Papers by Newton Carvalho
Objetivo: analisar os fatores epidemiológicos, manifestações clínicas e forma de tratamento da in... more Objetivo: analisar os fatores epidemiológicos, manifestações clínicas e forma de tratamento da infecção pelo papilomavírus. Métodos: todos os casos de condiloma acuminado em crianças e adolescentes atendidas no período de 1990 a 1995 no Ambulatório de Ginecologia Infanto-Puberal foram revisados, tendo sido coletados dados referentes a idade, manifestações clínicas, local das lesões, formas de transmissão e tratamento. Resultados: entre os 18 casos estudados, a média de idade foi de 6 anos e 11 meses (variando de 2 a 15 anos). A manifestação clínica mais comum foi a presença de verrugas (61,1%). As lesões eram localizadas na região vulvoperineal em 44,4% das pacientes, sendo que lesões perianais e vulvares foram observadas em 27,8% e 22,2% dos casos, respectivamente. Não foi possível confirmar a ocorrência de abuso sexual nem de lesões condilomatosas nos pais em 66,7% dos casos. Provável abuso sexual (não-confirmado) foi relatado em 2 casos. A terapêutica básica foi a cauterização química. Conclusões: o abuso sexual em crianças e adolescentes com condiloma acuminado deve ser investigado, apesar da existência de outras formas de transmissão, incluindo auto ou heteroinoculação. As formas de apresentação na idade jovem diferem das do adulto, sendo necessária uma terapêutica adequada a essa população. PALAVRAS-CHAVE: HPV. Condiloma acuminado. Abuso sexual. Doenças sexualmente transmissíveis. Infância e adolescência.
RESUMO Introdução: os meios de comunicação têm tido uma participação cada vez mais freqüente e in... more RESUMO Introdução: os meios de comunicação têm tido uma participação cada vez mais freqüente e intensa nas pessoas, principalmente nos jovens, mas não se tem conhecimento de que tipo de informação sobre erotização e prevenção de DST/Aids está sendo ...
Vaccine, 2008
Prophylactic VLP-based vaccines effectively prevent papillomavirus infections with a high level o... more Prophylactic VLP-based vaccines effectively prevent papillomavirus infections with a high level of antibodies and safety. An 18% increased efficacy against CIN 2+ lesions associated with HPVs 16/18 has been observed with the appliance of the HPV16/18 AS04 adjuvanted recombinant vaccine.
Objetivo: analisar os fatores epidemiológicos, manifestações clínicas e forma de tratamento da in... more Objetivo: analisar os fatores epidemiológicos, manifestações clínicas e forma de tratamento da infecção pelo papilomavírus. Métodos: todos os casos de condiloma acuminado em crianças e adolescentes atendidas no período de 1990 a 1995 no Ambulatório de Ginecologia Infanto-Puberal foram revisados, tendo sido coletados dados referentes a idade, manifestações clínicas, local das lesões, formas de transmissão e tratamento. Resultados: entre os 18 casos estudados, a média de idade foi de 6 anos e 11 meses (variando de 2 a 15 anos). A manifestação clínica mais comum foi a presença de verrugas (61,1%). As lesões eram localizadas na região vulvoperineal em 44,4% das pacientes, sendo que lesões perianais e vulvares foram observadas em 27,8% e 22,2% dos casos, respectivamente. Não foi possível confirmar a ocorrência de abuso sexual nem de lesões condilomatosas nos pais em 66,7% dos casos. Provável abuso sexual (não-confirmado) foi relatado em 2 casos. A terapêutica básica foi a cauterização química. Conclusões: o abuso sexual em crianças e adolescentes com condiloma acuminado deve ser investigado, apesar da existência de outras formas de transmissão, incluindo auto ou heteroinoculação. As formas de apresentação na idade jovem diferem das do adulto, sendo necessária uma terapêutica adequada a essa população. PALAVRAS-CHAVE: HPV. Condiloma acuminado. Abuso sexual. Doenças sexualmente transmissíveis. Infância e adolescência.
