CCS - DTG - Artigos publicados em periódicos
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Artigo Is rituximab effective for systemic sclerosis? A systematic review and meta-analysis(Springer, 2021) Piuvezam, Grasiela; Caldas, Marina Maria Vieira de Figueiredo; Azevedo, Kesley Pablo Morais de; Nunes, Ana Clara de França; Oliveira, Victor Hugo de; Pimenta, Isac Davidson Santiago Fernandes; Araújo, Isabela Dantas Torres de; Bezerra Neto, Francisco Alves; Oliveira, Ana Katherine da Silveira Gonçalves de; https://orcid.org/0000-0002-2343-7251Background: Systemic sclerosis (SSc) is a clinically complex and challenging disease, that leads to skin fibrosis. Its most frequent complication is interstitial lung disease (ILD), which leads to a worse prognosis. In this situation, cyclophosphamide is considered the gold standard for its treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option. Objectives: This paper objective was to analyze the scientific evidence on the RTX effects on SSc. Methods: A systematic review (SR) was performed including clinical trials (CTs) on the use of RTX in SSc, published up to May 2020. The studies were identified through systematic searches in bibliographic databases using a predefined search strategy. The following databases were used: PUBMED, SCOPUS, SCIELO, LILACS, SCIENCE DIRECT, WEB OF SCIENCE, COCHRANE, WHOLIS, PAHO and EMBASE. Also, a manual search was performed. The methodological quality of the studies was determined using Jadad scale, Risk of Bias Tool (RoB 2.0) and Risk of Bias in Non-Randomized Studies - of Interventions tool (ROBINS-I). A meta-analysis of the randomized CTs was performed, using Review Manager. Results: Ten CTs were included in this SR. Of these, three were randomized and seven were non-randomized. Five showed a statistically significant improvement in forced vital capacity (FVC) at some time during follow-up. Regarding the skin, eight studies showed statistically significant improvements according toa the modified Rodnan skin score. The meta-analysis found positive effects of RTX in SSc, with a statistical significance for lung disease. Conclusion: Rituximab is a promising strategy for the SSc-associated ILD and cutaneous fibrosis treatment. PROSPERO registration number: CRD42019132018Artigo Associations of the consumption of unprocessed red meat and processed meat with the incidence of cardiovascular disease and mortality, and the dose-response relationship: a systematic review and meta-analysis of cohort studies(Taylor and Francis, 2022) Piuvezam, Grasiela; Medeiros, Gidyenne Christine Bandeira Silva de; Mesquita, Gabriela Xavier Barbalho; Lima, Severina Carla Vieira Cunha; Silva, David Franciole de Oliveira; Azevedo, Kesley Pablo Morais de; Pimenta, isac Davidson Santiago Fernandes; Oliveira, Ana Katherine da Silveira Gonçalves de; Lyra, Clélia de Oliveira; Martínez, Daniel Guillén; https://orcid.org/0000-0002-2343-7251Objectives: The aim of this study was to examine the associations of unprocessed red meat and processed meat consumption with cardiovascular disease (CvD) incidence and mortality, and the dose-response relationship.Methods: Published literature was retrieved through a structured search of 10 electronic databases: MeDLiNe/PubMed, Scopus, ScieLO, LiLACS, ScienceDirect, web of Science, Cochrane (CeNTRAL), wHOLiS, PAHO and embase, without language or year of publication restrictions. in addition, we searched the references of published studies. This systematic review was performed in accordance with the Preferred Reporting items for Systematic Reviews and Meta-Analyzes: The PRiSMA Statement.Results: Twenty-one prospective cohort studies were included in the systematic review. The CvDs evaluated in the inserted studies were stroke, heart failure (HF) and coronary heart disease (CHD). Considering the heterogeneity found in the studies, for the meta-analysis, 9 articles were included. The results presented in the meta-analysis of the association of consumption of unprocessed red