Sexuality and quality of life of breast cancer patients post mastectomy

Aim: To evaluate the sexual functioning of breast cancer patients post mastectomy and its association with their quality of life, the personal characteristics of women and their partners, breast reconstruction, cancer staging and adjuvant therapies. Methods: A cross-sectional study was carried out in a University hospital located in the SouthEast of Brazil. A total of 100 women were included in the study. The parameters evaluated were sexual functioning, which was assessed based on the Sexual Quotient Female Version (SQ-F), quality of life (QoL), evaluated by the Medical Outcomes Study 36-item Short Form (SF-36), cancer staging, breast reconstruction, adjuvant therapies and the personal characteristics of patients (age, years of study and years of marriage) and their partners (age, years of study). Results: The majority (40.48%) of women had an unfavorable to regular SQ-F score. A significant positive correlation (p < 0.05) was found between the SQ-F score and years of education (p = 0.03), and the following SF-36 domains: functional capacity (p = 0.03), vitality (p = 0.06), emotional limitations (p = 0.00) and mental health (p = 0.03). A significant negative correlation was found between SQ-F score and the age of the partners (p = 0.03). SQ-F mean value was significantly higher (p = 0.04) among women who underwent breast reconstruction. Conclusions: Women with low educational level, who have older partners, and who did not have a breast reconstruction should receive special attention with respect to their sexuality, and the effects of mastectomy on the sexuality of patients should be assessed. Oncology nurses are best qualified to recognize issues related to sexuality and quality of life, and can offer specific and meaningful support for breast cancer patients. (C) 2010 Elsevier Ltd. All rights reserved.

Molecular evidence of horizontal transmission of hepatitis C virus within couples

Hepatitis C virus (HCV) transmission has decreased with the adoption of universal blood donor screening and social policies to reduce the risk of infection in intravenous drug users, but remains a worldwide health problem. The objective of this study was to evaluate the phylogenetic relationships among sequences from different HCV genomic regions from sexual partners of infected patients. Nine couples with a stable relationship and without other risk factors for HCV infection and 42 control patients were selected, and the NS3 and NS5B regions were analysed. Phylogenetic analysis showed that viruses from five of the couples had a common origin, clustering in the same monophyletic group, with bootstrap values greater than 70. For the other couples, monophyletic groups were observed, but without bootstrap support. Thus, using two different viral genome regions, a common source of infection was observed in both members of five couples. These data strongly support HCV transmission within couples.

Seroprevalence of Human Papillomavirus 6, 11, 16, and 18 in Young Primiparous Women in Sao Paulo, Brazil

Introduction: Data on epidemiology of HPV infection are needed for the development of human papillomavirus (HPV) vaccine recommendations, especially in countries where HPV vaccination is not yet included in public vaccination programs. The aim of this study was to determine the prevalence of serum antibodies to HPV types 6, 11, 16, and 18 and associated factors among young women after birth of the first child. Methods: This cross-sectional study was carried out in a large public maternity hospital in Sao Paulo, Brazil. Three hundred one women aged 15 to 24 years who gave birth to their first child were recruited between 43 and 60 days after delivery. Seroprevalence was performed using a type-specific enzyme-linked immunosorbent assay based on HPV Late protein 1 viruslike particles. The association of seroreactivity with these 4 HPV types with selected demographic and behavioral factors was assessed by Generalized Linear Model analysis. Results: Fifty-eight (19.3%) women (95% confidence interval, 15.0%-24.2%) had antibodies to any of the 4 viruslike particles tested. The overall seroprevalence rates of the HPV types were: HPV16, 9.0%; HPV18, 7.0%; and HPV 6+11, 7.7%, which are targeted by the HPV prophylactic vaccines. In the multivariate analysis, only age (inversely, P = 0.044 for trend) and previous sexually transmitted disease (P = 0.008) were 2 factors independently associated with HPV seropositivity. Conclusions: These data offer additional information on the epidemiology of HPV in a group of young Brazilian women after first delivery and contribute to establish a baseline of HPV seroprevalence against which post-HPV vaccine era seroprevalence can be compared.

