PPGCSA - Mestrado em Ciências da Saúde
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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.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.Master Thesis Associações entre aptidão física, comportamentos de movimento e pressão arterial imediatamente pós-exercício em pessoas idosas: uma perspectiva de redes(Universidade Federal do Rio Grande do Norte, 2025-09-12) Souto, Gabriel Costa; Costa, Eduardo Caldas; https://orcid.org/0000-0003-2807-7109; http://lattes.cnpq.br/1216441676725839; http://lattes.cnpq.br/9599342525585108; Oliveira, Ricardo Santos; Farah, Breno Quintella; https://orcid.org/0000-0003-2286-5892; http://lattes.cnpq.br/6914216878368661Introduction: Identifying factors associated with immediate post-exercise blood pressure (BP), a proxy for the BP response to exercise, is essential for refining cardiovascular risk stratification and guiding preventive and treatment strategies. This thesis aimed to explore the associations between components of physical complexity, movement behaviors, and immediate post-exercise BP in older adults using network analysis, a multivariate statistical approach for measuring complex systems. Methods: This is a cross-sectional study involving 237 older adults (mean age: 66 ± 5 years) with no previous diagnosis of cardiovascular disease. BP was measured at rest and immediately after a 3-minute submaximal walk test (equivalent to 5 METs). Moderate-to-vigorous physical activity (MVPA) and sedentary time were objectively assessed using accelerometry for seven consecutive days. The following were used as markers of physical exertion: (i) the sixminute walk test (6minWT), (ii) handgrip strength (HGS), and (iii) the 30-second sit-to-stand test (30s-SST). The associations between these variables were examined using network analysis, a multivariate statistical approach that simultaneously represents direct and indirect connections between multiple factors. Results: Lower scores on the HGS test (weight: -0.136) and 30s-SST (weight: -0.106) were directly associated with higher BP values immediately post-exercise. Furthermore, lower HGS (weight: -0.176) and low levels of MVPA (weight: -0.128) were directly associated with higher resting BP levels, which in turn, was the variable with the greatest direct association with BP immediately after exercise (weight: 0.581). Centrality measures highlighted the 6minWT (0.736), the 30s-SST (0.668), and sedentary time (0.350) as potential intervention points. MVPA emerged as a central variable in the network, while HGS was highly connected to other nodes. Conclusion: The results reveal a complex network of interactions, both direct and mediated by resting BP, between physical fitness, movement behaviors, and immediate post-submaximal exercise BP. Increased MVPA, improved cardiorespiratory fitness and muscle strength, and reduced sedentary time appear to be promising targets for interventions aimed at reducing submaximal exercise-related blood pressure overload in this population.Doctoral Thesis Pressão arterial ambulatorial em mulheres com síndrome dos ovários policísticos: comparação com mulheres ovulatórias e correlatos antropométricos, hormonais e inflamatórios(Universidade Federal do Rio Grande do Norte, 2025-09-29) Azevedo, Maria Fátima de; Costa, Eduardo Caldas; https://orcid.org/0000-0003-2807-7109; http://lattes.cnpq.br/1216441676725839; http://lattes.cnpq.br/6185606818998571; Puga, Guilherme Morais; https://orcid.org/0000-0002-9093-6640; http://lattes.cnpq.br/6305642051022927; Cambri, Lucieli Teresa; Oliveira, Ana Katherine da Silveira Gonçalves de; https://orcid.org/0000-0002-8351-5119; http://lattes.cnpq.br/3436756337251449; Micussi, Maria Thereza Albuquerque Barbosa Cabral; https://orcid.org/0000-0003-4140-5568; http://lattes.cnpq.br/2360845979410206This thesis aimed to compare 24-hour ambulatory blood pressure (ABP) between women with polycystic ovary syndrome (PCOS) and ovulatory women, and to explore potential anthropometric, hormonal, metabolic, and inflammatory correlates of ABP in women with PCOS. In this cross-sectional study, 50 women with PCOS (diagnosed by Rotterdam criteria) and 50 ovulatory controls underwent office and 24-hour ABP monitoring. Clinical, anthropometric, hormonal, metabolic, and inflammatory parameters were assessed. Between-group comparisons were adjusted for body mass index (BMI). LASSO regression was used to identify variables independently associated with ABP in the PCOS group. Women with PCOS showed significantly higher 24-hour and daytime mean arterial pressure (84 vs. 80 mmHg; p = 0.032) and heart rate (81 vs. 78 bpm; p = 0.034) as well as pulse pressure (41 vs. 38 mmHg; p = 0.029) compared to ovulatory women, even after adjustment for BMI. No differences were observed in nighttime ABP or office blood pressure (p>0.05). PCOS participants exhibited a more adverse cardiometabolic profile, including higher BMI, waist circumference, insulin, HbA1c, triglycerides, creatinine, and TNF-alfa, along with lower estradiol and progesterone levels. In LASSO models, BMI emerged as the only independent predictor of ABP across all periods. Additional predictors, such as HbA1c (nighttime mean BP), creatinine (daytime diastolic BP), and waist circumference (daytime systolic BP), were retained in specific models, while most hormonal, metabolic, and inflammatory markers were not associated with ABP in the PCOS group. In summary, women with PCOS exhibit higher 24-hour, and daytime ABP, and heart rate, and pulse pressure compared to ovulatory women, independently of BMI. Adiposity, as assessed by BMI, appears to