Background: Human Papillomavirus is the most common STI in United States and is most prevalent among the adolescents and young adults. HPV causes cervical, anal, vulvar, vaginal, penile, oropharyngeal cancers and ano-genital warts. Certain populations are found to be at higher risk such as African Americans. 3 doses of HPV vaccine are recommended to adolescents before sexual debut to immunize against HPV. The purpose of this study was to assess the factors associated with the completion of 3 dose HPV vaccination series particularly among the African American adolescents. Methods: National Immunization Survey – Teen 2012 data was used to assess the association of selected factors with the completion of 3 dose HPV vaccination series among the African American adolescents. Univariate and multivariate binary logistic regression was conducted. Results: Factors, gender, age and maternal education are associated with the completion of HPV vaccination series among the African American adolescents. The Black females are 5 times more likely to complete the HPV vaccination than males. The 15 year olds are thrice more likely to complete the HPV vaccination than 13 year olds. Adolescents with maternal education higher than high school are twice more likely to complete the HPV vaccination series. Conclusion: Among the African American adolescents, socio-demographic factors influence the completion of HPV vaccine series. This study provides a direction to public health practices to focus on Black male adolescents and subpopulations with low maternal education to improve HPV vaccination in US.

Thesis (Ph. D.)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (Ph. D.)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Epidermodisplasia verruciforme (EV) é uma genodermatose rara, com susceptibilidade para infecção pelo vírus do papiloma humano, considerada modelo de oncogênese viral. Comparou-se a expressão epidérmica das citoqueratinas (K) 1, 10, 14, 4, 16, involucrina, filagrina e e-caderina, em lesões de verrugas planas e nas verrugas planas da EV através de método imunohistoquímico. Na EV houve ausência ou retardo de expressão (queratinócitos mais superficias) de K1/10, com substituição pela K14. Houve expressão basal e suprabasal de K14 em ambos os grupos, bem como positividade para K4 e 16, e expressão de involucrina nas camadas mais inferiores da epiderme. A expressão de filagrina não foi alterada, e a de e-caderina apresentou-se diminuída nas células coilocitóticas superficiais na EV / Epidermodisplasia verruciforme (EV) is a rare genodermatosis with susceptibility to human papillomavirus infection, considered a model of viral oncogenesis. We compared epidermal expression of cytokeratins (K) 1, 10, 14, 4, 16, involucrin, filaggrin and e-cadherin in plane warts and plane wart-type lesions in EV by immunohistochemical technique. In EV there was absent or retarded expression (more superficial keratinocytes) of K1/10, being substituted by K14. There was basal and suprabasal expression of K14 in both groups, as well as positivity for K4 and K16, and involucrin expression in more inferior layers of epidermis. Filaggrin expression was not altered, and e-cadherin was diminished in superficial koilocytotic cells in EV

Epidermodisplasia verruciforme (EV) é uma genodermatose rara, com susceptibilidade para infecção pelo vírus do papiloma humano, considerada modelo de oncogênese viral. Comparou-se a expressão epidérmica das citoqueratinas (K) 1, 10, 14, 4, 16, involucrina, filagrina e e-caderina, em lesões de verrugas planas e nas verrugas planas da EV através de método imunohistoquímico. Na EV houve ausência ou retardo de expressão (queratinócitos mais superficias) de K1/10, com substituição pela K14. Houve expressão basal e suprabasal de K14 em ambos os grupos, bem como positividade para K4 e 16, e expressão de involucrina nas camadas mais inferiores da epiderme. A expressão de filagrina não foi alterada, e a de e-caderina apresentou-se diminuída nas células coilocitóticas superficiais na EV / Epidermodisplasia verruciforme (EV) is a rare genodermatosis with susceptibility to human papillomavirus infection, considered a model of viral oncogenesis. We compared epidermal expression of cytokeratins (K) 1, 10, 14, 4, 16, involucrin, filaggrin and e-cadherin in plane warts and plane wart-type lesions in EV by immunohistochemical technique. In EV there was absent or retarded expression (more superficial keratinocytes) of K1/10, being substituted by K14. There was basal and suprabasal expression of K14 in both groups, as well as positivity for K4 and K16, and involucrin expression in more inferior layers of epidermis. Filaggrin expression was not altered, and e-cadherin was diminished in superficial koilocytotic cells in EV