Este artigo consiste em uma revisão do tema associação entre o papilomavírus humano (HPV) e o cân... more Este artigo consiste em uma revisão do tema associação entre o papilomavírus humano (HPV) e o câncer peniano. Por meio de uma pesquisa fundamentada em periódicos eletrônicos e livros de clínicas médica e cirúrgica, confirmou-se essa associação, principalmente em se tratando dos subtipos basalóide e verrucoso de câncer peniano. Chan et al. encontraram 15,0% de associação entre o HPV e o câncer peniano, enquanto no estudo feito por Tornesello et al. 2 essa percentagem foi de 46,3%. Os principais tipos de HPV envolvidos no aparecimento da doença foram o 16 e o 18. Apesar dessas conclusões, a carência de dados e o caráter recente do tema requerem novos estudos para esclarecimentos. A relação da presença do HPV com a sobrevida do paciente ainda é tema que permanece em investigação. Palavras-chave: HPV, câncer de pênis, revisão.
BMC Cancer, 2012
BackgroundThe causal association between persistent human papillomavirus (HPV) infection and cerv... more BackgroundThe causal association between persistent human papillomavirus (HPV) infection and cervical cancer has been established, but the mechanisms that favor HPV persistence in cervical cells are still unknown. The diminished capability of the immune system to control and resolve HPV infection is one of several hypotheses. The tolerogenic protein HLA-G has shown aberrant expression in a variety of cancers, which has been suggested as a mechanism for tumor escape from immunosurveillance. In the present study we evaluate the role of epigenetic modification (promoter de-methylation) of the HLA-G gene on susceptibility to HPV infection and development of high-grade cervical lesions.MethodsA case–control study was carried out in Curitiba, Brazil, between February and June 2010. A total of 789 women aged 15–47 years were recruited: 510 controls with normal cervical cytology, and 279 cases with histologically confirmed cervical intraepithelial neoplasia grade 2 (CIN2, N = 150) or grade 3 (CIN3, N = 129). All women were administered a questionnaire by interview, which collected information on demographic and lifestyle factors, and a cervical sample was collected. HPV DNA detection was performed by GP5+/GP6+ primer-mediated PCR. HPV-positive samples were genotyped by multiplex PCR. A pilot analysis of HLA-G promoter methylation was carried out in a subset of the study population (96 cases and 76 controls) by pyrosequencing. HLA-G methylation and HPV infection status of cases and controls were compared, and confounding factors were computed by t Student and non-parametric Wilcoxon tests. Comparison of HLA-G methylation between cases and controls was assessed by the Bonferroni correction. The association of HLA-G methylation with CIN2/3 was evaluated by logistic regression.ResultsHPV prevalence was 19.6% in controls and 94.3% in CIN2/3 cases. HPV16, 31, 33, 35 and 18 were the most prevalent types. Methylation analysis of seven CpGs in the HLA-G promoter did not reveal any spontaneous de-methylation events in CIN2/3 cases (mean proportion of methylation: 75.8%) with respect to controls (mean 73.7%; odds ratio 1.01, 95% confidence interval 0.96, 1.07).ConclusionsThis study did not support the hypothesis that spontaneous de-methylation events in the HLA-G promoter play a primary role in promoting escape from immunosurveillance in the development of precancerous cervical lesions.
A gestação, para muitas mulheres, é uma das raras oportunidades de comparecerem a um serviço médi... more A gestação, para muitas mulheres, é uma das raras oportunidades de comparecerem a um serviço médico, seja para realizar o acompanhamento pré-natal, ou somente no momento do parto. É imprescindível ao médico detectar doenças ou qualquer outra situação clínica ou emocional que possam estar acometendo essas mulheres ou seus conceptos e que, de alguma forma, comprometam o resultado final da gestação. Diante disso, justifica-se a pesquisa de agravos que possam interferir na saúde do binômio materno-fetal. Sob este prisma é imperativo que o ginecologista e obstetra atue nos quadros clínicos que possam trazer danos à mãe ou ao seu filho. Nesse particular, apresentam interesses os que são potencialmente letais, como é a infecção pelo vírus da imunodeficiência humana (HIV).