be a key factor associated with ABP in this population. These findings highlight the importance of 24- hour ABP and BMI monitoring in the cardiovascular risk assessment and care of women with PCOS.Master Thesis Vesículas extracelulares de macrófagos M1 e nanopartículas agonistas de TLR3 regulam negativamente a imunossupressão e a metástase no câncer de mama triplo negativo(Universidade Federal do Rio Grande do Norte, 2025-07-11) Souza, Shirley Vitória de Paiva; Araújo Júnior, Raimundo Fernandes de; https://orcid.org/0000-0003-2349-2354; http://lattes.cnpq.br/1903940945895093; http://lattes.cnpq.br/7518321959352273; Farias, Naisandra Bezerra da Silva; http://lattes.cnpq.br/6590909272236189; Pereira, Karuza Maria Alves; https://orcid.org/0000-0002-2880-6466; http://lattes.cnpq.br/3193698890688967Triple-negative breast cancer (TNBC) is an aggressive form of the disease, with limited therapeutic options and a poor prognosis for patients. Tumor immune escape–induced metastasis has been implicated as one of the main factors contributing to this aggressiveness. Therefore, new therapies must be developed, particularly those involving nanoparticles and extracellular vesicles, which have emerged as promising platforms for delivering immune system components. In this context, extracellular vesicles derived from M1 macrophages (M1EVs) were isolated and subsequently combined with PLGA nanoparticles loaded with the TLR3 agonist poly(I:C) (NPIC), as a promising therapeutic strategy. The aim was to investigate their antitumor activity by negatively regulating immune escape within the tumor microenvironment (TME), in a murine orthotopic tumor growth model. Tumors were evaluated by qRT-PCR and immunohistochemistry, while cellular uptake and macrophage polarization of murine RAW 264.7 cells were analyzed in vitro by immunofluorescence and flow cytometry, respectively. Additionally, mouse survival, lymph node involvement, and metastatic spread were thoroughly assessed. In the animal model, the combined therapy significantly inhibited tumor progression, mainly through immunomodulation of the TME, resulting in reduced primary tumor volume (p < 0.0001) and metastasis, as well as an extension of survival by 11 days. Notably, both innate and adaptive immune responses were enhanced, as evidenced by increased CD8 expression (p < 0.0001), reduced PD-L1 levels in the TME, and increased CD11c expression in lymph nodes (p < 0.0001). Similarly, the combined therapy suppressed tumor progression by reducing AKT1 expression (p < 0.001) and increasing E-cadherin expression (p < 0.01). Altogether, these findings indicate that the combination of M1-EVs and NPIC functions as a "vaccine-like immunomodulatory strategy," promoting TME reprogramming and inhibiting metastasis in the murine model of TNBC.Master Thesis Melhorando o desempenho de discos de titânio embalados por meio do tratamento com plasma atmosférico frio(Universidade Federal do Rio Grande do Norte, 2025-05-05) Martins, Gabriel de Moura; Alves Júnior, Clodomiro; http://lattes.cnpq.br/7441669258580942; https://orcid.org/0000-0001-6489-4187; http://lattes.cnpq.br/6746106913768611; Cruz, Nilson Cristino; https://orcid.org/0000-0002-0354-3890; http://lattes.cnpq.br/7157327220048138; Araújo Júnior, Raimundo Fernandes de; https://orcid.org/0000-0003-2349-2354; http://lattes.cnpq.br/1903940945895093Although titanium (Ti)-based bone implants are already clinically established, ongoing research is being conducted to advance the fields of osseointegration and bacterial resistance, seeking further improvements in these areas. In this study, we present an innovative method for the treatment of Ti surfaces in hermetically sealed packaging. Ti discs in surgical-grade packaging were treated with cold atmospheric plasma (CAP). The surfaces were characterized in terms of wettability, crystal structure, and chemical composition. Hemocompatibility analyses were performed using sodium citrate-diluted blood (1:9 ratio) exposed to Ti disks for 30 minutes in a CO2 incubator at 37 °C. Subsequent evaluations included complete blood count (leukocytes, lymphocytes, neutrophils, and erythrocytes), prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet adhesion. Microbiological analyses were conducted using Pseudomonas aeruginosa (ATCC 27853) incubated for 4 hours at 37 °C. CAP treatment reduced the contact angle without altering the crystalline structure. No statistical differences were observed in blood count parameters. Plasma-treated samples exhibited significantly lower PT and APTT values compared to the control group. Platelet adhesion assessments revealed that CAP-treated surfaces showed increased platelet activation, platelet density, and thrombus formation compared to untreated samples. Additionally, treated surfaces demonstrated reduced bacterial colony formation relative to untreated surfaces. Thus, CAP emerges as a promising strategy for optimizing Ti-based bone implants in clinical settings.Master Thesis Associação entre vulnerabilidade, estado nutricional, fragilidade e qualidade de vida em pessoas idosas atendidas na Atenção Primária à Saúde(Universidade Federal do Rio Grande do Norte, 2025-05-16) Rocha, Kalyne Patricia de Macedo; Torres, Gilson de Vasconcelos; Dantas, Bruno Araújo da Silva; https://orcid.org/0000-0002-7442-0695; http://lattes.cnpq.br/8885053812468123; https://orcid.org/0000-0002-8557-1616; http://lattes.cnpq.br/8047488173594750; Brischiliari, Sheila Cristina Rocha; https://orcid.org/0000-0002-0591-7307; http://lattes.cnpq.br/3502122503814909; Nunes, Vilani Medeiros de Araújo; https://orcid.org/0000-0002-9547-0093; http://lattes.cnpq.br/8169308778262070Population