meat and CvD indicated that there was a significant association with total stroke incidence (RR 1.10; 95%; Ci 1.01 to 1.19; p = 0.02). There was no association with ischemic stroke incidence, nor CHD Mortality with consumption of unprocessed red meat. However, for Hemorrhagic Stroke Mortality the assessment in the consumption of unprocessed red meat showed an association of protection for women (RR 0.64; 95%; Ci 0.45 to 0.91; p = 0.01). As for the results of the meta-analysis of the association between consumption of processed meat and CvD, they indicated that there was a significant association with total stroke incidence (RR 1.17; 95%; Ci 1.08 to 1.26; p < 0.0001). There was no association with ischemic stroke, nor with CHD Mortality with consumption of processed meat. Some studies that showed no association of risk, presented a significant linear trend dose response for the association of the consumption of unprocessed red meat (Bernstein et al. 2010; Nagao et al. 2012) or processed meat (Bernstein et al. 2012) and CvD.Conclusion: According to the results found in the meta-analysis, the consumption of unprocessed red meat and processed meat are associated with the incidence of stroke, however, no positive association was observed in relation to mortality from CvD. This systematic review and meta-analysis protocol was registered on the PROSPeRO (number: CRD42019100914)Artigo Correlation between bacterial vaginosis and adverse obstetric outcomes in Brazilian women(Universidade Federal Fluminense, 2017) Monteiro, Michelly Nóbrega; Cobucci, Ricardo Ney Oliveira; Queiroz, Janice; Lucena, Eudes Euler de Souza; Vital, Ana Luísa Fernandes; Palitot, Tatyane Ribeiro de Castro; Eleutério Junior, José; Giraldo, Paulo César; Oliveira, Ana Katherine da Silveira Gonçalves deIntroduction:Vaginal infections and modifications in the vaginal flora are very prevalent during pregnancy and have been associated with adverse obstetric outcomes, such as preterm labor, preterm premature rupture of membranes and low birth weight. Objective: To evaluate the prevalence and associations of bacterial vaginosis (BV) and pregnancy outcomes among Brazilian pregnant women in the third trimester. Methods:A prospective observational study was conducted assessing vaginal microbiota on bacterioscopy (wet mount and Gram stain), using vaginal swabs obtained from pregnant women between 26 and 32 weeks’ gestation. The women were monitored until delivery, and their pregnancy outcome and demographic data were collected using an interviewer-administered questionnaire. Results: BV was assessed using both Amsel’s criteria and Nugent’s score in 77 of 190 women, resulting in the prevalence of 42.5%. BV was significantly associated with preterm labor (risk ratio [RR], 2.89; 95% confidence interval [CI], 2.35–3.56) and low birth weight (RR, 2.17; 95%CI, 1.61–2.92). Premature rupture of membranes was not associated with BV. Conclusion: BV was found to be very frequent among Brazilian pregnant women in the third trimester and correlated to unfortunate pregnancy outcomes. Regular screening of pregnant women may allow for early treatment and prevention of some obstetric complicationsArtigo Prevalence of sexual dysfunction among expectant women(Federação das Associações Brasileiras de Ginecologia e Obstetrícia (Febrasgo), 2016-12-22) Monteiro, Michelly Nóbrega; Lucena, Eudes Euler de Souza; Cabral, Patricia Uchoa; Queiroz Filho, José; Queiroz, Janice; Oliveira, Ana Katherine da Silveira Goncalves dePurpose To identify pregnancy as a causative factor of sexual dysfunction among expectant women. Methods A prospective study with 225 expectant mothers seen in the prenatal clinic of a federal university. Sexual function was evaluated by means of the Female Sexual Function Index (FSFI), and all domains were analyzed (desire, arousal, lubrication, orgasm, satisfaction, and pain). Initially, a univariate analysis of the sample was done. The averages for each domain according to the risk of sexual dysfunction (FSFI ≤ 26.5) were compared using the Student’s t-test for independent samples. The strength of the correlation between sexual dysfunction and all sociodemographic, clinical and behavioral variables was measured by the Chi-Square (X2) test. Then, odds ratios (ORs) and their confidence intervals were assigned to perform a bivariate analysis. Any p values less than 0.05 were considered significant. Results Approximately two-thirds of the women (66.7%) showed signs of risk of sexual dysfunction (FSFI ≤ 26.5). Within these cases, all sexual dysfunction domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were found to be statistically significant (p < 0.001). The domains most affected were desire (2.67), satisfaction (2.71) and arousal (2.78). Conclusions Pregnancy appears to be an important causative factor of sexual dysfunction among pregnant womenArtigo Impacto da inserção da temática saúde sexual e reprodutiva na graduação de Medicina(Thieme Open, 2014-03) Medeiros, Robinson Dias de; Azevedo, George Dantas de; Maranhão, Técia Maria de Oliveira; Oliveira, Ana Katherine da Silveira Goncalves de; Barros, Yasha Emerenciano; Araújo, Ana Cristina Pinheiro Fernandes de; Lima, Stênia Lins LeãoObjetivo: avaliar o impacto da inserção da temática saúde sexual e reprodutiva na graduação de Medicina em uma universidade pública do Brasil. Métodos: foi desenvolvido instrumento de avaliação cognitiva em saúde sexual e reprodutiva com base nos temas abordados no componente curricular optativo Saúde Reprodutiva, resultando em prova objetiva de múltipla escolha contendo 27 itens. Os temas selecionados foram: direitos humanos, sexuais e reprodutivos (DHSR), sexualidade, violência institucional, gênero, violência sexual, concepção, contracepção, aborto/interrupção legal da gestação, mortalidade materna e doenças sexualmente transmissíveis (DSTs) – HIV/AIDS. Os temas foram agrupados em três dimensões do conhecimento: DHSR, legal/institucional e biomédica. Na análise de covariância, dois modelos multivariados foram ajustados. Resultados: participaram do estudo 183 alunos, 127 do grupo que cursou o componente curricular eletivo saúde reprodutiva (Grupo SR) e 56 do grupo que não cursou (Grupo Não SR). Noventa e seis alunos (52,5%) eram do sexo masculino e 87 (47,5%) do sexo feminino. A média de idade foi de 24,7±1,9 anos no Grupo SR e de 24,4±2,6 no Não SR. O desempenho médio do Grupo SR foi superior ao Não SR nos temas DHSR, sexualidade, violência institucional, violência sexual, aborto/interrupção legal e DSTs – HIV/AIDS. Não houve diferença no desempenho dos sexos masculino e feminino, com a exceção do tema mortalidade materna, no qual o grupo masculino foi inferior (6,9±0,2 e 7,8±0,2, respectivamente; p<0,05). Conclusões: a participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva, o que sugere um impacto positivo dessa iniciativa na formação médica generalistaArtigo Mulheres com risco cardiovascular após pré-eclâmpsia: há seguimento no Sistema Único de Saúde?(Universidade de São Paulo (USP), 2014-01) Silva, Maria de Lourdes Costa da; Galvão, Ana Cristina Araújo de Andrade; Souza, Nilba Lima de; Azevedo, George Dantas de; Jerônimo, Selma Maria Bezerra; Araújo, Ana Cristina Pinheiro Fernandes deObjetivos: identificar mulheres com risco cardiovascular, cinco anos após a pré-eclâmpsia, e averiguar o seguimento dessas mulheres no Sistema Único de Saúde, em Natal, Rio Grande do Norte. Métodos: estudo exploratório, quantitativo, realizado na Maternidade Escola Januário Cicco, em Natal. A amostra foi de 130 mulheres, 65 com pré-eclâmpsia e 65 normotensas. Resultados: constatou-se diferença estatística significativa no que se refere ao índice de massa corpórea, peso, histórico familiar de doenças cardiovasculares e complicação cardiovascular entre as mulheres com pré-eclâmpsia prévia e as normotensas. Os grupos desconheciam os fatores de risco cardiovasculares e, além disso, referiam dificuldades de acesso aos serviços de atenção primária. Conclusões: as mulheres com histórico