Hypoactive sexual desire disorder in a population-based study of Brazilian women: associated factors classified according to their importance

Objective: The etiology of hypoactive sexual desire disorder (HSDD) is known to be multifactorial, involving biological, psychosexual, and context-related factors. The objective of the present study was to analyze the factors associated with female HSDD and to stratify these factors according to their importance. Methods: This was a population-based, hierarchical study conducted in Brazil, based on data from previous research on the Brazilian Sexual Life Study, conducted between November 2002 and February 2003 in various Brazilian cities. The primary study consisted of a self-administered and anonymous questionnaire, addressing sociodemographic parameters, general health, life habits, behavior, and complaints related to sexual function. The association between HSDD and various other factors was assessed. The data were evaluated by hierarchical multiple regression analysis. Results: The prevalence of HSDD in this sample was 9.5%. Associations were found with cardiovascular disease, breast cancer, posttraumatic stress, poorer education level, being older, being married, a lack of information on sexuality in childhood/adolescence, and a limited sexual repertoire. Women who consumed moderate amounts of alcohol were found to be less likely to have HSDD. Conclusions: Analysis of the associated factors classified in order of importance and analysis of the characteristics of the sexual relationships provide additional information to currently available data on the traditional concepts of HSDD.

Erectile Dysfunction and Correlated Factors in Brazilian Men Aged 18-40 years

Introduction. Few population-based studies in erectile dysfunction (ED) included subjects less than 40 years old and analyzed the several factors and consequences potentially associated with this condition. Aim. Evaluation of the prevalence of erectile dysfunction (ED) and associated factors in a sample of Brazilian men aged 18 to 40 years old. Methods. Cross-sectional study in which subjects were contacted in public places of 18 major Brazilian cities and interviewed using an anonymous questionnaire. Survey data were submitted to chi-squared, student`s t-test and logistic regression analyses. Main Outcome Measures. The data were collected by means of a self-administered questionnaire with 87 questions about sociodemographic variables, general health, habits and lifestyle-related factors, sexual behavior and sexual difficulties, including ED which was assessed by a single question. Results. Prevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete). Greater frequency of ED was seen in subjects that never had information about sex, experienced difficulties in the beginning of sexual life and have never masturbated. ED was associated to lower level of education, but not to race, sexual orientation, employment or marital status. Also, no association was found between ED and smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, hyperlipidemia, depression or anxiety. ED caused negative impact in men`s self-esteem, interpersonal relationships, work and leisure activities, and in sexual life satisfaction. Less than 10% of men with ED had received medical treatment for this problem. Conclusions. Prevalence of ED in this young population was high, mostly of mild severity. Low education and psychosocial problems were associated to ED and, due probably to the sample subjects` young age, no association was found with organic problems. Measures in the fields of education and psychosocial difficulties prevention would have a positive impact in the control of erectile dysfunction in the young population. Martins FG, and Abdo CHN. Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years. J Sex Med 2010;7:2166-2173.

Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both

Introduction. Sexual satisfaction is linked to life satisfaction, and erectile dysfunction (ED) may lead to an impaired quality of life (QOL). Aim. Our goal was to evaluate the QOL among Brazilian patients with ED, before and after three kinds of treatment. Methods. Men aged 25-55 years, with a diagnosis of psychogenic or mixed ED, according to the Classification of Mental and Behavioral Disorders of the International Classification of Diseases, 10th edition, and the Standard Practice in Sexual Medicine, were randomly assigned to three treatment groups: counseling, sildenafil, and sildenafil plus counseling. At baseline each group had 40 patients. Sildenafil was provided in 50 mg that could be adjusted to 100 mg. The patients could initially take one to two tablets per week and the entire treatment lasted for 3 months. Counseling was provided in group sessions that took place once a week. They were evaluated at baseline and after 3 months of treatment with the Male Sexual Quotient (MSQ) and the Sexual Health Inventory for Men (SHIM). Main Outcome Measures. The correlation between the patients` MSQ score and scores on the SHIM. Results. One hundred seventeen patients were enrolled. The three groups were similar according to age, marital status, mean time of ED, and ED severity and etiology. At baseline, MSQ and SHIM total scores were not different among the three groups. MSQ scores increased from 41.2 +/- 15.3, 38.7 +/- 18.0, and 46.8 +/- 17.0 to 48.5 +/- 15.3, 63.8 +/- 21.6, and 70.0 +/- 17.3 after counseling, sildenafil, and sildenafil plus counseling, respectively (P < 0.05). SHIM scores also increased significantly (9.6 +/- 4.1, 9.7 +/- 4.1, and 10.2 +/- 3.9 to 12.1 +/- 3.9, 16.7 +/- 5.6, and 17.7 +/- 4.5 after counseling, sildenafil, and sildenafil plus counseling, respectively) (P < 0.05). There were no serious adverse events related to sildenafil, and no patient was withdrawn from the study because of an adverse event. Conclusions. The three treatments were significantly efficient, and the best treatment was sildenafil associated with counseling.

