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Disertaciones |
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1
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FERNANDA COSTA SAMPAIO SILVA
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RELEVANCE OF CAROTID ECHOGRAPHIC PROFILE IN PATIENTS SUBMITTED TO ONCOLOGICAL SURGERY
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Líder : ROQUE ARAS JUNIOR
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MIEMBROS DE LA BANCA :
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CRISTIANO RICARDO BASTOS DE MACÊDO
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FRANCISCO JOSE FARIAS BORGES DOS REIS
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WAGNER RAMOS BORGES
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Data: 28-ene-2022
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Resumen Espectáculo
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Despite the known association between stroke and cancer, screening for Asymptomatic Carotid Disease in the preoperative period of oncologic surgeries is not yet formally recommended. Objectives: To determine the carotid ultrasound profile of patients undergoing major oncological surgeries and monitor them for the incidence of perioperative Stroke/TIA. Methods: A pilot, observational and prospective study was carried out in the ICU of Hospital Aristides Maltez, Salvador, Bahia, Brazil. Between 11/01/17 and 12/31/18, among the population of 480 patients in the immediate postoperative period admitted to the ICU, a consecutive sample was selected, consisting of individuals of both genders, aged between 19 and 75 years, asymptomatic from the cerebrovascular point of view. Patients who underwent head and neck surgery, patients with arrhythmias, neurological and carotid alterations were not included. Patients who presented with hemodynamic instability or other conditions that characterized imminent risk of death were excluded. The selected subjects underwent carotid and vertebral Doppler ultrasound until the second postoperative day, then classified according to the degree of stenosis established by the “2009 Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom” and also regarding the morphological evaluation of the carotid plaque according to the classification of Geroulakos et al. The individuals were followed up until discharge from the ICU or death, cataloging data regarding the occurrence of Stroke/TIA and correlating them with the existence or not of asymptomatic carotid disease. Mortality and length of stay in the ICU were also measured. Collection instruments, determination of surgical size and protocol for vascular ultrasound were standardized. The study received approval from the institutional research ethics committee, CAEE 79356417.0.0000.0050. Results: fourteen patients were enrolled. The mean age was 61.14 years (± 9.51). There was one case of stroke. The average length of stay in the ICU was 3.57 (± 0.78) days. The mean intima-media thickness was 0.70 mm (± 0.06) 95% CI [0.66 - 0.73] for the left side and 0.85 mm (± 0.06) 95% CI [0.7287 - 0.9713] for the right side. Stenosis <50% (n = 5, 35.71%) and predominantly echogenic plaque morphology (Type 3) were the predominant changes. Conclusions: Our work emphasizes the importance of investigating the association between carotid disease, documented by Doppler Vascular Ultrasound, and the incidence of Stroke/TIA in the postoperative period of oncologic surgeries. The present investigative model is feasible, low cost and reproducible.
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2
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MONAH SAMPAIO SANTOS
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TEMPOROMANDIBULAR DISORDERS IN PATIENTS WITH HIV AND FRAGILITY SYNDROME
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Líder : LILIANE ELZE FALCAO LINS KUSTERER
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MIEMBROS DE LA BANCA :
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CARLOS ROBERTO BRITES ALVES
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EDUARDO MARTINS NETTO
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FERNANDO MARTINS CARVALHO
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Data: 18-feb-2022
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Resumen Espectáculo
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Background: Untreated HIV infection leads to severe immunodeficiency and can be associated with accelerated aging process and a higher prevalence of frailty. Systemic changes are known to cause greater oral manifestations and decreased orofacial function. However, there is no investigation on temporomandibular disorders in this population.
Objective: The aim of this study is to assess the prevalence of TMD in individuals living with HIV/AIDS.
Methods: This cross-sectional study included HIV patients, with undetectable plasma viral load, under follow-up in the infectious diseases’ outpatient clinic at a university hospital. Socio-demographic data, Fried's frailty criteria, Fonseca anamnesis Index, Beck´s Depression Inventory and extra oral examination were collected. Statistical analysis used: Data analysis was conducted on SPSS-v18.
Results: The sample consisted of 198 patients. The prevalence of TMD was (51.5%), mostly affecting females (63,4%). Joint and muscular pain were the main symptoms of the disease. The prevalence of TMD was 49% and 39% in individual with chronic pain and depression, respectively. The predominantly symptoms in TMD were joint pain (92.3%), muscle pain (68.3%) and click (63,8%). Logistic regression showed an association between depression and TMD (OR: 1.06, CI 95%: 1.01-1.10).
Conclusion: The studied population showed a high prevalence of TMD in patients with HIV. TMD was related in presence of chronic pain and depression.
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3
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ROMANA SANTOS GAMA
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KNOWLEDGE OF ELDERLY PATIENTS ABOUT THE INDICATION OF PRESCRIBED MEDICATIONS
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Líder : LUIZ CARLOS SANTANA PASSOS
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MIEMBROS DE LA BANCA :
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CARLA HILARIO DA CUNHA DALTRO
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LUIZ CARLOS SANTANA PASSOS
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SOSTENES MISTRO
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Data: 09-jun-2022
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Resumen Espectáculo
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Patient adherence is associated to successful pharmacotherapy; however, many patients do not take their medications as prescribed because of poor understanding of their purpose. To understand how to use the medication correctly, patients need to obtain clear guidelines and instructions, as their behavior and characteristics play a fundamental role in the effectiveness of a medication. Objective: The aim of this study was assessed older people’s knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the aspects related to their level of knowledge of their medications. Methods: This was a cross-sectional study conducted in 22 basic health units in Brazil. Older adults who were waiting for medical consultations in the study facilities were interviewed after a consultation with a family practice physician. Data were collected from September 2016 to March 2019. Patients who were ≥ 60 years old who visited the primary care units were included in the study (n = 674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using a Poisson regression with robust variance. Results: The mean age of the sample was 70.1 (standard deviation ± 7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least 1 of their prescribed drugs; among them 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least 1 prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. Conclusion: This study demonstrated that there is a considerable lack of knowledge about prescribed medications among older Brazilian adults after a medical appointment. For this reason, health services and professionals need to implement strategies to improve patient’s knowledge
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4
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ANA CLARA GUIMARÃES DA SILVA KUNRATH
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DEVELOPMENT AND VALIDATION OF A HEALTH HUMANIZATION SCALE FOR TRANSGENDER POPULATION
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Líder : CARLOS ROBERTO BRITES ALVES
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MIEMBROS DE LA BANCA :
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LILIANE ELZE FALCAO LINS KUSTERER
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IRISMAR REIS DE OLIVEIRA
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MARCIA LILIAN SAMPAIO E SAMPAIO SA
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Data: 06-jul-2022
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Resumen Espectáculo
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Introduction: Stigma and discrimination against transgender people can lead to their segregation. Fighting stigma and discrimination is a crucial strategy to expand access to health services. The goals of the present study were to develop and validate a transgender healthcare humanization scale (THcH-scale) to evaluate the perception of humanization in healthcare for transgender individuals. Methods: This cross-sectional study included 340 healthcare providers aged ≥18 years. Participants answered a structured questionnaire when attending HIV/AIDS scientific meetings or at their place of work. An exploratory factor analysis was conducted, using a polychoric matrix and Robust Diagonally Weighted Least Squares extraction method. The number of retained factors was defined through the Parallel Analysis technique, with random permutation of the observed data and the use of Robust Promin´s rotation. Results: The interpretability of correlation matrix items was suggested by the Bartlett's sphericity tests (1633.7, df = 91; P < 0.001) and KMO (0.875). The factor structure showed adequate adjustment indices (2 = 44200, gl = 52; RMSEA p < 0.05; CFI = 0.968; TLI = 0.945; GFI= 0.995). Only one factor was retained by parallel analysis, explained by 54.17% of the variance of the construct and confirmed by the UniCo = 0.902, ECV = 0.828 and MIREAL = 0.279 indices. Good reliability was confirmed by Cronbach's alpha test (0.899). Conclusions: The THcH-scale showed good psychometric properties. This self-report questionnaire, which can be completed in 5 min, may be useful in scientific research and could guide healthcare providers in expansion of a Health Humanization Policy and in deconstructing prejudice against transgender people in healthcare settings.