aging has increased the demand for healthcare, especially in Primary Care. Factors such as vulnerability, nutritional status, and frailty influence the quality of life of older adults. This study aimed to assess the association between vulnerability and multidimensional aspects in older adults assisted by Primary Health Care. This is an observational, cross-sectional study with a quantitative approach, conducted between June 2023 and March 2024, involving 323 older adults attended by Primary Health Care services in Santa Cruz and Macaíba, Rio Grande do Norte, Brazil. Data collection was carried out through face-to-face interviews using validated instruments to assess sociodemographic, nutritional, cognitive, frailty, and quality of life aspects. The analysis considered categorical and scalar variables to measure the outcomes. Among the 323 older adults evaluated, 45.8% presented vulnerability (VES-13). Frailty (as measured by the EFE) was the main predictor of vulnerability. The study revealed a significant association between vulnerability in older adults in Primary Health Care and factors such as nutritional status, frailty, and quality of life, highlighting functional deficits as the main predictors. The findings reinforce the importance of integrated approaches and support prevention and screening strategies aimed at the comprehensive care of older adults.Master Thesis Abuso e violência contra pessoas idosas e sua relação com fragilidade, sintomas depressivos e estado nutricional: estudo transversal realizado na Atenção Primária à Saúde de uma região urbana do Brasil(Universidade Federal do Rio Grande do Norte, 2025-05-16) Andrade, Nathaly da Luz; Maia, Eulália Maria Chaves; Dantas, Bruno Araújo da Silva; https://orcid.org/0000-0002-0354-7074; http://lattes.cnpq.br/2021670670663453; Torres, Gilson de Vasconcelos; Brischiliari, Sheila Cristina Rocha; Nunes, Vilani Medeiros de AraújoViolence against older adults is a serious violation of human rights, directly impacting their dignity and quality of life. Factors such as frailty, depressive symptoms, and compromised nutritional status can intensify this vulnerability, especially in contexts of social inequality. Primary Health Care (PHC) plays a strategic role in the early identification and intervention in cases of violence, requiring actions that integrate different dimensions of health. This study aimed to investigate whether there is an association between the risk of violence and aspects such as frailty, presence of depressive symptoms, and nutritional impairment in older adults assisted by PHC in the municipalities of Santa Cruz and Macaíba, Rio Grande do Norte, Brazil. This is a cross-sectional study, with 323 participants, conducted in June 2023 and in March 2024. Validated instruments were used: H-S/EAST, CTS-1, EFS, GDS-15, MNA, and the Older Adult Health Booklet. Analyses included association tests, correlation, and logistic regression. Among the older adults assessed, 46.1% presented a risk of abuse and violence. Frailty, depressive symptoms, and altered nutritional status were significantly associated with the risk of violence. Logistic regression identified depressed mood and functional impairment as predictors of the risk. The results reinforce the importance of screening physical and emotional aspects in PHC, aiming at the prevention of violence and the protection of older adults. Interdisciplinary strategies that consider the complexity of aging are essential to promote comprehensive care and reduce vulnerabilities.Master Thesis Avaliação de risco de sarcopenia em pacientes idosos com câncer usando a ferramenta SARC-CALF: comparação entre a circunferência da panturilha bruta e ajustada pelo índice de massa corporal(Universidade Federal do Rio Grande do Norte, 2025-04-25) Nascimento, Maria Karolainy do; Fayh, Ana Paula Trussardi; https://orcid.org/0000-0002-9130-9630; http://lattes.cnpq.br/0049770583345803; http://lattes.cnpq.br/1665029931669511; Costa, Eduardo Caldas; Verde, Sara Maria Moreira LimaIntroduction: Sarcopenia is a concerning condition in elderly cancer patients and can lead to adverse outcomes. In clinical practice, screening tools are considered one of the most accessible methods for healthcare professionals. The SARC-CalF is an available screening method that includes the Calf Circumference (CC) parameter as a marker of Muscle Mass (MM). However, in overweight patients, adiposity may lead to false negatives. In these cases, adjusting CC by Body Mass Index (BMI) could help identify patients with low CC who are at risk of sarcopenia. Although BMI-adjusted CC is already available, no study has explored its prognostic value in SARC-CalF among an elderly cancer population. Objectives: To evaluate and compare the frequencies of positive scores using the unadjusted SARC-CalF with scores derived from the SARC-CalF after adjusting Calf Circumference (CC) by Body Mass Index (BMI). The secondary objective was to evaluate the prognostic value of the SARC-CalF after BMI adjustment, including hospitalization time and mortality. Methods: This is a prospective cohort study (2019-2023) of elderly (≥60 years) outpatients and inpatients recruited from the Onofre Lopes University Hospital (HUOL) in Brazil. Sociodemographic and clinical data were collected, including the outcomes of length of stay and in-hospital mortality at 6 and 12 months. Weight, height and WC were measured. BMI was classified according to the World Health Organization (WHO) and patients who were overweight (≥ 25 Kg/m²) had their WC adjusted based on the adjustment proposed by Gonzales