Orientador: Luiz Carlos Zeferino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T22:17:12Z (GMT). No. of bitstreams: 1 Camisao_ClaudiaCristina_M.pdf: 1298324 bytes, checksum: b601fea0721da5442843bd9c862e258c (MD5) Previous issue date: 2008 / Resumo: Introdução: A despeito do tratamento para o carcinoma de colo uterino, 30% das mulheres não obtêm resposta total e morrem precocemente, devido à recorrência ou persistência da doença. O método de imagem e o momento ideal para avaliar a resposta terapêutica, bem como fatores prognosticos destas pacientes, permanecem indefinidos. Objetivo: Avaliar as contribuições da Ressonância Magnética no estadiamento e na identificação de fatores prognósticos relevantes em pacientes submetidas a tratamento concomitante de quimioterapia e radioterapia, seguido de braquiterapia Sujeito e métodos: estudo de coorte longitudinal, com seguimento antes e após o tratamento das mulheres. Foram selecionadas 56 pacientes, com diagnóstico de carcinoma de colo uterino, tratadas com quimioterapia e radioterapia concomitantes seguido de braquiterapia e acompanhadas no HCII - INCA.Todas foram submetidas a Ressonâncias magnéticas seriadas, sendo a primeira no momento do estadiamento, a segunda após o tratamento concomitante e a terceira após a braquiterapia. Os fatores prognósticos estudados foram: volume tumoral e invasão de corpo uterino, medidos na primeira RM. As respostas ao tratamento foram subdividas de acordo com os criterios de RECIST em resposta completa, resposta parcial, doença estável e progressão de doença, e foram mensuradas no momento da segunda RM após o tratamento combinado e no momneto da terceira RM após a braquiterapia. Análise estatística: a concordância foi avaliada através do coeficiente de Kappa. A sobrevida foi avaliada pelo método de Kapplan-Meier e as curvas foram comparadas pelo teste de log-rank. Foram utilizados modelos de COX (simples e múltiplos) para calcular o Hazard Ratio. O nível de significância foi de 5% e o software utilizado foi o SAS versão 9.1.3. Resultados: O índice de Kappa entre estadiamento FIGO e o estadiamento com RM foi de 0,40. Na segunda RM após o tratamento concomitante, 1 paciente apresentou doença estável, 1 progressão de doença, 20 resposta parcial e 21 obtiveram resposta completa. Na terceira RM, após a braquiterapia, 4 tiveram progressão da doença, 4 resposta parcial e 33 obtiveram resposta completa. Pacientes com volume tumoral maior que 50cm3 tiveram sobrevida global pior. Conclusão: A concordância entre o estadiamento FIGO e o estadiamento com RM foi baixa. O volume tumoral mostrou ser um bom preditor de sobrevida global mesmo quando corrigido em análises multivaridas para o estadiamento FIGO. A invasão do corpo uterino mostrou-se limítrofe como fator de sobrevida global / Abstract: Introduction: Despite the available treatment for cervical cancer, 30% of women fail to achieve full response to therapy and die early due to recurrence or persistence of the disease. The ideal imaging method and the optimal time for evaluating therapeutic response, as well as the prognostic factors in these patients, remain undefined. Objective: To evaluate the contributions of magnetic resonance imaging (MRI) in staging and in the identification of relevant prognostic factors in patients submitted to treatment consisting of concurrent chemoradiotherapy followed by brachytherapy. The agreement between FIGO and MRI staging was also evaluated. Subjects and Methods: A longitudinal, cross sectional study with evaluations prior to and following treatment was carried out in 56 women with a diagnosis of cervical cancer treated with concurrent chemoradiotherapy followed by brachytherapy at the II Cancer Hospital of the National Cancer Institute (INCA). All patients were submitted to serial MRI, the first being carried out at the time of staging, the second following concurrent chemoradiotherapy and the third after brachytherapy. The prognostic factors studied were tumor volume and uterine invasion at first MRI. The responses to treatment were subdivided according to the Response Evaluation Criteria in Solid Tumors (RECIST) into complete response, partial response, stable disease or disease progression, and were assessed at the time of the second MRI following combined treatment and at the time of the third MRI after brachytherapy. Statistical Analysis: Agreement was evaluated using the kappa coefficient. Survival was assessed using the Kaplan-Meier method and the curves were compared using the log-rank test. Univariate and multivariate Cox models were used to calculate the hazard ratios. Statistical significance was defined at 5% and the statistical software package used was SAS, version 9.1.3. Results: The kappa index between FIGO staging and MRI-based staging was 0.40. At the second MRI after concurrent chemoradiotherapy, 1 patient was found to have stable disease, 1 had disease progression, 20 had achieved a partial response and 21 had achieved complete response. At the third MRI, following brachytherapy, 4 patients had disease progression, 4 had a partial response and 33 had obtained complete response. Overall survival was poorer in patients in whom tumor volume was > 50 cm3. Conclusion: Agreement between FIGO staging and MRI staging was low. Tumor volume was found to be a good predictor of overall survival even when corrected for FIGO staging in multivariate analyses. Uterine invasion was found to be a borderline predictive factor of overall survival / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

