Papilomaviry (HPV) u homosexuálů

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Pavel Čermák

Lidské papilomaviry jsou zodpovědné za 90 – 99 % případů rakoviny děložního čípku a 70 – 100 % případů rakoviny konečníku.

Jejich genetická informace je kódovaná v DNA a jsou známé pod anglickou zkratkou HPV (Human papillomavirus).

Dnes jsou zmapované genetické sekvence více než 170 typů lidských papilomavirů, které se dělí do pěti rodů: Alphapapillomavirus, Betapapillomavirus, Gammapapillomavirus, Mupapillomavirus Nupapillomavirus.

Kromě toho bylo zjištěno přinejmenším dalších 200 domnělých typů virů, které teprve čekají na zmapování svého genomu a klasifikaci.

Wikipedie nabízí následující přehled onemocnění způsobených papilomaviry a u nich vždy čísla typů , které je vyvolávají:

 

Onemocnění

Typ HPV

Common warts

2, 7, 22

Plantar warts

1, 2, 4, 63

Flat warts

3, 10, 8

Anogenital warts

6, 11, 42, 44 and others[13]

Anal dysplasia (lesions)

6, 16, 18, 31, 53, 58[14]

Genital cancers

  • Highest risk:[13] 16, 18, 31, 45
  • Other high-risk:[13][15] 33, 35, 39, 51, 52, 56, 58, 59
  • Probably high-risk:[15] 26, 53, 66, 68, 73, 82

Epidermodysplasia verruciformis

more than 15 types

Focal epithelial hyperplasia (oral)

13, 32

Oral papillomas

6, 7, 11, 16, 32

Oropharyngeal cancer

16

Verrucous cyst

60

Laryngeal papillomatosis

6, 11

 

DNA papilomavirů však byla zjištěna také v periferní krvi u 8,3 % zdravých dárců krve.

V další studii (Carlo Foresta) byly bílkoviny HPV nalezeny v lymfocytech Cd20+ a Cd56+ v periferní krvi a spermatu. Nález souvisel s infekcí spermatu papilomavirem typu 16.

Informace o nepřehledném počtu typů lidských papilomavirů a jejich výskytu v různých typech lidských tkání zde uvádím úmyslně, aby bylo jasné, o jak složitou problematiku se jedná a kolik toho ještě zbývá prozkoumat, protože jednotlivé typy virů se geneticky i chováním v organismu poměrně výrazně liší.

Nechci však vyvolávat paniku. S papilomaviry se během života setká každý a velká část z nich je pokládána za neškodné. Lidský organismus se jich většinou dokáže po infekci zbavit sám a vážné onemocnění způsobí jen v některých případech.

Na druhé straně se však nejedná o zanedbatelnou problematiku, jak vidíme z mohutné kampaně podporující očkování proti některým typům papilomavirů. Základní informaci o papilomavirech je možné nalézt například v článku, který napsal MUDr Fait.  http://www.hpv-guide.cz/clanek-mudr-tomas-fait-phd-co-dokazi-lidske-papilomaviry

Papilomaviry u homosexuálů

Výskytem papilomavirové infekce u mužů kteří mají sex s muži (MSM) se zabývá studie, kterou publikoval Stephen Goldstone a další autoři. Průměrný věk byl 22 let a do studie byli úmyslně vybráni muži, kteří nebyli nakaženi HIV (virem AIDS).

Přítomnost typů papilomavirů 6, 11, 16 nebo 18 byla zjištěna u 30 % MSM (mužů kteří mají sex s muži) v porovnání s 8 % heterosexuálních mužů. Tato studie pracovala s mladými muži o průměrném věku 22 let a tak je počet nakažených relativně nízký v porovnání s jinými studiemi.

Peter Newman a spoluautoři provedli metaanalýzu více studií a uvádějí, že anální infekce papilomaviry se vyskytuje u 15 % heterosexuálních mužů, 60 % MSM kteří jsou HIV negativní a téměř 95 % MSM HIV+ (mužů kteří mají sex s muži a jsou nakaženi virem působícím AIDS).

Vysoký výskyt anální infekce HPV souvisí se zvýšeným výskytem rakoviny konečníku, který je u MSM 44krát vyšší, než v běžné populaci. V případě MSM, kteří jsou nakaženi HIV je výskyt rakoviny konečníku dokonce 60krát vyšší.