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5
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KATNA DE OLIVEIRA ALMEIDA
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PHYSICAL FUNCTION, DAILY LIFE ACTIVITIES, HEALTH-RELATED QUALITY OF LIFE AND DETERMINANTS OF CARDIORESPIRATORY FITNESS AS MEASURED BY THE CARDIOPULMONARY STRESS TEST IN COVID-19 SURVIVORS - SYSTEMATIC REVIEW WITH METALYSIS SUBTITLE: FUNCTIONALITY, CARDIORESPIRATORY FITNESS AND COVID 19
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Líder : MANSUETO GOMES NETO
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MIEMBROS DE LA BANCA :
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CASSIO MAGALHAES DA SILVA E SILVA
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HELENA FRANCA CORREIA
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IURA GONZALEZ NOGUEIRA ALVES
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Data: 15-jul-2022
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Resumen Espectáculo
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INTRODUCTION: The post-covid 19 consequences can arise in the short, medium and long term, leading to physical changes, reduced cardiorespiratory capacity, functional repercussions, limitations in activities of daily living and restrictions on social participation. OBJECTIVES: To summarize studies that seek to identify the impact on physical function, activities of daily living, and health-related quality of life in COVID19 survivors, and studies that purchased cardiorespiratory fitness as measured by cardiopulmonary exercise testing in COVID-19 survivors , as well as the influence of potential moderating factors. METHODS: These systematic reviews were conducted following the PRISMA protocol, we searched the following databases MEDLINE/PubMed, Scopus, SciELO and the Cochrane Library for studies that assessed the eligibility criteria for both articles observational studies and population of post-covid 19 survivors, for article 1 the eligibility criteria were considered (studies that assessed physical function, activities of daily living and health-related quality of life after COVID-19 from the first available date until July 2021), for the article 2 (studies that investigated cardiorespiratory fitness (peak oxygen consumption - VO2 peak) measured by cardiopulmonary exercise testing until May 2022). The Newcastle Ottawa Scale was used to assess methodological quality. RESULTS: In article 1, we included 35 studies, these studies demonstrated that COVID-19 survivors had reduced levels of physical function, activities of daily living and health-related quality of life. In addition, incomplete recovery of physical function and performance in activities of daily living were observed 1 to 6 months after infection. In article 2, 48 studies were included, the results show that cardiorespiratory fitness is consistently impaired in COVID-19 survivors, in addition, peak VO2 was reduced according to age, time of covid, disease severity, dyspnea, and reduced blood pressure. exercise capacity. CONCLUSION: Health-related functionality and quality of life is negatively impacted in COVID-19 survivors, as well as reduced cardiorespiratory fitness, secondary to determinants.
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6
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DAYANA ALVES COSTA
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Work Ability and Associated Factors in People Living with HTLV-1.
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Líder : LILIANE ELZE FALCAO LINS KUSTERER
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MIEMBROS DE LA BANCA :
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FERNANDO MARTINS CARVALHO
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GLEICY GABRIELA VITÓRIA SPÍNOLA CARNEIRO FALCÃO
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VIVIANE ALMEIDA SARMENTO
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Data: 18-jul-2022
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Resumen Espectáculo
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Introduction: Human T lymphotropic virus (HTLV-1) infection affects about 10 to 15 million people worldwide. The impact of HTLV-1 infection on work ability is unknown. This study aimed to measure the frequency and identify factors associated with low work ability in patients living with HTLV-1. Casuistry and Methods: This is a crosssectional study with 207 individuals infected with HTLV-1, aged 18 years or older, who did not receive treatment, treated at the University Hospital of the Federal University of Bahia, Brazil. HTLV-1 antibodies were detected in the blood of participants by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western Blot. Participants answered a questionnaire about sociodemographic data, personal habits, clinical data, health-related quality of life, and work ability, assessed by the Work Ability Index questionnaire. A Poisson regression model with robust variance was used to analyze factors associated with the prevalence of low work ability. Results: The work ability of the 207 individuals was poor (54.1%); moderate (37.7%); and good (8.2%). No individual was classified as having excellent work ability. The prevalence of low work ability was strongly associated with physical inactivity (prevalence ratio (PR) = 1.30), neurological symptoms (PR = 1.25) and low summaries of physical components (PR = 0.95) and (PR = 0.98) of health-related quality of life. Conclusions: Low work ability in people living with HTLV-1 was associated with physical inactivity, neurological symptoms and poor health-related quality of life.
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7
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IURE DE FRANÇA LIMA
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COMMUNICATION DISORDERS IN THE PRISON SYSTEM: A SYSTEMATIC REVIEW
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Líder : AILTON DE SOUZA MELO
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MIEMBROS DE LA BANCA :
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AILTON DE SOUZA MELO
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BERNARDO MOTA COSTA RODRIGUES
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IZA CRISTINA SALLES DE CASTRO
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NILDO MANOEL DA SILVA RIBEIRO
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Data: 27-jul-2022
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Resumen Espectáculo
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Introduction: Good communication is essential for resolving to solve social conflicts, especially in a closed community, such as in prisons. However, we have observed that language and communication disorders are more frequent among individuals deprived of liberty than in the general population, reducing their problem-solving ability and increasing conflicts. Material and method: In this systematic review, articles were searched in the main databases of the last 38 years. After placing the descriptors, 1883 articles were found. After reading their titles and abstracts and applying the eligibility criteria, 25 articles were selected and included in the final review. Results: A sample of 2188 individuals was evaluated, two studies were conducted with a female population only, while twelve studied exclusively males, and 10 articles had a mixed population. All included studies evaluated language and communication disorders in general, with language impairment being more prevalent There are no English-language studies evaluating language and communication disorders in incarcerated individuals from African countries, Latin America or Asia. Discussion: The results of this systematic review suggest that individuals deprived of liberty have a high frequency of language and communication disorders, and thus end up being more vulnerable within the correctional system. Communication problems were found in different proportions among the groups; however, they affected all prison populations evaluated in this study. It is noticeable that even with the presence of speech and language pathology professionals in the correctional system, communication problems still occur, translating into the need for other strategies to improve reception and implementation.
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8
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Breno Lopes de Souza Marques
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NEUROPSYCHOLOGICAL EFFECTS OF KETAMINE FOR DISORDER TREATMENT-RESISTANT MAJOR DEPRESSIVE: A REVIEW LITERATURE SYSTEM
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Líder : ALINE SANTOS SAMPAIO
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MIEMBROS DE LA BANCA :
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ALINE SANTOS SAMPAIO
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GUSTAVO MARCELINO SIQUARA
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LUCAS DE CASTRO QUARANTINI
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Data: 05-ago-2022
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Resumen Espectáculo
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INTRODUCTION: Cognitive impairment is commonly present in individuals with treatmentresistant depression, especially in attention,memory, and executive functions. These deficits are related to symptomseverity, remission rates, and functional impairments during and after the acute phase of the disorder. Ketamine, an N-methyl-D-aspartate antagonist previously used as an anesthetic, brings promising antidepressant results. This study systematically reviews the neurocognitive effects of ketamine and esketamine in patients with treatment-resistant major depressive disorder. METHODS: Systematic searches were conducted at Embase, PubMed, and PsycINFOusing the terms depression, ketamine, and cognition. Title, abstract, and full-text reading were conducted independently by two of the authors (BSM and CSL). Risk of bias, study design, neuropsychological outcomes, and neuroimaging data were recorded. RESULTS: From a total of 997 hits, 14 articles were included. One study reported cognitive impairment after ketamine treatment for processing speed and verbal memory. Five studies reported improvements in processing speed, verbal memory, visual memory, working memory, or cognitive flexibility. The esketamine study suggested no changes to performance. Lower attention, slower processing speed, and higher working memory are reported as predictors of antidepressant response. Brain areas for emotional and reward processing, including the amygdala, insula, and orbitofrontal cortex, show a normalizing tendency after ketamine. CONCLUSIONS: Ketamine and esketamine do not seem to exert significant deleterious neurocognitive effects in the short or long term in individuals with treatment-resistant depression. Results suggest neuropsychological functions and brain areas commonly impaired in treatment-resistant depression may especially benefit from subanesthetic ketamine infusions. Key questions that remain unanswered are discussed.
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9
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PATRICIA DE ABREU FARIAS CARVALHO
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FUNCTIONAL CHARACTERIZATION OF INDIVIDUALS WITH IMPERFECT OSTEOGENESIS IN A REFERENCE CENTER IN BAHIA
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Líder : ANGELINA XAVIER ACOSTA
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MIEMBROS DE LA BANCA :
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JOANNA GOÉS CASTRO MEIRA
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JULIANA COSTA SANTOS
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MICHELI BERNARDONE SAQUETTO
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Data: 07-oct-2022
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Resumen Espectáculo
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Objective: To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. Materials and methods: This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). To assess respiratory function, manovacuometry was performed with measurement of inspiratory and expiratory muscle strength, in addition to peak expiratory flow (PEF) and ventilometry to measure forced vital capacity (FVC). Results: Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CAT evaluation, with a mean T score 23.9 (14.2 in type III). Assessment of respiratory function was performed in 23 individuals, with a mean age of 11.6 years. The mean inspiratory muscle strength was 64.4% of the predicted, and the expiratory 56.2% of the predicted. The mean PEF was 213.9 L/min, with 140.6 L/min in the type III group. Median FVC was 1.9 L, corresponding to 110% of the predicted. Conclusion: Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI. The respiratory function of those evaluated was altered, with values lower than expected in the entire sample for respiratory muscle strength, in addition peak expiratory flow reduced more expressively in the OI type III group.
