https://tedebc.ufma.br/jspui/handle/tede/1456 2026-05-20T15:31:34Z 2026-05-20T15:31:34Z CALDAS, Érica Alessandra https://tedebc.ufma.br/jspui/handle/tede/6951 2026-05-12T13:38:47Z 2023-09-05T00:00:00Z

Título: Alterações funcionais cocleovestibulares em pacientes com doença renal crônica em hemodiálise Autor: CALDAS, Érica Alessandra Primeiro orientador: SALGADO FILHO, Natalino Abstract: Introduction: Chronic kidney disease is characterized by progressive and irreversible reduction of renal function and can be classified according to glomerular filtration rate. When this rate reaches very low values, we find what is called renal functional failure, when it is necessary some kind of renal replacement therapy. Hemodialysis, one kind of these therapy can induce electrolyte, biochemical, immunological, osmotic and vascular changes that are capable of leading to changes in the functioning of the inner ear. Such changes can cause symptoms such as hearing loss and vestibular alterations. Objective: To determine which cochleovestibular alterations affect patients diagnosed with chronic kidney disease before and after hemodialysis. Method: Cross-sectional clinical study developed in the nephrology sector of the University Hospital of the Federal University of Maranhão. The sample consisted of 30 individuals aged between 18 and 59 years diagnosed with chronic kidney disease under hemodialysis treatment. The video head impulse test (vHIT) was performed for vestibular evaluation and the research of distortion product otoacoustic emissions (OAE-DP) and transient otoacoustic emissions (OAE-TE) for cochlear evaluation. All tests were performed before and after the hemodialysis session. Results: When analyzing the vestibulo-ocular reflex before and after hemodialysis through vHIT, no statistically significant changes were observed, regardless of gender, age group and treatment time on hemodialysis. Similarly, no alterations were observed in relation to asymmetry. Regarding the analysis of DPOAE, there was an increase in the number of patients who failed at the highest frequencies (4 and 5 KHz) in the post hemodialysis test, but no statistically significant change was observed after hemodialysis (p> 0.05). In relation to THEAE, when comfacing the pre and post HD tests there was an increase in patients who failed at frequencies of 2 and 4KHz, also without statistically significant alteration after hemodialysis (p> 0.05). Conclusion: There were no significant cochleovestibular alterations, assessed through vHIT and OAE, after a single hemodialysis session for the studied sample. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

2023-09-05T00:00:00Z RODRIGUES, Silmara Ribeiro Batista https://tedebc.ufma.br/jspui/handle/tede/6950 2026-05-12T13:21:41Z 2026-02-27T00:00:00Z

Título: Espécies da flora da Amazônia oriental maranhense como alternativa e/ou complemento terapêutico para infertilidade feminina: a etnofarmacologia como ferramenta para a bioprospecção e a farmacovigilância em fitoterapia Autor: RODRIGUES, Silmara Ribeiro Batista Primeiro orientador: AMARAL, Flavia Maria Mendonça do Abstract: Infertility constitutes a significant global public health problem, affecting approximately 17.5% of the population and impacting physical, emotional, and social well-being. In Brazil, the prevalence of infertility among women of reproductive age is estimated at 10 to 15%, suggesting the importance of expanding access to specialized therapies and public policies for equitable care. Given the limitations and high costs of conventional treatments, especially assisted reproductive techniques, there is a growing popular interest in the use of plant species; a traditional practice recognized as a potential source for therapeutic purposes, but which can trigger adverse events due to irrational use. In this context, this research aims to conduct an ethnopharmacological study to identify plant species associated with female infertility in São Luís, Maranhão, followed by a systematic review of the most representative plant species in the ethnopharmacological research and to propose educational actions in Pharmacovigilance in Phytotherapy. The first chapter is an observational, cross-sectional analytical study with data collected through structured and semi structured interviews using a questionnaire containing 26 questions focused on characterizing the plant species used and/or known in popular culture for the treatment of female infertility. The study included 389 interviewees, of whom only 208 had knowledge of/used plants for infertility. Forty-one plant species used in popular culture were identified, with Himatanthus drasticus (janaúba) being the most frequently cited (34.2%), exhibiting high ethnobotanical indices (IVs=143, FRC=0.6875, UCs=1.375). Although 88.94% reported no adverse events, the documentary analysis revealed toxic risks in species such as Aloe vera (dermatitis) and Stryphnodendron adstringens (abortive effects), highlighting gaps in scientific validation for this purpose. The second chapter comprises a synthesized review of data from preclinical studies evaluating the efficacy and toxicity of extracts, fractions, and isolated substances from the latex of Himatanthus drasticus (Mart.) Plumel. The 10 preclinical (in vitro/in vivo) studies confirmed the promising profile of H. drasticus latex, with low toxicity at the tested doses (low risk of bias according to ROBINS-I), with anti-inflammatory, healing, and antidiabetic actions. The third chapter addresses pharmacovigilance actions represented by a comic strip of the plant species that were highlighted in response to the toxicity of the species inventoried in the ethnopharmacological research. It is concluded that the integration of traditional knowledge, scientific validation, and regulation is essential to ensure the rational and safe use of medicinal plants as a therapeutic resource in female infertility, especially among populations with greater social vulnerability. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

2026-02-27T00:00:00Z CABRAL JUNIOR, João de Deus https://tedebc.ufma.br/jspui/handle/tede/6931 2026-04-24T12:12:32Z 2026-01-15T00:00:00Z

Título: Condições de vida, saúde mental, cognitiva e religiosidade de pessoas idosas quilombolas Autor: CABRAL JUNIOR, João de Deus Primeiro orientador: SIMÕES, Vanda Maria Ferreira Abstract: Introduction: Studies demonstrate the association between the quality of aging and socioeconomic conditions, lifestyle, and healthcare. Mental and cognitive health are important for the quality of aging, especially in quilombola populations. However, analyses of this relationship are still scarce in this population. In the context of health and illness, religiosity and spirituality appear to be important aspects capable of contributing to better indicators and protective factors. Objective: To analyze the mental health, cognition, dimensions of religiosity, and experiences of spirituality of elderly quilombola people residing in a municipality in the Baixada Maranhense region. Methods: This is a cross-sectional study and a population-based household survey, conducted with 223 elderly people (60 years or older) in eleven quilombola communities in Bequimão. Individual interviews were conducted in households to assess sociodemographic conditions, health, cognition, depression, functionality, and religiosity/spirituality, using the following instruments: Sociodemographic Questionnaire, Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination (ACE- R), Geriatric Depression Scale (GDS 15), Duke Religiosity Index (DUREL-P), Daily Spiritual Experience Scale (DSES), Pfeffer Functional Activity Questionnaire (PFAQ), and Hachinski Ischaemic Scale. Data was collected using RStudio® software (version 2024.4.2.764), employing descriptive statistics and prevalence calculations, with results presented in tables and graphs. The research was approved by the Research Ethics Committee of the University Hospital under opinion number 2.476.48. Results: Based on the analysis of mental health, cognition, religiosity, and spirituality among elderly quilombola people, it was identified that 19.4% presented mild cognitive impairment and 20.2% exhibited depressive symptoms, such as apathy and isolation. Despite precarious living conditions, the studied population showed low cognitive decline compared to other groups with low levels of education, and religiosity and spirituality were observed as positive practices in coping with daily difficulties. Conclusion: Sanitary, socioeconomic, and social assistance infrastructure characteristics are determinants of the precarious conditions in which elderly quilombola people live. It was possible to observe low cognitive decline, as well as a smaller number of elderly people with mild cognitive impairment, when compared to healthy groups with low levels of education. The prevalence of depression and a high rate of participation and expression in religious and spiritual experiences were identified. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

2026-01-15T00:00:00Z MACEDO, Alessandra Teixeira de https://tedebc.ufma.br/jspui/handle/tede/6921 2026-04-22T18:51:02Z 2025-12-16T00:00:00Z

Título: PERFIL CLÍNICO DE FUNGEMIA EM PACIENTES COM NEOPLASIAS HEMATOLÓGICAS EM UM HOSPITAL DE REFERÊNCIA DE SÃO LUÍS – MA, NOS ANOS DE 2022 A 2024 Autor: MACEDO, Alessandra Teixeira de Primeiro orientador: AZEVEDO, Conceição de Maria Pedrozo e Silva de Abstract: In recent years, invasive fungal infections (IFIs) have become an important cause of morbidity and mortality in patients with hematologic malignancies. The difficulty of early diagnosis, combined with emerging antifungal resistance and variability among etiological agents—such as non-albicans Candida and emerging species—worsens the clinical scenario. Factors such as prolonged antifungal exposure, neutropenia, and intensive care unit admission increase the risk of unfavorable outcomes. In this context, the present study aimed to evaluate the clinical aspects of fungemia in patients with hematologic malignancies treated at a referral hospital in São Luís, Maranhão, Brazil, between 2022 and 2024. This retrospective study assessed 89 episodes of fungemia, including clinical variables, risk factors, isolated species, antifungal susceptibility profiles, and outcomes. Additionally, a cluster involving 14 Candida vulturna bloodstream isolates identified over a four-month period in 2022 was analyzed. Initial identification was performed using MALDI-TOF mass spectrometry, followed by confirmation through ITS sequencing and whole-genome sequencing. Antifungal susceptibility testing was conducted using microdilution and Sensititre YeastOne. The study population showed a pediatric predominance (median age 8.5 years), with acute lymphoblastic leukemia as the most frequent underlying malignancy. Risk factors were widely present, including central venous catheter use (92.6%), prior exposure to antibiotics (85.4%), and therapy-induced immunosuppression (58.4%). Candida parapsilosis (32.6%) and Candida tropicalis (19.1%) were the most prevalent species, while emerging yeasts such as C. vulturna, C. duobushaemulonii, and C. haemulonii were also identified. Most isolates demonstrated susceptibility to antifungal agents, although fluconazole resistance was observed in some C. parapsilosis strains, and high MIC values were noted in emerging species. Overall mortality was 48.3%, although deaths were not directly attributed to fungemia. During the C. vulturna outbreak, phenotypic methods misidentified isolates as other species within the C. haemulonii complex, necessitating molecular and genomic confirmation. Wholegenome sequencing analyses demonstrated clonality among the 14 isolates, confirming a hospital outbreak. All isolates exhibited low MICs and favorable clinical outcomes. Fungemia in patients with hematologic malignancies in Maranhão exhibits distinct epidemiological characteristics, with a predominance of non-albicans species and a significant occurrence of emerging yeasts, underscoring the need for continuous surveillance. The C. vulturna outbreak highlights the importance of incorporating molecular and genomic tools into routine diagnostics, as conventional methods may fail to correctly identify these yeasts. The findings contribute to the regional understanding of fungemia and reinforce the need for preventive strategies, rational antimicrobial use, strict management of invasive devices, and advanced identification methods to improve clinical outcomes in highly vulnerable populations. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

2025-12-16T00:00:00Z