Sexual Dysfunction Treatment in a Patient With Mullerian Agenesy Submitted to Neovaginoplasty: A Case Report

Vagina agenesis is a rare entity. Mayer-Rokitansky-Kuster-Hauser syndrome is the most significant cause of vagina agenesis, whereas the second most common cause is complete androgen syndrome. Surgical treatment can propitiate a vaginal reconstruction, but sexual function depends on several factors that affect sexual performance. Many reports focus on the intraoperative and postoperative results and only describe the global approach to these patients, but reports focusing on the management of these patients to enable them to have a normal sexual life are lacking. This case report highlights a multidisciplinary treatment for this kind of morbidity and emphasizes the necessity of incorporating careful attention to sexual health in the treatment of these patients so that they may achieve a good therapeutic response, resulting in a pleasurable sexual life and a good quality of living.

Expression and characterization of HPV-16 L1 capsid protein in Pichia pastoris

Human papillomaviruses (HPVs) are responsible for the most common human sexually transmitted viral infections. Infection with high-risk HPVs, particularly HPV16, is associated with the development of cervical cancer. The papillomavirus L1 major capsid protein, the basis of the currently marketed vaccines, self-assembles into virus-like particles (VLPs). Here, we describe the expression, purification and characterization of recombinant HPV16 L1 produced by a methylotrophic yeast. A codon-optimized HPV16 L1 gene was cloned into a non-integrative expression vector under the regulation of a methanol-inducible promoter and used to transform competent Pichia pastoris cells. Purification of L1 protein from yeast extracts was performed using heparin-sepharose chromatography, followed by a disassembly/reassembly step. VLPs could be assembled from the purified L1 protein, as demonstrated by electron microscopy. The display of conformational epitopes on the VLPs surface was confirmed by hemagglutination and hemagglutination inhibition assays and by immuno-electron microscopy. This study has implications for the development of an alternative platform for the production of a papillomavirus vaccine that could be provided by public health programs, especially in resource-poor areas, where there is a great demand for low-cost vaccines.

Drug targets and mechanisms of resistance in the anaerobic protozoa

The anaerobic protozoa Giardia duodenalis, Trichomonas vaginalis, and Entamoeba histolytica infect up to a billion people each year. G. duodenalis and E. histolytica are primarily pathogens of the intestinal tract, although E. histolytica can form abscesses and invade other organs, where it can be fatal if left untreated. T. vaginalis infection is a sexually transmitted infection causing vaginitis and acute inflammatory disease of the genital mucosa. T. vaginalis has also been reported in the urinary tract fallopian tubes, and pelvis and can cause pneumonia, bronchitis, and oral lesions. Respiratory infections can be acquired perinatally. T. vaginalis infections have been associated with preterm delivery, low birth weight, and increased mortality as well as predisposing to human immunodeficiency virus infection, AIDS, and cervical cancer. All three organisms lack mitochondria and are susceptible to the nitroimidazole metronidazole because of similar low-redox-potential anaerobic metabolic pathways. Resistance to metronidazole and other drugs has been observed clinically and in the laboratory. Laboratory studies have identified the enzyme that activates metronidazole, pyruvate:ferredoxin oxidoreductase, to its nitroso form and distinct mechanisms of decreasing drug susceptibility that are induced in each organism. Although the nitroimidazoles have been the drug family of choice for treating the anaerobic protozoa, G. duodenalis is less susceptible to other antiparasitic drugs, such as furazolidone, albendazole, and quinacrine. Resistance has been demonstrated for each agent and the mechanism of resistance has been investigated. Metronidazole resistance in T. vaginalis is well documented, and the principal mechanisms have been defined Bypass metabolism, such as alternative oxidoreductases, have been discovered in both organisms. Aerobic versus anaerobic resistance in T. vaginalis is discussed. Mechanisms of metronidazole resistance in E. histolytica have recently been investigated ruing laboratory-induced resistant isolates. Instead of downregulation of the pyruvate:ferredoxin oxidoreductase and ferredoxin pathway as seen in G. duodenalis and T. vaginalis, E. histolytica induces oxidative stress mechanisms, including superoxide dismutase and peroxiredoxin. The review examines the value of investigating both clinical and laboratory-induced syngeneic drug-resistant isolates and dissection of the complementary data obtained. Comparison of resistance mechanisms in anaerobic bacteria and the parasitic protozoa is discussed as well as the value of studies of the epidemiology of resistance.

