Programa de Pós-Graduação em Ciências da Saúde
Permanent URI for this communityhttps://repositorio.ufrn.br/handle/123456789/11915
Browse
657 results
Search Results
Doctoral Thesis Exercício intervalado de alta intensidade: uma investigação integrada das respostas imunes e psicológicas em pessoas vivendo com HIV(Universidade Federal do Rio Grande do Norte, 2026-03-09) Varela, Phelipe Wilde de Alcântara; Dantas, Paulo Moreira Silva; Jaggers, Jason Reed; http://lattes.cnpq.br/0392766010188739; http://lattes.cnpq.br/6105647359411543; Cabral, Breno Guilherme de Araújo Tinôco; https://orcid.org/0000-0002-9966-9956; http://lattes.cnpq.br/8399135324397066; Belchior, Hindiael Aeraf; https://orcid.org/0000-0002-6898-3985; http://lattes.cnpq.br/2815729240392635; Medeiros, Rafaela Catherine da Silva Cunha de; http://lattes.cnpq.br/1195541128564844; Santos, Ronaldo Vagner Thomatieli dos; https://orcid.org/0000-0001-7010-2799; http://lattes.cnpq.br/9928572887023286HIV infection, even under effective antiretroviral therapy, remains associated with chronic immune activation, persistent inflammation, and an increased risk of comorbidities. In this context, physical exercise is recommended as an adjunctive strategy; however, studies simultaneously investigating the acute immunological safety and psychological acceptability of high-intensity interval exercise (HIIE) in people living with HIV (PLWH) are scarce. Therefore, this thesis aimed to analyze the acute effects of HIIE on immunological and psychological responses in PLWH, comparing them with moderate-intensity continuous exercise (MICE) and with individuals without HIV. Two experimental studies were conducted using randomized, counterbalanced, crossover designs. Study 1 evaluated changes in leukocyte counts and lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+), as well as cytokine production (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, and IFN-γ) at baseline, immediately post-exercise, 1 hour, and 24 hours after exercise. Study 2 investigated acute psychological responses, including rating of perceived exertion, affective responses, exercise enjoyment, and future exercise intention. The results demonstrated that HIIE promoted significant immune cell mobilization immediately after exercise in all groups. However, only PLWH exhibited sustained increases in leukocytes, monocytes, and neutrophils 24 hours after HIIE, along with persistent elevations in IL-2, IL-4, IL-17A, and IFN-γ production, suggesting a transient amplification of immune activation. Nevertheless, lymphocyte subpopulations returned to values close to baseline within 24 hours. From a psychological perspective, HIIE was well tolerated, with no impairment in affective responses or future exercise intention; additionally, the high-volume protocol elicited greater enjoyment among PLWH compared to healthy controls. In conclusion, HIIE induces more pronounced acute immunological responses in PLWH without compromising psychological acceptability, supporting its potential feasibility as a therapeutic exercise strategy when carefully prescribed.Master Thesis Efeitos da suplementação com proteínas do leite associada ao exercício físico na função musculoesquelética de idosos com sarcopenia, osteoporose ou osteosarcopenia: revisão sistemática(Universidade Federal do Rio Grande do Norte, 2025-11-03) Brito, Mário Duarte; Guerra, Ricardo Oliveira; https://orcid.org/0000-0003-3824-3713; http://lattes.cnpq.br/4265185619165890; https://orcid.org/0009-0001-2420-6068; http://lattes.cnpq.br/5032839123469180; Oliveira, Carolina Cunha de; https://orcid.org/0000-0003-1196-0683; http://lattes.cnpq.br/2469398994777156; Costa, Eduardo Caldas; https://orcid.org/0000-0003-2807-7109; http://lattes.cnpq.br/1216441676725839Introduction: Sarcopenia, osteoporosis, and osteosarcopenia are prevalent age-related conditions associated with increased risk of falls, fractures, functional decline, and loss of independence. Resistance training and adequate protein intake are recommended strategies to preserve musculoskeletal