PURPOSE: to verify the sensitivity, specificity and accuracy of some ultrasonographic measurement... more PURPOSE: to verify the sensitivity, specificity and accuracy of some ultrasonographic measurements in the diagnosis of stress urinary incontinence (SUI). METHODS: transvaginal ultrasound measurements of the bladder neck descent, urethral mobility and urethrovesical funneling caused by urination effort were performed in 40 women with SUI and in 40 women from a control group. Age, parity and the number of pregnancies were different in both groups. Several cut points were performed to evaluate the sensitivity, specificity and accuracy of these measurements as a diagnostic tool for SUI. The urodynamic results were used as gold standard. Univariated analysis was done using Yates c2 Test and Pearson c2 Test. RESULTS: in the best cut point for bladder neck descent measurements, sensitivity was 40%, specificity was 72% and accuracy was 57%; in the best cut point for urethral mobility measurements, sensitivity was 40%, specificity was 70% and accuracy was 55%; in the best cut point for urethrovesical funneling measurements, sensitivity was 58%, specificity was 48% and accuracy was 52%; in the best cut point for the addition of the differences of these three measurements, sensitivity was 32%, specificity was 62% and accuracy was 48%. CONCLUSION: vaginal ultrasonography was not a valid diagnostic method for stress urinary incontinence in the present study.
Jornal Brasileiro de Doenças Sexualmente Transmissíveis, 2013
Introduction: Many evidences have demonstrated the association between human papillomavirus (HPV)... more Introduction: Many evidences have demonstrated the association between human papillomavirus (HPV) infection and cervical cancer, and prophylactic vaccines have been effective to prevent this infection. In relation to the vaccination program of the population, it is important to study the sexual behavior of adolescent students, especially the onset age of sexual activity. Objective: To evaluate the sexual behavior of adolescent students from public schools in relation to some associated variables and to link the onset age of sexual activity with HPV vaccination of the population. Methods: The study was based on the application of a questionnaire to 500 students of public high schools of the city of Curitiba, aged between 13 and 19 years, to assess their sexual behavior and related questions. Of the 500 questionnaires, 488 were answered and analyzed by statistical methodology. The study was approved by local regulatory bodies. Results: Regarding sexual activity, it was observed that it was most frequent along male than female students. It is noticed that 47.8% of boys and 24.6% of girls answered positively to this question. Similarly, 38.7% of boys reported having initiated sexual activity before age 14 compared to only 8.5% of the girls. Other data about the perceived risk of contracting a sexually transmitted infection and contraception condom were assessed. The relation between drug use (tobacco, alcohol and marijuana) and sexual activity was demonstrated. About 45% of sexually active students stated regular use of drugs, compared with less than 20% of those who reported not having initiated sexual activity (p < 0.001), whereas this proportion was even more evident when analyzed only the use of marijuana. The "protector" effect of family environment shows an interesting finding: the adolescents who lived with their parents were less sexually active than those who did not report such situation with a percentage of 31.3% versus 59.4% (p = 0.003). Conclusion: We concluded that sexual activity was more evident among male participants as sexual initiation was earlier among boys. Use of drugs and independence of family environment were related to higher rate of earlier and current sexual activity. According to researches, 90% of the students who already are 17 years old had initiated sexual activity; therefore, we can conclude that the age of vaccination proposed by most governmental authorities and the Brazilian Federation of Gynecology and Obstetrics (Febrasgo) is adequately when it comes to prevent HPV infection. Keywords: adolescence, sexual behavior, HPV vaccine.
