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OBJETIVO: Determinar la asociación entre las características personales y los hallazgos de citología cervical de las usuarias que acudieron a los consultorios externos de ginecología del Hospital San Juan de Lurigancho durante el periodo de enero a diciembre del 2013. METODOLOGÍA: Estudio de tipo observacional, analítico, de casos y controles, retrospectivo de corte transversal. En la investigación participaron en total 150 usuarias que acudieron a consultorios externos de ginecología del Hospital San Juan de Lurigancho en el año 2013, tomándose en cuenta dos grupos muestrales: Grupo de casos (50 usuarias con diagnósticos patológicos de citología cervical) y grupo control (100 usuarias con citología cervical negativo). Se estimaron frecuencias absolutas, relativas y medidas de tendencia central para el análisis descriptivo. Para el análisis inferencial se calculó la prueba Chi cuadrado, con un nivel de confianza de 95%, y para cálculo del riesgo se calculó el Odd Ratio. RESULTADOS: Existe asociación entre el rango de edad entre 20 a 29 años con el hallazgo normal de citología cervical, (p=0.025), siendo considerado un factor protector (OR=0.255). Respecto a la asociación entre las características gineco-obstétricas y los hallazgos de citología cervical, se observó que la edad de inicio de las relaciones sexuales después de los 19 años (p=0.034), la multiparidad (p=0.014), el uso de acetato de medroxiprogesterona (p=0.044), el bloqueo tubárico (p=0.027), el resultado previo de citología cervical patológica (p<0.001), el resultado previo de ITS (p=0.002) se asocia al hallazgo patológico o normal de citología cervical, evidenciándose que el inicio de relaciones sexuales después de los 19 años y el uso de medroxiprogesterona fueron factores protectores para la presencia de hallazgos normales (OR=0.444 y OR=0.327 respectivamente); y la multiparidad, el bloqueo tubárico bilateral, el resultado previo de citología cervical y el antecedente de ITS representaron factores de riesgo (OR=2.364, OR=3.097, OR=5.359, OR=3.765 respectivamente). Asimismo, respecto a los estilos de vida, el Índice de Masa Corporal normal se asoció significativamente para un hallazgo normal (p=0.005) considerándose un factor protector (OR=0.224), mientras que el consumo de alcohol se asoció (p=0.029) como factor de riesgo (OR=4.409) para hallazgo patológico. CONCLUSIÓN: Se observa principal asociación entre el índice de masa corporal normal con los hallazgos normales de citología cervical, siendo un factor protector (OR=0.22); y asociación entre los resultados previos de citología cervical con los hallazgos de citología cervical patológica como factor de riesgo (OR=5.35).

M.Tech. (Chiropractic) / The purpose of this study was to establish whether cervical spinal manipulation induces an appreciable and sustainable alteration in muscle torque performance regarding the elbow flexor muscles. Forty asymptomatic individuals participated in this study. Twenty individuals were randomly assigned to either an experimental or control group. Participants selected had to be between 18 and 40 years of age and had to present with cervical motion restrictions involving the fourth to sixth cervical vertebrae, as determined by motion palpation assessment. Participants were randomly recruited from the University of Johannesburg and surrounding areas, based on their response to information pamphlets and word of mouth. The experimental group received cervical spinal manipulation involving the lower cervical segments on three separate occasions. The control group received no intervention. Elbow flexion torque assessments were conducted using the Biodex System 3, isokinetic dynamometer. Two assessments were done prior to intervention and one test following one week of intervention, to ascertain whether cervical manipulation can provoke a sustainable improvement in elbow flexion performance. Cervical range of motion (CROM) assessment was used as a secondary objective evaluation to assess the effectiveness of the manipulation procedures, considering that improvement in cervical range of motion following spinal manipulation is well documented. Minimal improvement in elbow flexion torque involving both arms was observed in the experimental group following one weeks‟ intervention however, no statistical significance was reported. Gender relations regarding the elbow flexion torque performances revealed and improvement in strength in the male participants and a reduction in performance in the female participants. Statistical significance was reported although the significance regarding intervention remains unclear. No sustainable improvement in elbow flexion torque was revealed following spinal manipulative therapy and therefore does not provide conclusive evidence to substantiate the motor neuron excitability theory. The contradictory results with regards to the female participants bring into context an indefinite and unfamiliar neuromusculoskeletal paradigm which requires additional research to clarify these anomalous findings.

