HPV DNA testing with cytology triage in cervical cancer screening: Influence of revealing HPV infection status

BACKGROUND: Knowledge of cervical human papillomavirus (HPV) status might influence a cytotechnician's assessment of cellular abnormalities. The authors compared original cytotechnicians' Papanicolaou (Pap) readings for which HPV status was concealed with Pap rereads for which HPV status was revealed separately for 3 screening populations. METHODS: Previously collected cervical Pap smears and clinical data were obtained from the Canadian Cervical Cancer Screening Trial (study A), the Democratic Republic of Congo Community-Based Screening Study (study B), and the Brazilian Investigation into Nutrition and Cervical Cancer Prevention (study C). Smears were reread with knowledge of HPV status for all HPV-positive women as well as a sample of HPV-negative women. Diagnostic performance of Pap cytology was compared between original readings and rereads. RESULTS: A total of 1767 Pap tests were reread. Among 915 rereads for HPV-positive women, the contrast between "revealed" and "concealed" Pap readings demonstrated revisions from negative to positive results for 109 women (cutoff was atypical squamous cells of undetermined significance or worse) and 124 women (cutoff was low-grade squamous intraepithelial lesions [LSIL] or worse). For a disease threshold of cervical intraepithelial neoplasia of grade 2 or worse, specificity significantly declined at the atypical squamous cells of undetermined significance cutoff for studies A (86.6% to 75.3%) and C (42.5% to 15.5%), and at the LSIL cutoff for study C (61.9% to 37.6%). Sensitivity remained nearly unchanged between readings, except in study C, in which reread performance was superior (91.3% vs 71.9% for the LSIL cutoff). CONCLUSIONS: A reduction in the diagnostic accuracy of Pap cytology was observed when revealing patients' cervical HPV status, possibly due to a heightened awareness of potential abnormalities, which led to more false-positive results. Cancer (Cancer Cytopathol) 2015. (c) 2015 American Cancer Society.

Ensino, aprendizagem e avaliação no Ensino Superior: Perspetivas e práticas

Tese de Doutoramento em Ciências da Educação - Especialidade de Desenvolvimento Curricular

Povoamento e paisagens no Vale Superior do Rio Terva, Boticas: projecto de investigação plurianual em arqueologia (PoPaTERVA 2013-2016): trabalhos arqueológicos no povoado das Batocas: relatório 2013-2014

O relatório que se apresenta respeita aos trabalhos arqueológicos desenvolvidos entre 2013 e 2014, inscritos no Projeto de Investigação Plurianual de Arqueologia (adiante PIPA) “Povoamento e Paisagens no Vale Superior do Rio Terva, Boticas – PoPaTERVA 2013-2016”, oportunamente aprovado pela Direção Geral do Património Cultural (DGPC: ofício n.º 2013/1 (169) CS: 875795 informação n.º 1704/DBC/2013). O projeto Povoamento e Paisagens no Vale Superior do Rio Terva, Boticas/ PoPaTERVA surge na sequência da conclusão do projeto de Conservação, Estudo, Valorização e Divulgação do Complexo Mineiro Antigo do Vale Superior do Rio Terva, Boticas, concebido em 2006 pela UAUM e executado entre 2010 e 2012 no âmbito de protocolo estabelecido com a Câmara Municipal de Boticas. Desta primeira ação de investigação resultou a classificação do Complexo Mineiro Antigo do Vale Superior do Rio Terva como Sítio de Interesse Público, promulgado pela Portaria n.º 386/2013 (DR, 2.º Série, n.º 115 de 18 de Junho de 2013 – ver Apêndice 7.1.2).

Povoamento e paisagens no Vale Superior do Rio Terva, Boticas: projecto de investigação plurianual em arqueologia (PoPaTERVA 2013-2016): trabalhos arqueológicos no Castro de Sapelos: relatório 2014

O presente relatório enquadra-se na execução do Projeto PoPaTERVA 2013-2016, um projeto PIPA aprovado pela DGPC em 2013 (oficio nº 06922, de 04-07-13. Ref. 2013/1 (169) CS 875795). Para o corrente ano de 2014 pretendemos dar continuidade às investigações decorrentes da implementação do projeto referido anteriormente, iniciando assim o estudo em pormenor do Castro de Sapelos. Os trabalhos arqueológicos foram iniciados a 1 de Julho e terminaram no mês de Dezembro, contaram com a participação de 4 jovens voluntários do programa municipal Boticas Mexe.