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Braquiterapia prost��tica: morbilidade urin��ria e sexual

RESUMO: Objectivos 1. Avaliar a morbilidade urin��ria e sexual secund��ria �� braquiterapia prost��tica com implante de I125. 2. Avaliar a influ��ncia da hormonoterapia neoadjuvante e adjuvante na morbilidade urin��ria e sexual secund��ria �� braquiterapia(I125). 3. Avaliar a influ��ncia da associa����o da radioterapia externa na morbilidade urin��ria e sexual secund��ria �� braquiterapia(I125). 4. Avaliar a morbilidade urin��ria dos doentes com contra-indica����o relativa (pr��statas volumosas, IPSS elevado).Material e m��todos De Setembro de 2000 a Dezembro de 2004 foram recrutados 204 doentes com o diagn��stico de carcinoma da pr��stata localizado (T1 e T2) ou localmente avan��ado (T3) e expectativa de vida superior a 10 anos. Foram submetidos a braquiterapia, com implante transperineal de Iodo 125 (I125) em monoterapia ou combinada com hormonoterapia e/ou radioterapia externa (tratamento trimodal). Definiram-se diversos sub-grupos de pacientes, consoante algumas caracter��sticas habitualmente referidas como factores de risco para a morbilidade do tratamento de braquiterapia prost��tica, com o objectivo de analisar a sua influ��ncia sobre a morbilidade urin��ria e sexual: Grupo 1: Braquiterapia em monoterapia (MONO) versus braquiterapia associada a radioterapia externa (BCOMB) Grupo 2: Pr��statas volumosas (>50ml) versus pr��statas n��o volumosas (<50ml)Grupo 3: Braquiterapia associada a hormonoterapia (HORM) versus braquiterapia sem hormonoterapia (NHORM)Grupo 4: IPSS elevado versus IPSS baixo Avaliou-se a evolu����o do IPSS, QoL, taxa de RTU-P e reten����o urin��ria p��s implante, e evolu����o do BSFI durante todo o per��odo de seguimento. Resultados Grupo 1: Para o grupo MONO o IPSS iniciou-se com 7.1, sofreu agravamento para 16.1 e 15.9 ao primeiro e terceiro meses. Aos 12 meses, o IPSS desceu para 10.1 enquanto que, aos 18 e 24 meses, o IPSS foi de 7.3 e 5.8. O grupo BCOMB iniciou com IPSS de 9.4. Sofreu agravamento ligeiro e pouco acentuado at�� aos 6 meses (IPSS de 14). A evolu����o do IPSS foi, ent��o, flutuante com IPSS de 5.9 aos 12 meses e 9.5 aos 18 meses. Aos 24 meses apresentava IPSS de 6.7. A taxa de reten����o urin��ria (6.4% e 0%) e de RTU-P (2.0% e 0%) foram semelhantes nos grupos MONO e BCOMB, respectivamente (p=0.375 e p=1). A evolu����o da qualidade das erec����es foi semelhante nos dois grupos excepto aos 6 meses em que MONO apresentou o valor 6 e BCOMB 3.7 (p=0.029). A percentagem de doentes potentes foi significativamente inferior nos primeiros 6 meses ap��s a braquiterapia para o grupo BCOMB relativamente ao grupo MONO: 36%���74%; 33%���73%; 33%���75%. Ap��s os 6 meses os grupos foram homog��neos. Grupo 2: O IPSS evoluiu nas pr��statas <50ml e >50ml de 7���9 para 15-19 ao primeiro m��s e 15-18 ao 3.�� m��s. Apenas ao primeiro m��s �� que as diferen��as no IPSS foram significativas (p=0.061). Ap��s o 3.�� m��s os dois grupos foram semelhantes: IPSS de 8 e 12 ao 12.�� m��s e 5.7 e 6 ao 24.�� m��s. As taxas de reten����o urin��ria e de RTU-P foram semelhantes (p=0.054 e p=0.286) Grupo 3: A evolu����o do IPSS, taxas de reten����o urin��ria e de RTU-P foram sobrepon��veis em ambos os grupos. A evolu����o da l��bido, erec����es, percentagem de doentes potentes, ejacula����o, inc��modo e satisfa����o foi significativamente inferior no grupo HORM relativamente ao grupo N HORM apenas ao primeiro m��s (valores de p<0.0001; <0.0001; < 0.0001; 0.009 e 0.002 respectivamente) Grupo 4: A evolu����o do IPSS nos doentes com IPSS elevado foi a seguinte: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) A evolu����o do IPSS nos doentes com IPSS baixo foi a seguinte: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) As taxas de RTU-P (2.8% e 0%) e reten����o urin��ria (5.1% e 5.9%) foram semelhantes em ambos os grupos de doentes (p=1). Conclus��es 1. A radioterapia intersticial da pr��stata com implante transperineal e ecoguiado de Iodo 125 �� frequentemente acompanhada de morbilidade urin��ria transit��ria e de intensidade moderada. A Morbilidade consiste em sintomatologia do aparelho urin��rio baixo (���LUTS ��� lower urinary tract symptoms���) que, na maioria dos doentes, sofre um agravamento m��ximo do primeiro ao 3.�� m��s. Segue-se uma melhoria ligeira at�� ao 6.�� m��s que �� mais acentuada da�� em diante. Por volta do 12.�� e 18.�� m��s, a maior parte dos doentes apresenta sintomatologia urin��ria muito semelhante �� que apresentava antes do tratamento. Ap��s o 18.�� m��s, os doentes mant��m uma melhoria da sintomatologia urin��ria para al��m da que apresentavam previamente ao implante. As taxas de reten����o urin��ria e de ressec����o transuretral prost��tica ap��s o implante de braquiterapia s��o muito baixas, inferiores a 10%. 2. A associa����o da braquiterapia prost��tica com radioterapia externa adjuvante influencia a evolu����o da sintomatologia urin��ria: o aparecimento da sintomatologia urin��ria �� mais lento, demorando 6 meses a atingir o seu valor m��ximo que, por sua vez, �� de intensidade menos acentuada do que quando a braquiterapia �� utilizada em monoterapia. 