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10
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Adriana Ribeiro Oliveira
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EVALUATION OF CARDIOEMBOLIC CHANGES IN SENT PATIENTS VENOUS THROMBOLYSIS DUE TO VASCULAR ACCIDENT ACUTE ISCHEMIC CEREBRAL
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Líder : ROQUE ARAS JUNIOR
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MIEMBROS DE LA BANCA :
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ALEX CLEBER IMPROTA CARIA
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CRISTIANO RICARDO BASTOS DE MACÊDO
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ANDRE SANT ANNA ZARIFE
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Data: 04-nov-2022
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Resumen Espectáculo
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Cerebrovascular accident (CVA) and ischemic heart disease are the biggest killers in the world. It is estimated that about 85% of strokes are ischemic in origin. Reperfusion therapy in the acute phase of ischemic stroke with recombinant human tissue plasminogen activator is effective, but some factors influence the success of this teatment. The aim of this study was to evaluate clinical aspects and possible determinants for reperfusion after venous thrombolysis. This is a retrospective, crosssectional, observational study based on a review of hospital records of inpatients diagnosed with ischemic stroke treated with intravenous thrombolysis, the main outcome being reperfusion or not. Data from this study revealed a predominance of females in the group of reperfused patients and males in the non-reperfused group, both maintaining moderate severity on the NIHSS discharge scale and admission without statistical significance (p>0.18). In addition, the mean admission severity score was 13.2 for the group of reperfused patients and 14.2 for those not reperfused, and the mean ejection fraction of both groups was within normal functionality, with a mean of 0.50 for reperfused patients and 0.62 for non-reperfused patients. We found an association between successful venous chemical thrombolysis reperfusion and lower mortality in patients with acute stroke.
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11
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BEATRIZ ALVES CARNEIRO
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MICRORNAS AS DIAGNOSTIC BIOMARKERS AND PREDICTORS OF ANTIDEPRESSIVE RESPONSE IN MAJOR DEPRESSIVE DISORDER: A SYSTEMATIC REVIEW
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Líder : LUCAS DE CASTRO QUARANTINI
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MIEMBROS DE LA BANCA :
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LUCAS DE CASTRO QUARANTINI
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RYAN DOS SANTOS COSTA
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REJANE CONCEICAO SANTANA
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Data: 23-nov-2022
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Resumen Espectáculo
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Despite the burden of major depressive disorder (MDD), there is still a lack of biomarkers to aid in its diagnosis and pharmacological management. MicroRNAs (miRNAs), an epigenetic mechanism, seem promising candidates for biomarkers of MDD and clinical response to antidepressants. Our aim was to summarize the findings to date, providing more robust evidence for the selection and use of specific miRNAs as biomarkers for the diagnosis and treatment of MDD. Thus, a systematic review of the literature was performed in PubMed/MEDLINE, Cochrane, PsycINFO, Embase and LILACS databases from March to May 2022 using two sets of terms, one for microRNAs and one for antidepressants. Studies involving humans, animal models and cell cultures were included. Studies that evaluated herbal medicines, non-pharmacological therapies or epigenetic mechanisms other than miRNA were excluded. Differences were found in the expression of many miRNAs comparing assessment times - before and after antidepressant treatment - and the populations studied. However, due to the heterogeneity of the investigated miRNAs, limited sample sizes and wide variety of antidepressants used, few conclusions could be made. Thus, there is a promising potential for the use of miRNAs as biomarkers for the diagnosis and treatment of MDD; however, more homogeneous studies are needed
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12
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CAROLINA DA SILVA BEDA SACRAMENTO
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VARIABLES ASSOCIATED WITH MODERATE-SEVERE EVOLUTION IN PATIENTS WITH CROHN'S DISEASE IN TWO CENTERS REFERENCE IN SALVADOR - BAHIA
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Líder : GENOILE OLIVEIRA SANTANA SILVA
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MIEMBROS DE LA BANCA :
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MARIA DE LOURDES DE ABREU FERRARI
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ANDRE CASTRO LYRA
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RAQUEL ROCHA DOS SANTOS
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Data: 25-nov-2022
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Resumen Espectáculo
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Background: The identification of variables associated with evolution to moderate-tosevere disease is essential for the therapeutic management of patients with Crohn's disease. However, studies on this topic are scarce in developing countries. The main objective of this study is to determine the variables associated with hospitalization in patients with Crohn's disease. The secondary objective is to identify variables associated with surgery, intestinal resection, hospital readmission, surgical recurrence, and use of immunobiological therapy. Methods: Cross-sectional study with a retrospective component that involved two reference centers for inflammatory bowel diseases in the public health system. Data were collected through a specific questionnaire and review of medical records in the period 2019 to 2021. The association between variables was evaluated through Chi-Square test and multivariate binary logistic regression. Results: Were included 220 patients, 50.9% female. The most common findings at diagnosis were age between 17 and 40 years (67.7%), colonic location (45.0%) and no stricturing no penetrating behavior (75.9%). Perianal disease was observed in 27.7% and involvement of the upper gastrointestinal in 16.1%. One hundred and seventy-four (79.1%) patients were hospitalized, 109 (49.5%) underwent surgery, being 50 (22.7%) bowel resection, 106 (60.9%) were readmitted, 13 (26.0%) presented surgical recurrence and 128 (58.2%) used immunobiologicals. Perianal disease was the only variable associated with hospitalization (p=0.012). Stricturing or penetrating behavior (p<0.001) and perianal disease (p<0.001) were associated with surgery. Regarding intestinal resection, ileal or ileocolonic location (p=0.044) and stricturing or penetrating behavior (p<0.001) were variables associated. The use of corticosteroids in the first flare (p<0.001) was associated with hospital readmission, and postoperative complications (p=0.029) with surgical recurrence. Age at diagnosis below 40 years (p=0.004), upper gastrointestinal involvement (p=0.040) and perianal disease (p<0.001) were associated with the use of immunobiologicals. Conclusion: This is a pioneer study in Brazil on variables associated with evolution to moderate-to-severe CD. Perianal disease and stricturing or penetrating behavior were associated with more than one outcome. Age at diagnosis below 40 years, ileal or ileo-colonic location, upper gastrointestinal involvement, use of corticosteroids in the first flare and postoperative complications were also variables found. These data are like those found in countries with a high prevalence of the disease.
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13
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MANUELA TELLES VARGAS LEAL
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USE OF ESCETAMINE IN TREATMENT-RESISTANT PSYCHOTIC DEPRESSION
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Líder : LUCAS DE CASTRO QUARANTINI
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MIEMBROS DE LA BANCA :
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ANA PAULA DE JESUS NUNES
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LUCAS ARAUJO DE FREITAS
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MONICA DE ANDRADE NASCIMENTO
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Data: 05-dic-2022
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Resumen Espectáculo
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Introduction: Psychotic depression (PD) is defined as a subtype of major depressive disorder (MDD), characterized by the presence of psychotic symptoms associated with depressive symptoms. Despite being a prevalent and serious disorder, there is no specific medication for its treatment. Ketamine has been used for the treatment of resistant depression with good response, but has been excluded in patients with psychotic symptoms due to its glutamatergic action. Currently, studies with ketamine in PD are limited to case reports and there are no randomized clinical trials evaluating the safety and efficacy of esketamine in patients with PD. Objectives: To assess the efficacy of esketamine in individuals with unipolar depression with treatment-resistant psychotic features. From the comparison between two populations of psychotic and non-psychotic resistant depression, to investigate whether there is a difference in the therapeutic response 24 hours after esketamine infusion. From the comparison between two populations of psychotic and non-psychotic resistant depression, to assess the safety of using esketamine in the presence of psychotic symptoms. Methods: An article related to the topic was prepared: a retrospective review of medical records of patients with PD followed by a matched case-control analysis in a ratio of 1:2 with individuals in non-psychotic depression (NPD). All patients were treated with a single subanesthetic dose of 0.5mg/kg of esketamine and evaluated for depressive symptoms 24 hours later. Results: We analyzed data from 45 subjects with treatment-resistant depression who received esketamine (15 with PD and 30 with NPD). We found a significant antidepressant effect in both groups. There was no statistical difference in therapeutic response when comparing groups. Treatment-induced dissociative symptoms were present in both groups but were self-limiting and no exacerbation of psychotic symptoms was reported. Conclusions: Esketamine appears to be an effective alternative in the treatment of PD and its response was comparable to that of patients with NPD. Furthermore, the use of esketamine was safe, with no evidence of worsening of psychotic symptoms. More clinical trials using ketamine in patients with PD are needed.
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14
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FELICE DEMINCO ALVES SANTOS
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VARIABILITY OF THE NEW CORONAVIRUS GENE S IN PATIENTS ASSISTED AT COMPLEX HOSPITALAR PROFESSOR EDGARD SANTOS-UFBA.