Introdução: as verrugas ungueais são consideradas o tumor benigno que mais acomete o complexo ungueal, sendo causadas pelo papiloma vírus humano. A maioria das alternativas terapêuticas é considerada ineficaz, com altas taxas de recidiva, além do potencial risco de distrofia ungueal. A bleomicina é a opção de tratamento que apresenta bom perfil de segurança e altas taxas de cura. A eletroquimioterapia é uma técnica que combina a eletroporação com a prévia administração de uma droga citotóxica de baixa permeabilidade, aumentando assim a penetração da droga no interior das células, o que amplia a eficácia do tratamento. A bleomicina é o agente quimioterápico mais utilizado na eletroquimioterapia, por ser um excelente exemplo de droga citotóxica não permeável à membrana celular (hidrofílica). Objetivos: avaliar a eficácia da eletroquimioterapia com bleomicina intralesional no tratamento das verrugas ungueais, comparando este método, com o uso isolado da bleomicina intralesional, além de descrever os efeitos adversos relacionados com o emprego das duas técnicas. Metodologia: Ensaio clínico randomizado duplo-cego e controlado. Incluíramse 44 pacientes de ambos gêneros, com idade variando entre 18 e 60 anos, e diagnóstico clínico e histológico de verruga ungueal de quirodáctilos. O estudo foi submetido e aceito pelo comitê de ética, e todos os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. Vinte e dois pacientes foram tratados apenas com bleomicina intralesional e 21 com eletroquimioterapia associada à bleomicina intralesional. Após uma única aplicação, os pacientes foram acompanhados por 180 dias. A comparação da cura entre os grupos foi avaliada pelo teste exato de Fisher para tabelas 2 x 2. O software utilizado foi o XLSTAT 2018. Resultados: dos 44 pacientes que participaram da pesquisa, um paciente do grupo da bleomicina intralesional isolada deixou o estudo antes da realização da técnica. A maioria das lesões se localizava na região periungueal (77,3%), enquanto que, os 22,7% das lesões restantes se localizaram na região subungueal. A média de idade dos pacientes foi de 37 anos para o grupo da eletroquimioterapia associada à bleomicina, e de 36 anos para o grupo da bleomicina. A maioria dos pacientes foi do gênero feminino (68%). Dos 22 pacientes finalizados para o grupo da bleomicina 11 (50,0%) apresentaram cura, enquanto que, dos 21 pacientes finalizados do grupo da eletroquimioterapia associada à bleomicina, 18 pacientes (85,7%) apresentaram cura. Foi observada associação significativa entre os pacientes com ou sem cura e os tratamentos do grupo bleomicina e do grupo eletroquimioterapia associada à bleomicina (teste exato de Fisher; p = 0,022). Nenhum dos pacientes, tanto do grupo da bleomicina, quanto do grupo da eletroquimioterapia associada à bleomicina, apresentou efeitos colaterais sistêmicos. Notou-se que os efeitos colaterais como a necrose hemorrágica e dor moderada ocorreram em maior proporção para os participantes do grupo da eletroquimioterapia associada à bleomicina, com quase 70% do total de 21 pacientes observados. Independentemente da técnica empregada, todos os participantes consideraram os efeitos adversos toleráveis. Conclusão: o uso intralesional da bleomicina associada à eletroporação (eletroquimioterapia), no tratamento das verrugas ungueais (periungueais e subungueais), apresentou cura estatisticamente superior quando comparada ao uso isolado da bleomicina intralesional. Os efeitos colaterais foram mais frequentes no grupo da eletroquimioterapia associada à bleomicina, em relação ao grupo de monoterapia com a bleomicina / Introduction: ungual warts are considered a benign tumor most commonly affecting the nail complex and caused by the human papillomavirus. Most therapeutic options are considered ineffective, with high relapse rates and a potential risk of ungual dystrophy. Bleomycin is a therapeutic option showing good safety profile, and high cure rates. Electrochemotherapy is a technique combining electroporation with the previous injection of a low permeability cytotoxic drug, which increases drug penetration into the cells, and therefore,enhances treatment efficacy. Bleomycin is the most commonly used chemotherapeutic agent in electrochemotherapy because it is an excellent example of cell-membrane non-permeable cytotoxic drug (hydrophilic). Objectives: evaluate the efficacy of electrochemotherapy plus intralesional bleomycin in the treatment of ungual warts in comparison with intralesional bleomycin alone, as well as describe the adverse effects of both techniques. Methodology: the research was a randomized, double-blind, controlled clinical trial. Forty-four 18-60-year-old female and male patients clinically and histologically diagnosed with ungual wart on fingers were included. The study was submitted to and accepted by the Ethics Committee, and all patients signed the Informed Consent Form. Twenty-two patients were treated with intralesional bleomycin alone and 21 with electrochemotherapy associated with intralesional bleomycin. After a single application, patients were followed for 180 days. Cure rate between groups was evaluated by using the Fisher\'s exact test for tables 2 x 2. The software used was XLSTAT 2018. Results: of the 44 included patients, 22 were randomized to the bleomycin group and 21 to the electrochemotherapy plus bleomycin group. One patient of the bleomycin group did not complete the study. Most lesions were located in the periungual region (77.3%), while the remaining 22.7% of lesions were located in the subungual region. Patient\'s mean age was 37 years for the electrochemotherapy plus bleomycin group and 36 years for the bleomycin group. Most patients were females (68%). Of 22 patients in the bleomycin group completing the study, 11 (50%) achieved the cure, while 18 (85.7%) of 21 patients completing the study in the electrochemotherapy plus bleomycin group showed cure. A significant association of patients with or without cure with the treatments received in the bleomycin group and the electrochemotherapy plus bleomycin group (Fisher\'s exact test; p = 0.022). None of the patients in either group had systemic side effects. Local side effects such as hemorrhagic necrosis and moderate pain were observed to occur in a higher proportion for electrochemotherapy plus bleomycin group, with almost 70% of total (21) patients. Regardless the technique used, all participants considered the adverse effects tolerable. Conclusion: the intralesional use of bleomycin associated with electroporation (electrochemotherapy) for the treatment of ungual warts (both periungual and subungual) showed high cure rate when compared with intralesional bleomycin alone. Side effects were more frequently seen in the electrochemotherapy plus bleomycin group than in the bleomycin monotherapy group