3. O volume prost��tico superior a 50 ml n��o influencia a morbilidade urin��ria. 4. A terap��utica hormonal, neoadjuvante e adjuvante, n��o influencia a sintomatologia urin��ria. 5. Os doentes com sintomatologia urin��ria pr��via muito acentuada n��o sofrem agravamento da referida sintomatologia. Pelo contr��rio, apresentam uma melhoria de sintomas urin��rios desde o primeiro m��s, e que se mant��m ao longo dos 24 meses de seguimento, apresentando, no final deste per��odo, sintomatologia urin��ria ligeira e muito inferior �� que apresentavam antes do implante. As taxas de reten����o urin��ria e RTU-P ap��s a braquiterapia s��o semelhantes ��s que ocorrem nos doentes assintom��ticos previamente ao implante. 6. A vida sexual est�� preservada, em mais de 70% dos casos, ao fim dos 24 meses de seguimento. No entanto, imediatamente ap��s o primeiro m��s de seguimento, ocorre uma diminui����o ligeira da qualidade das erec����es que se mant��m, sem melhoria ou agravamento, durante todo o per��odo de seguimento. A hormonoterapia afecta todos os par��metros da vida sexual, embora de forma apenas tempor��ria. Ap��s a suspens��o da terap��utica hormonal este grupo de doentes recupera a actividade sexual e apresenta-se id��ntico ao grupo de doentes que n��o foram sujeitos a essa terap��utica.----------------ABSTRACT: Objectives 1. To assess urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 2. To assess the influence of neoadjuvant and adjuvant hormone therapy in urinary and sexual morbility after prostatic brachytherapy with the implant of I125 seeds. 3. To assess the effects, on urinary and sexual morbility, of associating external radiotherapy after prostatic brachytherapy with the implant of I125 seeds. 4. To assess the urinary morbility in patients with relative contraindications (voluminous prostates, high IPSS). Material and Methods From September, 2000 to December, 2004 a total of 204 patients were recruited with a diagnosis of localized (T1 and T2) or locally advanced (T3) carcinoma of the prostate and a life expectancy in excess of 10 years. The patients underwent brachytherapy with transperineal seed implant of iodine (I125) as a monotherapy or in combination with hormone therapy and/or external radiotherapy (trimodal treatment). With the aim of evaluating the treatment���s influence on urinary and sexual morbility, a number of patient sub-groups were defined in accordance with certain characteristics normally mentioned as morbility risk factors for prostatic brachytherapy treatment: Group 1: Brachytherapy as monotherapy (MONO) versus brachytherapy in combination with external radiotherapy (BCOMB) Group 2: Voluminous prostates (>50ml) versus non- voluminous prostates (<50ml) Group 3: Brachytherapy in combination with hormone therapy (HORM) versus brachytherapy without hormone therapy (NHORM)Group 4: High IPSS versus a low IPSS. The evolution of the IPSS, QoL, TURP rate and post-implant urinary retention as well as the BSFI were assessed throughout the entire follow-up period. Results Group 1: For the MONO group the IPSS began at 7.1, and then rose to 16.1 and 15.9 in the first and third months, respectively. At month 12, the IPSS had dropped to 10.1 and at month 18 and 24 the IPSS was registered at 7.3 and 5.8, respectively. The BCOMB group started out with an IPSS of 9.4. It underwent a slight and little-significant rise until month 6 (IPSS at 14). The evolution of the IPSS then began to fluctuate from an IPSS of 5.9 at month 12 and 9.5 at month 18. At month 24 we registered an IPSS of 6.7. The urinary retention rate (6.4% and 0%) and TURP rate (2.0% e 0%) were similar to those of the MONO and BCOMB groups, respectively (p=0.375 and p=1). The evolution regarding the quality of erections was similar for the two groups except at 6 months when the MONO group displayed a value of 6 and the BCOMB group 3.7 (p=0.029). The percentage of sexually potent patients was significantly lower in the first six months after brachytherapy for the BCOMB group when compared with the MONO group: 36%���74%; 33%���73%; 33%���75%. After six months, the results became more consistent. Group 2: IPSS results evolved in <50ml and >50ml prostates from 7���9 to 15-19 in the first month and from 15-18 after the third month. It was only in the first month that the differences in the IPSS were significant (p=0.061). After the third month, the two groups displayed similar outcomes: IPSS 8 and 12 at month 12 and 5.7 and 6 at month 24. Urinary retention and TURP rates were similar (p=0.054 e p=0.286). Group 3: IPSS evolution and rates of urinary retention and TURP were identical in both groups. Figures regarding libido, erections, percentage of sexually potent patients, ejaculation, discomfort and sexual satisfaction were always significantly lower for the HORM group, when compared to the NHORM group in the first month only (values of p<0.0001; <0.0001; <0.0001; 0.009 e 0.002, respectively). Group 4: IPSS evolution in patients with