Roselaine Ruviaro Zanini

Vertical transmission of the human papillomavirus: a systematic quantitative review

In order to better understand the exact mode and risk of vertical transmission in asymptomatic pregnant women, as well as the relationship between HPV transmission and mode of delivery, we have proposed this systematic quantitative review of prospective cohort studies. A comprehensive search was performed in the Cochrane Library, MEDLINE, LILACS, CANCERLIT, and EMBASE, as well as in the reference lists from the identified studies. Nine primary studies, which included 2,111 pregnant women and 2,113 newborns, met our selection criteria and were analyzed. A positive HPV test in the mother increased the risk of vertical HPV transmission (RR: 4.8; 95%CI: 2.2-10.4). We also observed a higher risk of HPV infection after vaginal delivery than after cesarean section (RR: 1.8; 95%CI: 1.3-2.4). The results of this meta-analysis showed the HPV DNA-positive rate only after birth, but an HPV DNA-positive neonatal sample does not necessarily indicate infection; it could merely indicate contamination (perinatal HPV contamination may have occurred). Infants born through vaginal delivery were at higher risk of exposure to HPV.

Estudo da sobrevida de pacientes com câncer de mama atendidas no hospital da Universidade Federal de Santa Maria, Rio Grande do Sul, Brasil

This retrospective hospital-based study aimed to describe health conditions and to estimate the survival of 252 patients diagnosed with breast cancer and treated at the Mastology Outpatient Clinic at the University Hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil, from 1980 to 2000. Analysis followed the Kaplan-Meier and Cox model. Mean age was 54, and 73.4% of the patients had a histological diagnosis of invasive ductal carcinoma, 63.9% showed no lymph node involvement, and 57.6% were clinical stage II. At the end of the study, 64.7% were alive and free of breast cancer and 5.1% had died of other causes. Five-year survival was 87.7% for all women, and prognostic factors associated with survival were tumor size (HR = 12.03; > 5cm), lymph node involvement (HR = 3.08; N1) and number (HR = 4.66; None), and estrogen (HR = 0.34) and c-erbB-2 (HR = 2.51) receptors. Based on the results, intensive awareness-raising campaigns are vitally important for implementing breast cancer screening to achieve early diagnosis.

Efficacy of human papillomavirus vaccines: a systematic quantitative review.

Human papillomavirus (HPV) types cause approximately 70% of cervical cancer worldwide. Two vaccines have been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co, Inc, Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which vaccines against HPV were compared with placebo regarding efficacy, safety, and immunogenicity. Six studies met the inclusion criteria, which included 47,236 women. The first objective in this systematic review was to assess vaccine efficacy in the prevention of cytologically and/or histologically proven lesions. And the secondary objective was the evaluation of safety and vaccine immunogenicity. Bivalent and quadrivalent HPV vaccines significantly reduced the rate of lesions in the cervix, vulva, vagina, and anogenital region, with efficacy of 93% (95% confidence interval [CI], 87-96) and 62% (95% CI, 27-70), respectively, when compared with the control groups according to intention to treat. Regarding safety, we found more symptoms in the bivalent vaccine group (35%; 95% CI, 5-73) when compared with the control groups. In regard to vaccine immunogenicity, there was seroconversion in the group that received the vaccine when compared with the placebo group in the bivalent and quadrivalent vaccines. Prophylactic vaccination can prevent HPV infection in women aged 9 to 26 years not previously infected with the HPV subtypes covered by the vaccines. To evaluate cervical cancer incidence and mortality, a longer follow-up is necessary.

Analysis of independent risk factors for death among pediatric patients with candidemia and a central venous catheter in place.

OBJECTIVEnTo use multivariate analysis to determine risk factors for death among pediatric patients with candidemia and a central venous catheter in place.nnnDESIGNnRetrospective cohort study conducted at Santa Casa Complexo Hospitalar, a 1,200-bed teaching hospital in southern Brazil.nnnMETHODSnAll cases of candidemia in pediatric patients (age, <or=13 years) at our medical center over a 9-year period were reviewed. A diagnosis of sepsis was required for inclusion in the study. Severity of illness was confirmed by the presence of hypotension requiring inotropes and according to the following scores: the Pediatric Risk of Mortality (PRISM) II score, the PRISM III score, and the Pediatric Logistic Organic Dysfunction score. The following 2 outcomes were evaluated: early death, defined as death occurring within 7 days after candidemia was diagnosed, and late death, defined as death 8-30 days after candidemia was diagnosed.nnnRESULTSnA total of 61 patients were included in the study, including 14 neonates. Most (63.9%) of these patients were girls, and the median age was 0.3 years. A total of 80.3% of candidemia cases were due to species other than Candida albicans, primarily Candida parapsilosis (32.8% of cases) and Candida tropicalis (24.6% of cases). Using multivariate analysis, we demonstrated that failure to remove the central venous catheter was an independent risk factor for early death among pediatric patients with candidemia. However, patients whose catheters were retained were sicker than patients whose catheters were removed, and catheter removal had no impact on late death. Instead, severity of illness determined using the PRISM III score was also an independent predictor of late death.nnnCONCLUSIONSnResults from this study suggest that systematic removal of catheters from pediatric patients with candidemia does not reduce the occurrence of late death.