de pré-eclâmpsia possuíam risco aumentado de desenvolver doenças cardiovasculares, desconheciam as complicações tardias dessa doença e não recebiam seguimento ambulatorial diferenciado em relação às normotensasArtigo An innovative educational strategy to addressing cultural competence in healthcare for quilombola women(Taylor and Francis, 2019) Freitas Junior, Reginaldo Antonio de Oliveira; Santos, Carolina Araujo Damasio; Lisboa, Lilian Lira; Freitas, Ana Karla Monteiro Santana de Oliveira; Azevedo, George Dantas deThe Quilombola community is made up of descendants of enslaved Africans. These people represent an ethnic minority group within the Brazilian Black population with worse health indicators including higher rates of maternal mortality. Context: The Brazilian National Guidelines for education of health professionals state that cultural competence and education of ethnic‑racial relations need to be reinforced. Activities: An action research initiative was developed with the main goal of contributing to the development of cultural competence, interprofessional education, and collaborative work as well as improving the maternal and child indicators of the Quilombola community. An elective module for undergraduate health courses with the subject “Cultural Competence in Health Care for Quilombola Women” was implemented. Data on health‑related needs identification, students’ perceptions about interactions with the community, and competencies necessary to work with the Quilombola community were considered. Outcomes: Our educational strategy reinforces the importance of considering the processes that influence the health care of this population. The reflective capacity and communication skills emerged as the most important attitudinal and psychomotor components, respectively. Future Directions: Sustainability comes from partnerships established between the Quilombola community and the university to institutionalize educational and research strategies. This project contributes to reducing health inequities and deconstructing racism in the training of future health professionals. Conclusions: The creation of links, the building of trust between users and health staff, and the ability to reflect, with emphasis on communication, were shown as the main components of culturally competent behavior in maternal health care in the studied Quilombola populationArtigo Clustering of risk factors for cardiometabolic diseases in low-income, female adolescents(Sociedade Brasileira de Endocrinologia e Metabologia, 2016-06) Melo, Elza Maria Fernandes Seabra de; Azevedo, George Dantas de; Silva, João Batista da; Lemos, Telma Maria Araujo Moura; Maranhão, Técia M. O.; Freitas, Ana Karla Monteiro Santana de Oliveira; Spyrides, Maria H.; Costa, Eduardo CaldasObjective: To assess the prevalence and clustering patterns of cardiometabolic risk factors among low-income, female adolescents. Materials and methods: Cross-sectional study involving 196 students of public schools (11-19 years old). The following risk factors were considered in the analysis: excess weight, central obesity, dyslipidemia, high blood pressure, and high fasting glucose. The ratio between observed and expected prevalence and its confidence interval were used to identify clustering of risk factors that exceeded expected prevalence in the population. Results: The most prevalent risk factors were dyslipidemia (70.9%), and central obesity (39.8%), followed by excess weight (29.6%), and high blood pressure (12.8%). A total of 42.9% of adolescents had two or more risk factors, and 24% had three or more. Excess weight, central obesity, and dyslipidemia were common risk factors in the clustering patterns that showed higher-than-expected prevalence. Conclusions: Clustering of risk factors (≥ two factors) among the adolescents showed considerable prevalence, and there was a non-casual coexistence of excess weight, central obesity, and dyslipidemia (mainly low HDL-cholesterol).Artigo Mapeamento do fluxo das gestantes