M.Tech. / The aim of this study was to determine the effects of the application of therapeutic reflexology as a complementary medicine, in women with cervical cancer who were receiving radiation therapy with curative intent. Therapeutic reflexology is a therapy that involves stimulating specific reflexes in the hands, feet, body and ears by applying pressure to these reflexes with the thumbs and fingers, using specific techniques. All the body’s organs, glands and other parts of the body are reflected in the feet, body, hands and ears can be stimulated by working over the skin surface with the thumbs and fingers for a specific effect. These specific reflexes have been mapped in miniature on the feet, hands, body and ears (Graham, 1998: 5). Therapeutic reflexology promotes homeostasis within the body, by stimulating reflexes pertaining to organs and glands, and achieving normalisation of organs and glands in the receiver of the treatment. The therapy is non - invasive and non - pharmacological, and has no contra-indications (Graham, 1998: 8). Therapeutic reflexology is often used as a complementary or alternative medicine, yet very little information is available on its effects, which requires further research (Milligan, 2002: 489-96). The number of cancer patients using reflexology as a complementary therapy to allopathic medicine is rapidly rising (Apostolides, 1998: 71-95) It is because of this rise in the number of patients seeking complementary therapy that it is of vital importance that more accurate, results-orientated information is made available to both the patient and the medical practitioner. These findings will allow the patient and medical practitioner to make an informed decision regarding the choices available to complement allopathic medicine, to enhance wellbeing, and achieve better results for the allopathic protocol. A sample group of forty-four women were chosen by simple random selection. Twenty three were treated with therapeutic reflexology, and twenty one were given the placebo treatment for six weeks, while undergoing radiation therapy. The patients chosen for the sample group had stage IIIb as well as stage IIb cervical cancer, and were receiving radiation treatment. The result of the study has been determined by evaluating a questionnaire answered by each patient, after each treatment. The control group who received placebo treatment answered the same questionnaire, formulated in accordance with the Likert Scale, for means of comparison.

Magister Public Health - MPH / The aim of the study was to explore the challenges to uptake of cervical cancer screening among women accessing maternal and child health services at Nsambya Hospital in Kampala, Uganda.