Objetivo: comparar a prevalência da presença do DNA do papilomavírus humano (HPV) pela técnica de... more Objetivo: comparar a prevalência da presença do DNA do papilomavírus humano (HPV) pela técnica de PCR em amostras de tecido endometrial normal e com carcinoma endometrial de mulheres submetidas a tratamento cirúrgico (histerectomia) ou carcinoma endometrial e doença benigna. Métodos: trata-se de um estudo observacional do tipo caso-controle onde foram avaliadas 100 mulheres (50 com endométrio normal e 50 com carcinoma endometrial) quanto a presença do DNA do HPV em amostra tecidual conservada em blocos de parafina, pelo método de PCR. Foram excluídos os casos de carcinoma endometrial cujo sítio primário da lesão era duvidoso ou com história prévia ou atual de lesões pré-neoplásicas ou carcinoma do trato genital inferior. Variáveis como idade, tabagismo, trofismo endometrial, diferenciação escamosa e grau de diferenciação tumoral foram também avaliadas. Resultados: o risco relativo estimado da presença do HPV foi o mesmo nas mulheres com e sem carcinoma endometrial. O HPV foi detectado em 8% dos casos de carcinoma e 10% no endométrio normal. Apesar de o HPV ter sido detectado 3,5 vezes mais em mulheres fumantes no grupo sem carcinoma, não houve diferença estatística. A presença do HPV também não esteve correlacionada com a idade das mulheres, trofismo endometrial, diferenciação escamosa e grau de diferenciação tumoral. Os HPV 16 e 18 (5 dos casos com o tipo 16 e 4 com o tipo 18) foram os vírus mais freqüentemente encontrados, tanto no tecido endometrial normal, quanto no carcinomatoso. Nenhum vírus de baixo risco oncogênico foi detectado nas amostras. Conclusão: o HPV está presente no tecido endometrial de mulheres com carcinoma endometrial na mesma proporção que nas com tecido endometrial normal, não se demonstrando a possível associação deste vírus no desenvolvimento do carcinoma endometrial. PALAVRAS-CHAVE: Papilomavírus humano. HPV. Oncogênese. Carcinoma endometrial.
Objetivo: comparar a prevalência da presença do DNA do papilomavírus humano (HPV) pela técnica de... more Objetivo: comparar a prevalência da presença do DNA do papilomavírus humano (HPV) pela técnica de PCR em amostras de tecido endometrial normal e com carcinoma endometrial de mulheres submetidas a tratamento cirúrgico (histerectomia) ou carcinoma endometrial e doença benigna. Métodos: trata-se de um estudo observacional do tipo caso-controle onde foram avaliadas 100 mulheres (50 com endométrio normal e 50 com carcinoma endometrial) quanto a presença do DNA do HPV em amostra tecidual conservada em blocos de parafina, pelo método de PCR. Foram excluídos os casos de carcinoma endometrial cujo sítio primário da lesão era duvidoso ou com história prévia ou atual de lesões pré-neoplásicas ou carcinoma do trato genital inferior. Variáveis como idade, tabagismo, trofismo endometrial, diferenciação escamosa e grau de diferenciação tumoral foram também avaliadas. Resultados: o risco relativo estimado da presença do HPV foi o mesmo nas mulheres com e sem carcinoma endometrial. O HPV foi detectado em 8% dos casos de carcinoma e 10% no endométrio normal. Apesar de o HPV ter sido detectado 3,5 vezes mais em mulheres fumantes no grupo sem carcinoma, não houve diferença estatística. A presença do HPV também não esteve correlacionada com a idade das mulheres, trofismo endometrial, diferenciação escamosa e grau de diferenciação tumoral. Os HPV 16 e 18 (5 dos casos com o tipo 16 e 4 com o tipo 18) foram os vírus mais freqüentemente encontrados, tanto no tecido endometrial normal, quanto no carcinomatoso. Nenhum vírus de baixo risco oncogênico foi detectado nas amostras. Conclusão: o HPV está presente no tecido endometrial de mulheres com carcinoma endometrial na mesma proporção que nas com tecido endometrial normal, não se demonstrando a possível associação deste vírus no desenvolvimento do carcinoma endometrial. PALAVRAS-CHAVE: Papilomavírus humano. HPV. Oncogênese. Carcinoma endometrial.
International Journal of Gynecological Pathology, 2009
To determine the relationship between human papillomavirus (HPV) and endometrial carcinogenesis b... more To determine the relationship between human papillomavirus (HPV) and endometrial carcinogenesis by comparing data from women with endometrial carcinoma to those of women with normal endometrial tissue. The survey was conducted for 100 women (50 with endometrial carcinoma and 50 with normal endometrial tissue) through HPV-DNA testing of paraffin-embedded endometrial tissue sections by polymerase chain reaction. Age, cigarette consumption, squamous differentiation and tumor grade, endometrium trophism, and HPV types detected in endometrial tissues were studied. HPV estimated odds ratio was similar in endometrial carcinoma and in normal endometrial tissue. The presence of HPV was not associated with age, tobacco abuse, endometrial histology status, squamous differentiation, or tumoral grade. DNA sequences of HPV types 16 and 18 were the most frequently detected in both groups. An association between HPV and endometrial carcinoma was not observed.