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Líder : CARLOS ROBERTO BRITES ALVES
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MIEMBROS DE LA BANCA :
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FABIANNA MARCIA MARANHÃO BAHIA SOUZA
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GUBIO SOARES CAMPOS
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SARA NUNES VAZ
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Data: 21-dic-2022
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Resumen Espectáculo
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Introduction: COVID-19 is a new disease caused by a human coronavirus, whose etiological agent is SARS-CoV-2. Two years have passed and SARS-CoV-2 has a great genetic diversity, which favored the emergence of emergency variants during different periods of the pandemic. Due to the importance employed in viral surveillance and the limitations found in new generation sequencing platforms, the objective of this work was to identify the variability in the Spike region of SARS-CoV-2, from a Sanger sequencing platform, in patients with COVID-19 treated at the University Hospital Professor Edgard Santos in Salvador-BA. Methods: This is a cross-sectional observational study with preserved samples, positive for SARS-CoV-2, of individuals over 18 years of age, employees, or patients, treated at the Professor Edgard Santos University Hospital (HUPES). All samples from the enrolled participants were confirmed for COVID-19 by an RT-qPCR assay. The extracted viral genetic material was used for a NESTED-PCR assay on the SARS-CoV-2 S gene and the results revealed on a 1.5% agarose gel. The sequencing reaction using the BigDye Terminator V3.1 Cycle Senquencing kit was performed in a region of 1,120 base pairs and the result of this reaction was read by the SeqStudio capillary electrophoresis machine. The files of sequences generated by the machine were analyzed for the construction of the consensus sequence from the reference sequence and identification of mutations throughout the genome. Results: Of all 103 sequenced samples, 69 contained relevant variants represented by 20 BA.1, 13 delta, 22 gamma and 14 zeta, identified between June 2020 and February 2022. All sequences found were aligned with sequences representative of the variants. Conclusions: The protocol developed by this work was able to identify and monitor the variability of the SARS-CoV-2 S gene and, consequently, identify the most relevant variants for the pandemic, which could be an alternative methodology for viral molecular surveillance.
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Tesis |
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1
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FABIO LUCIANO ARCANJO DE JESUS
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COMPLEX STRENGTHENING ADDITION POSTEROLATERAL HIP TO MANUAL THERAPY AND Segmental stabilization in patients with low back pain CHRONICLE: FOLLOW-UP OF A RANDOMIZED CLINICAL TRIAL
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Líder : MANSUETO GOMES NETO
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MIEMBROS DE LA BANCA :
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GUSTAVO LEPORACE DE OLIVEIRA LOMELINO SOARES
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BRUNO PRATA MARTINEZ
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CASSIO MAGALHAES DA SILVA E SILVA
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CLARCSON PLACIDO CONCEIÇÃO DOS SANTOS
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CRISTIANO SENA DA CONCEICAO
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Data: 27-ene-2022
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Resumen Espectáculo
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Background: The clinical practice guidelines show that many interventions are available for the treatment of patients with chronic low back pain, but the vast majority of these interventions has a modest effect in reducing pain and functional disability. A biomechanical approach which has been raised is that a likely weakness of the abductor muscles, extensors and rotators of the hip side (posterolateral complex-PLC) would lead to excessive contralateral pelvic drop during discharge activities such as walking, run, walk up or down stairs, generating overload in the lumbar region. Although the hip PLC strengtheningbeen very used in the treatment of patients with dysfunction of knee and hip, there is a lack of evidence for your use in patients with chronic low back pain.Objective: To determine whether the combination of conventional physiotherapy and hip PLC strengtheningis superior to conventional physiotherapy in improving pain, disability and muscle strength in patients with chronic low back pain. Study design: it was initially performed a systematic review with meta-analysis. Was also performed a randomized controlled trial. Study localization: the databases Medline, LILACS, SciELO, Cochrane Library databases and PEDro, were consulted to produce a systematic review; the randomized controlled trial was conducted in a rehabilitation clinic in Salvador, Brazil. Participants: the systematic review examined 14 clinical trials, including 413 patients who made stabilization exercises, 297 who performed general exercises and 185 patients who performed manual therapy. In the clinical trial, a total of 46 patients with chronic nonspecific low back pain were included.Patients were randomly divided into two groups: the hip PLC strengtheningassociated with the conventional physiotherapy (n = 22) or conventional physiotherapy (n = 24). Outcomes: The outcomes of pain, disability and muscle strength of the CPL were assessed. Intervention: In clinical trial, each group received 12 sessions of 45 minutes each over a period of 6 weeks. Results: A systematic review with meta-analysis showed that the stabilization exercises were superior to General exercises improves pain and disability and that the stabilization exercises had effects similar to those of manual therapy. In the clinical trial, 46 patients completed the Protocol. There was no statistical difference in pain (mean change: 3.2 vs. 2.1 p = 0.12) or disability (mean change: 3.6 vs. 3.8 p = 0.87) between groups. In both groups, hip extensors muscle strength improved significantly (mean change: 4.1 vs. 3.4 p = 0.6), but without a statistically significant difference. Conclusion:The addition of hip posterolateral complex strengthening to a conventional physical therapy program does not appear to result in improved clinicaloutcome for patients with chronic nonspecific LBP.
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2
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VANESSA SERVA VAZQUEZ
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DEPRESSION, SUICIDAL MOTIVATION AND SUICIDAL IDEATION IN PATIENTS WITH ASTHMA
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Líder : ALVARO AUGUSTO SOUZA DA CRUZ FILHO
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MIEMBROS DE LA BANCA :
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ANA MARIA FERNANDES PITTA
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ANALICEA DE SOUZA CALMON SANTOS
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LUANE MARQUES MELLO
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PABLO DE MOURA SANTOS
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TEREZINHA DE LISIEUX QUESADO FAGUNDES
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Data: 25-mar-2022
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Resumen Espectáculo
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Backgroud: Asthma is a chronic, non-communicable disease, prevalent worldwide, associated with depression and suicidal events. Objectives: To estimate the frequency of depression, suicidal motivation and suicidal ideation and to identify clinical and psychosocial factors associated with these outcomes. Method: This is a cross-sectional study of a non-probabilistic sample of adults with asthma and controls without asthma. Asthma severity and asthma control were assessed by physician according to World Health Organization (WHO) (2010) and Global Iniciative for asthma (GINA) (2012) criteria. Depression, suicidal motivation and suicidal ideation were the outcomes assessed by Beck Depression Inventory. Psychosocial factors were evaluated by Community Violence Questionnaire, Social Support Scale, Stress Perceived Scale and Resilience Scale. Descriptive analyzes were performed with verification of mean, standard deviation, and prevalence. Associations between variables were verified by the Chi-square Test, Fisher's Exact Test, Mann-Whitney Test and by logistic regression models. Results: Two analyzes were performed and presented in two different articles. In the first, the sample consisted of 1,358 individuals with asthma and controls without asthma, of which 464 (34.17%) individuals were diagnosed with severe asthma, 445 (32.77%) with mild to moderate asthma and 449 (33.06%) without asthma. Among the total number of participants, 222 (16.30%) were depressed, 331 (24.40%) had suicidal motivation and 73 (5.40%) suicidal ideation. After adjustment, severe asthma increased the chance of depression by 53% and mild to moderate asthma enhanced by 11-fold the chance of suicidal ideation. The perception of low social support, [OR 3.59, 95% CI (2.44-5.28)], heightened the chance of depression. Distress enhanced suicidal motivation by [OR 1.37, 95% CI (1.20-1.56)] and low affective support perception raised the likelihood of SI by [OR 6.82, 95% CI (1.94-2.90)]. In the second study, prevalence analyzes were performed only with asthmatics, classified and compared according to asthma severity and asthma control. Individuals with uncontrolled asthma had the worst outcomes. Among them, 154 (86.00%) were depressed 212 (88.70%) individuals had suicidal motivation and 43 (78.20%) reported suicidal ideation. Poor education increased the chance of depression in individuals with severe and uncontrolled asthma. Resilience was associated with depression, suicidal motivation and uncontrolled asthma, and suicidal ideation and severe asthma, but it does not seem to fulfill its role as a protective factor. Conclusions: Severe asthma and mild to moderate asthma significantly increased the chance of depression and suicidal ideation, showing their impact on mental health. The psychosocial variable that most impacted depression was low social support; distress increased the chance of suicidal motivation, and little affective support increased the chance of suicidal ideation. Prevalence analyzes showed that individuals with uncontrolled asthma had worse outcomes than those with severe asthma; low education had a negative effect on asthma severity and control in this population.