et. al, (2021). In these individuals, the values of 3 cm, 7 cm and 12 cm were subtracted, according to the BMI values: 25-29.9 Kg/m², 30- 39.9 Kg/m² and ≥ 40.0 Kg/m², respectively. The SARC-CalF was used to assess the risk of sarcopenia (score ≥11). The data was analyzed using the Statistical Package for the Social Sciences (SPSS) and MedCalc software. The normality of the continuous variables was assessed using the Shapiro-Wilk normality test. Sex-specific and SARCCalF comparisons were conducted using the following tests: independent Student's ttest, Mann-Whitney U-test, Pearson's χ² test or Fisher's exact test, as appropriate. The variance ratio of SARC-CalF scores was assessed using the F-test. Crude and adjusted Cox regression analyses were conducted to assess the association between unadjusted and BMI-adjusted SARC-CalF. Results: A total of 206 individuals were included in this analysis, with a mean age of 69 years and half being male (52.1%). Excess weight was present in 36.4% (n=75), and their Calf Circumference (CC) was adjusted by Body Mass Index (BMI). The prevalence of low CC increased from 65% (n=134) to 84% (n=173) after BMI adjustment. The risk of sarcopenia was identified in 51% (n=105) of the population before adjustment, and after adjustment, the frequency of positive SARC-CalF scores increased to 65.0% (n=134). The unadjusted SARC-CalF was independently associated with mortality at 12 months (adjusted HR 2.26 [95% CI 1.38-3.71]). After adjusting CC by BMI, SARC-CalF emerged as an independent predictor of prolonged hospitalization (adjusted HR: 1.26 [95% CI 1.03-1.53]), mortality at 6 months (adjusted HR 1.42 [95% CI 1.07-1.87]), and at 12 months (adjusted HR 1.99 [95% CI 1.03-1.53]). Conclusion: The BMI-adjusted SARC-CalF could be a practical strategy to better identify overweight elderly cancer patients at risk of sarcopenia, representing a potential prognostic tool, as it was independently associated with prolonged hospitalization and mortality.Master Thesis Diferenças na composição e funcionalidade muscular: explorando os pontos anatômicos da tomografia computadorizada e os componentes do SARC-F(Universidade Federal do Rio Grande do Norte, 2025-03-14) Araújo, Janaina Oliveira de; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509; Fayh, Ana Paula Trussardi; Costa, Eduardo Caldas; Silva, Flávia MoraesIntroduction: Body composition assessment is essential for determining nutritional status and identifying conditions such as sarcopenia, which is associated with unfavorable clinical and functional outcomes in cancer patients. The SARC-F is a tool that identifies signs suggestive of sarcopenia, allowing for faster and more effective interventions. However, the SARC-F has limitations in terms of its correlation, which tends to be stronger with muscle functionality than with muscle mass. The use of precise techniques, such as computed tomography (CT), offers a comprehensive assessment of muscle status, including morphological quantity and quality. In this context, exploring the relationship between SARC-F components and different muscle sites from CT scans may improve our understanding of the complex interaction between SARC-F and muscle health, with a particular focus on muscle functionality. Objectives: To investigate the differences between the SARC-F score and muscle parameters measured in the L3, thigh and gluteal regions of CT scans in relation to each SARC-F component/question. Methods: A secondary cross-sectional analysis of a cohort with prospective data collection was carried out. The study involved patients treated at the Onofre Lopes University Hospital (HUOL), of both sexes, hospitalized or in outpatient care, all diagnosed with cancer, aged 18 years or over, who underwent a CT scan within three months of the evaluation. The sample was selected for convenience and there was no sample size calculation. The study participants completed the SARC-F questionnaire at the time of the assessment. An overall SARC-F score ≥ 4 was considered to be suggestive of sarcopenia. Muscle assessment through CT measurements was carried out using single cross-sectional images at the level of the third lumbar vertebra (L3) in the abdominal region, in the thigh region and in the total gluteal region at the level of the second sacral vertebra. Skeletal muscle cross-sectional area (SMA), skeletal muscle index (SMI, normalized for height2) and skeletal muscle density (SMD) were assessed for all anatomical points (L3, thigh and gluteus). Results: A total of 128 patients were included in this analysis (53.1% women, 61.7% elderly). Patients with SARC-F ≥ 4 had significantly lower MDS values at all landmarks (L3, thigh and gluteus). There was a statistical trend (P < 0.10) towards lower SMI at L3 and both lower SM and SMI at the gluteal site. Patients who reported difficulties with strength, requiring assistance to walk and climbing stairs had significantly lower MDS values at L3 (P = 0.039; P = 0.033; P = 0.012, respectively). At gluteal and thigh level, only patients with difficulty climbing stairs (P = 0.012) had significantly lower SMD values. Only gluteal MSD was independently associated with the SARC-F score (adjusted β -0.09, 95% CI -0.16 to -0.02). Conclusion: The study revealed an independent association between the SARC-F score and muscle composition (MSD) at the gluteal level. Our results indicate that individuals with changes in muscle composition may show signs suggestive of sarcopenia and impaired muscle functionalityMaster Thesis Nanocarreadores híbridos multicarregados com benznidazol e fitol como estratégia para o tratamento da infecção por Trypanosoma