health in older adults. This systematic review evaluated the effects of milk protein supplementation combined with physical exercise on muscle, bone, and functional outcomes in older adults diagnosed with sarcopenia, osteoporosis, or osteosarcopenia. Methods: This review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024555933). Randomized controlled trials including participants ≥65 years with confirmed diagnoses were eligible. Interventions consisted of milk protein supplementation combined with resistance or multicomponent exercise. Primary outcomes were muscle mass, muscle strength, physical performance, and bone-related measures. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated with GRADE. Due to clinical and methodological heterogeneity, a structured qualitative synthesis was conducted. Results: Seven randomized controlled trials (n = 573) were included. Improvements in muscle mass and strength were more frequently observed in supervised, higher-intensity programs combined with adequately dosed supplementation. However, comparable gains were often reported in exercise-only groups, indicating that resistance training was the primary driver of adaptation. Physical performance outcomes were heterogeneous, with limited additional benefit in frailer populations. Bone mineral density improvements were reported in a long-term high-intensity protocol in older men with osteosarcopenia. Conclusions: Resistance training remains central to improving musculoskeletal health in these populations. Milk protein supplementation may provide complementary benefits in specific contexts, particularly when dietary intake is insufficient and exercise is appropriately structured. Further high-quality trials are needed to clarify long-term clinical impact.Doctoral Thesis Impacto dos macrófagos associados ao tumor e da ativação das vias de sinalização STAT3/NF-kB na imunossupressão e progressão do câncer cervical: uma abordagem integrada retrospectiva e prospectiva em pacientes da Liga Norte-Riograndense Contra o Câncer - Natal, RN(Universidade Federal do Rio Grande do Norte, 2025-12-11) Lira, George Alexandre; Araújo Júnior, Raimundo Fernandes de; https://orcid.org/0000-0003-2349-2354; http://lattes.cnpq.br/1903940945895093; https://orcid.org/0000-0002-9169-3599; Rezende, Adriana Augusto de; https://orcid.org/0000-0003-2452-4047; http://lattes.cnpq.br/4245215108740331; Abreu, Bento João da Graça Azevedo; https://orcid.org/0000-0001-8010-806X; http://lattes.cnpq.br/1725848357337658; Pereira, Karuza Maria Alves; https://orcid.org/0000-0002-2880-6466; http://lattes.cnpq.br/3193698890688967; Oliveira, Radan Elvis Matias de; https://orcid.org/0000-0002-0370-4447; http://lattes.cnpq.br/0748885566401996This study investigated the interaction between tumor-associated macrophages (M2-TAMs), immunoregulatory pathways, and clinical outcomes in cervical cancer (CC) through two complementary studies conducted in patients treated at the Liga Norte-Riograndense Contra o Câncer, Natal, Brazil. In the first, retrospective study comprising 691 cases, TAM infiltration and activation of the STAT3/NF-κB signaling pathway were evaluated using tissue microarrays (TMA) and immunohistochemistry. A high stromal density of M2-TAMs expressing the surface markers CD163⁺ and CD204⁺ was significantly associated with increased immunoexpression of E-cadherin, vimentin, MMP9, VEGF-α, Bcl-2, Ki-67, CD25, MIF, FOXP3, and IL-17 (all p < 0.0001). Advanced stage IV disease (TNM) showed a strong correlation with the immunoexpression of STAT3/NF-κB, CD25, VEGF-α, and MIF, as well as with increased cellular proliferation assessed by Ki-67 labeling (all p < 0.001). Survival analysis demonstrated that elevated levels of SNAIL, E-cadherin, and Ki-67 were independent predictors of reduced overall survival and recurrence-free survival (HR = 1.52, 1.78, and 1.44, respectively). The second, prospective study included 100 patients with cervical cancer followed between 2018 and 2023, in whom tumor and blood samples were analyzed by RT-PCR, immunohistochemistry, and