de alto risco do pré-natal da Maternidade Escola Januário Cicco – MEJC(Revista Brasileira de Inovação Tecnológica em Saúde, 2016-08-17) Câmara, Hugo Estevam de Sales; Hékis, Hélio Roberto; Araújo, Bruno Gomes de; Cornetta, Maria da Conceição de Mesquita; Farias, Daniel José LeiteO mapeamento de processos é uma ferramenta importante que contribui na gestão das organizações, melhorando os níveis de produtividade, qualidade e reciprocidade das decisões tomadas e implementadas. Nesse sentido, o objetivo deste estudo é descrever o mapeamento dos macroprocessos do ambulatório de gestantes de alto risco para portadoras de diabetes da Maternidade Escola Januário Cicco - MEJC. O método de pesquisa utilizado foi descritivo. A partir de observações, entrevistas e análises foi possível entender que há sobrecarga de atividades de atendimento a pacientes com diabetes. Além disso, foi observado que não existe um sistema informatizado e, sobretudo, um banco de dados que permita um controle mais efetivo para o gerenciamento. Percebe-se que por meio do mapeamento desse setor pode-se ter uma visão mais clara e abrangente dos processos organizacionais, e, dessa forma, gerir as informações de modo eficiente e eficazArtigo Project Pró-Natal: population-based study of perinatal and infant mortality in Natal, Northeast Brazil(2000) Ramos, Ana Maria Oliveira; Maranhão, Técia Maria de Oliveira; Macedo, Albanita Leite Soares de; Pollock, Jon I.; Emond, AlanArtigo The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil(2002) Emond, Alan; Pollock, Jon; Costa, Nilma da; Maranhão, Técia Maria de Oliveira; Macedo, Albanita Leite Soares deArtigo Procoagulant state after raloxifene therapy in postmenopausal women(2005) Azevedo, George Dantas de; Franco, Rendrik França; Baggio, Márcia Sueli; Maranhão, Técia Maria de Oliveira; Sá, Marcos Felipe Silva deArtigo Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study(2004) Azevedo, George Dantas de; Prado, Maria Fernanda Massoni do; Ferriani, Rui Alberto; Reis, Rosana Maria dos; Berezowski, Aderson Tadeu; Ribeiro, Tatiane Flores; Silva, Ester; Maranhão, Técia Maria de Oliveira; Sá, Marcos Felipe Silva deArtigo Papel da extensão e do trabalho junto à comunidade na formação médica(2007) Silva, Thiago Demétrio Nogueira Costa e; Maranhão, Técia Maria de Oliveira; Corrêa, Edison JoséArtigo Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome(2008) Soares, Elvira Maria Mafaldo; Azevedo, George Dantas; Gadelha, Rafael Goncxalves Nóbrega; Lemos, Telma Maria Araújo Moura; Maranhão, Técia Maria OliveiraArtigo Metabolic syndrome in postmenopausal women: higher prevalence in the Northeastern Region of Brazil than in other Latin American countries and the influence of obesity and socioeconomic factors(2007) Silveira, Inavan Lopes da; Maranhão, Técia Maria de Oliveira; Azevedo, George DantasArtigo Prevalência de sintomas do climatério em mulheres dos meios rural e urbano no Rio Grande do Norte, Brasil(Revista Brasileira de Ginecologia e Obstetrícia, 2007) Silveira, Inavan Lopes da; Petronilo, Patrícia Arboés; Souza, Maxwell de Oliveira; Silva, Thiago Demétrio Nogueira Costa e; Duarte, João Marcelo Brasil Pinheiro; Maranhão, Técia Maria de Oliveira; Azevedo, George Dantas deArtigo Efeito da idade materna sobre os resultados perinatais(Revista Brasileira de Ginecologia e Obstetrícia, 2002) Azevedo, George Dantas de; Freitas Júnior, Reginaldo Antonio de Oliveira; Freitas, Ana Karla Monteiro Santana de Oliveira; Araújo, Ana Cristina Pinheiro Fernandes de; Soares, Elvira Maria Mafaldo; Maranhão, Técia Maria de OliveiraArtigo Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos(2010) Costa, Eduardo Caldas; Soares, Elvira Maria Mafaldo; Lemos, Telma Maria Araujo Moura; Maranhão, Técia Maria de Oliveira; Azevedo, George Dantas deArtigo Síndrome metabólica em mulheres com síndrome dos ovários policísticos: prevalência em cidade da região nordeste do Brasil(2007) Soares, Elvira Maria Mafaldo; Azevedo, George Dantas de; Maranhão, Técia Maria de Oliveira