http://repositorio.ufc.br/handle/riufc/394 2026-06-17T23:16:46Z http://repositorio.ufc.br/handle/riufc/86785 Título: Esclerose sistêmica em população de baixa renda: perfil clínico, epidemiológico e funcional em região de baixa latitude Autor(es): Alcantara, Vitória Myria Moura Arruda Abstract: Systemic sclerosis (SSc) is a rare autoimmune disease characterized by vasculopathy, inflammation, and progressive fibrosis of the skin and internal organs, with heterogeneous clinical presentations and outcomes influenced by socioeconomic factors. This study aimed to describe the clinical, sociodemographic, and epidemiological profile of patients with SSc, as well as to analyze associations with clinical outcomes and functional capacity. This is an observational, descriptive, cross-sectional study with retrospective components, conducted at the Rheumatology Outpatient Clinic of the Walter Cantídio University Hospital in Fortaleza, Brazil. A total of 90 patients diagnosed with SSc were included after providing informed consent. Data were organized in electronic spreadsheets and analyzed using descriptive and inferential statistics according to variable distribution, with categorical variables expressed as absolute and relative frequencies. The study was approved by the Research Ethics Committee (CAAE: 77968023.7.0000.5054). The sample was predominantly female (92%) and self-reported as mixed-race (91.1%), with a mean age of 51.7±12.7 years. A higher frequency of the diffuse cutaneous subtype (55.5%) was observed, in contrast to the literature, which typically reports predominance of the limited form. Regarding social determinants, 30.1% had income below one minimum wage and 26.7% had low educational level. In terms of functional capacity, 60.7% of patients had mild impairment, approximately one-third had moderate impairment, and a small proportion had severe impairment, reflecting disease heterogeneity. Clinical manifestations included cutaneous involvement (skin thickening 90%), gastrointestinal involvement (gastroesophageal reflux 77.8%), and interstitial lung disease (65.4%). Raynaud’s phenomenon was observed in 75.6% of patients, a lower frequency than reported in other cohorts. Lower educational level was associated with higher inflammatory activity and higher modified Rodnan skin score, while lower income showed a tendency toward longer time to diagnosis. Systemic sclerosis in this cohort presented a more severe profile, with predominance of the diffuse subtype and high frequency of pulmonary involvement. The lower prevalence of Raynaud’s phenomenon and the inversion in subtype distribution compared to the literature suggest possible regional clinical particularities. Socioeconomic factors showed a potential impact on disease progression, particularly regarding inflammatory profile and diagnostic delay, highlighting the need for a multidisciplinary approach and strategies that integrate clinical and social aspects to promote early diagnosis and greater equity in care. Tipo: Dissertação 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86780 Título: Características clínicas e socioeconômicas de pacientes com psoríase e artrite psoriásica em uma população de baixa renda Autor(es): Montenegro, Mariana Lima Abstract: Psoriasis (PsO) is a chronic inflammatory disease affecting the integumentary system and may also involve the joints, characterizing psoriatic arthritis (PsA). Inflammatory mediators associated with obesity and metabolic syndrome, such as cytokines and adipokines, have been implicated in the pathogenesis of PsO and PsA. Environmental and socioeconomic factors also influence both conditions; however, there are few studies involving low-income, non-predominantly White populations outside the Northern Hemisphere. We described the clinical profile of PsO and PsA in a low-income population, evaluating the impact of socioeconomic and environmental factors, including low latitude. Patients with PsO and PsA (CASPAR criteria), seen between January 2023 and January 2025, were examined, and medical records were reviewed to exclude other causes of arthritis and comorbidities. We recorded body mass index (BMI), serum C-reactive protein (CRP), Psoriasis Area and Severity Index (PASI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Disease Activity in Psoriatic Arthritis (DAPSA), Health Assessment Questionnaire (HAQ-DI), use of disease-modifying antirheumatic drugs (DMARDs), and Short Form-36 (SF-36) scores, as well as monthly family income and educational level. A total of 303 patients were included (149 with PsO and 154 with PsA), with a median age of 53 years (IQR: 38–61), of whom 188 (62.05%) were female. Plaque psoriasis (133; 89.26%) and polyarticular involvement (91; 59.09%) predominated. Most participants (192; 63.37%) reported a monthly income ≤ 1 minimum wage. The median BMI was 28.20 kg/m2 (IQR: 24.91–32.42), similar between PsO and PsA groups. Median CRP levels were 0.30 mg/dL (IQR: 0.20–0.70) in PsO and 0.84 mg/dL (IQR: 0.3–2.0) in PsA. The median PASI was 2.20 (IQR: 0.58–4.25) in PsO and 1.00 (IQR: 0–2.80) in PsA. Overall, disease activity was low, with ASDAS-CRP 2.20 (IQR: 1.00–2.90), BASDAI 3.50 (IQR: 0.75–5.30), and DAPSA 12.75 (IQR: 2.92–23.88). Quality of life, assessed by SF-36, was worse in PsA compared to PsO. Women with PsO had worse HAQ-DI scores than men (p = 0.005). Patients with lower income showed worse performance in the domains of physical functioning (p = 0.020), role physical (p = 0.028), and social functioning (p = 0.045). Most patients were receiving biologic therapies, with 111 (72.08%) in the PsA group and 93 (62.42%) in the PsO group. Despite low income and educational levels, with 116 (38.28%) having fewer than 8 years of schooling and only 70 (23.1%) having higher education, we observed low disease activity in both PsO and PsA. Women, despite more frequent use of DMARDs, had worse quality