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3
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TASSIA NERY FAUSTINO
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EFFECT OF COMBINED NON-PHARMACOLOGICAL INTERVENTIONS ON DELIRIUM PREVENTION IN CRITICAL PATIENTS
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Líder : DIMITRI GUSMAO FLORES
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MIEMBROS DE LA BANCA :
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ANTONIO ALBERTO DA SILVA LOPES
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CLAUDIA GEOVANA DA SILVA PIRES
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ELIEUSA E SILVA SAMPAIO
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MANSUETO GOMES NETO
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MARY GOMES SILVA
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Data: 31-mar-2022
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Resumen Espectáculo
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Delirium is a common acute brain dysfunction in intensive care units (ICU) and is associated with negative short- and long-term clinical outcomes. There is no strong scientific evidence to support the use of pharmacological measures for its prevention and treatment. This thesis aims to evaluate the effect of combined non-pharmacological interventions in the prevention of delirium in critically ill patients, with an emphasis on: 1) systematically review the evidence on non-pharmacological measures used to reduce delirium in this population; 2) perform a synthesis by meta-analysis of the impact of these measures in reducing the occurrence of delirium and important clinical outcomes; 3) perform a pilot study to determine the overall incidence of delirium in the study ICUs and by motor subtype and to assess negative clinical outcomes associated with motor spectra; and 4) perform a randomized clinical trial (RCT) to assess the effectiveness of combination non-pharmacological interventions in preventing delirium and reducing negative clinical outcomes in critically ill patients. The systematic review and meta-analysis included 51 and 38 studies, respectively. The non-pharmacological measures investigated in these publications were classi]´lfied into fourteen categories. When pooling study results, non-pharmacological interventions were associated with lower risk of occurrence (relative risk, 0.64; Confidence Interval - 95% CI, 0.45 to 0.91) and duration of delirium (difference in means, -0.97 day; CI 95 %, -1.45 to -0.50), with no effect on ICU mortality. The pilot study was carried out with 95 patients admitted to three ICUs of a Brazilian philanthropic hospital and demonstrated an incidence of delirium of 43.1% (n=41), with a predominance of the mixed subtype (51.2%; n=21). The median duration of delirium was significantly longer in the mixed subtype than in the hypoactive subtype (3 days [Interquartile Range – IQR, 1.0-4.0] versus 1 day [IQR, 1.0-2.0]; p=0.03) and the severity was greater in the delirium hyperactive spectrum (median of 7 points) when compared to the others (p=0.04). The RCT was conducted in the same ICUs as the pilot study. Patients were randomly allocated to either the control group that received standard unit care or the experimental group that received standard unit care and a package of five nonpharmacologic interventions. 144 patients were analyzed, with 72 participants in each allocation group. The delirium incidence density was significantly lower in the intervention group ((1.34 x 10-2 versus 2.29 x 10-2 person-days), with a 60% lower risk of developing this disorder compared to the control group (Hazard Ratio, 0.40; CI 95%, 0.17-0.95; p=0.04), after adjustment for Simplified Acute Physiology Score III, surgical admission, and alcoholism. In conclusion, the systematic review and meta-analysis performed support the use of non-pharmacological interventions to prevent and reduce the duration of delirium in critically ill patients. In the pilot study, the duration and severity of delirium were greater in the mixed and hyperactive subtypes, respectively. The RCT showed that combined nonpharmacological interventions reduced delirium in patients admitted to intensive care units compared to standard care.
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4
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DEBORA PATRÍCIA MEDEIROS SANTOS RIOS
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SWALLOWING PROFILE IN CHILDREN WITH MICROCEPHALY ASSOCIATED WITH THE ZIKA VIRUS
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Líder : RITA DE CASSIA SALDANHA DE LUCENA
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MIEMBROS DE LA BANCA :
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CLAUDIA MARINA TAVARES DE ARAUJO
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MARILIA CARVALHO SAMPAIO
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NAYARA SILVA ARGOLLO
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RITA DE CASSIA SALDANHA DE LUCENA
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VERA LUCIA DOS SANTOS ROCHA
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Data: 06-may-2022
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Resumen Espectáculo
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Congenital syndrome in children infected with Zika virus is characterized by neurological alterations that are associated with deficits in various domains of sensory, motor and cognitive functioning, directly affecting swallowing. Considering the impact of swallowing difficulties on the quality of life of children with ZVS, which can lead to impairments in physical and cognitive development and the scarcity of clinical data available in relation to these children's swallowing, the present study aimed to determine the swallowing profile in children with Zika virus microcephaly. Two studies were carried out. The cross-sectional and observational study enrolled 45 children diagnosed with CZS and 45 others with typical development. The observational cohort study included 22 children diagnosed with CZS. Swallowing was evaluated through clinical feeding evaluations (PAD-PED), a checklist of clinical signs indicative of laryngotracheal penetration/aspiration and using acoustic swallowing parameters (Doppler sonar). The mean ages of the children with CZS and those in the comparison group were 26.69 ± 4.46 and 26.62 ± 5.00. In the cross-sectional study, the presence of moderate to severe oropharyngeal dysphagia was verified in 71.1% of children with CZS, with a significant difference in relation to typical children (p<0.05). In the evaluation of the oral structure, lip closure (93.3%), altered tonus of the tongue (77.8%), and cheeks (75,6%) were verified. When liquid/food was offered, affected children presented difficulties in sucking-swallowing-breathing coordination (66,7%), pouring liquid into the oral cavity (77,8%). Pasty foods, deficits in spoon collection (75%), and residues in the oral cavity (86.4%) were noted. Signs of coughing, choking, and breathing with effort were found with differences in relation to typical children (p<0.05). In the children in the comparison group, only 13.3% presented insufficient lip closure and 2.2% had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. Acoustic parameters did not show significant differences in relation to typical children (p<0.05). In the cohort study, most changes found in the assessment of oral structure in the first year of life persisted in the second year. Persistence of oral vomiting (59.1%) and biting (50.0%) reflexes in the second year were also observed. No significant differences were found in terms of signs of gagging, panting and laboured breathing, between the first and second assessment. However, a significant difference was observed regarding coughing while feeding with liquids (x2꞊0.007). The Doppler sonar also showed significant differences in females between the consistencies in the assessment in the second year of life (p<0.05). In conclusion, children with CZS demonstrated alterations in the oral and pharyngeal phases of swallowing, with persistence of most deficits in the monitored children. The results of the acoustic parameters did not differ from those found in typical children, and studies are needed to support the clinical utility for detecting alterations in the pharyngeal phase of swallowing in children with neurological disorders.
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5
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ANDRE SANT ANNA ZARIFE
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ASSOCIATION BETWEEN PRESSURE VARIABILITY AND RISK CARDIOVASCULAR IN ELSA-Brasil PARTICIPANTS
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Líder : ROQUE ARAS JUNIOR
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MIEMBROS DE LA BANCA :
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ADRIANA LOPES LATADO BRAGA
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CRISTIANO RICARDO BASTOS DE MACÊDO
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FRANCISCO JOSE FARIAS BORGES DOS REIS
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LUCIANA PEREIRA FERNANDES
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SHEILA MARIA ALVIM DE MATOS
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Data: 10-jun-2022
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Resumen Espectáculo
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Introduction: Hypertension is considered the main risk factor for cardiovascular diseases. Studies have shown that in addition to the absolute values of blood pressure, pressure variability is also associated with the development, progression and severity of lesions in target organs of arterial hypertension, high cardiovascular risk and fatal and non-fatal cardiovascular events. The prognostic value of blood pressure variability, assessed by ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), has been analyzed by several crosssectional and longitudinal studies, demonstrating an association with cardiovascular outcomes. On the other hand, blood pressure variability assessed in a single visit, through casual measurements, has been less studied, with some studies showing a positive association with stroke, cardiovascular risk and total mortality and others showing no association with total and cardiovascular mortality. Objective: To evaluate the association between blood pressure variability on a single visit and cardiovascular risk among participants in the ELSA-Brasil cohort. Results: A total of 14,357 individuals were included for analysis, of which 7,884 were female. Individuals in the last quartile of systolic blood pressure variability had significantly higher medians of age (p<0.001), serum levels of LDL cholesterol (p<0.001), blood glucose (p=0.001) and glycated hemoglobin (p<0.001) in compared to the first quartile. The prevalence of diabetes and reduced glomerular filtration rate was significantly higher among individuals in the last quartile (p=0.001 and p=0.004 respectively). The median pulse wave velocity was also significantly higher in this quartile (p.0.001), as was the prevalence of high risk of cardiovascular atherosclerotic disease (p<0.001). In general, men had a higher prevalence of high cardiovascular risk than women (p<0.001). As systolic blood pressure variability was greater in both sexes, the prevalence of high cardiovascular risk was also higher, with the greatest difference being observed in favor of men in the last quartile. Multivariate analysis was performed to assess the association between cardiovascular risk and systolic blood pressure variability according to sex. There was a significantly greater association between men in the third and last quartiles (OR=1.19; 95% CI: 1.01 – 1.39; OR=1.50; 95% CI: 1.27 – 1, 76, respectively) and, among women, in the last quartile of variability (OR=1.30; 95% CI: 1.06 – 1.61), after adjusting for abdominal obesity, per capita income, educational level, and average systolic pressure. Conclusion: Higher values of systolic blood pressure variability in a single visit found among the participants of the ELSA-Brasil who composed the baseline of the study, were related to markers and risk factors, and associated with a high cardiovascular risk, especially among men, regardless of the mean systolic pressure observed.