Infekce papilomaviry, které patří k nejrozšířenějším původcům sexuálně přenosných nemocí, se tedy vyskytuje přibližně čtyřikrát častěji u mužů, kteří mají sex s muži, než u heterosexuálních mužů. Z toho vyplývají podobná varování jako u jiných pohlavních nemocí. Toto varování se týká v první řadě všech mužů, kteří mají někdy sex s jiným mužem (MSM). Týká se však také žen, které by měly být zvláště ostražité kdykoli mají podezření, že muž který o ně projevuje zájem je homosexuál, bisexuál, nebo má někdy homosex za peníze. Důsledky jsou jasné i pro případné dárcovství krve nebo jiných orgánů homosexuály.

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Многопредельный микропроцессорный датчик давления Метран-150 — умный, современный датчик избыточного, абсолютного, дифференциального (разности), гидростатического давлений, а также давления-разрежения. Цифровой датчик Метран-150 предназначен для постоянного измерения избыточного, вакуумметрического и абсолютного давлений, а также перепада давлений с мгновенным преобразованием полученного значения в унифицированный аналоговый токовый выходной сигнал. Технические характеристики М 150 варьируются в зависимости от особенностей исполнения модели.
Описание датчиков давления Метран-150

Можно отметить следующие отличительные особенности датчика Метран-150 по сравнению с его предшественниками:

новый улучшенный дизайн и более компактная конструкция;
блок электроники и ЖКИ с клавиатурой могут поворачиваться с шагом 90 гр.;
имеет более высокую (многократную) способность к перегрузкам;
наличие выхода по протоколу HART, благодаря чему датчик можно интегрировать в современные системы регулировки/управления техпроцессами;
встроена защита от переходных процессов;
на корпусе находится внешняя кнопка, защищенная металлической пластиной установки «нуля»;
ПО предусматривает постоянную непрерывную самодиагностику прибора;
простота обслуживания и ввода в эксплуатацию;
ценовой диапазон, соответствующий бюджетному сегменту отечественных аналогов в отличие от более дорогих устройств иностранного исполнения.

Какие возможности доступны с преобразователем Метран-150:

конструкция модуля сенсора Coplanar обеспечивает гибкость при выборе варианта подсоединения датчика к процессу: или разные фланцевые исполнения, или сборка с вентильными блоками, или сборка с выносными разделительными мембранами;
исполнение М150 для температуры атмосферы до минус 55 гр. дает возможность использовать датчики без установки дополнительных обогревающих устройств;
исполнение с ЖК-индикатором и с локальным интерфейсом позволяет быстро сразу по месту установки датчика производить изменения настроек;
также существует специальное кислородное исполнение.

Управление и перепрограммирование настроек датчика имеет следующие особенности:

возможно на самом преобразователе М150 при помощи универсального HART-коммуникатора;
возможно удаленно при помощи ПО H-Master/Metran-150, HART-модема для преобразователя М150, персонального компьютера или находящихся на производстве средств программирования АСУТП;
возможно при помощи специального прибора, поставляемого на заказ, оснащенного ЖКИ с пленочной клавиатурой.

В каких средах может эксплуатироваться преобразователь Метран-150:

в жидких кислотных и щелочных;
в условиях сухого или влажного пара;
в продуктах нефтеперегонки;
в разнообразных газообразных, в газовых смесях и конденсатах.

Датчик может измерять давление тех сред, которые не вызывают коррозионные изменения материалов, с ними контактирующих. Специально очищенные преобразователи предназначены для измерения давления кислорода в газообразном состоянии и кислородосодержащих смесей (опция кислородного исполнения — UC).

Датчик давления функционирует в следующих диапазонах давления: min — 0-0,025кПа, max — 0-60МПа и в широком диапазоне температур среды от -40гр. до +80гр.

По току различаются следующие типы аналоговых выходных сигналов:

4-20мА с HART-протоколом;
0-5мА.

В зависимости от модификации может быть следующее взрывозащищенное исполнение:

Exi — искробезопасная цепь;
Exd — взрывонепроницаемая оболочка.

Датчик М150 поддерживается HART коммуникатором серии 375. Производитель дает гарантию на сохранение эксплуатационных характеристик преобразователя — 3 года.
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