flow cytometry. The results showed that M2-TAM infiltration, mediated by STAT3/NF-κB activation, correlated with increased expression of Ki-67, VEGF-α, and FOXP3 (p < 0.001). Furthermore, deletion of the FOXP3 T allele, HLA-G polymorphisms, and activation of the CXCL12–CXCR4 axis were associated with increased STAT3 and SNAIL expression and elevated circulating cytokine levels (IL-4, IL-6, IL-12, and IL-17), resulting in a higher risk of mortality. Across both studies, the findings indicate that M2- TAM infiltration and activation of the STAT3/NF-κB and CXCL12–CXCR4 pathways drive tumor progression and systemic immunosuppression—including FOXP3 polymorphisms in regulatory T cells and dysregulation of antitumor cytokines— culminating in unfavorable clinical outcomes in cervical cancer. The integration of retrospective and prospective data reinforces the central role of TAM-mediated immune modulation as a prognostic biomarker and a potential therapeutic target in cervical cancer.Doctoral Thesis Eletroestimulação transcutânea auricular do nervo vago e exercício físico como estratégias de modulação da função autonômica cardíaca em pessoas vivendo com HIV/Aids(2025-11-14) Medeiros, Jason Azevedo de; Dantas, Paulo Moreira Silva; http://lattes.cnpq.br/0392766010188739; http://lattes.cnpq.br/3278133753906319; Cabral, Breno Guilherme de Araújo Tinôco; https://orcid.org/0000-0002-9966-9956; http://lattes.cnpq.br/8399135324397066; Jaggers, Jason R; Santos, Ronaldo Vagner Thomatieli dos; https://orcid.org/0000-0001-7010-2799; http://lattes.cnpq.br/9928572887023286; Borges Júnior, Uirassu; https://orcid.org/0000-0002-1032-0580; http://lattes.cnpq.br/8991476483839939People living with HIV/AIDS (PLWHA) may present with cardiac autonomic dysfunction resulting from the direct action of HIV on the central and autonomic nervous systems. Antiretroviral therapy (ART) remains the most effective strategy for controlling HIV viral replication. However, cardiovascular complications have been associated with the side effects of ART. Non-pharmacological strategies, such as transcutaneous auricular vagus nerve stimulation (taVNS) and physical exercise, may serve as important alternative therapies for modulating cardiac autonomic function. The aim of this thesis was to investigate, through two experimental studies and a rapid review, the effects of taVNS and the available evidence on physical exercise in the cardiac autonomic function of PLWHA. Two experimental studies were conducted: a proof-of-concept clinical trial to evaluate the acute effect of taVNS on cardiac vagal activity, and a pilot chronic study to analyze the effect of taVNS on post-exercise heart rate recovery. The rapid review sought to synthesize the acute and chronic effects of physical exercise on the cardiac autonomic function of PLWHA. The experimental studies included men living with HIV/AIDS who underwent a 30-minute taVNS protocol per session, with an intensity set at 200% of the sensory threshold, a frequency of 10 Hz, and a pulse width of 500 µs. Data collection included anamnesis, physical activity level assessment (IPAQ), anthropometric evaluation (weight and height), body composition by DEXA, sensory threshold determination, and pain perception using a visual analogue scale (VAS). In the acute study, cardiac vagal activity was assessed through vagally mediated heart rate variability (vmHRV) indices, including the root mean square of successive differences (rMSSD) and the percentage of differences between adjacent normal intervals greater than 50 ms (pNN50). In the chronic study, heart rate recovery (HRR) was assessed at 60-, 120-, and 300-seconds post-exercise. Peak oxygen consumption during the cardiopulmonary exercise test and the rate of perceived exertion (RPE) were also evaluated. In the acute study, no significant changes were observed in HRV parameters over time or between conditions, indicating that a single taVNS session was not sufficient to modulate cardiac vagal activity in PLWHA. Similarly, in the chronic study, no significant effects of