of life scores and greater symptom burden. This is the first description of a low-income, low-education population living at low latitude with PsO and PsA. These findings are noteworthy, as they suggest a better prognosis than that observed in populations with higher income and education levels living at higher latitudes. Tipo: Dissertação 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86530 Título: Investigação de testes de sarcopenia como preditores de quedas na doença de Parkinson leve a moderada: estudo de coorte prospectivo Autor(es): Gomes, Vlademir Carneiro Abstract: Parkinson's Disease (PD) is the second most prevalent neurodegenerative disease in Brazil, affecting 1% of the elderly population aged over 65 years and 4 to 5% of those aged over 85 years. It is a chronic and progressive central nervous system disorder associated with a decreased quality of life and functional impairment. The prevalence of falls in elderly individuals with PD is higher than in the general population, with an annual risk of falls ranging from 45% to 68%. It is known that there are differences between single fallers and recurrent fallers, but there are limited studies addressing this context. Sarcopenia is a complex and multifactorial condition characterized by a progressive and generalized reduction in the quantity and quality of skeletal muscle tissue. Currently considered a global public health issue, sarcopenia is associated with an increased risk of falls, fractures, functional impairment, and mortality in the elderly. The objective of this study was to investigate predictive factors for recurrent and non-recurrent falls based on the diagnostic criteria of sarcopenia in patients with mild to moderate Parkinson's Disease. This was a cohort study conducted at the Hospital Universitário Walter Cantidio in Fortaleza, Ceará, with patients from the Movement Disorders outpatient clinic of the Neurology department from March 2021 to March 2023. To be eligible, patients needed to have a confirmed diagnosis of PD, a Hoehn and Yahr severity stage between 1 and 3, and the ability to stand and walk independently. Individuals with severe medical problems or uncontrolled chronic diseases were excluded. Demographic and clinical data, anthropometric measurements, cognitive assessment using the Mini-Mental State Examination, evaluation of depressive symptoms using the Geriatric Depression Scale, assessment of parkinsonian symptoms using the Unified Parkinson's Disease Rating Scale, fall history, and sarcopenia assessment based on the Revised European Consensus on Sarcopenia recommendations were collected during the patients' regular appointments. Each patient received a questionnaire to fill out in case of falls during the 12-month period. Monthly phone calls were made to check for fall occurrences. The study sample consisted of 103 patients, of whom 38 (37%) were women and 65 (63%) were men, with an average age of 66 ± 10.5 years. Higher SARC-F scores and a longer disease duration were independent predictors of recurrent and non-recurrent falls over a 12-month period. Tipo: Dissertação 2023-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86129 Título: Efeitos da liraglutida, um agonista do receptor do peptídeo-1 semelhante ao glucagon (GLP-1), sobre parâmetros metabólicos e saciedade de pacientes com lipodistrofia generalizada congênita Autor(es): Araújo, Jéssica Silveira Abstract: Lipodystrophies comprise rare, often underdiagnosed conditions characterized by partial or complete loss of subcutaneous adipose tissue, resulting in ectopic fat deposition in organs such as the pancreas, skeletal muscle, and liver, which may lead to severe metabolic complications. The spectrum of these complications is directly related to the extent of body fat loss, with generalized forms exhibiting more pronounced metabolic impairment and hyperphagia driven by markedly low leptin levels. The literature on the effects of glucagon-like peptide-1 receptor agonists in patients with lipodystrophies remains limited. Therefore, this study represents the first to evaluate the effects of liraglutide on metabolic parameters and satiety in patients with congenital generalized lipodystrophy (CGL). This open-label interventional study included patients with CGL followed by the Brazilian Group for the Study of Hereditary and Acquired Lipodystrophies (BRAZLIPO), who received liraglutide for 12 weeks. Metabolic outcomes were assessed at baseline, after treatment (week 12), and following an additional 12-week off- treatment period (week 24), with complementary evaluation of body composition, satiety, and hepatic imaging. Changes over time were analyzed using the Friedman test, with a significance level set at 5%. Eight patients were included (aged 24–45 years, six females); gastrointestinal adverse events led to treatment discontinuation in three patients. After 12 weeks of liraglutide therapy, a median reduction in HbA1c (−2.5%; range 1.1 to 3.1%; p=0.012) and in total daily insulin dose (−20%; range 0 to 100%; p=0.042) was observed, along with a non-significant reduction in triglycerides (−127 mg/dL; range 64 to 1171 mg/dL; p=0.350). Following treatment discontinuation, all patients exhibited increases in HbA1c and body weight of 2.2% (range 0.8 to 3.5%; p=0.026) and 3.6% (range 3.5 to 4.7%; p=0.001), respectively. Triglyceride levels increased in 80% of patients (median 421.5 mg/dL; range 76 to 1649; p=0.334). Insulin requirements also increased overall, with one patient resuming insulin at 0.4 U/kg/day and the others showing a median dose increase of 22% (range 12 to 50%; p=0.024). This study provides the first evidence that liraglutide may confer metabolic benefits in patients with CGL. Larger and longer-term studies are warranted to better characterize its effects on satiety, body composition, and liver disease in this population. Tipo: Dissertação 2026-01-01T00:00:00Z