Alunos excelentes, alunos promissores? A questão dos alunos de mérito académico no ensino superior

A temática da sobredotação tem suscitado interesse por parte da comunidade científica e educativa, sendo que também se tem assistido, nos últimos anos, a um investimento no estudo da excelência humana, incluindo-se a excelência académica. A premissa de que os alunos universitários de mérito académico podem constituir um capital social importante, que deve ser reconhecido, coloca desafios ao contexto educativo para estimular a realização do potencial do aluno e promover o seu desenvolvimento através da concretização de um projeto vocacional. Ao longo deste trabalho procura-se refletir, do ponto de vista teórico, sobre as caraterísticas dos alunos de mérito escolar, no ensino superior, apresentando conceitos e modelos explicativos das altas habilidades e da realização académica excelente, e discutindo algumas possíveis práticas educativas. Finaliza-se com a apresentação de algumas sugestões para um maior investimento na área a nível do ensino superior português

Rendimento académico elevado e caraterísticas psicológicas associadas: diferenciação dos alunos de mérito académico no ensino superior

O talento académico, reconhecido algumas vezes pela atribuição de prémios de mérito aos alunos com desempenhos escolares excelentes, representa um potencial importante disponível em cada país, sendo que a transformação da excelência académica em sucesso profissional tem estimulado algum investimento da comunidade científica. Neste projeto, pretende-se validar um questionário de autorrelato (Scaeger et al, 2012), construído a partir das três componentes base do comportamento sobredotado e criativo segundo Renzulli (2005): habilidades, criatividade e motivação, o qual na versão portuguesa aparece com a denominação de Inventário de Caraterísticas Psicológicas Associadas ao Desempenho Académico (ICPADA). A amostra é constituída por 1366 alunos, do 1º ciclo do ensino superior português, e distribuídos por 3 áreas de saber: Ciências e Tecnologias; Ciências Sociais e Humanas; Artes e Humanidades. Apresentam-se os resultados da análise fatorial exploratória, bem como os valores de alfa de Cronbach, os quais se revelam adequados. Os resultados nas 6 dimensões do ICPADA - Cognitivo-criativa, Motivação e Estratégias de Aprendizagem, Persistência, Interação Social, Procura de Excelência e Interesse Cultural - apontam para uma diferenciação dos alunos do grupo de mérito escolar, em relação aos colegas, em todas as dimensões analisadas, exceto na dimensão Interação Social. Discutem-se algumas formas de intervenção com os alunos de excelência académica neste nível de ensino, bem como futuras investigações sobre a temática

Clinical characteristics of women diagnosed with carcinoma who tested positive for cervical and anal high-risk human papillomavirus DNA and E6 RNA

High-risk human papillomavirus (hrHPV) is an essential cause of cervical carcinoma and is also strongly related to anal cancer development. The hrHPV E6 oncoprotein plays a major role in carcinogenesis. We aimed to evaluate the frequency of hrHPV DNA and E6 oncoprotein in the anuses of women with cervical carcinoma. We analyzed 117 women with cervical cancer and 103 controls for hrHPV and the E6 oncogene. Positive test results for a cervical carcinoma included 66.7 % with hrHPV-16 and 7.7 % with hrHPV-18. One case tested positive for both HPV variants (0.9 %). The samples from the anal canal were positive for HPV-16 in 59.8 % of the cases. Simultaneous presence of HPV in the cervix and anal canal was found in 53.8 % of the cases. Regarding expression of E6 RNA, positivity for HPV-16 in the anal canal was found in 21.2 % of the cases, positivity for HPV-16 in the cervix was found in 75.0 %, and positivity for HPV-18 in the cervix was found in 1.9 %. E6 expression in both the cervix and anal canal was found in 19.2 % of the cases. In the controls, 1 % tested positive for HPV-16 and 0 % for HPV-18. Anal samples from the controls showed a hrHPV frequency of 4.9 % (only HPV16). The presence of hrHPV in the anal canal of women with cervical cancer was detected at a high frequency. We also detected E6 RNA expression in the anal canal of women with cervical cancer, suggesting that these women are at risk for anal hrHPV infection.