time or group × time interaction were found for HRR at 60-, 120-, or 300-second post-exercise, suggesting that four weeks of taVNS did not induce relevant changes in cardiac autonomic modulation in this population. The rapid review indicated that PLWHA tend to exhibit slower vagal reactivation after acute exercise, whereas chronic interventions particularly aerobic exercise tends to enhance parasympathetic modulation, reflected by higher SDNN and improved HRR values. Taken together, the results do not confirm the effect of taVNS on cardiac vagal activity or post-exercise HRR in PLWHA. Meanwhile, the review reinforces that chronic physical exercise, especially aerobic training, remains the most effective non-pharmacological strategy to improve autonomic modulation in this population.Doctoral Thesis Disfunção ventricular esquerda na gestação com doença hipertensiva da gravidez(Universidade Federal do Rio Grande do Norte, 2025-09-12) Lima, Ricardo Luiz de Medeiros; Jerônimo, Selma Maria Bezerra; Lima, Josivan Gomes de; http://lattes.cnpq.br/6456654111946909; http://lattes.cnpq.br/7120263570947836; http://lattes.cnpq.br/9151367703944069; Araújo, Ana Cristina Pinheiro Fernandes de; https://orcid.org/0000-0001-9802-6492; http://lattes.cnpq.br/7207146627442417; Britto, Luiz Murillo Lopes de; http://lattes.cnpq.br/1235638172987891; Oliveira, Gláucia Maria Moraes; https://orcid.org/0000-0002-0737-6188; http://lattes.cnpq.br/7081137143097605; Paiva, Maria Sanali Moura de Oliveira; http://lattes.cnpq.br/1789554697584994Hypertensive disorders of pregnancy (HDP) comprise a group of conditions characterized by elevated blood pressure (≥140/90 mmHg, measured on at least two occasions with a minimum interval of 4 hours) that manifest during pregnancy, delivery, or the postpartum period, and may be associated or not with proteinuria and/or signs of target-organ damage. They include both pre-existing conditions either before pregnancy (chronic hypertension) and those arising after conception (gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia). These disorders have a significant impact on maternal and fetal health, and there are evidences indicating that women with a history of preeclampsia, as well as their offspring, are at increased risk of developing cardiovascular events later in life. Transthoracic echocardiography with global longitudinal strain (GLS) analysis of the left ventricle (LV) has emerged as a sensitive tool for the early detection of myocardial dysfunction, including subclinical forms. The present study aimed to evaluate, using this technique, early signs of cardiovascular impairment in pregnant women. A longitudinal follow-up was conducted throughout pregnancy, and a cross-sectional analysis was performed in the immediate postpartum period, involving women who developed severe preeclampsia. The sample included 107 pregnant women and 20 postpartum women with a history of severe preeclampsia, assessed between February 2018 and March 2020 in Natal, Rio Grande do Norte, Brazil. Participants underwent serial echocardiograms, along with clinical, gestational, and anthropometric data collection. Ventricular function was analyzed using conventional parameters and GLS. Statistical analyses included logistic regression, correlation analysis, univariate analysis, and canonical correlation. Of the 107 pregnant women recruited, 87 completed follow-ups. Forty (47.1%) were primigravidae, aged 16–38 years (mean 28.1 ± 6.4 years). Sixty-one (70.1%) were overweight or obese (body mass index – BMI >25 kg/m²), with 36 (41.4%) overweight, 23 (26.4%) with grade I or II obesity, and 2 (2.3%) with grade III obesity. Myocardial hypertrophy or remodeling was identified in 12 women (13.8%). LV ejection fraction was <50% in 4 cases (4.6%), while GLS was below –18% in 6 cases (6.9%). Correlation matrix analysis showed no significant association between ventricular function parameters and clinical, anthropometric, gestational, or echocardiographic variables. However, comparison between the first and last echocardiograms of