Cervical cancer is the second most common cancer in women worldwide. The principal cause of cervical cancer is infection with human papillomavirus (HPV). HPV-16 is a high-risk virus and it is responsible for a high portion of all HPV-caused cancers. The HPV-16 genome consists of early and late genes. The virus initially infects basal cells of the cervix epithelium and in these cells early genes are expressed, whilst late genes, L1 and L2, are only expressed in the upper cell layers of the epithelium. Proteins encoded by the late genes are highly immunogenic, thus it is speculated that expression of the late genes earlier in the virus life cycle could lead to clearance of the virus due to interference of the immune system.     The aim of this study was to treat reporter cell lines with three different small molecule drugs to see if they had the ability to induce HPV-16 late gene expression. The reporter cell lines used in this study had been previously created by transfecting HeLa-cells with plasmids representing the HPV-16 genome. In these plasmids, L1 is replaced with a CAT reporter gene that encodes the CAT protein, which can be easily quantified using a sandwich ELISA.     Upon treating the reporter cell lines with TPA, a significant induction of late gene expression was detected. Furthermore, treatment with valproic acid showed some induction of late gene expression. In conclusion, TPA and valproic acid was deemed to have potential to act as a candidate drugs for treatment of HPV infections.

Cervical cancer is almost exclusively caused by the HPV virus, whit HPV 16 and 18 involved in the majority of cases. The HPV virus can be divided into high risk and low risk types, where the high risk types are most associated with cancer. HPV is spread by sexual skin to skin contact, many people get infected without getting cervical cancer. HPV is also involved in the development of several other types of cancers such as oral and other genital cancers. The HPV virus infects epithelium stem cells and disrupts basic functions of the cells. A high expression of the late genes early in an infection may result in that an HPV 16 infection dies out. The late gene expression was analysed by using a CAT ELISA method, in the cell lines used one of the late genes had been replaced by a CAT reporter gene. Several small molecules where investigated, to study the regulation of the late gene expression. The results of the study was that a regulation of the late gene expression could be seen when pBELMCAT was treated with TPA, TA and RA where TPA gave the highest increase in the late gene expression. TA/RA combined with TPA increased the expression even more. As a conclusion it seems possible for small molecules to be used in treatments for cervical cancer that is caused by HPV 16, to upregulate the late gene expression and maybe be able to eliminate the infection before serious damage and disease can develop.

Cancer of the cervix is the second most frequent type of tumor in the female population, with a worldwide incidence in 2008, according to the World Health Organization of 530,000 cases. In Brazil, according to the Health Department, the disease had an average incidence in 2010 of 18.43 new cases per 100,000 women. This condition can be prevented by early detection and treatment. The main and most widely used method for screening cancer of the cervix is the cytopathology cervix exam. However, the diagnosis of cervical cancer is based in cytology, colposcopy and histology, whereas the latter is the gold standard for diagnosis. In patients with HIV infection the whole screening for cervical cancer is a very special situation due to the reduced immune defense and greater vulnerability to lesions that may be precursors of the cancer of the cervix. Objective: To study the cytopathological, colposcopic and histopathological findings of women with HIV infection, attended at the Infectology Service of Hospital Universitário de Santa Maria, Brasil. Methods: crosssectional study conducted in Gynecology Service of the Hospital Universitário de Santa Maria, from March 2012 to July of 2013. The sample consisted of 80 HIV prior infection women by. Results: The rate of cytology exams altered was 3.4% for intraepithelial lesion low-grade and 1% for ASCUS. Among 12 women submitted to cervical biopsy, 16,6% had diagnosis of NIC I or II and 16.6% of NIC III. There was a statistically significant association between time of infection by HIV and histological changes. Discussion: The proportions of alterations found in cytology exams differ from those reported abroad; however, they were similar to those described in Brazil. Final considerations: The screening for cancer precursor lesions of the cervix, in women with HIV infection, should be prioritized in public health services. / O câncer de colo de útero é o segundo tipo de tumor mais frequente na população feminina. Em 2008, segundo a Organização Mundial de Saúde, apresentou incidência mundial de 530 mil casos. No Brasil, segundo o Ministério da Saúde, a doença apresentou uma incidência média, no ano de 2010, de 18,43 novos casos para cada 100.000 mulheres. Essa afecção pode ser prevenida através da detecção e do tratamento precoce. O método principal e mais amplamente utilizado para rastreamento do câncer do colo do útero é o exame citopatológico do colo do útero. Contudo, o diagnóstico do câncer cervical pode ser realizado com base na citologia, na colposcopia e na histologia, sendo essa última o padrão-ouro para o diagnóstico. Em pacientes com infecção pelo vírus do HIV, o rastreamento do câncer de colo de útero é uma situação muito especial em função da defesa imunológica reduzida e da maior vulnerabilidade às lesões precursoras do câncer do colo do útero. Objetivo: Estudar os resultados dos exames citopatológicos, colposcópicos e histopatológicos em mulheres com diagnóstico de infecção pelo HIV, atendidas no serviço de Infectologia do Hospital Universitário de Santa Maria, Brasil. Métodos: Estudo transversal, realizado no serviço de ginecologia do Hospital Universitário Santa Maria, no período de abril de 2012 a julho de 2013. A amostra foi constituída de 80 mulheres com infecção prévia pelo HIV. Resultados: A taxa de exames de citologia alterados foi de 3,4% para lesão intraepitelial de baixo grau e 1% para ASCUS. Dentre as 12 mulheres submetidas à biópsia do colo do útero, 16,6% tiveram diagnóstico de NIC I ou II e 16,6% de NIC III. Houve uma associação estatisticamente significativa entre o tempo de infecção pelo HIV e as alterações histológicas. Discussão: As proporções de alterações encontradas nos exames de citologia destoam das registradas por outras pesquisas mundiais; todavia, foram semelhantes às descritas no Brasil. Considerações finais: O rastreio das lesões precursoras do câncer do colo do útero em mulheres com infecção pelo HIV deve ser priorizado nos serviços públicos de saúde.