a high IPSS was as follows: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M) IPSS evolution in patients with a low IPSS was as follows: 5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M)TURP rates (2.8% e 0%) and those for urinary retention (5.1% e 5.9%) were similar in both patient groups (p=1). Conclusions 1. Interstitial radiotherapy of the prostate with transperineal, ultrasound-guided implant of Iodine-125 seeds is often followed by transitory urinary morbility of moderate intensity. The morbility involves symptoms of the lower urinary tract which, in most cases are at their worst from the first to the third months. There is a slight improvement up to the sixth month, at which point improvement becomes more accentuated. Around months 12 or 18, most patients display urinary symptoms that are very similar to those noted before treatment. After month 18, patients��� urinary symptoms continue to improve past the point they displayed prior to the implant. Urinary retention rates and those for transurethral resection of the prostate are very low (below 10%), after brachytherapy seed implant. 2. The combination of prostatic brachytherapy and adjuvant external radiotherapy affects the evolution of urinary symptoms: the appearance of urinary symptoms is much slower, taking six months to peak, and is less intense than when brachytherapy is employed as the only means of treatment. 3. The fact that the prostate displays a volume greater than 50 ml does not influence urinary morbility. 4. Neoadjuvant and adjuvant hormone therapy do not influence urinary symptomology. 5. Patients with severe, preexisting symptoms of the urinary tract do not experience a worsening of those symptoms. On the contrary, they exhibit an improvement in urinary symptoms as of the first month. This improvement continues for the 24 months, after which patients display symptoms of the urinary tract that are slight and a noticeable improvement over the urinary complaints registered before the implant. Urinary retention and TURP rates subsequent to brachytherapy are similar to those registered for asymptomatic patients. 6. The patient���s sexual performance is maintained in more than 70% of the cases, as noted after 24 months of follow-up. However, immediately after the first follow-up month there is a lessening in the quality of erections that continues, without improving or worsening, for the whole follow-up period. Hormone therapy affects all the parameters of sexual performance, albeit temporarily. After suspending hormone therapy, this group recovered with regard to sexual performance, and showed itself to be identical to the group of patients that had not undergone hormone therapy.-------------------RESUM��:Objectives 1. ��valuer la morbilit�� urinaire et sexuelle apr��s la realisation la curieth��rapie de la prostate avec implant de I125. 2. ��valuer l��� influence de la th��rapie hormonale n��oadjuvante et adjuvante en ce qui concerne la morbilit�� urinaire et sexuelle apr��s la r��alisation de la curieth��rapie (I125). 3. ��valuer l���influence de l���association de la radioth��rapie externe dans la morbilit�� urinaire et sexuelle apr��s la r��alisation de la curieth��rapie (I125). 4. ��valuer la morbilit�� urinaire des malades avec des contre indications relatives (prostates volumineuses, IPSS ��lev��). Mat��riel et m��thodologie De Septembre 2000 �� D��cembre 2004, on a recrut�� 204 patients ayant pour diagnostique un carcinome de la prostate localis�� (T1 et T2) ou localement avanc�� (T3) et dont l���expectative de vie ��tait de plus de 10 ans. Ils ont ��t�� soumis au traitement de la curieth��rapie avec l���implantation transp��rin��al de l���iode 125 (I125) en monoth��rapie ou en traitement combin�� avec une th��rapie hormonale et/ou radioth��rapie externe (traitement trimodale). Il y a eu plusieurs sous-cat��gories de patients, et cela d��pend de quelques caract��ristiques normalement consid��r��es comme des facteurs �� risque en ce qui concerne la morbilit�� du traitement de la curieth��rapie de la prostate, et l���objective ��tant d���analyser son influence sur la morbilit�� urinaire et sexuelle. Groupe 1: Curieth��rapie en traitement unique (MONO) par rapport �� la curieth��rapie associ��e au traitement externe (BCOMB). Groupe 2: Prostates volumineuses (>50ml) par rapport au prostates qui ne sont pas volumineuses (<50ml). Groupe 3: Curieth��rapie associ��e au traitement hormonale (HORM) par rapport �� la curieth��rapie sans traitement hormonale (NHORM). Groupe 4: IPSS ��lev�� par rapport au IPSS diminu��. Nous avons ��valu�� l���evolution du IPSS, Qualit�� de vie, le taux de RTU-P et la retention de l���urine apr��s l���implant, BSFI pendant toute la p��riode du traitement. R��sultats Groupe 1: Pour le groupe MONO l���IPSS a commen���� avec un taux de 7.1, et les patients ont souffert d���un empirement allant jusqu����� 16.1 et 15.9 pendant le premier et le troisi��me mois. 12 mois apr��s l���IPSS diminua jusqu����� 10.1 �� 18 mois le taux f��t de 7.3 et �� 24 mois il diminua encore jusqu����� atteindre 5.8. Le