Introdução: A síndrome de Cowden é um distúrbio multissistêmico de predisposição a diversos tipos de câncer e padrão de herança autossômica dominante. As lesões cutâneas e viscerais são consideradas proliferações hamartomatosas ou tumores malignos. As lesões mucocutâneas estão presentes em quase 100% dos indivíduos afetados. No entanto, alguns autores consideram que as manifestações mucocutâneas da síndrome de Cowden são, na realidade, verrugas virais em diferentes estágios de evolução. Há poucos estudos sobre manifestações orais da síndrome de Cowden. Objetivos: Estudar as manifestações orais da síndrome de Cowden em 9 pacientes, clínica e histopatologicamente. Métodos: As lesões orais presentes em 9 pacientes com diagnóstico de síndrome de Cowden foram estudadas através de revisão de prontuário, fotografias e biopsias em seus distintos aspectos. Resultados: Todas as lesões biopsiadas mostraram aspectos histopatológicos característico de verrugas virais em diferentes estágios de evolução. Conclusão: Nossos achados parecem reforçar a hipótese de que as manifestações mucocutâneas da síndrome de Cowden representam, na realidade, verrugas virais. Estudos adicionais são necessários para explicar porque esta síndrome, causada por uma mutação de um gene supressor tumoral, poderia causar propensão a verrugas / Background: Cowden disease is a multisystemic cancer predisposition disorder, inherited in a autosomal dominant pattern. Cutaneous and visceral lesions are either malignant tumors or are believed to represent hamartomatous growths. Mucocutaneos lesions are present on almost 100% of affected individuals. Nonetheless, some authors consider that the mucocutaneous manifestations of Cowden disease are, in reality, viral warts at distinct steps of evolution. There are only a few studies regarding the oral manifestation of Cowden disease. Objectives: To study the oral manifestation of Cowden disease in nine patients clinically and histopathologically. Methods: The oral mucosal aspects of nine patients with clinical diagnosis of Cowden disease were studied by reviewing medical charts, photographs and biopsies in their different aspects. Results: All biopsied lesions depicted histopathological aspects suggestive of viral warts at distinct steps of development. Conclusion: Our findings seem to reinforce the poorly understood hypothesis that the mucocutaneous manifestations of Cowden disease are in reality viral warts. Additional studies are needed to explain why a syndrome caused by the mutation of a tumor suppression gene may cause propensity to warts

