TEDE Coleção:

Condições de vida, saúde mental, cognitiva e religiosidade de pessoas idosas quilombolas

2026-04-24T12:12:32Z

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

PERFIL CLÍNICO DE FUNGEMIA EM PACIENTES COM NEOPLASIAS HEMATOLÓGICAS EM UM HOSPITAL DE REFERÊNCIA DE SÃO LUÍS – MA, NOS ANOS DE 2022 A 2024

2026-04-22T18:51:02Z

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

PERFIL EPIDEMIOLÓGICO E PADRÕES ESPACIAIS DO CÂNCER DE PÊNIS NO MARANHÃO: Análise de incidência, mortalidade e implicações para Políticas Públicas de Saúde

2026-03-06T19:26:30Z

Título: PERFIL EPIDEMIOLÓGICO E PADRÕES ESPACIAIS DO CÂNCER DE PÊNIS NO MARANHÃO: Análise de incidência, mortalidade e implicações para Políticas Públicas de Saúde Autor: SANTANA, Anderson Gomes Nascimento Primeiro orientador: SILVA, Gyl Eanes Barros Abstract: Penile cancer (CaPe) is a rare neoplasm in high-income countries; however, it remains an important public health problem in regions marked by socioeconomic vulnerabilities and limited access to healthcare services. It is estimated that approximately 100,000 men are affected globally, and in Brazil, although it represents about 2% of male cancers, it shows a profoundly unequal distribution, with a significant concentration in the Northeast Region. In this context, the state of Maranhão stands out for presenting the highest penile cancer incidence rates ever described worldwide, constituting a unique and alarming scenario. Objective: To analyze, in an integrated manner, the epidemiological profile, mortality, and spatial distribution of penile cancer cases in the state of Maranhão, identifying territorial risk patterns and priority areas for public health intervention. Methods: Cross-sectional, quantitative, population-based study, complemented by ecological analysis at the municipal level. The study population included men aged 18 years or older diagnosed with penile cancer between 2013 and 2022, with data obtained from reference hospitals and the Mortality Information System (SIM). A total of 518 patients were analyzed, of whom 261 progressed to death. Descriptive analyses and spatial analysis were performed using the Global and Local Moran’s Index (LISA), local empirical Bayesian estimates, and Kernel density, allowing identification of spatial autocorrelation patterns, concentration areas, and territorial inequalities in incidence and mortality rates. Results: Maranhão presented a standardized incidence rate of 18.83 cases per 100,000 men, making it the state with the highest disease burden in the country. The mortality rate was the highest in the Northeast region, reaching 8.03 deaths per 100,000 men. Most patients were 60 years or older (59.1%), of mixed race (36.3%), rural workers (45.8%), and had low educational attainment, including 25.6% who were illiterate. Squamous cell carcinoma was the most frequent histological type (60.7%), with a predominance of tumors in the early stage (T1: 23.4%), although mutilating procedures, such as partial penectomy, were widely used (49.6%). Spatial analysis revealed high-incidence clusters concentrated in the northern and southwestern regions of the state, while the eastern and southern areas showed lower rates. Dissociation between incidence and mortality was observed in some territories, suggesting inequalities in access to timely diagnosis and specialized treatment.Conclusions: Penile cancer in Maranhão presents a highly heterogeneous spatial distribution, strongly associated with contexts of social vulnerability, rurality, and weaknesses in the healthcare network. Integration of clinical, epidemiological, mortality, and spatial data highlighted critical territories that demand immediate actions in surveillance, prevention, early diagnosis, and strengthening of specialized care. These findings provide strategic support for territorialized planning of public policies aimed at men’s health and addressing health inequalities in the state. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

Uso do prebiótico fruto-oligossacarídeo na atenuação da gravidade da mucosite em pacientes com leucemia mielóide aguda sob quimioterapia.

2026-01-28T16:12:41Z

Título: Uso do prebiótico fruto-oligossacarídeo na atenuação da gravidade da mucosite em pacientes com leucemia mielóide aguda sob quimioterapia. Autor: MONTEIRO, Cinara Regina Aragão Vieira Primeiro orientador: MONTEIRO NETO, Valério Abstract: Antineoplastic treatment for acute myeloid leukemia causes systemic side effects in patients. Its cytotoxic action also affects healthy tissues, leading to oral and gastrointestinal changes that result in inflammatory manifestations, gastrointestinal mucosal ulceration, and a decrease in functional enterocytes, leading to mucositis. This study aimed to investigate whether the use of prebiotic fructo-oligosaccharides can reduce the severity of mucositis in patients with acute myeloid leukemia undergoing chemotherapy. This was a randomized, triple-blind, longitudinal clinical trial with a quantitative approach conducted at Maranhão's reference cancer hospital. The sample consisted of hospitalized patients with a confirmed diagnosis of acute myeloid leukemia aged between 18 and 69 years. The patients were randomized into two groups (FOS and placebo) and assessed at three time points. Data collection included clinical evaluation using a questionnaire developed by the research team, determination of inflammatory markers, and analysis of the fecal microbiome in relation to diversity and abundance at different taxonomic levels. Analysis of inflammatory cytokine concentrations showed a significant increase in IL-6 in the FOS group at T3 and an increase in IL-10 over time, although without a significant difference. Fecal calprotectin levels in the FOS group decreased from T1 to T3, indicating attenuation of the inflammatory response in the intestine. In the assessment of oral mucositis, patients in the FOS group did not develop mucositis at the end of the study, and its duration was shorter (p < 0.001). On the other hand, patients in the placebo group presented with grade 3 AE, which lasted beyond 21 days of the study. Additionally, three (60%) patients in this group died during the study period. A statistically significant difference was observed in the alpha-diversity analysis using the Shannon index (p = 0.0262), with a reduction in the diversity of “oligotypes” in patients who received FOS supplementation. Comparative analysis of alpha diversity at different time points showed that the FOS group had reduced diversity when comparing T3 vs. T2 (p < 0.01) and T3 vs. T1 (p < 0.001). Analysis of taxonomic profiles at all time points demonstrated the presence of 15 phyla, 14 of which were known and 1 unclassified, with dominance of microorganisms belonging to the phyla Firmicutes, Bacteroidota, Proteobacteria, and Actinobacteria, without significant differences in temporal variation. However, in patients in the FOS group, the genus Enterococcus clearly appeared on the heat map with profiles showing a significant increase in mean relative abundance, with increments at each time point of the study, while the genera Alistipes, Rombutsia, and Ruminococcus showed a significant reduction in differential abundance. In summary, the analysis of the data from the present study suggests that FOS has the potential to be used as an adjunct to conventional therapy to attenuate the severity and duration of mucositis in patients with leukemia undergoing chemotherapy by stimulating beneficial microorganisms in the gut microbiota and inducing modulation of the immune response. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese