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

Fri, 16 Jan 2026 00:00:00 GMT

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.

Fri, 17 Jan 2025 00:00:00 GMT

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

Prevenção do Câncer do Colo do Útero em um Município do Maranhão: Análise Epidemiológica e Avaliação das Barreiras e do Conhecimento em Comunidades Quilombolas

Mon, 15 Dec 2025 00:00:00 GMT

Título: Prevenção do Câncer do Colo do Útero em um Município do Maranhão: Análise Epidemiológica e Avaliação das Barreiras e do Conhecimento em Comunidades Quilombolas Autor: MIRANDA NETO, Pedro Agnel Dias Primeiro orientador: MONTEIRO, Silvio Gomes Abstract: Cervical cancer (CC) is a serious public health problem, a slow and progressive process involving reversible changes in the cervical epithelium associated with infection by the human papillomavirus (HPV). Prevention is challenging in vulnerable populations, such as quilombola communities, which face structural inequalities and specific sociocultural barriers. This research aimed to analyze CCU prevention in the municipality of Codó - MA, using a dual approach: a municipal epidemiological analysis and an in-depth study on knowledge and barriers in quilombola communities. To this end, we employed a mixed-methods methodology, combining a descriptive and retrospective epidemiological study, based on data from the Cancer Information System (SISCAN) referring to the period from 2018 to 2023, with a quantitative-qualitative field study that integrated surveys and participant observation with women from the Santo Antônio dos Pretos Quilombo. This study aimed to analyze CCU prevention in Codó, Maranhão (Brazil), by integrating a municipal epidemiological analysis with an in-depth assessment of knowledge and access barriers in Quilombola communities. The epidemiological study, based on 14,993 tests, revealed inefficient coverage, peaking at 12% in 2019 in the target population (25 to 64 years old), well below the 80% target recommended by the World Health Organization. The majority of tests (99.87%) were for initial screening and not for follow-up. Additionally, a study with 33 women from quilombola communities identified critical barriers explaining this low adherence: 33.3% were unaware of the cause of sexually transmitted infections (STIs), 36.4% did not know the symptoms of HPV, and 50% of those who did not undergo preventive testing did so because they did not feel ill, highlighting a perception of health focused on disease. Although 75.8% had undergone some preventive examination in their lives, only 27.3% do so regularly, and 42.4% had never spoken to a professional about HPV or ISTs. Statistical analysis revealed a strong correlation between age group and multiparity (χ²= 17.849; p= 0.0013), reflecting historically limited access to family planning. The barriers identified were structural (distance of 47 km and absence of local services), sociocultural (exhausting work routine, such as breaking babaçu coconuts, and difficulty in communication), and informational (inadequate technical language). The majority of women (75.8%) were farmworkers with an income of less than R$ 1,000/month, reflecting overlapping vulnerabilities. It is concluded that the low adherence to cervical cancer screening transcends the availability of the examination, being influenced by structural inequalities and deep sociocultural barriers that disproportionately affect quilombola women. The results reinforce the urgent need for intersectoral, territorially-based, and culturally sensitive public policies to promote health equity and strengthen the autonomy of quilombola women in cervical cancer prevention. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese

LESÕES VASCULARES RENAIS COMO FATORES PROGNÓSTICOS NA NEFRITE LÚPICA

Wed, 10 Dec 2025 00:00:00 GMT

Título: LESÕES VASCULARES RENAIS COMO FATORES PROGNÓSTICOS NA NEFRITE LÚPICA Autor: MUNIZ, Monique Pereira Rêgo Primeiro orientador: SILVA, Gyl Eanes Barros Abstract: Introduction: Lupus nephritis (LN) is one of the leading causes of morbidity and mortality in systemic lupus erythematosus. Its diagnosis and prognosis, according to the ISN/RPS classification, are primarily based on glomerular and tubulointerstitial findings, which do not fully capture the disease's pathophysiology. In this context, renal vascular lesions (RVLs) have increasingly been studied as important determinants of poor renal outcomes in LN, yet remain underreported in the Brazilian population. Methods: This was a multicenter retrospective cohort study including 440 patients with biopsyproven LN (2014–2024), stratified into groups with and without RVLs. The RVLs were categorized into arterial sclerosis (AS), thrombotic microangiopathy (TMA), non-inflammatory lupus vasculopathy (NILV), and true renal vasculitis (TRV). A generalized linear model was used to assess the association between RVLs and estimated glomerular filtration rate (eGFR) at the time of biopsy. In a second phase, 212 patients were followed for two years, and differences in eGFR between groups were analyzed using a linear mixed model. In both analyses, models were adjusted for confounding variables based on a theoretical causal framework defined by a Directed Acyclic Graph (DAG). Results: At the time of renal biopsy, patients with AS and TMA were more frequently hypertensive and exhibited lower eGFR, higher chronicity index, and greater interstitial fibrosis/tubular atrophy. The presence of TMA was also associated with a higher need for acute dialysis. In adjusted models, AS, TMA, and NILV remained independently associated with lower eGFR (mean reductions of 15.4, 24.2, and 18.5 mL/min/1.73 m², respectively; p < 0.05). During follow-up, patients without vascular lesions had consistently higher and progressively improving eGFR over 24 months. TMA was associated with lower baseline eGFR followed by partial recovery, while AS was associated with persistently reduced eGFR. Both TMA and AS emerged as independent risk factors for impaired eGFR recovery after treatment. Conclusion: In the Brazilian population, AS, TMA, and NILV are markers of renal dysfunction in LN. These findings underscore the prognostic relevance of renal vascular lesions in patients with LN. Instituição: Universidade Federal do Maranhão Tipo do documento: Tese