cruzi(Universidade Federal do Rio Grande do Norte, 2023-08-09) Gomes, Daniele Cavalcante; Silva Júnior, Arnóbio Antonio da; https://orcid.org/0000-0002-7516-1787; http://lattes.cnpq.br/2593509584288129; http://lattes.cnpq.br/5322004229215874; Luchessi, André Ducati; Kairuz, Álvaro Federico Jimenez; Araújo, Daniele Ribeiro deChagas disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi. In this scenario, the only drug of choice for treatment in Brazil is Benznidazole (BNZ). Despite its widespread use, this molecule has efficacy problems due to its high toxicity, difficulty in crossing biological barriers, and low solubility in aqueous media. Therefore, the co-delivery of benznidazole together with phytol (FIT), an acyclic monounsaturated diterpene alcohol that expresses promising antitrypanosomal activity, is justified. Nanocarriers have proven ability to cross most biological barriers and intracellular targeting of drugs. The objective of this work was to develop biodegradable hybrid nanocarriers containing benznidazole and phytol, to improve the targeting of the compounds to cells infected by Trypanosoma cruzi. The systems were produced by the nanoprecipitation method. The formulation development and obtaining parameters were optimized by measurements of mean particle size, polydispersity index, zeta potential, atomic force microscopy (AFM), scanning electron microscopy (SEM), infrared absorption spectroscopy with transform Fourier (FTIRATR), encapsulation efficiency and in vitro studies. Spherical and stable hybrid nanocarriers below 200 nm were obtained, with encapsulation efficiency greater than 95% for FIT and 30% for BNZ. The in vitro drug release kinetics demonstrated a slow release of the nanocarriers. In vitro assays in normal cells (3T3) and (RAW) showed cytocompatibility and in trypomastigotes (CL-Brenner) showed an increase in the antichagasic activity of nanocarriers containing BNZ-FIT over monoloaded systems and BNZ and free FIT. Thus, the present work systematically addresses the development of a nanotechnological system with innovative potential for increasing the antichagasic response from the association of actives.Master Thesis Eficácia do bloqueio do nervo supraescapular associado à fisioterapia comparado à fisioterapia no tratamento da capsulite adesiva: um ensaio clínico randomizado(Universidade Federal do Rio Grande do Norte, 2024-09-03) Medeiros Filho, João Felipe de; Egito, Eryvaldo Sócrates Tabosa do; Malavolta, Eduardo Angeli; http://lattes.cnpq.br/6907806915889763; https://orcid.org/0000-0002-4745-4566; http://lattes.cnpq.br/8263620611319600; Ferreira Neto, Arnaldo Amado; Medeiros, Aldo da CunhaAdhesive capsulitis (AC) is one of the primary causes of shoulder girdle dysfunction, characterized by pain and restricted mobility in the glenohumeral joint. There is no consensus concerning treatment, with various clinical and surgical approaches proposed. The purpose of this paper is to compare the results of AC treatment in patients who underwent suprascapular nerve block (SSNB) associated with physiotherapy (PT) and those who only underwent physiotherapy. Patients with AC were randomized into two groups: a Block group (SSNB + PT) and a Control group (PT). Four serial blocks were administered with 6 ml of 0.25% bupivacaine at 15-day intervals. Both groups were analyzed using range of motion (ROM) measured with digital goniometry, UCLA score, and visual analog scale (VAS) before treatment and at 2, 4, and 6 months. Analyses with a 95% confidence interval and p < 0.05 were considered statistically significant. A total of 290 patients were randomized, with 182 of them being followed up (FU). Sixty-nine patients received nerve block and physiotherapy (SSNB+PT), and 113 were controls (only PT). The t-test showed no statistical difference between the two groups at baseline, and at 2, 4, and 6 months (p > 0.05) for all evaluated scores. After 6 months, 15 patients underwent surgery, with no difference between groups. Serial suprascapular nerve block was not statistically superior in improving the parameters measured compared to the control group for AC treatment.Master Thesis Aspectos multidimensionais relacionados ao risco de queda em pessoas idosas da comunidade: estudo transversal realizado na atenção primária à saúde brasileira(Universidade Federal do Rio Grande do Norte, 2025-02-27) Almeida, Larissa Amorim; Torres, Gilson de Vasconcelos; Oliveira, Adriana Catarina de Souza; Oliveira, Adriana Catarina de Souza; Maia, Eulalia Maria Chaves; Coelho, Kellen RosaFalls represent a significant public health problem, particularly among the elderly population, affecting approximately 30% of this group and resulting in physical disabilities, reduced autonomy, and an impact on Quality of Life (QoL). This study aimed to evaluate the association between the risk of falls and socio-economic and multidimensional health aspects in elderly individuals receiving Primary Health Care (PHC) in Brazil. An observational, cross-sectional study with a quantitative approach was conducted with 257 elderly individuals (≥60 years) enrolled in the PHC system in the municipality of Santa Cruz, RN, Brazil. Data were collected through in-person interviews, using validated instruments such as the Fall Risk Score (FRS) to assess the risk of falls and, for evaluating multidimensional aspects: the Mini Nutritional Assessment (MNA), the Mini-Mental State Examination (MMSE), the Edmonton Frail Scale (EFS), the Barthel Index, and the Lawton & Brody Scale. The Elderly Health Booklet was used to collect sociodemographic data. Statistical analysis included Pearson's chi-square