Papers by Fabio Russomano
Revista da Associação Médica Brasileira, 2005
OBJETIVO. Comparar a qualidade de vida de mulheres após a menopausa usuárias e não usuárias de te... more OBJETIVO. Comparar a qualidade de vida de mulheres após a menopausa usuárias e não usuárias de terapia de reposição hormonal (TRH). MÉTODOS. Realizou-se um estudo de corte transversal com mulheres na pós-menopausa, com idade entre 40 e 65 anos, menopausadas há no máximo 15 anos. Consideraram-se como usuárias de TRH aquelas que faziam uso dessa terapia há pelo menos seis meses, e não usuárias aquelas que não fizeram uso dessa terapia nos últimos seis meses. Foram incluídas no estudo 207 mulheres: 106 usuárias e 101 não usuárias de TRH. Avaliaram-se as características sociodemográficas, clínicas e comportamentais. Aplicou-se o Índice de Kupperman para avaliar a intensidade dos sintomas climatéricos, e o questionário Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) para avaliação da qualidade de vida. Na análise dos dados utilizaram-se os testes t de student, Qui-quadrado, exato de Fisher e Mann-Whitney. RESULTADOS. As usuárias de TRH apresentaram média etária de 52,6±4,9 anos e as não usuárias de 54,3±4,7 anos (p=0,01). Houve diferença estatisticamente significativa em relação ao estado marital (p=0,04). As usuárias relataram menor freqüência de sintomas climatéricos de intensidade moderada e acentuada (p=0,001). Dos oito domínios de qualidade de vida avaliados, apenas a vitalidade apresentou escore abaixo de 50 (45) para os dois grupos. Não houve diferenças entre os grupos em relação aos componentes do SF-36. CONCLUSÕES. As mulheres na pós-menopausa usuárias e não usuárias de TRH apresentaram boa qualidade de vida. Não houve diferenças entre usuárias e não usuárias de terapia hormonal. UNITERMOS: Menopausa. Qualidade de vida. Questionário SF-36. Terapia de reposição hormonal. Índice de Kupperman.
![Research paper thumbnail of [Cytological diagnosis of atypical squamous cells: a critical evaluation of diagnostic guidelines]](https://attachments.academia-assets.com/45502934/thumbnails/1.jpg)
Revista brasileira de ginecologia e obstetrícia : revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2008
to identify valid guidelines for the approach of women with cytopathological diagnosis of undeter... more to identify valid guidelines for the approach of women with cytopathological diagnosis of undetermined significance atypias in squamous cells (ASC), discussing its applicability to the Brazilian scenario. an electronic search of publications at PubMed, National Guidelines Clearinghouse and Scholar Google was carried out, as well as a manual search of references from the texts found. The guidelines identified, and specifically related to the theme, were evaluated according to its validity and the recommendations were criticized and summarized. guidelines for the United Kingdom, France, Australia, the USA and New Zealand have been considered as valid. These documents recommend repeating the cytology in six or twelve months, in ASCs of undetermined significance (ASC-US) before referring to colposcopy, and immediate referral to colposcopy in ASCs, when it is not possible to disregard high degree lesions (ASC-H). We have also found valid colposcopy recommendations for women with ASC-US i...
![Research paper thumbnail of [Performance by cytology and hybrid capture II in screening for high-grade squamous intraepithelial lesions in women with HIV]](https://attachments.academia-assets.com/45502919/thumbnails/1.jpg)
Cadernos de saúde pública, 2011
HIV-infected women are at increased risk of developing high-grade squamous intraepithelial lesion... more HIV-infected women are at increased risk of developing high-grade squamous intraepithelial lesions (HSIL), the precursor lesions for cervical cancer. This study estimated and compared the performance of cytology and hybrid capture II in screening for precursor lesions of cervical cancer among HIV-infected women. The study population consisted of women from the open prospective cohort at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/Fiocruz). Colposcopy and histology were considered jointly in defining the gold standard. Cytology showed 31.8% sensitivity and 95.5% specificity, while hybrid capture II showed higher sensitivity (100%) and lower specificity (52%). The positive likelihood ratio was 7.1 for cytology and 2.1 for hybrid capture II, while the negative likelihood ratio was 0.7 for cytology and 0.0 for hybrid capture II.
