MARICY TACLA ALVES BARBOSA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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- Frequency of Chlamydia trachomatis infection in cervical intraepithelial lesions and the status of cytological p16/Ki-67 dual-staining(2017) ROBIAL, R.; LONGATTO-FILHO, A.; ROTELI-MARTINS, C. M.; SILVEIRA, M. F.; STAUFFERT, D.; RIBEIRO, G. G.; LINHARES, I. M.; TACLA, M.; ZONTA, M. A.; BARACAT, E. C.Background: Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. Methods: This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. Results: The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1. 35 (0.5-3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46-3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50-8.42) and OR = 19.00 (0.6-7.2), respectively]. Conclusions: The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).
- A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling(2023) LICHTENFELS, Martina; LORENZI, Noely Paula Cristina; TACLA, Maricy; YOKOCHI, Kaori; FRUSTOCKL, Flavia; SILVA, Camila Alves; SILVA, Andre Luiz da; TERMINI, Lara; FARIAS, Caroline BrunettoObjective To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix (R) - for detecting HPV-DNA.Methods A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling.Results HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling.Conclusion Self-sampling using the new Brazilian device SelfCervix (R) is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.
- Is electrosurgery fulguration a better procedure for Bartholin's gland cyst?(2020) KAMILOS, Marcia Farina; BORRELLI, Celso Luiz; SCIUTO, Ruben; COTRIM, Fernanda Pereira; VEIGA, Eduardo Carvalho de Arruda; SOARES JUNIOR, Jose Maria; TACLA, Maricy; BARACAT, Edmund ChadaOBJECTIVE: To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. DESIGN: Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS: There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION: The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.
- Energy-based devices in gynecology: the new frontier for the treatment of genitourinary syndrome of postmenopause?(2021) SOARES-JUNIOR, Jose Maria; BARBOSA, Maricy Tacla Alves; AGUIAR, Lana Maria; SEGANFREDO, Isadora Braga; PEREYRA, Elsa Aida Gay de; MELO, Nilson Roberto de; HADDAD, Jorge Milhem; BARACAT, Edmund Chada
- RELATION BETWEEN Candida SPECIES ISOLATED FROM VAGINAL MUCOSA AND LESIONS CAUSED BY HIGH-RISK HUMAN PAPILLOMAVIRUS FOR CERVICAL CANCER(2021) SOUZA, A. C. de; PAULA, C. R.; RUIZ, L. da Silva; MARGARIDO, P. F. R.; AULER, M. E.; LORENZI, N. P. C.; MOREIRA, D.; SANTOS, R. L. O. dos; TACLA, M.; MICHEL-CROSATO, E.; DOMANESCHI, C.This study characterized and related yeasts of the genus Candida isolated from vaginal mucous membranes of women with lesions caused by high-risk human Papillomavirus (HPV) for cervical cancer. Forty-two women treated at the Lower Genital Tract Pathology Clinic of the University of São Paulo Medical School Hospital of Clinics were examined, with 30 high-grade (G1) uterine lesions with a mean age of 36.5 years ± 11. 1 and 12 with low grade (G2) uterine lesions with a mean age of 34.7 years ± 15.5. Clinical conditions and laboratory data on HPV were collected from patients’ medical records; the socio-demographic data obtained from an appropriate questionnaire. For the study of association between the variables, Odds Ratio analysis was used from the STATA 13.1 program. Patients G1 had a higher prevalence for diabetes and the results indicated 27% prevalence of Candida spp. in vaginal mucosa, in G2 this was 33% in vaginal mucosa. Among the species found in vaginal mucosa of patients, Candida albicans was the most isolated with 88%, followed by C. tropicalis (8%) and C. glabrata (4%). The strains of C. albicans isolated from mucosa presented sensitivity to all antifungal agents tested, unlike the C. tropicalis strain isolated in G2 in vaginal mucosa, which presented a resistance profile to fluconazole. Thus, monitoring and supervision through clinical and laboratory testing of HPV patients is important, reinforcing the need for care, treatment and prevention of HPV-related infections and Candida spp. © 2021 Brazilian Society of Parasitology. All rights reserved.
- Human Papillomavirus (HPV) seroprevalence, cervical HPV prevalence, genotype distribution and cytological lesions in solid organ transplant recipients and immunocompetent women in Sao Paulo, Brazil(2022) MIYAJI, Karina Takesaki; INFANTE, Vanessa; PICONE, Camila de Melo; LEVI, Jose Eduardo; OLIVEIRA, Ana Carolina Soares de; LARA, Amanda Nazareth; TACLA, Maricy; DILLNER, Joakim; KANN, Hanna; EKLUND, Carina; CASTANHEIRA, Cristina Paula; MAYAUD, Philippe; SARTORI, Ana Marli ChristovamIntroduction Solid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women. Methods Cross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck (R)) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies. Results 125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent women (29.6% vs. 20.2%, p = 0.112), but this difference was not statistically significant. High-risk (HR)-HPV was significantly more frequent in SOT than in immunocompetent women (19.4% vs. 7.9%, p = 0.014). Simultaneous infection with >= 2 HR-HPV types was found in 3.1% of SOT and 0.9% of immunocompetent women. HPV seropositivity for at least one HPV type was high in both groups: 63.8% of 105 SOT and 69.7% of 119 immunocompetent women (p = 0.524). Low-grade (LSIL) and high-grade SIL (HSIL) were significantly more frequent in SOT (9.7% and 5.3%, respectively) than in immunocompetent women (1.6% and 0.8%, respectively) (p= 0.001). Conclusions These results may reflect the increased risk of HPV persistent infection and disease progression in SOT women due to chronic immunosuppression.