test, the Mann-Whitney test, and Spearman's correlation coefficient. The results indicated that 39.7% of participants had some level of fall risk, with this risk being more prevalent among elderly individuals with nutritional deficiencies, frailty, and impaired cognition. Factors such as preserved cognition, absence of frailty, and functional independence were identified as protective against the risk of falls. Furthermore, elderly individuals with a higher fall risk exhibited worse QoL, especially in the physical and functional domains. It was concluded that multidimensional aspects, such as nutrition, cognition, and functionality, played a central role in the fall risk of the sample. These findings reinforce the need for more specific protocols in PHC, including interventions aimed at improving these aspects, such as nutritional support, functional strengthening, and cognitive stimulation. Future studies should explore causal relationships through longitudinal approaches to enhance the applicability of the results.Master Thesis Influência dos padrões alimentares no risco de câncer de tireoide: uma revisão sistemática(Universidade Federal do Rio Grande do Norte, 2025-02-27) Nagashima, Yasmin Guerreiro; Brandão Neto, José; Lopes, Márcia Marilia Gomes Dantas; http://lattes.cnpq.br/6905360146925949; Serquiz, Alexandre Coelho; Piuvezam, Grasiela; https://orcid.org/0000-0002-2343-7251; http://lattes.cnpq.br/0391780760729166; Bezerra, Ingrid Wilza LealThe worldwide incidence of thyroid cancer (TC) has been rising, and this continuous increase cannot be attributed only to more meticulous detection of thyroid nodules and accurate diagnostic techniques. Interactions among nutrition and lifestyle may contribute to TC risk. Studies suggest a possible relationship between dietary patterns and TC risk, the current evidence remains inconclusive. Therefore, a deeper understanding of the biological mechanisms linking dietary patterns to TC risk could contribute to the identification of modifiable risk factors. This dissertation aimed to investigate the association between dietary patterns and TC risk through a systematic review of the available evidence; it was conducted between September 2023 and January 2025. To achieve this, the PubMed/Medline, Embase, Scopus, Web of Science, and LILACS databases were searched without restrictions on language or publication years. Three independent reviewers participated in the selection and data extraction from original publications of observational studies. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias, with most studies demonstrating excellent quality. A total of 45 studies were included–2 cross-sectional, 13 cohort, and 30 case-control studies. Of these, 40 examined the association of a posteriori dietary patterns with TC risk, while 5 analyzed a priori patterns. Significant findings for a posteriori dietary pattern showed that diets high in plant-based foods, fruits, fish, lowfat meats, dairy, and unsaturated fats were linked to a lower risk of TC. In contrast, high consumption of starchy foods, seafood, seaweed, processed meats, instant foods, fast food, and adherence to a Western dietary pattern increased the risk of TC. Regarding a priori dietary patterns, a diet with a higher inflammatory potential was positively associated with TC risk. In summary, while important links exist between diet, the environment, metabolism, and thyroid carcinogenesis, more robust studies with rigorous control of confounding variables and more homogeneous samples are needed for a complete elucidation of these mechanisms.Master Thesis Concentração de zinco e câncer de tireoide: um estudo de revisão e metanálise(Universidade Federal do Rio Grande do Norte, 2025-02-13) Soares, Aline Alves; Brandão Neto, José; Lopes, Márcia Marilia Gomes Dantas; https://orcid.org/0000-0002-0011-576X; http://lattes.cnpq.br/0512077912732473; http://lattes.cnpq.br/6905360146925949; Serquiz, Alexandre Coelho; Piuvezam, Grasiela; Lais, Lucia LeiteThyroid cancer (TC) represents the most common group of endocrine tumors and its incidence has increased rapidly over the last four decades. Investigations related to trace element imbalance have gained relevance, since the thyroid gland is sensitive to these elements. Studies reveal that some trace elements play a fundamental role in several physiological processes, while reduced levels of essential trace elements may be associated with carcinogenic evolution. In this context, zinc (Zn) emerges as an essential element for the action of the thyroid hormone, and possibly related to the pathogenesis of TC. This dissertation aims to contribute to the discussion on the association between low serum Zn concentrations and the occurrence of TC, through a systematic review and meta-analysis of the most recent scientific evidence. The search was carried out in the PubMed/MEDLINE, Scopus, Embase, LILACS and Web of Science databases, looking for observational studies that investigated changes in serum Zn concentration and the occurrence of TC in adults, published until december 2024. No restrictions were imposed on language or publication period. The primary outcome was low serum Zn concentration and the occurrence of TC. Three independent reviewers selected the studies and extracted the data from the original publications. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Data analysis was performed using R software (V.4.3.1), and heterogeneity was calculated using the I² statistic, with results based on random effects models. A total of 10 studies (n = 7 case-control and n = 3 cross-sectional) with sample sizes ranging from 44 to 294 individuals were included. The results indicated that serum Zn levels were not significantly lower in patients with TC compared with healthy controls (mean difference: -251.77; 95% confidence interval: -699.09, 195.54; I² = 100%, very low certainty). To elucidate the role of serum Zn in the occurrence of TC, further investigations, including rigorously designed observational studies with representative samples and improved control of potential confounding variables are indispensable.Master Thesis A estimulação transcraniana por corrente contínua sobre o córtex motor melhora a dor na doença renal em estágio terminal: um ensaio clínico randomizado(Universidade Federal do Rio Grande do Norte, 2024-12-23) Silva, Maria Eduarda da Fonseca Mendes; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509; https://orcid.org/0000-0002-6643-3568; http://lattes.cnpq.br/6089572255959116; Souza, Clécio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; Morya, EdgardImproving pain management and physical function remains a significant challenge for patients affected by end-stage renal disease (ESRD) undergoing hemodialysis. Nonpharmacological interventions, such as transcranial direct current stimulation (tDCS), have gained attention for their potential to alleviate pain and improve functional outcomes. This study explored the effects of tDCS on pain, fatigue, and functional performance in patients affected by ESRD undergoing hemodialysis and experiencing chronic pain. Thirty-four participants were randomized to receive either active or sham tDCS, with 15 sessions administered over five weeks. Anodal tDCS over C3 with an intensity of 2mA was administered in 15 sessions, 3 times per week. Visual Analogue Scale for pain (VAS), fatigue, functional performance (sit-to-stand test, stationary walk, timed up and go test (TUG), elbow flexion test, and manual dynamometry) were assessed. We found a significant difference in VAS (p < 0.001) between groups and across time (fifteenth session p < 0.001; at the first, p < 0.001; and second follow-up, p < 0.001). TUG showed significant differences between-group analysis (p = 0.009). No significant differences between groups were observed for fatigue (p = 0.21) and all others functional tests. These findings suggest that tDCS may be a promising, noninvasive intervention for managing pain and improving mobility in patients affected by ESRD undergoing hemodialysis. Future studies with larger samples and extended follow-ups are warranted to further validate these findings and explore the long-term benefits of tDCS.Master Thesis Explorando a utilidade da bioimpedância elétrica para avaliação da composição corporal em pacientes com câncer: novas perspectivas(Universidade Federal do Rio Grande do Norte, 2024-12-04) Guedes, Francisco Felipe de Oliveira; Fayh, Ana Paula Trussardi; https://orcid.org/0000-0002-9130-9630; http://lattes.cnpq.br/0049770583345803; http://lattes.cnpq.br/4195947664655045; Silva, Flávia Moraes; Verde, Sara Maria Moreira LimaCancer is a disease with high incidence and mortality rates worldwide, causing significant impacts on public health. Among its various implications, it notably promotes changes in body composition (BC), which can worsen patient prognosis. Thus, monitoring BC is essential to optimize clinical care. To this end, it is indispensable to use assessment methods that are reliable, accessible, and practical. Among the available alternatives, bioelectrical impedance analysis (BIA) has gained prominence. In addition to being practical and cost-effective, BIA provides a detailed and functional view of BC, demonstrating potential to overcome some limitations of more complex and less accessible methods. In this context, the present study aims to explore the utility of BIA in evaluating BC in cancer patients, encompassing a comparative analysis between different BIA devices, as well as assessing the potential of phase angle (PhA) as a marker of muscle quality. To achieve this, two cross-sectional studies were conducted, including hospitalized adult and elderly cancer patients. Study 1 analyzed the correlation and agreement between BIA results obtained using two homologous single-frequency tetrapolar devices from different manufacturers (Sanny® and RJL Systems®). Device comparisons were performed considering both raw parameters [resistance (R) and reactance (Xc)] and derived estimates [fat-free mass (FFM) and PhA]. Study 2 evaluated the performance of PhA as a measure of muscle quality compared to indicators of skeletal muscle radiodensity (SMD), muscle quality index (MQI), and strength-to-muscle radiodensity index (SMRi), which were used as indicators of morphological, functional, and “morpho-functional” muscle quality, respectively. The 33rd percentile was used to classify low muscle quality based on PhA, SMD, MQI, and SMRi, using results from the study sample. Statistical correlation and agreement tests were applied, with P-values < 0.05 considered statistically significant. In Study 1, 116 patients were included, with a mean age of 60.8 ± 14.8 years, of whom 51.7% were women. Significant correlations were observed between the devices for all evaluated outcomes, with very strong correlations for R (rho = 0.971) and FFM (r = 0.979), and strong correlations for Xc (rho = 0.784) and PhA (rho = 0.768). However, the measurements obtained using the Sanny® device showed no agreement with those from the RJL Systems® device, with less satisfactory results for Xc and PhA, showing biases of -14.18% [35.67 – (-64.04)] and -13.33% [40.30 – (- 66.80)], respectively. While R and FFM demonstrated better performance, with