Prevalência e fatores associados ao consumo de cigarros entre estudantes de escolas estaduais do ensino médio de Santa Maria, Rio Grande do Sul, Brasil, 2002

Smoking is the second cause of death in the world. It currently accounts for one out of ten deaths in adults worldwide (5 million per year). If current patterns persist, smoking will cause 10 million deaths a year by 2020 according to the World Health Organization. A prevalence study on smoking habits was conducted in 2002 among 459 students from eight public high schools in Santa Maria, Rio Grande do Sul State, Brazil. This study aimed to measure smoking prevalence and related factors by multivariate logistic regression. The overall smoking prevalence rate in the sample was 18% (95%CI: 14.6-21.7), and the students had begun smoking at a mean age of 14 years. Students from public high schools had begun smoking early, influenced by friends who smoked (OR = 4.37; p = 0.000), family income (OR = 2.04; p = 0.013), and age (OR = 1.86; p = 0.031). It is thus crucial to adopt measures to prevent adolescents access to smoking.

Infant mortality trends in the State of Rio Grande do Sul, Brazil, 1994-2004: a multilevel analysis of individual and community risk factors

The aim of this study was to analyze the trend in infant mortality rates in the State of Rio Grande do Sul, Brazil, from 1994 to 2004, in a longitudinal ecological study, by means of panel data analysis and multilevel linear regression (two levels: microregion and time) to estimate factors associated with infant mortality. The infant mortality rate decreased from 19.2 per thousand (1994) to 13.7 per thousand (2004) live births, and the principal causes of death in the last five years were perinatal conditions (54.1%). Approximately 47% of the variation in mortality occurred in the microregions, and a 10% increase in coverage by the Family Health Program was associated with a 1 per thousand reduction in infant mortality. A 10% increase in the poverty rate was associated with a 2.1 per thousand increase in infant deaths. Infant mortality was positively associated with the proportion of low birthweight newborns and the number of hospital beds per thousand inhabitants and negatively associated with the cesarean rate and number of hospitals per 100 thousand inhabitants. The findings suggest that individual and community variables display significant effects on the reduction of infant mortality rates.O objetivo deste trabalho foi analisar a tendencia das taxas de mortalidade infantil no Rio Grande do Sul, Brasil, de 1994 a 2004, em estudo ecologico longitudinal, por meio de analise de dados de painel e regressao linear multinivel (dois niveis: microrregiao e tempo) para estimar fatores associados a mortalidade infantil. A taxa de mortalidade infantil reduziu de 19,2‰ (1994) para 13,7‰ (2004) nascidos vivos, e a principal causa de obito, nos ultimos cinco anos, foi afeccoes perinatais (54,1%). Aproximadamente 47% da variacao nas taxas de mortalidade ocorreram nas microrregioes, e 10% de acrescimo na cobertura do Programa Saude da Familia esteve associado a reducao de 1‰ na mortalidade infantil. O aumento de 10% na taxa de pobreza esteve associado com um aumento de 2,1‰ nos obitos infantis. A mortalidade infantil associou-se positivamente com a proporcao de recem-nascidos com baixo peso e numero de leitos hospitalares por mil habitantes e negativamente com a proporcao de cesarianas e numero de hospitais por 100 mil habitantes. Os resultados sugerem que variaveis individuais e contextuais apresentam efeitos significativos na reducao das taxas de mortalidade infantil.

Accuracy of telomerase in cervical lesions: a systematic review.

The detection of telomerase activity in cervix may provide information on cervical carcinogenesis and may be a marker to monitor cervical intraepithelial neoplasia transition. A quantitative systematic review was performed to estimate the accuracy of telomerase assay in cervical lesions. Studies that evaluated the telomerase test (telomerase repeated amplification protocol) for the diagnosis of cervix lesions and compared it to paraffin-embedded sections as the diagnostic standard were included. Ten studies were analyzed, which included 1069 women. The diagnostic odds ratio (DOR) for a positive telomerase test for low-grade squamous intraepithelial lesions (Lo-SIL) vs normal or benign lesions was 3.2 (95% CI, 1.9–5.6). The DOR for a positive telomerase test for high-grade squamous intraepithelial lesions (Hi-SIL) vs Lo-SIL, normal or benign lesions was 5.8 (95% CI, 3.1–10). For cervix cancer vs Hi-SIL, the DOR for a positive telomerase test was 8.1 (95% CI, 3.2–20.3) and for cervix cancer vs Lo-SIL, normal or benign lesions, it was 40.9 (95% CI, 18.2–91). Our data support the current hypothesis that telomerase may activate an early event in cervical carcinogenesis that could be associated with the initiation and progression of cervical lesions

Poluição do ar como fator de risco para a saúde: uma revisão sistemática no estado de São Paulo

Alem de prejudicar a fauna e a flora, a poluicao atmosferica e capaz de afetar a saude das pessoas. Este estudo teve como objetivo realizar uma revisao sistematica dos estudos epidemiologicos desenvolvidos no estado de Sao Paulo que avaliaram os efeitos da poluicao do ar na saude da populacao. Todas as pesquisas encontradas sugerem que existe associacao da poluicao atmosferica com problemas na saude das populacoes estudadas. Dentre os principais trabalhos desenvolvidos, ha uma diversidade de doencas estudadas, demonstrando que o efeito da poluicao do ar nao afeta apenas o sistema respiratorio, mas pode ser causador de risco para outros problemas como o baixo peso ao nascer, incidencia e mortalidade por câncer, partos prematuros e anemia falciforme.