the same women revealed significant differences in LV end-diastolic diameter (p = 0.013), LV mass index (p = 0.003), relative wall thickness (p = 0.027), and mitral E/A ratio (p = 0.001), consistent with physiological cardiac changes induced by pregnancy. In the comparison between women with and without HDP, significant differences were observed in BMI (p = 0.036), LV mass index (p = 0.035), and mitral E/A ratio (p = 0.001). Postpartum women with a history of severe preeclampsia showed more altered echocardiographic parameters than pregnant women without HDP: LV mass index (p = 0.018), LV relative wall thickness (p = 0.001), mitral E/A ratio (p = 0.007), LV isovolumic relaxation time – IVRT (p = 0.001), and GLS (p = 0.042). Canonical correlation analysis showed moderate associations between anthropometric parameters and diastolic function (ρ = 0.65; p <0.001), hypertensive parameters and diastolic function (ρ = 0.64; p <0.001), anthropometric and hypertensive parameters (ρ = 0.57; p <0.001), and hypertensive parameters and systolic function (ρ = 0.57; p <0.001). Weak correlations were found between anthropometric parameters and systolic function (ρ = 0.49; p = 0.002), anthropometric and gestational parameters (ρ = 0.43; p = 0.003), and hypertensive and gestational parameters (ρ = 0.39; p = 0.045). In summary, women with HDP showed a significant association between BMI, LV mass index, and diastolic function. Postpartum women with severe preeclampsia maintained relevant alterations in LV mass index, LV relative wall thickness, mitral E/A ratio, IVRT, and GLS, even with preserved ejection fraction. Echocardiography with GLS proved to be capable of detecting subclinical alterations in LV systolic function, reinforcing the importance of cardiovascular monitoring during pregnancy and postpartum in cases of HDP, with a view to preventing maternal and fetal cardiovascular complications in the medium and long term.Doctoral Thesis Complexidade das doenças tropicais negligenciadas no Brasil: coinfecção HIV/Leishmania infantum e exposição de risco à esquistossomose(Universidade Federal do Rio Grande do Norte, 2025-07-18) Bezerra, Danielle Viviane Fernandes; Jerônimo, Selma Maria Bezerra; Nascimento, Eliana Lúcia Tomaz do; http://lattes.cnpq.br/3995803872021711; http://lattes.cnpq.br/7120263570947836; http://lattes.cnpq.br/6385068230701838; Salha, Daniella Regina Arantes Martins; https://orcid.org/0000-0002-1350-5919; http://lattes.cnpq.br/3695151190501921; Galvão, Joanna Gardel Valverde; http://lattes.cnpq.br/0166507910755600; Sousa, Anastácio de Queiroz; http://lattes.cnpq.br/0943719413944615; Carvalho Filho, Edgar Marcelino de; http://lattes.cnpq.br/6998360791945569Visceral leishmaniasis and schistosomiasis are two neglected tropical diseases that significantly affect populations living in conditions of social and environmental vulnerability. This work studied two distinct population-based studies: (1) an evaluation of the clinical progression of people living with HIV (PLHIV) residing in Natal, Brazil, who are at risk of exposure to Leishmania infantum; and (2) an investigation of factors associated with Schistosoma mansoni infection among residents of the municipality of Pureza, Rio Grande do Norte. The first study hypothesized that adherence to antiretroviral therapy (ART) reduces the risk of developing AIDS/visceral leishmaniasis (VL). This observational study collected data at two time points (T1 and T2) from 829 PLHIV at risk for Leishmania infantum exposure. Participants were categorized into two groups based on serological and/or molecular testing: HIV/Leishmania coinfection (asymptomatic) and HIV-only. Markers of immune activation, senescence, and exhaustion were assessed at T2 via flow cytometry. At T1, the prevalence of asymptomatic HIV/Leishmania coinfection was 11.5%. No participants developed VL over an average follow-up period of 8.2 ± 2.9 months. ART adherence was high, with 89.2% of participants on therapy at T1 and 98.2% at T2. A significant increase in CD4+ T cell counts and in the proportion of