groupe BCOMB commen��a avec un taux d���IPSS de 9.4. Ils souffrirent un empirement l��g��r et peu accentu�� jusqu���aux 6 premiers mois (IPSS de 14). L�����volution de l���IPSS ��tait fluctuante allant de 5.9 �� 12 mois et 9.5 �� 18 mois. �� 24 mois, l���IPSS ��tait de 6.7. Le taux de retention de l���urine (6.4% et 0%) et de la RTU-P (2.0% et 0%) ��taient simmilaires dans les groupes MONO et BCOMB respectivement (p=0.375 et p=1). L��� ��volution de la qualit�� des ��rections f��t semblable dans les 2 groupes except�� le groupe MONO qui pr��senta une valeure de 6 �� 6 mois et le groupe BCOMB qui pr��senta une valeure de 3.7 (p=0.029). Le pourcentage des malades sexuellement puissants a ��t�� significativement inf��rieur pendant les 6 premiers mois depuis la curieth��rapie pour le groupe BCOMB si on le compare au groupe MONO: 36%���74%; 33%���73%; 33%���75%. Apr��s cette p��riode, les groupes e��rent des r��sultats homog��nes. Groupe 2: L��� IPSS a ��volu�� dans les prostates <50ml et >50ml de 7���9 jusqu����� 15-19 pendant le premier mois et jusqu����� 15-18 au 3��me mois. C���est seulement pendant le premier mois que les diff��rences de l���IPSS ont ��t�� significatives (p=0.061). Apr��s le 3��me mois les deux groupes ont eu des r��sultats semblables: IPSS 8 et 12 �� 12.�� mois et 5.7 et 6 �� 24.�� mois. Le taux de retention de l���urine et de la RTU-P ont ��t�� simmilaires (p=0.054 e p=0.286). Groupe 3: L���evolution de l��� IPSS, les taux de retention de l���urine et de la RTU-P pourraient se surposer pour les deux groupes. L�����volution de la libido, des ��rections, le pourcentage des malades sexuellements puissants, l���incommodit�� et la satisfaction ont ��t�� toujours significativement inf��riures dans le groupe HORM par rapport au groupe NHORM d��s le premier mois (valeurs de p <0.0001; <0.0001; < 0.0001; 0.009 et 0.002 respectivement) Groupe 4: L�����volution de l��� IPSS pour les malades ayant un IPSS ��lev�� f��t ainsi: 22.17(0M); 19.5(1M); 20.5(3M); 15.3(6M); 15.7(12M); 11(18M); 8(24M)L�����volution de l��� IPSS pour les malades ayant un IPSS diminu�� f��t ainsi:5.9(0M); 15.3(1M); 14.9(3M); 12.2(6M); 8.9(12M); 7.2(18M), 5.5(24M) Le taux de RTU-P (2.8% e 0%) et de retention de l���urine (5.1% et 5.9%) ont ��t�� semblables dans les 2 groupes de malades (p=1). Conclusions 1. La radioth��rapie interstitielle de la prostate avec implant transp��rin��al de l���iode 125 est fr��quamment acompagn��e d���une morbilit�� urinaire transitoire et d���intensit�� mod��r��e. La morbilit�� consiste d���une symptomatologie de l���appar��il urinaire inf��rieure qui, dans la plupart des malades, empire gravement du premier au troisi��me mois. La situation s���am��liore l��g��rement jusqu���au 6��me mois, l���am��lioration ��tant plus accentu��e �� partir de l��. Autour du 12��me jusqu���au 18��me mois, la majorit�� des malades pr��sente une symptomatologie urinaire qui se ressemble beaucoup �� celle qu���ils avaient avant le traitement. Apr��s le 18��me mois l���am��lioration de la symptomatologie urinaire est constante par rapport �� celle qu���ils pr��sentaient avant l���implant. Le taux de retention de l���urine et de RTU-P apr��s l���implant de la curieth��rapie sont tr��s basses, au dessus de 10%. 2. L���association de la curieth��rapie de la prostate avec la radioth��rapie externe adjuvante a une influence sur l�����volution de la symptomatologie urinaire: l���apparition des sympt��mes est plus lente, prenant jusqu����� 6 mois pour atteindre son niveau maximum, qui �� son tour, a une intensit�� moins accentu��e que lorsque la curieth��rapie est utilis��e en monoth��rapie. 3. Le volume de la prostate sup��rieure �� 50 ml n���a pas d���influence sur la morbilit�� urinaire. 4. La th��rapie hormonale, n��oadjuvante et adjuvante, n���a pas d���influence sur la symptomatologie urinaire. 5. Les malades ayant une symptomatologie urinaire pr��alable et tr��s accentu��e ne souffrent pas d���empirement de leur situation. Au contraire, ils pr��sentent une am��lioration des sympt��mes urinaires �� partir du premier mois et ceci se maintient tout au long des 24 mois que dure le traitement, ayant �� la fin de cette p��riode une symptomatologie urinaire l��g��re et beaucoup plus basse que celle qu���ils pr��sentaient avant l���implant. Le taux de retention de l���urine et de la RTU-P apr��s la curieth��rapie est simmilaire �� celui que les malades qui n���ont pas de sympt��mes pr��sentent avant l���implant. 6. La vie sexuelle est pr��serv��e dans plus du 70% des cas �� la fin de la p��riode de traitement (24 mois). Entretemps, imm��diatement apr��s le premier mois d�����tude, on note une l��g��re diminution de la qualit�� des ��rections qui se maintient sans am��lioration ou empirement tout au long du traitement. Le traitement �� base d���hormones affecte tous les param��tres de la vie sexuelle, mais de fa��on temporaire. Apr��s la suspension de la th��rapie hormonale ce groupe de malades r��cup��re l���activit�� sexuelle et se pr��sente de fa��on ��gale au groupe de malades qui n���ont pas ��t�� soumis �� ce traitement.