Inclusão no ensino superior: modelos de atuação e contributos dos serviços de apoio em Portugal

A inclusão de estudantes com deficiência na Universidade tem desafiado as instituições a responderem às demandas de acesso e permanência específicas destes estudantes. Neste artigo analisaremos como estão organizadas as iniciativas institucionais de inclusão, tomando como objeto os serviços de apoio na universidade e os desafios explicitados pelos responsáveis dos setores. Participaram do estudo três responsáveis técnicas pelos serviços de inclusão em três universidades portuguesas. Os dados foram recolhidos por meio de entrevista semiestruturada e analisados numa abordagem exploratória. Os resultados apontam para o desafio de proporcionar, para além das condições de acesso, a qualificação das condições de permanência que possam resultar em experiências exitosas dos estudantes, ampliando a oportunidades de obter autonomia e sucesso académico. A partir da discussão, apresentaremos considerações que podem constituir indicadores de intervenção e, ainda, temas para investigações futuras que possam contribuir para práticas mais adequadas de atendimento a esse grupo de estudantes.

MMP-9/RECK imbalance: a mechanism associated with high-grade cervical lesions and genital infection by Human Papillomavirus (HPV) and Chlamydia trachomatis

"Manuscript"

Human papillomavirus (HPV) screening and cervical cancer burden. A Brazilian perspective

This review tackles the issues related to disease burden caused by cervical cancer (CC) and its precursor (CIN) lesions in Brazil. A special focus is given to new technologies with potential to interfere with the development of CC by reducing the high-risk human papillomavirus (hr-HPV)-induced lesions that remain a major public health burden in all developing countries where organized screening programs do not exist. Globally, 85 % of all incident CC and 50 % of CC deaths occur in the developing countries. Unfortunately, most regions of Brazil still demonstrate high mortality rates, ranking CC as the second most common cancer among Brazilian women. Recently, CC screening programs have been tailored in the country to enable early detection of CC precursor lesions and thereby reduce cancer mortality. A combination of HPV testing with liquid-based cytology (LBC) seems to be a promising new approach in CC screening, with high expectation to offer an adequate control of CC burden in this country.

High-level of viral genomic diversity in cervical cancers: a Brazilian study on human papillomavirus type 16

Invasive cervical cancer (ICC) is the third most frequent cancer among women worldwide and is associated with persistent infection by carcinogenic human papillomaviruses (HPVs). The combination of large populations of viral progeny and decades of sustained infection may allow for the generation of intra-patient diversity, in spite of the assumedly low mutation rates of PVs. While the natural history of chronic HPVs infections has been comprehensively described, within-host viral diversity remains largely unexplored. In this study we have applied next generation sequencing to the analysis of intra-host genetic diversity in ten ICC and one condyloma cases associated to single HPV16 infection. We retrieved from all cases near full-length genomic sequences. All samples analyzed contained polymorphic sites, ranging from 3 to 125 polymorphic positions per genome, and the median probability of a viral genome picked at random to be identical to the consensus sequence in the lesion was only 40%. We have also identified two independent putative duplication events in two samples, spanning the L2 and the L1 gene, respectively. Finally, we have identified with good support a chimera of human and viral DNA. We propose that viral diversity generated during HPVs chronic infection may be fueled by innate and adaptive immune pressures. Further research will be needed to understand the dynamics of viral DNA variability, differentially in benign and malignant lesions, as well as in tissues with differential intensity of immune surveillance. Finally, the impact of intralesion viral diversity on the long-term oncogenic potential may deserve closer attention.

Historical analysis of the Brazilian cervical cancer screening program from 2006 to 2013: a time for reflection

BACKGROUND: The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013. MATERIAL AND METHODS: The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change. RESULTS: We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually. CONCLUSIONS: The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.

Reprogramming energy metabolism and inducing angiogenesis : co-expression of monocarboxylate transporters with VEGF family members in cervical adenocarcinomas

Reprogramming energy metabolism and inducing angiogenesis: co-expression of monocarboxylate transporters with VEGF family members in cervical adenocarcinomas.

Recommendations on quality control and quality assurance in cervical cytology

Objective: We aimed to critically evaluate the importance of quality control (QC) and quality assurance (QA) strategies in the routine work of uterine cervix cytology. Study Design: We revised all the main principles of QC and QA that are already being implemented worldwide and then discussed the positive aspects and limitations of these as well as proposing alternatives when pertinent. Results: A literature review was introduced after highlighting the main historical revisions, and then a critical evaluation of the principal innovations in screening programmes was conducted, with recommendations being postulated. Conclusions: Based on the analysed data, QC and QA are two essential arms that support the quality of a screening programme.

O reforço da proteção do superior interesse da criança através da adoção por casais do mesmo sexo

Dissertação de mestrado em Direito das Crianças, Família e Sucessões