Diagnostic molecular pathology : the American journal of surgical pathology, part B, 2005
The aim of this study was to characterize the immune system profile in the uterine cervix of 17 h... more The aim of this study was to characterize the immune system profile in the uterine cervix of 17 human papillomavirus (HPV)-infected women, compared with 17 whom were coinfected with HIV-1. Five histologically normal cervices in immunocompetent women were used as controls. HPV infection was associated with a marked increase in cells expressing interleukin (IL)-6, interferon gamma (IFN-gamma), and tumor necrosis factor alpha (TNF-alpha). Coinfection by HPV and HIV-1 led to decreased expression of IL-6, TNF-alpha, and IFN-gamma. However, coinfection led to increased numbers of cells expressing IL-4, IL-10, and IL-8. Compared with the histologically normal cervices, increased numbers of macrophages (CD68, RFD7) and T lymphocytes (CD4, CD8) were seen in HPV-infected cervices; coinfection with HIV-1 was associated with a higher number of CD8 cells and lower number of CD68 cells. HPV DNA localized exclusively to the dysplastic squamous cells, whereas HIV-1 RNA was detected mainly in CD68-p...
Cadernos de Saúde Pública, 2009
This study aimed to estimate the incidence and types of cervical cytopathological findings in ado... more This study aimed to estimate the incidence and types of cervical cytopathological findings in adolescents who were treated in public health services between 1993 and 2006. This is a cohort study, with the following inclusion criteria: < 20 years of age, sexually-active, without cervical lesions upon entry into the study or sexually active < 1 year. The data were collected from 403 adolescents' medical records. Incidence density of cytopathological alterations was estimated and the actuarial method was used to calculate the 5year incidence during follow-up after sexual initiation. In the first year of sexual activity, the incidence of cervical lesions was 24.1%. The incidence decreased to 3-8% over the following 4 years. The incidence density was 4.7 cases per 100 persons per year. The first abnormal cytological diagnosis showed atypical squamous cells of undetermined significance (ASCUS) in 5.5% of patients, lowgrade squamous intra-epithelial lesions (LSIL) in 28% (113), and high-grade squamous intraepithelial lesions (HSIL) in 3% (12). Eight (67%) cases of HSIL occurred during the first year of sexual activity. The incidence of cytopathological findings at beginning of sexual life is high, suggesting the importance of including sexually-active adolescents in cervical cancer prevention programs. Cervical Intraepithelial Neoplasia; Adolescents; Papillomaviridae ARTIGO ARTICLE
PLoS ONE, 2011
Introduction: Despite the availability of preventive strategies (screening tests and vaccines), c... more Introduction: Despite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to impose a significant health burden in low-and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV) and thus development of cervical squamous intraepithelial neoplasia (CIN).
Revista Brasileira de Ginecologia e Obstetrícia, 2005
... Maisonnette de Athayde2, Michele Lopes Pedrosa3, Susana Cristina Aidé Viviani Fialho4, Fabio ... more ... Maisonnette de Athayde2, Michele Lopes Pedrosa3, Susana Cristina Aidé Viviani Fialho4, Fabio Bastos Russomano5, Beatriz Grinsztejn6, Luiz Guilherme Pessoa da ... foi observada a incidência de 7% de le-sões vulvares incluindo-se dois carcinomas inva-sores e sete VIN III6 ...
Revista Brasileira de Ginecologia e Obstetrícia, 2006
Objetivo: verificar a prevalência de lesões intra-epiteliais de alto grau (LIAG) e câncer invasor... more Objetivo: verificar a prevalência de lesões intra-epiteliais de alto grau (LIAG) e câncer invasor em mulheres com citologia com diagnóstico de ASCUS (atipias em células escamosas de significado indeterminado) persistente após 6 meses e verificar se a idade é fator indicador para a existência destas lesões neste grupo de mulheres. Métodos: foram incluídos 215 casos de mulheres nãogestantes e HIV-negativas com diagnóstico de ASCUS (sem especificação) persistente em duas citologias com intervalo mínimo de 6 meses. Tais resultados foram confrontados com o resultado histológico de biópsias, exéreses da zona de transformação (large loop excision of the transformation zone) ou cones. Foram considerados negativos para LIAG ou câncer quando a colposcopia foi satisfatória e sem alterações ou quando, apesar de insatisfatória, não foi detectada lesão em pelo menos um seguimento citológico e colposcópico. Para estabelecer a prevalência de lesões, calculamos a freqüência de diagnósticos com seus respectivos intervalos de confiança a 95% (IC 95%). Para análise estatística da diferença de proporções de LIAG ou câncer em cada faixa de idade, foi utilizado teste do χ 2 , e ainda estimamos o risco destas lesões entre mulheres com mais de 35 anos pela razão de prevalências com seu IC 95%. Resultados: encontramos um total de negativos de 49,3% dos casos (IC 95%: 42,. A prevalência de lesões intra-epiteliais de baixo grau foi de 38,6% (IC 95%: 32,1-45,1) e de LIAG de 10,7% (IC 95%: 6,5-14,8). Casos de câncer foram encontrados em 1,4% das pacientes (IC 95%: 0-2,9). Não foi possível estabelecer, de forma significativa, maior risco de LIAG/câncer considerando o corte de idade em 35 anos. Conclusão: a prevalência de LIAG/câncer encontrada em nosso estudo mostra que o risco de encontrarmos este tipo de lesão em mulheres atendidas no Sistema Único de Saúde em nosso município com duas citologias com diagnóstico de ASCUS é de cerca de 12%. Não foi possível evidenciar maior probabilidade de LIAG/câncer em qualquer das faixas etárias analisadas, porém este resultado pode ter sido limitado pelo pequeno tamanho amostral.