individuals with undetectable viral loads was observed over time in both groups (p ≤ 0.0011 and p = 0.004, respectively), likely attributable to consistent ART use. There were no significant differences in the levels of activated, senescent, or exhausted T cells between groups, suggesting that ART adherence may prevent immune deterioration and thereby reduce the risk of progression to VL. The second study, employing a cross-sectional design, evaluated 315 residents of Pureza, state of Rio Grande do Norte, Brazil, using the Kato-Katz parasitological technique to detect S. mansoni infection. Participants were divided into four groups: (1) newly diagnosed S. mansoni cases (n = 44); (2) individuals with a history of treatment (n = 78); (3) untreated neighbor contacts (n = 158); and (4) controls (n = 35). Male sex was significantly more prevalent among newly infected individuals (p < 0.05), and 38.6% of this group reported prior treatment, indicating reinfection. The average monthly per capita income was BRL 372.0 ± 225.9, with 45.1% of participants receiving benefits from the Bolsa Família income transfer program. In the control group, 77.1% reported never using freshwater bodies. Among those who did, the main reported purpose was recreational bathing—a known high-risk behavior for schistosomiasis. Despite awareness of endemic areas, the persistence of high-risk behaviors and reinfection highlight ongoing exposure to S. mansoni. Therefore, these two studies underscore the importance of educating the population about the causal factors of these infections and strategies to mitigate risk. They demonstrate that only through the consistent adoption of preventive measures will it be possible to reduce disease incidence.Master Thesis Efeitos do treinamento intervalado de alta intensidade ao ar livre baseado na percepção de esforço sobre a pressão arterial ambulatorial de 24 horas em pessoas idosas com hipertensão: um estudo piloto randomizado(Universidade Federal do Rio Grande do Norte, 2025-09-26) Araújo, Maria Beatriz da Fonseca; Costa, Eduardo Caldas; https://orcid.org/0000-0003-2807-7109; http://lattes.cnpq.br/1216441676725839; http://lattes.cnpq.br/8941322424798597; Elsangedy, Hassan Mohamed; http://lattes.cnpq.br/7777329239184430; Dias, Raphael Mendes Ritti; https://orcid.org/0000-0001-7883-6746; http://lattes.cnpq.br/7585097807348027The aim of this dissertation was to investigate the feasibility and antihypertensive effects of a highintensity interval training (HIIT) program, self-guided by perceived exertion (RPE), in older adults with hypertension. This pilot study included 31 randomized participants (66±4 years; hypertension diagnosis: 14±9 years; HIIT, n=18; Control, n=13). The HIIT group performed three weekly sessions on an outdoor track, progressing from four to eight 60-second high-intensity bouts (PE 7–8) with active recovery (PE 3–4) over six weeks. Heart rate (HR) and affective response (Feeling Scale, -5 to +5) were monitored weekly. The control group participated in weekly health education sessions (without exercise). Feasibility outcomes included Consent rate (% of randomized participants among interested individuals), adherence (% completing the study), attendance (% of sessions attended versus planned), fidelity (achieving vigorous intensity in HIIT: >60% of HR reserve and >80% of maximum HR), and intervention-related adverse events. Cardiovascular outcomes included 24-hour blood pressure (total, awake, and asleep); clinic blood pressure (central and brachial); and arterial stiffness measures: augmentation index (AIx) and aortic pulse wave velocity (PWV). Results showed a low recruitment rate (18.6%), but high adherence (83.3%) and session attendance (89.0%). Participants trained at >75% HR reserve and >85% maximum HR, demonstrating high fidelity to the intervention. On average, affective responses were positive (“fairly good”). Musculoskeletal issues occurred in 11.1% of participants. After six weeks, the HIIT group presented reductions in 24-hour systolic BP (-3 mmHg), diastolic BP (-2 