Cervical squamous intra-epithelial changes and human papillomavirus infection in women infected with human immunodeficiency virus in Pune, India

In view of the dual burden of HIV infection and cervical cancers in India, this study was undertaken to estimate the prevalence of Pap smear abnormalities and human papillomavirus infection among HIV-infected women. Consecutive HIV-infected women attending voluntary counseling testing clinics were enrolled. Written informed consent, demographic information, Pap smears, cervical swabs for HPV typing and a blood sample for CD4+ cell count were collected. Treatment for opportunistic and sexually transmitted infections and reproductive tract infections was provided. Women with Pap smear abnormality were referred for further intervention. Between January 2003 and May 2004, 287 HIV-infected women were enrolled. Pap smear abnormalities were seen in 6.3% women and were more common among women aged 30 and above (P=0.042) and those who had suffered from opportunistic infections (P=0.004). In multivariate analysis, Pap smear abnormalities were associated independently with opportunistic infections (P=0.02, AOR 3.8, 95% CI 1.2--11.5). Of the 100 random cervical specimens screened for HPV 16 and 18 genotypes, 33% (95 CI 23.9--43.1) were positive for HPV 16/18. Of the 122 patients who returned for a follow-up visit, 5 patients (4.1%) who did not have Pap smear abnormality at baseline, had developed Pap smear abnormality. The incidence of Pap smear abnormalities was 5.5 per 100 person year of follow-up. In order to prevent thousands of deaths due to cervical cancer in India, there is a need for strengthening the Pap smear screening program and HPV vaccine development.     

Seasonality in Pediatric Cancer

Although seasonal trends in incidence and diagnosis of pediatric cancers have been widely investigated, the results have been inconclusive. A consistent seasonal trend may possibly provide etiological insights into pediatric cancers. This study aims to determine if there is a seasonal variation in cancer diagnoses in the pediatric population at the IWK Health Centre, a tertiary care center serving three Canadian provinces: Nova Scotia, New Brunswick, and Prince Edward Island. All pediatric cancer patients aged 0–20 y diagnosed from 1995 to 2015 at the center were included in this study. The annual data was divided into four seasonal periods (December to February, March to May, June to August, and September to November). The cancer diagnoses were categorized as leukemia, lymphoma, sarcoma, brain tumors, and miscellaneous. Seasonal variation was assessed by a harmonic function in a Poisson regression model. The amplitude of multiplicative change in the incidence rate caused by the seasonal variation is expressed as the incidence rate ratio (IRR). For all cancer diagnoses for the entire cohort of 1200 patients, the IRR was 1.03 [95% confidence interval (CI) 0.96–1.13]. None of the IRRs for the cancer groups indicated a statistically significant seasonality of cancer diagnosis: Leukemia 1.11 (95% CI 0.96–1.28); Lymphoma 1.17 (95% CI 0.93–1.47); Sarcoma 1.29 (95% CI 0.99–1.69); Brain tumors 1.16 (95% CI 0.97–1.38); Miscellaneous 1.09 (95% CI 0.93–1.27). The present study did not show a seasonal variation in the various cancer types in the pediatric population at the IWK.     

HIV‐infected CD4+ T Cells Use T‐bet‐dependent Pathway for Production of IL‐10 Upon Antigen Recognition

Interleukin (IL)‐10 has been implicated in persistence of pathogens in a number of chronic infections. Infected CD4+ cells upon reactivation with HIV antigens were also shown to produce IL‐10, which might contribute to their persistence. Hence, it is crucial to determine mechanisms regulating IL‐10 production after activation with HIV antigens for devising effective blocking strategies. In this study, ERK‐, T‐bet‐ and FoxP3‐dependent pathways were evaluated for their possible roles in IL‐10 production by infected CD4+ cells after reactivation with HIV Env. Intracellular and secreted IL‐10 levels were determined by flow cytometry and Bioplex assay after treating PBMCs with PD98059, tipifarnib and cyclosporin A for blocking of ERK‐, T‐bet‐and FoxP3‐dependent pathways, respectively. Baseline levels of T‐bet, pERK were higher in P24+ CD4+ cells as compared to uninfected CD4+ cells, which increased further after activation with Env. Inhibition of T‐bet resulted in 2.3‐fold reduction of IL‐10 expression whereas ERK and FoxP3 inhibition failed to cause suppression of IL‐10 expression. Conversely, IL‐10 secreted by PBMCs was inhibited maximally after ERK inhibition suggesting its role in regulation of cytokine secretory pathway. IFN‐γ was found to be suppressed after treatment with inhibitors of all these pathways. Thus, the study highlighted need for IL‐10 blockade along with the use of antigens for therapeutic vaccinations or latency reversal and identified the T‐bet‐dependent pathway as an important pathway regulating IL‐10 production by infected CD4+ cells. However, simultaneous blockade of IFN‐γ precludes use of inhibitor of this pathway as an IL‐10 blocking strategy.     

对围绝经期妇女激素补充治疗的认知度调查

目的探讨医护人员和妇女主任对激素补充治疗(HRT)的知晓率及培训需求情况。方法采用自行设计的调查问卷,对桐乡市医护人员和妇女主任进行问卷调查,调查表的主要内容分为一般情况、对HRT的利弊认知度、推荐与否、培训需求等方面。结果共调查医护人员430人、妇女主任206人,两组人员在平均年龄、工作年限、文化程度等基本特征方面无统计学差异。68.9%的妇女主任认为围绝经期妇女有必要应用HRT,明显高于医护人员。只有8.6%的医护人员表示一定会推荐患者使用HRT,明显低于妇女主任。医护人员不推荐使用HRT的原因主要是对副作用的担心。医务人员组更倾向于从相关书籍、期刊获得信息,而妇女主任组更倾向于从医生及媒体获得相关信息。结论桐乡市部分医护人员对HRT的相关知识了解不够,担心HRT发生不良反应,HRT的推荐率低。医护人员和妇女主任在HRT的认知上存在差异。针对不同人群,开展形式多样的HRT知识宣教及培养妇女主任成为HRT知识的传播者是提高HRT应用的关键措施。