Cervical cancer is the third most commonly diagnosed cancer globally and it has also been identified as one of three AIDS defining malignancies. Highly active antiretroviral therapy (HAART) is a combination of three or more antiretroviral drugs which are classified as nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). HAART has been shown to play a significant role in reducing the incidence of some AIDS defining malignancies, although its effect on cervical cancer is still unclear. It is hypothesized that HAART might reduce cancer risk by interacting with different signalling molecules and pathways that are involved in cancer in order to induce cell death and thus inhibit cell proliferation. The broader aim of this study was to understand the relationship between cervical cancer and HAART. This was achieved by studying the expression of key signalling molecules in cancer; MUC1 and NFkB (P65) and morphological features using scanning electron microscopy following 24 hour treatment of a cervical cancer cell line, HCS-2 with drugs which are commonly used as part of HAART; Emtricitabine (FTC), Tenofovir disoproxil fumarate (TDF), Efavirenz (EFV), Atripla combination (ATP) and Kaletra combination (LPV/r) at their clinical plasma concentrations. Quantitative real time polymerase chain reaction (qPCR) was used in order to study the gene expression of MUC1 and P65 and the data was analysed using the 2-ΔΔCT method to calculate fold change. The statistical analysis was conducted using JMP 11 software. MUC1 and P65 gene expression was reduced following drug treatment. Protein expression was studied by means of Immunofluorescence and MUC1 and P65 protein expression was reduced following drug treatment. Scanning electron microscopy revealed characteristic features of apoptotic cell death such as loss of cell contacts, reduced density and size of microvilli, increase in surface blebbing and budding and degradation of apoptotic bodies following treatment with all the drugs. In conclusion, the drugs used in this study

M.Med., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Objectives Cancer of the cervix is one of the commonest cancers in South African females. Up to 30% of patients are HIV positive. The addition of chemotherapy to radiotherapy has been shown to significantly improve local control and survival and concurrent chemoradiation is the standard treatment for locally advanced cancer of the cervix. There is very limited literature available concerning the tolerance and efficacy of this treatment in HIV positive patients. This study aims to assess the acute toxicity of combined modality treatment in these patients. This study is part of a multicenter International Atomic Energy Agency sponsored study. Materials and methods Patients with FIGO stage IB2 to IIIB (without hydronephrosis) cervical cancer and who are HIV positive, were randomized to receive radiotherapy alone or chemo-radiation. All patients received 46 Gy in 23 fractions external beam radiation and high-dose-ratei brachytherapy 8 Gy x 3 fractions. Chemotherapy consisted of bolus Cisplatin 30mg/m2 weekly given concurrently with the radiotherapy. Acute treatment toxicity was documented weekly during treatment. Results 64 patients were recruited to the study. 31 patients were randomized to the chemoradiation arm and 33 patients to the radiation alone arm. Of the 64 patients recruited to the study, 6 in the chemoradiation arm and 5 in the radiation only arm did not receive any treatment and were therefore not evaluated. Stage IIB was the most common stage. The mean CD4 count was 410 in the chemoradiation arm vs. 358.4 in the radiation only arm at randomization. Only 6 patients were on antiretroviral therapy at start of treatment, 3 in each arm. The number of chemotherapy cycles received by patients in the chemoradiation arm ranged between 0 and 5 cycles. A total of 96 chemotherapy cycles were administered, with a median of 4 cycles per patient. Overall, at least 76% of patients received at least 4 cycles of chemotherapy. The full five intended courses of cisplatin were administered in 10 (40%) patients. Chemotherapy was not administered most commonly due to toxicity (renal, leucopaenia), other reasons being logistical and non compliance. The principle major adverse effects observed were leucopaenia and cutaneous reactions.