mmHg), and nocturnal systolic BP (-5 mmHg) (p<0.05). No significant group-by-time interactions were observed for other variables, and no changes occurred in the control group (p>0.05). In conclusion, RPE-guided HIIT appears feasible and has potential antihypertensive effects in older adults with hypertension. The findings of this dissertation may guide pragmatic clinical trials investigating the effects of HIIT in this population.Master Thesis Calcificação coronariana em pacientes com lipodistrofia congênita generalizada: uma série de casos(Universidade Federal do Rio Grande do Norte, 2025-09-22) Feijó, Bartira Miridan Xavier Cortez Rodrigues Rebouças; Lima, Josivan Gomes de; http://lattes.cnpq.br/6456654111946909; http://lattes.cnpq.br/7702452966160555; Gurgel, Aline Maria Cavalcante; http://lattes.cnpq.br/2092557812982253; Campos, Julliane Tamara Araújo de Melo; https://orcid.org/0000-0002-8501-5521; http://lattes.cnpq.br/3504274193684794Congenital generalized lipodystrophy (CGL), also known as Berardinelli-Seip syndrome, is a rare genetic disorder characterized by near-total absence of subcutaneous adipose tissue and severe metabolic disturbances, including marked insulin resistance, early-onset diabetes mellitus, dyslipidemia, and hepatic steatosis. Given the growing concern over cardiovascular mortality among young patients with CGL and the scarcity of studies on this topic, this work aimed to assess cardiovascular risk in this population by quantifying coronary artery calcification (CAC) using computed tomography to determine the coronary calcium score (CCS). In a crosssectional descriptive study, 19 patients with CGL followed at a university hospital in Northeastern Brazil were analyzed. The mean age was 21.1 years, with 42.1% being children. A positive CCS (greater than zero) was observed in 26.3% of patients, all under 50 years of age, with 60% of them showing values above 100 HU. Statistical analysis revealed a significant association between altered CCS and factors such as older age, diabetes, arterial hypertension, and lower ALT levels. The use of metreleptin, although associated with improvement in several metabolic comorbidities, was not correlated with the presence or absence of coronary calcification. Age and the FIB-4 score were the strongest predictors of altered CCS, suggesting a possible link between advanced liver disease and cardiovascular risk in patients with CGL. This study is the first to evaluate CCS in this population and highlights the importance of early screening for subclinical atherosclerosis in young and asymptomatic individuals with CGL, reinforcing the need for therapeutic strategies aimed at preventing cardiovascular outcomes. The multidisciplinary interface between endocrinology, cardiology, hepatology, genetics, and radiology proved essential for conducting and interpreting the findings.Doctoral Thesis Associações independentes e combinadas da capacidade cardiorrespiratória e da força muscular de membros inferiores com o risco e a ocorrência de eventos cardiovasculares adversos maiores em pessoas idosas(Universidade Federal do Rio Grande do Norte, 2025-09-08) Silva, Marcyo Câmara da; Costa, Eduardo Caldas; https://orcid.org/0000-0003-2807-7109; http://lattes.cnpq.br/1216441676725839; https://orcid.org/0000-0003-2381-6507; http://lattes.cnpq.br/2679094676790684; Araújo, Rodrigo Cappato de; http://lattes.cnpq.br/6358651010707043; Maciel, Álvaro Campos Cavalcanti; https://orcid.org/0000-0002-8913-7868; http://lattes.cnpq.br/9441132413428495; Cavalcante, Bruno Remigio; http://lattes.cnpq.br/7271001436441349; Cureau, Felipe Vogt; https://orcid.org/0000-0001-7255-9717; http://lattes.cnpq.br/0424285939336536This thesis investigated the independent and combined associations of cardiorespiratory fitness (CRF) and muscle strength (MS) with cardiometabolic and cardiovascular outcomes in older adults aged 60 to 80 years. CRF was assessed using the six-minute walk test, and MS was evaluated using the 30-second chair stand test. Cardiometabolic outcomes were determined by the