BACKGROUND : Cervical cancer is the second most common malignancy in women worldwide, and the leading cause of mortality among women. It affects approximately 500 000 women each year with about 270 000 deaths. Almost 80% of the mortalities occur in developing countries. The National Department of Health in South Africa introduced a cervical cancer screening policy in the year 2000. The aim of the policy was to screen more that 70% of the women aged 30 – 59 by the end of 10 years. Women aged 30 – 59 years are offered 3 Pap smears per life time, with an interval of 10 years between the smears. AIM: The aim of the study was to determine the uptake of cervical cancer screening among eligible women (age 30 – 59 years), their practice, knowledge and attitude, as well as the capacity of the facility and the service providers to offer cervical cancer screening service. METHODS: A health systems descriptive study. A two stage sampling technique was done. Purposeful sampling of the healthcare facilities in the defined area was done, targeting the Provincial Health clinics. Records were reviewed at the facility to determine the percent of women aged 30 – 39 years, who used the facility and had Pap smears over the period: August 2003 to July 2007. Facility managers at the Holani clinic and Stanza Bopape Community Health Center were interviewed. Self administered questionnaires were distributed to doctors and professional nurses at both facilities. Questionnaires were also distributed to the women aged 30 – 59 years who visited the facilities during data collection to determine the knowledge, attitude and practice of these women concerning Pap smear. Data entry was done using Epi-Info and Microsoft Excel. Data was analyzed using STATA version 9. Methods applied were frequencies, percentages and cross tabulations. Differences between groups were examined using Fisher’s exact test and Chi-square test. Results were presented in tables and graphs. RESULTS : Record review at Holani clinic indicated that the percent of women aged 30 – 59 years who had undergone Pap smears while attending clinic from January 2004 to July 2007 was 8%. Stanza Bopape had incomplete records. Only about 50% of the women interviewed had undergone Pap smear. Socio-demographic factors like age, education and employment did not have a significant effect on the knowledge, attitude and practice of cervical cancer screening by the targeted service users. Women of lower parity had undergone more Pap smears than those of higher parity. Women of lower parity had more knowledge about Pap smear (p-value=0.05). The knowledge and practice of Pap smear among women aged 30 – 59 years who attended the clinics were significantly associated with getting information from the nurse (p=0.01). Knowledge of the National Cervical Cancer Screening Policy by the service providers was limited. Both facilities had adequate resources for performing the procedure. The number of trained staff per facility was adequate for the performance of the procedure. There was enough privacy to do the procedure. Specimen transportation was adequate, and turn around time was acceptable. CONCLUSION : The extent of Pap smear investigation at the facilities is inadequate. The Service Providers need to calculate the minimum number of Pap smears needed per day to reach the required targets. Nurses at the primary healthcare setting play a major role in improving the uptake of cervical cancer screening. There is a need to actively recruit women to come for Pap smear, while at the same time strengthening health education. Copyright / Dissertation (MMed)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / Unrestricted