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6
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MONICA BIBIANA NARVAEZ BETANCUR
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SOCIO-DEMOGRAPHIC, PSYCHOLOGICAL CHARACTERISTICS AND QUALITY OF LIFE OF PEOPLE WITH POOR ADHERENCE TO ANTIRETROVIRAL THERAPY SEEN IN BOGOTÁ, COLOMBIA
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Líder : CARLOS ROBERTO BRITES ALVES
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MIEMBROS DE LA BANCA :
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FABIANNA MARCIA MARANHÃO BAHIA SOUZA
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FERNANDO MARTINS CARVALHO
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LILIANE ELZE FALCAO LINS KUSTERER
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LUDY ALEXANDRA VARGAS TORRES
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MARCIA LILIAN SAMPAIO E SAMPAIO SA
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Data: 05-jul-2022
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Resumen Espectáculo
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Adherence to highly combined antiretroviral therapy (cART) is vital to achieving therapeutic success and controlling the epidemic. Understanding the factors that influence adherence is relevant for clinical healthcare practitioners and the implementation of public health policies. Objective: To compare sociodemographic, clinical, psychological, and quality of life among people with adequate and poor adherence to cART. Methods: A cross-sectional study was conducted from December 2018 to March 2020. The study included 200 participants diagnosed with HIV/AIDS, aged between 18 and 65, undergoing cART for at least one year. The sample was divided into two groups: participants with adequate adherence with a previous undetectable viral load, and participants with poor adherence with two previous viral loads above 500 copies and with clinical criteria of poor adhesion. The following instruments were used: a survey with specific sociodemographic questions created for this research, the Adherence Follow-up Questionnaire and the Attitudes about HIV questionnaire designed by the AIDS Clinical Trial Groups (ACTG), the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), the 36-item Short-Form Health Survey and the WHOQOL-HIV BREF. Results: Intergroup differences between the following variables were observed: age (p<0.001), technical level education (p=0.032), family support (p=0.009), hazardous alcohol consumption (p=0.008), unprotected sexual behavior (p=0.039), number of pills (p=0.005), symptoms of depression (p<0.001) and symptoms of anxiety (p<0.001), and negative thoughts about HIV and treatment. Non-adherent patients had worse quality of life in all dimensions of the SF-36 and WHOQOL-HIV BREF questionnaires. Conclusion: Sociodemographic and psychological aspects play a crucial role in treatment adherence. Non-adherent patients show symptoms of depression and anxiety and worse health-related quality of life.
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7
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INÁCIO LIMA SILVA AGUIAR
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QUALITY OF LIFE RELATED TO GENERAL HEALTH AND ORAL HEALTH BEFORE AND DURING THE PANDEMIC IN PATIENTS WITH NON-ALCOHOLIC FATTY HEPATIC DISEASE
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Líder : LILIANE ELZE FALCAO LINS KUSTERER
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MIEMBROS DE LA BANCA :
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CAROLINA VILLA NOVA AGUIAR
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DARCI DE OLIVEIRA SANTA ROSA
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FERNANDO MARTINS CARVALHO
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HELMA PINCHEMEL COTRIM
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LILIANE ELZE FALCAO LINS KUSTERER
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Data: 19-jul-2022
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Resumen Espectáculo
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OBJECTIVE: to investigate the associations between general health-related quality of life (HRQoL), oral health-related quality of life (HRQoL) and non-alcoholic fatty liver disease (NAFLD) before and during the period of the novel coronavirus pandemic. METHODS: A systematic review was performed on the association between NAFLD and periodontal disease (PD), a study to validate the RAND-36 quality of life questionnaire, and a prospective cohort study to assess oral health-related quality of life. during the period of the novel coronavirus pandemic in patients with NAFLD. In the validation study, 763 individuals participated in the study, 400 (52.4%) with chronic liver disease, and the confirmatory factor analysis of the RAND-36 was performed. In the cohort study, 58 patients were followed between December 2019 and December 2021 at the Magalhães Neto Ambulatory of the Complexo Hospitalar Universitário Professor Edgard Santos. Patients were evaluated using a specific collection instrument with clinical and demographic data, a Health-Related Quality of Life assessment questionnaire, RAND-36 and the oral health-related quality of life assessment questionnaire, OHIP-14 . The patients' oral health was evaluated according to criteria recommended by the World Health Organization and the European Association of Sanitary Dentistry. Clinical, demographic and oral health characteristics were described using frequencies, mean and standard deviation. Wilcoxon's non-parametric test was used to compare the scores of the OHIP-14 and RAND 36 questionnaires between the 2019 and 2021 assessments. RESULTS: The systematic review brought important data that confirm that patients with NAFLD have a higher prevalence of PD when compared to healthy controls. Through the validation study of the RAND-36 questionnaire, we concluded that it is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. And the prospective cohort study showed that the pandemic significantly impacted the HRQoL and HRQoL of NAFLD patients. CONCLUSIONS: There is a higher prevalence of periodontal disease in people with nonalcoholic fatty liver disease compared to individuals without the disease, the RAND-36 has good psychometric properties to measure HRQoL in people with chronic liver disease and population without comorbidities and HRQoL and HRQoL decreased significantly in NAFLD patients during the novel coronavirus pandemic period.
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8
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ALEX CLEBER IMPROTA CARIA
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Analysis of miR-1-3p, miR-21-5p and miR-126-5p expression in the serum of patients with arterial hypertension, type 2 diabetes and obesity and their correlation with clinical and laboratory parameters
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Líder : ROQUE ARAS JUNIOR
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MIEMBROS DE LA BANCA :
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CRISTIANO RICARDO BASTOS DE MACÊDO
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FRANCISCO JOSE GONDIM PITANGA
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LUCIANA PEREIRA FERNANDES
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LUIZ PEREIRA DE MAGALHAES
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MARIA AMELIA BULHOES HATEM
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Data: 27-jul-2022
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Resumen Espectáculo
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Introduction: Systemic arterial hypertension is a multicausal and multifactorial disease of high prevalence in Brazil and worldwide. The development, progression and damage of target organ in the disease are associated with genetic and environmental factors, including recently linked to epigenetic factors such as regulation by microRNAs (miRNAs). MiRNAs have been described as potential biomarkers in hypertension, type 2 diabetes and obesity and their dysregulation has been associated with target organ damage such as loss of function and kidney damage. In this context, studies demonstrate that some deregulated miRNAs participate in the progression of chronic kidney disease, however the role of miRNA-1-3p, miRNA-21-5p and miRNA-126-5p in the development and progression of the disease has been little explored, as well as as the correlation of the expression of these miRNAs with clinical and laboratory parameters. Objective: Thus, our study aimed to analyze the expression of miRNA-1-3p, miRNA-21-5p and miRNA-126-5p in the serum of hypertensive, diabetic and obese patients compared with a healthy group and later to correlate with clinical parameters and laboratory. Methods: Using RT-qPCR, we evaluated the expression of these three miRNAs in the serum of 50 participants, control (n = 8), hypertensive (n = 21), hypertensive, diabetic and obese (n = 21). Results: The expression of miR-126-5p was significantly high in the hypertensive group when compared to the control group, however there was no statistical difference when compared to the hypertensive, diabetic and obese groups. MiR-1-3p and miR-21-5p showed no statistical differences between groups. Later in the correlation analysis, we identified a positive correlation of miR-126-5p with creatinine and a negative correlation with platelets. Conclusion: This study demonstrated the increased expression of miR-126-5p in the serum of hypertensive patients, being positively correlated with creatinine and negatively correlated with platelets, emphasizing the possible effectiveness of the analysis of the expression of this miRNA as an initial biomarker and diagnosis of loss of function and acute kidney injury, as well, increases the importance of the development of miRNA-based therapies.
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9
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ELEONARDO PEREIRA RODRIGUES
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EFFECTIVENESS OF PROCEDURAL COGNITIVE THERAPY AND EXPOSURE THERAPY AND RESPONSE PREVENTION IN THE TREATMENT OF PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: A RANDOMIZED CLINICAL TRIAL
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Líder : IRISMAR REIS DE OLIVEIRA
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MIEMBROS DE LA BANCA :
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AMANDA CRISTINA GALVAO OLIVEIRA DE ALMEIDA
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CELIA REGINA THOME
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EDUARDO PONDE DE SENA
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MARIO FRANCISCO JURUENA
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RICARDO HENRIQUE DE SOUSA ARAÚJO
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Data: 08-ago-2022
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Resumen Espectáculo
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Introduction: Obsessive-compulsive disorder (OCD) is the fourth most prevalent and disabling mental disorder, characterized by the occurrence of intrusive, invasive and uncomfortable thoughts (obsessions) and / or repetitive behavioral or mental rituals (compulsions), performed to reduce anxiety triggered by obsessions; sensory phenomena consisting of aversive or uncomfortable sensations or perceptions can also trigger compulsions. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitive distortions and nuclear beliefs (NB). Serotonin reuptake inhibitors, cognitive-behavioral therapy and exposure with response prevention (rituals) (ERP) are the treatments of choice. Cognitive Process Therapy is a recent and empirically validated psychotherapy whose focus is the restructuring of negative CNs. Objective: The objective of this study was to compare the effectiveness of Trial-Based Cognitive Therapy (TBCT) and Exposure with Response Prevention in the treatment of OCD. Method: A randomized, simple blind clinical trial was conducted, allocating 26 patients for individual treatment with the TCP (n = 12) or RPE (n = 14) groups. The groups were evaluated at baseline and at the end of the three-month treatment (12 sessions), and in the follow-up evaluations after three, six and twelve months. The primary measure was the change in the Yale-Brown Obsessive-Compulsive Symptom Scale (Y-BOCS) scores and the secondary measures included the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores. Results: There was a lack of evidence that TBCT and ERP were different from each other in reducing the scores of Y-BOCS, BDI and BAI. Both psychotherapies reduced the severity of symptoms, with high effect sizes. These results were maintained in the follow-up assessments. Conclusions: Despite the limitations resulting from the small number of treated patients, TBCT was similar to ERP, the gold standard in the treatment of OCD, in reducing the severity of symptoms, with a high effect size, indicating that TBCT is a clinically valid approach and can be promising in the treatment of this disorder.