biases of -0.91% [23.78 – (-25.60)] and -4.42% [26.14 – (-34.97)], respectively, the limits of agreement (95% CI) still demonstrated wide variation. In Study 2, 294 patients were included, with a median age of 62 years (59–69), of whom 53.7% were male. PhA showed a moderate correlation with SMD (rho = 0.48, P < 0.001) and a weak correlation with MQI and SMRi (rho = 0.22 and 0.26, respectively, P < 0.001). Moderate agreement was observed between low PhA and low SMD, while poor agreement was found when comparing low PhA with low MQI and SMRi values. Low PhA demonstrated moderate accuracy (AUC > 0.70) in classifying low SMD, and more modest accuracy in classifying low MQI and SMRi among men. In conclusion, BIA results are significantly influenced by the device manufacturer and the adequacy of the formulas applied to the equipment. Furthermore, PhA shows a modest capacity in classifying reduced muscle quality.Master Thesis Associação entre os aspectos sociodemográficos e de saúde com o risco de abuso e violência em pessoas idosas assistidas pela Atenção Primária à Saúde(Universidade Federal do Rio Grande do Norte, 2024-12-23) Silva, Bruna Caroline Cassiano da; Torres, Gilson de Vasconcelos; Brischiliari, Sheila Cristina Rocha; https://orcid.org/0000-0002-3192-8448; http://lattes.cnpq.br/6580454602764823; Maia, Eulalia Maria Chaves; https://orcid.org/0000-0002-0354-7074; http://lattes.cnpq.br/2021670670663453; Coelho, Kellen RosaThe exponential increase in the elderly population raises global and public health concerns about elder abuse and violence. Understanding this issue, recognized as a global public health problem due to its growing prevalence and recurrence, is crucial for developing preventive actions. This study aimed to analyze the association between sociodemographic and health aspects and the risk of abuse and violence against community-dwelling older adults. This is an observational, cross-sectional, and quantitative study conducted with 200 older adults assisted by Primary Health Care in the municipality of Foz do Iguaçu, Paraná, from April to July 2022. Data collection employed the following instruments: sociodemographic and health characterization, the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, the Edmonton Frail Scale (EFS), the Geriatric Depression Scale (GDS-15), and the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) to analyze the risk of violence. The study was approved by the Research Ethics Committee of the State University of Western Paraná, under opinion no. 4.662.293/2021. Participants provided written informed consent before data collection. The findings of this study, while not confirming the significance of this phenomenon, indicate a trend in the profile of sociodemographic and health aspects associated with the risk of abuse and violence. The main results showed that older adults aged 60 to 70 years with no risk of violence were predominantly literate, independent, non-depressed, and non-frail. Conversely, older adults over 70 years of age with no risk of violence were mostly literate, dependent, non-depressed, and non-frail. Elder abuse and violence constitute a public health issue that demands coordinated efforts by health managers to implement new public policy strategies aimed at promoting and protecting this vulnerable population group.Master Thesis A cicatrização como determinante da qualidade de vida em indivíduos com úlceras venosas de perna: um estudo clínico quase experimental(Universidade Federal do Rio Grande do Norte, 2024-12-23) Oliveira, Mário Lins Galvão de; Torres, Gilson de Vasconcelos; http://lattes.cnpq.br/5966448178240040; Maia, Eulália Maria Chaves; https://orcid.org/0000-0002-0354-7074; http://lattes.cnpq.br/2021670670663453; Coelho, Kellen RosaVenous ulcers represent around 90% of all leg ulcers worldwide. This condition severely alters the quality of life of affected individuals due to its recurrence and chronicity characteristics. Health care providers play an important role in encouraging and adopting necessary measures to guide the improvement of their patients' QoL. The present study aims to verify the influence of wound healing on the quality of life of people with hard-to-heal venous ulcers, assisted in the health care network in the city of Parnamirim in Rio Grande do Norte. This is a longitudinal, comparative study, with a quantitative approach and descriptive data analysis. Data collection was carried out through the application of the SF36 and CCVUQ instruments, in addition to clinical evaluation. Analysis and comparison of the characteristics of the injury and quality of life were carried out at two different moments, between the months of August 2020 and November 2021. 103 patients participated in the research, the majority of whom were female (72.8%), over 60 years old (66.0%), with income of up to one minimum wage (82.5%), not economically active (79.6%), with education up to elementary school (79.6%). Of these, 41.7% of patients progressed to complete healing after one year. The aspects of Health-Related Quality of Life that most improved wound healing were the physical and functional aspects, followed by social interaction. In both QoL assessment instruments, the results of this research showed that there was no significant difference between the scores related to the emotional state between the first and second moments, even among those who achieved complete cure. Therefore, this study reveals not only the impact of the biological dimension of the being on their perception of quality of life, but the importance of thinking about strategies aimed at improving emotional aspects.