PLoS ONE, 2012
Background: Minichromosome maintenance proteins (MCM) are highly expressed in actively replicatin... more Background: Minichromosome maintenance proteins (MCM) are highly expressed in actively replicating cells. The need for biological markers for cervical carcinoma and its precursor lesions is emerging. Our main aim was to determine the immunohistochemical expression of MCM-2 in HIV-positive and -negative dysplastic cervical specimens.
Revista Brasileira de Ginecologia e Obstetrícia, 2008
Resumo OBJETIVO: identificar recomendações válidas para abordagem de mulheres com diagnóstico cit... more Resumo OBJETIVO: identificar recomendações válidas para abordagem de mulheres com diagnóstico citopatológico de atipias de significado indeterminado em células escamosas (ASC), discutindo sua aplicabilidade ao cenário brasileiro. MÉTODOS: foi realizada uma busca eletrônica de publicações no PubMed, National Guidelines Clearinghouse e Google Acadêmico, além de busca manual das referências dos documentos encontrados. As diretrizes identificadas e especificamente relacionadas ao tema foram avaliadas segundo sua validade e suas recomendações, criticadas e sumarizadas. RESULTADOS: as diretrizes consideradas válidas foram aquelas elaboradas para o Reino Unido, França, Austrália, EUA e Nova Zelândia. Esses documentos recomendam que a citologia seja repetida seis ou doze meses antes de encaminhar para colposcopia nas ASC de significado indeterminado (ASC-US) e encaminhamento imediato para colposcopia em ASC nas quais não é possível afastar lesão de alto grau (ASC-H). Também foram encontradas recomendações válidas de colposcopia para mulheres com ASC-US em situações especiais (imunocomprometidas e que demandem asseguramento por especialista) e uso de testes para HPV oncogênico que, quando presente em mulheres com mais de 20 anos, deve motivar encaminhamento para colposcopia. CONCLUSÕES: as condutas clínicas preconizadas para o Programa Nacional de Controle do Câncer do Colo do Útero no Brasil podem ser aperfeiçoadas, acrescentandose o encaminhamento para colposcopia em situações especiais (imunocomprometidas e que demandem asseguramento por especialista), o uso do teste para detecção de HPV oncogênico em mulheres com mais de 20 anos (quando presente, deve-se encaminhar para colposcopia), a investigação de lesões vaginais e o uso de preparo estrogênico prévio à colposcopia em mulheres na pós-menopausa, dispensando a biópsia quando presentes alterações menores.
Sao Paulo Medical Journal, 2008
Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions ... more Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confidence intervals (95%). Levels of 5% were considered significant. 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66% and the incidence density was 3.3/1,000 patients-month. We did not find associations between the variables for stenosis. However, we observed borderline significance levels relating to hemorrhagic complications before and after the operation (p = 0.089).
Sao Paulo Medical Journal, 2013
Revista de Saúde Pública, 2009
Efetividade da abordagem "ver e tratar" em lesões pré-invasivas no colo uterino ABSTRACT OBJECTIV... more Efetividade da abordagem "ver e tratar" em lesões pré-invasivas no colo uterino ABSTRACT OBJECTIVE: To compare the effectiveness between the see-and-treat (S&T) approach and the conventional one (with prior biopsy) for squamous intraepithelial lesions of uterine cervix.
PLoS ONE, 2012
Background: Minichromosome maintenance proteins (MCM) are highly expressed in actively replicatin... more Background: Minichromosome maintenance proteins (MCM) are highly expressed in actively replicating cells. The need for biological markers for cervical carcinoma and its precursor lesions is emerging. Our main aim was to determine the immunohistochemical expression of MCM-2 in HIV-positive and -negative dysplastic cervical specimens.
PLoS ONE, 2013
Cell cycle protein expression plays an important role in the pathophysiology of cervical cancer. ... more Cell cycle protein expression plays an important role in the pathophysiology of cervical cancer. However, few studies have attempted to correlate the use of these biomarkers with the clinical progression of the tumor.