The purpose of this dissertation was to explore the determinants of Pap screening completion among sub-Saharan African immigrant women. Cervical cancer is a public health problem globally. The risk of invasive cervical cancer remains high among sub- Saharan African immigrant women in the US despite being a preventable cancer. Early detection through Pap screening is crucial for prevention, treatment and prognosis. The specific aims of this dissertation were to 1) examine Pap screening practices among African immigrant women and to identify gaps to guide future research; 2) explore barriers and motivators that influence Pap screening decisions among African immigrant women; and 3) explore African immigrant men’s knowledge of Pap screening and attitudes about supporting their wives/female partners to utilize Pap screening, and 4) explore predictors of Pap screening use among sub-Saharan African immigrant women, Specific aim one was addressed by a review and synthesis of literature focused on Pap screening among African immigrant women. Common factors influencing Pap screening completion included immigration status, health care interactions, knowledge deficiency, religiosity, and certain personal characteristics. Specific aim two was addressed by the conduct of a qualitative descriptive study of barriers and motivators contributing to Pap screening decisions in 22 African immigrant women. Women experienced different barriers including low knowledge of screening, cultural beliefs, fear and communication issues. Addressing knowledge gaps and other barriers related to Pap screening may improve Pap screening participation in this group. Specific aim three was addressed by a qualitative descriptive study of men’s attitudes and beliefs regarding Pap screening and support for their wives for Pap screening participation. African immigrant men demonstrated suboptimal knowledge and awareness of cervical cancer screening. Most men had a lack of knowledge regarding HPV and its link with cervical cancer. Despite knowledge deficiency men showed significant interest in supporting their wife/female partners. Specific aim four was addressed by conducting an analysis of cross sectional data collected from 108 sub-Saharan African women. Predictors of Pap screening completion was determined using logistic regression while controlling for age and education. Pap screening awareness and provider’s recommendations were independent predictors of Pap screening. Given the unequitable burden of cervical cancer experienced by this population, the findings from this dissertation point to the need for a multilevel targeted health interventions directed toward African immigrant population are needed to increase the rates of Pap screening among African immigrant women. Prevention efforts should focus on individual level factors and develop culturally relevant strategies that will effectively provide educational outreach interventions and alleviate barriers to Pap screening. Engaging spousal support and addressing social norms related to spouses/partners’ roles that may influence partaking in cervical cancer screening is important among African immigrant women. Cervical cancer is preventable; Pap screening will lead to early detection of cervical cancer in female African immigrants.

No description available.

A conservative strategy for women with a low-grade abnormal cervical smear is continued cytological surveillance by repeat Papinacolaou testing, but there is surprisingly little information on the management of such follow-up. Our objectives were to investigate such management pathways, their determinants, and psychological implications using data from the cytological surveillance arm of the Trial of Management of Borderline and Other Low-grade Abnormal cervical smears. A substantial proportion of participants had ongoing unresolved cytology at last follow-up (42.7%); a policy of following women solely though cytological surveillance to manage these women may be inefficient. A high-risk human papillomavirus test, smoking and age were significantly associated with the management pathways (p-value <0.05). While there were some limitations, our results were reassuring with respect to this group of women with ongoing unresolved cytology, since there were no differences in anxiety and depression scores across the management pathways after thirty months of follow-up.