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, but few studies have examined the progression from HPV infection to disease in men. Genital condyloma are the most common clinical manifestation of HPV infection. Though not associated with mortality, condyloma are a source of emotional distress, and treatment is often painful with a high recurrence rate. The aims of this study were to examine the distribution of HPV types present on the surface of condyloma, estimate the incidence of condyloma overall and after type-specific HPV infections, assess the sociodemographic and sexual behavior factors independently associated with incident condyloma, and examine the concordance between HPV types detected on the surface and in the tissue of condyloma. Participants included 2,487 men from the United States, Brazil, and Mexico who were enrolled in the prospective HPV in Men (HIM) Study and followed every six months for up to four years. At each study visit men completed a computer-assisted-self-administered risk factor questionnaire and samples of healthy penile skin were obtained to test for HPV DNA. A trained clinician examined men for the presence of condyloma and swabbed the surface of lesions to test for HPV DNA. Men were followed for a median of 17.9 months and 112 incident condyloma were identified. Thirty-four external genital lesions were also biopsied to test for HPV within the lesion tissue. PCR was used to test for HPV DNA and Linear Array was used to genotype 13 oncogenic and 24 non-oncogenic HPV types in samples obtained from swabbing the lesion surface. The LiPa assay was used to genotype 20 HPV types in biopsy samples. The Kaplan-Meier method was used to estimate incidence and Cox proportional hazards models were used to examine factors independently associated with incident condyloma. Using biopsy samples as the gold standard, sensitivity and specificity were calculated to examine concordance between HPV types detected on the surface and within the tissue of condyloma. Condyloma incidence was 2.35 per 1,000 person-years. HPV 6 (43.8%), 11 (10.7%), and 16 (9.8%) were the most common types detected on condyloma. The probability of developing condyloma within 24-months of an incident HPV 6/11 infection was 14.6% (95% confidence interval (CI): 7.5-21.1). The median time to condyloma development was 17.1 months (95% CI: 12.4-19.3), with the shortest time to detection observed among men with incident HPV infections with types 6/11 only (6.2 months; 95% CI: 5.6-24.2). Factors associated with condyloma were incident HPV 6/11 infection (hazard ratio (HR) = 12.42; 95% CI: 3.78-40.77), younger age (HR = 0.43; 95% CI: 0.26-0.77; 45-70 vs. 18-30 years), high lifetime number of female partners (HR = 5.69; 95% CI: 1.80-17.97); 21 or greater vs. 0), and sexual behaviors in the previous three months including infrequent condom use (HR = 2.44; 95% CI: 1.16-5.14;

Introdução: A síndrome de Cowden é um distúrbio multissistêmico de predisposição a diversos tipos de câncer e padrão de herança autossômica dominante. As lesões cutâneas e viscerais são consideradas proliferações hamartomatosas ou tumores malignos. As lesões mucocutâneas estão presentes em quase 100% dos indivíduos afetados. No entanto, alguns autores consideram que as manifestações mucocutâneas da síndrome de Cowden são, na realidade, verrugas virais em diferentes estágios de evolução. Há poucos estudos sobre manifestações orais da síndrome de Cowden. Objetivos: Estudar as manifestações orais da síndrome de Cowden em 9 pacientes, clínica e histopatologicamente. Métodos: As lesões orais presentes em 9 pacientes com diagnóstico de síndrome de Cowden foram estudadas através de revisão de prontuário, fotografias e biopsias em seus distintos aspectos. Resultados: Todas as lesões biopsiadas mostraram aspectos histopatológicos característico de verrugas virais em diferentes estágios de evolução. Conclusão: Nossos achados parecem reforçar a hipótese de que as manifestações mucocutâneas da síndrome de Cowden representam, na realidade, verrugas virais. Estudos adicionais são necessários para explicar porque esta síndrome, causada por uma mutação de um gene supressor tumoral, poderia causar propensão a verrugas / Background: Cowden disease is a multisystemic cancer predisposition disorder, inherited in a autosomal dominant pattern. Cutaneous and visceral lesions are either malignant tumors or are believed to represent hamartomatous growths. Mucocutaneos lesions are present on almost 100% of affected individuals. Nonetheless, some authors consider that the mucocutaneous manifestations of Cowden disease are, in reality, viral warts at distinct steps of evolution. There are only a few studies regarding the oral manifestation of Cowden disease. Objectives: To study the oral manifestation of Cowden disease in nine patients clinically and histopathologically. Methods: The oral mucosal aspects of nine patients with clinical diagnosis of Cowden disease were studied by reviewing medical charts, photographs and biopsies in their different aspects. Results: All biopsied lesions depicted histopathological aspects suggestive of viral warts at distinct steps of development. Conclusion: Our findings seem to reinforce the poorly understood hypothesis that the mucocutaneous manifestations of Cowden disease are in reality viral warts. Additional studies are needed to explain why a syndrome caused by the mutation of a tumor suppression gene may cause propensity to warts

The aim of this diploma thesis is to study and design experimental improvement of the convolutional neural network for disease detection. Another goal is to extend the classifier with a new type of detection. he new type of detection is damage fingerprint by pressure. The experimentally improved convolutional network is implemented by PyTorch. The network detects which part of the fingerprint is damaged and draws this part into the fingerprint. Synthetic fingerprints are used when training the net. Real fingerprints are added to the synthetic fingerprints.