Socio-demographic and epidemiological characteristics associated with human immunodeficiency virus type I (HIV-1) infection in HIV-1-explosed but uninfected individuals, and in HIV-1-infected patients from a southern brasilian population

The ability to control human immunodeficiency virus type 1 (HIV-1) infection and progression of the disease is regulated by host and viral factors. This cross-sectional study describes the socio-demographic and epidemiological characteristics associated with HIV-1 infection in 1,061 subjects attended in Londrina and region, south of Brazil: 136 healthy individuals (Group 1), 147 HIV-1-exposed but uninfected individuals (Group 2), 161 HIV-1-infected asymptomatic patients (Group 3), and 617 patients with AIDS (Group 4). Data were obtained by a standardized questionnaire and serological tests. The age of the individuals ranged from 15.1 to 79.5 years, 54.0% and 56.1% of the Groups 3 and 4 patients, respectively, were men. The major features of groups 2, 3, and 4 were a predominance of education level up to secondary school (55.8%, 60.2% and 62.4%, respectively), sexual route of exposure (88.4%, 87.0% and 82.0%, respectively), heterosexual behavior (91.8%, 75.2% and 83.7%, respectively), and previous sexually transmitted diseases (20.4%, 32.5%, and 38.1%, respectively). The patients with AIDS showed the highest rates of seropositivity for syphilis (25.6%), of anti-HCV (22.3%), and anti-HTLV I/II obtained by two serological screening tests (6.2% and 6.8%, respectively). The results documenting the predominant characteristics for HIV-1 infection among residents of Londrina and region, could be useful for the improvement of current HIV-1 prevention, monitoring and therapeutic programs targeted at this population.

Epstein Barr virus detection in cervical samples of women living with human immunodeficiency virus

Epstein Barr Virus (EBV) is transmitted commonly by saliva, but it has been found in genital secretions, which suggests sexual transmission and led researchers to connect EBV and cervical neoplasia. People living with human immunodeficiency virus (HIV) are reported to be at high risk of acquiring genital infections and cervical lesions. To verify the presence of EBV in the genital tract and/or it could affect cervical changes, we analyzed cervical smears from 85 HIV seropositive women for EBV DNA determination. EBV was only detected in two (2.3%) samples. The present study provides neither evidence for EBV as sexually transmitted infection nor discards this possibility.