- Lower genital tract infections in young female juvenile idiopathic arthritis patients(2019) V, Gabriela R. Ferreira; TOMIOKA, Renato B.; QUEIROZ, Ligia B.; KOZU, Katia; AIKAWA, Nadia E.; SALLUM, Adriana M. E.; SERAFINI, Paulo; TACLA, Maricy; BARACAT, Edmund C.; PEREIRA, Rosa M. R.; BONFA, Eloisa; SILVA, Clovis A.Background To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results The mean current age was similar in JIA patients and controls (23.3 +/- 6.24 vs. 26.1 +/- 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p = 0.206) and biological agent use (p = 0.238) were similar in both JIA groups. Conclusions To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.
- Local and systemic immunomodulatory mechanisms triggered by Human Papillomavirus transformed cells: a potential role for G-CSF and neutrophils(2017) ALVAREZ, Karla Lucia Fernandez; BELDI, Mariana; SARMANHO, Fabiane; ROSSETTI, Renata Ariza Marques; SILVEIRA, Caio Raony Farina; MOTA, Giana Rabello; ANDREOLI, Maria Antonieta; CARUSO, Eliana Dias de Carvalho; KAMILLOS, Marcia Ferreira; SOUZA, Ana Marta; MASTROCALLA, Haydee; CLAVIJO-SALOMON, Maria Alejandra; BARBUTO, Jose Alexandre Marzagao; LORENZI, Noely Paula; LONGATTO-FILHO, Adhemar; BARACAT, Edmund; LOPEZ, Rossana Veronica Mendoza; VILLA, Luisa Lina; TACLA, Maricy; LEPIQUE, Ana PaulaCervical cancer is the last stage of a series of molecular and cellular alterations initiated with Human Papillomavirus (HPV) infection. The process involves immune responses and evasion mechanisms, which culminates with tolerance toward tumor antigens. Our objective was to understand local and systemic changes in the interactions between HPV associated cervical lesions and the immune system as lesions progress to cancer. Locally, we observed higher cervical leukocyte infiltrate, reflected by the increase in the frequency of T lymphocytes, neutrophils and M2 macrophages, in cancer patients. We observed a strong negative correlation between the frequency of neutrophils and T cells in precursor and cancer samples, but not cervicitis. In 3D tumor cell cultures, neutrophils inhibited T cell activity, displayed longer viability and longer CD16 expression half-life than neat neutrophil cultures. Systemically, we observed higher plasma G-CSF concentration, higher frequency of immature low density neutrophils, and tolerogenic monocyte derived dendritic cells, MoDCs, also in cancer patients. Interestingly, there was a negative correlation between T cell activation by MoDCs and G-CSF concentration in the plasma. Our results indicate that neutrophils and G-CSF may be part of the immune escape mechanisms triggered by cervical cancer cells, locally and systemically, respectively.
- Age-related acceptability of vaginal self-sampling in cervical cancer screening at two university hospitals: a pilot cross-sectional study(2019) LORENZ, Noely Paula Cristina; TERMINI, Lara; LONGATTO FILHO, Adhemar; TACLA, Maricy; AGUIAR, Lana Maria de; BELDI, Mariana Carmezim; FERREIRA-FILHO, Edson Santos; BARACAT, Edmund Chada; SOARES-JUNIOR, Jose MariaBackground: To determine whether age is a barrier against acceptability of cervicovaginal self-sampling in screening for cervical cancer at two gynecology outpatient clinics. Methods: This is a cross-sectional study involving 116 women over 21 years of age with an abnormal Pap smear. Clinical and laboratorial data were recorded in electronic files. Women received detailed self-collection instructions. After the self-sampling procedure (Evalyn Brush (R)), women were instructed to answer a questionnaire about vaginal self-sampling acceptability that consisted of seven multiple-choice items. The participants were divided into three age brackets: 21 to 29 years, 30 to 49 years, and 50 years and over. Chi-square, Fischer exact, Kolmogorov-Smirnov and Kruskal-Wallis tests were used. Results: The analysis of the participants' perception of the procedure stratified according to age groups showed a decline in the fear of hurting oneself during the procedure as age increased. Most participants reported that it was very easy to understand how to use the self-sampling brush and that it was easy to use it. Most of them were neither embarrassed nor afraid of getting hurt during the procedure. The majority preferred self-sampling to collection by a healthcare professional. The main reason was practicality: the possibility of choosing the place and time for sampling. Conclusions: The participating women found self-collection simple to understand and easy to accept regardless of age. The younger women indicated more fear and discomfort in self-sampling, which points to the need for attraction strategies that are more appealing to the younger generations.