Jornal Brasileiro De Patologia E Medicina Laboratorial, 2004
BACKGROUND: The Bethesda Pap Smear System introduced two categories of undetermined atypias: atyp... more BACKGROUND: The Bethesda Pap Smear System introduced two categories of undetermined atypias: atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). The objective of this study is to report the prevalence and the disagreement percentile of ASCUS and AGUS as diagnosed by the Cervical Cancer Screening Program of Paraná and revised by the Unit for External Monitoring of Cytology Quality (UEMCQ). METHODS: The UEMCQ revised 65,753 cervical smears during 25 months and all undetermined atypias were selected. These cases were classified according to their agreement or not and then prevalence was obtained. RESULTS: Before the UEMCQ review, the number of undetermined atypias was 4,067 (5.45%); this number decreased to 3,584 after revising the data. Considering the whole sample, the ASCUS rate was 4.91% (3,235) and AGUS corresponded to only 0.51% (338). Most of the reclassified cases presented negative diagnoses (57.32%). The primary grouped diagnoses, including CIN I and HPV, was responsible for 51.1% of undetermined atypias after reclassification. DISCUSSION AND CONCLUSION: Undetermined atypias were the second most frequent among disagreement diagnosis groups.
Brazilian Journal of Infectious Diseases, 2011
In the last years, the prevalence of HPV infection in the anal region has increased, especially i... more In the last years, the prevalence of HPV infection in the anal region has increased, especially in some groups like homosexual and HIV-positive people. Since this infection can be associated with the development of squamous anal cancer due to its progression from HPV infection to anal intraepithelial neoplasia (AIN) and finally to cancer, the screening and evaluation of these conditions are important. Anal cytology and high resolution anoscopy are good methods that are available and can be used. Although useful, these methods should be performed correctly and not indiscriminately in all patients. Patients for whom anal cytology screening is recommended are: HIV-infected patients, homosexuals, women who present with high-grade vulvar squamous intraepithelial neoplasia, vulvar cancer or cervical cancer. An abnormal anal cytology should be further evaluated with high resolution anoscopy.
International Journal of Gynecological Pathology, 2009
To determine the relationship between human papillomavirus (HPV) and endometrial carcinogenesis b... more To determine the relationship between human papillomavirus (HPV) and endometrial carcinogenesis by comparing data from women with endometrial carcinoma to those of women with normal endometrial tissue. The survey was conducted for 100 women (50 with endometrial carcinoma and 50 with normal endometrial tissue) through HPV-DNA testing of paraffin-embedded endometrial tissue sections by polymerase chain reaction. Age, cigarette consumption, squamous differentiation and tumor grade, endometrium trophism, and HPV types detected in endometrial tissues were studied. HPV estimated odds ratio was similar in endometrial carcinoma and in normal endometrial tissue. The presence of HPV was not associated with age, tobacco abuse, endometrial histology status, squamous differentiation, or tumoral grade. DNA sequences of HPV types 16 and 18 were the most frequently detected in both groups. An association between HPV and endometrial carcinoma was not observed.
Vaccine, 2009
The present survey was conducted among medical students and physicians affiliated to the Federal ... more The present survey was conducted among medical students and physicians affiliated to the Federal University of Paraná, Curitiba, Brazil, between August 2006 and December 2007. 252 individuals responded to a questionnaire composed of 13 items regarding their individual status and their personal knowledge of the HPV vaccine properties. The data analysis that was carried out using chi-square test showed that 79.7% of the interviewed population would indicate the vaccine, and mostly, to girls aged 10-15 years old. While vaccine effectiveness and prophylaxis appeared to have been adequately understood, some of its properties such as safety and immunity duration still need further elucidation.
Uploads
Papers by Newton Carvalho