Memórias do Instituto Oswaldo Cruz, 2012
P16 INK4a is a cyclin-dependent kinase inhibitor that regulates the transition from the G1 to S p... more P16 INK4a is a cyclin-dependent kinase inhibitor that regulates the transition from the G1 to S phase and negatively influences cell proliferation in conjunction with other tumour suppressor proteins, such as the retinoblastoma gene (pRb) ). As pRb is functionally inactivated by the high-risk human papillo-human papilloma virus (HPV) oncoprotein E7, there is a concomitant overexpression of p16 INK4a . New data suggest that p16 overexpression in E7-expressing cells does not appear to result from pRB degradation, but from the induction of histone demethylases by HPV E7 . Although p16 INK4a immunostaining has been correlated with the severity of cytological and histological abnormalities in cervical lesions, variations in interpretation and a lack of standardised methodologies has resulted in uncertainty regarding the most appropriate cut-offs for the analysis of P16 INK4a levels ). This dilemma is underscored by the fact that P16 INK4a expression can be upregulated in non-dysplastic cervical lesions, including common squamous metaplasia. Moreover, published studies for the diagnostic performance of P16 INK4a in human immunodeficiency virus (HIV)infected patients remain limited ). In the present study, we assessed the expression of p16 INK4a in normal and abnormal cervical epithelium in HIV-positive and negative women and determined the diagnostic performance [receiving operating characteristics curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] of P16 INK4a for detecting cervical intraepithelial neoplasia (CIN) and invasive cervical cancer in tissue microarray (TMA) samples in each group.
Journal of Pediatric and Adolescent Gynecology, 2010
Our objective was to describe the evolution of cervical SIL within 24 months of the initial diagn... more Our objective was to describe the evolution of cervical SIL within 24 months of the initial diagnosis, in a cohort study of 147 sexually active adolescents attending a public health service in Rio de Janeiro, between 1993 and 2006. The participants were divided in two groups, according to whether cervical biopsy was performed or not. The median of the interval between sexual debut and the atypical cytopathology was 12 months and in 8.2% of patients there was a diagnosis of HSIL at the first abnormal smear. After a two-year follow-up by cytology, the regression (AS-CUS 91%, LSIL 63.6%, HSIL 50%) and progression (LSIL 6.1%) were verified. In the group undergoing biopsy, the final histological regression reached 59.4% for CIN1 and 71.4% for CIN2, while the progression from CIN1 to CIN 2/3 was 3.1%. Our results corroborate the recommendation for conservative management in compliant adolescents due to a high regression rate. However, there should be maintained a careful follow-up based on the possible evolution of the lesion.
International Journal of Infectious Diseases, 2009
Objectives: Human papillomavirus (HPV) infection is a major risk factor for cervical disease. Usi... more Objectives: Human papillomavirus (HPV) infection is a major risk factor for cervical disease. Using baseline data from the HIV-infected cohort of Evandro Chagas Clinical Research Institute at Fiocruz, Rio de Janeiro, Brazil, factors associated with an increased prevalence of HPV were assessed. Methods: Samples from 634 HIV-infected women were tested for the presence of HPV infection using hybrid capture II and polymerase chain reaction. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance. Results: The overall prevalence of HPV infection was 48%, of which 94% were infected with a high-risk HPV. In multivariate analysis, factors independently associated with infection with highrisk HPV type were: younger age (<30 years of age; PR 1.5, 95% confidence interval (CI) 1.1-2.1), current or prior drug use (PR 1.3, 95% CI 1.0-1.6), self-reported history of HPV infection (PR 1.2, 95% CI 0.96-1.6), condom use in the last sexual intercourse (PR 1.3, 95% CI 1.1-1.7), and nadir CD4+ T-cell count <100 cells/mm 3 (PR 1.6, 95% CI 1.2-2.1).
International Journal of Infectious Diseases, 2009
Experimental and Molecular Pathology, 2006
The purpose of this study was to look for associations between a newly described class of suppres... more The purpose of this study was to look for associations between a newly described class of suppressors of cytokine signaling (SSI/SOCS) and cytokine expression in the uterine cervix from HIV/HPV coinfected women. We examined the pro-inflammatory cytokines TNF-alpha and IL-6 since their expressions are linked and responsible for many aspects of both localized and systemic inflammatory responses. Further, expression of SSI/SOCS has been implicated in the negative feedback regulation of cytokine receptor signaling. PCR-amplified HIV-1 cDNA was noted mainly in the stroma, showing a perivascular distribution, and most of the infected cells colabeled with the macrophage marker CD68. The distribution of IL-6 and TNF-alpha was in the same area to HIV-1 and much greater than normal cervices from women with no evidence of viral infection. SOCS/SSI-1 and -3 mRNA positive cells in the uterine cervix were commonly detected in these noninfected cervical tissues; however, very few cells that contained SOCS were evident in areas where HIV-1, TNF-alpha, and IL-6 expressing cells were found. This suggests that viral-related suppression of SOCS/SSI-1-3 expression may be a factor in the marked local enhancement of TNF-alpha and IL-6 production which, in turn, may help facilitate viral spread; however, further studies should be done in order to elucidate the exact mechanisms of SOCS in the cervix.
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Papers by Fabio Russomano