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10
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GRAZIELE BEANES DA SILVA SANTOS
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Evaluation of the influence of genetic polymorphisms on the efficacy of ketamine and esketamine in patients with treatment-resistant depression
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Líder : LUCAS DE CASTRO QUARANTINI
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MIEMBROS DE LA BANCA :
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MARCOS LEITE SANTORO
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FERNANDA SANTANA CORREIA DE MELO
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GUBIO SOARES CAMPOS
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LUCAS DE CASTRO QUARANTINI
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RYAN DOS SANTOS COSTA
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Data: 10-ago-2022
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Resumen Espectáculo
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Ketamine is a glutamatergic drug that has emerged as a rapid-onset antidepressant. Although the mechanisms involving ketamine’s antidepressant action are not entirely clear, the main hypothesis highlights the implication of GluN2B-containing N-methyl-D-aspartate (NMDA) receptors, GluR1-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, and Brain-Derived Neurotrophic Factor (BDNF). Thus, genetic polymorphisms that change the structure and function of NMDA and AMPA receptors or reduce BDNF secretion in the synaptic cleft may impact ketamine’s antidepressant effects. Objectives: Evaluate the influence of genetic polymorphisms of GRIN2B (rs1805502), GRIA1 (rs1994862), and BDNF (rs6265) on the response, remission, and evolution of depressive symptoms in treatmentresistant depression (TRD) patients treated with ketamine or esketamine. Secondarily, we evaluated the influence of BDNF polymorphism (rs6265) on serum BDNF levels. Methods: We conducted a double-blind, bicentric clinical trial in which TRD patients were randomized to receive a single infusion with ketamine or esketamine. Blood samples were collected in PaxGene tubes for genetic analysis and in tubes with separator gel for assessing the serum levels of BDNF at baseline, 24 hours, and seven days after infusion. For clinical evaluations, the Montgomery-Asberg Depression Rating Scale (MADRS) was used at baseline, 24 hours, 72 hours, and seven days after ketamine or esketamine infusion. Results: We demonstrate that there was no influence of the studied genetic polymorphisms on the therapeutic efficacy of ketamine and esketamine. We also did not observe the impact of the rs6265 polymorphism on the peripheral levels of BDNF. Conclusion: The polymorphisms rs1805502, rs1994862 and rs6265 are not involved in the antidepressant response of ketamine and esketamine in our population. Further large-scale studies with larger samples are needed to clarify the utility of these genes of interest as predictors for antidepressant treatment with ketamine and esketamine.
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11
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RODRIGO SANTOS DE QUEIROZ
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FEASIBILITY, SAFETY AND PRELIMINARY EFFECTS OF THE ADDITION OF A PROGRESSIVE ACTIVE
MOBILIZATION PROTOCOL WITH DOSE CONTROL AND TRAINING LOAD IN CRITICAL PATIENTS (PROMOB)
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Líder : MANSUETO GOMES NETO
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MIEMBROS DE LA BANCA :
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BRUNO PRATA MARTINEZ
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CASSIO MAGALHAES DA SILVA E SILVA
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HELENA FRANCA CORREIA
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IURA GONZALEZ NOGUEIRA ALVES
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JOSÉ AILTON OLIVEIRA CARNEIRO
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Data: 23-ago-2022
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Resumen Espectáculo
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Early mobilization can help reduce the risk of functional disability in critically ill patients and increase survival, but the appropriate dose has not yet been established. The objective of this thesis is to evaluate the feasibility, safety and preliminary effects of the addition of a protocol of progressive active mobilization with dose control and training load in critically ill patients (PROMOB). PROMOB was developed based on the results obtained from a systematic review (ARTICLE – 1 of TESE) of the description of active mobilization protocols in patients on invasive mechanical ventilation admitted to intensive care units (ICU). Through this review, it became clear that studies in the area do not adequately report the exercise dose according to the guidelines of the main international guidelines. Important aspects of exercise prescription such as intensity, volume and progression are not adequately described, which makes replication difficult both in research and in clinical practice. Thus, PROMOB was developed respecting reproducibility criteria and completeness of description of exercise variables. PROMOB was tested in a randomized, controlled, double-blind clinical trial. Previously independent individuals with the ability to perform activities in bed (age 18 years or older, < 72 hours of hospitalization) were included. The control group received usual care from the inpatient unit, while the intervention group, in addition to usual care, received the PROMOB protocol additionally. Statistical analysis was conducted following intention-to-treat principles. A confidence interval of 95% was adopted. From July 15, 2019 to December 2, 2020, we randomly assigned 67 eligible adult patients to receive standard care (33 [49.3%]; control group) or standard care plus the PROMOB protocol (34 [50.7%] ; intervention group). Most were women (62.7%), the general mean age was 48.8 (±15.5) years, 62.7% of whom were surgical patients. The main cause of hospitalization was cardiovascular (47.8%). There were no adverse events and the patients tolerated the exercises, even when asked to develop higher speeds of execution. 82% of the application of the protocol occurred with complete delivery of the exercises. There was no difference between the groups: Length of ICU stay (-0.6; 95%CI: -2.5 to 1.3); ΔMRC (0.1; 95%CI: -3.2 to 3.4); ΔHandgrip (0.1; 95%CI: -3.0 to 3.0); ΔFSS-ICU (1.1; 95%CI: -2.8 to 5.1). In the intra-group analysis, there was a difference between Handgrip (2.3; 95%CI: 1.1 to 5.9) and FSS-ICU (5.6; 95%CI: 2.5 to 8.7) in the intervention and FSS group. -ICU (4.6; 95%CI: 1.1 to 8.2) in the control group. PROMOB added to usual care is feasible, safe and well tolerated by patients, the current sample still has low analytical power for statements about efficacy.
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12
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LIVIA NERY FRANCO GUERREIRO COSTA
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METABOLOMICS OF MAJOR DEPRESSION
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Líder : LUCAS DE CASTRO QUARANTINI
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MIEMBROS DE LA BANCA :
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ANA PAULA DE JESUS NUNES
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FERNANDA SANTANA CORREIA DE MELO
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LUCAS DE CASTRO QUARANTINI
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REJANE CONCEICAO SANTANA
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RYAN DOS SANTOS COSTA
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Data: 09-nov-2022
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Resumen Espectáculo
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Introduction: Although the understanding of the pathophysiology of major depressive disorder (MDD) has advanced, this has not translated into better therapeutic results. To date, no biomarkers have been identified for the diagnosis, prognosis and therapeutic management of MDD. Objective: to review the differentially expressed biomarkers in TDM. Methods: A systematic review was performed in January 2022 in PubMed/MEDLINE, Scopus, Embase, PsycINFO and Gale Academic OneFile databases for clinical studies published from January 2001 onwards using the following terms: “Depression” OR “Depressive disorder” AND “Metabolomic”. Results: Multiple metabolites were found at altered levels in MDD, demonstrating the involvement of cell signaling metabolites, cell membrane components, neurotransmitters, inflammatory and immune mediators, hormone activators and precursors, and sleep controllers. Kynurenine and acylcarnitine were identified as consistent with depression and response to treatment. Discussion: The most consistent evidence found was in relation to kynurenine and acylcarnitine. Although the data obtained allow us to identify how the metabolic pathways are affected in MDD, there is still not enough evidence to propose changes in current diagnostic and therapeutic actions. Limitations: Some limitations are the heterogeneity of studies on metabolites, detection methods, body fluids analyzed and treatments used. Conclusion: The experiments included in the review identify increased or reduced levels of metabolites, but not necessarily increased or reduced activity of associated pathways. The information acquired through metabolomic analysis does not specify whether the changes identified in the metabolites are cause or a consequence of the pathology.
