytokines, decreased epithelium keratinization and gingival tissues permeability resulting in exaggerated gingival edematous response to subgingival bacteria. In addition, hormonal variation act as a selective factor for bacterial growth in the subgingival environment and elevated subgingival counts of P. intermedia are found due to the interactions between female sex hormones with the fumarate reductase system [11,12].

New Polylactic Acid Composites for Packaging Applications: Mechanical Properties, Thermal Behavior, and Antimicrobial Activity

The interest in antimicrobial packaging materials based on polylactic acid (PLA) polymers has increased due to the need to improve food safety and environment quality and also to find alternatives to synthetic polymers made from petrochemicals. PLA films by addition of different fillers (grape wastes and celery fibers) were obtained. The mechanical, thermal, surface, and antimicrobial properties of the films were evaluated. The incorporation of inexpensive fillers into the PLA matrix could reduce costs and the studied formulations offer approaches to realize composites with high performances and antimicrobial response, suitable for film food-active packaging materials, especially by use of grape wastes.

Risk factors for high-risk human papilloma virus persistence after loop excision procedure as treatment of cervical dysplasia

Persistence of high-risk human papilloma virus types (HR-HPV) after surgical treatment of cervical intraepithelial neoplasia (CIN) is an important factor which influences the management and the recurrence risk. In this study, we assessed the efficiency of the loop electrosurgical excision procedure (LEEP) in HR-HPV removal. Cervical samples from 31 women, diagnosed with CIN and HR-HPV, were genotyped at six months after LEEP. We assessed the influence of various risk factors on HR-HPV persistence, using univariate and multivariate analysis: age, menopausal status, parity, abortions, oral contraception, smoking, sexual partners, initial cervical smear test and histopathological results. We detected persistent infections in 7 (22.6%) patients with 16, 18, 31, 39, 51 and 66 HPV types. Univariate analysis found that age over 30 years, multiparity, use of contraception and CIN2-3 were significant factors for persistence of HR-HPV after LEEP. Multivariate analysis showed that CIN2-3 was the only significant risk factor for HPV persistence (OR=10.7). Furthermore, although not significant, parity was also retained into final equation. HR-HPV persistence is a frequent phenomenon after LEEP. We highlight the importance of glandular involvement, residual tissue and difficulties of the resection procedure in multipara. HPV genotyping is a sensitive method to follow up this group of patients, as it can identify a type specific HPV infection. In our country with the known highest mortality rate in EU countries of cervical cancer, we need an organized cervical neoplasia screening with a validated HPV genotyping test.