Objetivo: Avaliar a função da coluna cervical, utilizando testes clínicos cervicais em indivíduos com e sem Disfunção Temporomandibular (DTM) associados ou não ao relato de dor de cabeça. Métodos: Estudo Transversal. Foram avaliadas 57 mulheres com idade de 18 a 60 anos, divididas em dois grupos: DTM (n=40), e controle (n=17). Dada a alta frequência de relato de dor de cabeça a amostra de DTM foi estratificada em DTM com cefaleia (n=25) e DTM sem cefaleia (n=15). A incapacidade cervical foi avaliada pelo Índice de Incapacidade Cervical (NDI) e a dor na ATM pela Escala Visual Analógica de dor (EVA). A avaliação funcional da coluna cervical foi conduzida uma única avaliação por um examinador fisioterapeuta experiente e foi constituída pelos testes clínicos: análise da Amplitude de Movimento Ativa da Coluna Cervical (ADM); realização do Flexion-Rotation Test (FRT) e Cranio-Cervical Flexion Test (CCFT). Os sujeitos com DTM que relataram a presença de dores de cabeça foram instruídos a responder um questionário sobre as principais características da cefaleia referida. Para comparações entre os grupos foram aplicados ANOVA one way seguida por teste Post Hoc de Tukey ou por Teste Kruskall Wallis quando necessário. Para a análise de associação entre as variáveis categóricas foram aplicados Teste chi-quadrado ou Teste Exato de Fisher quando apropriado e para a análise de associação entre variáveis ordinais/contínua foram aplicados Testes de Correlação de Spearman. Resultados: Os indivíduos com DTM independente do relato de dor de cabeça apresentaram menor mobilidade no plano sagital, menores valores no FRT e apresentaram pior performance dos flexores profundos cervicais comparados aos controles (p<0.05). Além disso, os dados de ADM, FRT e CCFT foram associados com a intensidade de dor na ATM e a incapacidade cervical (p<0.01). Conclusão: Pacientes com DTM independente do relato de cefaleia apresentaram limitação na amplitude de flexão/extensão e do segmento C1-C2 da coluna cervical, além do menor desempenho dos músculos flexores profundos. Adicionalmente, a incapacidade cervical e a dor na ATM apresentaram correlação moderada com os testes funcionais cervicais nos indivíduos com DTM. / Objective: To evaluate the function of the cervical spine, using cervical clinical tests in individuals with and without Temporomandibular Disorders (TMD)associated or not to the report of headache. Methods: Were analyzed 57 women with age between 18 and 60 years, divided in two groups: TMD (n=40) and control (n=17). Given the high frequency of headache report, the TMD sample was stratified into TMD with headache (n=25) and TMD without headache (n=15). Cervical disability was assessed by the Neck Disability Index (NDI) and TMJ pain by the Visual Analogue Scale of pain (VAS). The functional evaluation of the cervical spine was conducted by a physiotherapeutic examiner with 10 years of experience and was constituted by the clinical tests: Analysis of the Cervical Range of Motion (CROM); Flexion-Rotation Test (FRT) and Craniocervical Flexion Test (CCFT). Subjects with TMD who reported the presence of headaches were instructed to answer 11 questions that contained the main characteristics of referred headache. For comparisons between control groups, TMD with Headache and TMD without Headache, ANOVA was applied one way followed by Tukey\'s Post Hoc test or by Kruskall Wallis test when necessary. For the analysis of association between the categorical variables, chi-square test or Fisher\'s exact test were applied when appropriate and for analysis of association between ordinal / continuous variables, Spearman\'s Correlation Tests were applied. Results: Individuals with TMD independent of headache report showed less mobility in the sagittal plane, lower values in FRT and showed worse performance of the deep cervical flexors compared to Controls (p<0.05). In addition, CROM, FRT and CCFT were associated with an intensity of TMJ pain and cervical disability (p <0.01). Conclusion: Patients with TMD independently of the headache report showed limited flexion / extension range and C1-C2 segment of the cervical spine, as well as deficits in the performance of the deep flexor muscles. In addition, a cervical disability and TMJ pain report showed a moderate correlation with the functional tests of FRT and CCFT in individuals with TMD.

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

A história natural do câncer cervical invasivo começa com uma infecção produtiva pelo Papiloma vírus humana (HPV) na camada basal do epitélio. Infecções persistentes por vírus de HPVs de alto risco poderão provocar lesões que eventualmente darão origem ao carcinoma invasivo. Sabe-se que o infiltrado inflamatório pode ter um papel importante na evolução da doença. Neste trabalho, quantificamos e caracterizamos fenotipicamente linfócitos T, macrófagos e neutrófilos nas lesões precursoras assim como no carcinoma invasivo. Além disso, para determinar se existia alguma relação entre as populações foi realizada uma análise de correlação entres as populações descritas. Por outro lado, tentando determinar o efeito sistêmico do tumor avaliou-se a frequência de subtipos de monócitos circulantes e através de ensaios alogênicos foi avaliada a capacidade estimuladora das células dendríticas diferenciadas de monócitos circulantes. Os dados apresentados ajudarão a entender o papel que as células do sistema imune podem ter sobre a progressão da doença. / The natural history of cervical cancer begins with a human papilloma virus (HPV) infection of the cells of the basal layer of the epithelium. Persistent infection by high risk HPVs can originate precancerous lesions that may progress to invasive cancer. It has been established the role of the infiltrated inflammatory cells on the progression of the disease. In this work, the phenotype and the frequency of T lymphocytes, macrophages and neutrophils were characterized both in precursor lesions as in invasive carcinoma. In order to stablish a possible relation between the characterized cells, we made a correlation analysis. On the other hand, trying to determine the systemic effect of the tumor we evaluated the frequency of circulating monocyte subtypes and the capacity of dendritic cells to stimulate allogeneic T cells. The data presented will help to understand the role of the immune system cells on the progression of the disease.