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13
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Igor Dórea Bandeira
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Arketamine for bipolar depression: open-label, dose-escalation, pilot study
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Líder : LUCAS DE CASTRO QUARANTINI
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MIEMBROS DE LA BANCA :
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ANA PAULA DE JESUS NUNES
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ANGELA MARISA DE AQUINO MIRANDA SCIPPA
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FERNANDA SANTANA CORREIA DE MELO
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LUCAS DE CASTRO QUARANTINI
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RITA DE CASSIA SALDANHA DE LUCENA
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Data: 02-dic-2022
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Resumen Espectáculo
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Introduction: Ketamine has, in recent years, proven to be a fast-acting agent for the treatment of depressive symptoms. The molecular structure of ketamine has a chiral center, possessing the esketamine and arketamine isomers, each with distinctive properties. Arketamine has been tested on animal models, presenting rapid antidepressant effects with no adverse psychotomimetic events. However, no prior studies exist for the use of arketamine as an adjunctive treatment for bipolar depression. Objectives: To investigate the safety, feasibility, tolerability and antidepressant properties of intravenous arketamine as an adjunctive therapy in the treatment of bipolar depression and also to review the use of N-Methyl-D-Aspartate (NMDA) receptor antagonists for the management of bipolar disorder. Methods: Two articles related to the theme were prepared: (1) a pilot clinical trial of an escalating dose of arketamine infusion over 40 minutes, using a concentration of 0.5mg/kg, with follow-up after seven days using a concentration of 1mg/kg. The primary outcome was the change in total score on the Montgomery & Åsberg Depression Rating Scale (MADRS) after 24h of 1mg/kg infusion; (2) a literature review of several databases, selecting studies that evaluated the use of NMDA receptor antagonists in the adjunctive treatment of bipolar disorder in adults. Results: The mean total pre-infusion MADRS score was 36.66, which decreased to 27.83 24h after the first infusion of 0.5mg/kg of arketamine. This represents a reduction of 24.08% from the mean baseline MADRS score, or a mean difference of 8.83 points (95% CI: 0.29 - 17.37; p = 0.036). Only one subject met the response criteria (decrease ≥ 50% from baseline total MADRS score) 24h after infusion and none at day 7. Regarding the 1mg/kg dose, the mean total MADRS score before the second infusion was 32.0, which decreased to 17.66 24 hours later. This represents a 44.81% reduction from the mean baseline MADRS score or a mean difference of 14.34 points [95% CI 10.45-27.54, p<0.001]. Only two subjects met the response criteria 24h after the second infusion and only one individual presented response criteria seven days after the second infusion. Regarding the literature review, evidence points to glutamatergic abnormalities in the pathophysiology of bipolar disorder.The rapid antidepressant action of ketamine and its enantiomer, esketamine, has been reported in several clinical trials. Conclusion: Arketamine appears to have fast-acting antidepressant properties, as has been demonstrated in animal models of depression. All subjects tolerated both doses studied, showing no dissociative or manic symptoms. Arketamine proved to be a safe, tolerable and viable drug in the studied population. This pilot study is the first body of evidence to test intravenous arketamine for bipolar depression. Among the NMDA receptor antagonists, ketamine and its enantiomers appear to be the glutamatergic modulators with the greatest therapeutic potential.
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14
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Jorge Luis Motta dos Anjos
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Efficacy and Safety of Very Early Mobilization After Thrombolysis in Acute Ischemic Stroke: A Randomized Clinical Trial
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Líder : ANDRE RODRIGUES DURAES
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MIEMBROS DE LA BANCA :
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ANDRE RODRIGUES DURAES
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CLAUDILSON JOSE C BASTOS
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CLEBER LUZ SANTOS
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GIOVANI ASSUNCAO DE AZEVEDO ALVES
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ROQUE ARAS JUNIOR
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Data: 05-dic-2022
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Resumen Espectáculo
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Introduction: Stroke is an acute impairment of the neurological system, which has a vascular origin and develops clinical signs due to disturbances in brain function, lasting more than 24 hours. With high prevalence and currently 90% of survivors develop sequelae, making it an important cause of disability in adults. Objective: To examine the effects of high-intensity interval training on functionality and health-related quality of life in patients with post-stroke sequelae and to assess the safety and efficacy of very early mobilization of thrombolyzed post-ischemic stroke patients on the degree of disability and dependence for activities of daily living, balance, functional mobility and complications within 7 days of hospitalization and 90 days after hospital discharge. Methodology: To examine the effects of high-intensity interval training on functionality and quality of life, a systematic review with meta-analysis was performed by searching the following electronic databases: MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials, PEDro database and Scielo by January 2022 for randomized clinical trials investigating the effects of high-intensity interval training in post-stroke patients. Two reviewers independently selected the studies. Study quality was assessed using the PEDro scale. Mean difference (MD), standard mean difference (SMD) and 95% confidence intervals (CIs) were calculated. A randomized clinical trial was also performed comparing very early mobilization after thrombolysis and the usual care of patients with acute ischemic stroke in safety and functional recovery within 7 days of hospitalization and after 90 days of hospital discharge. Results: For the systematic review, nine studies met the study criteria (375 patients). The age of the participants ranged from 55.8 to 72.1 years. The studies ranged from patients within 2 weeks of stroke onset to patients with more than 1 month of stroke. High-intensity interval training resulted in improved cardiorespiratory fitness (peak oxygen consumption) MD (3.8 mL/kg/min, 95% CI: 2.62, 5.01, n=91), balance MD 5 .7 (95% CI: 3.50, 7.91; N = 64) and SMD gait speed (0.2 m/s; 95% CI: 0.05, 0.27; N = 100) in comparison with continuous aerobic training. Health-related quality of life did not differ between groups. Compared with usual care, high-intensity interval training improved SMD cardiorespiratory fitness (0.5 95% CI: 0.14, 0.81, n=239). No serious adverse events were observed. For the randomized clinical trial, a total of 104 patients with ischemic stroke who received thrombolytic treatment between August 2020 and July 2021 were prospectively recruited into the study. Of these, 51 patients received very early mobilization (VEMG) within 24 hours after the ictus and another 53 patients received usual care (UCG) with mobilization 24 hours after the ictus. When comparing the groups within 7 days of hospitalization and after 90 days of discharge, there were no differences in the degree of disability and dependence for activities of daily living (p= 0.44; p=0.15), balance (p=0 .17; p=0.27), functional mobility (p= 0.33; p=0.65), complications (p=0.55; p=0.56) and length of hospital stay (p=0. 69). Conclusion: High-intensity interval training was more efficient than continuous aerobic training for gaining cardiorespiratory fitness, balance and walking speed in patients with post-stroke sequelae and was not superior with regard to health-related quality of life. The very early mobilization strategy after thrombolysis in ischemic stroke was safe, but without evidence of short-term benefit.
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15
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TIAGO DA SILVA LOPES
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Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity
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Líder : RITA DE CASSIA SALDANHA DE LUCENA
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MIEMBROS DE LA BANCA :
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ANDRÉ RICARDO OLIVEIRA DA FONSECA
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YOSSI ZANA
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CLEBER LUZ SANTOS
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JUCIELE VALERIA RIBEIRO DE OLIVEIRA
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RAPHAEL SILVA DO ROSARIO
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Data: 09-dic-2022
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Resumen Espectáculo
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Chronic joint pain in individuals with sickle cell disease (SCD) is associated with several musculoskeletal problems, including joint osteonecrosis, osteomyelitis, osteoarthritis, dactylitis and bone infarction. The poor correlation between structural joint damage and reported joint pain intensity suggests the involvement of maladaptive plasticity in the central nervous system (CNS). Therefore, a better understanding of the CNS mechanisms related to joint pain is very important to guide the evaluation and treatment of individuals with SCD. This doctoral thesis consists of two articles: A) a review of the literature that sought to highlight the maladaptive plasticity in the CNS potentially related to chronic joint pain in SCD and to present updated information to health professionals about musculoskeletal assessment with reliable methods of clinical musculoskeletal examination; and B) A cross-sectional study that sought to characterize brain activity through EEG in SCD individuals with movement-related pain during the resting state, as well as during motor imagery. The results of the first article highlight that many phenomena associated with maladaptive plasticity of the CNS related to joint pain may also be present and should be systematically evaluated in SCD. These phenomena mainly include impairment of pain control mechanisms, central sensitization, reorganization of the primary motor cortex, motor behavior deficits, and arthrogenic muscle inhibition. Assessment methods range from multidimensional questionnaires to quantitative or electrophysiological sensory assessment techniques. The second article involved 25 individuals with SCD and pain secondary to osteonecrosis of the hip matched for sex and age with 19 healthy controls. An EEG was recorded with 32 electrodes in both groups during resting conditions and motor imagery of the hip and hand. The study revealed that individuals with SCD exhibit dysfunctional brain activity on EEG, characterized by higher power spectral density at low EEG frequencies (delta and theta) compared to healthy controls, during resting-state conditions, and motor imagery. Furthermore, EEG dysfunctional brain activity involved cortical areas, such as the inferior parietal lobe, the somatosensory and primary motor cortices, and the precuneus, which are involved in pain, movement, emotion, and attention processing. The results of these two articles may help to solidify substrates for new hypotheses involving clinical studies of non-invasive brain neuromodulation, as these techniques can potentially help in the management of individuals with chronic pain and maladaptive dysfunctional plasticity.
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