presence of metabolic syndrome and ideal cardiovascular health score, both defined according to the American Heart Association. Cardiovascular outcomes, termed major adverse cardiovascular events (MACE), included myocardial infarction, coronary artery disease, cardiac surgery, heart failure, stroke, and all-cause mortality. The first study (n = 360), a cross-sectional analysis, showed that low levels of CRF, independently and in combination with low MS, were associated with increased cardiometabolic risk, reflected by a higher prevalence of metabolic syndrome (PR 1.27, 95% CI 1.09–1.48; and PR 1.32, 95% CI 1.10–1.58, respectively) and poor cardiovascular risk score (PR 1.76, 95% CI 1.25– 2.47; and PR 1.65, 95% CI 1.19–2.28, respectively). The second study (n = 234), a longitudinal analysis with an average follow-up of five years, investigated the association of these physical capacities with the occurrence of MACE (n = 30). Results showed that low CRF was independently associated with a higher risk of MACE (HR 2.56; 95% CI: 1.05–6.24), even after adjusting for MS. Moreover, the combination of low CRF and low MS conferred the highest risk for such events (HR 3.58; 95% CI: 1.32–9.69), reinforcing the predictive value of jointly assessing these variables in clinical settings. Additive and multiplicative interaction analyses indicated a trend toward interaction (p = 0.085), although not statistically significant. Overall, the findings of this thesis support that a multidimensional assessment of physical fitness, especially the combination of CRF and MS, may enhance cardiovascular risk stratification in older adults, with relevant implications for prevention and clinical management in this population.Master Thesis Desenvolvimento de um sérum facial microemulsionado multifuncional utilizando o planejamento experimental Box-Behnken(Universidade Federal do Rio Grande do Norte, 2025-09-24) Cruz, Yasmin Ferreira da; Egito, Eryvaldo Sócrates Tabosa do; http://lattes.cnpq.br/6907806915889763; https://orcid.org/0000-0002-7726-1933; http://lattes.cnpq.br/7115213545673756; Oshiro Júnior, João Augusto; https://orcid.org/0000-0001-7247-1598; http://lattes.cnpq.br/7718234509377672; Ferreira, Leandro De Santis; https://orcid.org/0000-0002-8408-5886; http://lattes.cnpq.br/6622861873027635The international cosmetic market has been highlighted for the production and commercialization of multifunctional products, characterized by presence of several active ingredients. Then, the development of microemulsions (ME) as a cosmetic product stands out due to its ability to deliver different active ingredients to obtain properties as moisturizing, photoprotective and antioxidant. Based on this, the aim of this study was to produce and characterize a multifunctional facial booster (MFB) based on a Linum Usitatissimum (Linseed) Seed Oil (LO) ME containing Tocopherol, Hyaluronic Acid (HA), and Phenylbenzimidazole Sulfonic Acid (PBSA) by the Box-Benhken experimental design (BBD). The active ingredients concentrations were defined based on the BBD results of antioxidant activity, sun protector factor (SPF) and occlusivity. The MFB was characterized by its antioxidant activity, occlusivity, SPF and spreadability in vitro. In addition, MFB was physicochemically characterized by hydrodynamic droplet size distribution, polydispersity index (PdI) and pH. The BBD proposed a MFB composed by HA 5 %, Tocopherol 5 % and PBSA 7.5 %, that showed an antioxidant activity, SPF, occlusivity and spreadability of 8.02 ± 1.20 %, 12.65 ± 1.33, 27.65 ± 1.67 % and 2923 ± 167 mm², respectively. These results represent an effective radical scavenging ability, photoprotection, water loss prevention and adequate spreadability. Moreover, MFB showed a droplet size, PdI and pH of 34.74 ± 0.14 nm, 0.184 ± 0.02, 7.14 ± 0.02, respectively. The MFB showed physicochemical characteristics suitable for microemulsion systems and presented suitable stability for 90 days. Finally, the MFB was successfully produced and stands itself as a promising multifunctional cosmetic product.